Findings presented at the ESC Congress 2024 in London revealed significant changes in blood cholesterol profiles during the menopausal transition, potentially explaining the increased risk of cardiovascular disease in postmenopausal women.

In a study, investigators analyzed the data of 1,246 female participants in the Dallas Heart Study (DHS), categorized as premenopausal (n = 440, 35%), perimenopausal (n = 298, 24%), and postmenopausal (n = 508, 41%), along with 1,346 men as a reference group. The mean ages were 34, 42, and 54 years for pre-, peri-, and postmenopausal women, respectively, and 43 years for men.

The investigators used nuclear magnetic resonance (NMR) technology to measure common lipoproteins associated with cardiovascular disease (CVD), including atherogenic low-density lipoprotein (LDL) particles and small dense-LDL, at two time points (DHS1 and DHS2) over a median follow-up time of 7 years. The perimenopausal group was defined as women who were premenopausal at DHS1 and postmenopausal at DHS2.

The investigators found an increase in atherogenic LDL particles and a decrease in high-density lipoprotein (HDL) particles during and after menopause.

Among the key findings were:

• Perimenopausal women experienced the greatest percent change in LDL particles (8.3%) compared with pre- and postmenopausal groups.
• Postmenopausal women showed the largest decrease in HDL particles (-4.8%) compared with men.
• Small-dense LDL increased by 213% in the perimenopausal group, approximately 15% higher than both pre- and postmenopausal groups.

"There is an increase in 'bad' low-density type lipoprotein particles and a decrease in 'good' high-density lipoprotein particles that takes place during and after the menopause transition," emphasized Stephanie Moreno, MD, of the University of Texas Southwestern Medical Center.

The study highlighted that CVD accounts for 40% of all deaths among women, making it the leading cause of mortality in this population. Women typically develop CVD about 10 years later than men, with risk increasing postmenopause.

Previous studies have largely focused on traditional lipid measures (LDL cholesterol, HDL cholesterol, and triglycerides) without examining changes in advanced lipids, including lipid subfractions and particle numbers, which have been shown to be more predictive of CVD in various studies.

"Taken together, these changes suggest that menopause is associated with a transition to a higher-risk lipoprotein profile that could be more likely to cause cardiovascular disease such as coronary artery disease," Dr Moreno underscored.

The investigators acknowledged that more research is needed to investigate whether these adverse changes in lipoproteins translate to greater cardiovascular risk.