Women’s Risks for CVD and MetS Increase More Before Menopause than After

Prior research has always suggested women before menopause have a lower risk than men for CVD; after menopause there is an equal risk between the sexes which has been mostly attributed to hormonal reduction. However, data from a cohort of the ARIC study* recently published in the Journal of the American Heart Association (J Am Heart Assoc.), showed women undergoing the menopausal transition experienced a significantly rapid increase in metabolic syndrome (MetS) and cardiovascular disease (CVD) during the premenopausal and perimenopausal years as compared to women entering the postmenopausal stage.

The 10 year epidemiologic study of 1440 women aged 45- 60 years found:

  • In  white women the MetS severity scores were significantly higher in the premenopause and perimenopause phases compared to post menopause
    • Premenopause= 0.071, 95% CI 0.062-0.080, P<0.001,  and peri-menopausal=0.076, 95% CI 0.064-0.088, P<0.001 vs post menopause=0.062, 95% CI 0.050-0.075, P<0.001
  • In black women there was a greater and rapid increase in severity of MetS during premenopause (0.112, 95% CI 0.094-0.130, P<0.001) compared to their white counterparts
    • Suggesting increased risks for CVD, stroke and T2DM for black women during this time
  • Postmenopausal black women had significantly slower rates for MetS, compared to white postmenopausal women

Why is this clinically significant?

The findings from this long term study suggest that clinicians need to consider other factors that occur during the menopausal transition than simply a drop in hormone levels when evaluating for CVD risk. These results are compelling because they show:  

  • All women are not alike and while more research is needed, there may be a greater correlation to biological variance amongst races regarding risk for CVD, stroke and T2DM during menopausal years than previously known 
  • Changes in CVD risk and prevalence of MetS in postmenopausal women was related more to (possibly hormonal) changes just before onset of menopause and not to changes afterwards
  • Clinicians should consider  ethnic and biological variance when considering management of female patients, particularly in the late premenopause to perimenopausal years 
  • Clinicians must continue to encourage ALL patients, and especially their female patients,  to make improvements to lifestyle factors in the years leading up to menopause to offset the increase in CVD risk during that critical time period and beyond 

*ARIC is the Atherosclerosis Risk in Communities Study, an epidemiologic, prospective study sponsored by the National Health, Lung and Blood Institute in four US communities

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