The menopausal transition is a stronger determinant of cardiovascular risk factors than chronologic age, and leisure-time physical activity may attenuate menopause-associated atherogenic changes in healthy middle-aged women, according to study results published in Frontiers in Endocrinology.

Risk for cardiovascular disease has a marked and rapid increase after the onset of menopause, and this is associated with several atherogenic changes.

The current study is part of the large-scale population-based cohort study Estrogenic Regulation of Muscle Apoptosis (ERMA), in which healthy women aged 47 to 55 years were included in both cross-sectional (886 patients) and longitudinal (193 patients) study designs. Researchers aimed to assess the differences in serum cardiovascular risk factors in premenopausal, perimenopausal, and postmenopausal women; examine changes in these risk factors over the menopausal transition; and explore the effects of leisure-time physical activity.

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Comprehensive questionnaires, laboratory visits, anthropometric measurements, and physical activity data by self-report and accelerometers were used to characterize the menopausal groups, and serum lipid profiles were analyzed to quantify cardiovascular risk.

In the cross-sectional ERMA population, serum total cholesterol concentrations were significantly higher in the postmenopausal group compared with the other groups (P <.001). Total cholesterol levels were higher in the perimenopausal group compared with the premenopausal group (P <.050). Serum low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) concentrations followed similar trends (P <.001). These trends were also seen in the longitudinal ERMA population.

Self-reported leisure-time physical activity (metabolic equivalent task [MET]-h/d) was found to be an independent predictor of serum cardiovascular risk factors. In the cross-sectional ERMA population, self-reported leisure-time physical activity was positively associated with HDL-C and negatively associated with all other measured serum cardiovascular risk markers, except for total cholesterol. The results were similar in the longitudinal ERMA population, with leisure-time physical activity being positively associated with HDL-C and negatively associated with triglyceride, LDL-C, and fasting blood glucose levels. These associations were independent of chronologic aging.

The study had several limitations, including the lack of prospective, patient-centered outcomes, such as cardiovascular event incidence or mortality. In addition, the ERMA population was comprised entirely of white women.

“Based on our findings, [leisure-time physical activity] may attenuate menopause-associated atherogenic changes in the serum [cardiovascular] risk factors of healthy middle-aged women. However, [leisure-time physical activity] does not seem to entirely offset the lipid profile changes associated with the menopausal transition,” wrote the researchers.


Karvinen S, Jergenson MJ, Hyvärinen M, et al. Menopausal status and physical activity are independently associated with cardiovascular risk factors of healthy middle-aged women: cross-sectional and longitudinal evidence. Front Endocrinol. 2019;10:589.

This article originally appeared on Endocrinology Advisor