Disease Risk In Postmenopausal Women Research Articles

EFFECTS OF DIFFERENT SEX HORMONES ON CARDIOVASCULAR DISEASE: A META-ANALYSIS AND SYSTEMATIC REVIEW

Objective: Sex hormones play different roles in cardiovascular risk of male and female patients. Especially for postmenopausal women, sex hormone disorder is the main reason for their increased risk of cardiovascular disease. This study mainly explores the effects of different sex hormone levels on cardiovascular diseases in men and postmenopausal women. Design and method: This study included 16 studies with 404,474 patients, including 387,361 male patients and 17,113 female patients. Hazard ratio (HR) and 95%CI results of studies on sex hormones and cardiovascular disease risk in the included literature were extracted as research data. The main outcome events are: cardiovascular disease (CVD), heart failure (HF), cardiovascular death, major cardiovascular adverse events (MACE) and all-cause death. This paper mainly researches the effects of sex hormones on cardiovascular risk and the differences of cardiovascular events between men and women. Results: 1. DHT is a protective factor of cardiovascular risk in male patients, HR = 0.83, 95% CI (0.72, 0.96). 2. For postmenopausal women, SHBG and cFT are the risk factors of CVD in postmenopausal women, with HR 95%CI of 1.06(1.01,1.11) and 1.11 (1.04, 1.19) respectively. 3. DHEA and TT is a risk factor for heart failure in postmenopausal women, which can increase the risk by 17% (HR = 1.17, 95% CI (1.09, 1.24)) and HR = 1.07, 95% CI (1.03, 1.12), while the SHBG and DHEA had no significant effect on the occurrence of chronic heart failure. Conclusions: DHT is a protective factor of cardiovascular disease risk in men, and the increase of androgen level is an important risk factor of cardiovascular disease risk in postmenopausal women.

Metabolomics-Based Biomarker for Dietary Fat and Associations with Chronic Disease Risk in Postmenopausal Women

BackgroundThe Women’s Health Initiative (WHI) randomized, controlled Dietary Modification (DM) trial of a low-fat dietary pattern suggested intervention benefits related to breast cancer, coronary heart disease (CHD), and diabetes. Here, we use WHI observational data for further insight into the chronic disease implications of adopting this type of low-fat dietary pattern. ObjectivesWe aimed to use our earlier work on metabolomics-based biomarkers of carbohydrate and protein to develop a fat intake biomarker by subtraction, to use the resulting biomarker to develop calibration equations that adjusts self-reported fat intake for measurement error, and to study associations of biomarker-calibrated fat intake with chronic disease risk in WHI cohorts. Corresponding studies for specific fatty acids will follow separately. MethodsProspective disease association results are presented using WHI cohorts of postmenopausal women, aged 50–79 y when enrolled at 40 United States clinical centers. Biomarker equations were developed using an embedded human feeding study (n = 153). Calibration equations were developed using a WHI nutritional biomarker study (n = 436). Calibrated intakes were associated with cancer, cardiovascular diseases, and diabetes incidence in WHI cohorts (n = 81,954) over an approximate 20-y follow-up period. ResultsA biomarker for fat density was developed by subtracting protein, carbohydrate, and alcohol densities from one. A calibration equation was developed for fat density. Hazard ratios (95% confidence intervals) for 20% higher fat density were 1.16 (1.06, 1.27) for breast cancer, 1.13 (1.02, 1.26) for CHD, and 1.19 (1.13, 1.26) for diabetes, in substantial agreement with findings from the DM trial. With control for additional dietary variables, especially fiber, fat density was no longer associated with CHD, with hazard ratio (95% confidence interval) of 1.00 (0.88, 1.13), whereas that for breast cancer was 1.11 (1.00, 1.24). ConclusionsWHI observational data support prior DM trial findings of low-fat dietary pattern benefits in this population of postmenopausal United States women. Trial registration numberThis study is registered with clinicaltrials.gov identifier: NCT00000611.

