Cardiovascular Risk In Postmenopausal Women Research Articles

Association between fasting lipid profile, inflammatory markers and oxidative stress markera burden of cardiovascular risk in postmenopausal women with high Body Mass Index

Cardiovascular diseases are becoming more successful in the entire population of individuals and is the leading cause of death in both men and women. The effect of cardiovascular disease is not appreciated high enough in women when set side by side in men. Women have eccentric variable determinants that increases the probability of cardiovascular diseases and postmenopausal women are at higher risk of developing cardiovascular diseases. Postmenopause is the time when menstrual period stops permanently in a women’s life. Several hormonal imbalances as well as metabolic changes make them more prone for cardiovascular diseases. Fasting lipid profile, inflammatory markers like hs-CRP, TNF-α, Adiponectin and oxidative stress marker like Malondialdehyde are found altered in high BMI postmenopausal women and this altered parameters tend to become a major CV risk. Aim and objective. The aim is to associate the levels of fasting lipid profile, inflammatory markers like hs-CRP, TNF-α, Adiponectin and oxidative stress marker like Malondialdehyde with cardiovascular disease in normal and high BMI postmenopausal women. Materials and methods. The research was directed on 104 postmenopausal women of age group 45–60 years and we grouped them into 2. Group 1 having normal BMI (18.50–24.99) and group 2 having high BMI > 25.00 based on Asian’s classification for BMI. Approval from the Institutional Ethical Committee was obtained before beginning the study. Postmenopausal women were instructed to report to physiology department at 7.30 am following overnight fasting and 5 ml of blood was collected to assess their fasting lipid profile, oxidative stress marker and inflammatory markers. Results & conclusion. Unpaired t-test was used to analyse all parameters of the study (control and study group). BMI, Total Cholesterol, Triacylglycerol, LDL-C, VLDL-C, hs-CRP, TNF-α, Malondialdehyde were significantly elevated and the levels of HDL-C and adiponectin were found reduced in high BMI postmenopausal women when compared to normal BMI postmenopausal women (p < 0.05) and all these factors are reported to be risk factors for adverse CV events.

Effects of five types of exercise on vascular function in postmenopausal women: a network meta-analysis and systematic review of 32 randomized controlled trials.

As women age, especially after menopause, cardiovascular disease (CVD) prevalence rises, posing a significant global health concern. Regular exercise can mitigate CVD risks by improving blood pressure and lipid levels in postmenopausal women. Yet, the optimal exercise modality for enhancing vascular structure and function in this demographic remains uncertain. This study aims to compare five exercise forms to discern the most effective interventions for reducing cardiovascular risk in postmenopausal women. The study searched PubMed, Web of Science, Cochrane, EBSCO, and Embase databases. It conducted a network meta-analysis (NMA) of randomized controlled trials (RCTs) on five exercise interventions: continuous endurance training (CET), interval training (INT), resistance training (RT), aerobic combined with resistance training (CT), and hybrid-type training (HYB). Outcome measures included carotid artery intima-media thickness (IMT), nitric oxide (NO), augmentation index (AIx), pulse wave velocity (PWV), and flow-mediated dilatation (FMD) of the brachial artery. Eligible studies were assessed for bias using the Cochrane tool. A frequentist random-effects NMA was employed to rank exercise effects, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). The analysis of 32 studies (n = 1,427) indicates significant increases in FMD with CET, INT, RT, and HYB in postmenopausal women. Reductions in PWV were significant with CET, INT, RT, CT, and HYB. AIx decreased significantly with INT and HYB. CET, INT, and CT significantly increased NO levels. However, no significant reduction in IMT was observed. SUCRA probabilities show INT as most effective for increasing FMD, CT for reducing PWV, INT for decreasing AIx, CT for lowering IMT, and INT for increasing NO in postmenopausal women. The study demonstrates that CET, INT, RT, and HYB have a significant positive impact on FMD in postmenopausal women. Furthermore, all five forms of exercise significantly enhance PWV in this population. INT and HYB were found to have a significant positive effect on AIx in postmenopausal women, while CET, INT, and CT were found to significantly improve NO levels. For improving vascular function in postmenopausal women, it is recommended to prioritize INT and CT exercise modalities. On the other hand, as CET and RT were not ranked at the top of the Sucra value ranking in this study and were less effective than INT and CT as exercise interventions to improve vascular function in postmenopausal women, it is not recommended that CET and RT be considered the preferred exercise modality.

