Metabolic Syndrome Severity May Be Tied to Menopausal Transition

A higher prevalence of metabolic syndrome in post-menopausal women may be related more to changes during the menopausal transition as opposed to post-menopause, according to a study published in the Journal of the American Heart Association.

Matthew J. Gurka, PhD, of the University of Florida, and colleagues recently developed a metabolic syndrome severity score that they linked to long-term risk of cardiovascular disease (CVD) and diabetes. In the current investigation, they assessed changes in the rate of metabolic syndrome progression severity during menopause in individuals who participated in the Atherosclerosis Risk in Communities (ARIC) study.

“We hypothesized that given the potential for women to have greater visceral fat after menopause (due to insufficient estrogen levels) that MetS [metabolic syndrome] would worsen more rapidly after menopause as compared to before or during pre-menopausal years,” they wrote. “Such data could clarify the timing of change in a key CVD risk factor among post-menopausal women.”

A total of 1470 women from the ARIC cohort who experienced transition in menopausal status over 10 years were included in the study. An additional 2674 post-menopausal women without diabetes and 270 women who remained pre-menopausal throughout the study were used as separate comparator groups.

Dr Gurka and colleagues noted gradual increases in metabolic syndrome severity, but African-American women in particular experienced more rapid progression in severity during the pre- and peri-menopausal periods compared to the post-menopausal periods (P<.05). The rate of increase in severity during the pre-menopausal period was also more rapid among African-American women compared to white women (P<.001).

At baseline, African American women had higher waist circumferences, systolic blood pressures, and glucose levels, and were more likely to have hypertension, but lower triglycerides. White women were more likely to be on hormone replacement therapy.  

White women also had unfavorable decreases in high-density lipoprotein (HDL) while African-American women had favorable changes in waist circumference, triglycerides, HDL, and glucose. It is important to note these differences were observed after hormone replacement therapy.

After adjustment for socio-economic variables and hormone use, African-American women continued to have a slower progression of metabolic syndrome Z-scores during the post-menopausal period relative to earlier periods. In contrast, white women experienced a decrease in the rate of metabolic syndrome progression from the peri- to post-menopausal period (0.076 to 0.062), but this decrease did not reach statistical significance. African-American women had a higher increase in metabolic syndrome severity during both pre- and peri-menopausal periods, compared to white women (P<.001 and P<.036, respectively).

When researchers utilized the comparator groups, they found that women who were post-menopausal at entry (mean age: 54 years) experienced a rate of change in metabolic syndrome severity Z-scores of 0.057 (0.052-0.062) per year for white women and 0.061 (0.053-0.069) per year for African-American women. Those women who remained pre-menopausal (mean age: 45 years) had a rate of change in severity of 0.057 (0.039-0.074) for white women and 0.115 (0.080-0.150) for African-American women.

“We were especially struck by the difference in progression of MetS severity between African American and white women,” Dr Gurak and colleagues wrote. “It is possible that the relative race/ethnicity-specific nature of this score is the reason we noted a difference between African American and white women when other analyses of MetS during menopause had failed to.”

“Further research is needed to determine whether interventions during the menopausal transition such as diet, exercise, and insulin-sensitizing medication could slow this rate of progression of MetS severity and lower risk of future disease,” they concluded.

Reference

Gurka MJ, Vishnu A, Santen RA, DeBoer MD. Progression of metabolic syndrome severity during the menopausal transition. J Am Heart Assoc. 2016. doi: 10.1161/JAHA.116.003609.