After menopause, is an enlarging middle, an enlarging cardiovascular risk factor?
After menopause, is an enlarging middle, an enlarging cardiovascular risk factor?
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绝经后，腰围增大是心血管疾病的危险因素吗？
DOI：
10.1097/gme.0000000000001620
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Shufelt,ChrisandraL
中科院分区：
文献类型：
--
作者：
Lee,JulieJ;Shufelt,ChrisandraL
(CVD). 1-3 Although sex differences exist in adipose distribution, in that premenopausal women have greater numbers and larger sizes of adipocytes in the gluteofemoral region (gynoid pattern) than men who have more central distribution (android pattern), after menopause this distribution shifts. The mechanism of sex steroids on adipose distribution, however, remains largely unknown. One understanding is that after menopause, lipoprotein lipase activity, which converts circulating triglycerides into free fatty acids for storage into the adipocyte, downregulates in the gluteofemoral region, resulting in more central weight gain in women. 4 Coupled with obesity, women after menopause begin to take on an android pattern with more active metabolic fat resulting in a higher waist to hip ratio (WHR). 5 Android distribution of adipose tissue, particularly in women, leads to increased risk of hypertension, diabetes, and coronary artery disease. 6, 7 In this issue of Menopause, Eun et al, 8 evaluated in a crosssectional design, 582 menopausal Korean women without a history of CVD to determine if WHR measured by bioelectrical impedance analysis and serum lipid profiles were associated with coronary artery calcium (CAC) score. Study results found that higher WHR and triglyceride levels were associated with higher CAC scores. In addition, in a multivariate model, older age, triglycerides, hypertension, WHR (odds ratio: 1.103; 95% CI: 1.018-1.195; P= 0.017) were found to be significantly associated with CAC. Furthermore, when including WHR in the Brier score, a measure of the accuracy of probabilistic predictions, CAC prediction was found to have higher prognostic performance. The authors did note that although these were naturally menopausal women, surgical menopause and hormone therapy use were not considered for the analysis.This study finding notes an important association and one that might be both sex-and age-specific to women after menopause. Waist circumference alone has been correlated with risk of developing coronary heart disease. 9, 10 Of the predictors of coronary heart disease, CAC score is a marker of atherosclerosis and a predictive clinical biomarker for the development of CVD in multiple racial groups. 11 CAC score is also a novel biomarker for predicting all-cause mortality in both men and women. 12 Not many studies have, however, looked at the CAC scores in postmenopausal women especially in relation to CVD risk factors such as WHR. The Healthy Women Study followed 272 menopausal women over a 6-year period, and found that on average new CAC develops about 6% per year in menopausal women. 13 A prospective study following 573 menopausal women found a waist circumference above the median had a 1.5-fold increase in CAC, and an increase in waist over 9 to 14 years with a 2.2-fold increased risk of CAC score, with no relation of body mass index or hip circumference to risk of CAC. 14 A study in Circulation found that just the single indicator of a waist circumference greater than 88 cm with elevated triglycerides was predictive of accelerated atherogenesis and increased CVD mortality in menopausal women. 15 Although CAC has been found to be a good predictor for developing CVD, women have anatomical and physiological differences compared to men, and can experience signs and symptoms of ischemic heart disease without evidence of obstruction of coronary arteries on angiography. 16 Furthermore, women are more likely to have noncalcified plaque. 17 It is estimated that 50% of women with ischemic heart disease have a nonobstructive pattern and the use of CAC would not fully encapsulate …
