This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carr, M. C. Search for Related Content PubMed PubMed Citation Articles by Carr, M. C. Pubmed/NCBI databases Medline Plus Health Information Menopause Metabolic Syndrome

The Emergence of the Metabolic Syndrome with Menopause

Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington 98195-6426

Address all correspondence and requests for reprints to: Molly C. Carr, M.D., Division of Metabolism, Endocrinology, and Nutrition, Box 356426, University of Washington, Seattle, Washington 98195-6426. E-mail: carr{at}u.washington.edu.

Women with the metabolic syndrome (central obesity, insulin resistance, and dyslipidemia) are known to be at especially high risk for cardiovascular disease (CVD). The prevalence of the metabolic syndrome increases with menopause and may partially explain the apparent acceleration in CVD after menopause. The transition from pre- to postmenopause is associated with the emergence of many features of the metabolic syndrome, including 1) increased central (intraabdominal) body fat; 2) a shift toward a more atherogenic lipid profile, with increased low density lipoprotein and triglycerides levels, reduced high density lipoprotein, and small, dense low density lipoprotein particles; 3) and increased glucose and insulin levels. The emergence of these risk factors may be a direct result of ovarian failure or, alternatively, an indirect result of the metabolic consequences of central fat redistribution with estrogen deficiency. It is unclear whether the transition to menopause increases CVD risk in all women or only those who develop features of the metabolic syndrome. This article will review the features of the metabolic syndrome that emerge with estrogen deficiency. A better understanding of these metabolic changes with menopause will aid in the recognition and treatment of women at risk for future CVD, leading to appropriate interventions.

This work was supported in part by a grant from the Bristol-Myers Squibb Foundation and NIH Grant K23 (to M.C.C.).

Abbreviations: apo B, Apolipoprotein B; BMI, body mass index; CETP, cholesteryl ester transfer protein; CRP, C-reactive protein; CT, computed tomography; CVD, cardiovascular disease; E₂, estradiol; FFA, free fatty acid; HDL, high density lipoprotein; HL, hepatic lipase; HRT, hormone replacement therapy; LDL, low density lipoprotein; Lp(a), lipoprotein(a); PAI-1, plasminogen activator inhibitor-1; TG, triglycerides; tPA, tissue plasminogen activator; VLDL, very low density lipoprotein.

This article has been cited by other articles:

				L. M Ritland, D L. Alekel, O. A Matvienko, K. B Hanson, J. W Stewart, L. N Hanson, M. B Reddy, M. D Van Loan, and U. Genschel Centrally located body fat is related to appetitive hormones in healthy postmenopausal women. Eur. J. Endocrinol., June 1, 2008; 158(6): 889 - 897. [Abstract] [Full Text] [PDF]

				A. Towfighi, J. L. Saver, R. Engelhardt, and B. Ovbiagele A midlife stroke surge among women in the United States Neurology, November 13, 2007; 69(20): 1898 - 1904. [Abstract] [Full Text] [PDF]

				H. M. Kim, J. Park, S. Y. Ryu, and J. Kim The Effect of Menopause on the Metabolic Syndrome Among Korean Women: The Korean National Health and Nutrition Examination Survey, 2001 Diabetes Care, March 1, 2007; 30(3): 701 - 706. [Abstract] [Full Text] [PDF]

				L. Codes, T. Asselah, D. Cazals-Hatem, F. Tubach, D. Vidaud, R. Parana, P. Bedossa, D. Valla, and P. Marcellin Liver fibrosis in women with chronic hepatitis C: evidence for the negative role of the menopause and steatosis and the potential benefit of hormone replacement therapy Gut, March 1, 2007; 56(3): 390 - 395. [Abstract] [Full Text] [PDF]

				G. M.C. ROSANO, C. VITALE, and M. FINI Hormone Replacement Therapy and Cardioprotection: What Is Good and What Is Bad for the Cardiovascular System? Ann. N.Y. Acad. Sci., December 1, 2006; 1092(1): 341 - 348. [Abstract] [Full Text] [PDF]

				F. Magkos, B. W. Patterson, and B. Mittendorfer No effect of menstrual cycle phase on basal very-low-density lipoprotein triglyceride and apolipoprotein B-100 kinetics Am J Physiol Endocrinol Metab, December 1, 2006; 291(6): E1243 - E1249. [Abstract] [Full Text] [PDF]

