|Year : 2021 | Volume
| Issue : 1 | Page : 18-22
Menopausal status and metabolic syndrome among women with cardiovascular diseases: A cross-sectional study in Bangladesh
Marjia Sultana1, Towhid Hasan1, Lincon Chandra Shill1, Nafisa Habib Purba1, Akibul Islam Chowdhury1, Mahmudur Rahman1, Md Asaduzzaman Lashkar2, Md Kamrul Hasan2
1 Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, Noakhali, Bangladesh
2 Department of Medicine, Cumilla Medical College Hospital, Cumilla-3500, Bangladesh
|Date of Submission||14-Jan-2021|
|Date of Decision||18-Jan-2021|
|Date of Acceptance||20-Jan-2021|
|Date of Web Publication||19-Feb-2021|
Mr. Towhid Hasan
Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, Noakhali-3814
Source of Support: None, Conflict of Interest: None
Background: There are currently no reports showing the relationship between metabolic syndrome (MetS) and menopause among Bangladeshi women with cardiovascular disease (CVD).
Aim: The present study aims to examine the prevalence of MetS and evaluate the impact of menopausal status on the MetS among women with CVD in Bangladesh.
Materials and Methods: Data for the present analysis were collected from a cross-sectional study of 355 cardiovascular patients seeking care at five tertiary care hospitals in Bangladesh. A total of 146 women were included for this secondary analysis. The MetS was identified based on the definition of the Adult Treatment Panel (ATP) III of the National Cholesterol Education Program (NCEP).
Results: About 45.83% pre-menopausal and 59.02% post-menopausal women were noticed to have MetS. The mean waist circumference, systolic, and diastolic blood pressure, total cholesterol, LDL cholesterol, triglyceride, and random plasma glucose levels were higher in post-menopausal women whereas HDL cholesterol value was higher in pre-menopausal women. The multivariate-adjusted odds ratio showed that post-menopausal status (Adjusted odds ratio [AOR]: 1.72; 95% confidence interval [CI]: 1.04-4.94) and obesity (AOR: 8.20; 95% CI: 1.15-58.77) were significantly associated with the presence of the MetS among women with CVD.
Conclusion: The high prevalence of MetS among women with CVD is evident, particularly post-menopausal women. Hence, the present findings can alert women from the earlier stages of the menopausal transition to prevent the appearance of MetS.
Keywords: Bangladesh, cardiovascular diseases, menopause, metabolic syndrome
|How to cite this article:|
Sultana M, Hasan T, Shill LC, Purba NH, Chowdhury AI, Rahman M, Lashkar MA, Hasan MK. Menopausal status and metabolic syndrome among women with cardiovascular diseases: A cross-sectional study in Bangladesh. Curr Med Res Pract 2021;11:18-22
|How to cite this URL:|
Sultana M, Hasan T, Shill LC, Purba NH, Chowdhury AI, Rahman M, Lashkar MA, Hasan MK. Menopausal status and metabolic syndrome among women with cardiovascular diseases: A cross-sectional study in Bangladesh. Curr Med Res Pract [serial online] 2021 [cited 2022 Oct 1];11:18-22. Available from: http://www.cmrpjournal.org/text.asp?2021/11/1/18/309922
| Introduction|| |
Metabolic syndrome (MetS) is a serious health issue affecting about 23% of adults worldwide and it increases the risk factors of cardiovascular disease (CVD) such as hypertension, obesity, dyslipidaemia and insulin resistance. Different researchers define MetS in different ways and the criteria of MetS by the Adult Treatment Panel (ATP) III of the National Cholesterol Education Program has been widely used. According to ATP III, MetS is defined as the presence of three or more of the following risk factors namely (i) high cholesterol as ≥240 mg/dL, (ii) high low-density lipoprotein (LDL) cholesterol as ≥160 mg/dL, (iii) low high-density lipoprotein (HDL) cholesterol as <40 mg/dL, (iv) high triglyceride as ≥200 mg/dL, (v) abdominal obesity as waist circumference >90 cm for Asian male and >80 cm for Asian female according to WHO, (vi) hypertension as ≥130/85 mmHg of blood pressure and (vii) diabetes as fasting plasma sugar ≥110 mg/dL or random plasma glucose ≥200 mg/dL. Subjects who reported taking medications for hypertension or diabetes were also regarded as hypertensive or diabetic, respectively. Due to the changing environment and lifestyle, the number of people with MetS has increased over the world not only in developed countries but also in developing countries. Overweight, physical inactivity, genetic factors and old age are the common underlying factors of MetS. It is believed that menopause has been linked to some components of MetS.,
Menopause is an accelerated physical, physiological and neuroendocrine ageing in women and is defined as amenorrhea for 12 months following the final menstrual period., The post-menopausal life of women has a higher association with the risk of MetS as compared to pre-menopausal life. Previous studies have shown that MetS risk factors are significantly increased in the post-menopausal phase and MetS is a very common problem in women above 55 years of age., Mainly hormonal changes at menopausal transition (estrogen and testosterone) increase the risk of MetS. The prevalence of MetS among pre-menopausal and post-menopausal women differs from geographical location and population. However, in South Asia, there is a limitation of studies related to MetS and menopausal status.
