Menopause is associated to an adverse lipid profile in women from the Study of Health in Pomerania

Background The menopausal transition is associated with hormonal changes that may adversely affect cardiovascular risk factors, including lipid metabolism. Previous studies have suggested that postmenopausal women tend to have higher levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC), as well as changes in triglycerides (TG) and high-density-lipoprotein cholesterol (HDL-C), compared with premenopausal women. However, it remains unclear to what extent these differences are directly related to menopausal status rather than other factors such as ethnicity, body mass index (BMI), or lifestyle. Moreover, even though some prior studies come from European or multinational cohorts, none have specifically examined German populations. Purpose We aimed to evaluate the independent association between menopausal status and lipid parameters of pre- and postmenopausal women in a population-based cohort from Germany. By doing so, we expect to generate population-specific insights that contribute to improved cardiovascular risk prediction and management strategies tailored to menopausal women. Methods We estimated the association between menopause status and lipid outcomes in women from the Study of Health in Pomerania (START-0 and TREND-0 cohorts). To minimize confounding, we applied propensity score matching based on age, BMI, smoking status, alcohol consumption, menopausal hormone therapy use, type 2 diabetes, educational level, physical activity, and systolic blood pressure. Women were matched 1:1 using nearest-neighbour matching without replacement, applying a caliper of 0.2 of the standard deviation of the logit of the propensity score. Balance between menopausal groups was assessed in the matched sample. Outcome analyses were performed using linear regression models on the matched dataset, incorporating the matching weights. Regression coefficients (β) and 95% confidence intervals (CI) were calculated for each outcome. Results After matching, 296 postmenopausal women were compared with 296 premenopausal controls with well-balanced baseline characteristics (standardized mean difference < 0.155; Figure 1). Menopause was significantly associated with higher TG (mmol/L) levels (β = 0.145; 95% CI: 0.012–0.278; p = 0.033), LDL-C (mmol/L) (β = 0.331; 95% CI: 0.180–0.483; p < 0.001), and TC (mmol/L) (β = 0.457; 95% CI: 0.287–0.627; p < 0.001) (Figure 2). No significant association was observed for HDL-C (mmol/L) (β = 0.032; 95% CI: –0.029 to 0.092; p = 0.30). Conclusion In this population-based sample, menopause was independently associated with an adverse lipid profile, characterized by substantially higher LDL-C and TC and a moderate rise in TG. These findings suggest that menopausal status may contribute to elevated cardiovascular risk and highlight the need for targeted prevention strategies in midlife German women.Differences before and after matchingFor image description, please refer to the figure legend and surrounding text. Linear regression estimatesFor image description, please refer to the figure legend and surrounding text.