1
|
Uddenberg ER, Safwan N, Saadedine M, Hurtado MD, Faubion SS, Shufelt CL. Menopause transition and cardiovascular disease risk. Maturitas 2024; 185:107974. [PMID: 38555760 DOI: 10.1016/j.maturitas.2024.107974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
The risk of cardiovascular disease (CVD) notably increases in the fifth decade of a woman's life, coinciding with the onset of menopause and occurring 10 years later than the similar age-related increase in men. Menopause marks a significant transition in a woman's life and is accompanied by cardiometabolic changes, including a shift in body composition, increased blood pressure, disruptions in lipoproteins, and insulin resistance. There is increasing evidence that the menopause transition is a risk factor for CVD, independent of age-related changes, especially considering that the earlier the onset of menopause, the greater is the CVD risk. Further, menopause-related symptoms such as vasomotor symptoms, sleep disturbances, and mood changes may all have a direct impact on CVD risk. In this review, we summarize the current literature regarding CVD in midlife women, focusing on the cardiometabolic changes related to ovarian aging versus chronological aging, as well as those related to specific menopause characteristics, including age, type of menopause and the use of menopause hormone therapy.
Collapse
Affiliation(s)
- Erin R Uddenberg
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Nancy Safwan
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Jacksonville, FL, United States of America; Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America; Women's Health Research Center, Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
2
|
Nasr A, Brooks MM, Barinas-Mitchell E, Orchard T, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. High-density lipoprotein metrics during midlife and future subclinical atherosclerosis in women: the SWAN HDL study. Menopause 2024; 31:567-574. [PMID: 38743910 PMCID: PMC11213666 DOI: 10.1097/gme.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The clinical utility of high-density lipoprotein cholesterol (HDL-C) in risk classification is limited, especially in midlife women. Novel metrics of HDL may better reflect this risk. We clustered a comprehensive profile of HDL metrics into favorable and unfavorable clusters and assessed how these two clusters are related to future subclinical atherosclerosis (carotid intima media thickness [cIMT], interadventitial diameter [IAD], and carotid plaque presence) in midlife women. METHODS Four hundred sixty-one women (baseline age: 50.4 [2.7] years; 272 White, 137 Black, 52 Chinese) from the Study of Women's Health Across the Nation HDL ancillary study who had baseline measures of HDL cholesterol efflux capacity (HDL-CEC), lipid contents (HDL-phospholipids [HDL-PL] and HDL triglycerides [HDL-Tg]), and HDL particle (HDL-P) distribution and size, followed by carotid ultrasound (average 12.9 [SD: 2.6] years later), were included. Using latent cluster analysis, women were clustered into a favorable (high HDL-CEC, HDL-PL, large and medium HDL-P, less HDL-Tg and small HDL-P, larger size) or an unfavorable HDL cluster (low HDL-CEC, HDL-PL, large and medium HDL-P, more HDL-Tg, and small HDL-P, smaller size) and then linked to future subclinical atherosclerosis using linear or logistic regression. RESULTS The favorable HDL cluster was associated with lower cIMT, IAD, and odds of carotid plaque presence. These associations were attenuated by body mass index, except in Chinese women where the association with cIMT persisted (0.72 [0.63, 0.83]). CONCLUSIONS The association between favorable HDL clusters and a better postmenopausal subclinical atherosclerosis profile is largely explained by body mass index; however, racial/ethnic differences may exist.
Collapse
Affiliation(s)
- Alexis Nasr
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Maria M. Brooks
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 338, Pittsburgh PA 15213
| | - Trevor Orchard
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Jeffrey Billheimer
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Norman C. Wang
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, South Tower, 3 Floor, Room 352.9, Pittsburgh PA, USA
| | - Daniel McConnell
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Daniel J. Rader
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Samar R. El Khoudary
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA
| |
Collapse
|
3
|
Farukhi Z, Manson JE. High-density lipoprotein (HDL) and subclinical atherosclerosis in midlife women: new insights into HDL biology from SWAN. Menopause 2024; 31:565-566. [PMID: 38943038 DOI: 10.1097/gme.0000000000002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
|
4
|
Ranasinghe S, Cui Y, Muhyieddeen A, Obrutu O, Wei J, Gulati M, Bittner V, Reis S, Handberg E, Pepine CJ, Merz CNB. Elevated high-density lipoprotein cholesterol and adverse outcomes in women with symptoms of ischemic heart disease. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 40:100376. [PMID: 38510502 PMCID: PMC10946010 DOI: 10.1016/j.ahjo.2024.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
Background Emerging data in the general population and those with coronary artery disease demonstrate higher risk of adverse outcomes with high (>70 mg/dL) HDL-C levels. There are limited data on the risk of adverse outcomes in women with suspected ischemic heart disease. Objective To investigate relationships between high (>70 mg/dL), average (50-70 mg/dL), and low (<50 mg/dL) HDL-C levels with major adverse cardiac events (MACE) (death, myocardial infarction, stroke, and heart failure hospitalization), and all-cause mortality in women referred for coronary angiography for suspected myocardial ischemia. Methods A total of 607 women enrolled in the Women's Ischemia Syndrome Evaluation (WISE) original cohort (NCT00000554) with available HDL-C values were included in this analysis. Associations between HDL-C level and outcomes were evaluated using both multivariate Cox proportional hazard regression and spline regression analysis. Results The mean age was 59 ± 12 years, 62 % had 3 or more cardiac risk factors, and 66 (10.9 %) had a high HDL-C. High and low HDL-C were both associated with higher MACE risk compared to average HDL-C after adjusting for demographic and clinical characteristics (HR 1.80, CI 1.03-3.14, p = 0.038; HR 1.63, CI 1.09-2.42, p = 0.016, respectively). Similarly, high, and low HDL-C were associated with higher risk of all-cause mortality (HR 3.64, CI 1.84-7.20, p < 0.001; HR 2.81, CI 1.67-4.71, p < 0.001, respectively). Conclusions High and low HDL-C levels are both independently associated with higher MACE and all-cause mortality in women with suspected ischemia undergoing coronary angiography.
