HDL cholesterol paradoxically increases cardiovascular plaque in menopausal women

For women in menopause, high density lipoprotein (HDL) loses its well-documented atheroprotective ability and even becomes paradoxically proinflammatory, which leads to greater carotid intima-media thickness, according to researchers who presented their findings October 2, 2015 at the annual meeting of the North American Menopause Society (NAMS) in Las Vegas, NV.

“What we found is that, as women transition through menopause, increases in good cholesterol were actually associated with greater plaque buildup,” said the study’s lead author Samar El Khoudary, BPharm, PhD, MPH, assistant professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, in Pittsburgh, PA. “These findings suggest that the quality of HDL may be altered over the menopausal transition, thus rendering it ineffective in delivering the expected cardiac benefits.”

Hormonal alterations during menopause, especially reduction in estradiol, influence the accumulation of risk factors that could potentially impair the quality of HDL, the researchers suggested.

In this investigation, researchers included 225 women (mean age of 45) from the Study of Women's Health Across the Nation (SWAN). Subjects had up to 5 measures of carotid intima-media thickness (cIMT) over 9 years of follow-up, and all were free of cardiovascular disease (CVD) at baseline. Results showed that a larger increase in high density lipoprotein cholesterol (HDL-C) was significantly associated with a faster cIMT progression.

“These findings suggest that the quality of HDL may be altered over the menopausal transition rendering HDL dysfunctional and not providing the expected cardioprotective effect,” the researchers concluded.

Further research is needed to fully evaluate how all lipids are impacted during menopause, noted Wulf Utian, MD, PhD, DSC, executive director of NAMS. “There is such limited data available on this important topic,” he said. "We need to better understand how all lipids are impacted in order to protect patients from heart disease, which is the number one killer of women in this country."