Cardiovascular and physiological risk factors in women at mid-life and beyond.

Cardiovascular disease (CVD) is the leading cause of death in women. After menopause, sex-specific and gender-specific factors may play an important role in increasing CVD risk, with changes in sex hormones, body fat distribution, lipid and metabolic profile, and structural and functional vascular modifications. Premature and early-onset menopause are detrimental to cardiovascular health due to the early cessation of the protective effect of endogenous estrogen. An independent association of menopause with an increased risk of CVD has been documented in early menopause (<45 years). Sex-related differences are relevant in pharmacokinetics and pharmacodynamics; different enzyme formations, drug compatibility, efficacy, and side effects vary for different sexes. Despite some progress in sex and gender research in CVD, disparities remain. Menopausal hormone therapy (MHT) is available at mid-life for symptoms of menopause and may impact cardiovascular risk. Taken early, MHT may reduce CVD morbimortality. However, this is balanced against the risk of increased thrombosis. This paper reviews physiologic changes that contribute to cardiovascular risk in postmenopausal women and discusses clinical implications. Specifically, it explores the atheroprotective effects of estrogen and MHT and the associations between menopause with lipid levels, hypertension, body composition, and diabetes for women at mid-life and beyond.

BENEFICIAL ROLE OF DIETARY CHANGES IN MENOPAUSE: IMPACT ON CARDIOVASCULAR RISK

Objective: The changing hormonal milieu in post-menopausal women (PMW) predisposes them to increase cardiovascular (CV) risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia and arterial hypertension. Our ongoing study aims to evaluate the impact of dietary changes in CV risk in PMW. Design and method: For 1 year, 65 PMW with BMI 24-39 Kg/m2 and at least another CV risk factor were followed. Anthropometric parameters, plicometry and blood pressure (BP) were taken. Questionnaires on medical history, physical activity, and food frequency (FFQ) were administered. Balanced low-calorie dietary plan with quantitative advice were released. Repeated measures ANOVA at 1 year were performed. Results: We observed at 1 year significant reductions (p&lt;0.01) in weight (δ=-4.5 Kg), BMI (δ=-1.7 Kg/m2), waist (δ=-4.3cm) and hips (δ=-3.1cm) circumferences, subscapular (δ=-5.8mm), suprailiac (δ=-3.3mm) and triceps (δ=-5.5mm) skinfolds, adipose area of the arm (AFA) (δ=-7.3cm2), and fat mass (δ=-4.5kg) without variation of the lean mass (δ=-0.1 kg, p=0.48). All those reductions were followed by change in the obesity prevalence (-21.1%), in the fat mass distribution with 10% reduction in abdominal and truncular obesity and 5.2% reduction on waist-to-height ratio, and in systolic (δ=-8.8 mmHg) and diastolic (δ=-4.3 mmHg) BP. Significant positive correlations (p&lt;0.0001) were observed between weight reduction and the following variables: waist (r=0.61) and hip (r=0.77) circumferences, subscapularis (r=0.56) and triceps (r=0.66) skinfolds, and AFA (r=0.73). Significant reductions (p&lt;0.05) were observed in daily caloric intake (δ=-99.8Kcal/day), due to the reduction in fat intake (36.6-&gt;33.6%), specially saturated fatty acids (12-&gt;10.8%) and cholesterol (δ=-23.1mg/day), with maintenance of the average level of physical activity and in agreement with a significant reductions in consumption of animal meats, visible fat, processed meats, olive oil, sweets and baked goods detected by FFQ. Conclusions: The study underlines the medium-term utility of a 1 year balanced low-calorie diet in PMW with elevated CV risk factors with a clear reduction in CV risk.

