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Published on: August 13, 2019
Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study
Samar R El Khoudary1, Kelly J Shields1, Imke Janssen1
1University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213.
Context:
Cardiovascular risk increases in women after menopause. Mounting evidence demonstrates a role of cardiovascular fat (CF) in the pathogenesis of coronary heart disease, but no research has examined CF in relation to sex hormones or menopausal status in women.
Objective:
The objective was to determine the relationship between CF depots, menopausal status, and endogenous sex hormones.
Design:
Cross-sectional and longitudinal study designs were used.
Setting:
The setting included the Study of Women's Health Across the Nation (SWAN) Heart and Cardiovascular Fat Ancillary Study.
Participants:
A total of 456 women (mean age, 50.75 y); 62% premenopausal/early perimenopausal, and 38% late peri-/postmenopausal.
Intervention:
Menopausal status, endogenous sex hormones measured simultaneously with CF volumes, and circulating estradiol available 4.80 years (median) before CF measures.
Main Outcome Measures:
Volumes of CF (epicardial adipose tissue [EAT], paracardial adipose tissue [PAT], total heart adipose tissue [TAT = EAT + PAT], and aortic perivascular adipose tissue [PVAT]).
Results:
In final models, late peri-/postmenopausal women had 9.88% more EAT, 20.72% more PAT, and 11.69% more TAT volumes than pre-/early perimenopausal women (P < .05). PVAT was not associated with menopausal status. In final models, lower estradiol concentrations were associated with greater volumes of PAT and TAT (P < .05). Women with the greatest reduction in estradiol since baseline had greater volumes of PAT compared to women with the least reduction (P = .02).
Conclusions:
Late peri-/postmenopausal women have greater volumes of heart fat compared with pre-/early perimenopausal women independent of age, obesity, and other covariates. Endogenous sex hormones are associated with CF. Perhaps CF plays a role in the higher risk of coronary heart disease reported in women after menopause.
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