Age, menopause, and cardiovascular risk factors among korean middle-aged women: the 2005 Korea National Health and Nutrition Examination Survey

The effect of menopause on cardiovascular risk factors according to body mass index in middle-aged Korean women

BACKGROUND

Menopausal status and obesity are associated with an increased risk for cardiovascular diseases. However, there are few studies on the effect of menopause on cardiovascular risk factors according to the degree of obesity during the menopausal transition. We aimed to evaluate the effect of menopause on cardiovascular risk factors according to body mass index (BMI) in middle-aged Korean women.

METHODS

We analyzed 361 postmenopausal women and 758 premenopausal women (age: 45-55 years) without diabetes mellitus, hypertension, or dyslipidemia, using a cohort database released by the Korean National Health and Nutrition Examination Survey 2016-2018. Subjects were divided into two groups based on BMI. Women who underwent a hysterectomy or were pregnant were excluded from this study. Differences between groups adjusted for age and BMI were assessed.

RESULTS

Postmenopausal women (52 ± 2 years) were older than premenopausal women (48 ± 2 years), and BMI did not differ between the two groups (22.8 ± 2.9 vs. 23.0 ± 3.1 kg/m2). After adjustment for age and BMI in total and non-obese subjects (not obese subjects), postmenopausal women exhibited higher hemoglobin A1c and total cholesterol levels than premenopausal women. Subgroup analysis for 138 postmenopausal and 138 age- and BMI-matched premenopausal women showed that postmenopausal women had higher total cholesterol levels than premenopausal women with marginal significance (201 ± 25 vs. 196 ± 27 mg/dL).

CONCLUSION

Menopausal status was associated with increased glucose and cholesterol levels independent of age and BMI in middle-aged Korean women. Menopausal status showed a significant relationship with increased total cholesterol levels even after adjusting for age and BMI in non-obese women but not obese women. Therefore, intensive monitoring and treating of lipid status is necessary to prevent cardiovascular events during the menopausal transition, especially in non-obese subjects.

Association between Reproductive Factors and Type 2 Diabetes: A Cross-Sectional Study

(1) Introduction: The available studies on the association between type 2 diabetes mellitus (T2DM) and menopause report conflicting results. (2) Objective: This study aimed to investigate the association of menopausal status, age at menopause, and length of the reproductive period with T2DM. (3) Methods: This cross-sectional study is part of the ‘China Eastern Cohort Study’, which is a community-based cohort study. Multistage, stratified, clustered sampling was used to recruit the study participants in Shanghai, China. Age at menarche and menopause was recorded, and reproductive period was calculated. Weighted logistic regression was used to calculate the prevalence ratios (PRs) with 95% confidence intervals (CIs) of T2DM. Restricted cubic splines were used to assess the relationship between age at menopause, reproductive period, and T2DM. (4) Results: A total of 20,128 women were included. The prevalence of T2DM was 13.7%. Postmenopausal women exhibited a higher prevalence of T2DM than premenopausal women (p < 0.001) and an unfavorable metabolic profile, including higher body mass index, hypertension, and hyperlipidemia. A higher risk of T2DM was observed in postmenopausal women (PR2.12, 95%CI: 1.79–2.51, p < 0.001) compared with premenopausal women, independently of confounding factors. After adjustment for confounding factors, age at menopause and reproductive period were not significantly associated with T2DM. (5) Conclusions: Postmenopausal status is associated with T2DM, while menopausal age and reproductive period are not associated with T2DM. Menopausal status should be considered during T2DM screening.

Longitudinal Change in Myocardial Function and Clinical Parameters in Middle-Aged Subjects: A 3-Year Follow-up Study

BACKGROUND

Metabolic syndrome (MetS) is closely associated with the aging process. However, changes in metabolic conditions and cardiac function that occur in middle aged population remain unclear. We evaluated longitudinal changes in metabolic parameters and cardiac function during a 3-year period in subjects with suspected MetS.

METHODS

We studied 191 participants with suspected MetS at baseline and after 3 years. Anthropometric parameters, including waist circumference (WC), and metabolic parameters, including fasting blood glucose and lipid profile were measured. Conventional echocardiography with two-dimensional speckle tracking was performed.

RESULTS

Mean age was 56.2±4.4 years, and there were 97 women (50.8%). Men had increased WC and triglycerides (TG) (WC 91.2±6.8 cm vs. 84.0±8.0 cm, P<0.001; TG 184.4±116.3 mg/dL vs. 128.2±53.6 mg/dL, P<0.001), and reduced global longitudinal strain (GLS) (-15.4%±2.1% vs. -17.1%±2.0%, P<0.001) compared to women. After 3.4 years, values of WC and TG did not change in men but increased in women (all P<0.05). The absolute value of left ventricular (LV) GLS did not change in men but was reduced in women (P=0.011). Change in TG was independently associated with worsening of LV GLS only in women (standardized β, -0.309; 95% confidence interval, -0.130 to -0.009; P=0.025).

