In the Journals Plus

Lifestyle behaviors, race influence cardiometabolic risk during menopause transition

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November 5, 2018

Consuming a healthy diet and being physically active can lower the risk for developing metabolic syndrome during the menopause transition; however, race is also associated with likelihood for developing the condition, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

“Previous studies have largely focused on cardiovascular disease and type 2 diabetes in postmenopausal women,” Jennifer S. Lee, MD, PhD, associate professor of medicine at Stanford Medical Center and the Veteran Affairs Palo Alto Health Care System in Stanford, California, said in a press release. “This study is unique because it focuses on an earlier stage in women’s lives, the menopausal transition in midlife, to potentially prevent such diseases from occurring. Discovering which modifiable factors, like physical activity and a lower-calorie diet, are more common in midlife women who recover from metabolic syndrome, in this study, could better inform what preventive strategies to consider in women earlier in their lives.”

Lee and colleagues analyzed data from 3,003 women aged 42 to 52 years who had a menstrual period in the past 3 months at baseline, participating in the Study of Women’s Health Across the Nation (SWAN). Women completed interviews and questionnaires and provided fasting blood samples at baseline and annually. Researchers classified women as having metabolic syndrome if they had at least three of five components, including fasting triglyceride level at least 150 mg/dL; fasting HDL cholesterol level less than 50 mg/dL; fasting plasma glucose at least 100 mg/dL or on antihyperglycemic medication; waist circumference more than 88 cm (> 80 cm for ethnic Chinese or Japanese women); or systolic blood pressure at least 130 mm Hg or diastolic BP at least 85 mm Hg.

Incident metabolic syndrome was defined as the first visit in which at least three criteria for metabolic syndrome were present among women who did not have metabolic syndrome at baseline. Researchers stratified the cohort by metabolic syndrome status: women with the condition at baseline (prevalent metabolic syndrome), women who did not have metabolic syndrome at baseline and did not develop the condition during follow-up (never metabolic syndrome), women who developed metabolic syndrome during follow-up (incident metabolic syndrome), and women who had metabolic syndrome at baseline and then did not have the condition for at least two consecutive follow-up visits (recovery from metabolic syndrome).

Researchers used Cox regression models to estimate the degree to which participant characteristics were associated with increased or decreased risk for incident metabolic syndrome, as well as the three most frequent metabolic syndrome constellations and recovery from the condition.

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Within the cohort, 31% had no metabolic syndrome components, 25% had one component and 18% had two components at baseline. Among the 721 women with prevalent metabolic syndrome, 47% had three components, 31% had four components and 12% had all five components, whereas 493 women (16%) experienced incident metabolic syndrome and 1,789 women (60%) never experienced metabolic syndrome during follow-up.

Among the 721 women with prevalent metabolic syndrome at baseline, 119 women no longer had metabolic syndrome by their last follow-up visit (mean follow-up, 5 years), according to researchers, with the most common component lost being lower HDL cholesterol and the least common component lost being waist circumference.

In adjusted models, researchers found that consuming fewer kilocalories was associated with resolution of metabolic syndrome (HR = 0.96; 95% CI, 0.93-0.99), as was being physically active (HR = 0.91; 95% CI, 0.35-2.37).

Race also played a role in metabolic syndrome risk, according to researchers, with Hispanic women (HR = 1.61; 95% CI, 1.07-2.43) and black women (HR = 1.25; 95% CI, 1-1.57) having higher estimated risks for the condition vs. white women, whereas ethnic Japanese women were 27% less likely to develop the condition (HR = 0.73; 95% CI, 0.52-1.02) and ethnic Chinese women were 26% less likely to develop the condition (HR = 0.74; 95% CI, 0.51-1.06) vs. white women.

Physical activity was associated with a 60% decreased risk for developing any of the three most frequently occurring metabolic syndrome constellations, with the exception of obesity, hypertension and elevated triglycerides, whereas hormone therapy use was associated with a threefold increased risk (HR = 3.13; 95% CI, 1.56-6.31) for developing the metabolic syndrome constellation of obesity, hypertension and elevated fasting glucose, according to researchers. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.