Elevated Cardiovascular Risks among Postmenopausal Women: A Community Based Case Control Study from Nepal

Abstract

Cardiovascular disease (CVD) is one of the leading causes of death worldwide which is more prevalent in women after menopause. Hormonal changes associated with menopause are accountable for dyslipidemic pattern that causes CVD and associated complications. Therefore, the present study was commenced to compare the lipid profile in pre- and postmenopausal women. A descriptive cross-sectional study was conducted at Manmohan Memorial Institute of Health Sciences (MMIHS) from February 2016 to July 2016. A total of 260 fasting samples were collected from healthy women, 130 from premenopausal and 130 from postmenopausal women, and analyzed for Total Cholesterol (TC), Triacylglycerol (TAG), High Density Lipoprotein Cholesterol (HDL-C), and Low Density Lipoprotein Cholesterol (LDL-C) as per the guideline provided by the reagent manufacturer (Human, Germany). All the parameters were analyzed by Stat Fax 3300 semi auto analyzer. TC, TAG, HDL-C, and LDL-C were highly significantly increased in postmenopausal women when compared to premenopausal women. LDL/HDL ratio was significantly elevated in postmenopausal women than in premenopausal women. BMI was significantly positively correlated with TC and TAG in both pre- and postmenopausal population and it was positively correlated with HDL-C in premenopausal population while negatively correlated in postmenopausal population. Since more of the atherogenic lipid parameters are increased in postmenopausal women, they appear to be more prone to have CVD and associated complications in near future. Hence, it is mandatory to monitor and manage dyslipidemic pattern in every woman experiencing menopause.

Assessment of cardiovascular risk in post-menopausal women in Ghana

“…Although CVD is the major cause of death and disability in women, it usually starts about 10 years late in men of the same age. It is also true that CVD are the major cause of mortality in post-menopausal women 4 . The patterns of dyslipidemia that leads to CVD and its associated complications have been linked with hormonal changes associated with menopause.…”

“…Cardiovascular diseases (CVD) are the major cause of death among post-menopausal women 4 . Studies have shown that premenopausal women have a low risk of CVD as compared to men but after menopause the level of risk increases 5 .…”

The Role and Function of HDL in Patients with Chronic Kidney Disease and the Risk of Cardiovascular Disease

“…CKD women experience kidney dysfunction-mediated premature menopause. In the postmenopausal period, women are more prone to develop diseases associated with estrogen deficiency, including heart diseases, osteoporosis, and dyslipidemia [88][89][90] due to hormonal changes involving the decrease in estrogen level and increase in luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels. These changes exert significant effect on plasma lipid and lipoprotein metabolism [89,91].…”

“…Estrogen cardioprotective effect are related to the maintenance of high levels of HDL and low levels of LDL-C and triacylglycerols [90]. Estrogen regulates HDL levels directly by influencing mRNA production for specific protein, for example, proteins involved in lipid metabolism including lipoprotein lipase (LPL) and hormone sensitive lipase (HSL) in adipose tissue, and by promoting hepatic expression of apoprotein gene as well as indirectly through the impact on adipose tissue by stimulating release of other hormones, namely, growth hormone (GH), catecholamine, and glucagon, which increases activity of HSL [90,92]. 17-Beta-estradiol, which is a main circulating form of estrogen, increases the rate of apoA-I and apoA-II synthesis leading to higher HDL concentration [90].…”

“…Some studies have demonstrated significant lowering in the level of HDL in postmenopausal women, whereas other studies have noticed a substantial increase in level of HDL in this population. This discrepancy may be related to the differences in studied population, life intervention, and duration of menopause [90]. A cross-sectional study of premenopausal and postmenopausal women with metabolic syndrome (MS) and CKD failed to find significant changes in serum HDL cholesterol level between these two groups [93].…”