CONCLUSION

In middle aged population, a vulnerable period for metabolic disturbance, cardiac remodeling tended to progress, which was prominent in women. Progression of adiposity and dyslipidemia after menopause may accelerate subclinical cardiac remodeling in middle-aged women. Lifestyle modification and medical interventions may help prevent further cardiac dysfunction in these subjects.

Serum concentration of sex hormone-binding globulin in healthy volunteers and patients with breast cancer stratified by sex and age

The objective of the present study was to compare sex hormone-binding globulin (SHBG) levels according to sex (healthy male and female volunteers) and age to determine reference values. Serum SHBG expression levels in patients with breast cancer with different tumor burden states were also determined. A total of 109 samples were obtained from 34 patients in 3 different disease states (non-tumor, localized tumor and systemic metastasis) during follow-up. A sandwich ELISA was conducted to measure SHBG, cancer antigen (CA)15-3 and CA125 expression levels. Wilcoxon rank-sum tests were performed on non-normally distributed data and an unpaired t-test was used for normally distributed variables. SHBG expression levels were higher in females compared with males (P<0.0001). When SHBG expression levels were compared by sex, the difference was maintained in the age groups <30, 30–39 and ≥50 years, but not in the 40–49 years group. In males, SHBG expression levels increased until the age of 49 and then decreased (P=0.01). In females, SHBG expression levels exhibited a decreased trend until the age of 49 (P=0.66). In patients with breast cancer, the SHBG expression levels revealed a decreasing trend after the age of 50, which was different compared with the healthy females. There was a decreasing trend of SHBG expression levels from pre-menopause to post-menopause healthy volunteers (P=0.74). CA15-3 (r²=0.07; P=0.59) and CA 125 (r²=−0.18; P=0.17) levels did not exhibit any significant correlation with SHBG expression levels. There was a significant difference in the SHBG expression levels between male and female healthy volunteers. SHBG expression levels also revealed different patterns between healthy female volunteers and female patients with breast cancer ≥50 years of age. The present study demonstrated that SHBG does not have value as a biomarker, but different reference values according to age and sex may aid in predicting high-risk groups for hormone-dependent cancer and guide treatment direction for post-menopausal breast cancer.

Lipid profile changes during the menopausal transition

OBJECTIVES

There is evidence that the menopausal transition in women is accompanied by changes in the metabolic profile. We evaluated the lipid profile during the perimenopause to postmenopause transition and its association with menopausal status.

METHODS

This is a retrospective observational study of laboratory studies from women presenting to the gynecology unit of Hospital Quirón Salud, Madrid (2007-2018) with irregular menstruation, amenorrhea or menopausal symptoms. Inclusion criteria were one or more blood samples with determinations of fasting glucose and lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol [HDL-c] and triglycerides [TGs]) from women with a menopause diagnosis recorded in the hospital database. The determinations were classified as perimenopausal or postmenopausal based on the date of last menstruation.

RESULTS

In total, 13,517 laboratory studies (3,073 perimenopausal and 10,444 postmenopausal) from 275 women were analyzed. Total cholesterol, LDL-c, and TG levels were significantly higher in postmenopausal women than in perimenopausal women, whereas HDL-c levels were significantly lower (P < 0.05 in all cases). Further adjustment by age showed differences only in LDL-c levels. Menopausal status, TG levels, and the number of pregnancies were independently related with total cholesterol and LDL-c levels. HDL-c levels were independently affected by menopausal age, TG levels, and number of pregnancies. Finally, TG concentration was independently affected by total cholesterol, LDL-c, and HDL-c levels.

CONCLUSION

Our study suggests that significant changes in LDL-c levels occur during the menopausal transition. Total cholesterol and LDL-c changes are independently affected by menopausal status and HDL-c is influenced by menopausal age.

The Association Between Body Mass Index and Open-angle Glaucoma in a South Korean Population-based Sample

PURPOSE

The purpose of this article is to investigate the association between body mass index (BMI) and open-angle glaucoma (OAG) in a sample of the South Korean population.

MATERIALS AND METHODS

The sample consisted of a cross-sectional, population-based sample of 10,978 participants, 40 years of age and older, enrolled in the 2008 to 2011 Korean National Health and Nutrition Examination Survey. All participants had measured intraocular pressure <22 mm Hg and open anterior chamber angles. OAG was defined using disc and visual field criteria established by the International Society for Geographical and Epidemiological Ophthalmology. Multivariable analyses were performed to determine the association between BMI and OAG. These analyses were also performed in a sex-stratified and age-stratified manner.

RESULTS

After adjusting for potential confounding variables, lower BMI (<19 kg/m) was associated with greater risk of OAG compared with normal BMI (19 to 24.9 kg/m) [odds ratio (OR), 2.28; 95% confidence interval (CI), 1.22-4.26]. In sex-stratified analyses, low BMI remained adversely related to glaucoma in women (OR, 3.45; 95% CI, 1.42-8.38) but not in men (OR, 1.72; 95% CI, 0.71-4.20). In age-stratified analyses, lower BMI was adversely related to glaucoma among subjects 40- to 49-year old (OR, 5.16; 95% CI, 1.86-14.36) but differences in glaucoma prevalence were not statistically significant between those with low versus normal BMI in other age strata.