Metabolomics Biomarkers for Fatty Acid Intake and Biomarker-Calibrated Fatty Acid Associations with Chronic Disease Risk in Postmenopausal Women

BackgroundA substantial observational literature relating specific fatty acid classes to chronic disease risk may be limited by its reliance on self-reported dietary data. ObjectivesWe aimed to develop biomarkers for saturated (SFA), monounsaturated (MUFA), and polyunsaturated (PUFA) fatty acid densities, and to study their associations with cardiovascular disease (CVD), cancer, and type 2 diabetes (T2D) in Women’s Health Initiative (WHI) cohorts. MethodsBiomarker equations were based primarily on serum and urine metabolomics profiles from an embedded WHI human feeding study (n = 153). Calibration equations were based on biomarker values in a WHI nutritional biomarker study (n = 436). Calibrated intakes were assessed in relation to disease incidence in larger WHI cohorts (n = 81,894). Participants were postmenopausal women, aged 50–79 when enrolled at 40 United States Clinical Centers (1993–1998), with a follow-up period of ∼20 y. ResultsBiomarker equations meeting criteria were developed for SFA, MUFA, and PUFA densities. That for SFA density depended somewhat weakly on metabolite profiles. On the basis of our metabolomics platforms, biomarkers were insensitive to trans fatty acid intake. Calibration equations meeting criteria were developed for SFA and PUFA density, but not for MUFA density. With or without biomarker calibration, SFA density was associated positively with risk of CVD, cancer, and T2D, but with small hazard ratios, and CVD associations were not statistically significant after controlling for other dietary variables, including trans fatty acid and fiber intake. Following this same control, PUFA density was not significantly associated with CVD risk, but there were positive associations for some cancers and T2D, with or without biomarker calibration. ConclusionsHigher SFA and PUFA diets were associated with null or somewhat higher risk for clinical outcomes considered in this population of postmenopausal United States women. Further research is needed to develop even stronger biomarkers for these fatty acid densities and their major components.This study is registered with clinicaltrials.gov identifier: NCT00000611.

Does calcium supplementation increase cardiovascular disease risk in postmenopausal women?

1University of Chicago NorthShore Family Medicine Residency, Evanston, IL The corresponding author is Deborah Miller; [email protected] The authors declare no conflicts of interest.

Associations of Biomarker-Calibrated Healthy Eating Index-2010 Scores with Chronic Disease Risk and Their Dependency on Energy Intake and Body Mass Index in Postmenopausal Women

Prior studies examined associations between the Healthy Eating Index (HEI) and chronic disease risk based on self-reported diet without measurement error correction. Our objective was to test associations between biomarker calibration of the food-frequency questionnaire (FFQ)-derived HEI-2010 with incident cardiovascular disease (CVD), cancer, and type 2 diabetes (T2D) among Women's Health Initiative (WHI) participants. Data were derived from WHI postmenopausal women (n = 100,374) aged 50-79 y at enrollment (1993-1998) at 40 US clinical centers, linked to nutritional biomarker substudies and outcomes over subsequent decades of follow-up. Baseline or year 1 FFQ-derived HEI-2010 scores were calibrated with nutritional biomarkers and participant characteristics (e.g., BMI) for systematic measurement error correction. Calibrated data were then used in HR models examining associations with incidence of CVD (total, subtypes, mortality), cancer (total, subtypes, mortality), and T2D in WHI participants with approximately 2 decades of follow-up. Models were multivariable-adjusted with further adjustment for BMI and doubly labeled water (DLW)-calibrated energy. Multivariable-adjusted HRs modeled a 20% increment in HEI-2010 score in relation to outcomes. HRs were modest using uncalibrated HEI-2010 scores (HRs = 0.91-1.09). Using biomarker-calibrated HEI-2010, 20% increments in scores yielded multivariable-adjusted HRs (95% CIs) of 0.75 (0.60, 0.93) for coronary heart disease; 0.75 (0.61, 0.91) for myocardial infarction; 0.96 (0.92, 1.01) for stroke; 0.88 (0.75, 1.02) for CVD mortality; 0.81 (0.70, 0.94) for colorectal cancer; 0.81 (0.74, 0.88) for breast cancer; 0.79 (0.73, 0.87) for cancer mortality; and 0.45 (0.36-0.55) for T2D. Except for cancer mortality and T2D incidence, results became null when adjusted for DLW-calibrated energy intake and BMI. Biomarker calibration of FFQ-derived HEI-2010 was associated with lower CVD and cancer incidence and mortality and lower T2D incidence in postmenopausal women. Attenuation after adjustment with BMI and DLW-calibrated energy suggests that energy intake and/or obesity are strong drivers of diet-related chronic disease risk in postmenopausal women. The Women's Health Initiative is registered at clinicaltrials.gov at NCT00000611.

