European Journal of Cardiovascular Medicine

Menopause denotes a condition of permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity and cessation of menstruation. Incidence of CAD in women under 50 years of age is less as compared to women above 50 years of age. After the age of 50 years incidence of CAD  becomes equal in Males and Females. As the Menopause is attained, estrogen decreases, LH & FSH Increases  which affects the levels of plasma Lipids and Lipoprotein Metabolism⁷.After Menopause low estrogen production from the ovaries leads to deranged glucose & insulin⁹ metabolism, deranged lipoprotein metabolism, alterations in the vascular endothelium. In our  study we are comparing the Lipid Profile in Pre-Menopausal and Post-Menopausal females, so that the risk of CAD  can be assessed.

Study was case control study conducted at Dr D Y Patil Medical College Hospital & Research centre Pimpri, Pune from January 2023 to December 2023. Women attending Outpatient department were included in the study. The study comprised total 100 women, which included 50 Postmenopausal women and 50 post-menopausal Women.  Women with Diabetes Mellitus, Cardiovascular diseases, Hypertension, Diabetes Mellitus, malignancy or  any other inflammatory disease and those who are on hormonal treatment and on hypolipidemic drugs were excluded from the study.

After 12 hour overnight fasting  venous blood samples collected from both the groups and estimated for  serum total cholesterol (TC) and serum triglycerides (TG), HDL Levels. TC level estimated by CHOD-PAP method,(9) TG level by GPO Trinder method,(10) HDL level by Phosphotungstic acid method end point.11 And LDL, VLDL values were calculated by applying Friedwald’s equation.(12) VLDL = TG/5 and LDL = TC – (VLDL + HDL)

Statistical Analysis:

The results of all profiles Total Cholesterol, Triglyceride, LDL, VLDL, HDL of 100 samples were expressed as mean ± SD. Software Used: MS Excel (Microsoft 365), RStudio (Version: 2023.08.0-daily+170) and IBM SPSS Statistics 27.Independent samples t-test (indicated by ‡) or Mann Whitney U test. Statistically Significant*.. P–value of less than 0.05 was considered significant. And P value less than 0.001 was considered highly significant.

Table 1: Comparison of parameters in both pre and post-menopausal women

Comparison between pre and post menopausal females for Lipid Profile

Values displayed are mean ± SD; two independent samples t-test (indicated by ‡) or Mann Whitney U test. P < 0.05; Statistically Significant*.

Table 2: Correlation of Age with different tests

Pearsons’s product moment correlation coefficient. test used: Pearson’s correlation test, P < 0.05; Statistically Significant*.

Total Cholesterol (p<0.001) ,  Triglycerides (p<0.001) ,VLDL Cholesterol (p<0.001) ,

LDL Cholesterol(p<0.001) showed statistically significant values. Values of the above parameters were significantly increased in post-menopausal women > 50 yrs as compared to pre-menopausal women < 50 yrs

Menopause denotes a condition of permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity and cessation of menstruation. Menopause is also associated with decreased physical activity which leads to altered lipid profile. During exercise free fatty acids are required for energy production which is in turn produced by metabolism of triglycerides in the adipose tissues. The triglycerides are hydrolysed to free fatty acids and glycerol by lipoprotein lipase enzyme.

Adrenal cortex and gonadal hormones ²⁴are also responsible for degradation of lipids. As gonadal activity is also less in post menopausal period. adverse changes in glucose and insulin metabolism, body fat distribution, coagulation, fibrinolysis and vascular endothelial dysfunction²².There are  various hormonal adverse changes in glucose and insulin metabolism, body fat distribution, coagulation, fibrinolysis and vascular endothelial dysfunction.

The major effect of Estrogen on lipid metabolism is by its action on regulation of various LDL receptors in Liver. Estrogen acts on these LDL receptors on the hepatocytes and leads to increased clearance of LDL-C particles. By this mechanism levels of LDL-C are regulated in the serum. If the concentration of small dense particles are increased it is characterized by elevated serum total cholesterol , triglycerides, LDL-C,VLDL and reduced HDL-C. In association to these changes in lipid profile the individuals also show increased adipose tissues and increased insulin resistance [9]. These fractions of lipid profile are highly atherogenic and lead to increased chances of CAD. Estrogen increases HDL-C which is considered to be good cholesterol for CVS by increased hepatic productions of Apolipoprotein -A and decreased hepatic elimination of HDL2 cholesterol by decreasing the activity of hepatic lipase enzyme. Since during menopause estrogen is low and which leads to hampering of all these functions

All these factors combined together leads to elevated TC,TG,LDL-C,and reduced HDL-C levels in serum of post menopausal women leading to increased risk of CAD.

Post-Menopausal women  are at an increased risk of cardiovascular diseases due to decrease in estrogen, HDL and increase in Total Cholesterol. LDL, VLDL and Triglycerides. So postmenopausal women should be counselled about having low fat diet, high fibre diet, exercise and getting their Lipid profile done at least once a year to assess the risk of CVD.