Endothelial dysfunction influences augmented aortic hemodynamic responses to metaboreflex activation in postmenopausal women.

Postmenopausal women experience augmented aortic hemodynamic responses to isometric handgrip (IHG) exercise and metaboreflex activation post-exercise muscle ischemia (PEMI). Relationships between endothelial function brachial artery flow-mediated dilation (FMD) and aortic stiffness carotid-femoral pulse wave velocity (cfPWV) with aortic pulsatile hemodynamics during IHG and PEMI have not been determined. The relationships between aortic hemodynamic responses to PEMI were evaluated. Aortic blood pressure (BP), wave reflection, and pressure of forward (Pf) and backward (Pb) waves were measured using arterial tonometry at rest, IHG at 30% maximal force, and PEMI in 30 (15/group) postmenopausal women with low (≤ 4.5%) and normal (≥ 5.5%) FMD. Hemodynamic responses were analyzed as the change (Δ) from rest to the last minute of IHG and PEMI. Brachial and aortic systolic BP (SBP) responses to IHG were higher in the low vs normal FMD group (P < 0.05). Aortic SBP (Δ20 ± 8 vs Δ11 ± 7mmHg), pulse pressure (PP) (Δ12 ± 8 vs Δ6 ± 4mmHg), augmented pressure (AP) (Δ5 ± 3 vs Δ2 ± 2mmHg), and Pb (Δ6 ± 4 vs Δ3 ± 2mmHg) responses to PEMI were greater (P < 0.05) in women with low vs. normal FMD. FMD was negatively correlated with aortic SBP, PP, AP, and Pb (P < 0.05) responses to PEMI. cfPWV was not correlated with responses to PEMI. Endothelial dysfunction relates to augmented aortic pulsatile load during metaboreflex activation, which may increase cardiovascular risk in postmenopausal women.

Improving Cardiovascular Risk in Postmenopausal Women with an (-)-Epicatechin-Based Nutraceutical: A Randomly Assigned, Double-Blind vs. Placebo, Proof-of-Concept Trial.

Age-adjusted rates of cardiovascular disease (CVD) are higher in men than in women. CVD risk-factor outcomes are underrecognized, underestimated, and undertreated in women because the clinical expressions in women differ from those of men. There are no universally accepted recommendations on what to do in women when the values of fasting glucose, blood pressure, and lipids are only slightly altered or at borderline values. We reported the positive effects on CVD risk markers using cacao by-products, showing that alternative approaches can be used to prevent cardiovascular disease in women. The objective was to evaluate the changes in lipoprotein subfractions induced by three months of treatment with an epicatechin-enriched cacao supplement. A double-blind, placebo-controlled proof-of-concept study was developed to evaluate the effects of 3 months of treatment with an (-)-epicatechin-enriched cacao supplement on lipoprotein subfractions. The usual screening workshop for postmenopausal women could be insufficient and misleading. Assessing the effect of a (-)-epicatechin-enriched cacao supplement employing a lipoprotein subfractionation profile analysis suggests a decrease in cardiovascular risk. A simple, low-cost, safe (-)-epicatechin-enriched cacao supplement product can improve the cardiovascular risk in postmenopausal women.

Abdominal obesity, serum estradiol and cardiovascular risk among Nigerian postmenopausal women: a cross-sectional study.

