Heart Disease Risk Grows as Women Move through Menopause

A marker for heart disease risk considerably worsens as women transition through menopause, according to a new analysis from the largest and longest running study of women’s health in midlife, the Study of Women’s Health Across the Nation (SWAN). Black women experience this accelerated decline earlier in menopause than their white counterparts.

According to the research team, led by scientists at the University of Pittsburgh Graduate School of Public Health, the findings add to growing evidence that menopause is a critical time for changes in cardiovascular health and underscore the importance of women and their doctors focusing on heart health during the menopausal transition. The results are reported online and will appear in the March issue of Arteriosclerosis, Thrombosis, and Vascular Biology, a journal of the American Heart Association.

“Midlife is not just a period where women have hot flashes and experience other menopausal symptoms,” said senior author Samar R. El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “It’s a time when their cardiovascular disease risk is increasing as we see significant changes in multiple clinical measures of their physical health.”

El Khoudary and her team used a subset of data from SWAN Heart, an ancillary study that enrolled women from Pittsburgh and Chicago between 2001 and 2003 and included two examinations of early markers of cardiovascular health over time. Ultimately, 339 women were included in this study, 36% black and the rest white.

The study focused on how arterial stiffness changes as women transition through menopause. Arterial stiffness refers to the elasticity of arteries and is measured by looking at how fast blood flows through arteries. Stiffer arteries can lead to dysfunction in how well the heart pumps and moves blood, and damage to the heart, kidneys and other organs.

The researchers tracked the women through SWAN for up to 12.5 years, or until they reached menopause, allowing them to confidently anchor the arterial stiffness measure to the menopausal transition.

On average, as women went through menopause, their arterial stiffness increased by about 0.9% up to one year before their last menstrual period to about 7.5% within one year before and after their last period, a considerable acceleration. The black women in the study experienced greater increases in arterial stiffness earlier in the transition than white women, more than a year before menopause. The findings held after adjusting for numerous factors that could affect heart health, including waist circumference, blood pressure, lipids, smoking status, physical activity levels and financial stress.

“SWAN is a unique source of data on changes in women’s health over several decades, and this is the latest in a long line of research by our team and others that indicates the menopausal transition is a very important time for heart health,” said lead author Saad Samargandy, M.P.H., a Ph.D. student at Pitt Public Health. “While there are limitations to our study, including that a sizeable minority of the women had their arterial stiffness measured at only one time point, we were still able to see that major changes to cardiovascular disease risk happen around menopause.”

This study follows several others that link the menopausal transition to the accumulation of heart fat, changes in cholesterol, inflammation and coronary artery calcification, among other heart disease risk factors.

“Our study is not able to tell us why we’re seeing these changes during the menopausal transition,” El Khoudary said. “But we speculate that the dramatic hormonal changes accompanying menopause might play a role by increasing inflammation and affecting vascular fat deposition, a hypothesis that we would like to test in future studies.”

Clinical trials will be needed to test if lifestyle interventions, such as changes to diet or physical activity; medications, such as statins or hormone replacement therapy; or even increased screening and tracking of measures of heart health could be beneficial as women go through menopause, she said.

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

Source: EurekAlert!

Hot Flashes Impair Memory Performance

If you’re having difficulty identifying the right word to express yourself clearly or remembering a story correctly, you may blame menopause. A new study suggests that physiologic hot flashes are associated with decreased verbal memory and with alterations in brain function during encoding and retrieval of memory, especially in the hippocampus and prefrontal cortex. Study results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

Previous studies have already shown that women experience a decline in memory for verbal material, such as words and stories, as they transition through menopause. In this new study, functional magnetic resonance imaging (MRI) was used to document the occurrence of physiologic hot flashes and their specific effect on hippocampal and prefrontal cortex function during encoding and recognition conditions of a memory task. The strengths of this study are in the use of physiologic hot flash monitoring to confirm the hot flash versus relying on patient recall and the use of functional MRI to specifically evaluate real-time changes occurring within the brain during the memory testing.

Although larger studies are needed to fully evaluate the reliability of the relationship between hot flashes and altered brain function, this study provides new insights into specific areas in the brain involved in memory that appear to be adversely affected by hot flashes.

The study results appear in the article “Hot flashes are associated with altered brain function during a memory task.”

“The findings of this preliminary study, although small, support an association between objectively monitored hot flashes and adverse functional changes in the brain that affect memory. Further study is needed to determine whether hot flashes actually cause these brain changes and whether treatment of hot flashes will prevent or normalize them,” says Dr. Stephanie Faubion, NAMS medical director.