Collapse
Affiliation(s)
- Sachini Ranasinghe
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Yujie Cui
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Amer Muhyieddeen
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Okezi Obrutu
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Vera Bittner
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Steven Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Eileen Handberg
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| |
Collapse
|
5
|
Clayton GL, Borges MC, Lawlor DA. The impact of reproductive factors on the metabolic profile of females from menarche to menopause. Nat Commun 2024; 15:1103. [PMID: 38320991 PMCID: PMC10847109 DOI: 10.1038/s41467-023-44459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
We explore the relation between age at menarche, parity and age at natural menopause with 249 metabolic traits in over 65,000 UK Biobank women using multivariable regression, Mendelian randomization and negative control (parity only). Older age of menarche is related to a less atherogenic metabolic profile in multivariable regression and Mendelian randomization, which is largely attenuated when accounting for adult body mass index. In multivariable regression, higher parity relates to more particles and lipids in VLDL, which are not observed in male negative controls. In multivariable regression and Mendelian randomization, older age at natural menopause is related to lower concentrations of inflammation markers, but we observe inconsistent results for LDL-related traits due to chronological age-specific effects. For example, older age at menopause is related to lower LDL-cholesterol in younger women but slightly higher in older women. Our findings support a role of reproductive traits on later life metabolic profile and provide insights into identifying novel markers for the prevention of adverse cardiometabolic outcomes in women.
Collapse
Affiliation(s)
- Gemma L Clayton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| |
Collapse
|
6
|
Wu B, Fan B, Qu Y, Li C, Chen J, Liu Y, Wang J, Zhang T, Chen Y. Trajectories of Blood Lipids Profile in Midlife Women: Does Menopause Matter? J Am Heart Assoc 2023; 12:e030388. [PMID: 37947109 PMCID: PMC10727300 DOI: 10.1161/jaha.123.030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023]
Abstract
Background It remains controversial whether changes of lipids over menopause transition (MT) are more age-related or more menopause-related. We aimed to classify women into different trajectory groups based on pattern and level of total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB), high-density lipoprotein cholesterol (HDL-C), triglyceride, and apolipoprotein A-I over the MT, as well as examine the effect of MT-related factors on lipid trajectory groups and levels. Methods and Results The cohort included 2582 subjects from the Study of Women's Health Across the Nation. Different trajectory patterns of lipids during the MT were determined using the latent class growth mixture model. The predictors of distinct blood lipids trajectory groups were determined by multiple linear regression models and multinomial logistic regression models. Women were categorized into either inverse U-shape or progressing trajectory group in each blood lipids measurement. The inverse U-shape total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, high-density lipoprotein cholesterol, log(TG), and apolipoprotein A-I trajectories showed an increasing trend before menopause but a decreasing trend after menopause. The U-shape total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B trajectories started to rise 5 years before menopause. Age at menopause, follicle-stimulating hormone, vasomotor symptoms, and estradiol predicted the shape and level of the women's lipids over the MT. Conclusions Distinct lipid trajectories were identified during the MT, and the existence of at least 1 trajectory in each lipid parameters suggested a contribution of menopause. Our study highlights the need for earlier and continuous surveillance of lipids during the MT.
Collapse
Affiliation(s)
- Bingjie Wu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Bingbing Fan
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Yanlin Qu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Chunxia Li
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jiahao Chen
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Ying Liu
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jiali Wang
- Department of Emergency and Chest Pain CenterQilu Hospital, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
- Key Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital, Shandong UniversityJinanShandongChina
| | - Tao Zhang
- Department of Biostatistics, School of Public HealthQilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
| | - Yuguo Chen
- Department of Emergency and Chest Pain CenterQilu Hospital, Shandong UniversityJinanShandongChina
- Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineQilu Hospital, Shandong UniversityJinanShandongChina
- Key Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital, Shandong UniversityJinanShandongChina
| |
Collapse
|
7
|
Vermeulen RFM, van Altena JL, Gaarenstroom KN, van Beurden M, Kieffer JK, Aaronson NK, Kenter GG, Korse CM. Impact of risk-reducing salpingo-oophorectomy on lipid determinants, HbA1c and CRP. Climacteric 2023; 26:489-496. [PMID: 37288958 DOI: 10.1080/13697137.2023.2211762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Risk-reducing salpingo-oophorectomy (RRSO) is advised before 40-45 years of age for BRCA1/2 mutation carriers. This study describes the effect of RRSO on lipid determinants, hemoglobin A1c (HbA1c) and C-reactive protein (CRP). METHODS A total of 142 women with increased risk of ovarian cancer were included, 92 premenopausal and 50 postmenopausal. Serum levels of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and total cholesterol, triglycerides, HbA1c and CRP were determined at three points in time: before (T0) and 6 weeks (T1) and 7 months (T2) following RRSO. The Hot Flush Rating Scale was administered at the same time points. RESULTS In premenopausal women, levels of HDL-cholesterol, the cholesterol ratio and HBA1c increased significantly over time, although still staying within the reference range. In this group, hot flushes increased over time (p < 0.001). In postmenopausal women, no significant changes were observed following RRSO. At T2, serum LDL-cholesterol, triglycerides, HbA1c and CRP were significantly lower in premenopausal women compared to postmenopausal women, whereas HDL was increased. CONCLUSIONS Seven months after RRSO, the lipid profile in premenopausal women had changed, although still staying within the reference range. For postmenopausal women, we did not observe any significant changes. Our results do not suggest a worsening of cardiovascular risk within 7 months of RRSO.
Collapse
Affiliation(s)
- R F M Vermeulen
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J L van Altena
- Department of Family Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - K N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - M van Beurden
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J K Kieffer
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G G Kenter
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C M Korse
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Obesity is accompanied by atherogenic dyslipidemia, a specific lipid disorder characterized by both quantitative and qualitative changes of plasma lipoproteins. The main alterations in the lipid profile include hypertriglyceridemia, reduced high-density lipoprotein (HDL) cholesterol level, and elevated small dense low-density lipoprotein (LDL) particles. Epidemiological data show that obesity is more common in women and is a frequent risk factor for reproductive disorders, metabolic complications in pregnancy, and cardiometabolic disease later in life. The aim of this narrative review is to discuss recent advances in the research of dyslipidemia in obesity, with an emphasis on female-specific disorders and cardiometabolic risk. RECENT FINDINGS The focus of current research on dyslipidemia in obesity is moving toward structurally and functionally modified plasma lipoproteins. Special attention is paid to the pro-atherogenic role of triglyceride-rich lipoproteins and their remnants. Introduction of advanced analytical techniques enabled identification of novel lipid biomarkers with potential clinical applications. In particular, proteomic and lipidomic studies have provided significant progress in the comprehensive research of HDL's alterations in obesity. Obesity-related dyslipidemia is a widespread metabolic disturbance in polycystic ovary syndrome patients and high-risk pregnancies, but is seldom evaluated with respect to its impact on future cardiometabolic health. Obesity and associated cardiometabolic diseases require a more depth insight into the quality of lipoprotein particles. Further application of omics-based techniques would enable a more comprehensive evaluation of dyslipidemia in order to reduce an excessive cardiovascular risk attributable to increased body weight. However, more studies on obesity-related female reproductive disorders are needed for this approach to be adopted in daily clinical practice.