CONCLUSIONS

Lower BMI was associated with increased odds of OAG in a sample of the South Korean population. Multivariate analysis revealed the association to be statistically significant in women and those in the youngest age stratum.

Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study

The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.

INTRODUCTION

To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.

METHODS

We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.

RESULTS

The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.

CONCLUSIONS

The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.

Study on the prevalence and incidence of urolithiasis in Korea over the last 10 years: An analysis of National Health Insurance Data

Purpose

We aimed to analyze the incidence and prevalence of urolithiasis in Korea over the last decade using the National Health Insurance (NHI) sample cohort data.

Materials and Methods

From January 2002 to December 2013, we enrolled sample cohort data from the NHI. Patients diagnosed with international classification of diseases code N20 or N13.2 were included. The incidence and prevalence rate was counted from the same period and patients previously diagnosed with urolithiasis were excluded. We compared the incidence and prevalence of urolithiasis by region, age, and sex, and identified the changes.

Results

Total 1,111,828 subjects were included. Of these subjects, 36,857 had urolithiasis. The male-to-female ratio was 1.57:1, and total incidence rate was 3.27 per 1,000 person-years (1,000p-yrs). The annual incidence was lowest in 2013 (3,138 patients) and highest in 2005 (3,751 patients). Incidence rate by diagnostic code was highest in ureter stone only (2.49 per 1,000p-yrs) and was lowest in kidney and ureter stone both (0.17 per 1,000p-yrs). Prevalence gradually increased from 3,172 in 2002 and 5,758 in 2013. Jeollanam-do had the highest incidence rate of 3.70 persons per 1,000p-yrs, and Jeju had the lowest rate of 2.84 persons per 1,000p-yrs. In gender analysis, Daegu had the highest incidence (4.56) in males, Jeollanam-do had the highest incidence (3.20) in females.

Conclusions

Annual incidence remained stable, whereas prevalence gradually increased. The incidence in male was 1.57 times higher than female, and the peak incidence age was 45–49 years, with the highest incidence occurring in Jeollanam-do and the lowest in Jeju.

Ischemic stroke across sexes: What is the status quo?

Stroke prevalence is expected to increase in the next decades due to the aging of the Western population. Ischemic stroke (IS) shows an age- and sex-dependent distribution in which men represent the most affected population within 65 years of age, being passed by post-menopausal women in older age groups. Furthermore, a sexual dimorphism concerning risk factors, presentation and treatment of IS has been widely recognized. In order to address these phenomena, a number of issue have been raised involving both socio-economical and biological factors. The latter can be either dependent on sex hormones or due to intrinsic factors. Although women have poorer outcomes and are more likely to die after a cerebrovascular event, they are still underrepresented in clinical trials and this is mirrored by the lack of sex-tailored therapies. A greater effort is needed in the future to ensure improved treatment and quality of life to both sexes.

Ischemic stroke across sexes: what is the status quo?

Stroke prevalence is expected to increase in the next decades due to the aging of the Western population. Ischemic stroke (IS) shows an age- and sex-dependent distribution in which men represent the most affected population within 65 years of age, being passed by post-menopausal women in older age groups. Furthermore, a sexual dimorphism concerning risk factors, presentation and treatment of IS has been widely recognized. In order to address these phenomena, a number of issue have been raised involving both socio-economical and biological factors. The latter can be either dependent on sex hormones or due to intrinsic factors. Although women have poorer outcomes and are more likely to die after a cerebrovascular event, they are still underrepresented in clinical trials and this is mirrored by the lack of sex-tailored therapies. A greater effort is needed in the future to ensure improved treatment and quality of life to both sexes.

Dependency of cardiovascular risk on reproductive stages and on age among middle-aged Chinese women

OBJECTIVE

To assess the 10-year cardiovascular risk in middle-aged Chinese women living in the same community and the impact of reproductive aging and age.

METHODS

This was a cross-sectional study in the Yuetan Community of Beijing. Data on lifestyle habits, prevalence and treatment of chronic diseases with significance for cardiovascular disease (CVD) development were collected by interview. CVD risk factors were assessed by physical examination and laboratory tests. The 10-year cardiovascular risk was calculated using the Framingham 10-year risk score. STRAW +10 criteria were used for the stages of reproductive aging.

RESULTS

A total of 536 women, aged 40-60 years, were enrolled. The incidences of hypertension, dyslipidemia, abdominal obesity, glucose intolerance and diabetes were 32.6%, 45.7%, 65.5%, 37.9% and 10.1%, respectively. After adjustment, the incidence of hypertension and diabetes increased with age and with reproductive aging. Dyslipidemia and glucose intolerance were only associated with age. Abdominal obesity was related neither to age nor to reproductive aging. The 10-year cardiovascular risk ranged from 1% to 24.8%; 11.6% of women had a moderate or high Framingham 10-year risk score.

