Bad cholesterol levels increase during menopause, and 10% of this increase is due to changes in sex hormones. This is the result of research published today in the European Journal of Preventive Cardiology, a journal of the ESC.1
Women typically experience menopause between the ages of 48 and 52, which leads to a drop in estrogen and an increase in follicle-stimulating hormone (FSH). Menopause is thought to predispose women to heart disease because it usually develops 10 years later than in men, and the risk increases after menopause. Previous studies have shown that menopause is associated with levels of heart disease-promoting metabolites, but this study is the first to link this change to changes in female sex hormones. Metabolite changes were partially improved with hormone replacement therapy (HRT).
“Menopause is inevitable, but it’s possible that negative metabolite change can be decreased by eating a healthy diet and being physically active,” said study author Dr. Eija K. Laakkonen of the University of Jyväskylä, Finland. “In particular, women should pay attention to the quality of fat in their diet and exercise enough to maintain cardiorespiratory fitness. HRT is an option that women should discuss with healthcare providers at this stage in their lives. »
The analysis included 218 perimenopausal women not using HRT at baseline. Levels of 180 metabolites (lipids, lipoproteins, and amino acids) and two hormones (estradiol and FSH) were obtained from blood samples at baseline and every three to six months until the onset of postmenopause. Menopausal status was assessed using menstrual diaries and FSH blood levels. Early postmenopause was defined as absence of menstruation for more than six months and elevated FSH levels on at least two consecutive occasions. A total of 35 women (15%) started HRT during the study.
Dr. Laakkonen explained: “Our study investigated whether the hormonal change of menopause modulates the metabolite profile measured in blood samples taken before and after menopause. Because the menopausal transition, that is, the period with varying hormonal levels and irregular periods, varies greatly from person to person, the times of assessment have been individualized.
The researchers performed detailed statistical analyzes to determine what changes occur in metabolite levels during the menopausal transition and whether these changes are related to changing sex hormone levels. They also tested whether the trajectory of metabolites varied between HRT users and non-users.
The mean age at baseline was 51.7 years and the median follow-up was 14 months. Menopause was associated with a statistically significant change in the levels of 85 metabolites. An exploratory analysis showed that the hormonal change of menopause directly explained the change in 64 of 85 metabolites, with effect sizes ranging from 2.1% to 11.2%. These included low density lipoprotein (LDL) cholesterol, triglycerides and fatty acids. and amino acids. Analyzes were adjusted for age at baseline, duration of follow-up, level of education, smoking status, alcohol consumption, physical activity and diet quality . A second exploratory analysis found that HRT was associated with increases in high-density lipoprotein (“good”) cholesterol and reductions in LDL (“bad”) cholesterol.
Dr Laakkonen said: “This study links hormonal changes during menopause to metabolic alterations that promote heart disease. Previous studies did not confirm menopausal status with hormonal measurements, meaning they could not differentiate the effects of menopause from aging. Our results should be interpreted with caution, as links to sex hormones and HRT were found in exploratory analyzes and need to be confirmed.
She added: “As far as HRT is concerned, very strong conclusions cannot be drawn based on our observational study alone, as the number of women starting treatment was low and the type of drug was uncontrolled. Nevertheless, our results indicate that initiating HRT at the onset of menopause, i.e. during the menopausal transition, offers the greatest cardioprotective effect. Women considering HRT should discuss this with their healthcare professional as there are many choices and some potential contraindications such as a history of cancer or stroke that need to be considered.