Cardiovascular disease risk increases in women after the menopausal transition; why
this inflection point occurs remains uncertain. We aimed to characterize the influence
of menopause on vascular aging by prospective assessment of change in indexes of subclinical
atherosclerosis across the menopausal transition. We evaluated 411 healthy women from
SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation),
for subclinical atherosclerosis at baseline and again after an average of 2.3 years.
Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound.
Coronary artery calcium scores were obtained by computed tomography. Women were grouped
by menopausal status as premenopausal, postmenopausal, or having undergone the transition
during follow-up. Analyses of changes were adjusted for age at baseline and time between
scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted
in carotid intima-media thickness and log coronary artery calcium + 1 from baseline
to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was
higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more
sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical
atherosclerosis in women undergoing the menopausal transition. Serial assessment of
such changes could potentially elucidate mechanisms of disease and identify women
to target for aggressive lifestyle risk factor modification.
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Article info
Publication history
Published online: July 04, 2018
Accepted:
June 11,
2018
Received in revised form:
June 4,
2018
Received:
April 29,
2018
Footnotes
Sources of Funding: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH. SWAN Heart was supported by grants from the NHLBI (HL065581, HL065591, and HL089862). The Chicago site of the SWAN Heart study was also supported by the Charles J. and Margaret Roberts Trust.
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