CONCLUSIONS

CVD risk factors were frequent and more than 10% of the women were at moderate or high risk of developing cardiovascular disease within the next 10 years. To our knowledge, this was demonstrated for the first time in middle-aged Chinese women. Thus, women should maintain a healthy lifestyle and physicians should monitor them to prevent CVD.

Stroke incidence, prevalence and mortality in women worldwide

BACKGROUND

The study of sex differences on stroke incidence, prevalence and mortality is an emerging field of stroke epidemiology and care.

AIMS

This study sought to determine the information available on stroke epidemiology in women worldwide and possible sex differences in stroke epidemiology, and, if so, describe the nature of these differences and whether they are consistent across countries/groups of countries.

SUMMARY

We searched the available literature in English published between 1 January 2008 and 5 May 2015. Out of 17.789 papers only 56 peer-reviewed papers (29 community-based studies, 17 retrospective studies, 6 reviews, and 4 cross-sectional studies) have been included in the study. This review adopted the epidemiologic transition theory, which classifies countries into four stages according to their levels of industrialization and economy. For the first and second stages, reliable registries and health certification are lacking, and therefore our sought after data were very limited.In the third stage, specifically for Eastern Europe (post-socialist countries), the burden from stroke in women was on the rise, while in the fourth stage, despite an aging population, decreases in stroke incidence, prevalence and mortality have been observed, even in subjects older than 80 years for both sexes. However, regarding studies of US populations, these trends for women were less pronounced for African Americans, and Hispanics as well as Indians. This suggests a "gender-gap" regarding access to treatment and care.In conclusion, identifying the presence of differing global burden between the sexes will allow us to better understand how to prevent, treat, and manage both men and women.

Association Between Drinking and Obesity in Pre- and Postmenopausal Women: Korea National Health and Nutrition Examination Survey 2010-2012

BACKGROUND

Women are more vulnerable to the adverse effects of alcohol than men. The present study aimed to investigate the link between drinking and obesity in pre- and postmenopausal women in Korea.

METHODS

We performed a cross-sectional study of 4374 premenopausal and 2927 postmenopausal women using a multistage probability cluster survey sample to produce nationally representative estimates. We assessed the subjects' alcohol drinking tendencies rates according to their drinking levels as well as Alcohol Use Disorders Identification Test (AUDIT); obesity was identified based on body mass index (BMI) ≥25 kg/m², waist circumference (WC) ≥80 cm, and waist-to-height ratio (WHtR) ≥50%. We performed t-tests and chi-square tests to assess the association between drinking and obesity.

RESULTS

In premenopausal subjects, obesity indices increased significantly as alcohol consumption rose. Significant correlations between drinking level and obesity factors were found in premenopausal women after adjusting for age (odds ratios [ORs] for BMI, WC, and WHtR were 1.58 [1.08-2.31], 1.94 [1.11-3.00], and 1.80 [1.24-2.61], respectively). Furthermore, an AUDIT score of 20 or higher indicated a significantly higher likelihood of obesity (ORs for BMI, WC, and WHtR were 2.02 [1.18-3.46], 2.75 [1.70-4.87], and 2.86 [1.78-4.59], respectively). There was a significant correlation between AUDIT scores and obesity factors after adjusting for age, energy intake, fat intake, exercise, smoking, education, and income in premenopausal women (ORs for BMI and WHtR were 1.71 [0.85-3.47] and 1.73 [0.97-3.06], respectively).

CONCLUSION

Our results suggest that alcohol is associated with a risk factor for obesity in premenopausal women.

Femoral geometry, bone mineral density, and the risk of hip fracture in premenopausal women: a case control study

Background

The purpose of this study was to determine the relationships among hip geometry, bone mineral density, and the risk of hip fracture in premenopausal women.

Methods

The participants in this case–control study were 16 premenopausal women with minimal-trauma hip fractures (fracture group) and 80 age-and BMI-adjusted controls. Subjects underwent dual-energy X-ray absorptiometry (DXA) to assess BMD at the proximal femur and to obtain DXA-derived hip geometry measurements.

Results

The fracture group had a lower mean femoral neck and total hip BMD than the control group (0.721 ± 0.123 vs. 0.899 ± 0.115, p <0.001 for the femoral neck BMD and 0.724 ± 0.120 vs. 0.923 ± 0.116, p <0.001 for the total hip BMD). In addition, participants in the fracture group had a longer hip axis length (HAL; p = 0.007), narrower neck shaft angle (NSA; p = 0.008), smaller cross sectional area (CSA; p < 0.001) and higher cross sectional moment of inertia (CSMI; p = 0.004) than those in control group. After adjusting for BMD, the fracture group still had a significantly longer mean HAL (p = 0.020) and narrower NSA (p = 0.006) than the control group.

