Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association

Effect of combined aerobic exercise and resistance training on postmenopausal women with type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

There is no strong evidence demonstrating whether or not aerobic exercise in conjunction with resistance exercise improves metabolic diabetes markers in postmenopausal women.

OBJECTIVE

To evaluate the effect of aerobic exercise and resistance training on metabolic markers in postmenopausal women with type 2 diabetes mellitus (T2DM) by means of a systematic review and meta-analysis.

METHODS

The searches were completed using EMBASE, MEDLINE/PubMed, Scopus and Web of Science databases. This study included non-blinded, single or double-blinded randomized control trials and postmenopausal women diagnosed with T2DM. The imposed intervention was aerobic exercise plus any training protocol to strengthen muscle groups for resistance intervention. The outcomes of interest were the blood glucose levels, insulin secretion, homeostasis model assessment-insulin resistance index (HOMA-IR) and glycated hemoglobin (HbA1c). Risk of Bias tools and GRADE were obligatory.

RESULTS

Three studies were included (83 participants). Exercise intervention ranged between two to four days per week. Compared to the control group, in the group submitted to aerobic exercise + resistance training, no significant change was noted for HbA1c (subtotal = mean difference - 0.35 [95% CI: -0.85, 0.15], p = .17, and heterogeneity = 0%) (GRADE: very low), nevertheless, HOMA-IR index was significantly improved (subtotal = mean difference -0.52 [95% CI: -0.99, -0.05], p = .03, and heterogeneity = 0%) (GRADE: very low).

CONCLUSION

Despite the very low certainty found in the quality of evidences, our analysis showed that aerobic exercise along with strength exercise seems to improve some metabolic diabetes markers in postmenopausal women with T2DM. There is a need for further studies to support our preliminary findings.

Resveratrol attenuates pressure overload-induced myocardial remodeling in ovariectomized rats by rescuing the adaptive angiogenic response

BACKGROUND

Resveratrol (RES), a polyphenol with putative estrogen (E2) -like effects, is believed to counteract left ventricular hypertrophy (LVH). However, how RES exerts its protection is not well understood, particularly when prominent risk factors, such as E2 depletion and pressure overload (PO), coexist. Here, we evaluated the impact of RES and E2 on angiogenesis and LVH in rats subjected to ovariectomy (OVX) and PO.

METHODS

Three weeks after bilateral OVX induction, abdominal aortic banding was performed on Wistar female rats to trigger PO. The animals were treated with either RES or E2 for six weeks. Finally, the heart-to-body weight ratio (HW/BW), cell size, fibrosis, and atrial natriuretic peptide (ANP) mRNA expression were assessed. Angiogenesis was determined by evaluating vascular endothelial growth factor (VEGF) mRNA and protein expression and by CD31 immunostaining. Serum E2 levels were also measured.

RESULTS

OVX + PO caused more severe myocardial hypertrophy (HW/BW) and fibrosis compared with PO alone, but did not aggravate cell size and ANP mRNA expression. OVX blunted the angiogenic response to PO, with reduced VEGF expression. RES increased VEGF expression and CD31, and abrogated LVH and fibrosis. E2 treatment improved VEGF expression and fibrosis, but not to the same extent as RES. RES improved serum levels of E2 in OVX + PO rats.

CONCLUSION

Our findings suggest that RES limits OVX-induced exacerbation of LVH and fibrosis in a PO model, and targets systemic E2 levels and myocardial angiogenesis as underpinning protective mechanisms. Thus, RES may provide cardioprotection for post-menopausal women.

Targeting the CD39/CD73 pathway: New insights into cardiac fibrosis and inflammation in female cardiac surgery patients

Women undergoing cardiac surgery suffer from worse outcomes than their male counterparts. The reasons for this disparity are multifactorial, but the loss of the protective effects of estrogen likely plays a role. Estrogen acts on the CD39/CD73 purine pathway, and loss of estrogen effects may contribute to the increased inflammation seen in post-menopausal women. We aimed to compare CD39/CD73 expression and downstream fibrosis, and inflammation in men and women undergoing cardiac surgery and then used an ovariectomy/high fat diet mouse model to approximate women who present for cardiac surgery to test therapeutics. We found decreased CD39 and CD73 in women compared to men, which was associated with increased fibrosis. Apyrase supplementation (a CD39 mimetic) improved ejection fraction and decreased E/e'. Increased CD73 function (via dipyridamole) decreased fibrosis. This study demonstrates the importance of purinergic dysfunction in cardiovascular disease in women and presents two potential therapeutics to improve cardiac health via manipulation of purine pathways.

Overexpression of adipose tissue ERα enhances PVAT anticontractility via NOX4-derived H2O2 and is protective against high-fat diet-induced dysfunction

