This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Matthews, K. A. Articles by Sutton-Tyrrell, K. Search for Related Content PubMed PubMed Citation Articles by Matthews, K. A. Articles by Sutton-Tyrrell, K. Related Collections Related Articles

QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CARDIOVASCULAR RISK AND MENOPAUSE

Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?

Karen A. Matthews, PhD^_*,,_*, Sybil L. Crawford, PhD, Claudia U. Chae, MD, Susan A. Everson-Rose, PhD^||, Mary Fran Sowers, PhD^¶, Barbara Sternfeld, PhD^# and Kim Sutton-Tyrrell, PhD

^_* Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Biostatistics Research Group, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
^|| Department of Medicine, University of Minnesota, Minneapolis, Minnesota
^¶ Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
^# Division of Research, Kaiser Permanente, Oakland, California

Manuscript received April 17, 2009; revised manuscript received October 13, 2009, accepted October 17, 2009.

^_* Reprint requests and correspondence: Dr. Karen A. Matthews, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213 (Email: matthewska{at}upmc.edu).

Objectives: This prospective study examined whether changes in traditional and novel coronary heart disease (CHD) risk factors are greater within a year of the final menstrual period (FMP), relative to changes that occur before or after that interval, in a multiethnic cohort.

Background: Understanding the influence of menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian samples.

Methods: SWAN (Study of Women's Health Across the Nation) is a prospective study of the menopausal transition in 3,302 minority (African American, Hispanic, Japanese, or Chinese) and Caucasian women. After 10 annual examinations, 1,054 women had achieved an FMP not due to surgery and without hormone therapy use before FMP. Measured CHD risk factors included lipids and lipoproteins, glucose, insulin, blood pressure, fibrinogen, and C-reactive protein. We assessed which of 2 models provided a better fit with the observed risk factor changes over time in relation to the FMP: a linear model, consistent with chronological aging, or a piecewise linear model, consistent with ovarian aging.

Results: Only total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B demonstrated substantial increases within the 1-year interval before and after the FMP, consistent with menopause-induced changes. This pattern was similar across ethnic groups. The other risk factors were consistent with a linear model, indicative of chronological aging.

Conclusions: Women experience a unique increase in lipids at the time of the FMP. Monitoring lipids in perimenopausal women should enhance primary prevention of CHD.

Key Words: menopause • risk factors • lipids • inflammation • race

Abbreviations and Acronyms   AIC = Akaike information criterion   Apo = apolipoprotein   CHD = coronary heart disease   CRP = C-reactive protein   FSH = follicle-stimulating hormone   HDL-C = high-density lipoprotein cholesterol   LDL-C = low-density lipoprotein cholesterol   Lp(a) = lipoprotein(a)   PAI-1 = plasminogen activator inhibitor type 1   t-PA-ag = tissue-type plasminogen activator antigen

Related Articles

Menopause, Age, and Cardiovascular Risk: A Complex Relationship

Vera Bittner
J. Am. Coll. Cardiol. 2009 54: 2374-2375. [Full Text] [PDF]

This article has been cited by other articles:

				B. Lubiszewska, M. Kruk, G. Broda, E. Ksiezycka, W. Piotrowski, P. Kurjata, T. Zielinski, and R. Ploski The impact of early menopause on risk of coronary artery disease (PREmature Coronary Artery Disease In Women - PRECADIW case-control study) European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 2012; 19(1): 95 - 101. [Abstract] [Full Text] [PDF]

				X. Huang, S. D. Harlow, and M. R. Elliott Distinguishing 6 Population Subgroups by Timing and Characteristics of the Menopausal Transition Am. J. Epidemiol., January 1, 2012; 175(1): 74 - 83. [Abstract] [Full Text] [PDF]

				N. Santoro Update in Hyper- and Hypogonadotropic Amenorrhea J. Clin. Endocrinol. Metab., November 1, 2011; 96(11): 3281 - 3288. [Abstract] [Full Text] [PDF]

				D. Vaidya, D. M. Becker, V. Bittner, R. A. Mathias, and P. Ouyang Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data BMJ, September 6, 2011; 343(sep06_2): d5170 - d5170. [Abstract] [Full Text] [PDF]

				A. H. E. M. Maas, Y. T. van der Schouw, V. Regitz-Zagrosek, E. Swahn, Y. E. Appelman, G. Pasterkamp, H. ten Cate, P. M. Nilsson, M. V. Huisman, H. C. G. Stam, et al. Red alert for women's heart: the urgent need for more research and knowledge on cardiovascular disease in women: Proceedings of the Workshop held in Brussels on Gender Differences in Cardiovascular disease, 29 September 2010 Eur. Heart J., June 1, 2011; 32(11): 1362 - 1368. [Abstract] [Full Text] [PDF]

				J. Puurunen, T. Piltonen, L. Morin-Papunen, A. Perheentupa, I. Jarvela, A. Ruokonen, and J. S. Tapanainen Unfavorable Hormonal, Metabolic, and Inflammatory Alterations Persist after Menopause in Women with PCOS J. Clin. Endocrinol. Metab., June 1, 2011; 96(6): 1827 - 1834. [Abstract] [Full Text] [PDF]

				X. Wang, F. Magkos, and B. Mittendorfer Sex Differences in Lipid and Lipoprotein Metabolism: It's Not Just about Sex Hormones J. Clin. Endocrinol. Metab., April 1, 2011; 96(4): 885 - 893. [Abstract] [Full Text] [PDF]

				B. D. Johnson, K. M. Dwyer, F. Z. Stanczyk, V. Bittner, S. L. Berga, G. D. Braunstein, R. Azziz, Y. Yang, G. E. Hale, and C. N. Bairey Merz The Relationship of Menopausal Status and Rapid Menopausal Transition with Carotid Intima-Media Thickness Progression in Women: A Report from the Los Angeles Atherosclerosis Study J. Clin. Endocrinol. Metab., September 1, 2010; 95(9): 4432 - 4440. [Abstract] [Full Text] [PDF]

				F. Magkos, E. Fabbrini, B. S. Mohammed, B. W. Patterson, S. Klein, and B. Mittendorfer Estrogen Deficiency after Menopause Does Not Result in Male Very-Low-Density Lipoprotein Metabolism Phenotype J. Clin. Endocrinol. Metab., July 1, 2010; 95(7): 3377 - 3384. [Abstract] [Full Text] [PDF]

				S. Brown How women stay feminine may be in the hands of a single gene Menopause Int, March 1, 2010; 16(1): 2 - 4. [Full Text] [PDF]

				Does Perimenopause Bring More Than the Last Period? Journal Watch Women's Health, January 28, 2010; 2010(128): 3 - 3. [Full Text]

				Perimenopausal Changes in Cardiac Risk Factors Journal Watch (General), January 12, 2010; 2010(112): 2 - 2. [Full Text]

				V. Bittner Menopause, Age, and Cardiovascular Risk: A Complex Relationship J. Am. Coll. Cardiol., December 15, 2009; 54(25): 2374 - 2375. [Full Text] [PDF]