Menopause moves fat to women’s hearts

"By showing that menopause appears to be associated with a shift in fat deposits that leads to more fat around the heart, we've uncovered a new potential contributor to increased risk of cardiovascular disease in women," says Samar R. El Khoudary. (Credit: iStockphoto)

Late- and post-menopausal women have significantly high volumes of fat around their hearts—a risk factor for heart disease.

New research suggests the extra fat can likely be attributed to changing hormone levels. The findings could guide potentially life-saving interventions.

“Cardiovascular disease is the leading cause of death in women, and it increases after age 50—the average age when a woman is going through menopause,” says lead author Samar R. El Khoudary, assistant professor of epidemiology at University of Pittsburgh.

“By showing that menopause appears to be associated with a shift in fat deposits that leads to more fat around the heart, we’ve uncovered a new potential contributor to increased risk of cardiovascular disease in women.”

Cardiovascular fat

Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.

No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events.

For the new study, published in the Journal of Clinical Endocrinology & Metabolism, researchers evaluated clinical data, including blood samples and heart CT scans, on 456 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.

As concentrations of the sex hormone estradiol—the most potent estrogen—declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after researchers took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use, and chronic diseases.

Prevention strategies

“Developing prevention strategies to reduce cardiovascular fat in women at midlife may reduce their heart disease risk, especially knowing that the menopausal transition puts women at risk for excess fat around their hearts,” El Khoudary says.

“Previous studies suggest that reducing heart fat is feasible through weight loss or weight management, but these studies only looked at small numbers of people and there have been no clinical trials linking cardiovascular outcomes with heart fat changes due to weight management interventions. Clearly there is a need for larger scale studies to determine the best intervention strategies to help post-menopausal women reduce fat near the heart.”

Other researchers from University of Pittsburgh and from the Allegheny Health Network, Rush University Medical Center, the Los Angeles Biomedical Research Institute, and University of Minnesota Medical School are coauthors of the study.

The National Institutes of Health and the American Heart Association funded the study.

Source: University of Pittsburgh