HDL benefit may decrease in menopausal women

Women may lose some of the protective cardiovascular effects of high-density lipoprotein cholesterol (HDL-C) as they move into menopause, a recent study suggests. But the authors emphasize that the results are preliminary and don’t prove a causal relationship.

The University of Pittsburgh study retroactively analyzed data on aortic calcification, coronary artery calcification, carotid plaque, and intima media thickness among 316 premenopausal or early perimenopausal women and 224 late perimenopausal or postmenopausal women (average age, 50 years). None of the women had taken hormone replacement therapy or oral contraceptives within 3 months of the study. Menopausal status was self-reported.

The odds of high aortic calcification decreased by 3% for every1 mg/dL increase in HDL-C level in the pre- and early perimenopausal group but increased by 3% in the late perimenopausal and menopausal group. Odds of any left main coronary calcification increased by 8% for every 1 mg/dL of HDL-C in the menopausal group. The protective effect of HDL-C against carotid plaque and intima media thickness also held for the pre- and early perimenopausal group but not the menopausal group.

“This a preliminary, cross-sectional analysis, and, thus, a causal relationship between change in menopause status and HDL cannot be inferred,” emphasize lead author Genevieve A. Woodard, PhD, and colleagues at the University of Pittsburgh Graduate School of Public Health. They note that, although the findings suggest that the protective effect of HDL may weaken in postmenopausal women and the effect of low-density lipoprotein cholesterol (LDL-C) may grow stronger, future research should explore whether the presumed relationship is “due to changes in HDL size, functionality, or related changes in other lipids or lipoproteins.”

Data from a subset of 53 women showed significant differences in the lipoprotein subclass profiles of the 2 groups Menopausal women had smaller and more HDL particles on average. They also had more LDL particles and significantly higher triglyceride and LDL-C levels (P<.05).

The study was published online November 19 in Menopause.