Menopause Linked to Worsening Cholesterol Levels

Published in the Dec. 15/22 issue of the Journal of the American College of Cardiology, the study led by of the University of Pittsburgh's Karen Matthews, PhD demonstrated that within one year of a woman's final menstrual period, her blood levels of total cholesterol, LDL-cholesterol, and apoliprotein B, all risk factors for coronary heart disease (CHD), show a sharp increase. For total cholesterol, the average increase was about 10 mg/dL. These observations led investigators to conclude that lipid changes appear to be menopause-induced.

While earlier research has linked menopause with increases in total and LDL cholesterol, these studies were based on Caucasian women and didn't measure risk factors simultaneously with changes in menopausal status. The current study involved 1054 women of several ethnic groups, including African American, Hispanic, Japanese, Chinese, and Caucasian women. These women were enrolled at 7 U.S. sites in a study called SWAN, which stands for the Study of Women's Health Across the Nation. The researchers studied several risk factors for CHD, caused by a narrowing of the coronary arteries that feed the heart. They measured blood pressure and blood levels of lipids and lipoproteins, glucose, insulin, fibrinogen, and CRP annually for nine years. The changes in risk factors for CHD followed the same patterns for women from all the ethnic groups.

The new study suggests that even if women have previously had their lipid levels checked, they may need to have them rechecked within the year following their final menstrual period. Increased lipid levels are known to contribute to a person's risk for heart disease and stroke. A doctor will take lipid levels as well as other risk factors into account when deciding to recommend lifestyle changes and/or to prescribe lipid-lowering medication. According to the National Cholesterol Education Program, a desirable level of total cholesterol is less than 200 mg/dL and LDL-C levels are optimal below 100 mg/dL.

"Our data specifically identify the critical time period, the year immediately around the FMP, as the time of the most adverse changes in the lipid profile in all ethnic groups," the researchers write. "This study underscores the need to closely monitor lipid profiles of pre-menopausal and peri-menopausal women, and the importance of emphasizing proven lifestyle measures and therapeutic interventions before the menopause transition to counter and possibly prevent this adverse change in lipids associated with menopause itself."

Women's risk of heart disease eventually becomes similar to men's after menopause. The time of pre- and peri-menopause may be an especially critical time for women to pay more attention to lifestyle factors associated with cardiovascular risk. They may benefit if they lose weight, and keep it off, get more physical activity, and stop smoking, Matthews recently told a publication of the federal Office on Women's Health.

This study will continue to chart the changes that occur in women after menopause, such as hot flashes and associated medical problems.

Karen A. Matthews et al. Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition? J Am Coll Cardiol 2009; 54: 2366–73.

Menopause Often Means Worsening Cholesterol. U.S. Department of Health and Human Services Office of Women's Health. Available online at http://www.womenshealth.gov/news/english/633896.htm through http://www.womenshealth.gov. Posted December 11, 2009. Accessed February 2, 2010.

National Heart, Lung, Blood Institute. National Cholesterol Education Program Guidelines, Cholesterol, ATP III (online information). Available online at http://www.nhlbi.nih.gov. Accessed February 2010.