Rates of cardiovascular (CV) disease mortality is usually higher in men but this equalizes with that of women following menopause. This was to determine the contribution of abdominal obesity and estradiol to cardiovascular risk in postmenopausal women (PMW) as well as estimate their CV risk profile. 271 consenting PMW were recruited consecutively into this cross-sectional hospital-based study. Data relating to their socio-demography, blood pressure and anthropometry was obtained and laboratory analysis of lipid profile and serum estradiol was done. Cardiovascular risk of participants was estimated using standardized calculators. Mean age of participants was 57.8±5.5 years. Significant correlation existed between each of triglyceride (Positive), High Density Lipoprotein (negative) and Waist-Hip-Ratio (WHR) (p=0.001 and 0.000 respectively). Hypertension and dyslipidaemia were significantly associated with WHR (p=0.01 and 0.031 respectively). Significant negative correlation existed between CV risk profile and serum estradiol (rs = -0.140, p = 0.028). Ten-unit increase in WHR was associated with two-fold risk of hypertension (OR> 1.73, C.I.= 1.13-2.66). A unit change in age was associated with 0.61 increase in TC. Abdominal obesity and serum estradiol significantly influence cardio-metabolic risk. Newer risk calculator which incorporates factors peculiar to women such as serum E2 is hereby recommended.

Associations of reproductive factors with incidence of myocardial infarction and ischemic stroke in postmenopausal women: a cohort study

BackgroundTo assess the association between the reproductive factors of age at menarche, age at menopause, and reproductive span and the incidence of myocardial infarction (MI) and ischemic stroke (IS).MethodsWe used a population-based retrospective cohort study from the National Health Insurance Service database of Korea including a total of 1,224,547 postmenopausal women. Associations between age at menarche (≤ 12, 13–14 [reference], 15, 16, and ≥ 17 years), age at menopause (< 40, 40–45, 46–50, 51–54 [reference], and ≥ 55 years), and reproductive span (< 30, 30–33, 34–36, 37–40 [reference], and ≥ 41 years) and the incidence of MI and IS were assessed by Cox proportional hazard models with adjustment for traditional cardiovascular risk factors and various reproductive factors.ResultsDuring a median follow-up of 8.4 years, 25,181 MI and 38,996 IS cases were identified. Late menarche (≥ 16 years), early menopause (≤ 50 years), and short reproductive span (≤ 36 years) were linearly associated with a 6%, 12–40%, and 12–32% higher risk of MI, respectively. Meanwhile, a U-shaped association between age at menarche and risk of IS was found, with a 16% higher risk in early menarche (≤ 12 years) and a 7–9% higher risk in late menarche (≥ 16 years). Short reproductive span was linearly associated with an increased risk of MI, whereas both shorter and longer reproductive spans were associated with an increased risk of IS.ConclusionsThis study demonstrated different patterns of association between age at menarche and incidence of MI and IS: a linear association for MI versus a U-shaped association for IS. Female reproductive factors in addition to traditional cardiovascular risk factors should be considered when assessing overall cardiovascular risk in postmenopausal women.

Impact of Diet on Serum Lipids, Atherogenic Index of Plasma and Non HDL-c in Pre and Postmenopausal Women