It is well known that MetS is a common risk factor of cardiovascular mortality and morbidity. The prevalence of MetS is increasing rapidly in developing countries of South Asia leading to increased mortality and morbidity due to CVD and type 2 diabetes mellitus and it is found that one-third of urban South Asian people have evidence of MetS. It has been seen that MetS and related risk factors of CVD are higher among rural to urban migrant people and the main factors are rapid nutritional changes, lifestyle and socioeconomic transitions, consequent to increasing affluence, urbanisation, mechanisation and rural-to-urban migration., Although MetS among men and women increases with age, menopause is a contributing factor for MetS among post-menopausal women. Scant data exist at the association of MetS and menopause in Bangladesh, not so many studies have been conducted to indicating the relationship between MetS and menopause. A study by Jesmin et al. has reported that over 85% of rural Bangladeshi women have low HDL cholesterol and nearly 31% have high fasting blood glucose. Hence, it is necessary to focus on MetS along with menopausal status.
Thus, our study aimed to examine the difference in the prevalence of the MetS risk factors between post-menopausal and pre-menopausal women and assessed the effect of menopausal status on the MetS in Bangladesh.
| Materials and Methods|| |
Study design and subjects
A cross-sectional study was carried out from January to June 2019 selecting 355 cardiovascular patients seeking care at five tertiary care hospitals (four from Comilla district and one from Noakhali district) of Bangladesh. Hospitals were selected purposively and convenient sampling was used to collect data from the participants. Of 355 participants, only female (146) subjects were included for the present analysis. Before including this study, participants were examined for CVD based on their self-reporting and reviewing their medical records. Pregnant women, critically ill individuals and those who did not consent were excluded from the study. The ethical review board of each of the hospitals approved the study protocol and informed consent was obtained from participants before including them into the study.
A locally adapted and pre-tested WHO STEPS questionnaire (v3.2) was used for this study. The questionnaire was organised into three distinct steps – Step 1: Information on sociodemographic and behavioural measurements; Step 2: Included physical measurements such as height, weight, blood pressure and waist circumference; Step 3: Information on biochemical parameters such as blood glucose level and lipid profile containing total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol.
Four supervisors and three enumerators comprised the study team. Postgraduate (MSc) students were the enumerators who accomplished the interviews. Two physicians and two lecturers were in the supervisory team. The postgraduate students underwent rigorous training for 1 week by the supervisory team on data collection before starting the fieldwork. A pilot study was executed to pre-test the survey instruments and procedures. A face-to-face interview was conducted to collect the required information and the WHO-recommended techniques were followed for anthropometric measures. All biochemical measurements except blood glucose were noted from participants’ recent medical reports. For blood glucose level measurement, a commercial glucometer (ACCU-CHEK Active, Roche India Ltd.) was used.
