The association of menopause with cardiometabolic disease risk factors in low- and middle-income countries: a systematic review and meta-analyses

Abstract

Importance: Menopause is an integral part of women's health, and studies in high-income countries have shown an increase in cardiometabolic disease (CMD) risk factors in postmenopausal compared with premenopausal women. However, to date, no study has combined and assessed such studies across low- and middle-income countries. This would better inform early monitoring and intervention strategies for reducing CMD risk factor levels in midlife women in these regions.

Objective: This study aimed to evaluate evidence from the literature on differences in CMD risk factors between premenopausal and postmenopausal midlife women living in low- and middle-income countries.

Evidence review: A systematic review with meta-analysis of original articles of all study designs from the databases PubMed, PubMed Central, Scopus, and ISI Web of Science was conducted from conception until April 24, 2023. Studies that met the inclusion criteria were included in the analysis. Quality assessment of the articles was done using the Newcastle-Ottawa Scale, adapted for each study design. The study protocol was registered with the International Prospective Register of Systematic Reviews and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. For the meta-analysis, fixed-effects models were used to pool the odds ratios (OR), as measures of association.

Findings: Our search identified 4,849 relevant articles: 44 for the systematic review and 16 for the meta-analysis, in accordance with our inclusion criteria. Compared with premenopausal women, the postmenopausal stage was associated with metabolic syndrome (OR, 1.18 [95% CI, 1.11-1.27]), high waist-to-hip ratio (OR, 1.22 [95% CI, 1.12-1.32]), hypertension (OR, 1.10 [95% CI, 1.04-1.16]), elevated triglycerides (OR, 1.16 [95% CI, 1.11-1.21]), and elevated plasma glucose (OR, 1.21 [95% CI, 1.15-1.28]).

Conclusions and relevance: This study confirmed that CMD risk factors are present at higher levels in postmenopausal than premenopausal women. This demonstrates an urgent need for public health policies that focus on early monitoring and interventions targeted at reducing CMD risk and related adverse outcomes in midlife women in these nations.

Figure 1. PRISMA flow chart of literature screening and selection. PRISMA - preferred reporting items for systematic reviews and meta-analysis

Figure 2. Meta-analysis of studies showing differences in cardiometabolic disease risk factors according to menopausal stage

High BMI (body mass index) (≥28 kg/m²), elevated cIMT (carotid intima media thickness) (≥0.70mm), elevated FG (fasting glucose) (≥6.1 mmol/L), low HDL-C (high density lipoprotein cholesterol) (<1.29 mmol/L), Hyp (hypertension) 1 (systolic BP ≥140 mmHg and diastolic BP ≥90 mmHg), Hyp 2 (systolic BP ≥130 mmHg and diastolic BP ≥85 mmHg), MetS (metabolic syndrome) (NCEP ATP III definition), high TG (triglycerides) (≥1.69 mmol/L), high WC (waist circumference) 1 (≥80 cm), high WC2 (≥88 cm), and high WHR (waist-to-hip ratio) (≥0.85). Odds ratios presented as post- vs. premenopausal stage.