Introduction: Menopause is an inevitable phase of a woman’s natural ageing process, marked by cessation of ovarian function. Hormonal changes during the phase causes derangement of lipid metabolism and thereby increasing cardiovascular risk in postmenopausal women. Diet plays a major role in influencing serum lipids. Aim: To determine and compare lipid profile, Atherogenic Index of Plasma (AIP) and non High-Density Lipoprotein-cholesterol (HDL-c) in pre and postmenopausal women based on vegetarian and non vegetarian diet. Materials and Methods: This cross-sectional study was comprised of 92 women (46 were premenopausal and 46 were postmenopausal) carried out at AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India between December 2019-May 2020. The groups were further divided into vegetarian and non vegetarians. Fasting lipid profile was determined by enzymatic methods. AIP and non HDL levels were calculated. Comparison of means between two groups was done using student t-test. Association between categorical variables was analysed using Chi-square test. Statistical significance was considered at p&lt;0.05. Results: Serum Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein-cholesterol (LDL-c), Very Low-Density Lipoprotein-cholesterol (VLDL-c), AIP and non HDL-c levels were LDL-c and HDL-c was high (184.09±17.49, 131.96±9.49, 106.00±20.92, 26.46±1.96, 0.05±0.07, 132.45±22.39 and 51.64±5.88, respectively) in vegetarians compared to non vegetarians in premenopausal women. In postmenopausal women, similar pattern was observed with regards to serum TC, TG, LDL-c, VLDL-c, AIP, non HDL-c and HDL-c in vegetarians and non vegetarians (p&lt;0.05). An alarming proportion of non vegetarian postmenopausal women showed “very high” TC (91.3%), “low” HDL-c (56.5%), “very high” LDL-c (69.6%) and “high-risk” AIP (91.3%). Conclusion: The findings of this study indicated that all lipid parameters, AIP and non HDL-c were higher in non vegetarians except HDL-c in pre and postmenopausal women. Relevant dietary recommendations can be given to premenopausal women to promote positive health outcomes and alleviate cardiovascular risk.

Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE).

Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

SERUM LIPID PROFILE AMONG POST-MENOPAUSAL WOMEN ATTENDING TERTIARY HOSPITAL AT CHITWAN, NEPAL

Background: Menopause is a phase of woman’s natural aging process and is marked by the cessation of ovarian function. The increased incidence of cardiovascular risk in post-menopausal women may be due to hormonal imbalance leading to derangement of lipid profile. The aim of study was to study the serum lipid profile among post-menopausal women attending at a tertiary care hospital in Nepal. Methods: This was a hospital based descriptive cross-sectional study carried out among 156 post-menopausal women attending Medicine Out Patient Department at Chitwan medical college and teaching hospital. Serum Lipid profile were measured by an automated on Dimension® clinical chemistry analyzer and serum estrogen was measured by CLIA on Siemen ADVIA Centaur XP immunoassay. Data were analyzed using SPSS version 20. Results: Study finding suggests that serum Triglycerides, Total cholesterol, and LDL were found to be elevated in 48.7%, 23.7% and 14.7% study participants respectively while serum HDL level was found to be low in 10.9% study subjects. Serum HDL had significantly associated with different age groups and estrogen(p&lt;0.05). The serum TG, TC, and LDL were negatively correlated (r = -0.096, p = 0.23), (r = -0.09, p = 0.22), (r = -0.18, p = 0.04) with estrogen respectively while serum HDL was positively correlated (r = 0.32, p = 0.01) with estrogen. The serum TG, TC, LDL were negatively correlated with age and serum HDL was positively correlated with age. Conclusions: Due to changes in lipid profiles and the loss of estrogen’s cardio preventive impact, post-menopausal women are at an increased risk of developing cardiovascular disease.

G protein-coupled estrogen receptor 1: a novel target to treat cardiovascular disease in a sex-specific manner?

As an agonist of the classical nuclear receptors, estrogen receptor-α and -β (NR3A1/2), estrogen has been assumed to inhibit the development of cardiovascular disease in premenopausal women. Indeed, reduced levels of estrogen after menopause are believed to contribute to accelerated morbidity and mortality rates in women. However, estrogen replacement therapy has variable effects on cardiovascular risk in postmenopausal women, including increased serious adverse events. Interestingly, preclinical studies have shown that selective activation of the novel membrane-associated G protein-coupled estrogen receptor, GPER, can promote cardiovascular protection. These benefits are more evident in ovariectomised than intact females or in males. It is therefore possible that selective targeting of the GPER in postmenopausal women could provide cardiovascular protection with fewer adverse effects that are caused by conventional 'receptor non-specific' estrogen replacement therapy. This review describes new data regarding the merits of targeting GPER to treat cardiovascular disease with a focus on sex differences.