Source: The North American Menopause Society


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Premature Menopause Increases the Risk of Multiple Health Problems in the 60s

Women who experience premature menopause are almost three times more likely to develop multiple, chronic medical problems in their 60s compared to women who went through the menopause at the age of 50 or 51.

These are the findings from a study of 5107 women who were part of a national study of 11,258 Australian women, aged 45-50 years in 1996 and who were followed until 2016. The study is published in Human Reproduction, one of the world’s leading reproductive medicine journals.

As life expectancy is now more than 80 years for women in high income countries, a third of a woman’s life is spent after the menopause. It is known already that premature menopause, occurring at the age of 40 or younger, is linked to a number of individual medical problems in later life, such as cardiovascular disease and diabetes. However, there is little information about whether there is also an association between the time of natural menopause and the development of multiple medical conditions – known as multimorbidity.

Researchers at the Centre for Longitudinal and Life Course Research at The University of Queensland, Brisbane (Australia) used data on women who had joined the prospective Australian Longitudinal Study on Women’s Health between 1946 and 1951. The women responded to the first survey in 1996 and then answered questionnaires every three years (apart from a two-year interval between the first and second survey) until 2016. The women reported whether they had been diagnosed with or treated for any of 11 health problems in the past three years: diabetes, high blood pressure, heart disease, stroke, arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, depression, anxiety or breast cancer. Women were considered to have multimorbidity if they had two or more of these conditions.

The women’s age at natural menopause was defined as at least 12 months without monthly bleeding, where this was not the result of a surgical intervention such as removal of the ovaries or hysterectomy.

During the 20 years of follow-up, 2.3% of women experienced premature menopause and 55% developed multimorbidity. Compared with women who experienced menopause at the age of 50-51 years, women with premature menopause were twice as likely to develop multimorbidity by the age of 60, and three times as likely to develop multimorbidity from the age of 60 onwards.

Dr Xiaolin Xu, who conducted the research as part of his PhD thesis at the University of Queensland and who is now a research professor at Zhejiang University, China, said: “We found that 71% of women with premature menopause had developed multimorbidity by the age of 60 compared with 55% of women who experienced menopause at the age of 50-51. In addition, 45% of women with premature menopause had developed multimorbidity in their 60s compared with 40% of women who experienced menopause at the age of 50-51.”

Professor Gita Mishra, director of the Centre and senior author of the paper, said: “Our findings indicate that multimorbidity is common in mid-aged and early-elderly women. Premature menopause is associated with an increased risk of developing multimorbidity, even after adjusting for previous chronic conditions and for possible factors that could affect the results, such as whether or not the women had children, how many, education, body mass index, smoking and physical activity.”

Dr Xu added: “We also found that premature menopause is associated with a higher incidence of individual chronic conditions.”

The researchers say they believe that this is the first study to assess the link between premature menopause and the development of multimorbidity in a large group of women and with long-term, prospective follow-up.

“Our findings suggest that health professionals should consider providing comprehensive screening and assessment of risk factors when treating women who experience natural premature menopause in order to assess their risk of multimorbidity,” said Prof Mishra. “Our findings also highlight that multimorbidity should be considered as a clinical and public health priority when policy-makers are considering how to control and prevent chronic health problems in women.”

The study does not show that premature menopause causes the development of multimorbidity, only that there is an association. A limitation of the study is that the researchers relied on self-reported information from the women.

The researchers are now investigating what risk factors could be targeted in order to prevent or slow down the development of health problems in women who experience premature menopause. These include improving diet and exercise, not smoking, controlling body weight, engaging in mentally stimulating activity and regular screening for cancer and other medical problems related to the reproductive system.

Source: European Society of Human Reproduction and Embryology


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Too Little Sleep after Menopause Linked to Weaker Bones

Vishwadha Chander wrote . . . . . . . . .

Bones may age faster in older women who get too little sleep, a U.S. study suggests.

Based on data from nearly 11,000 participants in a long-term study, researchers found that postmenopausal women who slept less than five hours a night were more likely to have low bone mass than those who averaged seven hours sleep. Short sleepers were also up to twice as likely to have osteoporosis of the hip and spine, according to the report in the Journal of Bone and Mineral Research.

The bone mass differences between the short sleepers and those who logged seven hours were small, but roughly equivalent to about one year of aging, the study team notes.

“We were building on our previous work, which showed women who slept too little had higher fracture risk,” said epidemiologist Dr. Heather Ochs-Balcom of the school of public health at the State University of New York, Buffalo, who led the study.

