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Freelance writer for Contemporary OB/GYN
Postmenopausal women are significantly more likely to meet criteria for metabolic syndrome than are premenopausal women, according to a cross-sectional analysis of women aged 45 to 85.
According to data from 2012 and 2013, the estimated incidence of metabolic syndrome in Canadian women is 20%, and as high as 38% among women aged 60 to 79.
“Most recently, metabolic syndrome has been associated with an increased risk of breast cancer development, poor prognostic characteristics including triple-negative hormone receptor status, increased likelihood of recurrence, and higher mortality,” wrote the Canadian investigators, who presented their findings in the journal Menopause.1
The authors evaluated whether menopause is an independent risk factor for the development of metabolic syndrome or its components, including hypertension, central obesity, dyslipidemia, and elevated glycated hemoglobin.
The study cohort consisted of 12,611 women whose baseline data were included in the Canadian Longitudinal Study on Aging Comprehensive Cohort. The data were collected from 2012 to 2015.
Among the cohort, 79.6% had undergone menopause and 20.4% were premenopausal.
Overall, 32.6% of postmenopausal women met the criteria for metabolic syndrome versus 20.5% of premenopausal women (P < 0.001).
In both postmenopausal and premenopausal women with a small waist circumference threshold (≥ 80 cm), based on the criteria for metabolic syndrome, the prevalence of metabolic syndrome was higher: 38.2% and 23.2%, respectively (P < 0.001).
However, after adjusting for age, body mass index (BMI), and other covariates, the occurrence of menopause was not linked to a significantly higher relative risk of metabolic syndrome when using the unified criteria. For metabolic syndrome: adjusted relative risk (aRR) 1.09; 95% confidence interval (CI): 0.99 to 1.19. (A unified set of criteria were developed in 2009 by organizations including the International Diabetes Federation, the American Heart Association, and the National Heart, Lung, and Blood Institute.)
But women in menopause had a significantly higher relative risk of metabolic syndrome when using criteria for the lower waist circumference: aRR 1.10; 95% CI: 1.01 to 1.19.
The study also found that menopause, rather than the metabolic syndrome, was associated with a higher risk of impaired glucose tolerance (aRR 1.42; 95% CI: 1.26 to 1.59), elevated blood pressure (aRR 1.12; 95% CI: 1.03 to 1.21), and elevated triglycerides (aRR 1.17; 95% CI: 1.08 to 1.26).
Conversely, there was no significant difference in the risk of metabolic syndrome or the occurrence of menopause by age group.
Among postmenopausal women, 38.7% reported using menopausal hormone therapy (MHT), but there was no significant difference in the risk of metabolic syndrome among postmenopausal women on MHT compared to those who were not on therapy.
Premenopausal women reported more weight gain than postmenopausal women. This finding is of particular importance to the Canadian population, “as perhaps women in Canada gain weight earlier, presenting an opportunity to increase awareness among younger women around expected weight change during their upcoming menopause transition,” wrote the authors.
Lifestyle interventions targeted at women with metabolic syndrome can prevent type 2 diabetes mellitus and cardiovascular risk, according to the authors. “Perimenopause may be an important preventative care opportunity to assess metabolic risk factors and improve health and longevity of Canadian women,” they wrote.
Christakis MK, Hasan H, De Souza LR, Shirreff L. The effect of menopause on metabolic syndrome: cross-sectional results from the Canadian Longitudinal Study on Aging. Menopause. 2020 Sep;27(9):999-1009. doi:10.1097/GME.0000000000001575