Risk of metabolic syndrome rises near menopause

NEW YORK (Reuters Health) - As women begin to enter menopause, their risk of developing a collection of heart disease risk factors appears to climb, a study has found.

Researchers found that among 949 U.S. women followed for nearly a decade, the risk of developing metabolic syndrome increased during perimenopause -- the years during which a woman's body begins to transition into menopause, usually starting somewhere in her 40s.

Metabolic syndrome refers to this cluster of risk factors for heart disease, stroke and diabetes -- including high blood pressure, abdominal obesity, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits.

The new findings, published in the Archives of Internal Medicine, appear to be the first showing that the incidence of metabolic syndrome begins to rise during perimenopause.

More specifically, the study found, the risk is related to increases in testosterone activity.

The "main message" here for women is that maintaining a healthy lifestyle may be especially critical during perimenopause, lead researcher Dr. Imke Janssen, of Rush University Medical Center in Chicago, told Reuters Health.

Not smoking, eating a healthy diet and getting regular exercise can all help reduce a woman's risk of the various components of metabolic syndrome, Janssen said.

She and her colleagues based their findings on an ethnically diverse sample of U.S. women who were between the ages of 42 and 52 and free of metabolic syndrome at the outset. The women were followed for nine years.

Overall, Janssen's team found, nearly 14 percent developed metabolic syndrome by the time they had their final menstrual period. The risk of developing the syndrome increased progressively starting six years before the final menstrual period.

But while the odds of developing metabolic syndrome were elevated after menopause, the risk was greater during perimenopause, Janssen noted.

It has long been known that women generally have a lower risk of cardiovascular disease than men do before the age of 45. But after age 55, the trend reverses, with women actually being at greater risk than men their age.

"Obviously, something happens there, between 45 and 55," Janssen said, noting that it was once assumed that diminishing levels of estrogen told the whole story.

But in this study, women's estrogen levels were unrelated to the odds of developing the metabolic syndrome. Instead, the syndrome correlated with an increase in testosterone activity -- suggesting that the direct negative effects of testosterone are more important than the loss of estrogen's positive effects in women's cardiovascular risks.

This idea, Janssen and her colleagues note, is consistent with clinical trials that have found no cardiovascular benefits from estrogen replacement therapy.

The bottom line for women, according to Janssen, is that during these years of hormonal change, healthy habits become more important than ever.

SOURCE: Archives of Internal Medicine, July 28, 2008.