Conclusions

BMD is an important predictor of hip fracture in premenopausal women. Furthermore, HAL and NSA are BMD-independent predictors of hip fracture in premenopausal women. Hip geometry may be clinically useful for identification of premenopausal women for whom active fracture prevention should be considered.

Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression

BACKGROUND

There are limited data about whether patients who receive initial treatment for differentiated thyroid cancer (DTC) gain or lose weight during long-term follow-up under thyroid stimulating hormone (TSH) suppression. This study was aimed to evaluate whether DTC patients under TSH suppression experience long-term weight gain after initial treatment. We also examined the impact of the radioactive iodine ablation therapy (RAIT) preparation method on changes of weight, comparing thyroid hormone withdrawal (THW) and recombinant human TSH (rhTSH).

METHODS

We retrospectively reviewed 700 DTC patients who underwent a total thyroidectomy followed by either RAIT and levothyroxine (T4) replacement or T4 replacement alone. The control group included 350 age-matched patients with benign thyroid nodules followed during same period. Anthropometric data were measured at baseline, 1 to 2 years, and 3 to 4 years after thyroidectomy. Comparisons were made between weight and body mass index (BMI) at baseline and follow-up.

RESULTS

Significant gains in weight and BMI were observed 3 to 4 years after initial treatment for female DTC but not in male patients. These gains among female DTC patients were also significant compared to age-matched control. Women in the THW group gained a significant amount of weight and BMI compared to baseline, while there was no increase in weight or BMI in the rhTSH group. There were no changes in weight and BMI in men according to RAIT preparation methods.

CONCLUSION

Female DTC patients showed significant gains in weight and BMI during long-term follow-up after initial treatment. These changes were seen only in patients who underwent THW for RAIT.

Assessment of Cardiovascular Risk in Adults With Type 2 Diabetes and Metabolic Syndrome

Purpose

The purpose of this study was to assess risk of cardiovascular disease (CVD) by comparing the Framingham and United Kingdom Prospective Diabetes Study (UKPDS) risk equations in Korean adults with type 2 diabetes (T2DM) and metabolic syndrome.

Methods

The study was a cross-sectional survey enrolling a convenience sample of 110 Korean adults with T2DM and metabolic syndrome. The 10-year CVD risk scores were calculated using the Framingham risk equation and UKPDS risk engines.

Results

Overall participants had a moderate prevalence (average, 64.3%) of metabolic syndrome factors, with the most prevalent being abdominal obesity (86.4%) and elevated blood pressure (78.2%). A lower percentage of women were current smokers and consumed alcohol than men, whereas a higher percentage of men had their weight and stress controlled than women. The mean scores of 10-year CVD risk using the Framingham and UKPDS equations were 14.55% and 15.99%, respectively. However, there were no significant differences between results of the 2 equations. Regarding level of CVD risk, the percentage of high risk (>20%) was about 24% using both equations. Also, the area under the receiver operating characteristic curves using Framingham and UKPDS equations was similar: 0.707 and 0.696, respectively, which indicated moderate accuracy.

Conclusions

About one-fourth of adults with T2DM and metabolic syndrome had high level of CVD risk (>20%). In practice, people with diabetes and metabolic syndrome could be managed earlier and more intensively based on their risk estimated by the Framingham or UKPDS equations.

Does accelerated reproductive aging underlie premenopausal risk for cardiovascular disease?

OBJECTIVE

The menopausal transition is associated with an increase in risk for cardiovascular disease; however, whether variability in reproductive aging relates to cardiovascular risk factors in the premenopausal period has not been studied.

METHODS

In a multiethnic sample of 951 healthy, regularly cycling women aged 25 to 45 years (mean [SD] age, 35.2 [5.5] y), we examined antimüllerian hormone (AMH), a validated marker of ovarian reserve, in relation to the overall number of cardiometabolic risk factors, calculated as the sum of the five components of metabolic syndrome (triglycerides ≥150 mg/dL; high-density lipoprotein <50 mg/dL; homeostasis model assessment of insulin resistance ≥2.6; waist circumference equal to or higher than race-specific cutoff; and hypertensive [vs normotensive] status), and in relation to each of these risk factors individually.

RESULTS

In age-adjusted models, results showed that the number of cardiometabolic risk factors was 52.1% higher among women with low versus high AMH levels and 46.0% higher among women with mid versus high AMH levels. In addition, results showed that low and mid levels of AMH (vs high) were associated with an increase in risk with respect to high-density lipoprotein (odds ratio [OR], 1.814; 95% CI, 1.211-2.718 and OR, 1.568; 95% CI, 1.083-2.269, respectively), waist circumference (OR, 2.012; 95% CI, 1.380-2.934 and OR, 1.881; 95% CI, 1.333-2.654, respectively), and hypertensive status (OR, 2.373; 95% CI, 1.095-5.143 and OR, 2.052; 95% CI, 0.976-4.314, respectively) outcomes. Associations, however, attenuated when body mass index was covaried (Ps > 0.05).

