Cardiac Health in Women With Metabolic Syndrome: Clinical Aspects and Pathophysiology

Abstract

Although the classical cardiovascular risk factors (e.g., smoking and hypertension) are becoming more effectively managed, a continuous increase of the so-called "cardiometabolic risk" is noted. Starting from this century, the nomenclature "metabolic syndrome" has become more popular to identify a cluster of disorders including obesity, dyslipidemia, hypertension, and insulin resistance. It is a primary risk factor for diabetes and cardiovascular disease in both genders. Interestingly, the metabolic diseases display a distinct gender disparity with an apparent "female advantage" in the premenopausal women compared with age-matched men. However, women usually lose such "sex protection" following menopause or affliction of metabolic syndrome especially insulin resistance. A controversy exists in the medical literature concerning whether metabolic syndrome is a real syndrome or simply a cluster of risk factors. Several scenarios are speculated to contribute to the gender dimorphism in the cardiovascular sequelae in patients with metabolic syndrome including sex hormones, intrinsic organ function, and the risk factor profile (e.g., hypertension, dyslipidemia, obesity, sedentary lifestyle, and atherogenic diet). With the alarming rise of obesity prevalence, heart problems in metabolic syndrome continue to rise with a distinct gender dimorphism. Although female hearts seem to better tolerate the stress insults compared with the male counterparts, the female sex hormones such as estrogen can interact with certain risk factors to precipitate myopathic changes in the hearts. This synthetic review of recent literature suggests a role of gender disparity in myopathic factors and risk attributable to each metabolic component in the different prevalence of metabolic syndrome.

Gender differences in the prevalence of metabolic syndrome in 50-year-old Swedish men and women with hypertension born in 1953

“…It is well documented that premenopausal women are relatively safer from CVD as compared with men of the same age. 25 However, women's risk of CVD increases after menopause. 20 For instance, premenopausal women have a lower tendency to develop hypertension than do age-matched men.…”

“…Although in recent years gender differences in CVD risk have increasingly been recognized in the medical profession, usually clinical management of MetS is not tailored in a gender-specific manner. 25 Further research is needed to ascertain a better understanding of the pathophysiology underlying gender differences in MetS in order to identify gender-specific criteria for prevention, diagnosis and treatment of MetS in hypertensive patients. Given that the risk of metabolic aberrations is greater in hypertensive women than in hypertensive men at age 50, as was observed in our study, suggests that lifestyle interventions, known to be effective in reducing the clustering of risk in the MetS and potentially also treatment to reach recommended BP levels, should be more aggressive for women.…”

Estrogen Replacement Therapy and Cardiac Function Under Metabolic Syndrome

“…3 However, a reduced incidence of type 2 diabetes mellitus and obesity was noted in otherwise healthy postmenopausal women who received estrogen. 3 This inverse correlation between estrogen and metabolic syndrome suggests that estrogen deficiency that accompanies menopause may play a role in the onset and development of metabolic syndrome. Thus, despite the controversies regarding ERT, it appears that younger postmenopausal women with metabolic syndrome may benefit from ERT.…”

“…The pathophysiology of metabolic syndrome in perimenopausal and postmenopausal women is still not well understood, although ambient reproductive hormone levels are believed not to be the only variables that affect the frequency and severity of metabolic syndrome in women. It is particularly worrisome that some studies have indicated a potential tie between severity of menopausal syndrome (eg, hot flashes) and increased cardiovascular risk, 1,3 suggesting that younger postmenopausal women with metabolic syndrome who most need ERT for symptom relief may be at a greater risk of adverse effects from ERT.…”

“…[1][2][3][4] This postmenopausal increase is believed to result from the loss of endogenous estrogen. Although estrogen replacement therapy (ERT) has long been thought to protect against menopauseassociated cardiovascular anomalies, osteoporosis, hot flashes, and thinning of the vaginal epithelium, [3][4][5] findings from the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study 5 do not support the notion that ERT protects the cardiovascular system. Instead, the data indicate just the opposite, that is, increased risk of cardiovascular disease, in addition to the apparent higher risk of breast cancer and deep vein thrombosis.…”