PDF
ePub
Citation
Print
Abstract
Metabolic syndrome (MS) in women, which is characterized with central obesity, insulin resistance, and dyslipidemia, is associated with high risk of cardiovascular disease (CVD) and diabetes. Menopause may be related with the prevalence of MS and increased CVD risk through effects on central obesity, lipid metabolism, and prothrombotic state. The emergence of these risk factors may be a direct result from the failure of estrogen production. Alternatively, metabolic changes with estrogen deficiency may be the indirect cause of those risks. Additionally, most women may have a few chances of developing MS during their life, such as pregnancy-related weight gain, hormonal contraceptive use and polycystic ovary syndrome. Therefore, it is difficult to conclude that menopause itself can be the cause of MS. Representative managements of MS are life style modification and use of lipid lowering medication. This article will review the relationship between the development of MS and menopause. A better understanding on the metabolic changes with menopause will help identify women with risk factors of CVD and provide appropriate interventions
Figures and Tables
Fig. 1
Women's Health Initiative CEE/MPA study graph of incidence of diabetes with time. CEE/MPA: conjugated equine estrogen/medroxyprogesterone acetate, CI: confidence interval, HR: hazard ratio.
References
1. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988. 37:1595–1607.
2. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998. 15:539–553.
3. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.
4. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome--a new worldwide definition. Lancet. 2005. 366:1059–1062.
5. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005. 112:2735–2752.
6. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002. 287:356–359.
7. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2003. 163:427–436.
8. Kim SM, Kim SH, Lee JR, Jee BC, Ku SY, Suh CS, et al. The effects of hormone therapy on metabolic risk factors in postmenopausal Korean women. Climacteric. 2011. 14:66–74.
9. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006. 295:1549–1555.
10. Legato MJ, Gelzer A, Goland R, Ebner SA, Rajan S, Villagra V, et al. Gender-specific care of the patient with diabetes: review and recommendations. Gend Med. 2006. 3:131–158.
11. LaRosa JC. Triglycerides and coronary risk in women and the elderly. Arch Intern Med. 1997. 157:961–968.
12. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996. 275:1557–1562.
13. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995. 25:305–313.
14. Verdecchia P, Palatini P, Schillaci G, Mormino P, Porcellati C, Pessina AC. Independent predictors of isolated clinic ('white-coat') hypertension. J Hypertens. 2001. 19:1015–1020.
15. Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo Study. Diabetes Care. 1998. 21:1236–1239.
16. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002. 100:245–252.
17. Cohen A, Pieper CF, Brown AJ, Bastian LA. Number of children and risk of metabolic syndrome in women. J Womens Health (Larchmt). 2006. 15:763–773.
18. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005. 294:2601–2610.
19. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002. 25:1862–1868.
20. Di Cianni G, Lencioni C, Volpe L, Ghio A, Cuccuru I, Pellegrini G, et al. C-reactive protein and metabolic syndrome in women with previous gestational diabetes. Diabetes Metab Res Rev. 2007. 23:135–140.
21. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003. 14:368–374.
22. Solomon CG, Seely EW. Hypertension in pregnancy. Endocrinol Metab Clin North Am. 2006. 35:157–171.
23. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2006. 65:137–145.
24. Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest. 2006. 29:270–280.
25. Crawford SL, Casey VA, Avis NE, McKinlay SM. A longitudinal study of weight and the menopause transition: results from the Massachusetts Women's Health Study. Menopause. 2000. 7:96–104.
26. Ferrara CM, Lynch NA, Nicklas BJ, Ryan AS, Berman DM. Differences in adipose tissue metabolism between postmenopausal and perimenopausal women. J Clin Endocrinol Metab. 2002. 87:4166–4170.
27. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003. 349:523–534.
28. Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002. 288:49–57.
29. Kannel WB, Cupples LA, Ramaswami R, Stokes J 3rd, Kreger BE, Higgins M. Regional obesity and risk of cardiovascular disease; the Framingham Study. J Clin Epidemiol. 1991. 44:183–190.
30. Despres JP. Abdominal obesity as important component of insulin-resistance syndrome. Nutrition. 1993. 9:452–459.
31. Poehlman ET, Toth MJ, Gardner AW. Changes in energy balance and body composition at menopause: a controlled longitudinal study. Ann Intern Med. 1995. 123:673–675.
32. Guo SS, Zeller C, Chumlea WC, Siervogel RM. Aging, body composition, and lifestyle: the Fels Longitudinal Study. Am J Clin Nutr. 1999. 70:405–411.
33. Zamboni M, Armellini F, Milani MP, De Marchi M, Todesco T, Robbi R, et al. Body fat distribution in pre- and post-menopausal women: metabolic and anthropometric variables and their inter-relationships. Int J Obes Relat Metab Disord. 1992. 16:495–504.
34. Lynch NA, Ryan AS, Berman DM, Sorkin JD, Nicklas BJ. Comparison of VO2max and disease risk factors between perimenopausal and postmenopausal women. Menopause. 2002. 9:456–462.
