MENOPAUSE AND CARDIOVASCULAR RISK (Atena Editora)

Climacteric, 2014

To explore the cardiovascular risk attributable to menopausal status in a 9-year follow-up, population-based study. All middle-aged women who met our eligibility criteria were selected from the Tehran Lipid and Glucose Study cohort. Data were collected by face-to-face interviews, physical examination and biochemical assessments at 3-year intervals. The World Health Organization classification was used to define menopausal status. Cardiovascular events that occurred in the cohort were investigated by a panel of medical specialists. Based on menopausal status, there were no significant differences in cardiovascular disease after adjustment for age, body mass index and other confounders; however, significant relationships between serum concentrations of low density cholesterol and total cholesterol and menopausal status were observed. Menopause, independent of other cardiovascular disease risk factors, incurred cardiometabolic risk.

Current Vascular Pharmacology

This special issue of Current Vascular Pharmacology (CVP) is dedicated to the menopause. CVP provides current knowledge with regard to the treatment of vascular disease, bridging the gap between ongoing research and clinical practice. This special issue consists of updated, comprehensive and clinically-oriented reviews on the association between menopause, either occurring at a normal age or prematurely, and cardiovascular (CV) disease (CVD). Menopausal hormone therapy (MHT) is also considered. Tsiligiannis et al. [1] refer to premature ovarian insufficiency (POI, defined as age of menopause <40 years) and its longterm health consequences (such as CV, bone, psychological, neurological and fertility), as well as the ability to reverse any changes with MHT. The authors identify areas where research is needed to ensure optimal management of these patients. Perimenopause and its CV consequences are covered by Stevenson et al. [2]. The authors consider changes in CVD risk, such as dyslipidaemia, deranged glucose homeostasis, arterial hypertension and body fat redistribution, that occur as the result of the loss of ovarian function during perimenopause [2]. The pathophysiology of this cluster of metabolic abnormalities, the so called metabolic syndrome (MetS), in the postmenopausal period, is analysed by Mumusoglou and Yildiz [3]. The authors address the issue whether menopause (either early or at an expected age) has an independent effect on the risk of MetS as a whole or its individual components. They also refer to MetS-associated risks, such as type 2 diabetes mellitus (T2DM) and CVD, during menopause. The former risk is analysed by Paschou et al. [4]. The authors consider the risk factors leading to T2DM in menopausal women. They also refer to the optimal management of vasomotor symptomatology in women with T2DM, as well as to the optimal management of T2DM during menopause [4]. MHT constitutes the cornerstone of treatment of symptoms related to oestrogen deficiency (mainly vasomotor ones) [5, 6]. After the publication of the Women's Health Initiative and the ensuing scepticism regarding MHT [7], evidence during the last decade has restored our knowledge on this topic. In this context, Anagnostis et al. [8] present epidemiological data on the association between menopause and CVD risk and the effect of MHT on this risk. The authors also comment on the distinct effect in terms of oestrogen dose, route of administration, combination with progestogen, as well as the type of progestogen used. Optimal guidance with respect to MHT regimen, on an individualized basis, taking risks and benefits into consideration, is provided. In cases in which MHT is contra-indicated, a non-hormonal therapeutic strategy for the management of vasomotor symptomatology is suggested by international guidelines [5, 6]. Mareti et al. [9] refer to this alternative, widely prescribed regimen, which includes selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, clonidine and phytoestrogens. The authors comment on the risks and benefits of this therapeutic strategy.

