Women may experience increase in risk factors for heart disease and stroke before menopause

During the years before menopause, women had an increase in metabolic syndrome severity that could lead to a higher risk for heart disease, stroke and type 2 diabetes, according to an analysis of a community-based, epidemiological cohort study.

The metabolic syndrome components included waist circumference, triglyceride level, high-density lipoprotein cholesterol, systolic blood pressure and fasting glucose.

Lead researcher Matthew J. Gurka, PhD, of the University of Florida, and colleagues published their results online in the Journal of the American Heart Association on Aug. 3.

The researchers previously developed a metabolic syndrome severity score and found that the rate of increase in metabolic syndrome severity was significantly higher in middle-aged women than men.

For this analysis, they evaluated data from 1,470 women who participated in the ARIC (Atherosclerosis Risk in Communities) study, which was held from 1987 to 1989 at four sites in the U.S. The women were all 60 years old and younger at baseline, had fasting laboratory values and menopause information and had no history of coronary heart disease or diabetes. They also progressed in their menopausal stage during their four visits.

The researchers used sex- and race-based formulas to calculate metabolic syndrome severity z-scores at each of the four visits for all participants. They also used a group of 2,674 women who were post-menopausal and without diabetes at baseline and 270 women who remained pre-menopausal throughout the study as comparator groups.

After adjusting for age, women had a significantly higher increase in the rate of metabolic syndrome severity during the pre- and peri-menopausal period than they did during the post-menopausal period. African American women had the highest rate of increase.

After adjusting for socioeconomic status and hormone use, African American women had a slower increase in metabolic syndrome severity after menopause compared with before and during menopause. White women also had a decrease in the rate of metabolic syndrome severity progression following menopause, but the difference between the peri- and post-menopausal period was not significantly different.

“Of course, you could argue that all of us should be eating better and making sure we’re getting enough exercise,” senior study author Mark D. DeBoer, MD, of the University of Virginia, said in a news release. “That’s definitely true, but the years transitioning to menopause may represent a ‘teachable moment,’ when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their cardiovascular disease risk.”

The researchers said it was unclear why there was a slower rate of progression in metabolic syndrome severity after menopause. However, they said it could be related to changes in estrogen levels and the action of adipocytes and hepatic function. After menopause, 13.8 percent of white women and 6.6 percent of African American women used estrogen replacement therapy.

The study had a few limitations, according to the authors, including that it relied on a composite assessment of menopause that may have not properly classified the women. They also did not include women who were not in the age-range for being near the timing of menopause.

“Further research is needed to determine whether interventions during the menopausal transition such as diet, exercise and insulin-sensitizing medication could slow this rate of progression of [metabolic stroke] severity and lower risk of future disease,” the researchers wrote.