				J. L. Turgeon, M. C. Carr, P. M. Maki, M. E. Mendelsohn, and P. M. Wise Complex Actions of Sex Steroids in Adipose Tissue, the Cardiovascular System, and Brain: Insights from Basic Science and Clinical Studies Endocr. Rev., October 1, 2006; 27(6): 575 - 605. [Abstract] [Full Text] [PDF]

				M. Alevizaki, K. Saltiki, E. Mantzou, E. Anastasiou, and I. Huhtaniemi The adrenal gland may be a target of LH action in postmenopausal women. Eur. J. Endocrinol., June 1, 2006; 154(6): 875 - 881. [Abstract] [Full Text] [PDF]

				V. Bittner Menopause and Cardiovascular Risk: Cause or Consequence? J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1984 - 1986. [Full Text] [PDF]

				F Gomez Real, C Svanes, E H Bjornsson, K Franklin, D Gislason, T Gislason, A Gulsvik, C Janson, R Jogi, T Kiserud, et al. Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey Thorax, January 1, 2006; 61(1): 34 - 40. [Abstract] [Full Text] [PDF]

				K. E. Innes, C. Bourguignon, and A. G. Taylor Risk Indices Associated with the Insulin Resistance Syndrome, Cardiovascular Disease, and Possible Protection with Yoga: A Systematic Review J Am Board Fam Med, November 1, 2005; 18(6): 491 - 519. [Abstract] [Full Text] [PDF]

				T. M. D'Eon, S. C. Souza, M. Aronovitz, M. S. Obin, S. K. Fried, and A. S. Greenberg Estrogen Regulation of Adiposity and Fuel Partitioning: EVIDENCE OF GENOMIC AND NON-GENOMIC REGULATION OF LIPOGENIC AND OXIDATIVE PATHWAYS J. Biol. Chem., October 28, 2005; 280(43): 35983 - 35991. [Abstract] [Full Text] [PDF]

				R. E. Van Pelt, C. M. Jankowski, W. S. Gozansky, R. S. Schwartz, and W. M. Kohrt Lower-Body Adiposity and Metabolic Protection in Postmenopausal Women J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4573 - 4578. [Abstract] [Full Text] [PDF]

				N. Santoro, J. Torrens, S. Crawford, J. E. Allsworth, J. S. Finkelstein, E. B. Gold, S. Korenman, W. L. Lasley, J. L. Luborsky, D. McConnell, et al. Correlates of Circulating Androgens in Mid-Life Women: The Study of Women's Health Across the Nation J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4836 - 4845. [Abstract] [Full Text] [PDF]

				A. Tchernof, A. Desmeules, C. Richard, P. Laberge, M. Daris, J. Mailloux, C. Rheaume, and P. Dupont Ovarian Hormone Status and Abdominal Visceral Adipose Tissue Metabolism J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3425 - 3430. [Abstract] [Full Text] [PDF]

				B. Lamarche and S. Desroches Metabolic syndrome and effects of conjugated linoleic acid in obesity and lipoprotein disorders: the Quebec experience Am. J. Clinical Nutrition, June 1, 2004; 79(6): 1149S - 1152S. [Abstract] [Full Text] [PDF]

				K. N. Hewitt, K. Pratis, M. E. E. Jones, and E. R. Simpson Estrogen Replacement Reverses the Hepatic Steatosis Phenotype in the Male Aromatase Knockout Mouse Endocrinology, April 1, 2004; 145(4): 1842 - 1848. [Abstract] [Full Text] [PDF]

				S. Palomba, T. Russo, F. Orio Jr, A. Sammartino, F. M. Sbano, C. Nappi, A. Colao, P. Mastrantonio, G. Lombardi, and F. Zullo Lipid, glucose and homocysteine metabolism in women treated with a GnRH agonist with or without raloxifene Hum. Reprod., February 1, 2004; 19(2): 415 - 421. [Abstract] [Full Text] [PDF]

				R. Wolk, A. S.M. Shamsuzzaman, and V. K. Somers Obesity, Sleep Apnea, and Hypertension Hypertension, December 1, 2003; 42(6): 1067 - 1074. [Abstract] [Full Text] [PDF]