35. De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005. 16:1330–1338.
36. Jeon SK, Hong HR, Yi KW, Park HT, Shin JH, Lee NW, et al. Relationship between metabolic syndrome and bone mineral density in middle-aged women. J Korean Soc Menopause. 2010. 16:142–147.
37. Poehlman ET, Toth MJ, Ades PA, Rosen CJ. Menopause-associated changes in plasma lipids, insulin-like growth factor I and blood pressure: a longitudinal study. Eur J Clin Invest. 1997. 27:322–326.
38. Li Z, McNamara JR, Fruchart JC, Luc G, Bard JM, Ordovas JM, et al. Effects of gender and menopausal status on plasma lipoprotein subspecies and particle sizes. J Lipid Res. 1996. 37:1886–1896.
39. Carr MC, Kim KH, Zambon A, Mitchell ES, Woods NF, Casazza CP, et al. Changes in LDL density across the menopausal transition. J Investig Med. 2000. 48:245–250.
40. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA. 1988. 260:1917–1921.
41. Jensen J, Nilas L, Christiansen C. Influence of menopause on serum lipids and lipoproteins. Maturitas. 1990. 12:321–331.
42. Do KA, Green A, Guthrie JR, Dudley EC, Burger HG, Dennerstein L. Longitudinal study of risk factors for coronary heart disease across the menopausal transition. Am J Epidemiol. 2000. 151:584–593.
43. Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med. 1976. 85:447–452.
44. Carr MC, Brunzell JD. Increased hepatic lipase activity and intraabdominal fat across the transition from pre- to postmenopause. 2003. In : The 85th annual meeting of the endocrine society; 2003 June 19-22; Philadelphia, PA: The Endocrine Society;p. Abstract P2-280.
45. Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis. 1993. 98:83–90.
46. Pouliot MC, Despres JP, Nadeau A, Moorjani S, Prud'Homme D, Lupien PJ, et al. Visceral obesity in men. Associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992. 41:826–834.
47. Lindheim SR, Buchanan TA, Duffy DM, Vijod MA, Kojima T, Stanczyk FZ, et al. Comparison of estimates of insulin sensitivity in pre- and postmenopausal women using the insulin tolerance test and the frequently sampled intravenous glucose tolerance test. J Soc Gynecol Investig. 1994. 1:150–154.
48. Walton C, Godsland IF, Proudler AJ, Wynn V, Stevenson JC. The effects of the menopause on insulin sensitivity, secretion and elimination in non-obese, healthy women. Eur J Clin Invest. 1993. 23:466–473.
49. Guthrie JR, Ball M, Dudley EC, Garamszegi CV, Wahlqvist ML, Dennerstein L, et al. Impaired fasting glycaemia in middle-aged women: a prospective study. Int J Obes Relat Metab Disord. 2001. 25:646–651.
50. Margolis KL, Bonds DE, Rodabough RJ, Tinker L, Phillips LS, Allen C, et al. Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative Hormone Trial. Diabetologia. 2004. 47:1175–1187.
51. Juhan-Vague I, Pyke SD, Alessi MC, Jespersen J, Haverkate F, Thompson SG. Fibrinolytic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris ECAT Study Group. European Concerted Action on Thrombosis and Disabilities. Circulation. 1996. 94:2057–2063.
52. Lindoff C, Petersson F, Lecander I, Martinsson G, Astedt B. Passage of the menopause is followed by haemostatic changes. Maturitas. 1993. 17:17–22.
53. Gebara OC, Mittleman MA, Sutherland P, Lipinska I, Matheney T, Xu P, et al. Association between increased estrogen status and increased fibrinolytic potential in the Framingham Offspring Study. Circulation. 1995. 91:1952–1958.
54. Pfeilschifter J, Koditz R, Pfohl M, Schatz H. Changes in proinflammatory cytokine activity after menopause. Endocr Rev. 2002. 23:90–119.
55. Salpeter SR, Walsh JM, Ormiston TM, Greyber E, Buckley NS, Salpeter EE. Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab. 2006. 8:538–554.
56. Dallongeville J, Marecaux N, Isorez D, Zylbergberg G, Fruchart JC, Amouyel P. Multiple coronary heart disease risk factors are associated with menopause and influenced by substitutive hormonal therapy in a cohort of French women. Atherosclerosis. 1995. 118:123–133.
57. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002. 288:321–333.
58. Despres JP, Pouliot MC, Moorjani S, Nadeau A, Tremblay A, Lupien PJ, et al. Loss of abdominal fat and metabolic response to exercise training in obese women. Am J Physiol. 1991. 261:E159–E167.
59. Schrott HG, Bittner V, Vittinghoff E, Herrington DM, Hulley S. Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replacement Study (HERS). The HERS Research Group. JAMA. 1997. 277:1281–1286.
XML Download