European Journal of Cardiovascular Medicine

Women play the pivotal role as custodians of family health, significantly influencing the well-being of their communities. A woman’s reproductive years span from her menarche to menopause, with these milestones reflecting ovarian function and aging. The timing of these events is crucial, as both early and late onsets are linked to increased risks of adverse health and psychosocial outcomes. Menopause marks the cessation of ovulation and the production of estrogen and progesterone. The perimenopausal period, which precedes menopause, is characterized by fluctuating hormone levels, primarily estrogen. During perimenopause, estrogen levels typically decline, but this decline is often irregular [1,2].

The reduction in estrogen levels is a contributing factor to the heightened risk of cardiovascular disease among postmenopausal women. Estrogen positively affects the inner layer of artery walls, helping to maintain blood vessel flexibility, allowing them to relax and expand to accommodate blood flow. The estrogen deficiency associated with menopause can alter lipid profiles, thereby increasing the predisposition of postmenopausal women to cardiovascular diseases [3,4]. Numerous studies have demonstrated a positive correlation between menopause and increased cardiovascular disease risk [5-7], although some studies have not found this association [8,9]. For instance, Torng et al. [10] found that while cardiovascular risk factors increased in postmenopausal Taiwanese women, this increase was strongly correlated with age.

This study aimed to examine premenopausal and postmenopausal women to gather relevant data on cardiovascular risk factors and determine whether the loss of estrogenic support increases the propensity for cardiovascular disease in postmenopausal women.

A cross-sectional study was conducted on 363 women aged 35–60 years (183 were premenopausal and 180 were postmenopausal). The study included apparently healthy women with no prior history of cardiovascular or endocrine disorders. Exclusions comprised chronic drinkers, smokers, individuals with cardiopulmonary diseases, hormonal imbalances, chronic illnesses, or those currently on medications affecting cardiac status. Informed written consent was obtained from all participants.

Radial pulse was measured at the wrist to assess rhythmic arterial expansion and contraction. Systolic and diastolic blood pressure were measured in millimeters of mercury (mm Hg) using a mercury sphygmomanometer and auscultatory method. Height was measured in centimeters (cm) using an inch tape, and weight was measured in kilograms (kg) using a weighing machine. Body mass index (BMI) was calculated using the formula: BMI = Weight (kg) / Height (m²). WHO BMI classifications were applied. Hip Circumference was measured around the widest part of the buttocks using inch tape. Waist Circumference was measured at the midpoint between the lower rib margin and top of the iliac crest using a stretch-resistant tape, approximately 1 inch above the umbilicus.

Random Blood Sugar (RBS) was obtained using capillary blood on glucometer strips. For Lipid Profile Assessment, a 3 ml blood sample was collected in a plain vial, allowed to clot, and serum samples were analyzed for triglycerides (TG), very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol using an autoanalyzer machine.

Data entry was performed using MS Office Excel software, and SPSS software version 19.0 was used for analysis. Descriptive statistics such as frequency, percentages, mean, and standard deviation characterized the data. Unpaired t-tests and Chi-square tests were used for association and differences, with significance set at P < 0.05.

While age and some anthropometric parameters like height, weight, and BMI did not significantly differ between pre-menopausal and post-menopausal women, the waist-hip ratio does show a notable variation between these groups (Table 1). The pulse rate showed a slight difference between the two groups. Although the difference was statistically significant it was relatively small and may not have clinical significance. SBP and DBP exhibited notable differences between pre-menopausal and post-menopausal women, indicating potential physiological changes associated with menopause (Table 2). Table 3 presents the comparison of random blood sugar (RBS) levels between pre-menopausal and post-menopausal study groups. Data indicates that post-menopausal women tend to have higher RBS levels compared to pre-menopausal women, highlighting a potential association between menopause and alterations in blood sugar regulation.

Table 4 displays the comparison of lipid profile parameters between pre-menopausal and post-menopausal study groups. The mean triglyceride (TG) level and very low-density lipoprotein (VLDL) levels exhibited a significant difference between the two groups (p < 0.01). The post-menopausal group had a significantly higher mean LDL level. Conversely, high-density lipoprotein (HDL) cholesterol levels were lower in the post-menopausal group compared to the pre-menopausal group (p < 0.01).  The total cholesterol levels also demonstrated a notable difference between the two groups, with the pre-menopausal group having a mean total cholesterol level lesser than that in the post-menopausal group. These findings suggest significant alterations in lipid profile parameters associated with menopause, including higher levels of LDL cholesterol and total cholesterol, lower levels of HDL cholesterol, and elevated VLDL levels.

