J Korean Med Sci.  2023 Aug;38(31):e238. 10.3346/jkms.2023.38.e238.

Substantial Lipid Increases During Menopausal Transition in Korean Middle-Aged Women

• Park J
• Son MK
• Park HY

• KMID: 2544957
• DOI: http://doi.org/10.3346/jkms.2023.38.e238

Abstract

Background
Adverse lipid profiles are observed in postmenopausal women. However, there is insufficient evidence of the association between lipids and reproductive aging in Korean women. We aimed to characterize lipid changes with respect to timing relative to menopause in Korean middle-aged women.
Methods
This study included 1,436 premenopausal women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models.
Results
All lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index. During the period, high-density lipoprotein cholesterol (HDL-C) levels increased at 0.42 mg/dL per year (95% confidence interval [CI], 0.29 to 0.55 mg/dL). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72 mg/dL), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the nonHDL-C to HDL-C ratio (P < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off.
Conclusion
Women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease prevention in women.

Keyword

Lipids; Menopause; Cardiovascular Diseases; Obesity

Figure

• 

  Fig. 1 LOESS estimated means of lipids across the follow-up period relative to years since menopause LOESS estimated values of (A) total cholesterol, (B) triglyceride, (C) HDL-C, (D) LDL-C, (E) non-HDL-C, and (F) non-HDL-C to HDL-C ratio over time since menopause at a smoothing of 0.50. Solid line presents the mean, and dashed lines present the 95% confidence intervals.LOESS = locally weighted scatterplot smoothing, HDL-C = high-density lipoprotein cholesterol, LDL-C = low-density lipoprotein cholesterol.

• 

  Fig. 2 Means of lipid values in years around menopause. Annual mean values compared with estimated values from piecewise linear mixed-effects models of (A) total cholesterol, (B) triglyceride, (C) HDL-C, (D) LDL-C, (E) non-HDL-C, and (F) non-HDL-C to HDL-C ratio over time since menopause.HDL-C = high-density lipoprotein-cholesterol, LDL-C = low-density lipoprotein-cholesterol.

• 

  Fig. 3 Patterns of lipid changes according to premenopausal body mass index. Estimated values from piecewise linear mixed-effects models of (A) total cholesterol, (B) triglyceride, (C) HDL-C, (D) LDL-C, (E) non-HDL-C, and (F) non-HDL-C to HDL-C ratio over time since menopause by body mass index.HDL-C = high-density lipoprotein-cholesterol, LDL-C = low-density lipoprotein-cholesterol.

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