Menopause has unequivocally been associated with cardiovascular risk and obesity. Loss of estrogen bioavailability is a hallmark of menopause. Estrogen is generally considered vasculoprotective, with estrogen receptor α (ERα) being the predominant receptor subtype that mediates these positive effects. Similarly, estrogen and ERα are known to stimulate white adipose tissue metabolism. However, it is unknown whether ERα could exert a beneficial effect on mesenteric perivascular adipose tissue (PVAT). PVAT is a heterogeneous tissue that surrounds most peripheral blood vessels. In physiological conditions, PVAT has an anticontractile effect on the vasculature. However, in several diseases, PVAT switches its phenotype to become procontractile. To date, the role of ERα in PVAT function in health and disease is unknown. Therefore, we hypothesized that overexpression of adipose tissue ERα (ERαOE) would 1) increase the anticontractile effect of PVAT in chow diet conditions and 2) protect mice against a high-fat diet (HFD)-induced PVAT dysfunction. To test this hypothesis, mesenteric resistance arteries, with and without PVAT, were isolated from female ERαOE mice, which had either been on a regular chow diet or an HFD for 19 wk. We observed that ERαOE amplifies the anticontractile effect of mesenteric PVAT via NADPH oxidase 4 (NOX4)-derived hydrogen peroxide (H2O2) in chow conditions, and ERαOE is protective against a dysfunctional PVAT that is observed after an HFD, via the same anticontractile mechanism. Collectively, these data demonstrate that ERα is vasculoprotective in the context of PVAT. Harnessing this signaling could be important for reducing cardiovascular risk in postmenopausal women.NEW & NOTEWORTHY We have revealed for the first time that overexpression of adipose tissue estrogen receptor α (ERαOE) amplifies the anticontractile effect of mesenteric PVAT via the biosynthesis of NADPH oxidase 4 (NOX4)-derived hydrogen peroxide (H2O2), and this overexpression is protective against HFD-induced PVAT dysfunction. Collectively, these data demonstrate an important mechanism by which ERα signaling is vasculoprotective in the context of PVAT.

Dietary patterns derived using reduced rank regression in postmenopausal women and risk of mortality: A population-based study

OBJECTIVES

The menopause transition increases the risk of chronic conditions in women. Given the crucial role of diet in health, we identified dietary patterns that explain variations in factors related to major health concerns in postmenopausal women. Also, we explored their association with all-cause and cardiovascular mortality.

STUDY DESIGN

This study was conducted on 1814 postmenopausal women from the population-based Rotterdam Study.

MAIN OUTCOME MEASURES

Dietary patterns were identified using reduced rank regression. Response variables included bone mineral density, body composition parameters, lipid profile markers, insulin resistance, systolic blood pressure, cognitive function, depression, and sleep quality. The associations with risk of mortality were assessed using Cox proportional hazard models.

RESULTS

The first dietary pattern, characterized by higher intake of vegetables, whole grains, legumes, nuts, coffee, tea, alcoholic beverages, and cheese, explained 2.95 % of the variation in responses, accounted for 12.11 % of the variation in general cognitive function captured by G-factor, 5.62 % in systolic blood pressure, and 4.13 % in bone mineral density, and was correlated with less adiposity, lower blood pressure, lipid markers, and insulin resistance. The second dietary pattern, characterized by higher intakes of processed meat, unprocessed red meat, poultry, eggs, and coffee, and lower intakes of sweets and tea, explained 1.54 % of the variation in responses, accounted for 5.45 % of variation in fat mass percentage, 3.47 % in lean mass index, and 3.29 % in bone mineral density, and was correlated with higher adiposity, insulin resistance, and lipid markers. No associations with mortality risk were identified after adjusting for confounders such as demographics, socioeconomic status, lifestyle, disease history, and medication use.

CONCLUSIONS

We identified dietary patterns explaining a range of variation in health factors related to postmenopausal health. While these dietary patterns explained a large variation in some of the individual factors, their combined explained variation across multiple risk factors simultaneously was limited and no significant association with mortality risk was observed. This study provides a foundation for future research aimed at identifying optimal dietary patterns, integrating diverse health aspects, to improve health in postmenopausal populations.

Sex hormones correlate with heart rate variability in healthy women and this correlation is conserved in women with well-controlled type 2 diabetes mellitus

SUBJECTS AND METHODS

In this study, four groups of women were designated according to their health status (control or T2DM) and fertility status (premenopausal or postmenopausal). Five serum sex hormones were measured (estradiol, progesterone, testosterone, LH and FSH), and time-domain and frequency-domain HRV indices were determined during three conditions: supine position, active standing, and rhythmic breathing. For the complete sample (n=118), bivariate Pearson correlations and linear multiple regressions were used to analyze the relationship between sex hormones, HRV indices, and other independent variables, such as glycemia and age. A p-value <0.05 was considered as significant.

RESULTS

There were no differences in sex hormones or HRV indices when comparing the healthy and T2DM groups. All bivariate Pearson correlations were significant between sex hormones and HRV indices; estradiol, progesterone, and testosterone have positive correlations; meanwhile, LH and FSH were negative in the time-domain (SDNN, RMSSD, pNN20) and frequency domain (PLF and PHF) indices. Regression models adjusted for mean heartbeat intervals confirmed an association between all sex hormones and HRV indices. Estradiol maintained significance in the regression models for specific HRV indices during supine and active standing conditions even after adjusting for age and glucose levels.

CONCLUSIONS

All sex hormones correlate with HRV indices. Regression analysis confirms that this correlation is independent from the mean heartbeat interval. However, in regression models adjusted for age and glucose levels, only estradiol was found to be significant, and should be considered an important variable related to cardiovascular and autonomic balance in T2DM women and may provide crucial information to improve cardiovascular risk algorithms.

Effects of jazz dance and concurrent training on physical variables in postmenopausal women

OBJECTIVE

This study aimed to analyze the effects of jazz dance or concurrent training on the cardiorespiratory fitness (CRF), muscle strength and sleep quality of postmenopausal women.

METHOD

A randomized clinical trial with 6-month and 12-month follow-up was conducted including 70 postmenopausal women (mean age 53.19 ± 3.39 years). Participants were randomized into the jazz dance intervention (JD) group, concurrent training intervention (CT) group and control group (CG). CRF was assessed using the 6-min walk test, muscle strength using the isokinetic dynamometer and sleep quality using the Pittsburgh Sleep Quality Index questionnaire. Generalized estimating equations with post-hoc minimum significant difference were used, and intention-to-treat and protocol adherence analyses were performed.

