Abstract 028: Increase in Abdominal Visceral Adipose Tissue Accelerates Two Years Prior to Menopause: The Study of Women’s Health Across the Nation (SWAN) Heart

Abstract

Introduction: Abdominal visceral adipose tissue (VAT) contributes to pathogenesis of cardiometabolic disease through endocrine and paracrine secretion of adipocytokines. Midlife women experience adipose tissue redistribution towards increasing central adiposity. A few studies suggested a contribution of the menopausal transition, but evidence is lacking to characterize the change in VAT relative to time of the final menstrual period (FMP). We hypothesized that VAT would change non-linearly relative to FMP with a significant rise close to FMP. Methods: We evaluated participants with no self-reported CVD from the SWAN Heart Ancillary study. Women had up to two computed tomographic planimetric measurements of VAT over a median of 2.2 years of follow-up and known dates of FMP. LOESS splines were used to determine potential inflection points of VAT change relative to FMP. Piecewise linear mixed-effects models were used to estimate and compare yearly % changes in VAT at LOESS spline-identified time segments. Results: The study included 321 women (at baseline: mean age (SD) of 51.0 (2.8) years; 60% White, 40% Black; 9% premenopausal, 51% early/ 13% late perimenopausal, and 27% postmenopausal). LOESS splines suggested a non-linear association between VAT change and time of FMP with two inflection points demarcating 3 segments: segment 1: > 2 years before FMP, segment 2: 2 years before FMP to the FMP, and segment 3: after FMP (Figure) . Adjusting for covariates listed under the Figure , VAT increased significantly by 10.5% (95% CI: 5.9, 15.3) per year in segment 2, and this increase was greater than changes in segments 1 [1.3% (-2.0, 4.7)] and 3 [3.1% (0.8, 5.4)], both P=0.01. Additional adjustment for concurrent body mass index attenuated difference only between segments 2 and 3 (P=0.07). Conclusions: Women show significantly faster increase in VAT two years prior to menopause, which may place them at greater risk of cardiometabolic outcomes later in life. These results encourage lifestyle modifications early in menopausal transition.