“Here, we examined a measure of bone mineral density, to see if that could explain the previous finding,” she told Reuters Health in an email.

Ochs-Balcom and her colleagues analyzed data from the Women’s Health Initiative Study, which originally enrolled 161,808 postmenopausal women aged 50 to 79 at 40 clinical centers and followed them over time.

For the current study, the researchers focused on 11,084 women who had undergone full body scans to assess bone density and had answered sleep questionnaires. This group was 78% non-Hispanic white, with an average age of 63, and nearly one in 10 reported sleeping five hours or less per night. One in three also met criteria for insomnia.

Using seven hours of sleep as the reference point, researchers found that women who slept only five hours or less had lower bone mass in whole-body, hip, neck and spine measurements. They were also twice as likely to have osteoporosis in the whole-body measurement, 63% more likely to have it at the hip and 28% more likely to have osteoporosis in the spine.

Women sleeping six hours a night had slightly increased risk of spine and whole-body osteoporosis as well, the analysis found.

The researchers note that the sleep and bone-density assessments reflect a single point in time, so the study cannot determine whether short sleep causes changes in bone health. It is important, they write, to consider the possibility that lower bone mineral density could also be tied to factors that affect sleep.

A number of things contribute to skeletal health, said Dr. Alana Serota of the Hospital for Special Surgery in New York City, who wasn’t involved in the study. “I feel all our sins are written on our skeletons,” she said in a phone interview.

Serota noted that there is no clear answer on the ideal amount of sleep for postmenopausal women, but it is important to wake up feeling rested.

“We know poor sleep has an impact on cardiovascular health, leads to diabetes, poor sugar control and hypertension. It stands to reason these things can also impact the skeleton,” she added.

“The most important thing is to stay active,” Serota said. “Even if one hasn’t exercised before, it is a good time to start. The diagnosis of any chronic condition, or a transition in any point of life, is a good time for a health reset.”

Source: Reuters


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Early Menopause Tied to Heart Problems before 60

Lisa Rapaport wrote . . . . . . . . .

Women who go through menopause earlier in life may be more likely to have a heart attack or stroke before they reach age 60 than their counterparts who go through menopause later on, a recent study suggests.

Researchers examined data from 15 observational studies with a total of more than 300,000 women, including almost 13,000 women who survived events like a heart attack or stroke after menopause.

Compared with women who went through menopause at age 50 or 51, women who experienced premature menopause, before age 40, were 55% more likely to have events like a heart attack or stroke after menopause. With early menopause, from age 40 to 44, women had a 30% greater risk of cardiovascular events after menopause; with relatively early menopause, from age 45 to 49, the increased risk was 12%.

“Heart disease is a leading cause of illness and death for women,” said senior study author Gita Mishra of the University of Queensland in Brisbane, Australia.

“These findings will help to identify women at most risk of cardiovascular disease for closer monitoring and earlier diagnosis and even prevention of the disease,” Mishra said by email.

Women go through menopause when they stop menstruating. As the ovaries curb production of the hormones estrogen and progesterone, women can experience symptoms ranging from vaginal dryness to mood swings, joint pain and insomnia.

Earlier menopause has previously been linked to an increased risk of heart disease, osteoporosis, diabetes and sleep problems. It can also leave women with fewer reproductive years, particularly when it’s preceded by premature ovarian failure, when the ovaries stop working before age 40.

In the current study, women were 50 years old on average when they went through menopause. Only 1.2% of the women in the study had premature menopause before age 40; and 4.7% experienced early menopause from age 40 to 44.

Among women who had events like a heart attack or stroke after menopause, an average of 13.5 years passed between menopause and these cardiovascular events, researchers report in the Lancet Public Health.

Compared to women who didn’t experience events like a heart attack or stroke, women who did were less likely to be educated, and more likely to be obese, and current smokers with a history of high blood pressure.

The study wasn’t a controlled experiment designed to prove whether or how menopause timing might directly impact cardiovascular health.

One limitation of the analysis is that many of the cardiovascular events were self-reported by study participants, not confirmed by medical records. It’s also possible that use of hormone therapy after menopause may have impacted the results, the study team notes.

Still, the results highlight a need for women to be hypervigilant about heart health if they go through menopause earlier in life, Mishra said.

“For women who are experiencing earlier menopause, active management of other risk factors for cardiovascular disease, such as avoiding cigarette smoking and maintaining a healthy body weight are all the more important for reducing their overall risk of cardiovascular disease,” Mishra advised. “These women may also consult with health professionals for regular monitoring of their risk of cardiovascular disease.”

Source: Reuters


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