RESULTS

CRF showed changes between groups, times and interactions, but the CT group achieved greater gains compared to the JD group. Isokinetic strength showed long-term intragroup improvement for both intervention groups, at peak extension and flexion. Intergroup differences were observed, with the JD group presenting higher means in peak extension at all times compared to the CG post intervention; however, the CT group achieved higher means compared to the JD group; and at peak flexion, the JD group presented with higher averages compared to the CG post intervention. The JD group showed an improvement in sleep duration in the short term, while the CT group did so at the 6-month follow-up. There were intergroup changes in the reduction in sleep medication in both intervention groups compared to the CG.

CONCLUSION

Both modalities are effective for improving CRF, muscle strength and sleep quality.

Menopause and diabetes: Interconnected associations of risk

Menopause is an important transition in a women's life that has been associated with a worsening cardiometabolic risk profile. Diabetes is a well-known risk factor for cardiovascular disease risk in women. Recent studies have improved the understanding of the hormonal and metabolic changes that occur during menopause, which have provided an opportunity to intervene with preventive efforts. Despite this, menopause's role and its direct (independent) relationship with cardiovascular risk factors, such as diabetes, remain largely unknown. This review highlights the inter-relationships between menopause, vasomotor symptoms, and menopausal hormone therapy with the risk of developing diabetes and outlines further knowledge gaps.

Chain effect of lifecourse reproductive characteristics and body fat and muscle on cardiovascular disease in women: a Mendelian randomization study

BACKGROUND

Delineating the causal chain effects of reproductive traits and fat- and muscle-related traits on cardiovascular disease (CVD) is essential for optimizing precision prevention and control of cardiovascular health in women.

METHODS

In this study, we applied the two-sample Mendelian randomization (MR) analyses and two-step MR framework to investigate the causal chain effects and the mediating effect pathways among reproductive factors and fat- and muscle-related traits on CVD outcomes in women, applying the genome-wide association study summary statistics of 16 women's reproductive traits across puberty and pre-pregnancy, pregnancy and postpartum, and menopausal transition stages, 16 women's fat- and muscle-related traits, and five CVD outcomes of coronary artery disease (CAD), myocardial infarction (MI), heart failure, atrial fibrillation, and ischemic stroke (IS) from over one million individuals of European descent.

RESULTS

The MR analyses revealed the associations of genetically predicted nine reproductive traits (i.e., age at menarche [odds ratio (OR) for CAD: 0.92], age at first sexual intercourse [AFS; 0.71], age at first birth [AFB; 0.89], hypertensive disorders of pregnancy [HDP; 1.21], pre-eclampsia [PE; 1.34], preterm birth [PTB; 1.09], sex hormone-binding globulin [SHBG; 0.73], bioavailable testosterone [BT; 1.17], and number of stillbirths [OR for IS: 2.14]) and 13 fat- and muscle-related traits with at least one of five CVD outcomes. Two-step MR identified 30 causal pathways where AFS, AFB, HDP, PE, PTB, SHBG, and BT mediated the effects of body composition on five CVD outcomes, and nine pathways where waist-to-hip ratio, trunk-trunk fat ratio, abdominal subcutaneous adipose tissue, and gluteofemoral adipose tissue mediated the effects of reproductive traits on CAD and MI.

CONCLUSIONS

Lifecourse reproductive characteristics and fat- and muscle-related traits manifested reciprocal mediating effects on CVD, informing targeted strategies for bridging cardiovascular health inequalities in women.

SIRT3 Represses Vascular Remodeling via Reducing Mitochondrial Ac-CoA Accumulation in Vascular Smooth Muscle Cells

BACKGROUND

Vascular remodeling characterized by vascular smooth muscle cell (VSMC) phenotypic switching is a key pathological process leading to numerous cardiovascular diseases, often accompanied by a decrease in mitochondrial oxidative phosphorylation. However, whether VSMC mitochondrial homeostasis plays a central role in vascular remodeling remains elusive. In this study, we investigated the role of SIRT3 (sirtuin 3), a deacetylase that maintains mitochondrial homeostasis, in vascular remodeling.

METHODS

We established a VSMC-specific SIRT3 knockout mouse and a VSMC-specific SIRT3 overexpression mouse. Mice were infused with Ang II (angiotensin II) to establish the conventional abdominal aortic aneurysm model and underwent carotid artery ligation to establish the neointima formation model to investigate the role of SIRT3 in vascular remodeling. In vitro, quiescent-state VSMCs were stimulated with PDGF-BB (platelet-derived growth factor type BB) to investigate the direct role of SIRT3 in VSMC phenotypic switching, and the detailed mechanisms were investigated.

RESULTS

The expression and activity of SIRT3 were decreased in the aortas from mice with Ang II-induced abdominal aortic aneurysm or ligation-induced neointima formation. VSMC-specific knockout of SIRT3 exacerbated vascular remodeling, whereas overexpression or activation of SIRT3 in VSMCs displayed therapeutic effect. Moreover, the reduction of SIRT3 was shown to increase the expression level of KLF4, an important transcription factor that orchestrates VSMC phenotypic switching. Mechanistically, SIRT3 repression caused mitochondrial Ac-CoA (acetyl coenzyme A) accumulation that increased acetylated histone 3 lysine 27 levels in the KLF4 gene promoter region. Blockage of mitochondrial Ac-CoA transporting into the cytoplasm by inhibiting ACLY (ATP-citrate lyase) also inhibited VSMC phenotypic switching and thus attenuated vascular remodeling even when SIRT3 was knocked down.

CONCLUSIONS

This study provides evidence that mitochondrial dysfunction induced by SIRT3 inhibition is a major factor leading to VSMC phenotypic switching and vascular remodeling. Restoration of mitochondrial function and inhibition of mitochondrial Ac-CoA accumulation by activation of SIRT3 may help to treat remodeling-related cardiovascular damage.