The Combined Effect of High-intensity Interval Training and Soy Isoflavone Diet on MicroRNA-133 Gene in Ovariectomized Rats

Background: The combination of exercise and soy extract supplementation decreases cardiac related disease risk in postmenopausal women. Objectives: We assessed the combined impacts of soy isoflavone (IF) supplementation and exercise on the expression of microRNA-133 gene in ovariectomized rats’ hearts. Methods: This study was conducted on 50 female Wistar rats, which were assigned to five groups, including sham-operated (SHAM), ovariectomized (OVX), ovariectomized with soy IF supplementation (OVX + IF), OVX with exercise (OVX + HIIT), and OVX with both soy IFs and exercise (OVX + IF + HIIT). The experimental rats underwent high-intensity interval training (5 days/week) and/or supplied a soy IF supplementation for six weeks. The cardiac microRNA-133 gene expression was analyzed using real-time PCR after six weeks of intervention. Results: Ovariectomy down-regulated cardiac microRNA133 gene expression, but 42 days of IF administration or HIIT reversed this effect (P > 0.05). The HIIT reversed estrogen-deficiency-related microRNA-133 down-regulation greater than IF or combining IF and HIIT (P > 0.05). The OVX + IF and OVX + IF + HIIT (P > 0.05) showed no significant difference. Conclusions: Our results suggested that treatment with exercise, soy IF, and the combined treatment could benefit microRNA-133 in ovariectomized rats. This effect was significant when exercise alone was used to induce treatment. Thus, these treatments could offer protection in the menopausal period.

Evaluating the association between amino acid and acylcarnitine profiles and different levels of coronary artery disease risk in postmenopausal women using targeted metabolomics technique.

Postmenopausal women are at increased risk of developing coronary artery disease (CAD). Metabolomic approaches aim at discovering more helpful biomarkers of CAD to reduce the disease burden in the future. Here, we intend to find potential blood biomarkers, amino acids, and acylcarnitines in postmenopausal women with different severity of CAD by using high-throughput methods. This cross-sectional study was performed on postmenopausal women ( n = 183) who underwent coronary CT scans. Coronary artery calcium scoring (CACS) was assessed to detect plaque burden and degree of coronary artery obstruction. The participants were divided into three groups based on the score as follows (i) "low CACS" ( n = 96); a score of 0 to 10, (ii) "medium CACS" ( n = 35); a score between 11 and 100 and (iii) "high CACS" ( n = 52); a score greater than 100. Metabolites, including amino acids and acylcarnitines, were quantified using a targeted mass spectrometry method in serum samples. The association between metabolites and disease status was evaluated using univariate and multivariate regression analyses with adjustment for confounding factors. Factor analysis was used to deal with multiple comparisons. Metabolites, including proline, glutamic acid, and phenylalanine, were significantly lower in the high CACS group than the low CACS one. Also, a lower level of lysine and phenylalanine in high CACS compared with medium one was observed. Concerning acylcarnitines, it was found that C4 and C8:1 significantly were higher in women with high CACS. The logistic regression analysis revealed that the circulating levels of these metabolites (except C4) were associated with the presence of coronary artery calcification independently of age, body mass index, and time of menopause. Also, the amino acids were associated independently of medication and diabetes. The present study indicated that circulating levels of amino acids and acylcarnitines profile in postmenopausal women are partly associated with the severity of CAD in these participants.

Melatonin Alleviates Ovariectomy-Induced Cardiovascular Inflammation in Sedentary or Exercised Rats by Upregulating SIRT1.

