Carr MC. The emergence of the metabolic syndrome with menopause.
J Clin Endocrinol Metab. 2003 Jun;88(6):2404-11.

Review

This particular article focuses on the metabolic changes that occurs in women once they reach menopause and the effects these changes have in terms of increasing cardiovascular risk in postmenopausal women. Atherosclerotic disease, which refers to the development of plaques within the major arteries of the body, leads to the development of not only ischaemic heart disease, but also stroke and peripheral vascular disease. Premenopausal women are generally protected from atherosclerotic disease when compared to men of similar age. However, it is known that the incidence of cardiovascular disease in women begins to increase in the years after menopause.

Thus by the age of 70 years, the incidence of cardiovascular disease in men and women is equal.

Endogenous estrogen (estrogen that a woman naturally produces) appears protective in the premenopausal years, whereas its loss in the postmenopausal years appears to lead to an increased risk of cardiovascular disease.

The metabolic syndrome is becoming an increasingly recognised occurrence of the menopausal state. It is characterised by

• the accumulation of visceral adiposity (central abdominal fat),
• insulin resistance (tendency to diabetes),
• hypertension (elevated blood pressure)
• an adverse lipid profile characterised by hypertriglyceridemia, reduced HDL-cholesterol and elevated small dense LDL particles.

These small dense LDL particles are known to be highly atherogenic (causes plaques to develop on the wall of arteries) and increase the risk for cardiovascular disease by 3 – 4 times. They also cannot be measured on routine tests for cholesterol. However, their presence can be inferred in an individual if the lipid profile reveals an elevated triglyceride level and a low level of HDL cholesterol (good cholesterol).

In the USA this syndrome is estimated to affect 20 – 30% of the middle-aged population and the prevalence is increasing with the increase prevalence of obesity and sedentary lifestyles. Menopausal status alone is associated with a 60% increased risk of the metabolic syndrome, independent of age, obesity and physical inactivity. Importantly menopause itself is not associated with an increase in obesity, rather there is a redistribution of adipose tissue (fat) centrally to the abdomen.

The most important aspect of the metabolic syndrome for menopausal women is that regardless whether a woman takes or does not take hormone therapy (HT) [also known as hormone replacement therapy (HRT)], menopausal women are at increased risk for cardiovascular disease.

Thus all postmenopausal women need to regularly attend their normal treating physician at least once a year to have an assessment of their cardiovascular risk factors, such as their

• blood pressure,
• fasting blood glucose level and
• an assessment of their lipid profile.

In addition lifestyle issues in regards to weight, diet and exercise should also be discussed.

These preventative strategies will help minimise the risk of cardiovascular disease in menopausal women.

Useful Resources

 Content updated November 11, 2003