Collapse
Affiliation(s)
- Jelena Vekic
- Department of Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, P. Box 146, 11000, Belgrade, Serbia.
| | - Aleksandra Stefanovic
- Department of Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, P. Box 146, 11000, Belgrade, Serbia
| | - Aleksandra Zeljkovic
- Department of Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, P. Box 146, 11000, Belgrade, Serbia
| |
Collapse
|
9
|
Conlon DM, Welty FK, Reyes-Soffer G, Amengual J. Sex-Specific Differences in Lipoprotein Production and Clearance. Arterioscler Thromb Vasc Biol 2023; 43:1617-1625. [PMID: 37409532 PMCID: PMC10527393 DOI: 10.1161/atvbaha.122.318247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
Therapeutic approaches to reduce atherogenic lipid and lipoprotein levels remain the most effective and assessable strategies to prevent and treat cardiovascular disease. The discovery of novel research targets linked to pathways associated with cardiovascular disease development has enhanced our ability to decrease disease burden; however, residual cardiovascular disease risks remain. Advancements in genetics and personalized medicine are essential to understand some of the factors driving residual risk. Biological sex is among the most relevant factors affecting plasma lipid and lipoprotein profiles, playing a pivotal role in the development of cardiovascular disease. This minireview summarizes the most recent preclinical and clinical studies covering the effect of sex on plasma lipid and lipoprotein levels. We highlight the recent advances in the mechanisms regulating hepatic lipoprotein production and clearance as potential drivers of disease presentation. We focus on using sex as a biological variable in studying circulating lipid and lipoprotein levels.
Collapse
Affiliation(s)
| | | | - Gissette Reyes-Soffer
- Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University College of Physicians and Surgeons
| | - Jaume Amengual
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences. University of Illinois Urbana Champaign
| |
Collapse
|
10
|
Park J, Son MK, Park HY. Substantial Lipid Increases During Menopausal Transition in Korean Middle-Aged Women. J Korean Med Sci 2023; 38:e238. [PMID: 37550806 PMCID: PMC10412034 DOI: 10.3346/jkms.2023.38.e238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/06/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Adverse lipid profiles are observed in postmenopausal women. However, there is insufficient evidence of the association between lipids and reproductive aging in Korean women. We aimed to characterize lipid changes with respect to timing relative to menopause in Korean middle-aged women. METHODS This study included 1,436 premenopausal women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models. RESULTS All lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index. During the period, high-density lipoprotein cholesterol (HDL-C) levels increased at 0.42 mg/dL per year (95% confidence interval [CI], 0.29 to 0.55 mg/dL). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72 mg/dL), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the non-HDL-C to HDL-C ratio (P < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off. CONCLUSION Women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease prevention in women.
Collapse
Affiliation(s)
- Jungeun Park
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Mi Kyoung Son
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Hyun-Young Park
- Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea.
| |
Collapse
|
11
|
Kavanagh K, Bashore AC, Davis MA, Jorgensen MJ, McClouth CJ, Beavers DA, Parks JS. Early time-restricted feeding improves high-density lipoprotein amount and function in nonhuman primates, without effects on body composition. Obesity (Silver Spring) 2023; 31 Suppl 1:75-84. [PMID: 36229981 PMCID: PMC9877107 DOI: 10.1002/oby.23564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/04/2022] [Accepted: 08/01/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Time-restricted feeding (TRF), whereby caloric intake is limited to a <12-hour window, is a potential regimen to ameliorate metabolic syndrome and cardiovascular disease (CVD) risk co-occurring with aging and with obesity. Early TRF (eTRF; early morning feeding followed by overnight fasting) times calorie consumption with hepatic circadian gene expression rhythms. Brief TRF trials demonstrate that high-density lipoprotein (HDL) cholesterol increases similar to diet/exercise interventions, which may impart beneficial CVD effects. Using a nonhuman primate (NHP) model, the efficacy of eTRF to raise HDL and increase plasma cholesterol efflux capacity (CEC) (primarily mediated by cholesterol efflux to HDL particles, a process that is inversely associated with CVD risk) was examined. METHODS Adult (8-16 years old, n = 25) and geriatric (≥17 years old) NHPs were randomized to ad libitum feeding or eTRF for 12 months, and relevant body composition, glycemic control, and plasma HDL cholesterol levels and CEC were measured. RESULTS Impaired CEC was found in geriatric NHPs. eTRF induced larger-sized HDL particles, increased HDL apolipoprotein A-1 content, lowered triglyceride concentrations, and increased plasma CEC (primarily to HDL particles) in both adult and geriatric NHPs without changes in glycemic control or body composition. CONCLUSIONS A beneficial effect of eTRF on increasing HDL CEC in NHPs was demonstrated.