We aimed to evaluate the impact of hormone replacement, melatonin, or exercise alone or their combination on oxidative damage and functional status of heart, brain, and aorta of ovariectomized (OVX) rats and to determine whether the signaling pathway is dependent on sirtuin-1 (SIRT1). Ovariectomized Sprague Dawley rats were orally given either a hormone replacement therapy (1mg/kg/day,17β estradiol; HRT) or melatonin (4mg/kg/day) or HRT + melatonin treatments or tap water, while each group was further divided into sedentary and exercise (30min/5days/week) groups. After the heart rate measurements and memory tests were performed, trunk blood was collected at the end of the 10th week to determine metabolic parameters in serum samples. Tissue samples of abdominal aorta, heart, and brain were taken for biochemical measurements and histopathological evaluation. Heart rates and memory performances of the OVX rats were not changed significantly by none of the applications. Melatonin treatment or its co-administration with HRT upregulated the expressions of IL-10 and SIRT1, reduced the expressions of IL-6 and TNF-α, and reduced DNA damage in the hearts and thoracic aortae of non-exercised rats. Co-administration of melatonin and HRT to exercised OVX rats reduced inflammatory response and upregulated SIRT1 expression in the aortic and cardiac tissues. The present study suggests that melatonin treatment, either alone or in combination with exercise and/or HRT, upregulates SIRT1 expression and alleviates oxidative injury and inflammation in the hearts and aortas of OVX rats. Melatonin should be considered in alleviating cardiovascular disease risk in postmenopausal women.

Biomarkers for Components of Dietary Protein and Carbohydrate with Application to Chronic Disease Risk in Postmenopausal Women

We recently developed protein and carbohydrate intake biomarkers using metabolomics profiles in serum and urine, and used them to correct self-reported dietary data for measurement error. Biomarker-calibrated carbohydrate density was inversely associated with chronic disease risk, whereas protein density associations were mixed. To elucidate and extend this earlier work through biomarker development for protein and carbohydrate components, including animal protein and fiber. Prospective disease association analyses were undertaken in Women's Health Initiative (WHI) cohorts of postmenopausal US women, aged 50-79 y when enrolled at 40 US clinical centers. Biomarkers were developed using an embedded human feeding study (n=153). Calibration equations for protein and carbohydrate components were developed using a WHI nutritional biomarker study (n=436). Calibrated intakes were associated with chronic disease incidence in WHI cohorts (n=81,954) over a 20-y (median) follow-up period, using HR regression methods. Previously reported elevations in cardiovascular disease (CVD) with higher-protein diets tended to be explained by animal protein density. For example, for coronary heart disease a 20% increment in animal protein density had an HR of 1.20 (95% CI: 1.02, 1.42) relative to the HR for total protein density. In comparison, cancer and diabetes risk showed little association with animal protein density beyond that attributable to total protein density. Inverse carbohydrate density associations with total CVD were mostly attributable to fiber density, with a 20% increment HR factor of 0.89 (95% CI: 0.83, 0.94). Cancer risk showed little association with fiber density, whereas diabetes risk had a 20% increment HR of 0.93 (95% CI: 0.88, 0.98) relative to the HRs for total carbohydrate density. In a population of postmenopausal US women, CVD risk was associated with high-animal-protein and low-fiber diets, cancer risk was associated with low-carbohydrate diets, and diabetes risk was associated with low-fiber/low-carbohydrate diets.

Four-Day Food Record Macronutrient Intake, With and Without Biomarker Calibration, and Chronic Disease Risk in Postmenopausal Women.

We recently evaluated associations of biomarker-calibrated protein intake, protein density, carbohydrate intake, and carbohydrate density with the incidence of cardiovascular disease, cancer, and diabetes among postmenopausal women in the Women's Health Initiative (1993-present, 40 US clinical centers). The biomarkers relied on serum and urine metabolomics profiles, and biomarker calibration used regression of biomarkers on food frequency questionnaires. Here we develop corresponding calibration equations using food records and dietary recalls. In addition, we use calibrated intakes based on food records in disease association estimation in a cohort subset (n=29,294) having food records. In this analysis, more biomarker variation was explained by food records than by FFQs for absolute macronutrient intake, with 24-hour recalls being intermediate. However, the percentage of biomarker variation explained was similar for each assessment approach for macronutrient densities. Invasive breast cancer risk was related inversely to carbohydrate and protein densities using food records, in analyses that included (calibrated) total energy intake and body mass index. Corresponding analyses for absolute intakes did not differ from the null, nor did absolute or relative intakes associate significantly with colorectal cancer or coronary heart disease. These analyses do not suggest major advantages for food records or dietary recalls in comparison with less costly and logistically simpler food frequency questionnaires for these nutritional variables.