The Effect of Endocrine Disruptors on the Cardiovascular System: does sex matter?

Endocrine disruptors (EDs) are environmental chemicals that interfere with hormone function, posing significant risks to human health, including the cardiovascular system. This review comprehensively examines the impact of EDs on cardiovascular health, with a specific focus on sex differences observed in various models. Utilizing in-vitro studies, in vivo animal models, and human clinical data, we delineate how sex-specific hormonal environments influence the cardiovascular effects of ED exposure. In vitro studies highlight cellular and molecular mechanisms that differ between male and female-derived cells. In vivo models reveal distinct physiological responses and susceptibilities to EDs, influenced by sex hormones. Human studies provide epidemiological evidence and clinical observations that underscore the variability in cardiovascular outcomes between men and women. This review underscores the necessity of considering sex as a critical factor in understanding the cardiovascular implications of ED exposure, advocating for gender-specific risk assessment and therapeutic strategies. The findings aim to enhance awareness and inform future research and policy-making to mitigate the adverse cardiovascular effects of EDs across different sexes.

Epicardial fat thickness is increased in menopausal patients in comparison with premenopausal patients with similar excess weight: a cross-sectional study

BACKGROUND

The prevalence of excess weight and ageing is notably high in contemporary Western societies. The effectiveness of body mass index (BMI) and waist circumference as tools for identifying excess weight and ectopic fat deposition, both associated with an increased cardiovascular risk, is questionable.

METHODS

Our objective is to compare women affected by overweight and obesity during fertile years and menopausal time and identify easily accessible clinical parameters associated with ectopic fat deposition, providing valuable insights into cardiovascular risk. Over 1300 female patients with excess weight referred to the CASCO Centre (High Specialization Centre for the Care of Obesity) at Umberto I Polyclinic in Rome, Italy, were included. Each participant underwent a DXA scan and a cardiac ultrasound, and blood tests to verify menopausal status and evaluate metabolic profile and hepatic steatosis through indirect measurements.

RESULTS

775 patients were in the pre-menopausal phase and 617 in the post-menopausal phase. The two cohorts did not differ in BMI, total body fat and lean mass, or waist circumference. However, the post-menopausal group showed an increased visceral fat deposition, evaluated by waist-to-hip ratio and epicardial fat thickness (EFT), and a worse metabolic profile.

CONCLUSION

Menopause is associated with a worsening of the metabolic features observed in obesity, with an increase in visceral fat deposition. Of note, these alterations are more pronounced despite similar BMI and waist circumference.

Menopause and mental health

PURPOSE OF REVIEW

This review discusses mental health changes commonly experienced by individuals during the menopause transition (MT). The pathophysiology of the MT, the chronology and type of mental health symptoms arising from this pathophysiology, and evidence-based options for treating midlife patients are discussed. This review concludes with treatment options to enable clinicians to more effectively counsel, recognize and treat symptoms during the MT.

RECENT FINDINGS

The MT begins earlier than previously understood with mood and cognitive issues as common initial mental health symptoms significantly impacting quality of life. These symptoms are due to profound changes in the brain's structure, connectivity, energy metabolism, and inflammation linked to perimenopausal hormone shifts. Hormone therapy, psychiatric medication, psychotherapy, and lifestyle adjustments all play a role in the management of mental health symptoms arising during the MT. Lack of both obstetrician and gynecologist and mental health clinician awareness can leave patients undertreated and vulnerable to nonevidence-based approaches.

SUMMARY

Patients in the MT are at increased risk for mental health issues, both preexisting and new onset. The OB/GYN clinician plays a key role in recognizing and addressing these conditions to improve health outcomes in midlife women.

Health-related quality of life across menopausal stages among middle-aged Korean women

OBJECTIVES

We examined the health-related quality of life (HRQoL) during menopause transition (MT) among middle-aged Korean women.

METHODS

This cross-sectional study comprised 2,290 middle-aged women who completed web-based questionnaires between 2020 and 2022. Based on self-reported menstrual cycle patterns, menopause status was classified as premenopausal, early or late transition, or postmenopausal. HRQoL was assessed using the Patient-Reported Outcomes Measurement Information system, with all 29 items scored using a T-score metric. Multiple linear regression analyses were performed to investigate whether HRQoL varied based on MT stages. Antimüllerian hormone levels were used as an objective measure instead of self-reported menstrual status in the sensitivity analysis. Logistic regression models were used to estimate the prevalence ratios for moderate or severe HRQoL symptoms across menopausal stages.

RESULTS

The mean T-scores for anxiety, depression, and pain interference and intensity were significantly higher with advancing menopausal stage. Anxiety, depression, sleep disturbances, pain interference, and intensity were significantly and linearly positively correlated with MT stages after adjusting for potential confounders. Physical function significantly worsened in the late transition stage compared with premenopausal status ( β = -1.51 [95% CI, -2.72 to -0.31] in late MT and β = -1.92 [95% CI, -3.46 to -0.37] in postmenopause, P for trend = 0.007). However, no significant trends were observed in the sensitivity analysis using antimüllerian hormone levels. Women with moderate or severe symptoms in all domains except physical function had significantly higher prevalence ratios according to MT.

CONCLUSIONS

Overall HRQoL was lower with advancing menopausal stages. All symptoms should be monitored to control early transition symptoms. Thus, women undergoing MT should consistently assess and manage not only menopausal symptoms but also the overall quality of their health to prevent both menopause-specific and nonspecific conditions and their consequences.

Pregnancy Metal Mixtures and Blood Pressure and Hypertension in Mid-Life: A Prospective U.S. Cohort Study

BACKGROUND

The long-term associations between metal mixtures in pregnancy and women's mid-life blood pressure (BP) and hypertension remain unclear.

