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LDL Rises Around Time of Menopause

Aging Did Not Explain LDL Cholesterol Increase
By
WebMD Health News
Reviewed by Louise Chang, MD

Dec. 11, 2009 – Blood levels of LDL, or "bad", cholesterol increase dramatically in women around the time of menopause, and the rise is not related to aging, new research confirms.

The finding could help explain why postmenopausal women have a much higher risk for heart attacks, strokes, and other cardiovascular events than women who are still menstruating.

Menopause did not appear to have a direct impact on other heart and vascular risk factors including blood pressure, insulin resistance, inflammation, and the ability of the blood to clot.

Menopause Raises LDL

Researchers followed 1,054 women in their 40s and early 50s who were still menstruating when they entered the study but had stopped by the time follow-up ended about nine years later.

They found that total cholesterol, LDL cholesterol, and a related protein known as ApoB rose substantially one year before to one year after a woman’s final menstrual period.

Even after considering the influence of age and other risk factors for rising cholesterol, the association was clear, lead researcher Karen A. Matthews, PhD, of the University of Pittsburgh tells WebMD.

“You couldn’t miss it,” she says. “This study shows for the first time that the change in menstruation correlates directly with the change in cholesterol.”

The menopause-related increase was seen for all women in the study, regardless of their prior cardiovascular risk factors or their ethnicity, suggesting that menopause has a similar influence on blood lipid, or fat, levels for all women.

“The data really underscore the need to monitor LDL cholesterol levels as women age and enter the menopausal transition,” study co-author Kim Sutton-Tyrrell, PhD, said at a news conference held today.

Estrogen Drops, LDL Rises

Cardiologist Vera Bittner, MD, MSPH, of the University of Alabama, Birmingham, says women need to be made aware that their risk for heart attack and stroke is likely to increase as menstruation ends.

“I don’t think this necessarily represents a change, but rather a reminder, that risk factors change at the time of menopause,” she tells WebMD. “Women should have their risk factors measured on a regular basis and discuss with their physicians what interventions are indicated.”

Cholesterol-lowering statin drugs may be needed if attempts to address rising lipid levels through lifestyle are not working, Matthews says.

“Most physicians would not start with statins before trying to make changes in lifestyle like following a healthier diet and increasing exercise,” she says.

Matthews says the rise in LDL cholesterol around the time of menopause is most likely linked to the drop in the hormone estrogen, which regulates the menstrual cycle.

Hormone replacement therapy has been shown in some studies to lower LDL levels, but it has also been linked to an increased risk for strokes and breast cancer in postmenopausal women.

Matthews says statins are a much better option than hormone replacement for postmenopausal women with high cholesterol who require drug treatment.

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