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High-Density Lipoprotein Cardioprotection Function Deteriorates as Women Transition Through Menopause: The SWAN HDL
Samar R El Khoudary1, James Matuk1, Maria Brooks1
1Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Cholesterol efflux capacity (CEC) protects premenopausal women against cardiovascular disease (CVD). This protective effect diminishes after menopause, especially in Black women, indicating CEC is not a consistent CVD risk indicator post-menopause.
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.
Background:
Women show a rise in high-density lipoprotein cholesterol efflux capacity (CEC) as they traverse menopause. Whether this rise is associated with a lower risk of cardiovascular disease overtime is not clear.
Objectives:
The authors tested whether CEC association with subclinical vascular health, measured using a composite subclinical vascular health score based on levels of carotid intima-media thickness, carotid-femoral pulse wave velocity, and presence of coronary artery calcium score (>10), varies by time relative to the final menstrual period (FMP).
Methods:
279 women (baseline age 51 ± 2.8 years; 68.5% White) who had CEC and outcome measures were included. The subclinical vascular health measures were related to CEC through a Bayesian hierarchical linear mixed effects model using the latent composite measure as the outcome, and time relative to FMP, CEC, and their interaction as explanatory variables. Differences by racial subgroups were explored.
Results:
Higher CEC was associated with a lower composite subclinical measure of vascular health at the time of the FMP. In both unadjusted and adjusted models, the inferred interaction effect (posterior probability >0.99) implies that the pre-FMP protective association of CEC diminishes after FMP. This was consistent across all components of the composite score. In Black women, the protective association of CEC diminished more rapidly compared to White women (posterior probability >0.90).
Conclusions:
In women, higher CEC is associated with a lower risk of subclinical vascular health only before menopause. Higher CEC is not a consistent indicator of greater cardiovascular disease protection in women traversing menopause.
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