Cardiovascular health and the menopause, metabolic health

Cardiovascular disease (CVD) is a leading cause of death in women worldwide, mostly attributed to coronary heart disease (CHD) and, to a lesser extent, to cerebrovascular or peripheral artery disease (PAD) [1]. Except for obstructive CHD, which occurs 7-10 years later than in men, coronary artery spasm and coronary microvascular dysfunction mostly account for the prevalence of ischemic CHD in women [1]. Furthermore, compared with men, women demonstrate a more diffuse pattern of atherosclerosis, with fewer vascular calcifications, but more frequent soft atherosclerotic plaques, which are more vulnerable to rupture [1]. These differences are mostly attributed to the differential effect of sex steroid hormones on the vasculature. The decline in estrogen concentrations during menopause leads to impaired endothelial and vascular function and increased systemic inflammation, further enhancing the atherosclerotic process [2]. Moreover, transition to menopause leads to accumulation of several CVD risk factors, such as abdominal adiposity, atherogenic dyslipidaemia, insulin resistance and arterial hypertension (AH), which may be reversed after prompt administration of menopausal hormone therapy (MHT) [2].

The aim of this narrative review is to describe the effect of menopause on the woman’s cardiometabolic risk, as well as the effect of MHT on this regard. Specific consideration to the management of postmenopausal women under certain conditions, such as dyslipidemia and diabetes, is also provided.

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