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Current Vascular Pharmacology

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ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

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Review Article

Cardiovascular Risk in Perimenopausal Women

Author(s): John C. Stevenson*, Sophia Tsiligiannis and Nick Panay

Volume 17, Issue 6, 2019

Page: [591 - 594] Pages: 4

DOI: 10.2174/1570161116666181002145340

Price: $65

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Abstract

Cardiovascular disease, and particularly coronary heart disease (CHD), has a low incidence in premenopausal women. Loss of ovarian hormones during the perimenopause and menopause leads to a sharp increase in incidence. Although most CHD risk factors are common to both men and women, the menopause is a unique additional risk factor for women. Sex steroids have profound effects on many CHD risk factors. Their loss leads to adverse changes in lipids and lipoproteins, with increases being seen in low density lipoprotein (LDL) cholesterol and triglycerides, and decreases in high density lipoprotein (HDL) cholesterol. There is a reduction in insulin secretion and elimination, but increases in insulin resistance eventually result in increasing circulating insulin levels. There are changes in body fat distribution with accumulation in central and visceral fat which links to the other adverse metabolic changes. There is an increase in the incidence of hypertension and of type 2 diabetes mellitus, both major risk factors for CHD. Oestrogens have potent effects on blood vessels and their loss leads to dysfunction of the vascular endothelium. All of these changes result from loss of ovarian function contributing to the increased development of CHD. Risk factor assessment in perimenopausal women is recommended, thereby permitting the timely introduction of lifestyle, hormonal and therapeutic interventions to modify or reverse these adverse changes.

Keywords: Perimenopause, coronary heart disease, metabolic risk factors, hypertension, diabetes mellitus, vascular function.

