Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?

OBJECTIVES This prospective study examined if changes in traditional and novel coronary heart disease (CHD) risk factors are greater within a year of the final menstrual period (FMP), relative to changes that occur before or after that interval, in a multi-ethnic cohort. BACKGROUND Understanding the influence of the menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian samples. METHODS The Study of Women’s Health across the Nation (SWAN) is a prospective study of the menopausal transition in 3302 minority (African American, Hispanic, Japanese, or Chinese) and Caucasian women. After 10 annual exams, 1054 women had achieved a FMP not due to surgery and without HT use prior to FMP. Measured CHD risk factors included lipids and lipoproteins, glucose, insulin, blood pressure, fibrinogen, and C-reactive protein. We compared which of two models provided a better fit to the observed risk factor changes over time in relation to FMP: a linear model, consistent with chronological aging, or a piece-wise linear model, consistent with ovarian aging. RESULTS Only total cholesterol, LDL-C, and apolipoprotein-B demonstrated substantial increases within the 1 year interval before and after FMP, consistent with menopause-induced changes. This pattern was similar across ethnic groups. The other risk factors were consistent with a linear model, indicative of chronological aging. CONCLUSIONS Women experience a unique rise in lipids at the time of FMP. Monitoring lipids in perimenopausal women should enhance primary prevention of CHD.