Menopause and Cardiovascular Changes: A Unique Opportunity for Risk Assessment

Menopause, defined as the permanent cessation of menstrual bleeding for 12 months, is associated with hormonal, cardiovascular and metabolic changes, starting about 2 years before the final menstrual period. Most women experience natural menopause at or around age 50. Natural menopause before age 40 is associated with an increased risk of cardiovascular disease. This is less clear for artificial early menopause, induced by bilateral ovarian surgery or chemotherapy. Weight gain around the menopause is closely related to aging, whereas the development of central obesity seems to be a direct result of the menopause. There is also an increase in endothelial dysfunction, which seems to be age related. The blood pressure increase around the menopause is probably more closely related to age and BMI than to ovarian failure. The changes in lipid profile include an increase in total cholesterol, LDL cholesterol, triglycerides, and a decrease in HDL cholesterol. Insulin resistance and the increase in the prevalence of metabolic syndrome are associated with menopause. Inflammatory co-morbidities often appear in women in their 40s, in association with the decline in estrogen levels. The years around menopause are crucial to initiate preventive measures if needed. The use of the CAC score can be very helpful to discriminate between low- and high-risk women.