Collapse
Affiliation(s)
- Kylie Kavanagh
- Department of PathologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- College of Health and MedicineUniversity of TasmaniaHobartAustralia
- Department of Internal Medicine‐Section on Molecular MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Alexander C. Bashore
- Department of Internal Medicine‐Section on Molecular MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Matthew A. Davis
- Department of Internal Medicine‐Section on Molecular MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Matthew J. Jorgensen
- Department of PathologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christopher J. McClouth
- Department of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Daniel A. Beavers
- Department of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - John S. Parks
- Department of Internal Medicine‐Section on Molecular MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| |
Collapse
|
12
|
Kostara CE, Bairaktari ET, Tsimihodimos V. Effect of Clinical and Laboratory Parameters on HDL Particle Composition. Int J Mol Sci 2023; 24:ijms24031995. [PMID: 36768319 PMCID: PMC9916693 DOI: 10.3390/ijms24031995] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The functional status of High-Density Lipoprotein (HDLs) is not dependent on the cholesterol content but is closely related to structural and compositional characteristics. We reported the analysis of HDL lipidome in the healthy population and the influence of serum lipids, age, gender and menopausal status on its composition. Our sample comprised 90 healthy subjects aged between 30 and 77 years. HDL lipidome was investigated by Nuclear Magnetic Resonance (NMR) spectroscopy. Among serum lipids, triglycerides, apoAI, apoB and the ratio HDL-C/apoAI had a significant influence on HDL lipid composition. Aging was associated with significant aberrations, including an increase in triglyceride content, lysophosphatidylcholine, free cholesterol, and a decrease in esterified cholesterol, phospholipids, and sphingomyelin that may contribute to increased cardiovascular risk. Aging was also associated with an atherogenic fatty acid pattern. Changes occurring in the HDL lipidome between the two genders were more pronounced in the decade from 30 to 39 years of age and over 60 years. The postmenopausal group displayed significant pro-atherogenic changes in HDLs compared to the premenopausal group. The influence of serum lipids and intrinsic factors on HDL lipidome could improve our understanding of the remodeling capacity of HDLs directly related to its functionality and antiatherogenic properties, and also in appropriate clinical research study protocol design. These data demonstrate that NMR analysis can easily follow the subtle alterations of lipoprotein composition due to serum lipid parameters.
Collapse
Affiliation(s)
- Christina E. Kostara
- Laboratory of Clinical Chemistry, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Eleni T. Bairaktari
- Laboratory of Clinical Chemistry, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: ; Tel.: +30-2651007362
| |
Collapse
|
13
|
El Khoudary SR, Chen X, Qi M, Derby CA, Brooks MM, Thurston RC, Janssen I, Crawford S, Lee JS, Jackson EA, Chae CU, McConnell D, Matthews KA. The independent associations of anti-Müllerian hormone and estradiol levels over the menopause transition with lipids/lipoproteins: The Study of Women's health Across the Nation. J Clin Lipidol 2023; 17:157-167. [PMID: 36517413 PMCID: PMC9974763 DOI: 10.1016/j.jacl.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The menopause transition (MT) is linked to adverse changes in lipids/lipoproteins. However, the related contributions of anti-Müllerian hormone (AMH) and estradiol (E2) are not clear. OBJECTIVE To evaluate the independent associations of premenopausal AMH and E2 levels and their changes with lipids/lipoproteins levels [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB) and apolipoprotein A-1 (apoA-1)] over the MT. METHODS SWAN participants who transitioned to menopause without exogenous hormone use, hysterectomy, or bilateral oophorectomy with data available on both exposure and outcomes when they were premenopausal until the 1st visit postmenopausal were studied. RESULTS The study included 1,440 women (baseline-age:mean±SD=47.4±2.6) with data available from up to 9 visits (1997-2013). Lower premenopausal levels and greater declines in AMH were independently associated with greater TC and HDL-C, whereas lower premenopausal levels and greater declines in E2 were independently associated with greater TG and apo B and lower HDL-C. Greater declines in AMH were independently associated with greater apoA-1, and greater declines in E2 were independently associated with greater TC and LDL-C. CONCLUSIONS AMH and E2 and their changes over the MT relate differently to lipids/lipoproteins profile in women during midlife. Lower premenopausal and/or greater declines in E2 over the MT were associated with an atherogenic lipid/lipoprotein profile. On the other hand, lower premenopausal AMH and/or greater declines in AMH over the MT were linked to higher apo A-1 and HDL-C; the later found previously to be related to a greater atherosclerotic risk after menopause.
Collapse
Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States.
| | - Xirun Chen
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States
| | - Meiyuzhen Qi
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States
| | - Carol A Derby
- Albert Einstein College of Medicine Department of Neurology and Department of Epidemiology & Public Health, Bronx, NY, United States
| | - Maria M Brooks
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States
| | - Rebecca C Thurston
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Rush Medical Center, Chicago, IL, United States
| | - Sybil Crawford
- University of Massachusetts Tan Chingfen Graduate School of Nursing at UMass Chan Medical School, Worcester, MA, United States
| | - Jennifer S Lee
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Elizabeth A Jackson
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Claudia U Chae
- Massachusetts General Hospital, Boston, MA, United States
| | - Daniel McConnell
- University of Michigan Department of Epidemiology, Ann Arbor, MI, United States
| | - Karen A Matthews
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Clinical and Translational Science Institute, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
14
|
English CJ, Lohning AE, Mayr HL, Jones M, Reidlinger DP. Interrelationships among platelet-activating factor and lipoprotein-associated phospholipase A 2 activity and traditional cardiovascular risk factors. Biofactors 2022; 49:457-471. [PMID: 36538603 DOI: 10.1002/biof.1928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Traditionally cardiovascular disease (CVD) risk has been assessed through blood lipids and inflammatory marker C-reactive protein (hsCRP). Recent clinical interest in novel pro-inflammatory markers platelet-activating factor (PAF) and lipoprotein-associated phospholipase A2 (Lp-PLA2 ) recognizes that vascular damage can exist in the absence of traditional risk factors. This cross-sectional study investigated the potential relationship between circulating PAF, Lp-PLA2 , hsCRP, and traditional risk factors for CVD. One hundred adults (49 ± 13 years, 31% male) with variable CVD risk were recruited. Fasting inflammatory markers PAF, Lp-PLA2 and hsCRP and total, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, and triglycerides were measured. Blood pressure, body mass index, and waist circumference were measured. Medical and physical activity data were self-reported. Linear and multiple regressions were performed. PAF, Lp-PLA2 , and hsCRP independently correlated with several CVD risk factors. PAF was correlated significantly with risk factors in an unexpected way; there was a medium positive correlation between PAF and HDL cholesterol (r = 0.394, p < 0.001) and medium negative correlations with Total:HDL cholesterol; (r = -0.436, p < 0.001) systolic blood pressure; (r = -0.307, p = 0.001); BMI (r = -0.381, p < 0.001); and waist circumference (r = -0.404, p < 0.001). There were large positive correlations between Lp-PLA2 and LDL (r = 0.525, p < 0.001) and non-HDL cholesterol (r = 0.508, p < 0.001). There were large positive correlations between hsCRP and Total:HDL cholesterol (r = 0.524, p < 0.001); BMI (r = 0.668, p < 0.001); and waist circumference (r = 0.676, p < 0.001). PAF, Lp-PLA2 , and hsCRP are implicated in the pathophysiology of inflammation in CVD; however, the relationships between each marker and traditional risk factors were different suggesting they may be involved in different atherogenic pathways.
