The Concept of CMR

Metabolic consequences of adipose tissue redistribution after menopause

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Figure 2: Development of an atherogenic profile associated with menopause-related gain in intra-abdominal adiposity

Figure 2: Development of an atherogenic profile associated with menopause-related gain in intra-abdominal adiposity

As mentioned above, women generally accumulate more intra-abdominal adipose tissue as they go through menopause. It is unclear whether menopause is a cardiovascular risk factor for all women or only for those with the android pattern of adipose tissue distribution. However, it is well established that increasing intra-abdominal adipose tissue is one of the most prevalent manifestations of a cluster of abnormalities referred to as the metabolic syndrome, which predicts an increased cardiovascular disease risk (23). Some atherogenic metabolic changes associated with menopause are illustrated in Figure 2.

There is some debate about whether menopause increases the risk of cardiovascular disease independent of normal ageing (2, 24, 25). However, postmenopausal women have higher total cholesterol, increased LDL cholesterol and triglyceride as well as lower HDL (increased HDL₃ and decreased HDL₂) cholesterol levels than pre-menopausal women (26, 27). High levels of HDL₂ cholesterol appear to be responsible for the cardioprotective effect of HDL cholesterol. Substantial changes in LDL concentrations occur early in the transition from pre-menopause to post-menopause (28). The proportion of small, dense LDL particles also increases in women during this period (29). Menopause is therefore associated with the development of an atherogenic lipoprotein-lipid profile, which may raise coronary heart disease risk in post-menopausal women.

Reference

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28. Matthews KA, Kuller LH, Sutton-Tyrrell K, et al. Changes in cardiovascular risk factors during the perimenopause and postmenopause and carotid artery atherosclerosis in healthy women. Stroke 2001; 32: 1104-11.

29. Campos H, McNamara JR, Wilson PW, et al. Differences in low density lipoprotein subfractions and apolipoproteins in premenopausal and postmenopausal women. J Clin Endocrinol Metab 1988; 67: 30-5.

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