Cardiovascular Disease Risk Factor Burden During the Menopause Transition and Late Midlife Subclinical Vascular Disease: Does Race/Ethnicity Matter?

Abstract

Background The extent to which cardiovascular disease ( CVD ) risk factors across the menopause explain racial/ethnic differences in subclinical vascular disease in late midlife women is not well documented and was explored in a multi‐ethnic cohort. Methods and Results Participants (n=1357; mean age 60 years) free of clinical CVD from the Study of Women's Health Across the Nation had common carotid artery intima‐media thickness, interadventitial diameter, and carotid plaque presence assessed by ultrasonography on average 13.7 years after baseline visit. Early to late midlife time‐averaged cumulative burden of traditional CVD risk factors calculated using serial measures from baseline to the ultrasound visit were generally less favorable in black and Hispanic women compared with white and Chinese women, including education and smoking status and time‐averaged cumulative blood pressure, high‐density lipoprotein cholesterol, and fasting insulin. Independent of these risk factors, BMI , and medications, common carotid artery intima‐media thickness was thicker in black women, interadventitial diameter was wider in Chinese women, yet plaque presence was lower in black and Hispanic women compared with white women. CVD risk factor associations with subclinical vascular measures did not vary by race/ethnicity except for high‐density lipoprotein cholesterol on common carotid artery intima‐media thickness; an inverse association between high‐density lipoprotein cholesterol and common carotid artery intima‐media thickness was observed in Chinese and Hispanic but not in white or black women. Conclusions Race/ethnicity did not particularly moderate the association between traditional CVD risk factors measured across the menopause transition and late midlife subclinical vascular disease. Unmeasured socioeconomic, cultural, and nontraditional biological risk factors likely play a role in racial/ethnic differences in vascular health and merit further exploration.

Genetic polymorphism of IDOL gene was associated with the susceptibility of coronary artery disease in Han population in Xinjiang, China

“…China. 4 Department of General Practice, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China.…”

“…Certain risk factors, including increased plasma low-density lipoprotein (LDL), triglyceride (TG) levels, smoking, obesity, hypertension, diabetes, aging etc. increase the incidence of atherosclerosis [ 4 , 5 ]. In recent years, with the development of genome technology, researchers have found that several genetic susceptibility genes and the risks of CAD were associated in several ways.…”

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman

“…67 The extent to which CVD risk factors across the menopause explain racial/ethnic differences in subclinical vascular disease in late midlife women is not well documented, but was explored in a multi-ethnic cohort subset of the Study of Women's Health Across the Nation including 1357 women, mean age 60 years, and free of clinical CVD. 68,69 Although race/ethnicity differences in subclinical CVD in late midlife women were identified, with thicker carotid walls in black women, wider arterial diameter in Chinese women, and less carotid plaque in black and Hispanic women compared with white women, the investigators found that CVD risk factor associations with subclinical vascular measures did not vary by race/ethnicity except for high-density lipoprotein cholesterol on common carotid artery intima-media thickness, where an inverse association between high-density lipoprotein cholesterol and common carotid artery intima-media thickness was observed in Chinese and Hispanic but not in white or black women. 68 To-date, the adverse effects of menopause on CV health have been largely attributed to hypoestrogenemia, as seen in primary ovarian insufficiency.…”

“…68,69 Although race/ethnicity differences in subclinical CVD in late midlife women were identified, with thicker carotid walls in black women, wider arterial diameter in Chinese women, and less carotid plaque in black and Hispanic women compared with white women, the investigators found that CVD risk factor associations with subclinical vascular measures did not vary by race/ethnicity except for high-density lipoprotein cholesterol on common carotid artery intima-media thickness, where an inverse association between high-density lipoprotein cholesterol and common carotid artery intima-media thickness was observed in Chinese and Hispanic but not in white or black women. 68 To-date, the adverse effects of menopause on CV health have been largely attributed to hypoestrogenemia, as seen in primary ovarian insufficiency. 59,70 These effects include evolution to an atherogenic cardiometabolic profile with increases in total cholesterol, low density lipoprotein (LDL)-cholesterol, and lipoprotein (a) [Lp(a)], and decreased high density lipoprotein (HDL)-cholesterol, impaired glucose tolerance, elevated blood pressure (BP), and transition to an android adipose tissue distribution (increased central obesity).…”

Early Menopause and Cardiovascular Disease Risk in Women With or Without Type 2 Diabetes: A Pooled Analysis of 9,374 Postmenopausal Women

“…The extent to which early menopause compounded by T2DM places women at an even higher risk of CVD is unknown. Additionally, despite previous evidence showing racial/ethnic heterogeneities in menopausal age ( 14 ), burden of T2DM ( 15 ), and postmenopausal CVD risk ( 15 , 16 ), it is unclear whether the effect of early menopause on CVD risk differs among races/ethnicities. Prior studies were limited by insufficient clinical events to determine whether early menopausal age contributes to a higher risk for CVD in racial minorities, such as non-Hispanic Blacks (Blacks) ( 8 , 10 ).…”