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[1]
Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case control study. Lancet 2004; 364: 937-52.
[2]
Witteman JCM, Grobbee DE, Kok FJ, Hofman A, Valkenburg HA. Increased risk of atherosclerosis in women after the menopause. BMJ 1989; 298: 642-4.
[3]
LaCroix AZ, Haynes SG, Savage DD, Havlik RJ. Rose questionnaire angina among United States black, white, and Mexican-American women and men. Am J Epidemiol 1989; 129: 669-86.
[4]
Hackshaw A, Morris JK, Boniface S, Tang JL, Milenkovic D. Low cigarette consumption and risk of coronary heart disease and stroke: Meta-analysis of 141 cohort studies in 55 study reports. BMJ 2018; 360: 5855.
[5]
Oliver MF, Boyd GS. Effect of bilateral ovariectomy on coronary artery disease and serum lipid levels. Lancet 1959; 2: 690-2.
[6]
Sznajderman M, Oliver MF. Spontaneous premature menopause, ischaemic heart disease and serum lipids. Lancet 1963; 1: 962-4.
[7]
Spencer CP, Godsland IF, Stevenson JC. Is there a menopausal metabolic syndrome? Gynecol Endocrinol 1997; 11: 341-55.
[8]
Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis 1993; 98: 83-90.
[9]
Anagnostis P, Stevenson JC, Crook D, Johnston DG, Godsland IF. Effects of menopause, gender and age on lipids and high-density lipoprotein cholesterol subfractions. Maturitas 2015; 81: 62-8.
[10]
Ference BA, Ginsberg HN, Graham I, et al. Lipoproteins cause atherosclerotic cardiovascular disease. 1, Evidence from genetic, epidemiologic and clinical studies. A consensus statement from the European atherosclerosis society consensus panel. Eur Heart J 2017; 38: 2450-72.
[11]
Austin MA, Breslow JL, Hennekens CH, et al. Low density lipoprotein subclass patterns and risk of myocardial infarction. JAMA 1988; 26: 1917-21.
[12]
Carr MC, Kim KH, Zambon A, et al. Changes in LDL density across the menopausal transition. J Investig Med 2000; 48: 245-50.
[13]
Di Angelantonio E, Sarwar N, Perry P, et al. Emerging risk factors collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993-2000.
[14]
McBride P. Triglycerides and risk for coronary artery disease. Curr Atheroscler Rep 2008; 10: 386-90.
[15]
Danesh J, Collins R, Peto R. Lipoprotein (a) and coronary heart disease. Meta-analysis of prospective studies. Circulation 2000; 102: 1082-5.
[16]
Anagnostis P, Karras S, Lambrinoudaki I, Stevenson JC, Goulis DG. Lipoprotein (a) in postmenopausal women: Assessment of cardiovascular risk and therapeutic options. Int J Clin Pract 2016; 70: 967-77.
[17]
Rönnemaa T, Laakso M, Pyörälä K, Kallio V, Puukka P. High fasting plasma insulin is an indicator of coronary heart disease in non-insulin-dependent diabetic patients and non-diabetic subjects. Arteriosclerosis 1991; 11: 80-90.
[18]
Ley CJ, Swan J, Godsland IF, et al. Insulin resistance, lipoproteins, body fat and hemostasis in non-obese males with angina and normal or abnormal coronary angiograms. J Am Coll Cardiol 1994; 23: 377-83.
[19]
Stout RW. Insulin and atheroma. 20-yr perspective. Diabetes Care 1990; 13: 631-54.
[20]
Båvenholm P, Proudler AJ, Tornvall P, et al. Insulin, intact and split proinsulin and coronary artery disease in young men. Circulation 1995; 92: 1422-9.
[21]
Krauss RM. The tangled web of coronary risk factors. Am J Med 1991; 90: 36-41.
[22]
Ferrannini E, Buzziogli G, Bonadonna R, et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350-7.
[23]
Juhan-Vague I, Alessi MC, Joly P, et al. Plasma plasminogen activator inhibitor 1 in angina pectoris. Influence of plasma insulin and acute-phase response. Arteriosclerosis 1989; 9: 362-7.
[24]
Stevenson JC, Lees B, Bruce R, Ley C, Crook D. Influence of body composition on lipid metabolism in postmenopausal women. In: Christiansen C, Overgaard K Eds Osteoporosis 1990,Osteopress. ApS: Copenhagen. 1990; pp. 1837-8.
[25]
Proudler AJ, Felton CV, Stevenson JC. Ageing and the response of plasma insulin, glucose and C-peptide concentrations to intravenous glucose in postmenopausal women. Clin Sci 1992; 83: 489-94.
[26]
Walton C, Godsland IF, Proudler AJ, Wynn V, Stevenson JC. The effects of the menopause on insulin sensitivity, secretion and elimination in non-obese, healthy women. Eur J Clin Invest 1993; 23: 466-73.
[27]
McCarty MF. A paradox resolved: The postprandial model of insulin resistance explains why gynoid adiposity appears to be protective. Med Hypotheses 2003; 61: 173-6.
[28]
Ley CJ, Lees B, Stevenson JC. Sex- and menopause-associated changes in body-fat distribution. Am Jof Clin Nutr 1992; 55: 950-4.
[29]
Wiinber N, Hoegholm A, Christensen HR, et al. 24-h ambulatory blood pressure in 352 normal Danish subjects, related to age and gender. Am J Hypertens 1995; 8: 978-86.
[30]
Lewington S, Clarke R, Qizilbash N, Peto R, Collions R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903-13.
[31]
Staessen J, Bulpitt CJ, Fagard R, Lijnen P, Amery A. The influence of menopause on blood pressure. J Hum Hypertens 1989; 3: 427-33.
[32]
Coylewright M, Reckelhoff JF, Ouyang P. Menopause and hypertension. Hypertension 2008; 51: 952-9.
[33]
Abbott W, Lillioja S, Young A. Relationships between plasma lipoprotein concentrations and insulin action in an obese hyperinsulinaemic population. Diabetes 1987; 36: 897-904.
[34]
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Mortality from coronary heart disease and stroke in relation to degree of glycaemia: The Whitehall study. BMJ 1983; 287: 867-70.
[35]
Park SK, Harlow SD, Zheng H, et al. Association between changes in oestradiol and folliclestimulating hormone levels during the menopausal transition and risk of diabetes. Diabet Med 2017; 34: 531-8.
[36]
Brand JS, van der Schouw YT, Onland-Moret NC, et al. InterAct Consortium. Age at menopause, reproductive life span, and type 2 diabetes risk: Results from the EPIC-InterAct study. Diabetes Care 2013; 36: 1012-9.
[37]
Shen L, Song L, Li H, et al. Association between earlier age at natural menopause and risk of diabetes in middle-aged and older Chinese women: The Dongfeng-Tongji cohort study. Diabetes Metab 2017; 43: 345-50.
[38]
Appiah D, Winters SJ, Hornung CA. Bilateral oophorectomy and the risk of incident diabetes in postmenopausal women. Diabetes Care 2014; 37: 725-33.
[39]
LeBlanc ES, Kapphahn K, Hedlin H, et al. Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: Findings from the women’s health initiative. Menopause 2017; 24: 64-72.
[40]
Gangar KF, Vyas S, Whitehead M, et al. Pulsatility index in internal carotid artery in relation to transdermal oestradiol and time since menopause. Lancet 1991; 338: 839-4.
[41]
Taddei S, Virdis A, Ghiadoni L, et al. Menopause is associated with endothelial dysfunction in women. Hypertension 1996; 28: 576-82.
[42]
Moreau KL, Hildreth KL, Meditz AL, Deane KD, Kohrt WM. Endothelial function is impaired across the stages of the menopause transition in healthy women. J Clin Endocrinol Metab 2012; 97: 4692-700.
[43]
Wingrove CS, Garr E, Pickar JH, Dey M, Stevenson JC. Effects of equine oestrogens on markers of vasoactive function in human coronary artery endothelial cells. Mol Cell Endocrinol 1999; 150: 33-7.
[44]
Wingrove CS, Stevenson JC. 17β-oestradiol inhibits stimulated endothelin release in human vascular endothelial cells. Eur J Endocrinol 1997; 137: 205-8.
[45]
Sturdee DW, Hunter MS, Maki PM, et al. The menopausal hot flush: A review. Climacteric 2017; 20: 296-305.
[46]
Collins P, Webb CM, De Villiers T, Stevenson J, Panay N, Baber R. Cardiovascular risk assessment in women - an update. Climacteric 2016; 19: 329-36.

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