METHODS

In Project Viva (enrolled 1999-2002), we measured nonessential (arsenic, barium, cadmium, cesium, mercury, lead) and essential metals (copper, magnesium, manganese, selenium, zinc) in red blood cells, along with folate and vitamin B12 in plasma, collected during pregnancy. We measured mid-life BP from 2017 to 2021 (median age, 51.2 years). We examined associations of individual metals with BP using linear regression and with hypertension (≥130/80 mm Hg or use of antihypertensive medication) using modified Poisson regression. We used Bayesian kernel machine regression to examine the mixture effects of metals and micronutrients.

RESULTS

The median follow-up time of the 493 women was 18.1 years (interquartile range, 17.8-18.6 years). After adjustment, a doubling of copper and manganese was associated with 0.75 (95% CI, 0.57-0.99) and 0.80 (95% CI, 0.71-0.91) times the risk of hypertension, respectively. Although higher cesium and selenium levels were associated with a slightly increased risk of hypertension, the 95% CIs were wide and crossed the null. A doubling of vitamin B12 was associated with a 3.64 (95% CI, 1.23-6.04) mm Hg lower systolic BP and a 2.52 (95% CI, 0.72-4.32) mm Hg lower diastolic BP. Bayesian kernel machine regression showed linear associations with no metal-metal or metal-micronutrient interactions. The essential metal mixture was monotonically associated with lower BP, while its association with hypertension showed threshold effects.

CONCLUSIONS

Optimizing essential metal levels during pregnancy, particularly copper and manganese, along with vitamin B12, may protect against higher BP and hypertension in mid-life women.

Liver-Kidney-Metabolic Health, Sex, and Menopause Impact Total Scores and Monovessel vs. Multivessel Coronary Artery Calcification

INTRODUCTION

Liver-kidney-metabolic health (LKMH) depends on complex interactions between metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD), sex, and reproductive status. This study evaluates in a holistic manner how LKMH, sex, and menopause influence coronary artery calcification (CAC) burden.

METHODS

Patients without previous cardiovascular disease were prospectively recruited. Liver fat was assessed via ultrasonography and categorized as mild or moderate-to-severe. CKD was classified using estimated glomerular filtration rate (eGFR). CAC burden was quantified as 0, 1-299, ≥ 300, single-vessel, or multivessel with coronary computed tomography. Stepwise backward multinomial logistic regression was applied for analysis.

RESULTS

A total of 446 patients (59.2% female, average age 52.9 years) were included. Moderate-to-severe MASLD was independently associated with an increased risk of CAC 1-299 [OR 2.30 (1.21-4.36)], CAC ≥ 300 [OR 4.93 (1.46-16.59)], and single-vessel CAC [OR 2.03 (1.03-4.00)]. Mild MASLD [OR 2.47 (1.20-4.21)], moderate-to-severe MASLD [OR 3.74 (1.76-7.93)], and CKD stage 2 [OR 2.27 (1.26-4.08)] were independently associated with increased multivessel CAC risk. Liver fat content showed a dose-response association with CAC burden. Subgroup analysis revealed that MASLD and CKD increased CAC risk in male but not female patients, with menopause significantly modifying LKMH's effect.

CONCLUSION

LKMH's impact on CAC burden is significantly influenced by liver fat content, eGFR, sex, and menopause, suggesting that MASLD, CKD, sex, and reproductive status should be integrated into CAC risk prediction models.

Structural and load-dependent arterial stiffness across the adult life span

BACKGROUND

The arterial stiffening is attributed to the intrinsic structural stiffening and/or load-dependent stiffening by increased blood pressure (BP). The respective lifetime alterations and major determinants of the two components with normal aging are not clear.

METHODS

A total of 3053 healthy adults (1922 women) aged 18-79 years were enrolled. The carotid intima-media thickness, diameter, and local BPs were automatically determined by the radio frequency ultrasound system. The Peterson and Young elastic moduli were then calculated to represent total arterial stiffness. Structural stiffness was recalculated at a reference BP of 120/80 mmHg with established models. Load-dependent stiffness was the difference between total and structural stiffness.

RESULTS

Both structural and load-dependent stiffness increased with aging, with much larger changes in the structural components. The age-related increasing rates were higher in women for the structural stiffness than men ( P  < 0.05), but similar for the load-dependent stiffness. The clinical characteristics and arterial stiffness were widely correlated, but most correlations were quite weak ( r  < 0.3) other than BPs. Multiple regression analyses adjusted for sex, age and other clinical correlates showed that structural stiffness increased with pulse pressure (PP) and load-dependent stiffness increased with mean arterial pressure (MAP), respectively.

CONCLUSION

The age-related arterial stiffening is mainly caused by the intrinsic structural stiffening, which demonstrated significant age-sex interaction. BPs were the major clinical determinants of arterial stiffness, with PP and MAP associated with different arterial stiffness components. The differentiation of the structural and load-dependent arterial stiffness should be highlighted for the optimal vascular health management.

