Cardiovascular Disease in Women: Does Menopause Matter?

Abstract

It is known that the menopause transition (MT) is a complex period during a woman's life, but there has been ongoing debate on whether the increase in cardiovascular disease (CVD) during midlife is due to chronological aging or ovarian aging. The purpose of this review is to summarize the recent findings on the role of ovarian aging versus chronological aging on cardiovascular disease (CVD) outcomes and its risk factors in women. Recent data from longitudinal studies have shown that menopause-related factors, such as earlier age at menopause and surgical menopause are associated with higher CVD outcomes. The MT is also associated with detrimental changes in vascular health as well as cardiometabolic risk factors including body composition, visceral fat accumulation, lipids/lipoproteins, blood pressure and the metabolic syndrome. The robust evidence from recent research indicating increases in CVD risk over the MT beyond aging call for immediate efforts to rise awareness among women and their health care providers of CVD risk acceleration accompanying the MT. Efforts should also be directed toward developing and testing novel preventive approaches that target women during this time period to counteract the expected increase in CVD risk.

Keywords: Menopause; cardiovascular disease; menopause transition; women’s health.

Figure 1:. Hypothetical graph of changes in cardiovascular risk factors related to chronological aging versus ovarian aging over the menopause transition

With chronological aging, changes in CVD risk factors over the menopause transition are linear. On the other hand, with ovarian aging, inflection points can be identified around the perimenopausal stage, where the worsening of CVD is steepest during this period.

Figure 2:. Summary of changes in CVD risk factors related to ovarian aging in women

During the menopause transition, women experience changes in CVD risk factors, including increases in LDL-C and Apo-B, deteriorations in quality of HDL, increased accumulation of visceral adipose tissue and fat mass, loss of lean mass, increase in blood pressure and metabolic syndrome, and worsening of subclinical atherosclerosis. This period provides a “window of opportunity” where targeted prevention could counteract the adverse changes in CVD risk.