Adjuvant Hormonotherapy and Cardiovascular Risk in Post-Menopausal Women with Breast Cancer: A Large Population-Based Cohort Study.

Simple SummaryFor post-menopausal women with estrogen-receptor-positive breast cancer, treatment with aromatase inhibitors reduces disease recurrence and mortality, as compared to tamoxifen. Nevertheless, women treated with aromatase inhibitors more often develop hyperlipidemia, hypercholesterolemia and hypertension, which are recognized cardiovascular (CV) risk factors. Concerns about CV safety of aromatase inhibitors had been raised by several studies. Our results showed that adjuvant therapy with aromatase inhibitors of breast cancer women is associated with increased risk of heart failure and combined CV events, and such therapy probably amplifies the “intrinsic” CV risk of the patient. They underline the importance of interdisciplinary collaboration between oncologists and cardiologists in evaluating the risk/benefit ratio of the choice of hormone therapy.Background: Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women. Methods: By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting. Results: The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia. Conclusions: Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.

Evaluation of Physical Activity Level and Cardiovascular Risk in Postmenopausal Women in a Sub-saharan Urban Area

Evaluation of Physical Activity Level and Cardiovascular Risk in Postmenopausal Women in a Sub-saharan Urban Area

Lecitina colesterol aciltransferasa en mujeres postmenopáusicas y su relación con factores bioquímicos y antropométricos asociados a riesgo cardiovascular

ObjectiveTo determine the serum levels of lecithin cholesterol acyltransferase in a group of postmenopausal women and to establish their relationship with factors associated with cardiovascular risk. Materials and methodsA descriptive, correlational and cross-sectional study was performed that included 56 postmenopausal women. Anthropometric and biochemical (lipid profile and baseline blood glucose) variables associated with cardiovascular risk were measured, and were correlated with the serum concentrations of lecithin cholesterol acyltransferase. ResultsThe mean serum level of lecithin cholesterol acyltransferase was 7.89±1.26μg/ml. The women with a body mass index greater than 25 had significantly higher serum levels of the enzyme than those that had a normal body mass index. No significant relationships were observed between the levels of lecithin cholesterol acyltransferase and the biochemical variables evaluated. ConclusionsThis study is one of the first that has evaluated the serum levels of lecithin cholesterol acyltransferase in postmenopausal women of the Colombian Caribbean. A significant relationship was found between the serum levels of lecithin cholesterol acyltransferase and elevated values of the body mass index. Further studies are required for a better understanding of the relationship between the serum levels of lecithin cholesterol acyltransferase and cardiovascular risk in postmenopausal women.

Cardiovascular Risk in Postmenopausal Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women of reproductive age. The hormonal alterations of PCOS have been linked with a higher risk of metabolic disturbances in young, reproductively active women. However, it remains to be clarified whether the presence of PCOS increases the risk of cardiovascular disease (CVD) later in life. Aging ameliorates the clinical manifestations of PCOS; hyperandrogenaemia and metabolic abnormalities, however, persist beyond the menopause. On the other hand, aging and menopause increase CVD risk in the general female population. The results of the limited available studies in aging women with a previous diagnosis of PCOS demonstrate early atherosclerosis. However, studies addressing clinical CVD outcomes in women with PCOS report inconsistent findings. A possible explanation for this heterogeneity is the difficulty in diagnosing PCOS after the menopausal transition, due to the absence of validated diagnostic criteria for this population. Larger prospective studies of women diagnosed during their reproductive years will shed more light on the longer-term CVD implications of PCOS.

