Introduction: Menopause is thought to be associated with adverse cardiovascular disease (CVD) risk factors, in particular lipid levels, but risk factors also deteriorate because of natural aging.
Hypothesis: We hypothesized that menopausal status has an effect on CVD risk factors independent of age.
Methods: We used data from LifeLines, a population-based prospective cohort study in the Netherlands. Female participants aged 18-65 years old were divided into groups according to menopausal status: pre- (n=42,987), peri- (n=14,266), natural post- (n=11,175) and surgically postmenopausal (n=5,234). To assess the effect of menopausal status, we compared mean risk factor levels by menopausal status, within one-year age strata, using linear regression. We assessed the effect of age per year on mean CVD risk factor level, within each menopausal status, using linear regression and splines to check for non-linearity. Models were adjusted for oral contraceptive use, smoking status and body mass index (BMI).
Results: As expected, systolic and diastolic blood pressure (SBP, DBP), and low-density lipoprotein cholesterol (LDL-c) levels increased with age for women in each menopausal status; but high-density lipoprotein cholesterol (HDL-c) also increased. The increase of SBP with age seemed more pronounced in premenopausal women (Figure 1). SBP levels were significantly higher in premenopausal women compared to peri-, natural post- and surgically postmenopausal women. Natural and surgically postmenopausal women had significantly higher LDL-c levels compared to premenopausal women. HDL-c levels were highest in natural postmenopausal women and lowest in surgically postmenopausal women. BMI increased slightly with age, and roughly stabilized from age 45. BMI was lowest in postmenopausal women, higher for pre- and perimenopausal women and highest for surgical postmenopausal women.
Conclusions: This study provides evidence for an effect of menopausal status on CVD risk factors, independent of biological aging.