August 04, 2016
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Metabolic syndrome severity may increase before menopause

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Women, particularly black women, have a greater risk for metabolic syndrome and its five risk factors for CVD, stroke and diabetes before menopause rather than after menopause, according to new data published in the Journal of the American Heart Association.

“Previous research showed that, after menopause, women were at much greater risk for metabolic syndrome than before menopause began,” Mark DeBoer, MD, MSc, MCC, associate professor of pediatric endocrinology at the University of Virginia, Charlottesville, said in a press release. “This latest study indicated that the increased risk observed earlier may be related more to the changes happening as women go through menopause and less to the changes that take place after menopause.”

DeBoer and colleagues analyzed data from 1,470 women enrolled in the ARIC study to measure changes in the rate of progression of metabolic syndrome severity during the menopausal transition. Women were classified as premenopausal (menstrual period in last 2 years and no menopause), perimenopausal (menstrual period in last 2 years and in current menopause or uncertain of status) or postmenopausal (no menstrual period in last 2 years and no surgical removal of ovaries or uterus). Metabolic syndrome severity z scores were calculated during four visits over 10 years. Median follow-up was 9 years.

According to the results, women experienced a faster increase in metabolic syndrome severity during the premenopause and perimenopause periods compared with postmenopause (P < .05 for all). Black women had a greater rate of increase in severity during premenopause and perimenopause compared with white women (P < .001 and P = .036, respectively).

The rate of change in metabolic severity z scores per year was 0.057 for white premenopausal women and 0.061 for black postmenopausal women, while the rate of change was 0.057 and 0.115 for white and black premenopausal women, respectively.

Use of hormone-replacement therapy was not associated with metabolic syndrome severity during any menopause stage in this study. “We did not note differences in the rate of change in metabolic syndrome severity by current estrogen use —though we lacked data regarding dose and adherence to estrogen use, which may have further influenced any effect. Overall, however, hormone replacement did not appear to explain the racial differences in metabolic syndrome severity,” the researchers wrote.

When the researchers studied change in individual components of the metabolic syndrome, they found that black women had “more favorable” rates of change in waist circumference (P < .001), triglycerides (P < .01), HDL (P < .05) and fasting glucose (P < .05) during postmenopause compared with white women.

“We found that, both overall and particularly among [black] women in ARIC, the rate of increase in metabolic syndrome severity was rapid during the menopausal transition and decreased afterward. This most closely paralleled a rapid rise in triglyceride levels, as … had been noted in previous studies of women during menopause,” DeBoer and colleagues wrote in the study.

According to the researchers, while the mechanisms behind these findings are “unclear,” changes in estrogen levels and related action of hepatic function and adipocytes may be related.

These findings provide an opportunity to motivate women to make lifestyle changes to reduce their risk for metabolic syndrome and related diseases, DeBoer said.

“ … [T]he years transitioning to menopause may represent a ‘teachable moment,’ when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their [CVD] risk,” he said in the press release. by Tracey Romero

Disclosure: The researchers report no relevant financial disclosures.