CONCLUSIONS

Cross-sectional evidence suggests that having a greater ovarian reserve is associated with having a healthier cardiometabolic risk factor profile. Future longitudinal studies are needed to determine whether this association may be mediated by body mass index.

Disruptions in ovarian function are related to depression and cardiometabolic risk during premenopause

OBJECTIVE

The aim of this study was to evaluate the extent to which mild disruptions in ovarian function, indexed by changes in menstrual cycle length, may relate to cardiometabolic and psychological health in premenopausal women.

METHODS

Among 804 healthy, regularly cycling women (aged 25-45 y; mean [SD] age, 35.5 [5.5] y), patterns of any change (shortening, lengthening, or increased variability) versus no change in menstrual cycle length were examined in relation to a composite of cardiometabolic risk and individual risk factors (high-density lipoprotein, triglycerides, waist circumference, glucose, and hypertensive status), as well as in relation to depression indicators (Center for Epidemiological Studies Depression Scale score ≥16 [yes/no], lifetime depression diagnosis [yes/no], and lifetime antidepressant medication use [yes/no]). Models were also explored to test whether changes in menstrual cycle length mediated relations between depression history and cardiometabolic risk.

RESULTS

In covariate-adjusted models compared with no change, any change in menstrual cycle length was associated with higher cardiometabolic risk composite scores and lower high-density lipoprotein (P < 0.05). In addition, compared with no change, any change in menstrual cycle length was associated with a Center for Epidemiological Studies Depression Scale score of 16 or higher, having received a depression diagnosis, and having used antidepressant medications (P < 0.05). In exploratory analyses, any change in menstrual cycle length partially mediated the relation between depression history and cardiometabolic risk (b = 0.152, P = 0.040), which attenuated (b = 0.129, P = 0.083) when any change in menstrual cycle length was covaried.

CONCLUSIONS

Findings suggest that disruptions in ovarian function, marked by subtle changes in menstrual cycle length, may relate to aspects of cardiometabolic and psychological health among healthy, premenopausal women.

Effect of postmenopausal status and age at menopause on type 2 diabetes and prediabetes in Japanese individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17)

OBJECTIVE

Findings on the effect of menopause or age at menopause on the presence of hyperglycemia are controversial, and why women after menopause have a higher probability of having hyperglycemia than men in the same age range remains unknown.

RESEARCH DESIGN AND METHODS

We reviewed data on 29,189 men, 6,308 premenopausal women, and 4,570 postmenopausal women in Japan. Odds ratios (ORs) for diabetes or prediabetes indicated by American Diabetes Association criteria were calculated for men and for pre- and postmenopausal women.

RESULTS

Compared with premenopausal women, women after natural menopause had an age-adjusted OR of 1.40 (95% CI 1.03-1.89) for diabetes, and women after menopause by surgical or other causes had an age-adjusted OR of 1.59 (1.07-2.37). The age-adjusted OR in men was 4.02 (3.15-5.14). Compared with premenopausal nondiabetic women, postmenopausal nondiabetic women had a significantly elevated OR of 1.33 (1.20-1.48) for prediabetes; nondiabetic men had an OR of 1.93 (1.77-2.10) independently of age and demographic and metabolic factors. Even among women aged <50 years, postmenopausal status was significantly associated with an elevated OR (1.50 [1.18-1.91]) for dysglycemia (either diabetes or prediabetes). Postmenopausal women aged ≥50 years had a particularly elevated OR for dysglycemia, regardless of age at menopause.

CONCLUSIONS

The postmenopausal state was significantly associated with the presence of dysglycemia independently of normal aging, although the increased probability in postmenopausal women did not equal that in men. Among women, menopause and older age might additively influence the elevated probability of dysglycemia.

Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women

OBJECTIVE

To determine whether reproductive age, as indexed by a validated marker of ovarian reserve (antimüllerian hormone [AMH]), varies among women of different race/ethnic backgrounds.

DESIGN

Cross-sectional study.

SETTING

Community-based sample.

PATIENT(S)

Multiethnic sample of 947 (277 white, 237 African American, 220 Latina, and 213 Chinese) healthy and regularly cycling premenopausal women, ages 25-45.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

AMH level.

RESULT(S)

A multivariate model was fit examining race/ethnicity, covariates, nonlinear terms for age (age(2), age(3)), and body mass index (BMI(2), BMI(3)), and two-way interactions between race/ethnicity and each of the other predictor variables in relation to AMH. After backward elimination, significant effects included race/ethnicity (F = 8.45), age (F = 349.94), race/ethnicity-by-linear age interaction (F = 4.67), age(2) (F = 31.61), and BMI (F = 10.69). Inspection of the significant race/ethnicity-by-linear age interaction showed AMH levels were consistently lower among Latina women compared with white women across all ages, whereas AMH levels were lower among African American and Chinese women compared with the white women at younger and middle ages, respectively. The AMH levels were higher among African American compared with Latina and Chinese women at older ages.

