Menopause and cardiovascular disease

Newson, Louise

doi:10.1177/2053369117749675

Cited by 113 publications

(84 citation statements)

References 41 publications

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“…The major advantage of our study is the extensive investigation of hemostatic parameters in a homogenous group of RA patients in comparison with strictly matched control subjects. This is of particular importance knowing that the CVD risk profile is altered in menopausal women [29]. Moreover, the levels of single coagulation factors increase, while the levels of natural anticoagulants decline with menopause in healthy women [30].…”

Section: Discussionmentioning

confidence: 99%

Assessment of hemostatic disturbances in women with established rheumatoid arthritis

et al. 2019

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Objectives This study was aimed to assess hemostatic disturbances in female patients with established rheumatoid arthritis (RA) in relation to menopausal status and disease activity. Method Ninety women were included in the study, 42 patients and 48 age-matched healthy controls. There were no differences between the investigated groups regarding the presence of traditional cardiovascular risk factors. Two global hemostatic assays were employed, namely endogenous thrombin potential (ETP) and overall hemostasis potential (OHP). The parameters of the ETP assay (ETP, C-max, t-lag, t-max) and OHP assay (overall coagulation potential (OCP) and overall fibrinolytic potential (OFP)) were assessed. Moreover, the parameters of the fibrin clot (lag time, Max Abs, and slope) were measured by clot turbidity and scanning electron microscopy (SEM). Both patients and controls were divided into four subgroups according to menopause status. Results The premenopausal controls differed significantly from all other subgroups in terms of diminished levels of ETP (p = 0.02), C-max (p = 0.01), OCP (p = 0.02), OHP (p = 0.001), and Max Abs (p = 0.008), while OFP (p = 0.0001) was increased. This tendency was not seen in the premenopausal RA patients compared with the postmenopausal RA patients. SEM images showed denser clots composed of thinner fibers in samples from RA patients. The disease activity measured by DAS28 correlated with OCP and OHP (r = 0.54; p = 0.001 and r = 0.44; p = 0.003, respectively) indicating persistent hypercoagulable condition in the whole group of RA patients. Conclusions Our results point towards coagulation activation in premenopausal women with established RA. The patients were well characterized, which enabled assessment in a real-life setting. Key Points • Extensive assessment points towards persistent coagulation activation in premenopausal women with established rheumatoid arthritis. • Impaired thrombin generation and fibrin formation are associated with menopause in healthy women, while rheumatoid arthritis closes the gap within patients regarding menopause. • Fibrin morphology is unfavorably altered and fibrinolysis is decreased in patients with established rheumatoid arthritis. • Increased activity of thrombin activatable fibrinolysis inhibitor (TAFI) may contribute to impaired fibrinolysis in patients with rheumatoid arthritis.

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Section: Discussionmentioning

confidence: 99%

Assessment of hemostatic disturbances in women with established rheumatoid arthritis

et al. 2019

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“…The decrease in estrogen levels that accompanies menopause causes an increased risk of cardiovascular disease. Typically, women are around 10 years older than men at first presentation of atherosclerotic coronary heart disease and this can be related to decline in ovarian hormone concentrations during the menopausal transition and beyond [2]. In fact, estrogens through their intracellular receptors regulate various aspects of glucose and lipid metabolism, that results in the phenotype of the metabolic syndrome [3].…”

Section: Introductionmentioning

confidence: 99%

Effects of a combined nutraceutical on glucose and lipid metabolism in women with post-menopausal incident metabolic syndrome: a double-blind, placebocontrolled, randomized clinical trial

