Cardiovascular diseases are the leading cause of death in women according to the 2019 Global Burden of Disease study (1), with cardiovascular diseases accounting for 45% of older women’s (aged 50 and above) deaths globally (2). By managing blood sugar levels and maintaining a healthy weight you can minimize your risk of developing one of these chronic diseases, improve hot flashes and even lose weight during menopause.
Factors that increase a women’s risk of developing cardiovascular and cardiometabolic disease during perimenopause and menopause are multifactorial and include changes both in physiology and lifestyle. Physiological factors include blood sugar imbalances, dyslipidemia, hypertension and abdominal obesity (3). By analyzing specific biomarkers related to these factors we can assess personal risk which can then inform dietary and lifestyle interventions.
Glucose and Insulin Biomarkers
Elevated blood glucose is one of the key risk factors for CVD (4) with peri and post menopausal women being at risk for elevated blood glucose due to a number of factors (including weight gain due to lowering levels of estradiol and reduction in lean muscle mass). In turn, high blood glucose levels can lead to hyperinsulinemia, obesity, metabolic syndrome and insulin resistance, all of which are risk factors for the development of atherosclerosis and CAD (5,6).
Blood glucose can be measured using a number of biomarkers including fasted and post-prandial glucose, and HbA1C, which is used to diagnose Type 2 Diabetes. Additionally, Fasting Insulin levels are a key contributor to the development of cardiometabolic disease and atherosclerosis (7).
Lipid Biomarkers
Whilst standard lipid panels have traditionally been used to measure an individual’s risk for cardiometabolic disease, new studies show that markers such as LDL Cholesterol and Apolipoprotein A and B can provide a deeper insight into lipid status. During menopause a woman’s level of LDL-C increases (due to lower levels of estradiol) with higher levels of LDL more susceptible to oxidation and glycation, creating narrowing and hardening of the artery walls (8). Apolipoprotein A and Apolipoprotein B are found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) respectively and when measured in conjunction with LDL and HDL cholesterol can be used to evaluate risk of CVD (9).
Although LDL-cholesterol and HDL-cholesterol are known risk factors, Apolipoprotein B and Apolipoprotein A are thought to be better predictors of acute myocardial infarction than total cholesterol and LDL-cholesterol.
Inflammatory Biomarkers
Levels of inflammation can rise in peri and post menopausal women due to possible abdominal weight gain (increased amounts of adipose tissue increases the amount of pro-inflammatory cytokines released) and lowering levels of progesterone, a hormone that inhibits production of pro-inflammatory cytokines (10). Increased levels of inflammation drives the expression of many cardiometabolic diseases, including arterial inflammation, atherosclerosis and CVD.
hsCRP is a useful biomarker in assessing risk factors for cardiometabolic disease as it may illustrate risk level for arterial inflammation, atherosclerosis and CVD and may indicate higher levels of oxidative stress (11). More specifically, homocysteine levels can be measured as an indicator of the health of the aerial lining as higher levels of this amino acid may cause damage to the artery wall and lead to blood clots or blood vessel blockages (12).
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References:
- https://vizhub.healthdata.org/gbd-results/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790210/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325449/#:~:text=It%20identified%209%20risk%20factors,moderate%20alcohol%20consumption%2C%20and%20lack
- https://www.mdpi.com/1422-0067/21/5/1835
- https://diabetesjournals.org/care/article/14/3/173/16697/Insulin-Resistance-A-Multifaceted-Syndrome
- https://pubmed.ncbi.nlm.nih.gov/32155866/
- https://eje.bioscientifica.com/view/journals/eje/161/2/223.xml
- https://www.hindawi.com/journals/omcl/2017/1273042/
- https://pubmed.ncbi.nlm.nih.gov/11755609/
- https://www.nature.com/articles/mi201735#:~:text=Progesterone%20can%20also%20decrease%20inflammation,cytokines%2C%20including%20IL%2D10.
- https://www.internationaljournalofcardiology.com/article/S0167-5273(13)01324-7/fulltext
- https://journals.sagepub.com/doi/10.1177/1479972310391284
- https://my.clevelandclinic.org/health/articles/21527-homocysteine