Objective:

Menopause increases the risk of cardiovascular disease (CVD) which in part has been attributed to the rises in cholesterol and blood pressure (BP). This study examined the hypothesis that menopausal changes in body composition and regional fat depots relate to the change in CVD risk factors.

Methods:

A prospective recall study was designed to capture premenopausal women to be reexamined soon after menopause. A total of 97 women from the Oxford Biobank underwent dual x-ray absorptiometry, blood biochemistry and BP readings pre- and post-menopause.

Results:

Despite minimal changes in body weight over the 5.1±0.9 year follow-up period, there was an increase in total fat mass and a decline in lean mass, where the proportional change of regional fat mass was the greatest for the visceral fat depot (+22%, p<0.01). Plasma ApoB (+12%, p<0.01) and CRP (+45%, p<0.01) increased as did systolic (+7%, p<0.001) and diastolic BP (+5%, p<0.001). Plasma NEFA decreased (-20%, p<0.05) which may reflect on a change in adipose tissue function across the menopause. PCSK-9 decreased (-26%, p<0.01) which suggests a compensation for the postmenopausal reduction in LDL receptor activity. Using a multilinear regression analyses the changes in ApoB and DBP were associated with visceral fat mass change, but this association was lost when adjusted for total fat mass change.

Conclusion:

The increase in CVD risk factor burden across menopause may not be driven by changes in body composition, rather by functional changes in end organs such as adipose tissue and liver.