Menopause and modifiable coronary heart disease risk factors: A population based study

Cardiometabolic risk profiles in pre- versus postmenopausal women with spinal cord injury:: preliminary findings

OBJECTIVE

To compare the cardiometabolic risk (CMR) profile of premenopausal and postmenopausal women with spinal cord injury (SCI).

METHOD

Post hoc analysis of a multicenter cross-sectional study assessing CMR. Seventeen women with ASIA Impairment Scale (AIS) A or B SCI between C5 and T12 were stratified into 2 groups according to menopausal status (11 premenopausal vs 6 postmenopausal women). Data collected included demographic, social, medical, menopausal, hormone use, and menstrual histories. Assessments included physical, anthropometric, and blood pressure measures; fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and hemoglobin A1C (Hb1Ac); calculated low-density lipoprotein (LDL-C); and an oral glucose tolerance test.

RESULTS

The premenopausal group had a mean age of 32.4 years compared with 56.0 years in the postmenopausal group. Similar group findings included body mass index (BMI) (22.4 vs 22.2), HDL-C (52.5 vs 53 mg/dL), HbA1c (4.9 vs 5.1%), fasting blood glucose (FBG) (79.3 vs 84.8 mg/dL), and systolic blood pressure (SBP) (104.6 vs 111.8 mm Hg). TG, TC and LDL-C were significantly higher in postmenopausal group (55.7 vs 101.8 mg/dL, P = .01; 158.3 vs 191.6 mg/dL, P = .04; 94.7 vs 118.2 mg/dL, P = .04).

CONCLUSIONS

The findings from this study suggest that postmenopausal women with SCI have CMR trends similar to those observed in nondisabled women, characterized by increases in TG, TC, and LDL-C despite favorable BMIs and glycemic indices. Even though the present study includes significant limitations, future evidence may also suggest that heightened surveillance and guideline-driven interventions are indicated for perimenopausal and postmenopausal women with SCI.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project

BACKGROUND AND AIMS

The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting.

METHODS AND RESULTS

27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m(2)) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk.

CONCLUSION

standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

Sex-related differences in carotid plaque features and inflammation

OBJECTIVE

Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women.

METHODS

Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation.

RESULTS

A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity.

CONCLUSIONS

Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.

Methanol extract of dried exudate of Commiphora mukul prevents bone resorption in ovariectomized rats

CONTEXT

Gum guggul, a resinous exudate of the plant Commiphora mukul Engl. (Burseraceae), has been found efficacious in the treatment of bone fractures, arthritis, and hyperlipidemic disorders.

OBJECTIVE

The present study is an effort to explore the anti-bone-resorptive potential of the dried methanol extract of the gummy exudate of C. mukul (MECM) in ovariectomized rat model.

MATERIALS AND METHODS

The animals were randomly divided into five groups of equal size (n = 6). Animals in all the groups were ovariectomized except group 1, which was sham operated. Groups 3, 4 and 5 were treated with Raloxifene, MECM 250 mg/kg and MECM 500 mg/kg, respectively. The 2nd group was fed with vehicle.

ASSESSMENT

biochemical estimations, viz., alkaline phosphatase (ALP), tartarate resistant acid phosphatase (TRAP), serum calcium (Ca); biomechanical evaluations, and histopathological examinations.

RESULTS

The LD(50) of MECM was found to be > 2500 mg/kg orally. A significant elevation was observed in the ALP, TRAP, Ca and cholesterol levels in the 2nd group with a significant reduction in biomechnical strength. Groups 3, 4 and 5, showed a significant reduction in TRAP and ALP levels (p < 0.001). The Ca levels were normalized in the groups 4 and 5, while cholesterol levels dropped in group 5. The bone strength, however, was normalized in all the groups (p < 0.001) along with the histopathology.

DISCUSSION AND CONCLUSION

Findings suggested a significant gain in bone strength and nearly complete restoration of bone microarchitecture along with lowered levels of TRAP indicating the anti-bone resorptive potential of the extract.

A reversal of decreasing trends in population cholesterol levels in Västerbotten County, Sweden

Background

High cholesterol is identified as a major risk factor for chronic non-communicable diseases, especially cardiovascular and cerebrovascular diseases. Monitoring trends of cholesterol levels and comparing trends across population groups are important to assess population distribution and risks related to cholesterol change over time. Cholesterol surveillance data are lacking, even in high-income countries.

Objectives

To describe the trends in cholesterol and triglyceride levels in different population groups and to estimate the risk of developing hypercholesterolemia and hypertriglyceridemia in Västerbotten County, Sweden during 1990–2010.

Designs and Methods

Since 1990, 133,082 individuals living in Västerbotten County, Northern Sweden, invited on their 30th, 40th, 50th and 60th birthdays, participated in the Västerbotten Intervention Program. Ten years after baseline data collection, 34,868 individuals were surveyed for a second time. In addition to a self-administered health questionnaire (that included information on socioeconomic status, demographics, self-reported health and lifestyle behaviours), blood cholesterol and triglyceride were examined.

Results

The level and prevalence of hypercholesterolemia decreased significantly from 1990 to 2007, but the trends began to increase during 2008–2010 in men, women, and in all educational groups. Men had significantly higher serum triglyceride levels than women and their cholesterol levels were similar to those of the women. This study shows that those with basic education and who live in rural inlands had consistently higher triglyceride level than those who live in the city and have higher educational attainments. People with basic education are also at higher risk of developing hypercholesterolemia and hypertriglyceridemia at 10-year follow-up; the risk is much higher among the older cohorts, particularly women. During 1990–2010, the proportion of participants who reported treatment with lipid-lowering agents increased from 1.1% to 9.6% among men and 0.5% to 5.3% among women. About 60% of those treated achieved treatment goals for cholesterol or triglycerides.

