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Risk factors for heart disease increase before menopause

Risk factors for heart disease increase earlier for black women than white women. (iStock)

Risk factors for heart disease, diabetes and stroke increase more quickly than expected in the years preceding menopause, according to new research, and the risk factors seem to be more prominent in black women.

Metabolic syndrome describes a constellation of risk of factors that contribute to cardiovascular disease, including a large waist, high triglyceride levels, high blood pressure and high blood sugar when fasting. It has been known that metabolic syndrome is more common in women post-menopause, but it wasn't clear when the symptoms start to kick in.

Researchers assessed data from 1,470 women taking part in the Atherosclerosis Risk in Communities cohort, a long-term national study that looks at the root and effects of artery hardening. The analysis covered changes in menopause status over 10 years.

Mark DeBoer, a pediatric endocrinologist at the University of Florida and one of the lead researchers on the study, said his previous research on metabolic syndrome in children showed differences across racial and ethnic backgrounds.

“Metabolic syndrome is [a] cluster that appears more often than you’d think,” he said. “African Americans were less likely to be diagnosed even though there is a higher rate of heart disease and diabetes.”

DeBoer and other researchers found that menopausal black women are at greater risk for cardiovascular disease and diabetes than their white counterparts.

Women across all backgrounds experienced a rapid surge in metabolic syndrome severity during the transition to menopause. However, black women experienced an increase in metabolic syndrome severity before the transition to menopause. Black women overall had higher rates of metabolic syndrome, especially with high blood pressure and high fasting blood sugar levels, compared to white women.

Nearly 45 percent of black women in the study had hypertension compared to 15 percent of white women. Almost 10 percent of black women had high glucose compared to 8 percent of white women. Black women had a slower rate of metabolic syndrome increase after menopause compared to white women, however.

Although nearly 14 percent of white women used hormone replacement therapy in contrast to almost 7 percent of black women, that didn't explain the racial differences. DeBoer observed that the women in the study had a much higher use of hormone replacement therapy than what is currently the norm.

JoAnn Pinkerton, an OBGYN and executive director of the North American Menopause Society, said she was struck by the rapid progression of metabolic syndrome during the transition to menopause, or perimenopause. Pinkerton noted that it is the most difficult phase of menopause, saying that women can gain five to 10 pounds per year in the time leading up to actual menopause, and fibroid tumor growth is possible due to changes in estrogen and progesterone.

“Women who approach the perimenopause need to be really careful about keeping their exercise going and decreasing their portion sizes,” she said.

Pinkerton said the medical field needs to start testing women earlier for metabolic syndrome. “Intervention for women at risk or who are developing metabolic syndrome should not wait until 50 or post-menopause,” she said. “We need to start looking at women in the 40s before they hit those hormonal fluctuations.”

“The most important thing is an awareness of changes at the time leading up to menopause that increase cardiovascular diseases,” said DeBoer. “This serves as a motivator [for] healthy lifestyle changes.”