Collapse
Affiliation(s)
- Carolyn J English
- Bond University, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Anna E Lohning
- Bond University, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Hannah L Mayr
- Bond University, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Mark Jones
- Institute of Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Dianne P Reidlinger
- Bond University, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| |
Collapse
|
15
|
El Khoudary SR, Nasr A. Cardiovascular Disease in Women: Does Menopause Matter? CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2022; 27:100419. [PMID: 37274015 PMCID: PMC10237361 DOI: 10.1016/j.coemr.2022.100419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It is known that the menopause transition (MT) is a complex period during a woman's life, but there has been ongoing debate on whether the increase in cardiovascular disease (CVD) during midlife is due to chronological aging or ovarian aging. The purpose of this review is to summarize the recent findings on the role of ovarian aging versus chronological aging on cardiovascular disease (CVD) outcomes and its risk factors in women. Recent data from longitudinal studies have shown that menopause-related factors, such as earlier age at menopause and surgical menopause are associated with higher CVD outcomes. The MT is also associated with detrimental changes in vascular health as well as cardiometabolic risk factors including body composition, visceral fat accumulation, lipids/lipoproteins, blood pressure and the metabolic syndrome. The robust evidence from recent research indicating increases in CVD risk over the MT beyond aging call for immediate efforts to rise awareness among women and their health care providers of CVD risk acceleration accompanying the MT. Efforts should also be directed toward developing and testing novel preventive approaches that target women during this time period to counteract the expected increase in CVD risk.
Collapse
Affiliation(s)
- Samar R. El Khoudary
- Department of Epidemiology School of Public Health at the University of Pittsburgh, Pittsburgh, PA
| | - Alexis Nasr
- Department of Epidemiology School of Public Health at the University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
16
|
Nasr A, Matthews KA, Brooks MM, Barinas‐Mitchell E, Orchard T, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. Early Midlife Cardiovascular Health Influences Future HDL Metrics in Women: The SWAN HDL Study. J Am Heart Assoc 2022; 11:e026243. [PMID: 36285790 PMCID: PMC9673623 DOI: 10.1161/jaha.122.026243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
Background Utility of high-density lipoprotein cholesterol (HDL-C) in assessing the antiatherogenic properties of HDL may be limited in midlife women. Novel metrics of HDL function, lipid contents, and subclasses may better reflect the atheroprotective capacities of HDL, supporting the need to evaluate how cardiovascular health affects these metrics in women. We assessed the relationship of early midlife Life's Simple 7 (LS7) score and its health behavior components with future HDL function (HDL-cholesterol efflux capacity), HDL-phospholipid, HDL-triglyceride, HDL particles (HDL-P) and size, and the relationship between LS7 score and changes in HDL metrics over time. Methods and Results We analyzed 529 women (baseline age: 46.4 [2.6] years, 57% White) from the SWAN HDL (Study of Women's Health Across the Nation HDL) study who had baseline LS7 followed by future repeated HDL metrics. Multivariable linear mixed models were used. Higher LS7 score was associated with favorable future HDL profile (higher HDL-phospholipid, total HDL-P and large HDL-P, lower HDL-triglyceride, and larger overall HDL size). Ideal body mass index was associated with higher HDL-cholesterol efflux capacity, HDL-phospholipid, and large HDL-P, lower HDL-triglyceride and small HDL-P, and larger overall HDL size. Ideal physical activity was associated with higher HDL-phospholipid, and total, large, and medium HDL-P. Ideal smoking was associated with less HDL-triglycerides. Diet was not related to HDL metrics. Higher LS7 score and ideal body mass index were associated with slower progression of HDL size over time. Conclusions Novel HDL metrics may better reflect the clinical utility of HDL. Improving lifestyle at midlife, particularly maintaining ideal body mass index, is associated with better future HDL phenotype.
Collapse
Affiliation(s)
- Alexis Nasr
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Karen A. Matthews
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Maria M. Brooks
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Emma Barinas‐Mitchell
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Trevor Orchard
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Jeff Billheimer
- Departments of Medicine and GeneticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Norman C. Wang
- Division of Cardiology, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Dan McConnell
- Department of EpidemiologyUniversity of MichiganAnn ArborMI
| | - Daniel J. Rader
- Departments of Medicine and GeneticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Samar R. El Khoudary
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| |
Collapse
|
17
|
El Khoudary SR, Chen X, McConnell D, Brooks MM, Billheimer J, Orchard TJ. Associations of HDL subclasses and lipid content with complement proteins over the menopause transition: The SWAN HDL ancillary study: HDL and complement proteins in women. J Clin Lipidol 2022; 16:649-657. [PMID: 35987805 PMCID: PMC11218699 DOI: 10.1016/j.jacl.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The menopause transition (MT) could trigger low-grade chronic inflammation which may modify high-density lipoproteins (HDL) and lead to additional inflammatory responses contributing to atherosclerosis development. OBJECTIVE To test whether complement proteins C3 and C4 increase around the final menstrual period (FMP), and whether changes in HDL subclasses and lipid content associate with C3 and C4 levels over time in midlife women. METHODS The study included 471 women (at baseline: age 50.2(2.7) years; 87.3% pre or peri-menopausal) who had nuclear magnetic resonance spectroscopy HDL subclasses, lipid content, and C3 and C4 measured up to 5 times over the MT. RESULTS Adjusted annual changes in C3 and C4 varied by time segments relative to FMP with significant increases, steeper for C3, only observed within 1 year before to 2 years after the FMP. Greater decreases in large HDL particles (HDL-P), HDL size, and HDL-phospholipids, and greater increases in small HDL-P and HDL-Triglycerides were associated with higher C3 and C4 over time, although associations with C4 were weaker than those with C3. CONCLUSION Complement proteins C3 and C4 significantly rise around menopause with C3 showing the steepest rise. Changes in HDL subclasses, overall size, and lipid content, over the MT may play a role in modulating inflammation responses known to be related to atherosclerosis. These results raise the possibility that novel therapeutic agents focusing on HDL might contribute to CVD protection by modulating inflammation.
