Postmenopausal status increases risk of metabolic syndrome

The metabolic syndrome (MetS) is characterized by the clustering of abdominal obesity, hypertension, impaired glucose tolerance, and atherogenic dyslipidaemia; it is associated with an increased risk of cardiovascular disease. This study investigated the influence of postmenopausal status on the prevalence of the MetS, including its individual components, and the effects of postmenopausal status according to the number of years since menopause.
Commentary
Joon Cho et al. confirm the findings already reported elsewhere that women develop features of the metabolic syndrome (MetS) during the transition to the postmenopausal state. Ethnic differences in the prevalence of MetS have also been documented. Given the potential long-term health consequences of the MetS, appropriate and timely intervention is obviously important.
Women who had ever used oestrogen therapy were excluded from this study and it would have been interesting to see if there were differences in the development of central obesity in women who were not oestrogen deficient. The time-related development of features of the MetS, such as central adiposity, hypertension, and changes in glucose metabolism, is well documented.
There is a considerable literature indicating that women with polycystic ovary syndrome (PCOS) are at a much higher risk of MetS than the general population [1. Glueck CJ, Papanna R, Wang P, et al. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003;52:908-15.(close)]. Postmenopausal women with a history consistent with the diagnosis of PCOS have a worse cardiovascular risk on the basis of features compatible with the MetS [2. Shaw LJ, Bairey Merz CN, Azziz R, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health–National Heart, Lung, and Blood Institute sponsored Women”s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab. 2008;93:1276-84.(close)]. Hyperandrogenaemia is a particular risk factor for MetS and type 2 diabetes [3. Corbould A. Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome? Diabetes Metab Res Rev. 2008 Jul 10. [Epub ahead of print](close)],[4. Cheung LP, Ma RC, Lam PM, et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod. 2008;23:1431-8.(close)]. An assessment of androgen status might therefore have contributed to the information presented in this study.
In summary, many of the features of the MetS develop in the postmenopausal period, and MetS is more common in postmenopausal compared with premenopausal women. Ethnicity is important, but studies to date show a variable prevalence. Changes around the menopause include body fat distribution, body mass index, blood pressure, and glucose levels, which impact on the development of the MetS. Women with PCOS are at particular risk and should be carefully monitored well beyond their reproductive years. Assessment of androgen status, in addition to metabolic parameters, is important as hyperandrogenaemia is an added risk factor for the abnormalities in glucose and insulin characteristic of the MetS. Careful ongoing assessment of women in their postmenopausal years is therefore essential.
Features of the metabolic syndrome (MetS), such as abdominal adiposity, insulin resistance, and dyslipidaemia, develop with the transition from pre- to postmenopausal status in women. This study investigated the effects of postmenopausal status on the prevalence of the MetS according to years since menopause.
The study included a total of 1,002 women, 618 premenopausal and 384 postmenopausal, who participated in annual health examinations at Anam Hospital in Seoul, Korea.
Using multivariate logistic regression analysis, the authors determined that postmenopausal status was an independent risk factor for the MetS. Moreover, after controlling for age and body mass index, postmenopausal women had an increased risk of MetS (odds ratio, 2.93; 95% confidence interval 1.62-5.33) and the abnormalities of its individual components.
The risk for MetS increased up to 14 years since menopause, then decreased. For its individual components, postmenopausal women who were 5-9 years since menopause were at highest risk of high blood pressure; postmenopausal women who were less than 5 years since menopause had an increased risk of abdominal obesity and high glucose levels. At 10-14 years since menopause, postmenopausal women had an increased risk of high triglyceride levels
The authors concluded that postmenopausal status is an independent risk factor for the MetS and all of its individual components. The risk for the MetS increased up to 14 years since menopause. In addition, postmenopausal status has effects during different periods since menopause for each of these components.
References
1. Glueck CJ, Papanna R, Wang P, et al. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003;52:908-15.
2. Shaw LJ, Bairey Merz CN, Azziz R, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health–National Heart, Lung, and Blood Institute sponsored Women”s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab. 2008;93:1276-84.
3. Corbould A. Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome? Diabetes Metab Res Rev. 2008 Jul 10. [Epub ahead of print]
4. Cheung LP, Ma RC, Lam PM, et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod. 2008;23:1431-8.
Author Commentary
Prof. Z.M. van der Spuy
Dept of Obstetrics and Gynaecology
Faculty of Health Sciences
University of Cape Town and Groote Schuur Hospital
Groote Schuur
Cape Town
South Africa

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