Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation)

Abstract

Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.

The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)

“…Women who transitioned over a mean of 2.4 years of follow-up experienced greater progression in aortic pulse wave velocity, a marker of arterial stiffness, than women who remained premenopausal or those who were postmenopausal at baseline. 89…”

The Menopause Transition and Women’s Health at Midlife: A Progress Report From the Study of Women’s Health Across the Nation (SWAN)

“…Women who transitioned over a mean of 2.4 years of follow-up experienced greater progression in aortic pulse wave velocity, a marker of arterial stiffness, than women who remained premenopausal or those who were postmenopausal at baseline. 88…”

Greater Periaortic Fat Volume at Midlife Is Associated with Slower Gait Speed Later in Life in Women: The SWAN Cardiovascular Fat Ancillary Study

“…During the menopausal transition, concomitant increase in fat mass and a decline in physical functioning occurs (12,14). We have previously shown that during menopause, women experience vascular alterations and arterial remodeling as evidenced by unfavorable changes in carotid intima media thickness, arterial stiffness and adventitial diameter around menopause (13,34,35), and with significant physical function limitations in postmenopausal women (36,37). We have reported that in midlife women, higher inflammatory markers are associated with greater self-reported physical functioning limitations (38).…”