The Metabolic Syndrome in Women

Effect of hormone replacement therapy with the anti-mineralocorticoid progestin Drospirenone compared to tibolone on endothelial function and central haemodynamics in post-menopausal women

Drospirenone (DRSP) is an antialdosterone agent with progestogenic and antiandrogenic effects. This compound, has been recently used in combination with 17β-estradiol (E2) as hormonal therapy in postmenopausal women and has been shown to exert a significant antihypertensive effect in hypertensive post-menopausal women. Aim of the present study was to compare the effect of DRSP/E2 with those of Tibolone (T) on endothelial function, arterial stiffness, and lipid profile of early postmenopausal women naïve on post-menopausal hormonal therapy. Twenty-four women met the inclusion criteria and entered the study. Women were randomized to receive either DRSP/E2 or T for 6months. Blood pressure and heart rate were similar in both groups at baseline and at the end of the study. Compared to baseline, endothelial function assessed by Reactive Hyperemia (RH) significantly improved in women receiving E2/DRSP, whereas no significant differences between baseline and follow up were detected in women receiving Tibolone. Women receiving E2/DRSP showed a significant decrease in pulse wave velocity and Augmentation Index compared to baseline while no changes were observed in women receiving Tibolone. The capacity of sera to trigger endothelial cells apoptosis in vitro measured by cell death assay was significantly reduced by E/DRSP but not by T (HFA-E 70±5,6% vs HFD-E 41±4,5%, p<0,001). In conclusion, the present study shows that the association of Estradiol and Drospirenone as hormonal replacement therapy significantly improves vascular parameters and the composition of sera relevant for vascular protection in early post-menopausal normotensive women. These effects are not shared by Tibolone.

High normotension is associated with higher metabolic syndrome risk in postmenopausal women

AIM

Cardiovascular disease and diabetes are important causes for mortality in older people. Both hypertension and prehypertension are correlated with them. Recently, health promotion and disease prevention in postmenopausal women have become an essential issue of public health policy. The present study aimed to evaluate whether the harmful effects of blood pressure (BP) could still be found in normotensive postmenopausal women (below 120/80 mmHg).

METHODS

A total of 4539 normotensive postmenopausal women aged 51 years or older, undergoing routine health examinations, were enrolled in the cross-sectional analyses. To mitigate the effect of age on BP, participants within the same age were divided into tertiles according to their systolic BP (SBP). Then, participants in the low-SBP tertile of each age stratum were pooled together to form a larger group (low-normal SBP group [LNSBP]). Similarly, the middle- and high-normal SBP were grouped accordingly (MNSBP and HNSBP). Metabolic syndrome (MetS) was considered to be a surrogate for future cardiovascular disease and diabetes.

RESULTS

The study showed that HNSBP bore a higher likelihood of having abnormal MetS components, elevated low-density lipoprotein cholesterol levels and a higher odds ratio (1.46; 95% confidence interval 1.17-1.81) for having MetS than LNSBP. In contrast, age, body mass index, fasting plasma glucose and low-density lipoprotein cholesterol were significantly related to SBP in multiple regression analysis.

CONCLUSIONS

The risk of having MetS was significantly associated with higher SBP even within normotension. Primary prevention, such as lifestyle modification, and more strict control of BP should be stressed in postmenopausal women.

The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study

OBJECTIVE

Cardiovascular disease is the first cause of mortality in women in North America. The risk of cardiovascular disease increases sharply after middle age in women, especially after menopause. The aim was to investigate changes in body composition and cardiometabolic profile throughout the menopausal transition.

METHODS

This was a 5-year observational, longitudinal study on the menopausal transition. The study included 102 premenopausal women at baseline (age, 49.9 ± 1.9 y; body mass index, 23.3 ± 2.2 kg/m). Outcome measures include menopause status, body composition by dual-energy x-ray absorptiometry (total fat mass [FM], trunk FM, and total fat-free mass), waist circumference, visceral and abdominal subcutaneous fat, fasting glucose and insulin levels, homeostasis model assessment of insulin resistance, plasma lipid levels (triglycerides, total cholesterol, and high- and low-density lipoprotein cholesterol), and resting blood pressure.

RESULTS

Repeated-measure analyses revealed significant increases for FM, percentage FM, trunk FM, visceral fat, plasma fasting glucose, and high-density lipoprotein cholesterol (0.05 > P < 0.01) and a significant decrease for plasma glucose levels after follow-up. Those who were in perimenopause or postmenopause by year 3 of the study showed a significant increase in visceral fat (P < 0.01) compared with baseline. Despite some significant changes in the metabolic profile among the menopause statuses, the women did not show any cardiometabolic deterioration by the end of the study.

CONCLUSIONS

Our results suggest that changes in body composition and fat distribution can occur in nonobese women as they go through the menopausal transition. However, these changes were not accompanied by cardiometabolic deteriorations in the present study.