Collapse
Affiliation(s)
- Samar R El Khoudary
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA (Drs Khoudary, Chen, Brooks, and Orchard).
| | - Xirun Chen
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA (Drs Khoudary, Chen, Brooks, and Orchard).
| | - Dan McConnell
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA (Dr McConnell).
| | - Maria M Brooks
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA (Drs Khoudary, Chen, Brooks, and Orchard).
| | - Jeff Billheimer
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA (Dr Billheimer).
| | - Trevor J Orchard
- University of Pittsburgh School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA (Drs Khoudary, Chen, Brooks, and Orchard).
| |
Collapse
|
18
|
Abrahams C, Woudberg NJ, Lecour S. Anthracycline-induced cardiotoxicity: targeting high-density lipoproteins to limit the damage? Lipids Health Dis 2022; 21:85. [PMID: 36050733 PMCID: PMC9434835 DOI: 10.1186/s12944-022-01694-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022] Open
Abstract
Doxorubicin (DOX) is an anthracycline antibiotic frequently used against a wide range of cancers, including breast cancer. Although the drug is effective as a treatment against cancer, many patients develop heart failure (HF) months to years following their last treatment with DOX. The challenge in preventing DOX-induced cardiotoxicity is that symptoms present after damage has already occurred in the myocardium. Therefore, early biomarkers to assess DOX-induced cardiotoxicity are urgently needed. A better understanding of the mechanisms involved in the toxicity is important as this may facilitate the development of novel early biomarkers or therapeutic approaches. In this review, we discuss the role of high-density lipoprotein (HDL) particles and its components as possible key players in the early development of DOX-induced cardiotoxicity. HDL particles exist in different subclasses which vary in composition and biological functionality. Multiple cardiovascular risk factors are associated with a change in HDL subclasses, resulting in modifications of their composition and physiological functions. There is growing evidence in the literature suggesting that cancer affects HDL subclasses and that healthy HDL particles enriched with sphingosine-1-phosphate (S1P) and apolipoprotein A1 (ApoA1) protect against DOX-induced cardiotoxicity. Here, we therefore discuss associations and relationships between HDL, DOX and cancer and discuss whether assessing HDL subclass/composition/function may be considered as a possible early biomarker to detect DOX-induced cardiotoxicity.
Collapse
Affiliation(s)
- Carmelita Abrahams
- Cardioprotection Group, Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7935, South Africa
| | - Nicholas J Woudberg
- Cardioprotection Group, Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7935, South Africa
| | - Sandrine Lecour
- Cardioprotection Group, Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7935, South Africa.
| |
Collapse
|
19
|
Karppinen JE, Törmäkangas T, Kujala UM, Sipilä S, Laukkanen J, Aukee P, Kovanen V, Laakkonen EK. Menopause modulates the circulating metabolome: evidence from a prospective cohort study. Eur J Prev Cardiol 2022; 29:1448-1459. [PMID: 35930503 DOI: 10.1093/eurjpc/zwac060] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
AIMS We studied the changes in the circulating metabolome and their relation to the menopausal hormonal shift in 17β-oestradiol and follicle-stimulating hormone levels among women transitioning from perimenopause to early postmenopause. METHODS AND RESULTS We analysed longitudinal data from 218 Finnish women, 35 of whom started menopausal hormone therapy during the study. The menopausal transition was monitored with menstrual diaries and serum hormone measurements. The median follow-up was 14 months (interquartile range: 8-20). Serum metabolites were quantified with targeted nuclear magnetic resonance metabolomics. The model results were adjusted for age, follow-up duration, education, lifestyle, and multiple comparisons. Menopause was associated with 85 metabolite measures. The concentration of apoB (0.17 standard deviation [SD], 99.5% confidence interval [CI] 0.03-0.31), very-low-density lipoprotein triglycerides (0.25 SD, CI 0.05-0.45) and particles (0.21 SD, CI 0.05-0.36), low-density lipoprotein (LDL) cholesterol (0.17 SD, CI 0.01-0.34) and particles (0.17 SD, CI 0.03-0.31), high-density lipoprotein (HDL) triglycerides (0.24 SD, CI 0.02-0.46), glycerol (0.32 SD, CI 0.07-0.58) and leucine increased (0.25 SD, CI 0.02-0.49). Citrate (-0.36 SD, CI -0.57 to -0.14) and 3-hydroxybutyrate concentrations decreased (-0.46 SD, CI -0.75 to -0.17). Most metabolite changes were associated with the menopausal hormonal shift. This explained 11% and 9% of the LDL cholesterol and particle concentration increase, respectively. Menopausal hormone therapy was associated with increased medium-to-large HDL particle count and decreased small-to-medium LDL particle and glycine concentration. CONCLUSIONS Menopause is associated with proatherogenic circulating metabolome alterations. Female sex hormones levels are connected to the alterations, highlighting their impact on women's cardiovascular health.
Collapse
Affiliation(s)
- Jari E Karppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Internal Medicine, Central Finland Health Care District, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pauliina Aukee
- Department of Obstetrics and Gynecology, Pelvic Floor Research and Therapy Unit, Central Finland Health Care District, Jyväskylä, Finland
| | - Vuokko Kovanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
20
|
Lipoprotein subfractions and subclinical vascular health in middle aged women: does menopause status matter? Menopause 2022; 29:911-919. [PMID: 35819840 PMCID: PMC9339472 DOI: 10.1097/gme.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During midlife, women experience changes in lipoprotein profiles and deterioration in vascular health measures. We analyzed the associations of groups of lipoprotein subfractions as determined by principal component analysis (PCA) with subclinical vascular health measures in midlife women and tested if these associations were modified by menopause status. METHODS PCA was used to generate principal components (PCs) from 12 lipoprotein subfractions quantified among 545 midlife women. The associations of the identified PCs and concurrent vascular health measures were assessed using linear or logistic regressions among participants with carotid intima-media thickness (cIMT; n = 259), coronary artery calcium (n = 249), or aortic calcium (n = 248) scores. RESULTS PCA generated four PCs representing groups of (1) small, medium, and large very low-density lipoproteins subclasses-very low-density lipoprotein PC; (2) very small, small, and medium low-density lipoprotein (LDL) subclasses-small-medium LDL-PC; (3) large and small high-density lipoproteins subclasses and midzone particles-high-density lipoprotein PC; and (4) large LDL and small intermediate-density lipoproteins-large LDL-PC. Small-medium LDL-PC was positively associated with cIMT, coronary artery calcium, and aortic calcium in unadjusted but not in adjusted models. Menopause status modified the positive association of the small-medium LDL-PC with cIMT (interaction P = 0.02) such that this association was stronger after versus before menopause (P = 0.01). CONCLUSIONS Carotid intimal medial thickening is positively and independently associated with small- and medium-sized LDL particles after menopause. Monitoring levels of specific lipoprotein fractions may have value in identifying midlife women at risk for developing atherosclerotic vascular disease.