Data management and analysis
SPSS (v26.0) for Windows (SPSS, Inc. Chicago. IL. USA) was used to perform data analyses and P < 0.05 was considered statistically significant. Baseline characteristics and risk factors prevalence for MetS among pre-menopausal and post-menopausal women were presented by mean, standard deviation (SD), 95% confidence interval (CI) for mean and percentages where necessary. A multivariate logistic regression analysis was conducted to evaluate the independent contribution of sociodemographic factors to the presence of the MetS.
| Results|| |
The baseline characteristics of pre-and post-menopausal women with CVD are represented in [Table 1]. The mean (±SD) age of pre-menopausal and post-menopausal women was 28.04 (±4.26) and 59.31 (±11.62) years, respectively. The mean waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides and random plasma glucose were higher among post-menopausal women as compared to pre-menopausal women; however, body mass index (BMI) and HDL cholesterol levels were higher in pre-menopausal women.
[Table 2] exhibits the prevalence of risk factors for MetS concerning menopausal status. High total cholesterol, high LDL cholesterol, low HDL cholesterol, high triglycerides, hypertension and diabetes were observed with higher frequency in post-menopausal women than in pre-menopausal women.
|Table 2: Prevalence of risk factors for the metabolic syndrome among pre- and post-menopausal women|
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The prevalence of MetS (having three or more of the risk factors) was 45.83% and 59.02% among pre-menopausal and post-menopausal women, respectively. About 12.5% pre-menopausal and 2.46% post-menopausal women were completely free from any risk factors for MetS. No pre-menopausal women were found with all the risk factors, while 5.74% of post-menopausal women had all the risk factors for MetS [Figure 1].
|Figure 1: Percentage of pre-menopausal and post.menopausal women with a number of risk factors for the metabolic syndrome|
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Multiple logistic regression revealed that menopausal status and obesity were significantly associated with the presence of MetS [Table 3]. Post-menopausal women with CVD had a significantly higher risk of MetS than pre-menopausal women with CVD (adjusted odds ratio: 1.72; 95% CI: 1.04–4.94). Obese (BMI ≥30 kg/m2) women with CVD had 8.2 times more risk of having MetS than underweight (BMI <18.5 kg/m2) women with CVD (P = 0.036).
|Table 3: Mean number of risk factors and odds ratios for the metabolic syndrome among participants|
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| Discussion|| |
To the best of our knowledge, the present study is the first to demonstrate the effect of menopause on the MetS in women with CVD in Bangladesh. MetS is not a single disease entity, rather regarded as a group of closely related risk factors that lead to a higher incidence of noncommunicable diseases like CVD. In the present study, a higher prevalence of MetS was noted among women aged >40 years as compared to their younger counterparts. This finding is consistent with other national and international studies.,, However, few studies have recorded no association between the risk of the MetS and menopausal status., Alterations in the pattern of metabolic risk factors may be partly due to ageing; however, this alone cannot explain the rapid acceleration in the rate of MetS suffered by women during their menopause. Estrogen deficiency is thought to be responsible for most of the metabolic abnormalities in post-menopausal women.
Research has unveiled that obesity can cause metabolic abnormalities, thus impacting health. Several environmental and genetic factors are attributed to the expression of central and abdominal obesity. The ageing process influences the intra-abdominal fat increment in both normal and overweight individuals, and natural menopause is associated with increased central adiposity., Our result supports this statement. Obese women with CVD had a higher risk of MetS than underweight women with CVD. This finding is in line with other studies.,,,
In the present study, all blood lipid parameters, namely total cholesterol, LDL cholesterol and triglyceride values, were higher among post-menopausal women with CVD than in pre-menopausal women with CVD except for HDL cholesterol level. Whether menopause affects lipid parameters is a matter of controversy. Some studies indicate the elevation of cholesterol, LDL cholesterol and triglyceride and reduction of HDL cholesterol after menopause.,, On the other hand, few studies had contradicted this.,
It is difficult to evaluate the effect of menopause on blood pressure due to the influence of ageing on blood pressure. Many studies have addressed a strong correlation of blood pressure with menopause,, while other studies have not.,, In our study, the mean systolic and diastolic blood pressure of post-menopausal women was higher as compared to pre-menopausal women.
The present study has some limitations. First, it was a cross-sectional study conducted in five tertiary care hospitals in Bangladesh among cardiovascular patients, and hence, the results cannot be generalised to other populations. Second, while using the present findings to compare with other studies, some factors such as participant's age, method of data collection and measurement instruments used during the survey need to be considered.
| Conclusion|| |
The prevalence of MetS among women with CVD is high. The present study indicates that post-menopausal status and obesity might be predictors of MetS. A larger population would be necessary to evaluate the actual association between these variables. Based on the findings of our study, we suggest that an attempt should be made to prevent MetS from the earlier stages of menopause transition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008;28:629-36.
