Menopause and Risk Factors for Coronary Heart Disease

Abstract

Postmenopausal women are believed to have a higher risk of coronary artery disease than premenopausal women. In this study, we prospectively determined changes in coronary risk factors that were attributable to natural menopause in 541 healthy, initially premenopausal women 42 to 50 years of age. After approximately 2 1/2 years, 69 women had spontaneously stopped menstruating for at least 12 months, and 32 women had stopped natural menstruation and received hormone-replacement therapy for a period of at least 12 months. An equal number of age-matched premenopausal women in the study group served as controls. In women who had a natural menopause and did not receive hormone-replacement therapy, serum levels of high-density lipoprotein (HDL) cholesterol declined as compared with those of premenopausal controls (-0.09 vs. 0.00 mmol per liter; P = 0.01), and levels of low-density lipoprotein (LDL) cholesterol increased (+0.31 vs. +0.14 mmol per liter; P = 0.04). In menopausal women who received hormone-replacement therapy, HDL and LDL cholesterol levels did not change, but the levels of triglycerides (+0.42 vs. -0.04 mmol per liter; P less than 0.001), apolipoprotein A-I (+0.18 vs. +0.03 g per liter; P less than 0.01), and apolipoprotein A-II (+0.05 vs. -0.03 g per liter; P less than 0.05) increased as compared with premenopausal controls. Natural menopause did not affect blood pressure, plasma glucose or insulin levels, body weight, the total number of kilojoules consumed in the diet, or the total number of kilojoules expended in physical activity. These results suggest that a natural menopause has an unfavorable effect on lipid metabolism, which may contribute to an increase in the risk of coronary disease. Hormone-replacement therapy may prevent some of these changes.

Changes in body weight and onset of hypertension in perimenopausal women

“…Further, the prevalence of hypertension was increased four-fold in postmenopausal as compared to premenopausal women. 4 However, in the few longitudinal studies available [5][6][7][8] the menopausal transition of hypertension has not been convincingly demonstrated. The current view is that BP does not rise during the transition phase from perimenopause to menopause, but rather that the increase in BP takes an average of 5-20 years to develop.…”

Elevated mean arterial pressure in the ovariectomized rat was normalized by ETA receptor antagonist therapy: absence of cardiac hypertrophy and fibrosis

“…Albeit, in postmenopausal women, this trend was lost, and found to be quantitatively similar to men (Becker, 1995;Schwartz et al, 1995). Coronary artery disease, as well as cerebrovascular stroke represent two salient complications associated with menopause, and may be in part related to the increase in circulating LDL, oxidized-LDL, and concomitant decrease in HDL production (Simon et al, 2001;Greendale et al, 1999;Matthews et al, 1989). Lastly, an increased incidence of systemic hypertension has been documented in post-menopausal women (Reckelo , 2001), and identi®ed as an independent risk factor in the development of coronary artery disease, cerebrovascular stroke, as well as congestive heart failure (Stokes et al, 1989;Kannel et al, 1976).…”

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

“…4 Concurrently other adverse changes occur in cardiac risk factors including rises in LDL and insulin resistance, falls in HDL, and changes in fat distribution. 17 Gender protection is lost so the incidence of CHD in women equals that in men by the age of 65. 18 Hypertensive women in the Nurses Health Study had a 3.5-fold increase in risk of CHD with a 2.6-fold increase in stroke compared with nonhypertensives.…”