The menopausal transition and multiple physiologic measures of early brain health in the Coronary Artery Risk...

This study proposed to investigate the cross-sectional and longitudinal associations of menopausal status with physiologic brain magnetic resonance imaging measures.

The sample included women from the Coronary Artery Risk Development in Young Adults study who self-reported their reproductive histories and participated in the brain magnetic resonance imaging substudies at the year 25 (n = 292) and year 30 (n = 258) follow-up examinations. Menopausal status was classified based on natural menstrual cycle regularity/cessation at both time points. Gray matter cerebrovascular reactivity (CVR) was calculated as mean percent change in blood oxygen level-dependent signals in activated voxels following a breath-hold challenge. Gray matter cerebral blood flow (CBF) was assessed using pseudo-continuous arterial spin labeling. Linear regression models were used to examine cross-sectional and longitudinal associations of menopausal status with gray matter CVR and CBF after adjustment for potential age-related covariates.

Women were mean age 50 years at year 25; 37% were Black; and 46% were postmenopausal. Relative to premenopause or perimenopause, postmenopause was associated with lower gray matter CVR at year 30 cross-sectionally (1.86% vs 1.69%, P = 0.03, respectively) and longitudinally for women who were postmenopausal at both time points (-0.32% [95% CI, -0.63% to -0.02%]) after covariate adjustment. Mean CVR values were also lower for these women when compared with women who remained premenopausal or perimenopausal (1.71% compared with 2.04%, respectively). Menopausal status was unrelated to either concurrent or longitudinal gray matter CBF.

These findings suggest that the ability of vessels to adapt in response to hypercapnia may be impaired during menopause, even within a relatively short time window.