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Menopause potentially linked to adverse cardiovascular health

By Priscilla Lynch - 23rd Sep 2024

Menopause cardiovascular health

New research presented at the European Society of Cardiology Congress 2024 in London, UK shows that women in the menopause transition period show changes in their blood cholesterol profiles which could have an adverse impact on their cardiovascular health. 

“We found that menopause is associated with adverse changes in lipoprotein profiles, with the most pronounced changes found to be in increases in ‘bad’ LDL-particles and subfractions observed for peri-menopausal women,” said study author Dr Stephanie Moreno, University of Texas Southwestern Medical Centre, Dallas, US.

“When looked at together, these changes could help explain the increase of cardiovascular disease in post-menopausal women and help determine if earlier interventions are warranted.”

Cardiovascular disease (CVD) is the biggest killer of women, despite the misconception that CVD is a ‘man’s disease’ – 40 per cent of all deaths in women are from CVD. While women develop CVD approximately 10 years later than men, risk of CVD in women rises after menopause. The mechanisms underlying this acceleration in CVD risk are not well understood, but adverse changes in blood fat (lipid) measures are known to occur during the perimenopause period. Previous investigations have been largely restricted to traditional lipid measures (LDL cholesterol, HDL cholesterol, and triglycerides) and have not examined changes in advanced lipids, including lipid subfractions and particle number, which have been shown to be more predictive of cardiovascular disease in various studies.

In this study, the authors examined the changes over time in lipoprotein particles that occur during the menopause transition. A total of 1,246 participants in the Dallas Heart Study (DHS) with known menopause status underwent measurement of common lipoproteins associated with CVD, including atherogenic LDL-P and small dense-LDL. Using nuclear magnetic resonance (NMR) technology, at two time points (DHS1 and DHS2) they compared longitudinal changes in lipoprotein measures between pre-, peri-, post-menopausal women and men using statistical modelling. For their analysis peri- is the group that was pre-menopause at DHSI and post-menopause at DHS2.

There were also 1,346 men (reference group) included in the study with a mean age of 43 years. There was a total of 1,246 women with a mean age of 42 years for the peri-group, 54 years for the post-group, and 34 years for the pre-group. Of the women, 440 (35 per cent) were pre-menopausal, 298 (24 per cent) were peri-menopausal, and 508 (41 per cent) were post-menopausal.

Over a median follow-up time of seven years, all three female groups had an increase in LDL-P, but the greatest percentage change was found to be between peri- and post-groups at 8.3 per cent. When compared to men, the post-group has the greatest per cent change of HDL-P with a negative change of 4.8 per cent. 

Small-dense LDL had a greater per cent change in the peri-group when compared to men with a change of 213 per cent; ~15 per cent higher than both pre- and post-menopause groups. 

“More research is needed to investigate whether these adverse changes in lipoproteins translate to greater cardiovascular risk,” Dr Moreno concluded.

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