High-Density Lipoprotein Cardioprotection Function Deteriorates as Women Transition Through Menopause: The SWAN HDL...

Area of Science:

• Cardiovascular Health
• Endocrinology
• Women's Health

Background:

• HDL cholesterol efflux capacity (CEC) increases during menopause.
• The association between this rise in CEC and long-term cardiovascular disease (CVD) risk is not well understood.

Purpose of the Study:

• To investigate if the association between CEC and subclinical vascular health varies by menopausal stage.
• To assess subclinical vascular health using a composite score of carotid-intima media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), and coronary artery calcium (CAC).

Main Methods:

• A cohort of 279 women (mean age 51 years) with CEC and vascular health measures were analyzed.
• A Bayesian hierarchical linear mixed effects model was employed to assess the relationship between CEC, time relative to final menstrual period (FMP), and subclinical vascular health.
• Exploratory analyses examined differences across racial subgroups.

Main Results:

• Higher CEC was linked to better subclinical vascular health before the FMP.
• The protective association of CEC significantly diminished after the FMP, affecting all composite score components.
• This protective effect waned more rapidly in Black women compared to White women.

Conclusions:

• Elevated CEC is associated with reduced subclinical vascular disease risk only in premenopausal women.
• CEC is not a reliable marker for cardiovascular protection in women undergoing menopause.