Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study

Khoudary, Samar R. El; Shields, Kelly J.; Janssen, İmke; Hanley, Carrie; Budoff, Matthew J.; Barinas‐Mitchell, Emma; Everson‐Rose, Susan A.; Powell, Lynda H.; Matthews, Karen A.

doi:10.1210/jc.2015-2110

Cited by 84 publications

(85 citation statements)

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“…The menopause transition coincides with the accumulation of several adverse alterations in sex hormones (22, 23), body weight and fat distribution (24, 25), and lipid/lipoprotein profile (26), may place women at higher risk of chronic inflammation. Whether this inflammation could impair the quality of HDL particles as women transition through menopause will require further research.…”

Section: Discussionmentioning

confidence: 99%

Increase HDL-C level over the menopausal transition is associated with greater atherosclerotic progression

Khoudary

Wang

Brooks

et al. 2016

Journal of Clinical Lipidology

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Context Experimental and observational evidence demonstrates that high density lipoprotein (HDL) can lose its well-documented atheroprotective functions and even adopt a paradoxically proinflammatory nature in certain conditions. Hormonal alterations, especially estradiol reduction, influence the accumulation of risk factors that could potentially impair the quality of HDL during the menopausal transition (MT). Limited data exist to evaluate the relationship between changes in HDL-Cholesterol (HDL-C) and its main carried protein, apolipoprotein-A (apo-A), over the MT and atherosclerosis development. Objective To evaluate the associations of changes in HDL-C and apoA with progression of carotid intima-media thickness (cIMT), carotid adventitial diameter (cAD) and presence of carotid plaque relative to the onset of the postmenopause. Design Longitudinal study. Setting The Study of Women's Health Across the Nation (SWAN). Participants 213 participants (age (mean (SD)): 45.7(2.5) years at baseline; 70% White). Main Outcome Measures Up to 5 measures of cIMT, cAD and carotid plaque over a maximum of 9 years of follow-up. Results Adjusting for sociodemographic, CVD risk factors, CVD medication use and C-reactive protein, a larger increase in HDL-C since baseline was significantly associated with a greater cIMT progression (P=0.008). Additionally, a higher apoA level at baseline was significantly associated with a lower cIMT progression (P=0.03). No significant associations were found with cAD or plaque presence. Conclusions As women transition through menopause, increases in HDL-C levels are independently associated with greater cIMT progression. Thus, the quality of HDL may be altered over the MT rendering HDL dysfunctional and not providing the expected cardioprotective effect.

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Section: Discussionmentioning

confidence: 99%

Increase HDL-C level over the menopausal transition is associated with greater atherosclerotic progression

Khoudary

Wang

Brooks

et al. 2016

Journal of Clinical Lipidology

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“…SWAN Heart ancillary study was a study of changes in subclinical measures of atherosclerosis during the menopausal transition (3). The sample size for this pilot study was determined based on several factors including availability of blood specimens, CT scans, subclinical atherosclerosis measures, and menopausal status at SWAN Heart baseline visit.…”

Section: Methodsmentioning

confidence: 99%

“…During this period, women are subjected to several biological alterations including adverse changes in sex hormones, lipid/lipoprotein profile and body fat composition (2, 3). Interestingly, women over 50 years of age significantly had higher level of circulating complement protein C3 (4), which was found to be associated with postmenopausal status (5).…”

Section: Introductionmentioning

confidence: 99%

“…The detection of C3 and C4 depositions on the outside layers of the vasculature, which are usually surrounded by a local fat depot known as perivascular fat (11), suggested this fat depot as a potential local source of these proteins. Interestingly, postmenopausal women have higher volumes of cardiovascular fat (3). Therefore, it is possible that cardiovascular fat could be a potential local source of complement proteins (10, 12) and could contribute to any associations between complement proteins and subclinical atherosclerosis in midlife women.…”

Section: Introductionmentioning

confidence: 99%

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Complement proteins and arterial calcification in middle aged women: Cross-sectional effect of cardiovascular fat. The SWAN Cardiovascular Fat Ancillary Study