World Health Organization. The Asia-Pacific perspective: Redefining obesity and its treatment. Sydney: Health Communications Australia: World Health Organization; 2000. Report No.: 0957708211.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003;88:2404-11.
Kim HM, Park J, Ryu SY, Kim J. The effect of menopause on the metabolic syndrome among Korean women: The Korean National Health and Nutrition Examination Survey, 2001. Diabetes Care 2007;30:701-6.
Ebrahimpour P, Fakhrzadeh H, Heshmat R, Ghodsi M, Bandarian F, Larijani B. Metabolic syndrome and menopause: A population-based study. Diabetes Metab Syndr Clin Res Rev 2010;4:5-9.
Mesch VR, Boero LE, Siseles NO, Royer M, Prada M, Sayegh F, et al
. Metabolic syndrome throughout the menopausal transition: Influence of age and menopausal status. Climacteric 2006;9:40-8.
Misra A, Khurana L. The metabolic syndrome in South Asians: Epidemiology, determinants, and prevention. Metab Syndr Relat Disord 2009;7:497-514.
Prasad D, Kabir Z, Dash A, Das B. Cardiovascular risk factors in developing countries: A review of clinico-epidemiological evidence. CVD Prev Control 2010;5:115-23.
Jesmin S, Mia S, Islam AM, Islam R, Sultana SN, Zaedi S, et al
. Prevalence of metabolic syndrome among rural Bangladeshi women. Diabetes Res Clin Pract 2012;95:e7-9.
World Health Organization. The World Health OrganizationSTEPwise approach to noncommunicable disease risk factor surveillance. Geneva, Switzerland: World Health Organization; 2017.
World Health Organization. Physical status: the use of and interpretation of anthropometry. Report of a World Health Organization Expert Committee: World Health OrganizationTechnical Report Series; 1995. p. 854.
Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.
Marjani A, Moghasemi S. The Metabolic Syndrome among Postmenopausal Women in Gorgan. Int J Endocrinol 2012;2012:953627.
Wamala SP, Lynch J, Horsten M, Mittleman MA, Schenck-Gustafsson K, Orth-Gomér K. Education and the metabolic syndrome in women. Diabetes Care 1999;22:1999-2003.
Lobo RA. Metabolic syndrome after menopause and the role of hormones. Maturitas 2008;60:10-8.
Crawford SL, Casey VA, Avis NE, McKinlay SM. A longitudinal study of weight and the menopause transition: Results from the Massachusetts Women's Health Study. Menopause 2000;7:96-104.
Jensen J, Nilas L, Christiansen C. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990;12:321-31.
Bergmann S, Siegert G, Wahrburg U, Schulte H, Assmann G, Jaross W. Influence of menopause and lifestyle factors on high density lipoproteins in middle-aged women. Menopause 1997;4:52-61.
Peters HW, Westendorp IC, Hak AE, Grobbee DE, Stehouwer CD, Hofman A, et al
. Menopausal status and risk factors for cardiovascular disease. J Intern Med 1999;246:521-8.
Casiglia E, d'Este D, Ginocchio G, Colangeli G, Onesto C, Tramontin P, et al
. Lack of influence of menopause on blood pressure and cardiovascular risk profile: A 16-year longitudinal study concerning a cohort of 568 women. J Hypertens 1996;14:729-36.
Gierach GL, Johnson BD, Bairey Merz CN, Kelsey SF, Bittner V, Olson MB, et al
. Hypertension, menopause, and coronary artery disease risk in the Women's Ischemia Syndrome Evaluation (WISE) Study. J Am Coll Cardiol 2006;47:S50-8.
Rosenthal T, Oparil S. Hypertension in women. J Hum Hypertens 2000;14:691-704.
Staessen JA, Ginocchio G, Thijs L, Fagard R. Conventional and ambulatory blood pressure and menopause in a prospective population study. J Hum Hypertens 1997;11:507-14.
[Table 1], [Table 2], [Table 3]