Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Instituto de Investigación e Innovación en Salud Integral and Laboratorio de Biomedicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
Lancet Diabetes Endocrinol. 2022 Jun;10(6):442-456. doi: 10.1016/S2213-8587(22)00076-6. Epub 2022 May 4.
Menopause is often a turning point for women's health worldwide. Increasing knowledge from experimental data and clinical studies indicates that cardiometabolic changes can manifest at the menopausal transition, superimposing the effect of ageing onto the risk of cardiovascular disease. The menopausal transition is associated with an increase in fat mass (predominantly in the truncal region), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Exposure to endogenous oestrogen during the reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. In particular, women with vasomotor symptoms during menopause seem to have an unfavourable cardiometabolic profile. Early management of the traditional risk factors of cardiovascular disease (ie, hypertension, obesity, diabetes, dyslipidaemia, and smoking) is essential; however, it is important to recognise in the reproductive history the female-specific conditions (ie, gestational hypertension or diabetes, premature ovarian insufficiency, some gynaecological diseases such as functional hypothalamic amenorrhoea, and probably others) that could enhance the risk of cardiovascular disease during and after the menopausal transition. In this Review, the first of a Series of two papers, we provide an overview of the literature for understanding cardiometabolic changes and the management of women at midlife (40-65 years) who are at higher risk, focusing on the identification of factors that can predict the occurrence of cardiovascular disease. We also summarise evidence about preventive non-hormonal strategies in the context of cardiometabolic health.
绝经通常是全球女性健康的一个转折点。越来越多的实验数据和临床研究表明，心血管代谢变化可能在绝经过渡期间出现，从而增加了心血管疾病的风险。绝经过渡与脂肪量增加（主要在躯干部位）、胰岛素抵抗、血脂异常和内皮功能障碍有关。生殖期内内源性雌激素的暴露为女性提供了对心血管疾病的保护，这种保护在绝经开始后 10 年左右消失。特别是在绝经期间出现血管舒缩症状的女性似乎具有不利的心血管代谢特征。早期管理心血管疾病的传统危险因素（即高血压、肥胖、糖尿病、血脂异常和吸烟）至关重要；然而，重要的是要在生殖史中识别出可能增加绝经过渡期间和之后心血管疾病风险的女性特有的情况（即妊娠高血压或糖尿病、卵巢早衰、一些妇科疾病如功能性下丘脑性闭经，可能还有其他情况）。在这篇综述中，是两部分系列的第一篇，我们提供了理解心血管代谢变化和管理处于更高风险的中年（40-65 岁）女性的文献综述，重点关注可以预测心血管疾病发生的因素。我们还总结了关于心血管代谢健康背景下预防非激素策略的证据。
