Schindler Louise S, Subramaniapillai Sivaniya, Ambikairajah Ananthan, Barth Claudia, Crestol Arielle, Voldsbekk Irene, Beck Dani, Gurholt Tiril P, Topiwala Anya, Suri Sana, Ebmeier Klaus P, Andreassen Ole A, Draganski Bogdan, Westlye Lars T, de Lange Ann-Marie G
LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
Department of Psychology, University of Oslo, Oslo, Norway.
Front Glob Womens Health. 2023 Dec 21;4:1320640. doi: 10.3389/fgwh.2023.1320640. eCollection 2023.
The menopause transition is associated with several cardiometabolic risk factors. Poor cardiometabolic health is further linked to microvascular brain lesions, which can be detected as white matter hyperintensities (WMHs) using T2-FLAIR magnetic resonance imaging (MRI) scans. Females show higher risk for WMHs post-menopause, but it remains unclear whether changes in cardiometabolic risk factors underlie menopause-related increase in brain pathology.
In this study, we assessed whether cross-sectional measures of cardiometabolic health, including body mass index (BMI) and waist-to-hip ratio (WHR), blood lipids, blood pressure, and long-term blood glucose (HbA1c), as well as longitudinal changes in BMI and WHR, differed according to menopausal status at baseline in 9,882 UK Biobank females (age range 40-70 years, premenopausal = 3,529, postmenopausal = 6,353). Furthermore, we examined whether these cardiometabolic factors were associated with WMH outcomes at the follow-up assessment, on average 8.78 years after baseline.
Postmenopausal females showed higher levels of baseline blood lipids (HDL = 0.14, < 0.001, LDL = 0.20, < 0.001, triglycerides = 0.12, < 0.001) and HbA1c ( = 0.24, < 0.001) compared to premenopausal women, beyond the effects of age. Over time, BMI increased more in the premenopausal compared to the postmenopausal group ( = -0.08, < 0.001), while WHR increased to a similar extent in both groups ( = -0.03, = 0.102). The change in WHR was however driven by increased waist circumference only in the premenopausal group. While the group level changes in BMI and WHR were in general small, these findings point to distinct anthropometric changes in pre- and postmenopausal females over time. Higher baseline measures of BMI, WHR, triglycerides, blood pressure, and HbA1c, as well as longitudinal increases in BMI and WHR, were associated with larger WMH volumes ( range = 0.03-0.13, ≤ 0.002). HDL showed a significant inverse relationship with WMH volume ( = -0.27, < 0.001).
Our findings emphasise the importance of monitoring cardiometabolic risk factors in females from midlife through the menopause transition and into the postmenopausal phase, to ensure improved cerebrovascular outcomes in later years.
绝经过渡与多种心血管代谢危险因素相关。心血管代谢健康状况不佳还与微血管脑病变有关，使用T2加权液体衰减反转恢复序列（T2-FLAIR）磁共振成像（MRI）扫描可将其检测为脑白质高信号（WMHs）。女性绝经后出现WMHs的风险更高，但尚不清楚心血管代谢危险因素的变化是否是绝经相关脑病变增加的基础。
在本研究中，我们评估了9882名英国生物银行女性（年龄范围40-70岁，绝经前=3529人，绝经后=6353人）的心血管代谢健康横断面指标，包括体重指数（BMI）和腰臀比（WHR）、血脂、血压和长期血糖（糖化血红蛋白HbA1c），以及BMI和WHR的纵向变化，是否因基线时的绝经状态而异。此外，我们还研究了这些心血管代谢因素在基线后平均8.78年的随访评估中是否与WMH结果相关。
绝经后女性的基线血脂（高密度脂蛋白HDL：差异=0.14，P<0.001；低密度脂蛋白LDL：差异=0.20，P<0.001；甘油三酯：差异=0.12，P<0.001）和HbA1c（差异=0.24，P<0.001）水平高于绝经前女性，超出了年龄的影响。随着时间的推移，绝经前组的BMI增幅大于绝经后组（差异=-0.08，P<0.001），而两组的WHR增幅相似（差异=-0.03，P=0.102）。然而，只有绝经前组的WHR变化是由腰围增加驱动的。虽然BMI和WHR的组间水平变化总体较小，但这些发现表明绝经前和绝经后女性的人体测量学变化随时间推移存在明显差异。较高的基线BMI、WHR、甘油三酯、血压和HbA1c水平，以及BMI和WHR的纵向增加，与更大的WMH体积相关（相关系数范围=0.03-0.13，P≤0.002）。HDL与WMH体积呈显著负相关（相关系数=-0.27，P<0.001）。
我们的研究结果强调了从中年期到绝经过渡再到绝经后阶段监测女性心血管代谢危险因素的重要性，以确保晚年改善脑血管结局。