Association between Reproductive Factors and Cardiovascular Disease Risk in Post-Menopausal Women: Cross-Sectional Study from the 2016–2017 Korea National Health and Nutrition Examination Survey

Association between Reproductive Factors and Cardiovascular Disease Risk in Post-Menopausal Women: Cross-Sectional Study from the 2016–2017 Korea National Health and Nutrition Examination Survey

Abstract MP46: Metabolomic Response to Randomized Treatment With Estrogen and Estrogen Plus Progestin Therapy in Postmenopausal Women

Introduction: Hormone therapy (HT) has been linked to chronic disease risk in postmenopausal women, but the effect of HT on the metabolome is unclear. Hypothesis: Randomized HT is associated with perturbations in the metabolome. Methods: The discovery set, from the Women’s Health Initiative (WHI), included 288 women in the conjugated equine estrogens-alone (CEE) trial (139 active; 149 placebo) and 244 women in the CEE + medroxyprogesterone acetate (CEE+MPA) trial (133 active; 111 placebo). Blood samples were collected 1 year after intervention. The validation set included 494 women from the Nurses’ Health Study (NHS) and NHS2 (264 non-users, 158 estrogen-alone users, and 72 estrogen + progestogen users). Plasma metabolome was profiled by liquid chromatography-tandem mass spectrometry; 478 known metabolites were used in analyses. We used elastic net regressions to develop metabolomic signatures for CEE and CEE+MPA in the WHI, adjusting for age and race. We applied the signature models to NHS/NHS2 and compared the signatures of current HT users to those of non-users. Pathway analysis was done using MetaboAnalyst. Results: In the WHI, we identified a CEE metabolomic signature comprised of 42 metabolites and a CEE+MPA signature comprised of 34 metabolites ( Fig. A ). The two signatures shared 8 metabolites (4 amino acids, 2 glycerophospholipids, and 2 quaternary amines). In NHS/NHS2, CEE and CEE+MPA signatures were highly correlated ( r =0.85) and both significantly higher in current HT users than non-users ( P ≤2.7х10 -15 ) ( Fig. B ). The CEE+MPA signature metabolites were enriched in 3 pathways (glycerophospholipid metabolism; aminoacyl-tRNA biosynthesis; and glycine, serine and threonine metabolism); no pathway enrichment was found for the CEE signature. Conclusions: We identified and validated metabolomic signatures for CEE and CEE+MPA use in postmenopausal women from WHI and NHS/NHS2. Whether alterations in lipid or amino acid metabolism mediate associations of HT use with chronic disease needs future investigation.

Trajectories of Age-Related Arterial Stiffness in Chinese Men and Women

BackgroundArterial stiffening is central in the vascular aging process. Traditionally, vascular research has focused on atherosclerotic vascular disease, whereas arterial stiffness has not attracted similar attention. ObjectiveSThe purpose of this study was to assess lifetime trajectories of arterial stiffening in Chinese populations facing a high burden of cardiovascular disease, with a particular focus on age–sex interactions and potential determinants. MethodsThis large-scale observational study comprised 2 independent cross-sectional population samples and 1 prospective cohort totaling 80,415 healthy subjects with brachial-ankle pulse wave velocity (baPWV) measurements available. Associations with potential risk conditions were analyzed using linear regression, linear random intercepts mixed models, and L1-regularized linear models. ResultsThe dynamics of age-dependent arterial stiffening differed in sexes, with stiffer vessel observed in men from adolescence to age 58 years and in women thereafter. The steeper increase in baPWV in women after menopause is partly explained by the fact that vascular risk factors are more strongly associated with arterial stiffness in women than in men. Age and systolic blood pressures were the strongest determinants of baPWV, whereas other vascular and metabolic risk factors, except low-density lipoprotein cholesterol, showed consistent associations of moderate strength. ConclusionsThe significant age–sex interaction in arterial stiffening provides an important clue of explanation for the heightened cardiovascular disease risk in postmenopausal women. Detailed knowledge on lifetime trajectories of arterial stiffening, and its potential risk factors is a prerequisite for the development of new prevention strategies counteracting vascular aging.