Associations of exposure to individual polyfluoroalkyl substances and their mixtures with vitamin D biomarkers in postmenopausal women

The potential impact of polyfluoroalkyl substances (PFAS) on vitamin D status in postmenopausal women remains unexplored. This study examined the effects of individual PFAS and their combined exposures on vitamin D biomarkers among 2114 postmenopausal women utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018. The serum levels of four PFAS compounds, including perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), and perfluorononanoic acid (PFNA), were assessed alongside the 25-hydroxyvitamin D [25(OH)D] level. Our findings indicated that elevated log-transformed PFAS concentrations were significantly associated with reduced 25(OH)D levels (βPFOS: -15.969, 95 % CI: -19.154, -12.785; βPFOA: -17.288, 95 % CI: -22.446, -12.131; βPFNA: -8.510, 95 % CI: -12.148, -4.871; βPFHxS: -4.056, 95 % CI: -7.003, -1.110) and increased odds of vitamin D deficiency (ORPFOS: 2.495, 95 % CI: 1.685, 3.694; ORPFOA: 3.146, 95 % CI: 1.823, 5.429; ORPFNA: 1.906, 95 % CI: 1.357, 2.677; ORPFHxS: 1.480, 95 % CI: 1.109, 1.976). These associations were modified by race, the family incomepoverty ratio and the survey cycle. Notably, non-Hispanic White individuals presented a stronger inverse association between PFOS exposure and 25(OH)D levels. Bayesian kernel machine regression and weighted quantile sum analyses demonstrated that the effects of exposure to mixtures of the four studied PFAS were consistent with the effects of exposure to individual PFAS. These findings indicate that exposure to individual PFAS, particularly PFOA and PFOS, and their four mixtures may adversely affect serum 25(OH)D concentrations in postmenopausal women, underscoring the need for further investigation into the potential impact of PFAS on vitamin D status in this population.

Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander

PURPOSE OF REVIEW

The aim of this review was to discuss cardiometabolic risk factors that affect women.

RECENT FINDINGS

Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women.

SUMMARY

Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

Weight change and cardiovascular disease incidence in breast cancer survivors: a nationwide cohort study

BACKGROUND

Breast cancer survivors (BCS) face a higher risk of cardiovascular disease (CVD) due to treatment-related cardiotoxicity and pre-existing conditions. We investigated how post-diagnosis weight changes and obesity impact CVD risk in this population.

METHOD

Using the Korean National Health Insurance Service database (2010-2019), BCS without previous history of CVD were enrolled. Weight change was determined using standardized anthropometric protocols during biennial health examinations pre- and post-diagnosis. The primary outcome was incident CVD, a composite of myocardial infarction (MI) and ischemic stroke. Adjusted hazard ratios (aHRs) and confidence intervals (CIs) were estimated, accounting for cardiovascular risk factors, cancer treatments, and sociodemographic variables.

RESULTS

During a mean follow-up of 3.70 years among the 42,547 BCS (mean [SD] age 53.4 [9.4] years), substantial weight gain (> 10%) was associated with increased CVD risk (aHR 1.66, 95% CI 1.05-2.62) and MI risk (aHR 1.83, 95% CI 1.01-3.33) compared to those who maintained their weight. The association between change in obesity status and CVD risk was not significant. Among BCS with sustained obesity, CVD risk was more pronounced in younger survivors (< 50 years) (aHR 3.58, 95% CI 1.94-6.61), and in those using tamoxifen (aHR 1.74, 95% CI 1.11-2.75) (P-interactions < 0.05).

CONCLUSIONS

Our findings suggest that BCS who experience substantial weight gain post-diagnosis have an increased risk of CVD. Further intervention studies (e.g., GLP-1 agonist) are needed to ascertain the effects of weight changes on CVD risks in BCS.

The effects of menopausal hormone therapy for the risk of systemic lupus erythematosus: A nationwide cohort study in Korea

OBJECTIVES

This retrospective cohort study aimed to investigate the influence of menopausal hormone therapy (MHT) on the occurrence of systemic lupus erythematosus (SLE) in postmenopausal women. Additionally, the study aimed to examine the specific effects of individual MHT drugs.

METHODS

In this population-based cohort study conducted in Korea, a total of 452,124 women aged >40 years seeking healthcare for menopause were assessed from January 1, 2011, to December 31, 2014. After employing propensity score matching, 139,331 pairs were included in the MHT and non-MHT groups. Follow-up of participants continued until December 31, 2020. The diagnosis of SLE was based on the International Classification of Diseases 10th edition criteria.

RESULTS

The median follow-up in the study was 7.9 [6.9-8.9] years. SLE developed in 134 (0.1 %) of the 139,197 participants in the MHT group and 143 (0.1 %) of the 139,188 of the non-MHT group, individually. The risk of SLE in the MHT group did not show a significant increase compared to the non-MHT group {hazard ratio (HR) 1.114, 95 % confidence interval (CI) 0.88-1.41}. Subgroup analysis results indicated no significant differences based on the type of MHT or the duration of MHT use, except tibolone. In the group that used tibolone within 3 years, the HR for SLE risk was 1.45 (95 % confidence interval: 1.051-2.001).

CONCLUSION

The utilization of MHT did not demonstrate a substantial impact on the development of SLE in postmenopausal women. Caution is required in the early stages of tibolone use.

Associations of gestation length and offspring birthweight for gestational age with menopausal symptoms and age of natural menopause at midlife among women enrolled in a prebirth longitudinal cohort

OBJECTIVE

Reproductive history may help identify women at higher risk for experiencing menopausal symptoms. We hypothesized that gestation length and offspring birthweight for gestational age z-scores would be associated with menopausal symptoms and age at natural menopause in midlife among women in a longitudinal prebirth cohort.

METHODS

Among 691 women enrolled in pregnancy and followed to midlife, we examined associations of gestation length and offspring birthweight for gestational age z-score at the index pregnancy with total menopausal symptoms assessed with the 11-item Menopause Rating Scale (MRS) using linear regression models, with individual menopausal symptoms using binomial regression models with a log link function, and with age at natural menopause using Cox proportional hazards models. We adjusted all models for age at enrollment, education, parity, annual household income, and prepregnancy body mass index.

