Understanding of and clinical approach to cardiometabolic transition at the menopause

Abstract

Cardiovascular disease (CVD) represents the leading cause of death and accounts for almost 50% of all deaths in women worldwide. The menopausal transition is associated with central body fat accumulation, a decrease in energy expenditure, weight gain, insulin resistance and a pro-atherogenic lipid profile. Moreover, menopause is independently associated with an adverse effect on functional and structural indices of subclinical atherosclerosis. Women with premature ovarian insufficiency have heightened CVD risk compared to women of natural age at menopause. Furthermore, women with severe menopausal symptoms may have a more adverse cardiometabolic profile than those without symptoms. We reviewed the latest evidence on the cardiovascular management of perimenopausal or postmenopausal women. Clinicians should aim for cardiovascular risk stratification, followed by dietary and lifestyle advice as required based on individual needs. The medical management of cardiometabolic risk factors at midlife should always be individualized, focusing on hypertension, diabetes and dyslipidemia. Menopausal hormone therapy, when prescribed for the management of bothersome menopausal symptoms or for the prevention of osteoporosis, has also a beneficial effect on cardiometabolic risk factors. This narrative review aims to summarize the cardiometabolic alternations occurring during the menopausal transition and to outline the appropriate prevention strategies to prevent future cardiovascular adverse outcomes.

摘要

心血管疾病（CVD）是全球女性死亡的主要原因, 约占所有女性死亡的近50%。绝经过渡期与中心体脂肪积累、能量消耗减少、体重增加、胰岛素抵抗和促动脉硬化脂质谱的不利变化相关。此外, 绝经与亚临床动脉粥样硬化的功能和结构指标的不良影响独立相关。患有早发性卵巢功能不全的女性与自然绝经年龄的女性相比, 心血管疾病风险更高。此外, 有严重绝经症状的女性可能比没有症状的女性具有更不利的心脏代谢健康状况。我们回顾了有关围绝经期或绝经后女性心血管管理的最新证据。临床医生应该进行心血管风险分层, 然后根据个体需求提供饮食和生活方式建议。中年期心脏代谢风险因素的医学管理应始终个体化, 重点关注高血压、糖尿病和血脂异常。对于为缓解令人困扰的绝经症状或预防骨质疏松而开具的绝经激素疗法, 也对心脏代谢风险因素具有益处。这篇综述旨在总结绝经过渡期心血管代谢变化, 并概述预防策略, 以防止未来的心血管不良结果。

Keywords:

• Menopause
• estrogen deficiency
• androgens
• cardiovascular disease
• lipids
• diabetes
• hormone replacement therapy

Source of funding

Nil.