Abstract MP29: Body Fat and Cardiovascular Disease Risk in Postmenopausal Women With Normal Body Mass Index: the Women’s Health Initiative

Introduction: Excess body weight characterized by higher BMI is associated with increased risk of cardiovascular disease (CVD). In individuals with normal BMI, the extent to which body fat distribution may impact CVD risk is unclear, particularly in postmenopausal women who often experience fat redistribution. Hypothesis: We hypothesized a detrimental impact of trunk fat and a favorable impact of leg fat on risk of CVD risk among postmenopausal women with normal BMI. Methods: We analyzed data from 2683 normal-weight (BMI: 18.5-24.9 kg/m 2 ) women in the Women’s Health Initiative study without known CVD at baseline (1993-1998). Body composition including whole body and regional fat mass (FM) were determined by dual-energy X-ray absorptiometry. Incident CVD events including coronary heart disease (coronary death, nonfatal myocardial infarction, or coronary revascularization) and stroke were ascertained through February 2017. Results: There were 291 incident cases of CVD during a median 17.9 years of follow-up. After multivariable adjustment, whole body FM or FM percentage was not significantly associated with CVD risk. Higher trunk FM percentage was associated with increased risk of CVD (HR comparing extreme quartiles = 1.91, 95% CI: 1.33-2.74, P -trend <0.001), while higher leg FM percentage was associated with lower risk of CVD (HR = 0.62, 95% CI: 0.43-0.89, P -trend = 0.008) ( Figure ). These associations were slightly attenuated but remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher trunk fat combined with lower leg fat was associated with particularly higher risk of CVD (HR comparing extreme groups = 3.33, 95% CI: 1.46-7.62). Similar significant associations of trunk fat and leg fat were observed for coronary heart disease but not for stroke. Conclusions: Among postmenopausal women with normal BMI, higher trunk fat was associated with increased risk of CVD, while higher leg fat was associated with decreased risk of CVD, independently of central adiposity measures.

Follicle-Stimulating Hormone, Its Association with Cardiometabolic Risk Factors, and 10-Year Risk of Cardiovascular Disease in Postmenopausal Women.

BackgroundCardiovascular disease is the leading cause of mortality in postmenopausal women. Follicle‐stimulating hormone (FSH) shows negative associations with obesity and diabetes mellitus in postmenopausal women. We aimed to study the associations between FSH and 10‐year risk of atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women.Methods and Results SPECT‐China (the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors) is a 22‐site, population‐based study conducted during 2014–2015. This study included 2658 postmenopausal women. A newly developed effective tool for 10‐year ASCVD risk prediction among Chinese was adopted. Regression analyses were performed to assess the relationship among FSH, 10‐year ASCVD risk, and multiple cardiometabolic risk factors. With the increase in FSH quartiles, the mean 10‐year ASCVD risk in postmenopausal women decreased from 4.9% to 3.3%, and most metabolic parameters were significantly ameliorated (all P for trend <0.05). In regression analyses, a 1‐SD increment in ln‐FSH was negatively associated with continuous (B −0.12, 95% confidence interval, −0.16, −0.09, P<0.05) and categorical (odds ratio 0.65, 95% confidence interval, 0.49, 0.85, P<0.05) 10‐year ASCVD risk. These significant associations existed in subgroups with or without medication use, obesity, diabetes mellitus, hypertension, and dyslipidemia. Body mass index and waist circumference (both B −0.35, 95% confidence interval, −0.40, −0.30, P<0.05) had the largest associations of all metabolic measures, and blood pressure had the smallest association.ConclusionsSerum FSH levels were negatively associated with 10‐year ASCVD risk in postmenopausal women. Among cardiometabolic factors, obesity indices had the largest associations with FSH. These results indicated that a low FSH might be a risk factor or a biomarker for cardiovascular disease risk in postmenopausal women.