et al. 2015

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Background CVD risk increases in women after menopause. Recent data suggest higher levels of complement protein C3 and cardiovascular fat (CF) in postmenopausal women. Whether complement proteins are associated with early markers of atherosclerosis in healthy midlife women has never been evaluated. Additionally, the potential impact of the local CF on these associations has never been assessed. Methods Participants (n=100, age (mean(SD)):50.48(2.63), 50% premenopausal) were from the Study of Women's Health Across the Nation (SWAN). Arterial calcification (aortic-AC and coronary-CAC) and CF volumes around the heart and aorta (total heart-TAT and aortic perivascular adipose tissue-PVAT) were quantified using EBCT scans. AC and CAC were each evaluated as presence (Agatston scores>0) and extent of calcification (log (Agatston scores +1)). Logistic and linear regression models were used for statistical analysis. Results Adjusting for age, race, menopausal status and lipids, C3 was significantly associated with both presence and extent of AC and CAC, all P values <0.05. Associations between C3 and presence and extent of AC and CAC were explained by additional adjustment for logTAT and logPVAT, respectively. Association between C3 and log(AC+1) was more pronounced at higher volumes of logTAT (interaction-P=0.013) adjusting for study variables. No associations were found with C4. Conclusions Higher C3 was significantly associated with presence and greater extent of arterial calcification in midlife women. These associations were explained by higher volumes of CF, suggesting CF as a potential source of C3. C3 could be a potential non-invasive biomarker of early diagnosis of atherosclerosis. These findings need to be replicated in larger studies.

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“…Se ha demostrado que la cantidad de tejido adiposo epicárdico está significativamente relacionado con el espesor de la íntima media de la carótida, un índice de la aterosclerosis subclínica. Un reciente estudio señala una clara relación entre la menopausia, los niveles de estrógenos endóge-nos, grasa cardíaca y el riesgo cardiovascular, lo cual es una razón más para evitar el aumento de peso en esta etapa de la vida femenina (22) .…”

Section: Enfermedad Cardiovascularunclassified

Terapia hormonal de la menopausia, ¿por qué prescribirla?

Maldonado

2018

Rev peru ginecol obstet.

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Financiamiento: Autofinanciado Conflicto de interés:La autora declara no tener algún conflicto de interés RESUMENDurante el climaterio, la mayoría de las mujeres presenta muchos síntomas que afectan su calidad de vida. Estos síntomas han sido vinculados con trastornos de la neuroquímica provocados por la carencia de estrógenos. El sistema nervioso central-SNC también está involucrado en los cambios de la composición corporal y en el aumento de tejido adiposo que se produce durante el climaterio. El adipocito del obeso produce adipocitoquinas que llevan a un estado inflamatorio crónico con incremento del riesgo de diabetes, hipertensión e hipercoagulabilidad, aumentando el riesgo cardiovascular. El déficit de estrógenos también modula señales celulares (RANKL, NPY) que favorecen la reabsorción ósea y el riesgo de osteoporosis. La obesidad asociada al climaterio incrementa además el riesgo de cáncer de mama, endometrio, colon y vesícula al aumentar la leptina e interleucina 6. Estas adipocitoquinas modulan una serie señales celulares (STAT3, AP-1, MAPK, ERKs) que a su vez aumentan la aromatasa, la síntesis de estrógenos y la activación de receptores alfa en las células malignas, estimulando la proliferación celular. También, algunos estudios experimentales sugieren una acción anti-Alzheimer de los esteroides ováricos. Palabras clave. Terapia hormonal, Menopausia, Calidad de vida, Enfermedades crónicas. ABSTRACTDuring the climacteric, most women have many symptoms that affect their quality of life. These symptoms have been linked to neurochemical disorders caused by the lack of estrogen. The CNS is also involved in changes in body composition and in the gain in adipose tissue that occurs during the climacteric. Obese adipocytes produce adipocytokines that lead to a chronic inflammatory status with a higher risk for diabetes, hypertension and hypercoagulability; all these increase the cardiovascular risk. Estrogen deficiency also modulates cellular signals (RANKL, NPY) that favor bone resorption and osteoporosis risk. Obesity associated with menopause also increases the risk of breast, endometrial, colon and bladder cancer by raising the levels of leptin and interleukin 6. These adipocytokines modulate a series of cellular signals (STAT3, AP-1, MAPK, ERKs) series which in turn increase aromatase, the synthesis of estrogens and the activation of alpha receptors in malignant cells, stimulating cell proliferation. Also, some experimental studies suggest an anti-Alzheimer action of ovarian steroids.

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Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study

Cited by 84 publications

References 41 publications

Increase HDL-C level over the menopausal transition is associated with greater atherosclerotic progression

Increase HDL-C level over the menopausal transition is associated with greater atherosclerotic progression

Complement proteins and arterial calcification in middle aged women: Cross-sectional effect of cardiovascular fat. The SWAN Cardiovascular Fat Ancillary Study

Terapia hormonal de la menopausia, ¿por qué prescribirla?

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