This study aimed to examine premenopausal and postmenopausal women to collect relevant data on cardiovascular risk factors and determine whether the loss of estrogenic support increases the propensity for cardiovascular disease in postmenopausal women.

The mean BMI of women in the postmenopausal group was slightly higher than that of the premenopausal group, though no significant difference in mean BMI was observed between the two groups. This finding is consistent with results from other studies [8,11,12], though some earlier studies did find significant differences in BMI between premenopausal and postmenopausal groups [5,13]. Obesity in postmenopausal women can be attributed to hormonal imbalances. In our study, the mean waist-hip ratio of women in the postmenopausal group was higher than in the premenopausal group, with a highly significant difference between the two groups. This finding aligns with previous studies [5,7], indicating that an increased waist circumference, a major risk factor for cardiovascular disease, is more prevalent in postmenopausal women.

We also found that the mean SBP in the postmenopausal group was higher than in the premenopausal group, with a highly significant difference between the two. Similarly, the mean DBP was higher in the postmenopausal group, again with a highly significant difference. These results are consistent with those of other studies [11,14]. Furthermore, the mean pulse rate was higher in the postmenopausal group, with a highly significant difference between the groups. Overall, both SBP and DBP, along with the mean pulse rate, increased significantly in postmenopausal women. Soman et al. [15] reported hypertension incidences of 46.96% in premenopausal versus 80.12% in postmenopausal women, while Dosi et al. [7] found 52% of cases and 12% of controls to be hypertensive. Staessen et al. [16] observed that postmenopausal women in Belgium had higher systolic, diastolic, and pulse pressures than premenopausal subjects, with a steeper increase in systolic blood pressure associated with menopause, independent of age.

Our study revealed that mean triglycerides (TG), very low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) levels were significantly higher in the postmenopausal group compared to the premenopausal group. Conversely, high-density lipoprotein (HDL) levels decreased in the postmenopausal group. These results align with those of other investigators [6,13,17-19], though Matthews et al. [20] found that increases in LDL cholesterol and triglycerides and declines in HDL cholesterol were more pronounced during perimenopause than postmenopause.

We also found that the mean RBS levels were significantly higher in the postmenopausal group than in the premenopausal group. Matthews et al. [20] similarly demonstrated that increases in blood pressure and fasting glucose levels were greater during the postmenopausal period.

Our study reiterates that menopause involves several traditional cardiovascular disease (CVD) risk factors, including changes in body fat distribution from a gynecoid to an android pattern, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, increased sympathetic tone, endothelial dysfunction, and vascular inflammation due to the loss of estrogenic support. Menopause is associated with a progressive increase in total cholesterol, particularly LDL, lipoprotein-α, and triglycerides, and a decrease in HDL, resulting in a more atherogenic lipid profile in postmenopausal women. Elevated cholesterol levels are a significant risk factor for CVD [21-23].

The findings of increased cardiovascular disease risk in postmenopausal women in our study highlight the need for preventive strategies to curb the development of CVD in this population. However, a key limitation of our study is that we did not separately examine cardiovascular risk factors in perimenopausal women, as our premenopausal group included perimenopausal women as well. We suggest conducting a larger study to investigate cardiovascular risk factors in the perimenopausal group separately, allowing for comparisons among premenopausal, perimenopausal, and postmenopausal groups, particularly focusing on cardiovascular disease risk in perimenopausal women, a less-studied group.

Adverse changes in lipid profiles, along with a significant increase in cardiac risk ratios observed in postmenopausal women in this study, indicate a heightened risk of cardiovascular disease complications for this group in the near future. Consequently, cardiac care should commence during the premenopausal period. Early detection and primary prevention are crucial to reducing morbidity and mortality in this high-risk population. The combination of aging, loss of estrogenic support, and increased BMI likely contributes to the elevated cardiovascular risk in postmenopausal women. Therefore, interventions such as optimal exercise routines, a plant-based healthy diet, and education about maintaining an ideal body weight should be prioritized for postmenopausal women.

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