Cardiovascular risk, metabolic syndrome and co-morbidity during the climacteric

Main Article Content

Peter Chedraui

Abstract

During the menopausal transition women increase weight, in part due to decreasing levels of ovarian estrogens, and also due to aging. Obesity is becoming a worldwide public health issue. Weight increase in mid-aged women is related to the development of diabetes, hypertension, insulin resistance, dyslipidemia, cancer, among other conditions that impair quality of life. One important one is the metabolic syndrome which is group of lipid and non-lipid factors that increase cardiovascular risk. These factors include abdominal obesity, low HDL-C levels and high serum triglycerides, fasting glucose and/or blood pressure levels; with three or more items required to meet diagnosis. The most important feature of the syndrome is abdominal obesity. Although reports indicate that the rate of the syndrome increases after the female menopause, as a consequence of an emergence of several of aforementioned features, in general due to changes in lifestyle habits and the fact that women increase body weight during the menopausal transition much before menopause onset there seems to be an increase in the rate of the syndrome before the menopause. The metabolic syndrome is considered a pro-inflammatory state with high secretion of adipocytokines which subsequently produce endothelial dysfunction and increases cardiovascular morbidity and mortality and the risk of developing diabetes. This document aims at performing an overview addressing cardiovascular risk, the metabolic syndrome and co-morbidities during the female climacteric.

Article Details

How to Cite
1.
Chedraui P. Cardiovascular risk, metabolic syndrome and co-morbidity during the climacteric. Rev. Med. UCSG [Internet]. 2023 Jun. 6 [cited 2024 Jul. 3];24(1):7-20. Available from: https://rmedicina.ucsg.edu.ec/index.php/ucsg-medicina/article/view/1206
Section
Artículos de Revisión

References

Sierra B, Hidalgo LA, Chedraui PA. Measuring climacteric symptoms in an Ecuadorian population with the Greene Climacteric Scale. Maturitas. 2005;51(3):236-245.

Hidalgo LA, Chedraui PA, Schwager G, Chavez P. Densidad mineral ósea en columna lumbar en una población de mujeres climatéricas Ecuatorianas. Rev Ecuatr Ginecol Obstet. 2003;10:288-291.

Hidalgo LA, Chedraui PA, Naveda C. Ultrasonido cuantitativo en radio y su correlación con los niveles séricos de osteocalcina en mujeres climatéricas. Rev Ecuatr Ginecol Obstet. 2004;11:213-218.

Hidalgo LA, Chedraui PA, Morocho N, Alvarado M, Chavez D, Huc A. The metabolic syndrome among postmenopausal women in Ecuador. Gynecol Endocrinol. 2006;22(8):447-454.

Chedraui P, Hidalgo L, Chavez D, Morocho N, Alvarado M, Huc A. Quality of life among postmenopausal Ecuadorian women participating in a metabolic syndrome screening program. Maturitas. 2007;56(1):45-53.

Chedraui P, Hidalgo L, Chavez D, Morocho N, Alvarado M, Huc A. Menopausal symptoms and associated risk factors among postmenopausal women screened for the metabolic syndrome. Arch Gynecol Obstet. 2007;275(3):161-168.

Yánez D, Castelo-Branco C, Hidalgo LA, Chedraui PA. Sexual dysfunction and related risk factors in a cohort of middle-aged Ecuadorian women. J Obstet Gynaecol. 2006;26(7):682-686.

Chedraui P, Aguirre W, Hidalgo L, Fayad L. Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale. Maturitas. 2007;57(3):271-278.

Castelo-Branco C, Blumel JE, Chedraui P, et al. Age at menopause in Latin America. Menopause. 2006;13(4):706-712.

Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88(6):2404-2411.

Rossouw JE, Anderson GL, Prentice RL, 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(3):321-333.

Blümel JE, Castelo-Branco C, Chedraui PA, et al. Patients' and clinicians' attitudes after the Women's Health Initiative study. Menopause. 2004;11(1):57-61.

Royer M, Castelo-Branco C, Blumel JE, et al. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III): prevalence of the metabolic syndrome in postmenopausal Latin American women. Climacteric. 2007;10(2):164-170.

Blümel JE, Castelo-Branco C, Sanjuán A, et al. A simplified method to quantitate atherosclerosis in the rabbit aorta. Maturitas. 2001;39(3):265-271.

Adams MR, Kaplan JR, Clarkson TB, Koritnik DR. Ovariectomy, social status, and atherosclerosis in cynomolgus monkeys. Arteriosclerosis. 1985;5(2):192-200.

