  
Premenopausal cardiovascular risk factors predict disease after menopause
Last Updated: 2001-05-03 18:33:39 EDT (Reuters Health)
By Will Boggs, MD
WESTPORT, CT (Reuters Health) - Although substantial increases in cardiovascular disease follow the menopause, risk factors in premenopausal years can accurately identify women who should receive preventive interventions, according to a report in the May issue of Stroke: Journal of the American Heart Association.
LDL cholesterol levels increase and HDL cholesterol levels decrease among menopausal women, the authors explain, but little information is available that compares the association of premenopausal and postmenopausal risk factors with the development of cardiovascular disease and stroke.
Dr. Karen A. Matthews and colleagues from the University of Pittsburgh described changes in these risk factors in 372 women in the early years after menopause and compared them with extent of carotid intimal medial thickness and plaque index measured 5 to 8 years after menopause.
All risk factors, except HDL cholesterol, changed significantly during the early postmenopausal years, the authors report.
During the first menopausal year, the report indicates, changes were most marked in LDL cholesterol, triglycerides, and body mass index. In contrast, changes in systolic blood pressure, pulse pressure, and fasting blood glucose were most notable during the ensuing 5 years.
It is worth noting, Dr. Matthews told Reuters Health, "that hormone replacement therapy users showed smaller increases in lipids than nonusers."
Premenopausal risk factors, including systolic and pulse pressure, LDL and HDL cholesterol, triglycerides, and body mass index predicted intimal medial thickness and plaque index, the researchers note, whereas change in pulse pressure was the only factor in the early postmenopausal years that predicted both.
"The premenopausal risk factors may be a stronger predictor of carotid atherosclerosis because they represent cumulative risk factor exposure during the premenopausal years, whereas the risk factor changes during the early postmenopausal years have a shorter time for influence," Dr. Matthews commented in an American Heart Association statement.
"This suggests that we can look relatively early, before the onset of symptoms, to see who is at high risk," Dr. Matthews added. "Prevention strategies should not be put off until menopause when a woman's risk of cardiovascular disease increases dramatically."
Perhaps even the risk criteria should be changed, argue Drs. Gretchen E. Tietjen from Medical College of Ohio in Toledo, Ohio and Robin Brey from University of Texas Health Sciences Center in San Antonio, Texas in a related editorial.
"Their work highlights the importance of reestablishing normal ranges for blood pressure and lipids for premenopausal women with a risk continuum in mind, and investigating the benefits of cholesterol-lowering statins, aggressive blood pressure control, and HRT use for primary stroke prevention in women," they write.
Stroke 2001;32:000-000. http://stroke.ahajournals.org.
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