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Midlife women transitioning to menopause have a higher risk of metabolic syndrome, which predisposes to heart disease and type 2 diabetes

Midlife women transitioning to menopause may be able to lower their risk of developing heart disease and type 2 diabetes, if they exercise more or eat a lower calorie diet, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Metabolic syndrome describes a cluster of risk factors that increase the chances of developing heart disease, stroke, and diabetes. The exact cause of metabolic syndrome is not known but genetic factors, too much body fat, and lack of exercise can add to its development. According to recent data, one in five Americans has metabolic syndrome. These patients are diagnosed when they have three or more of these risk factors: large amount of abdominal body fat, low ("good") cholesterol, high levels of fat in the blood, high blood pressure, and high blood glucose.

"Previous studies have largely focused on cardiovascular disease and type 2 diabetes in postmenopausal women. This study is unique because it focuses on an earlier stage in women's lives, the menopausal transition in midlife, to potentially prevent such diseases from occurring," said lead study author Jennifer S. Lee, M.D., Ph.D., Associate Professor of Medicine, Stanford Medical Center and the Veteran Affairs Palo Alto Health Care System in Stanford, Calif. "Discovering which modifiable factors like physical activity and a lower calorie diet are more common in midlife women who recover from metabolic syndrome, in this study, could better inform what preventive strategies to consider in women earlier in their lives."

In the prospective, multi-ethnic cohort study, researchers studied 3,003 (1412 non-Hispanic White, 851 Black, 272 Japanese, 237 Hispanic, 231 Chinese) midlife women undergoing the transition to menopause. They identified patterns of cardiometabolic risk and found central obesity to be the most common factor for causing metabolic syndrome. They also found that lifestyle changes like more physical activity and a lower calorie diet could help patients recover from metabolic syndrome. Additionally, physically active women in the study were less likely to get incident metabolic syndrome than inactive women.


Cardiometabolic conditions increase in midlife but early customized prevention strategies are not established for such women.

To characterize, and identify factors related to, constellations of cardiometabolic risk components longitudinally in multi-racial/ethnic midlife women.

We conducted a prospective longitudinal, multi-ethnic cohort study of 3,003 midlife women, undergoing the menopausal transition (MT). Metabolic syndrome (MetS) meant having at least 3 of 5 components: high fasting triglyceride (hTG), low high density lipoprotein cholesterol (lHDL), high fasting plasma glucose (hGluc), large waist circumference (Ob), and hypertension (HTN). We described the patterns of constellations and estimated hazard ratios (HRs) for constellations at 1) incident MetS and 2) recovery from MetS, using multivariable-adjusted Cox regression.

Seven U.S. sites

1412 non-Hispanic White, 851 Black, 272 Japanese, 237 Hispanic, 231 Chinese women

Race/ethnicity, lifestyle factors, MT stage

Main Ooutcomes Measures
Cardiometabolic constellations; incident MetS; MetS recovery

Central obesity was the most frequent component. Having no components was the most frequent (31%) baseline constellation. Physical activity (HR = 1.68, 95% CI: 1.06-2.68) and lower caloric intake (HR = 0.96; 95% CI: 0.93-0.99, per 100 Cal/day) were associated with recovery from MetS. Ob/hTG/lHDL (18%), Ob/HTN/lHDL (16%), and Ob/HTN/hGluc (14%) were frequent incident constellations. Physically active women had 26-62% lower hazards of incident MetS than inactive women.

Modifiable lifestyle behaviors were related to recovery from MetS and/ decreased risk of the most frequent MetS constellations in midlife women.


Ward E, Gold EB, Johnson WO1, Ding F, Chang PY, Song P, El Khoudary S, Karvonen-Gutierrez C, Ylitalo KR, Lee JS5. Patterns of Cardiometabolic Health as Midlife Women Transition to Menopause: A Prospective Multi-Ethnic Study. J Clin Endocrinol Metab. 2018 Oct 25. doi: 10.1210/jc.2018-00941. [Epub ahead of print]

Content updated 30 October 2018

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