Abstract MP55: The Cardioprotective Feature of High-Density Lipoprotein Function Diminishes as Women Transition Through Menopause: The Swan HDL Study

Abstract

Objective: HDL cholesterol efflux capacity (CEC) is a key metric of the cardioprotective HDL functionality. CEC generally rises as women traverse the menopause but it is unclear whether this rise reduces future CVD risk. We tested whether the association between CEC and subclinical CVD burden, measured using a composite subclinical CVD score based on carotid-intima media thickness (c-IMT), carotid-femoral pulse wave velocity (cf-PWV) and presence of coronary artery calcium (CAC score ≥10), varies by time relative to the final menstrual period (FMP). Design: We included 279 women (at baseline: age 51±2.8 years; 68.5% White; 31.5% Black; 60.6% Pre-/perimenopausal) who had HDL metrics and subclinical CVD outcome measures measured once (N=115 [41.2%]) or twice (N=164 [58.8%]). The composite subclinical CVD score was computed using a factor analysis for mixed data approach (FactoMineR R package), which combines principal component analysis for continuous (c-IMT, cf-PWV) and multiple correspondence analysis for categorical data (CAC≥10). A linear mixed effects model was used to model the composite score of subclinical CVD and estimates were back transformed to the individual observed components. We tested the interaction between CEC and time relative to FMP in this model. Results: Higher CEC was associated with a lower composite subclinical CVD score at FMP in unadjusted analyses (Illustration). This association was negligible after adjustment for confounders. In all models, association of CEC varied by time relative to FMP such that the pre-FMP protective association of CEC diminishes after the FMP. This pattern was consistent across all components of the composite score (Illustration). Conclusions: In women, higher CEC is associated with a lower risk of subclinical CVD burden before but not after menopause. High CEC is not a consistent indicator of CVD protection in women traversing menopause.