How menopause affects blood vessel health

New research suggests that menopause is likely to raise the risk of cardiovascular disease — in part because the pace of arterial stiffening accelerates before and after the last period. Also, this may occur earlier in black women than white women.

Samar R. El Khoudary, Ph.D., an associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, in Pennsylvania, is the senior author of the study, while Saad Samargandy, a doctoral candidate at the same institution, is the first author.

As Samargandy and colleagues explain, it is no mystery that the risk of cardiovascular disease increases with age.

In women, several metabolic and physiological changes occur during menopause, including adverse changes in the structure of the carotid arteries and an increase in blood lipid levels, waist circumference, and metabolic syndrome risk.

An additional change that can affect cardiovascular health involves a shift in the levels of the hormone estradiol that occurs within 1 year of the final menstrual period.

But does the elasticity of the arteries also change during menopause? More specifically, does arterial stiffness — a predictor of cardiovascular disease risk and a marker of vascular aging — also increase with menopause?

To find out, El Khoudary and the team analyzed data from one of the largest “multiethnic, multisite longitudinal [studies] of the physical, biological, and psychosocial changes of the menopause transition,” called the Study of Women’s Health Across the Nation (SWAN).

The researchers published their findings in the American Heart Association (AHA) journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Marked increase in arterial stiffness

SWAN had enrolled participants between 2001 and 2003. For the new study, the researchers clinically followed 339 women for a period of up to 12.5 years. Thirty-six percent of the women were black.

The team examined the change in arterial stiffness, as measured by carotid-femoral pulse wave velocity — the most established measure of arterial stiffness that conveys how fast blood moves through the arteries.

The researchers looked at how this measure changed within 1 year before and after each participant’s final menstrual period and whether the change occurred differently in black women and white women.

The scientists found that arterial stiffness rose by approximately 0.9% up to 1 year before the final menstrual period and by 7.5% in the year that followed it.

Furthermore, the team determined that black women experienced this increase in stiffness sooner than white women — that is, more than a year before their final periods.

Menopause-related cardiovascular risk

“SWAN is a unique source of data on changes in women’s health over several decades, and this is the latest in a long line of research by our team and others that indicates the menopausal transition is a very important time for heart health,” comments lead author Samargandy.

“While there are limitations to our study, including that a sizable minority of the women had their arterial stiffness measured at only one time point, we were still able to see that major changes to cardiovascular disease risk happen around menopause.”

“Our study is not able to tell us why we’re seeing these changes during the menopausal transition,” says El Khoudary. “But we speculate that the dramatic hormonal changes accompanying menopause might play a role by increasing inflammation and affecting vascular fat deposition, a hypothesis that we would like to test in future studies.”

“But we can say right now that women should be made aware that their cardiovascular health is likely to worsen as they go through menopause,” cautions El Khoudary.

“Therefore, frequent monitoring of cardiovascular risk factors may be prudent, particularly in black women, who are at even greater risk earlier in the menopausal transition.”
– Samar R. El Khoudary

The senior author adds that “Midlife is not just a period where women have hot flashes and experience other menopausal symptoms.”

“It’s a time when their cardiovascular disease risk is increasing, as we see significant changes in multiple clinical measures of their physical health.”

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