Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?

Karen A. Matthews, Sybil L. Crawford, Claudia U. Chae, Susan A. Everson-Rose, Mary Fran Sowers, Barbara Sternfeld, Kim Sutton-Tyrrell

Research output: Contribution to journalArticlepeer-review

490 Scopus citations


Objectives: This prospective study examined whether changes in traditional and novel coronary heart disease (CHD) risk factors are greater within a year of the final menstrual period (FMP), relative to changes that occur before or after that interval, in a multiethnic cohort. Background: Understanding the influence of menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian samples. Methods: SWAN (Study of Women's Health Across the Nation) is a prospective study of the menopausal transition in 3,302 minority (African American, Hispanic, Japanese, or Chinese) and Caucasian women. After 10 annual examinations, 1,054 women had achieved an FMP not due to surgery and without hormone therapy use before FMP. Measured CHD risk factors included lipids and lipoproteins, glucose, insulin, blood pressure, fibrinogen, and C-reactive protein. We assessed which of 2 models provided a better fit with the observed risk factor changes over time in relation to the FMP: a linear model, consistent with chronological aging, or a piecewise linear model, consistent with ovarian aging. Results: Only total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B demonstrated substantial increases within the 1-year interval before and after the FMP, consistent with menopause-induced changes. This pattern was similar across ethnic groups. The other risk factors were consistent with a linear model, indicative of chronological aging. Conclusions: Women experience a unique increase in lipids at the time of the FMP. Monitoring lipids in perimenopausal women should enhance primary prevention of CHD.

Original languageEnglish (US)
Pages (from-to)2366-2373
Number of pages8
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - 2009

Bibliographical note

Funding Information:
SWAN (Study of Women's Health Across the Nation) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (grants NR004061 , AG012505 , AG012535 , AG012531 , AG012539 , AG012546 , AG012553 , AG012554 , and AG012495 ). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.


  • inflammation
  • lipids
  • menopause
  • race
  • risk factors


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