Wiener klinische Wochenschrift, 2009

Unser Ziel war es, den Nutzen eines Screenings auf kardiovaskuläre Risikofaktoren sowie den Effekt der Anwendung professioneller Leitlinien zur Risikoreduktion bei postmenopausalen Frauen entsprechend dem Framingham und dem Hoch-Risiko "Systemic Coronary Risk Evaluation (SCORE)" zu überprüfen. Methodik: Von 18 an der Studie teilnehmenden Menopause-Kliniken in Ungarn wurden 2789 Patienten rekrutiert. Die Ärzte wurden aufgefordert, entsprechend den professionellen Leitlinien zur Primärprävention kardiovaskulärer Erkrankungen bei diesen Patienten vorzugehen. Die Patienten wurden gebeten, ein Jahr lang alle vier Monate zur Kontrolle zu erscheinen. Ergebnisse: Das mittlere Alter der Patientinnen war 56,7 ± 6,9 Jahre. Die letzte Menstruation lag im Mittel 9,2 ± 7,2 Jahre zurück. 29,4% der Patientinnen erschienen zumindest zu einer Kontrolluntersuchung. Bei der Erstuntersuchung wurden hohe (> 5 mmol/L) Gesamt-Cholesterinwerte bei 78%, hohe Triglyzeridwerte (> 1,7 mmol/L) bei 29%, ein hoher systolischer und/oder diastolischer Blutdruck (> 140/90 mmHg) bei 32%, Nüchternblutzuckerwerte > 6,1 mmol/L in 15%, sowie ein erhöhter Taillenumfang (> 88 cm) bei 85,8% der Patienten erhoben. 18,3% der Patientinnen waren und blieben Raucher. Nach 12 Monaten besserten sich alle Laborparameter und der Blutdruck signifikant. Sowohl die Beurteilung sowohl durch das Framingham System als auch durch das SCORE System ergaben eine deutliche Besserung im kardiovaskulären Risikostatus. Die Anzahl der Patientinnen mit einem metabolischem Syndrom sank bis zum Ende der Studie signifikant. Schlussfolgerungen: Ein Screening von postmenopausalen Frauen auf kardiovaskuläre Risikofaktoren, sowie die Anwendung professioneller Leitlinien zur Primärprävention kann das Risiko einer koronaren Herzerkrankung signifikant reduzieren. Die Compliance der Patientinnen, bei den Kontrollen zu erscheinen, muss aber unbedingt erhöht werden. Summary. Objective: Our aim was to evaluate the usefulness of screening for cardiovascular risk factors and the effect of applying professional guidelines for risk reduction in postmenopausal women, as judged by the Framingham and the high-risk systematic coronary risk evaluation (SCORE) methods. Methods: 18 menopause clinics in Hungary participated in the study, enrolling a total of 2789 patients. Physicians were asked to follow professional guidelines for the primary prevention of cardiovascular disease. Patients were requested to attend follow-up every four months for 12 months. Results: The mean age of the patients was 56.7 ± 6.9 years, and the time elapsed since the last menstrual period was 9.2 ± 7.2 years. Overall, 29.4% of patients attended at least one follow-up visit. At the initial visit, high total cholesterol level (> 5 mmol/l) was detected in 78% of patients, high triglyceride level (> 1.7 mmol/l) in 29%, high systolic and/or diastolic blood pressure (> 140/90 mmHg) in 32%, fasting plasma glucose level > 6.1 mmol/l in 15%. Increased waist circumference (> 88 cm) was found in 85.8% of the patients; 18.3% of the patients smoked, which did not change. After 12 months, all laboratory parameters and the blood pressure had improved significantly. Both the Framingham and SCORE systems showed a significant improvement in the cardiovascular risk status, and the rate of metabolic syndrome had decreased significantly by the end of the study. Conclusions: Screening postmenopausal women for cardiovascular risk and the application of professional guidelines for primary prevention may significantly reduce the risk of coronary artery disease in this group. Patient compliance with follow-up visits needs improvement.

American Journal of Epidemiology, 2007

After the initial report from the Women's Health Initiative estrogen-progestin trial, which found that menopausal hormone therapy was associated with an increased risk of coronary heart disease in the overall cohort (age range: 50-79 years; mean age: 63 years), researchers took a closer look at the data from this and other studies, focusing on the timing of initiation of such therapy. The results suggest that hormone therapy may have a beneficial effect on the heart if started in early menopause, when a woman's arteries are still likely to be relatively healthy, but a harmful effect if started in late menopause, when advanced atherosclerosis may be present. The implication of the timing hypothesis for clinical practice is not that recently menopausal women be given hormone therapy for coronary heart disease prevention but rather that clinicians can be reassured about cardiac risks when considering short-term use of hormone therapy for vasomotor symptom relief in such women. The reduction in vasomotor symptoms must be weighed against other risks and benefits of treatment, but coronary disease is typically not a major factor in the equation for women who are recently menopausal.

Maturitas, 1998

With many risk factors for cardiovascular disease, myocardial infarction in particular now being well defined, it becomes increasingly clear that a majority of these factors are not only age, but also gender specific. Confidential risk factors such as smoking, hypertension, diabetes mellitus, overweight and hyperlipaemia, might have a different impact in women than in men. Moreover, there are substantial clinical differences between male and female ischaemic heart disease, both as to presentation, as well as to diagnosis, therapy and prognosis. In addition to a discussion to the risk factors mentioned above, the cardioprotective actions of oestrogens will be reviewed.

Vascular Disease Prevention, 2009

Although initial experimental data and results of observational studies suggest that hormone replacement therapy (HRT) is associated with a reduction in the risk of heart disease, the results for events such as stroke or thromboembolism are less clear. Randomized secondary and primary prevention studies have found that HRT is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. Therefore, HRT therapy should not be initiated to prevent vascular disease among postmenopausal women. There are numerous explanations for the divergent findings of observational and randomized clinical trials of HRT. For example, study design and differing biological effects of HRT on vascular risk factors. The use of HRT for young postmenopausal women with moderate to severe menopausal vasomotor symptoms appears to be safe. The absolute risk of vascular event associated with HRT is low and varies depending on factors like age or years since the menopause. The presence or absence of cardiovascular risk factors determines the differences in vascular risk linked to HRT. Further studies should identify the mechanisms involved and determine whether and how different regimens of HRT influence vascular risk as well as the influence of individual patient characteristics.

Journal of Clinical Medicine

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

International Journal of Epidemiology, 2019

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the subcohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-[HR confounder and intermediate adjusted per-year decrease ¼ 1.02, 95% confidence interval (CI) ¼ 1.01-1.03, p ¼ 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HR confounder-adjusted ¼ 1.25, 95% CI ¼ 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR ¼ 1.12, 95% CI ¼ 0.96-1.29, p ¼ 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Transfusion, 2011

Objective: The presence of vasomotor menopausal symptoms (VMS) may be a marker for susceptibility to cardiovascular preventive effects of postmenopausal hormone therapy (HT). We examined whether the association between HT use and coronary heart disease (CHD) risk differed between women with and without VMS.

Maturitas, 2011

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