RESULTS

Mean (SD) MRS total score was 7.9 (5.8) points at age 52.1 (3.8) years, and mean (SD) age at natural menopause was 50.8 (3.7) years. We observed null associations of gestation length (β = -0.07 points per week, 95% confidence interval [CI] = -0.32 to 0.18) and birthweight for gestational age z-score (β = 0.16 points per z-score, 95% CI = -0.31 to 0.63) with the MRS total score in adjusted models. We also observed null associations of gestation length (adjusted hazards ratio = 0.99 per week, 95% CI = 0.94-1.06) and birthweight for gestational age z-score (adjusted hazards ratio = 1.06 per z-score, 95% CI = 0.94-1.19) with age of onset of natural menopause.

CONCLUSIONS

Birth outcomes were not associated with total menopause symptom scores or age at natural menopause.

Sex-dependent alterations in cardiac cytochrome P450-mediated arachidonic acid metabolism in pressure overload-induced cardiac hypertrophy in rats

Cardiac hypertrophy is a risk factor for heart failure and is usually less common in young women than in men. Cytochrome P450 (CYP) enzymes in the heart metabolize arachidonic acid into hydroxyeicosatetraenoic acids (HETEs), which generally have hypertrophic effects, and epoxyeicosatrienoic acids, which have cardioprotective effects. In this study, we aimed to investigate sex-specific differences in cardiac hypertrophy and cardiac CYP, HETE, and epoxyeicosatrienoic acid levels in response to pressure overload. Adult male and female Sprague-Dawley rats were subject to sham or abdominal aortic constriction (AAC) surgeries. Five weeks postsurgery, cardiac function was assessed by echocardiography. The mRNA and protein levels of hypertrophic markers and CYP enzymes were measured by real-time polymerase chain reaction and Western blot. Heart tissue HETE levels and microsomal formation of HETEs and epoxyeicosatrienoic acids were measured by liquid chromatography-tandem mass spectrometry. Our results show significant sex-specific differences in AAC-induced cardiac hypertrophy. Echocardiography and ventricular wall measurements showed more hypertrophy in male rats. Some hypertrophic markers were significantly upregulated only in male AAC rats and were significantly higher in the hearts of male rats compared to female AAC rats. Different CYP hydroxylases such as CYP1B1, CYP4A, and CYP4F and epoxygenases such as CYP2C and CYP2J10 were significantly upregulated in the hearts of male AAC rats only. The heart level of 12(R)-HETE and the microsomal formation of several HETEs were also significantly increased only in male rats. In conclusion, male rats developed stronger AAC-induced cardiac hypertrophy compared to female rats, which was accompanied by a significant increase in cardiac CYP enzymes and HETEs. SIGNIFICANCE STATEMENT: Previous studies demonstrated that male rats experience more severe cardiac hypertrophy compared to female rats. To our knowledge, this research is the first to investigate and compare the expression of cytochrome P450 enzymes and arachidonic acid metabolites in male and female rat hearts following pressure overload-induced hypertrophy. This study highlights significant sex-specific differences in cytochrome P450-mediated metabolism during hypertrophy, providing valuable insights into the molecular mechanisms underlying these responses and identifying potential targets for sex-specific therapies in cardiac diseases.

Nonlinear relationships between the triglyceride glucose-body mass index and cardiovascular disease in middle-aged and elderly women from NHANES (1999-2018)

This study aims to investigate the relationship between the triglyceride-glucose body mass index (TyG-BMI) and cardiovascular disease (CVD) among middle-aged and elderly women, using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. TyG-BMI was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] × BMI. After applying the sampling weights from NHANES, the study sample of 6,343 participants is representative of approximately 59,174,898 American women. We categorized TyG-BMI into quartiles, using Q3 as the reference group. In the crude model, Q4 exhibited a 40% increased odds of CVD (odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.09-1.79, P = 0.009). In the fully adjusted model, the increased odds of CVD for Q4 relative to Q3 was 39% (OR = 1.39, 95% CI 1.06-1.82, P = 0.019). Further analysis using restricted cubic splines (RCS) and threshold effect analysis confirmed a nonlinear relationship between them. Below a TyG-BMI threshold of 260, there was no significant association with CVD odds. However, above 260, each 10-unit increase in TyG-BMI was associated with a 2.4% increase in CVD odds in this demographic. Sensitivity analyses confirmed the stability of the results.

Longitudinal changes in circulating cyclic guanosine monophosphate in women over the menopause transition compared to men: the Coronary Artery Risk Development in Young Adults (CARDIA) study

OBJECTIVE

The menopause transition is a period of accelerated cardiovascular disease (CVD) development in women, and sex differences in CVD incidence are reduced after menopause. Higher plasma cyclic guanosine monophosphate (cGMP) levels are also associated with greater CVD risk. Thus, we examined the changes in cGMP levels associated with the menopause transition.

METHODS

We measured plasma cGMP levels in 511 women and 283 men in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

RESULTS

Over a 20-year follow-up period, women who completed the menopause transition had smaller reductions in cGMP relative to women who remained premenopausal (P < 0.05) but had similar changes compared to men (P = 0.3) after adjusting for demographic variables.

CONCLUSIONS

Plasma cGMP changes through the menopause transition may reflect the underlying mechanisms associated with greater cardiovascular disease risk.