Collapse
|
21
|
Hernández-Vásquez A, Vargas-Fernández R. Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles among Adults in Peru: Findings from a Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137867. [PMID: 35805525 PMCID: PMC9265298 DOI: 10.3390/ijerph19137867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022]
Abstract
Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.
Collapse
Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence:
| | | |
Collapse
|
22
|
Nasr A, Matthews K, Janssen I, Brooks MM, Barinas-Mitchell E, Orchard TJ, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. Associations of Abdominal and Cardiovascular Adipose Tissue Depots With HDL Metrics in Midlife Women: the SWAN Study. J Clin Endocrinol Metab 2022; 107:e2245-e2257. [PMID: 35298649 PMCID: PMC9113818 DOI: 10.1210/clinem/dgac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT The menopause transition is accompanied by declines in the atheroprotective features of high-density lipoprotein (HDL), which are linked to deleterious cardiovascular (CV) outcomes. OBJECTIVE This work aimed to assess the relationship between abdominal and CV visceral adipose tissues (VAT) with future HDL metrics in midlife women, and the role of insulin resistance (IR) on these associations. METHODS Temporal associations compared abdominal and CV fat with later measures of HDL metrics. This community-based cohort comprised 299 women, baseline mean age 51.1 years (SD: 2.8 years), 67% White, 33% Black, from the Study of Women's Health Across the Nation (SWAN) HDL ancillary study. Exposures included volumes of abdominal VAT, epicardial AT (EAT), paracardial AT (PAT), or perivascular AT (PVAT). Main outcomes included HDL cholesterol efflux capacity (HDL-CEC); HDL phospholipids (HDL-PL), triglycerides (HDL-Tgs), and cholesterol (HDL-C); apolipoprotein A-I (ApoA-I), and HDL particles (HDL-P) and size. RESULTS In multivariable models, higher abdominal VAT was associated with lower HDL-CEC, HDL-PL, HDL-C, and large HDL-P and smaller HDL size. Higher PAT was associated with lower HDL-PL, HDL-C, and large HDL-P and smaller HDL size. Higher EAT was associated with higher small HDL-P. Higher PVAT volume was associated with lower HDL-CEC. The Homeostatic Model Assessment of Insulin Resistance partially mediated the associations between abdominal AT depots with HDL-CEC, HDL-C, large HDL-P, and HDL size; between PVAT with HDL-CEC; and PAT with HDL-C, large HDL-P, and HDL size. CONCLUSION In midlife women, higher VAT volumes predict HDL metrics 2 years later in life, possibly linking them to future CV disease. Managing IR may preclude the unfavorable effect of visceral fat on HDL metrics.
Collapse
Affiliation(s)
- Alexis Nasr
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Karen Matthews
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Billheimer
- Departments of Medicine and Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Norman C Wang
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dan McConnell
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Rader
- Departments of Medicine and Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
23
|
O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O, Smith GN, Rich-Edwards JW, Garovic VD, El Khoudary SR, Honigberg MC. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ Res 2022; 130:652-672. [PMID: 35175837 PMCID: PMC8870397 DOI: 10.1161/circresaha.121.319895] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.
Collapse
Affiliation(s)
- Anna C. O’Kelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane V. Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Margo B. Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA,Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH,The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA,Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
24
|
El Khoudary SR, Nasr A, Billheimer J, Brooks MM, McConnell D, Crawford S, Orchard TJ, Rader DJ, Matthews KA. Associations of Endogenous Hormones With HDL Novel Metrics Across the Menopause Transition: The SWAN HDL Study. J Clin Endocrinol Metab 2022; 107:e303-e314. [PMID: 34390340 PMCID: PMC8684446 DOI: 10.1210/clinem/dgab595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 01/28/2023]
Abstract
CONTEXT Novel metrics of high-density lipoprotein (HDL) (subclasses, lipid content, and function) may improve characterization of the anti-atherogenic features of HDL. In midlife women, changes in these metrics vary by time relative to the final menstrual period (FMP), supporting a contribution of estradiol (E2) and follicle-stimulating hormone (FSH). OBJECTIVE We tested associations of endogenous E2 and FSH with novel HDL metrics and assessed whether these associations varied by time relative to FMP. METHODS This study was a longitudinal analysis from the Study of Women's Health Across the Nation (SWAN) HDL study, using a community-based cohort of 463 women, baseline mean age 50.2 (2.7) years. The main outcome measures were HDL cholesterol efflux capacity (HDL-CEC), HDL phospholipids (HDL-PL), HDL triglycerides (HDL-Tg), HDL particles (HDL-P), HDL size, and HDL cholesterol (HDL-C). RESULTS In multivariable analyses, E2 was positively associated with HDL size, large HDL-P, HDL-CEC, and HDL-Tg, but negatively with medium HDL-P (P values < 0.05). The positive association between E2 and HDL-Tg was stronger 2 years post-FMP than before, (interaction P = 0.031). FSH was positively related to total and medium HDL-P, but negatively to HDL size, large HDL-P, and HDL-CEC per particle (P values < 0.05). Associations of higher FSH with greater total HDL-P and smaller HDL size were only evident at/after menopause (interaction P values < 0.05). CONCLUSION Some of the associations linking E2 and FSH with novel HDL metrics were vulnerable to time relative to menopause onset. Whether a late initiation of hormone therapy relative to menopause could have a detrimental effect on lipid content of HDL particles should be tested in the future.