Is Vigorous Exercise Training Superior to Moderate for CVD Risk after Menopause?

Postmenopausal women have an increased risk for cardiovascular disease through many factors, such as a sedentary lifestyle and reduced heart rate variability (HRV). Endurance training improves coronary risk but the role of exercise intensity is unclear. The purpose of this observational study was to evaluate the effects of moderate versus vigorous exercise on cardiovascular disease risk in postmenopausal women. Thirty-six postmenopausal women who self-reported training at moderate (3–5.9 METS; n=18; age 58.9±4.4yr) or vigorous intensities (>6 METS; n=18; age 59.7±5.2yr) participated. C-reactive protein (CRP), HRV, VO 2 max, and stress (Perceived Stress Survey, Menopause Rating Scale) were measured. Groups were compared using independent samples t- tests, and associations of exercise intensities with CRP and HRV were assessed using multiple regression. CRP, HRV, and VO 2 max were similar ( p >0.05). Vigorous exercise had lower stress subscale scores ( p <0.01) and higher counter-stress subscale scores compared to moderate ( p <0.05). There was a positive association between time spent in vigorous exercise and HRV ( p <0.05).Vigorous exercise may not confer additional benefits in CRP and HRV over moderate, except for stress reduction. However, more time spent in vigorous exercise was associated with higher HRV. Therefore, increased parasympathetic tone may provide cardioprotection after menopause.

Abstract 14: Diet Quality and Cardiovascular Disease Risk in Postmenopausal Women With Type 2 Diabetes: the Women’s Health Initiative

Introduction: Both type 2 diabetes (T2D) and cardiovascular disease (CVD) are known to be influenced by dietary intake, however there is little evidence from large and well characterized cohort studies regarding the relationship between popular dietary patterns and CVD risk in populations with T2D. Understanding how common diet scores associate with CVD risk may provide better nutrition recommendations, education, and targeted interventions in the population with T2D. Hypothesis: We hypothesize that high diet quality as represented by higher scores on four different a priori diet indices is associated with a lower risk of developing CVD in postmenopausal women with T2D. Methods: We analyzed data of 6031 postmenopausal women with type 2 diabetes from the Women’s Health Initiative (WHI) cohort with no history of CVD at baseline. Dietary intake was assessed by a validated WHI food frequency questionnaire. Diet scores for four different diet patterns were calculated: Mediterranean (aMed), Dietary Approaches to Stop Hypertension (DASH), Paleolithic diet, and American Diabetes Association dietary recommendations (ADA). Multivariate Cox proportional hazards regression was used to estimate the hazard ratio of incident coronary heart disease (CHD) and stroke during study follow up for each dietary pattern score, adjusting for demographic, lifestyle and clinical measures. Results: Over 21 years of follow up 11.2% (675/6031) of women developed CHD and 6.7% (408/6031) had a stroke. There was a strong, monotonic inverse association between higher aMed, DASH, and ADA diet scores and risk of incident CHD and stroke; and no association between the Paleolithic dietary pattern score and CHD or stroke (Table 1). Conclusions: There are multiple dietary avenues to lower CVD risk in a population with T2D via the aMed, DASH, and ADA diets; whereas there was no evidence the Paleolithic diet score is associated with CVD risk in a population with T2D.

Combined exercise reduces arterial stiffness, blood pressure, and blood markers for cardiovascular risk in postmenopausal women with hypertension.

