Key result
HDL efflux capacity links to subclinical vascular health before menopause, but weakens after the final period.
Why the study?
Women exhibit an increase in high-density lipoprotein cholesterol efflux capacity during menopause, but whether this rise corresponds to a lower risk of cardiovascular disease over time is unclear.
Does the cardioprotective association of high-density lipoprotein cholesterol efflux capacity (HDL-CEC) with subclinical vascular health change as women transition through menopause?
Cohort (n=279)
Yes
Does the cardioprotective association of high-density lipoprotein cholesterol efflux capacity (HDL-CEC) with subclinical vascular health change as women transition through menopause?
Higher HDL cholesterol efflux capacity is associated with better subclinical vascular health before menopause, but this cardioprotective effect significantly deteriorates as women transition through menopause.
HDL-CEC's vascular association may attenuate after menopause; leaves open whether targeting CEC alters perimenopausal risk or merits trials.
BACKGROUND: Women show a rise in high-density lipoprotein cholesterol efflux capacity (CEC) as they traverse menopause. Whether this rise is associated with a lower risk of cardiovascular disease overtime is not clear. OBJECTIVES: The authors tested whether CEC association with subclinical vascular health, measured using a composite subclinical vascular health score based on levels of carotid intima-media thickness, carotid-femoral pulse wave velocity, and presence of coronary artery calcium score (>10), varies by time relative to the final menstrual period (FMP). METHODS: 279 women (baseline age 51 ± 2.8 years; 68.5% White) who had CEC and outcome measures were included. The subclinical vascular health measures were related to CEC through a Bayesian hierarchical linear mixed effects model using the latent composite measure as the outcome, and time relative to FMP, CEC, and their interaction as explanatory variables. Differences by racial subgroups were explored. RESULTS: Higher CEC was associated with a lower composite subclinical measure of vascular health at the time of the FMP. In both unadjusted and adjusted models, the inferred interaction effect (posterior probability >0.99) implies that the pre-FMP protective association of CEC diminishes after FMP. This was consistent across all components of the composite score. In Black women, the protective association of CEC diminished more rapidly compared to White women (posterior probability >0.90). CONCLUSIONS: In women, higher CEC is associated with a lower risk of subclinical vascular health only before menopause. Higher CEC is not a consistent indicator of greater cardiovascular disease protection in women traversing menopause.
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Khoudary et al. (2025) conducted a cohort in Subclinical cardiovascular disease during menopause transition (n=279). High-density lipoprotein cholesterol efflux capacity (HDL-CEC) vs. Lower HDL-CEC and time relative to final menstrual period was evaluated on Composite subclinical measure of vascular health (cIMT, cfPWV, and coronary artery calcium score >10) (interaction posterior mean 0.08, 95% CI 0.02-0.16, p=posterior probability 0.993). Higher HDL cholesterol efflux capacity was associated with a better composite measure of subclinical vascular health before menopause, but this cardioprotective association diminished significantly after the final menstrual period (adjusted interaction posterior mean 0.08).
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