Conclusions

The increasing trend in cholesterol level in the Västerbotten population during 2008–2010 needs to be closely monitored. Addressing the unequal distribution of cholesterol, as well as other risk factors such as obesity, physical inactivity, high blood glucose, among those with basic education, and particularly among populations in rural areas are important to prevent higher burdens of chronic non-communicable diseases in this population.

Menopause with cardiovascular disease and its risk factors among rural Chinese women in Beijing: a population-based study

OBJECTIVES

This study was to explore the independent influence of menopause on cardiovascular disease (CVD) and its risk factors in rural Chinese females.

STUDY DESIGN

This cross-sectional population-based study enrolled 2245 premenopausal and 2498 postmenopausal women aged 40-59 years in Fangshan district, Beijing, China. Data was collected by face-to-face interview, physical examination and biochemical examination during 2009 and 2010. General liner models were employed to calculate age-adjusted means of cardiovascular risk factors (CRFs). The comparisons of CVD and it risk factors according to menopausal status, and calculation of adjusted odds ratios/coefficients and their 95% confidence intervals for the associations of quartiles of elapsed time since menopause and age at menopause with CVD and its risk factors was performed by multivariate logistic/liner regression models separately.

RESULTS

After adjustment for age and other confounders, no statistically significant association of menopause with CVD was observed in our participants; however, dyslipidemia prevalence and levels of waist-to-hip ratio, triglycerides, total cholesterol and low-density lipoprotein cholesterol were presented higher in postmenopausal group, compared to the premenopausal one (P<0.05). Compared to women who had been menopausal for less than1 year, those with the elapsed time since menopause of 2-3 years had higher CHD prevalence, higher triglycerides level and lower high-density lipoprotein cholesterol level (P<0.05).

CONCLUSIONS

Postmenopausal women in rural China had worse CRFs profile than the premenopausal ones, which implied menopause might aggravate the CRFs epidemic beyond effects of aging, and would increase the CVD burden during and after their middle ages.

Effects of Erxian decoction, a Chinese medicinal formulation, on serum lipid profile in a rat model of menopause

BACKGROUND

The prevalence and risk of cardiovascular disease increase after menopause in correlation with the progression of abnormality in the serum lipid profile and the deprivation of estrogen. Erxian decoction (EXD), a Chinese medicinal formulation for treating menopausal syndrome, stimulates ovarian estrogen biosynthesis. This study investigates whether EXD improves the serum lipid profile in a menopausal rat model.

METHODS

Twenty-month-old female Sprague Dawley rats were treated with EXD and its constituent fractions. Premarin was administered for comparison. After eight weeks of treatment, rats were sacrificed and the serum levels of total cholesterol, triglyceride, high-density-lipoprotein cholesterol and low-density-lipoprotein cholesterol were determined. The hepatic protein levels of 3-hydroxy-3-methyl-glutaryl-CoA reductase and low-density-lipoprotein receptor were assessed with Western blot.

RESULTS

The serum levels of total cholesterol and low-density-lipoprotein cholesterol were significantly lower in the EXD-treated group than in the constituent fractions of EXD or premarin groups. However, the serum levels of triglyceride and high-density-lipoprotein cholesterol were not significantly different from the control groups. Results from Western blot suggest that EXD significantly down-regulated the protein level of 3-hydroxy-3-methyl-glutaryl-CoA reductase and up-regulated low-density-lipoprotein receptor. Conclusion EXD improves serum lipid profile in a menopausal rat model through the suppression of the serum levels of total cholesterol and low-density-lipoprotein cholesterol, possibly through the down-regulation of the 3-hydroxy-3-methyl-glutaryl-CoA and up-regulation of the low-density-lipoprotein receptor.

Circulating testosterone and SHBG concentrations are heritable in women: the Framingham Heart Study

CONTEXT

Many factors influence the concentration of circulating testosterone and its primary binding protein, SHBG. However, little is known about the genetic contribution to their circulating concentrations in women, and their heritability in women is not well established.

OBJECTIVE

Our objective was to estimate the heritability of circulating total testosterone (TT), free testosterone (FT), and SHBG in women in families from the Framingham Heart Study.

METHODS

Women in the Framingham Heart Study who were not pregnant, had not undergone bilateral oophorectomy, and were not using exogenous hormones were eligible for this investigation. TT was measured using liquid chromatography tandem mass spectrometry and SHBG using an immunofluorometric assay (Delfia-Wallac), and FT was calculated. Heritability estimates were calculated using variance-components methods in Sequential Oligogenic Linkage Analysis Routines (SOLAR) and were adjusted for age, age(2), body mass index (BMI), BMI(2), diabetes, smoking, and menopausal status. Bivariate analyses were done to assess genetic correlation between TT, FT, and SHBG.

RESULTS

A total of 2685 women were studied including 868 sister pairs and 688 mother-daughter pairs. Multivariable adjusted heritability estimates were 0.26 ± 0.05 for FT, 0.26 ± 0.05 for TT, and 0.56 ± 0.05 for SHBG (P < 1.0 × 10(-7) for all). TT was genetically correlated with SHBG [genetic correlation coefficient (ρG) = 0.31 ± 0.10] and FT (ρG = 0.54 ± 0.09), whereas SHBG was inversely correlated with FT (ρG = -0.60 ± 0.08).

CONCLUSION

Circulating TT, FT, and SHBG concentrations in women are significantly heritable, underscoring the importance of further work to identify the specific genes that contribute significantly to variation in sex steroid concentrations in women. The strong shared genetic component among pairs of TT, FT, and SHBG concentrations suggests potential pleiotropic effects for some of the underlying genes.