Assessment of cardiovascular risk in post-menopausal women in Ghana

Background: Cardiovascular diseases (CVD) continue to be a major cause of death among post-menopausal women. We sought to assess cardiovascular risk among pre- and post-menopausal women living within the Cape Coast Municipality by comparing the lipid profiles and other emerging biomarkers of CVD, i.e. the atherogenic index of plasma (AIP), visceral adiposity index (VAI), body adiposity index (BAI) and Castelli index I (CRI-I). Methods: A comparative cross-section of 150 women (75 pre-menopausal women and 75 post-menopausal women) visiting the University of Cape Coast hospital for regular checkups were randomly recruited into the study. Socio-demographic and clinical characteristics of participants were obtained with the aid of a structured questionnaire. Blood pressure (BP) was measured and lipid profile was estimated using fasting blood samples. Other markers of cardiovascular risk such as BMI, AIP, VAI, BAI and CRI-I were estimated. Results: We report elevated levels of total cholesterol (TC) (p&lt;0.0001), low density lipoprotein (LDL) (p&lt;0.0001), very low-density lipoprotein (VLDL) (p=0.0021), triglycerides (TG) (p&lt;0.0001) and non-high-density lipoprotein (non-HDL-C) cholesterol (p&lt;0.0001) in post-menopausal women compared with pre-menopausal women. High-density lipoprotein (HDL) (p&lt;0.0001) was, however, decreased in post-menopausal women. Mean AIP (p&lt; 0.0001), VAI (p&lt; 0.0001), BAI (p&lt; 0.0038) and CRI-I (p&lt;0.0001) were significantly increased in post-menopausal women compared to pre-menopausal women. We also report a positive correlation of TC, TG, VLDL and non-HDL with atherogenic markers AIP, VAI and CRI-I in post-menopausal women. A negative correlation of HDL with AIP, VAI, and CR in post-menopausal women was also observed. Conclusions: Menopause could lead to changes in lipid profile to atherogenicity with associated increase in the risk of CVD. Atherogenic markers such as AIP, VAI, BAI, and CR can serve as potential biomarkers for predicting CVD.

Eating patterns, body composition and cardiometabolic health in menopause

Menopausal transition is associated with hormonal changes, which contribute to the increase in visceral fat mass and the development of abdominal obesity in postmenopausal women. Additionally, postmenopausal period is characterized by several lifestyle changes resulting in decrease in energy expenditure, mainly as a result of the reduction in physical activity, as well as changes in food choices. Some of these changes have been depicted in the relevant research, examining nutrient intake and dietary adequacy. However, there is limited evidence on the dietary patterns of postmenopausal women and relevant recommendations. Dietary (or eating) patterns are a new approach in nutrition research, aiming at capturing a broader picture of dietary habits. The study of dietary patterns, beyond the intake of individual nutrients and/or food groups, provides important public health and clinical information, as these patterns more are easily interpreted for nutrition intervention and education. Among them, Mediterranean diet has been widely studied in relation to cardiovascular health. It is characterized by the abundance of plant foods: fruits (an after-dinner dessert or a between-meal snack), vegetables (either as main or side dish), bread and other forms of cereals, legumes, nuts, and seeds. Olive oil is the principal source of fat. Mediterranean diet also includes moderate amounts of dairy products (principally the fermented ones, i.e. cheese and yogurt), low to moderate amounts of fish and poultry, red meat in low amounts and wine, consumed modestly, normally with meals. Ain of the presentation is to review the available evidence on the Mediterranean and other a priori or a posteriori defined patterns and conclude on clear messages on their potential effect on obesity and cardiovascular risk in postmenopausal women.

Circulating PCSK9 concentrations are increased in postmenopausal women with the metabolic syndrome

