HDL and the menopause.

Area of Science:

• Cardiovascular Science
• Endocrinology
• Lipid Metabolism

Background:

• Menopause is associated with complex changes in lipid profiles, particularly high-density lipoprotein (HDL).
• Traditional metrics like HDL cholesterol (HDL-C) may not fully capture the functional alterations in HDL during menopause.
• Estradiol levels significantly influence HDL metabolism and function.

Purpose of the Study:

• To review recent findings on conventional and novel HDL metrics in relation to menopause.
• To explore the evolving understanding of HDL function and its connection to menopausal transition.
• To highlight the need for further research into HDL's role in cardiovascular disease (CVD) risk post-menopause.

Main Methods:

• Review of current literature on HDL metrics and menopause.
• Analysis of studies examining HDL cholesterol (HDL-C), HDL subclasses, and cholesterol efflux capacity.
• Synthesis of findings related to estradiol's impact on HDL during menopausal transition.

Main Results:

• Menopause-related changes in HDL-C are inconsistent, indicating a complex relationship.
• Higher HDL-C may not consistently confer cardio-protection in midlife women.
• Novel HDL metrics show significant alterations post-menopause, linked to estradiol, suggesting potential dysfunctionality not captured by HDL-C alone.

Conclusions:

• The long-term impact of menopausal HDL metric changes on cardiovascular disease (CVD) risk remains unclear.
• Current understanding relies heavily on cross-sectional data, limiting causal inference.
• Longitudinal studies are crucial to assess how improved HDL function metrics predict CVD risk in women transitioning through menopause.