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Menopause Transition and CVD Risk
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Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.
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Additional Info
Circulation
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association
Circulation 2020 Dec 22;142(25)e506-e532, SR El Khoudary, B Aggarwal, TM Beckie, HN Hodis, AE Johnson, RD Langer, MC Limacher, JE Manson, ML Stefanick, MA Allison, American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke NursingFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The menopausal transition is a challenging time period for both the patient and those individuals providing care for these women. Relevant issues for the practitioner include the occurrence of vasomotor symptoms, sleep disturbances, higher rates of depression, and worsening of risk factors for chronic disease in general and cardiovascular disease in particular. Given this, it would seem prudent to more closely monitor women undergoing this transition for these problems as well as potentially adverse metabolically relevant changes such as weight gain (especially central adiposity), loss of lean muscle mass, and dyslipidemia, among others. If such changes are identified, the literature does provide some support for initiation of a multidimensional lifestyle program aimed at weight reduction and maintenance of lean muscle mass, which may also provide benefits with respect to dyslipidemia. Moreover, and based on other studies not referenced in this statement, the lifestyle program may result in improvements in sleep disturbances and depressive symptoms. Notably, even seemingly modest symptoms of sleep disturbance and depressive symptoms should alert the clinician to further assess these complaints and institute appropriate further evaluation and treatment. Finally, addressing vasomotor symptoms (when present) will be a high priority for the patient. In this regard, there is still debate and unanswered questions about the best course of treatment for this situation. Current recommendations from some national societies include the use of hormone therapy among women under the age of 60 years, which is started as close to the menopause as possible. Regardless of the choices made for the individual patient, it is strongly recommended that healthcare practitioners consider an aggressive prevention-based approach for women at this stage in their lives to decrease the probability of a future CVD event.
Cardiovascular disease is the number one killer of women in the developed world. It has been long recognized that cardiovascular disease increases after menopause; however, a detailed understanding of what aspects of this increased risk are associated with aging as opposed to menopausal transition remains less clearly defined. This scientific statement from the AHA clearly and concisely summarizes the current scientific understanding of how the menopausal transition relates to cardiovascular risk factors and its implications for cardiovascular disease prevention. Vital to this is the understanding that the timing of menopause may be an important predictor of cardiovascular health and clinicians should recognize that women who undergo early menopause are at increased cardiovascular risk. In addition, data suggest that menopause is a time of detrimental changes in cardiometabolic risk factors and that application of preventive behavioral interventions prior to the onset of menopause can positively impact subsequent cardiovascular disease risk. This statement highlights the importance of the perimenopausal period as a window for clinicians to pursue cardiovascular risk reduction. Further data will in the future help us better understand how best to care for these women; but, for now, this article should cement the importance of menopause in the assessment of cardiovascular risk in women.