Why menopause affects the health of your blood vessels

New research suggests that menopause is likely to increase the risk of cardiovascular disease— partially because the speed of arterial stiffening hastened before and after the last phase.

A nurse checking the heart of her patient
New research finds that menopause may increase cardiovascular risk earlier in black women than in white women.

The senior author of the study is Samar R. El Khoudary, Ph.D., an associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health in Pennsylvania, while the first author is Saad Samargandy, a doctoral candidate at the same institution.

As Samargandy and colleagues clarify, it’s no surprise that age raises the risk of cardiovascular disease.

In women, many changes in metabolism and physiology arise during menopause, including adverse changes in the carotid artery structure and an increase in blood lipid levels, waist circumference and risk of metabolic syndrome.

An additional adjustment which may affect cardiovascular health includes a shift in hormone estradiol levels occurring within 1 year of the final menstrual period.

But does the artery elasticity improve during menopause too? More precisely, does arterial stiffness— a cardiovascular disease risk factor and a vascular aging marker— also increase with menopause?

To find out, El Khoudary and the team analyzed data from one of the largest “multiethnic, multi-site longitudinal[ studies] of menopause transition physical, biological, and psychosocial shifts,” called the study of Women’s Health Across the Nation (SWAN).

The researchers published their findings in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, of the American Heart Association (AHA).

Marked increase in arterial stiffness

Between 2001 and 2003, SWAN had recruited participants. The researchers scientifically monitored 339 women for up to 12.5 years for the new study. The women were thirty-six per cent black.

The team analyzed the shift in arterial stiffness as measured by the amplitude of the carotid-femoral pulse wave— the most known indicator of arterial stiffness that measures how rapidly blood flows through the artery.

The researchers examined how this variable changed within 1 year before and after the final menstrual period for each woman, and whether the transition took place differently in black women and white women.

The scientists found that arterial stiffness increased by about 0.9 percent up to 1 year before the final menstrual period and 7.5 percent in the following year.

In fact, the team found that black women witnessed this increase in stiffness earlier than white women– that is, more than a year before their final periods.

Menopause-related cardiovascular risk

“SWAN is a valuable source of data on patterns in women’s health over several decades, and this is the latest in a long line of research by our team and others that shows the menopause transition is a very important time for heart health,” commented lead author Samargandy.

“Although our research has limitations, including the fact that a significant minority of women had their arterial stiffness assessed at only one stage, we were still able to see that major changes in the risk of cardiovascular disease occur during menopause.”

“Our work can not tell us why we see these changes during the menopause cycle,” El Khoudary says. “However we suspect that the drastic hormonal changes that follow menopause may play a role in increasing inflammation and influencing the deposition of vascular fat, a theory that we would like to test in future studies.”

“But we can say right now that women should be made aware that their cardiovascular health is likely to deteriorate as they go through menopause,” El Khoudary cautions.

“Therefore, frequent monitoring of cardiovascular risk factors may be prudent, particularly in black women, who are at even greater risk earlier in the menopausal transition.”

– Samar R. El Khoudary

The senior author continues that “Midlife is not just a phase in which women have hot flashes and experience certain menopausal symptoms.”

“This is a time when their risk of cardiovascular disease is the, as we see significant changes in their physical health in several clinical measures.”

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