New risk for CVD in older women: Fat around the heart

Women with greater reductions in estrogen after menopause tend to have more fat around the heart—a risk factor for heart disease—according to a study from the University of Pittsburgh Graduate School of Public Health, in Pittsburgh, PA, which has shown this for the first time.

“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,” said lead author Samar R. El Khoudary, PhD, MPH, assistant professor in Pitt Public Health’s Department of Epidemiology. “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.”

The study, published online and scheduled for the September 1 issue of The Journal of Clinical Endocrinology & Metabolism, noted that weight gain in women during and after menopause has long been attributed to aging rather than to menopause itself. However, separate research suggested that hormonal fluctuations that occur during menopause cause changes in body fat composition and distribution.

Mounting evidence has also demonstrated that cardiovascular fat plays a role of in the pathogenesis of coronary heart disease (CHD), but no research has examined cardiovascular fat in relation to sex hormones or menopausal status in women.

In this study, the 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.

The researchers found that women who had lower concentrations of the hormone estradiol during menopause had greater volumes of cardiovascular fat. This finding held even after the team took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use, and chronic diseases.

Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, the researchers explained, causing local inflammation and leading to heart disease. A doubling of one kind of cardiovascular fat in particular—epicardial fat—can lead to a more than 50% increase in coronary events.

Weight management is a potential prevention strategy, the authors wrote, but more research is needed.

“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,” Dr. El Khoudary said. “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 postmenopausal women reduce fat near the heart.”