CONCLUSION(S)

Although the results must be considered preliminary, the findings are twofold: African American women may have lower AMH levels at younger ages but experience less of a reduction in AMH with advancing age, and Latina and Chinese women compared with white women may have lower AMH levels, marking a lower ovarian reserve and a possibly increased risk for earlier menopause.

Isoflavone supplementation influenced levels of triglyceride and luteunizing hormone in Korean postmenopausal women

We conducted a double-blind, randomized, placebo-controlled trial to evaluate the effects of soy-derived isoflavone on blood glucose, lipid profiles, and sex hormones related to cardiovascular disease in Korean postmenopausal women. One hundred thirteen postmenopausal women were recruited from the Seoul metropolitan area. To confirm postmenopausal and gynecologic status, the subjects were clinically examined by a gynecologist using ultra sound and X-ray. Finally, 85 postmenopausal women whose follicle-stimulating hormone (FSH) levels were higher than 40 IU/ml were enrolled. Subjects received either 70 mg isoflavone or placebo capsules daily for 12 weeks. As a result, the values of fasting glucose, insulin and HOMA-IR, as well as those of TC, LDL-C, HDL-C and FFA, were not different between the groups after supplementation. However, triglyceride (TG) levels in the treatment group decreased significantly compared with those of the placebo group (p = 0.0215). The levels of luteinizing hormone (LH) significantly decreased in the treatment group (p = 0.027); however, the levels of FSH, estrone and estradiol were not changed after intervention. In conclusion, isoflavone supplement of 70 mg/day for 12 weeks decreased blood levels of TG and LH in Korean postmenopausal women.

Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey

SUMMARY

The association between secondhand smoke (SHS) exposure and lumbar and femoral neck osteoporosis was assessed in postmenopausal never-smoking Korean women. The presence of family members who actively smoked was associated with femoral neck osteoporosis. The number of cigarettes consumed by cohabitant smokers was positively associated with lumbar and femoral neck osteoporosis.

INTRODUCTION

This study aimed to assess the association between SHS and postmenopausal osteoporosis.

METHODS

Of 2,067 postmenopausal women (age, ≥55 years) participating in the Fourth Korea National Health and Nutrition Examination Survey, 925 never-smokers identified through interviews and urinary cotinine level verification were enrolled. Cross-sectional relationships between self-reported SHS exposure and osteoporosis of the lumbar vertebrae and femoral neck (defined using the World Health Organization T-score criteria) were investigated by bone densitometry.

RESULTS

Participants having actively smoking family members showed increased adjusted odds ratio (aOR) for femoral neck osteoporosis compared with participants not exposed to SHS (aOR, 3.68; 95 % confidence interval [CI], 1.23-10.92). Participants whose cohabitant smokers consumed any number of cigarettes per day showed increased occurrences for lumbar and femoral neck osteoporosis compared with the nonexposed group. Participants whose cohabitant smokers consumed ≥20 cigarettes/day showed increased aORs for lumbar (aOR, 5.40; 95 % CI, 1.04-28.04) and femoral neck (aOR, 4.35; 95 % CI, 1.07-17.68) osteoporosis compared with participants not exposed to SHS.

CONCLUSIONS

In postmenopausal never-smoking Korean women, exposure to SHS was positively associated with osteoporosis. This finding further emphasizes a need to identify vulnerable groups exposed to SHS to increase bone health.

Osteoporosis is associated with the risk of colorectal adenoma in women

BACKGROUND

Recently, it was reported that postmenopausal women with lower bone mineral density have an increased risk of colorectal cancer. An association between lower bone mineral density and colorectal cancer suggests that colorectal adenoma, which is a precursor of colorectal cancer, may also be associated with lower bone mineral density.

OBJECTIVE

The aim of this study was to determine the association between colorectal adenoma and osteoporosis.

DESIGN AND PATIENTS

We conducted a retrospective cross-sectional study between January 2007 and May 2011. Women older than 50 years of age who underwent dual-energy x-ray absorptiometry for bone mineral density and screening colonoscopy at Gangdong Kyung Hee University Hospital in Korea during a routine health checkup were eligible for this study. We performed multivariate analysis adjusted for age, family history of colorectal cancer, alcohol consumption, current smoking, regular aspirin use, exercise, menopause, and postmenopausal hormone use to identify independent predictors for the presence of colorectal adenoma.

MAIN OUTCOME MEASURES

The primary outcome measured was the prevalence of colorectal adenoma according to the bone mineral density level.

RESULTS

A total of 992 women older than 50 years were assigned to an osteoporosis group (n = 231) or a control group (n = 231) after menopause matching. In univariate analysis, the proportion of colorectal adenoma was significantly higher in the osteoporosis group than in the control group (29.9% vs 20.8%, p = 0.025). Furthermore, osteoporosis (OR = 1.592, 95% CI = 1.004-2.524, p = 0.048) was found to be an independent risk factor for the presence of colorectal adenoma.

