Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.
Bibliographical noteFunding Information:
Clinical Centers: University of Michigan, Ann Arbor?Siob?n Harlow, PI 2011?present; MaryFran Sowers, PI 1994?2011; Massachusetts General Hospital, Boston, MA?Joel Finkelstein, PI 1999?present; Robert Neer, PI 1994?1999; Rush University, Rush University Medical Center, Chicago, IL?Howard Kravitz, PI 2009?present; Lynda Powell, PI 1994?2009; University of California, Davis/Kaiser?Ellen Gold, PI; University of California, Los Angeles?Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY?Carol Derby, PI 2011?present, Rachel Wildman, PI 2010?2011; Nanette Santoro, PI 2004?2010; University of Medicine and Dentistry?New Jersey Medical School, Newark?Gerson Weiss, PI 1994?2004; and the University of Pittsburgh, Pittsburgh, PA?Karen Matthews, PI. National Institutes of Health Program Office: National Institute on Aging, Bethesda, MD?Winifred Rossi 2012?present; Sherry Sherman 1994?2012; Marcia Ory 1994?2001; National Institute of Nursing Research, Bethesda, MD?Program Officers. Central Laboratory: University of Michigan, Ann Arbor?Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating Center: University of Pittsburgh, Pittsburgh, PA?Maria Mori Brooks, PI 2012?present; Kim Sutton Tyrrell, PI 2001?2012; New England Research Institutes, Watertown, MA?Sonja McKinlay, PI 1995?2001. Steering Committee: Susan Johnson, Current Chair; Chris Gallagher, Former Chair. We thank the study staff at each site and all the women who participated in SWAN.