1. Do K A, A Green, J R Guthrie, E C Dudley, H G Burger and L Dennerstein.Longitudinal study of risk factors for coronary heart disease across the menopausal Transition. Am.J. Epidemiol.2000;151(6):584-93.
2. Berg G, Mesch V, Boero L et al.Lipid and lipoprotein profile in menopausal transition. Effects of hormones, age and fat distribution. Horm Metab Res. Apr. 2004 ; 36(4) : 215-20 . 3. Bade G, Shah S,Nahar P, Vaidya S.
3. Usoro CA, Adikwuru CC, Usoro IN, Nsonwu AC. Lipid profile of postmenopausal women in Calabar, Nigeria. Pak J Nutr 2006;5:79-82.
4. Bade G, Shah S,Nahar P, Vaidya S. Effects of menopause on lipid profile in relation to body mass index. Chron young sci 2014;5(1):20-4.
5. Gupta R, Rastogi P, Sarna M, Gupta VP, Sharma SK, Kothari K. Body-mass index, waist- size, waist-hip ratio and cardiovascular risk factors in Urban subejcts. J Assoc Physicians India 2007; 55:621-27. 5. Usoro CA, Adikwuru CC, Usoro IN, Nsonwu AC. Lipid profile of postmenopausal women in Calabar, Nigeria. Pak J Nutr 2006;5:79-82.
6. Park K. Park’s Textbook of Preventive and Social Medicine.20th ed. Jabalpur:M/S Banarsidas Bhanot; 2009. p.345-9.
7. Domenico d, Marco G, Michele M, Francesco P, Modena AB, Bolis PF et al.The effect of menopause on blood lipid and lipoprotein levels. Atherosclerosis 1999 July; 147:147-53.
8. Hurd WW, Amesse LS, Randolph JF Jr .Menopause.In:Jonathan SB , editor. Novek’s Gynaecology , 13th ed.Philadelphia: Lippincott Williams and wilkins;2002.p 1109-42.
9. Tchernof A, Lamarche B, Prud’Homme D, Nadeau A, Moorjani S, Labrie F, et al. The dense LDL Phenotype. Association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men. Diabetes Care 1996;19:629-37.
10. Medina RA, Aranda E, Verdugo C, Kato S, Owen GI. The action of ovarian hormones in cardiovascular disease. Biol Res 2003;36:325-41.
11. Swapnali RK, Kisan R, Murthy DS. Effect of menopause on lipid profile and Apolipoproteins. Al Ameen J Med Sci 2011;4:221-8.
12. Kalavathi L, Dhruvanarayan HR, Zachariah E. Plasma estradiol and lipid profile in perimenopausal women. Indian J Physiol Pharmacol 1991;35:260-2.
13. Bonithon-Kopp C, Scarabin PY, Darne B, Malniejac A, Guize L. Menopause related changes in lipoproteins and some other cardiovascular risk factors. Int J Epidemiol.1990; 19 (1): 42-8. .......................................... How to cite this article? Tiwari J, Naagar JK. Changes in serum lipid profile in postmenopausal women with reference to Body mass index (BMI). Int J Med Res Rev 2015;3(5):456-460
14. Williams P, Robinson D, Bailey A. High density lipoprotein and coronary risk factor. Lancet 1979;1:72.
15. Riedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
16. Igweh, J.C., Nwagha, I.U., Okaro, J.M. (2005). The effects of menopause on the serum lipid profile of normal females of south east Nigeria. Nigerian Journal of Physiological Sciences. 520 (1-2): 48-53. 20. Usoro, C.A.O., Adikwuru, C.C., Usoro, I.N., Nsonwu, A.C. Lipid profile of postmenopausal women in Calabar, Nigeria. Pakistan Journal of Nutrition. 2006;5(1): 79-82
17. Mathews KA, Wing RR et al... Influence of the Perimenopause on Cardiovascular Risk Factors and Symptoms of Middle Aged Healthy Women. Arch Int Med 1994; 154: 2349-2355.
18. Taddec S, Virdis A, Ghiadoni L, Mattec P, Sudano I, Bernini G. Menopause is associated with endothelial dysfunction in women.Hypertension. 1996;.28: 576-82.
19. JC Igweh et al.. ,The effects of menopause on the serum lipid profile of normal females of south east Nigeria. Nigerian Journal of Physiological Sciences. 2005; 20 (1- 2): 48-53
20. Adashi EY. The climacteric ovary as a functional gonadotropin driven androgen- producing gland. Fertil Steril. 1994;62:20-7.
21. Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA. 1991;265:1861-7.
22. Groedstein F, Stampfer MJ, Manson JE, Colditz GA, Willet WC, Rosner B, et al... Post-menopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996;335:453-61. 27. Wild RA, Taylor EL, Knehans A. The gynecologist and the prevention of cardiovascular disease. Am J Obstet Gynecol. 1995;172:1-13.
23. Kalavathi L Dhruvanarayan HR, Zachariah E. Plasma estradiol and lipid profile in perimenopausal women. Indian J Physiol Pharmacol. 1991;35:260-