BackgroundHigh PCSK9 concentrations are associated with an increased risk of cardiovascular disease (CVD). We investigated PCSK9 concentrations and their association with metabolic parameters in Thai subjects and to compare PCSK9 concentrations in pre- and postmenopausal women with and without metabolic syndrome (MetS). MethodsAnthropometric data, serum lipids, fasting blood glucose (FBG), and PCSK9 concentrations were measured in 436 Thai subjects (152 men, 143 premenopausal, and 141 postmenopausal women). ResultsPCSK9 concentrations were significantly higher in women than in men (p = .002) and increased in subjects with an increasing number of MetS components (p for trend = .011). PCSK9 concentrations were significantly higher in postmenopausal women than in premenopausal women (p < .001), in the MetS group than in the non-MetS group (p = .037), and in postmenopausal women with MetS than in premenopausal women without MetS (p < .001). Serum PCSK9 concentrations were positively correlated with several metabolic parameters, including age, BMI, systolic blood pressure (SBP), total cholesterol, triglyceride, LDL-C, and FBG. ConclusionPCSK9 concentrations are influenced by age, gender, MetS status, and menopausal status among Thai subjects. These findings suggest that an elevation in PCSK9 concentrations may increase cardiovascular risk in postmenopausal women with MetS.

Abstract P4-10-05: High risk for cardiovascular disease in postmenopausal breast cancer survivors

Abstract Background: The majority of women diagnosed with breast cancer are considered to have a good prognosis and can expect to survive the disease. Cardiovascular risk in postmenopausal women treated for breast cancer is higher than in women without cancer. Objective: To evaluate cardiovascular risk factors in postmenopausal breast cancer survivors, in comparison to postmenopausal women without breast cancer. Methods: In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared to 192 postmenopausal women (controls), aged 45 to 75 years. The main group included women with amenorrhea &amp;gt; 12 months, aged ≥45 years, with a histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). The control group consisted of women with amenorrhea &amp;gt; 12 months, aged ≥45 years, without breast cancer and CVD. Groups were matched by age, time since menopause, and body mass index (BMI) in a ration of 1 case to 2 controls, according to sample calculation, with a minimum of 92 breast cancer survivors. Clinical and anthropometric data (BMI and waist circumference) were collected by interview and physical examination. For biochemical analysis, total cholesterol, HLD, LDL, triglycerides, glucose and insulin levels were measured. Women presenting with three or more of the following criteria were diagnosed with metabolic syndrome (MetS): waist circumference (WC)&amp;gt; 88 cm; TG≥ 150 mg/dL; HDL cholesterol &amp;lt;50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. For measurement of plasma HSP 60 and 70 concentrations, immunoassays were used (ELISA test). Atherosclerotic disease was determined by intima-media thickness (IMT&amp;gt; 1 mm) of the carotid arteries and / or by the presence of atheromatous plaque, assessed by carotid artery ultrasound (scanner duplex). For statistical analysis, Student's t-test, Gamma Distribution (asymmetric variables), Chi-Square Test and Logistic Regression (odds ratio-OR) were used. Results: Breast cancer survivors had high mean systolic and diastolic blood pressure (p &amp;lt;0.001), and mean blood triglycerides and glucose, above desirable levels (p &amp;lt;0.05). Breast cancer patients had higher HSP60 levels and lower HSP70 levels than controls (p &amp;lt;0.05). Atheromatous plaque occurred more frequently in breast cancer survivors than in controls (19.8% vs. 9.4% respectively) (p &amp;lt;0.05). Analysis of risk adjusted for age, time since menopause and BMI, showed that women treated for breast cancer have a significantly higher risk of MetS (OR = 4.21, 95% CI 2.28-7.76), atheromatous plaque (OR = 2.61, 95% CI 1.19-5.72), diabetes (OR=4.42; 95%CI 1.86- 10.49), hypertriglyceridemia (OR = 2.32, 95% CI 1.33-4.0) and increased waist circumference (OR = 11.22, 95% CI 4.0 - 31.65) than women without breast cancer. Conclusion: Postmenopausal breast cancer survivors are at higher risk for metabolic syndrome, diabetes, atherosclerotic disease, hypertriglyceridemia and abdominal obesity (major risk factors for cardiovascular disease), in comparison to postmenopausal women without breast cancer. Citation Format: Buttros DdAB, Branco MT, Orsatti CL, Nahas-Neto J, Nahas EAP. High risk for cardiovascular disease in postmenopausal breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-05.