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Progression of Metabolic Syndrome Severity During the Menopausal Transition

View Article: PubMed Central - PubMed

ABSTRACT

Background: After menopause, women exhibit a higher prevalence of the metabolic syndrome (MetS) and higher risk of cardiovascular disease. However, the timing of changes in MetS severity over the menopausal transition and whether these changes differ by racial/ethnic group remain unclear.

Methods and results: We assessed data from 1470 women from the Atherosclerosis Risk in Communities cohort who experienced transition in menopausal status over 10 years (visits 1–4). We used linear mixed models to evaluate changes by menopausal status (premenopause, perimenopause, and postmenopause) in a MetS severity Z‐score and in the individual MetS components. While there were gradual increases in MetS severity over time across menopause stages, black women in particular exhibited more rapid progression in MetS severity during the premenopausal and perimenopausal periods than during the postmenopausal period. In the postmenopausal period (compared with prior periods), white women exhibited unfavorable decreases in high‐density lipoprotein, while black women exhibited favorable alterations in the rate of change for waist circumference, triglycerides, high‐density lipoprotein, and glucose, contributing to the slowed progression of MetS severity. These changes were all observed after adjusting for hormone replacement treatment.

Conclusions: During menopausal transition, women exhibited rapid increases in MetS severity during the premenopausal and perimenopausal periods, with black women having significant reductions in this increase in severity during the postmenopausal period. These data suggest that the higher prevalence of MetS in postmenopausal women may be caused more by changes during the menopausal transition than by postmenopause. These findings may thus have implications regarding the timing of cardiovascular risk relative to menopause.

No MeSH data available.


Related in: MedlinePlus

Model‐generated MetS severity score over time and rate of change by menopausal status. Mean and 95% confidence intervals are shown for white (light grey) and black (dark grey) participants who exhibited menopausal transition over the 4 visits of ARIC. Rates of change in MetS severity were higher among participants who were premenopausal and perimenopausal compared with those who were postmenopausal, specifically among black women. The model included age, education, family income and hormone use. Significance between race: ***P<0.001.
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jah31640-fig-0001: Model‐generated MetS severity score over time and rate of change by menopausal status. Mean and 95% confidence intervals are shown for white (light grey) and black (dark grey) participants who exhibited menopausal transition over the 4 visits of ARIC. Rates of change in MetS severity were higher among participants who were premenopausal and perimenopausal compared with those who were postmenopausal, specifically among black women. The model included age, education, family income and hormone use. Significance between race: ***P<0.001.

Mentions: Table 3 shows model estimates for the central analysis and Figure 1 shows model‐based mean MetS severity Z‐scores and average change in Z‐score by menopausal status and by race, in a model that included age, socioeconomic variables, and hormone use. Following adjustment for socioeconomic and hormone use, black women continued to have a slower progression of MetS Z‐scores during the postmenopausal period relative to earlier periods. For white women, there was a decrease in the rate of MetS progression from the perimenopausal period to the postmenopausal period (from 0.076 to 0.062), but this failed to reach statistical significance (P=0.106). Compared with white women, black women had a higher increase in MetS severity during the premenopausal and perimenopausal periods (P<0.001 and P=0.036, respectively). As a comparison, women who were postmenopausal at study entry (mean age 54 years) exhibited a rate of change in MetS severity Z‐scores of 0.057 (0.052, 0.062) per year for white women and 0.061 (0.053, 0.069) per year for black women (Tables S1 and S2), while women who remained premenopausal throughout the study (mean age 45 years) had a rate of change of 0.057 (0.039, 0.074) for white women and 0.115 (0.080, 0.150) for black women (Table S3). Use of estrogen replacement therapy was not associated with slope in MetS severity during any of the menopausal stages. A sensitivity analysis that excluded women who had menopause because of surgical removal of ovaries resulted in similar results.


Progression of Metabolic Syndrome Severity During the Menopausal Transition
Model‐generated MetS severity score over time and rate of change by menopausal status. Mean and 95% confidence intervals are shown for white (light grey) and black (dark grey) participants who exhibited menopausal transition over the 4 visits of ARIC. Rates of change in MetS severity were higher among participants who were premenopausal and perimenopausal compared with those who were postmenopausal, specifically among black women. The model included age, education, family income and hormone use. Significance between race: ***P<0.001.
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jah31640-fig-0001: Model‐generated MetS severity score over time and rate of change by menopausal status. Mean and 95% confidence intervals are shown for white (light grey) and black (dark grey) participants who exhibited menopausal transition over the 4 visits of ARIC. Rates of change in MetS severity were higher among participants who were premenopausal and perimenopausal compared with those who were postmenopausal, specifically among black women. The model included age, education, family income and hormone use. Significance between race: ***P<0.001.
Mentions: Table 3 shows model estimates for the central analysis and Figure 1 shows model‐based mean MetS severity Z‐scores and average change in Z‐score by menopausal status and by race, in a model that included age, socioeconomic variables, and hormone use. Following adjustment for socioeconomic and hormone use, black women continued to have a slower progression of MetS Z‐scores during the postmenopausal period relative to earlier periods. For white women, there was a decrease in the rate of MetS progression from the perimenopausal period to the postmenopausal period (from 0.076 to 0.062), but this failed to reach statistical significance (P=0.106). Compared with white women, black women had a higher increase in MetS severity during the premenopausal and perimenopausal periods (P<0.001 and P=0.036, respectively). As a comparison, women who were postmenopausal at study entry (mean age 54 years) exhibited a rate of change in MetS severity Z‐scores of 0.057 (0.052, 0.062) per year for white women and 0.061 (0.053, 0.069) per year for black women (Tables S1 and S2), while women who remained premenopausal throughout the study (mean age 45 years) had a rate of change of 0.057 (0.039, 0.074) for white women and 0.115 (0.080, 0.150) for black women (Table S3). Use of estrogen replacement therapy was not associated with slope in MetS severity during any of the menopausal stages. A sensitivity analysis that excluded women who had menopause because of surgical removal of ovaries resulted in similar results.

View Article: PubMed Central - PubMed

ABSTRACT

Background: After menopause, women exhibit a higher prevalence of the metabolic syndrome (MetS) and higher risk of cardiovascular disease. However, the timing of changes in MetS severity over the menopausal transition and whether these changes differ by racial/ethnic group remain unclear.

Methods and results: We assessed data from 1470 women from the Atherosclerosis Risk in Communities cohort who experienced transition in menopausal status over 10&nbsp;years (visits 1&ndash;4). We used linear mixed models to evaluate changes by menopausal status (premenopause, perimenopause, and postmenopause) in a MetS severity Z&#8208;score and in the individual MetS components. While there were gradual increases in MetS severity over time across menopause stages, black women in particular exhibited more rapid progression in MetS severity during the premenopausal and perimenopausal periods than during the postmenopausal period. In the postmenopausal period (compared with prior periods), white women exhibited unfavorable decreases in high&#8208;density lipoprotein, while black women exhibited favorable alterations in the rate of change for waist circumference, triglycerides, high&#8208;density lipoprotein, and glucose, contributing to the slowed progression of MetS severity. These changes were all observed after adjusting for hormone replacement treatment.

Conclusions: During menopausal transition, women exhibited rapid increases in MetS severity during the premenopausal and perimenopausal periods, with black women having significant reductions in this increase in severity during the postmenopausal period. These data suggest that the higher prevalence of MetS in postmenopausal women may be caused more by changes during the menopausal transition than by postmenopause. These findings may thus have implications regarding the timing of cardiovascular risk relative to menopause.

No MeSH data available.


Related in: MedlinePlus