CARDIOVASCULAR DISEASE RISK IN PRE- AND POSTMENOPAUSAL WOMEN
Background: Coronary heart disease is an important cause of morbidity and mortality in postmenopausal women. The present study aimed to compare cardiovascular risk factors: blood pressure, alterations in lipid profile and structural changes in heart in pre- and postmenopausal women. Method: It was a hospital based study including 41 women selected on basis of menstrual history. After taking detailed history, clinical examination was performed and fasting blood sample was collected for lipid profile and blood sugar estimation. Atherogenic indices like Castelli’s Risk Index-I and II, Atherogenic Index of Plasma and Atherogenic Coefficient were calculated from lipid profile values. Cardiac evaluation was done by echocardiography. Results: A statistically significant increase in blood pressure in postmenopausal women was observed. A statistically significant increase was also noted in total cholesterol (p<0.01), low density lipoprotein (p<0.02) and Castelli Risk Index-II (p<0.04) in postmenopausal women. An increase in Interventricular Septal Thickness in diastole (p<0.003), Left Ventricular Posterior Wall Thickness in diastole (p<0.0003), Aortic Diameter (p<0.01), Left Atrial Diameter (p<0.008), Relative Wall Thickness (p<0.005), Left Ventricular Mass (p<0.004) and Left Ventricular Mass indexed to body Surface Area (p<0.002) and Height2.7 (p<0.001) was also found to be statistically significant in post menopausal women. Conclusion: Menopause leads to dyslipidemia with atherogenic lipid profile with structural changes in left ventricle structure and mass.
2. Fernandez ML, Murillo AG. Postmenopausal women have higher HDL and decreased incidence of low HDL than premenopausal women with metabolic syndrome. Healthcare 2016;4(20):1–10.
3. Pavlica T, Mikalacki M, Matic R, Korovljev D, Cokorilo N, Vujkov S, et al. Relationship between BMI and skinfold thicknesses to risk factors in premenopausal and postmenopausal women. Coll Antropol 2013;37(2):119–24.
4. Hu FB, Grodstein F, Hennekens CH, Colditz GA, Johnson M, Manson JAE, et al. Age at normal menopause and risk of cardiovascular diseases. Arch Intern Med 1999;159(10):1061–6.
5. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J 2010;18(12):598–602.
6. Alessandri N, Piccioni MG, Isabelli V, Alessandri G, Di Matteo A, Padovani D, et al. Morphological and functional changes of cardiovascular system in postmenopausal women. Eur Rev Med Pharmacol Sci 2007;11:107–17.
7. Umeshchandra S, Umeshchandra DG, Awanti SM. Atherogenic Index of Plasma (AIP) in post menopausal women. Res J Pharm Biol Chem Sci 2012;3(1):519–23.
8. Swapnali RK, Kisan R, Murthy DSJ. Effect of menopause on lipid profile and apolipoproteins. Al Ameen J Med Sci 2011;4(3):221–8.
9. Abbott RD, Wilson PW, Kannel WB, Castelli WP. High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham study. Arterioscler Thromb Vasc Biol 1988;8:207–11.
10. Scheuer J, Malhotra A, Schaible TF, Capasso J. Effects of gonadectomy and hormonal replacement on rat hearts. Circ Res 1987;61:12–9.
11. Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009;5:757–65.
12. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography. Results of a survey of echocardiographic measurements. Circulation 1978;56:1072–83.
13. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57(6):450–8.
14. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects. Eur Heart J 2009;31(5):588–94.
15. Garg B, Yadav N, Vardhan H, De AK. Asymptomatic obese hypertensives and need of routine echocardiography for left ventricular mass assessment and treatment. J Clin Diagn Res 2013;7(8):1599–603.
16. Staessen J, Bulpitt CJ, Fagard R, Lijnen P, Amery A. The influence of menopause on blood pressure. J Hum Hypertens 1989;3 (6):427–33.
17. F Al-Azzawi. The menopause and its treatment in perspective. Postgrad Med J 2001;77:292–304.
18. Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis 2012;1(4):1–0.
19. Suzukia H, Kondo K. Pulse wave velocity in postmenopausal women. Pulse 2013;1: 4–13.
20. de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJC, Broemans FJM, van der Schouw YT. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med 2017;15:2.
21. Ranjit PM, Guntuku G, Pothineni RB. New atherogenic indices: Assessment of cardiovascular risk in postmenopausal dyslipidemia subjects. Asian J Med Sci 2015;6(6):25–32.
22. Nair D, Carrigan TP, Curtin RJ, Popovic ZB, Kuzmiak S, Schoenhagen P, et al. Association of total cholesterol/high‐density lipoprotein cholesterol ratio with proximal coronary atherosclerosis detected by multislice computed tomography. Preventive Cardiol 2009;12(1):19–26.
23. Dobiasova M. AIP-atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice. Vnitr Lek 2006;52(1):64–71.
24. Suzukia H, Kobayashib K, Okadab H. Combination of echocardiography and pulse wave velocity provides clues for the differentiation between white coat hypertension and hypertension in postmenopausal women. Pulse 2013;1:131–8.
25. Düzenli MA, Ozdemir K, Sokmen A, Soylu A, Aygul N, Gezginc K, et al. Effects of menopause on the myocardial velocities and myocardial performance index. Circ J 2007;71:1728–33.
26. Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Porcellati C. Early cardiac changes after menopause. Hypertension 1998;32:764–9.
27. Fantin F, Bulpitt CJ, Bonapace S, Cameron JD, Rajkumar C. Is vascular stiffness associated with the diameter of the abdominal aorta? Age Ageing 2009;38:466–9.
28. Casaclang-Verzosa G, Gersh BJ, Tsang TSM. Structural and functional remodeling of the left atrium. Clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol 2008;51:1–11.
29. Hayward CS, Webb CM, Collins P. Effect of sex hormones on cardiac mass. Lancet 2001;357:1354–56.
30. Levy D, Anderson KM, Savage DD, Kannel WB, Christiansen JC, Castelli WP. Echocardographically detected left ventricular hypertrophy: prevalence and risk factors. The Framingham Heart Study. Ann Intern Med 1988;108:7–13.