Rosenberg L, Hennekens CH, Rosner B, Belanger C, Rothman KJ, Speizer FE. Early menopause and the risk of myocardial infarction. Am J Obstet Gynecol. 1981;139(1):47-51.

Blümel JE, Prieto JC, Leal T, Cruz MN, Gallardo L. Impacto de los factores de riesgo coronario en mujeres de edad media [Cardiovascular risk factors in middle-age women with acute coronary syndromes]. Rev Med Chil. 2001;129(9):995-1002.

Blümel JE, Castelo-Branco C, González P, et al. Transdermal estrogens do not appear to modify the extent of lesional areas of aortic atherosclerosis in oophorectomized rabbits on a cholesterol-rich diet. Atherosclerosis. 2000;148(2):303-308.

Christian RC, Liu PY, Harrington S, Ruan M, Miller VM, Fitzpatrick LA. Intimal estrogen receptor (ER) beta, but not ER alpha expression, is correlated with coronary calcification and atherosclerosis in pre- and postmenopausal women. J Clin Endocrinol Metab. 2006;91(7):2713-2720.

Sumino H, Ichikawa S, Ohyama Y, et al. Effect of transdermal hormone replacement therapy on the monocyte chemoattractant protein-1 concentrations and other vascular inflammatory markers and on endothelial function in postmenopausal women. Am J Cardiol. 2005;96(1):148-153.

Bath PMW, Gray LJ. Association between hormone replacement therapy and subsequent stroke: a meta-analysis. BMJ. 2005;330(7487):342.

Cushman M, Kuller LH, Prentice R, et al.; Women's Health Initiative Investigators. Estrogen plus progestin and risk of venous thrombosis. JAMA. 2004;292(13):1573-1580.

Wu O. Postmenopausal hormone replacement therapy and venous thromboembolism. Gend Med. 2005; 2 Suppl A:S18-27.

Anderson GL, Limacher M, Assaf AR, et al. The Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women’s Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701-1712.

Cosman F, Baz-Hecht M, Cushman M, et al. Short-term effects of estrogen, tamoxifen and raloxifene on hemostasis: a randomized-controlled study and review of the literature. Thromb Res. 2005;116(1):1-13.

Pines A. Postmenopausal hormone therapy: the way ahead. Maturitas. 2007;57(1):3-5.

International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Brussels: IDF. 2005. http://www.idf.org/webdata/docs/metac_syndrome_def.pdf.

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(3):356-359.

Gruppo di Studio Progetto Menopausa Italia. Risk factors for high blood pressure in women attending menopause clinics in Italy. Maturitas. 2006;53(1):83-88.

Barriga J, Castelo-Branco C, Chedraui P, Hidalgo L, Veas P. Educational and organizational interventions used to improve the knowledge of metabolic syndrome among postmenopausal women. Fertil Steril. 2008;90(2):444-446.

Pérez-Lopez FR, Chedraui P, Gilbert JJ, Pérez-Roncero G. Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women’s Health Initiative era. Fertil Steril. 2009;92(4):1171-1186.

Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008;31(5):635-643.

Cappuccio FP, Stranges S, Kandala NB, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. Hypertension. 2007;50(4):693-700.

Perez-Lopez FR, Robyn C. Studies on human prolactin physiology. Life Sci. 1974;15(4):599-616.

Juliá-Mollá MD, García-Sánchez Y, Romeu Sarrió A, Pérez-López FR. Cimicifuga racemosa treatment and health related quality of life in postmenopausal Spanish women. Gynecol Endocrinol. 2009;25(1):21-26.

Kinder LS, Carnethon MR, Palaniappan LP, King AC, Fortmann SP. Depression and the metabolic syndrome in young adults: findings from the Third National Health and Nutrition Examination Survey. Psychosom Med. 2004;66(3):316-322.

Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299(23):2751-2759.

Chedraui P, Pérez-López FR, Morales B, Hidalgo L. Depressive symptoms among climacteric women are related to menopausal symptom intensity and partner factors. Climacteric. 2009;12(5):395-403.

Armon G, Shirom A, Shapira I, Melamed S. On the nature of burnout-insomnia relationships: a prospective study of employed adults. J Psychosom Res. 2008;65(1):5-12.

Pérez-López FR. Vitamin D metabolism and cardiovascular risk factors in postmenopausal women. Maturitas. 2009;62(3):248-262.

Melamed ML, Michos ED, Post W, Astor B. 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008 2008;168(15):1629-1637.

Cutolo M, Seriolo B, Villaggio B, Pizzorni C, Craviotto C, Sulli A. Androgens and estrogens modulate the immune and inflammatory responses in rheumatoid arthritis. Ann N Y Acad Sci. 2002;966:232-237.