Collapse
Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
- Correspondence: Samar R. El Khoudary, PhD, MPH, FAHA, Associate Professor of Epidemiology, Clinical and Translational Science Institute, Epidemiology Data Center, 4420 Bayard Street, Suite 600, Pittsburgh, PA, 15260, USA.
| | - Alexis Nasr
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Jeffrey Billheimer
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Dan McConnell
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Daniel J Rader
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Karen A Matthews
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| |
Collapse
|
25
|
Zhang W, Jin J, Zhang H, Zhu Y, Dong Q, Sun J, Guo Y, Dou K, Xu R, Li J. The value of HDL subfractions in predicting cardiovascular outcomes in untreated, diabetic patients with stable coronary artery disease: An age- and gender-matched case-control study. Front Endocrinol (Lausanne) 2022; 13:1041555. [PMID: 36714594 PMCID: PMC9877453 DOI: 10.3389/fendo.2022.1041555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The aim of the present study was to examine the value of high-density lipoprotein (HDL) subfractions for predicting cardiovascular events (CVEs) in untreated type 2 diabetes mellitus (T2DM) patients with stable coronary artery disease (SCAD) using an age- and gender-matched case-control study. METHODS In total, 185 SCAD patients and 185 T2DM patients with SCAD were enrolled and subjected to a clinical follow-up of CVEs. HDL subfractions were analyzed using the Quantimetrix Lipoprint System. The relationship between HDL subfractions and CVEs in T2DM patients with SCAD was evaluated by Kaplan-Meier analysis and Cox proportional hazard models. RESULTS During a median 37.7-month follow-up, T2DM patients with SCAD had a higher percentage of CVEs compared to SCAD patients (p=0.039). The concentration of the combined intermediate and small HDL-C subfraction (defined as the mixed HDL subfraction) was related to the event incidence in T2DM patients with SCAD (p=0.004), and it was positively associated with increased CVEs even after adjustment in three models. Kaplan-Meier curve analysis indicated that T2DM patients with SCAD in the high mixed HDL subfraction group (>28 mg/dL) had lower event-free survival rates (p=0.008). CONCLUSIONS Elevated concentration of the mixed HDL subfraction concentration predicts events in T2DM patients with SCAD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Ruixia Xu
- *Correspondence: Ruixia Xu, ; JianJun Li,
| | - JianJun Li
- *Correspondence: Ruixia Xu, ; JianJun Li,
| |
Collapse
|
26
|
Matthews KA, Chen X, Barinas‐Mitchell E, Brooks MM, Derby CA, Harlow S, Jackson EA, Thurston RC, El Khoudary SR. Age at Menopause in Relationship to Lipid Changes and Subclinical Carotid Disease Across 20 Years: Study of Women's Health Across the Nation. J Am Heart Assoc 2021; 10:e021362. [PMID: 34482713 PMCID: PMC8649503 DOI: 10.1161/jaha.121.021362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Younger age at final menstrual period (FMP) is associated with increased risk for cardiovascular disease events. This paper evaluated whether older age at FMP is associated with more favorable patterns of lipid changes during the menopause transition and whether these changes are associated with less subclinical carotid disease in the postmenopausal years. Methods and Results Lipids and lipoproteins were measured repeatedly among 1554 premenopausal women who had a natural menopause during follow-up years (median=18.8 years); a subset of 890 women also had measures of carotid intima media thickness, adventitial diameter, and plaque. Women who had an older FMP age had less adverse changes in cholesterol from 1 to 3 years after FMP, and in triglycerides from FMP to 3 years after FMP, but they had more adverse changes in ApoB and Apo A1 from 3 years before to 1 year after the FMP. Increasing cholesterol and ApoB from 1 to 3 years after FMP were associated with greater intima media thickness and adventitial diameter, and the greater likelihood of a plaque score >2 the older the age at FMP. Conclusions Despite the epidemiological literature showing early age at FMP is associated with elevated risk for cardiovascular disease events, older age at FMP had inconsistent associations with less adverse lipid changes in midlife, which did not translate into less risk for subclinical carotid disease and in some cases more risk. These findings are restricted to women who experience FMP in the normative age range for the menopausal transition.
Collapse
Affiliation(s)
- Karen A. Matthews
- Department of PsychiatryUniversity of PittsburghPA,Department of EpidemiologyUniversity of PittsburghPA
| | - Xirun Chen
- Department of EpidemiologyUniversity of PittsburghPA
| | | | | | - Carol A. Derby
- Departments of Neurology, and of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Sioban Harlow
- Department of EpidemiologyUniversity of MichiganAnn ArborMI
| | - Elizabeth A. Jackson
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of AlabamaBirminghamAL
| | - Rebecca C. Thurston
- Department of PsychiatryUniversity of PittsburghPA,Department of EpidemiologyUniversity of PittsburghPA
| | | |
Collapse
|
27
|
Associations of HDL metrics with coronary artery calcium score and density among women traversing menopause. J Lipid Res 2021; 62:100098. [PMID: 34303684 PMCID: PMC8385165 DOI: 10.1016/j.jlr.2021.100098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022] Open
Abstract
The cardioprotective association of high-density lipoprotein cholesterol (HDL-C) may vary by menopause stage or estradiol level. We tested whether associations of comprehensive HDL metrics (HDL subclasses, phospholipid and triglyceride content, and HDL cholesterol efflux capacity [HDL-CEC]) with coronary artery calcium (CAC) score and density vary by menopause stage or estradiol level in women transitioning through menopause. Participants (N = 294; mean age [SD]: 51.3 [2.9]) had data on HDL metrics and CAC measures at one or two time points during the menopause transition. Generalized estimating equations were used for analyses. Effect modifications by menopause stage or estradiol level were tested in multivariable models. In adjusted models, menopause stage modified the associations of specific HDL metrics with CAC measures. Higher small HDL particles (HDL-P) concentrations (p-interaction = 0.008) and smaller HDL size (p-interaction = 0.02) were associated with greater odds of CAC presence in late perimenopause than in pre/early perimenopause stage. Women in the highest estradiol tertile, but not the lower tertiles, showed a protective association of small HDL-P with CAC presence (p-interaction = 0.007). Lower large HDL-P concentrations (p-interaction = 0.03) and smaller HDL size (p-interaction = 0.03) were associated with lower CAC density in late perimenopause than in postmenopause stage. Associations of HDL phospholipid and triglyceride content and HDL-CEC with CAC measures did not vary by menopause stage or estradiol level. We concluded that HDL subclasses may impact the likelihood of CAC presence and the stability of coronary plaque differently over the menopause transition. Endogenous estradiol levels may contribute to this observation.
Collapse
|