Postmenopausal women exhibit elevated brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, which is associated with an increased risk of cardiovascular events and mortality. The purpose of this study is to examine the impact of combined resistance and aerobic exercise training on baPWV, blood pressure (BP), and cardiovascular fitness in postmenopausal women with stage 1 hypertension. Twenty postmenopausal women (age, 75 ± 2 y; systolic BP, 152 ± 2 mm Hg, diastolic BP, 95 ± 3 mm Hg) were randomly assigned to a "no-exercise" (CON, n = 10) or combined exercise (EX, n = 10) group. The EX group performed resistance and aerobic exercise for 12 weeks, 3 times per week. Exercise intensity was increased gradually, from 40% to 70% of heart rate reserve, every 4 weeks. BaPWV, BP, blood nitrite/nitrate, endothelin-1 (ET-1), cardiovascular fitness, and body composition were measured before and after the 12-week intervention. BP, baPWV (-1.2 ± 0.4 m/s), ET-1 (-2.7 ± 0.3 μmol/mL), nitrite/nitrate (+4.5 ± 0.5 μM), functional capacity, and body composition were significantly improved (P < 0.05) in the EX group after 12 weeks of training, but no changes were observed in the CON group. These findings indicate that 12 weeks of combined exercise training improves arterial stiffness, BP, ET-1, blood nitrite/nitrate, functional capacity, and body composition in postmenopausal women with stage 1 hypertension. Thus, this study provides evidence that combined exercise training is a useful therapeutic method to improve cardiovascular health which can reduce cardiovascular disease risk in postmenopausal women with hypertension.

Endogenous sex hormone levels and coronary heart disease risk in postmenopausal women: A meta-analysis of prospective studies.

Background Low testosterone levels have been associated with coronary heart disease (CHD) morbidity and mortality in men, but the influence of hormones in postmenopausal women is unclear. This meta-analysis aimed to examine whether there is an association between endogenous sex hormones and CHD risk in postmenopausal women. Methods A systematic search of the PubMed and EMBASE databases from 1966 to 30 November 2016 was performed for prospective studies that reported an association between endogenous sex hormones and CHD in postmenopausal women. Summary relative risks (RRs) and 95% confidence intervals (CIs) were combined by using a random-effects model. Results A total of 13 publications (12 studies, including six prospective cohort and six nested case-control studies) were included. The summary RRs for CHD were 1.01 (95% CI 0.77-1.31) comparing the highest versus lowest tertile of total testosterone, with evidence of high heterogeneity ( I2 = 80.7%). In subgroup and meta-regression analyses, none of the variables were identified as contributing to significant heterogeneity. Based on a comparison of the highest versus lowest tertile models, the summary RRs (95% CIs) for CHD were 0.88 (0.63-1.23, I2 = 48.7%) for free testosterone, 1.16 (0.82-1.63, I2 = 47.8%) for estradiol, 0.98 (0.90-1.07, I2 = 3.2%) for sex hormone-binding globulin and 1.19 (0.89-1.58, I2 = 0) for dehydroepiandrosterone. Conclusion There is limited evidence to suggest that endogenous levels of sex hormones are not significantly associated with CHD risk in postmenopausal women.

Novel Lipid Indices as a Better Marker of Cardiovascular Disease Risk in Postmenopausal Women

ABSTRACT Introduction Cardiovascular disease (CVD) is the major leading cause of mortality in men and women around the globe. The incidence of CVD increases with age in both the sexes, whereas it has been noted that there is a marked increase in risk among women after menopause. The hormonal changes associated with the menopause like low level of plasma estrogen and marked increase in follicle stimulating hormone levels exert a significant effect on metabolism of plasma lipids and lipoproteins leading to atherosclerosis, thereby increasing the risk of CVD in postmenopausal women. Objectives To study the lipid profile parameters and to calculate and compare the lipid indices with lipid profile parameters in pre- and postmenopausal women. Materials and methods The study group included 90 women comprising 45 postmenopausal (cases) and 45 premenopausal (control) women. To estimate lipid profile, enzymatic method was used and for calculation of lipid indices appropriate formula was used. Results Altered lipid profile was observed in postmenopausal women, but it was not statistically significant. Atherogenic Index of Plasma, Castelli's risk index-I, atherogenic coefficient, and nonhigh-density lipoprotein cholesterol were significantly increased in postmenopausal women compared with premenopausal women, but there was no significant increase in Castelli's risk index-II. Conclusion Lipid indices may be considered as a better and cost-effective tool in assessing the risk of CVD in postmenopausal women. How to cite this article Sirigere M, Meera S. Novel Lipid Indices as a Better Marker of Cardiovascular Disease Risk in Postmenopausal Women. Indian J Med Biochem 2017;21(1):38-41.