Fogacci¹,

Colletti²,

Cicero³

et al. 2019

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Background: Metabolic syndrome is characterized by the impairment of several metabolic and haemodynamic parameters. Several natural compounds have just demonstrated to improve glucose and lipid levels in humans. Aim: To assess the short-term glucose and lipid-lowering effects of a combination of nutraceuticals based on Lagerstroemia speciosa, Berberis aristata, Curcuma longa, alpha-lipoic acid, chrome picolinate and folic acid in patients with post-menopausal incident metabolic syndrome. Methods: We performed a double-blind, placebo-controlled, parallel-group, randomized clinical trial by enrolling 40 women in primary prevention of cardiovascular disease and affected by metabolic syndrome occurred in menopause. After 2-week run-in period of dietary standardization, enrolled patients were allocated to active treatment or placebo for 8 weeks. Data related to lipid pattern, insulin resistance, liver function and hsCRP were obtained at the beginning and at the end of the study. Results: No patient experienced any subjective or laboratory adverse event. During the study, there were no significant changes in waist circumference, body mass index, blood pressure and low-density lipoprotein cholesterol in either treatment groups. Subjects randomized to nutraceutical treatment experienced a significant improvement in triglycerides (TG=-32.2%), high-density lipoprotein cholesterol (HDL-C= +5.7%), fasting plasma insulin (FPI=-14.1%), and in homeostasis model assessment of insulin resistance (HOMA-Index=-27.3%) versus the baseline values, as welle as compared to the placebo-treated group. Conclusions: The tested nutraceutical compound showed to be effective in improving TG, HDL-C, FPI and HOMA-Index, with an optimal tolerability profile in patients with post-menopausal incident metabolic syndrome.

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“…A male healthy survivor effect may be a possible factor; compared with women, men develop CVD on average 10 years earlier so a greater proportion of men who will experience an event during their lifetime will already have done so by the age of 75 years. Female sex hormones may be another factor as CVD protection among women recedes following menopause,32–34 which may lead to a steeper rise in CVD incidence among women as compared with men in later life.…”

Section: Discussionmentioning

confidence: 99%

How do cardiovascular risk prediction equations developed among 30–74 year olds perform in older age groups? A validation study in 125 000 people aged 75–89 years

Mehta

Jackson

Poppe

et al. 2020

J Epidemiol Community Health

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BackgroundCardiovascular disease (CVD) risk prediction equations are being used to guide risk management among increasingly older individuals. We examined the performance of recent equations, derived from a 2006 cohort including almost all New Zealanders aged 30–74 years, among older people.MethodsAll New Zealanders aged 75–89 years in contact with state-funded health services in 2006 without prior CVD or heart failure and with complete predictor data were identified by anonymised individual-level linkage of eight national administrative health datasets. Baseline 5-year CVD risk was estimated using sex-specific New Zealand risk equations, and CVD hospitalisations or deaths occurring between 2007 and 2011 inclusive were ascertained. Performance was assessed with calibration plots and standard metrics.ResultsAmong 124 358 New Zealanders aged 75–89 years old, 30 152 CVD events were recorded during follow-up. Sex-specific equations derived from 30–74 year olds slightly underestimated CVD risk among women and slightly overestimated risk among men aged 75–89 years. Discrimination metrics were poor in both sexes and the risk equations explained only 9.4% of the variation in time to CVD event among women and 6.0% for men. In the 5-year age bands, progressively worsening underprediction in women, overprediction in men and poorer performance metrics were observed with increasing age.ConclusionEntire-population CVD risk equations developed among 30–74 year olds do not perform well among older people. Existing risk algorithms developed from primarily middle-aged or early-retirement cohorts should be used with caution in those aged ≥75 years until carefully validated in narrow age bands to avoid masking poorer performance in older age groups.

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Menopause and cardiovascular disease

Cited by 113 publications

References 41 publications

Assessment of hemostatic disturbances in women with established rheumatoid arthritis

Assessment of hemostatic disturbances in women with established rheumatoid arthritis

Effects of a combined nutraceutical on glucose and lipid metabolism in women with post-menopausal incident metabolic syndrome: a double-blind, placebocontrolled, randomized clinical trial

How do cardiovascular risk prediction equations developed among 30–74 year olds perform in older age groups? A validation study in 125 000 people aged 75–89 years

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