CONCLUSIONS

Osteoporosis is associated with an increased risk of colorectal adenoma in women older than 50 years.

Sex differences in management and mortality of patients with ST-elevation myocardial infarction (from the Korean Acute Myocardial Infarction National Registry)

There has been controversy over the disparity between men and women with regard to the management and prognosis of acute myocardial infarction. Analyzing nationwide multicenter prospective registries in Korea, the aim of this study was to determine whether female gender independently imposes a risk for mortality. Data from 14,253 patients who were hospitalized for ST-segment elevation myocardial infarction from November 2005 to September 2010 were extracted from registries. Compared to men, women were older (mean age 56 ± 12 vs 67 ± 10 years, p < 0.001), and female gender was associated with a higher frequency of co-morbidities, including hypertension, diabetes, and dyslipidemia. Women had longer pain-to-door time and more severe hemodynamic status than men. All-cause mortality rates were 13.6% in women and 7.0% in men at 1 year after the index admission (hazard ratio for women 2.01, 95% confidence interval 1.80 to 2.25, p < 0.001). The risk for death after ST-segment elevation myocardial infarction corresponded highly with age. Although the risk remained high after adjusting for age, further analyses adjusting for medical history, clinical performance, and hemodynamic status diminished the gender effect (hazard ratio 1.00, 95% confidence interval 0.86 to 1.17, p = 0.821). Propensity score matching, as a sensitivity analysis, corroborated the results. In conclusion, this study shows that women have a comparable risk for death after ST-segment elevation myocardial infarction as men. The gender effect was accounted for mostly by the women's older age, complex co-morbidities, and severe hemodynamic conditions at presentation.

Higher hemoglobin level is associated with subtle declines in renal function and presence of cardiorenal risk factors in early CKD stages

BACKGROUND

Patients with advanced renal dysfunction have comorbidities, including anemia, as a consequence of reduced production of erythropoietin. However, little is known about the renal response to early decreases in estimated glomerular filtration rate (eGFR) before the onset of anemia. We therefore investigated the hemoglobin concentration across subtle declines in renal function stratified by cardiorenal risk factors, in subjects with eGFR ≥50 mL/min/1.73 m(2).

METHODS

Based on the data from routine health checkups in tertiary university hospitals during the last 15 years, 145 865 adult subjects were identified.

RESULTS

Hemoglobin levels among eGFR Groups 2-6 (50 ≤ eGFR < 100 mL/min/1.73m(2)) were significantly higher compared to eGFR group ≥100 mL/min/1.73m(2) (P < 0.001), and the highest level of mean hemoglobin was seen at eGFR 50-59 mL/min/1.73m(2). The mean hemoglobin level of subjects with eGFR 50-59 mL/min/1.73m(2) and eGFR ≥ 100 mL/min/1.73m(2) were 13.36 [95% confidence interval (CI): 13.33-13.40] g/dL versus 12.92 (95% CI: 12.88-12.95) g/dL in women (P < 0.001); in men, 15.60 (95% CI: 15.57-15.63) g/dL versus 15.15 (95% CI: 15.11-15.18) g/dL (P < 0.001). Among each eGFR group, hemoglobin levels were higher in subjects with hypertension (P < 0.001 in both genders), diabetes mellitus (P < 0.001 in both genders) and components of MS (P < 0.003 in both genders) compared to subjects without these conditions.

CONCLUSION

Hemoglobin concentration may be slightly higher across subtle declines in renal function and the presence of cardiorenal risk factors in early CKD stages.

Gender Difference in the Level of HDL Cholesterol in Korean Adults

Background

High density lipoprotein (HDL) cholesterol level varies with ethnicity and gender. In Korea there has not been an agreement on standards for HDL cholesterol level. Therefore, in order to establish a foundation for research on HDL cholesterol, we investigated the gender difference in HDL cholesterol level after adjusting associated factors.

Methods

The study population included 4,465 individuals (1,833 men, 2,632 women) representing 33,502,918 Koreans 20 years of age or older, who participated in the 2005 Korean National Health and Nutrition Survey. After stratifying by gender, we analyzed the HDL cholesterol level according to the general characteristics of the study population. Then we identified independent factors associated with HDL cholesterol level. After adjusting for covariates, we estimated the gender difference in HDL cholesterol level.

Results

We demonstrated that age, current smoking, body mass index, alcohol intake, triglyceride and low density lipoprotein cholesterol level have significant impact on HDL cholesterol level. In addition, educational status was also an important factor for men, while fat intake was a significant factor for women. After adjusting associated factors, the means (standard errors) of HDL cholesterol level were 43.8 (0.2) mg/dL in men and 46.3 (0.2) mg/dL in women, respectively.

Conclusion

The mean gender difference in HDL level (2.5 mg/dL) in Korean adults was, therefore, less than those observed in previous western studies.