Chronic treatment with photobiomodulation decreases blood pressure and improves endothelial function in ovariectomized rats

Menopause is a natural phase, related to the aging reproductive female, characterized by decreased production of hormones steroids, mainly estrogen, involved in multiple physiological process, including cardiovascular function. This estrogen decline can lead to the development of hypertension, as well as other cardiovascular diseases. Strategies therapeutics complementary he comes winning emphasis as option for management women's insurance at menopause, such as photobiomodulation. Photobiomodulation (PBM) is the application of no invasive low light sources level, normally in the forms of low level lasers therapy (LLLT) or light emitting diodes (LEDs) that present potentials benefits therapeutics in the treatment of inflammation and stress oxidative, favoring angiogenesis, improving function cardiac and remodeling tissue. The objective of this work was to evaluate the in vivo effects of photobiomodularion on cardiovascular parameters in ovariectomy-induced menopause in female rats. Twenty-six 70-day-old female Wistar rats were randomly assigned to three experimental groups: sham (SH), ovariectomized (OVX), and ovariectomized treated with photobiomodulation (OVX + PBM). The ovaries of all animals in the OVX groups were surgically removed at 12 weeks of age. The OVX + PBM group received photobiomodulation treatment with 5.6 Joules per point at six points on the abdominal region, using a power of 100mW at a wavelength of 660 nm, applied twice a week for two weeks. Blood pressure was measured using tail plethysmography, and endothelial function was assessed through vascular reactivity tests. At the end of the treatment period, the mean blood pressure in the OVX + PBM group was significantly lower than in the untreated OVX group. PBM treatment also improved endothelium-dependent vasodilation in aortic rings of OVX rats compared to the untreated OVX group, with no significant difference between the OVX + PBM and Sham groups. In addition, PBM increased serum nitric oxide (NO) levels compared to the OVX group. These results suggest that PBM treatment effectively reduced blood pressure, increased serum NO levels, and reversed endothelial dysfunction in ovariectomized rats.

Analysis of multimorbidity patterns in perimenopausal women based on medical examination data

OBJECTIVE

The concurrent presence of multiple chronic diseases, termed multimorbidity, is increasingly prevalent among patients with chronic illnesses. This phenomenon is particularly pronounced in middle-aged women, yet has not received adequate attention. The objective of this study was to investigate the pattern of multimorbidity and its changes over time in perimenopausal women.

METHODS

A longitudinal study was conducted on the coexistence of chronic diseases in 3990 middle-aged women aged 40-65 years. The primary analytical tools were association rule mining and cross-lagged panel modeling, applied to the comprehensive medical examination data of the cohort.

RESULT

At the first medical examination, 77.72% of participants were diagnosed with two or more chronic diseases, a figure that rose to 86.98% by the last examination. The most frequently observed multimorbidity combination pair under strong association rules is obesity and dyslipidemia. Additionally, the findings indicated that central obesity significantly influences lipid composition.

CONCLUSION

This study highlights the elevated prevalence of multimorbidity in perimenopausal women and the added complexity of endocrine-related disorders at this life stage. There is an urgent need to develop personalized health management strategies for this demographic and to monitor and intervene in their health status in order to achieve healthy aging for perimenopausal women.

Long-term trajectory of estimated glomerular filtration rate in ambulatory patients with type 2 diabetes and heart failure: clinical insights and prognostic implications

BACKGROUND

Although previous studies have evaluated renal function decline in patients with heart failure (HF), there is limited evidence on long-term renal trajectories, especially in patients with concomitant HF and type 2 diabetes (T2D). This study aims to provide a detailed analysis of renal function decline over an extended follow-up period in a well-characterized cohort of patients with HF and T2D.

METHODS

This is a post hoc subanalysis of a prospective registry involving ambulatory patients with HF and T2D referred to a specialized HF clinic. The estimated glomerular filtration rate (eGFR) was assessed at baseline and during scheduled follow-up visits every three months using the Chronic Kidney Disease Epidemiology Collaboration formula. Loess curves were plotted for predefined subgroups, and multivariable longitudinal Cox regression analyses were performed to evaluate the associations between eGFR trajectories and all-cause mortality.

RESULTS

A total of 1,114 patients with HF and T2D were included, with a mean age of 69.3 ± 10.3 years, and 68.2% were men. In total, 10,830 scheduled creatinine measurements were analysed, with a mean of 15.8 ± 9.4 measurements per patient. A significant progressive decline in the eGFR was observed, with an average annual rate of - 2.05 (95% CI - 2.11 to - 1.95, p < 0.001) ml/min/1.73 m2. Subgroup analysis indicated that older age, nonischaemic HF aetiology, HFpEF or HFmrEF, poor glycaemic control, and higher baseline eGFRs were associated with a more pronounced decline in renal function. Furthermore, a decrease in the eGFR was independently associated with an increased risk of all-cause mortality.

CONCLUSIONS

This study offers novel insights into long-term renal function trajectories in patients with HF and T2D and identifies key clinical factors associated with accelerated renal decline. Future research is warranted to validate these results in larger, more diverse cohorts and to explore potential therapeutic interventions.

Menopause-related changes in vascular signaling by sex hormones

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

Effects of physical exercise on the lipid profile of perimenopausal and postmenopausal women: a systematic review and meta-analysis

During the climacteric period, the decline in ovarian hormones leads to changes in the lipid profile. Physical exercise is the main non-pharmacological recommendation for controlling lipid levels. However, the effects on the lipid profile in perimenopausal and postmenopausal women are incipient and inconclusive. In this context, we searched the Embase, PubMed, Scopus, and Web of Science databases for randomized clinical trials on the effects of exercise on the lipid profile of these women. We excluded studies that did not specify criteria for classifying the climacteric phase, that involved women undergoing hormone replacement therapy, or that examined combined treatments or acute effects of physical exercise. The meta-analysis indicated that general physical exercise increased high-density lipoprotein cholesterol (HDL-C) levels (mean difference [MD]=4.89; 95% confidence interval [95%CI]=0.97 to 8.81) in perimenopausal women. For obese postmenopausal women, 16 weeks of aerobic training increased HDL-C levels (MD=3.88; 95%CI=0.56 to 7.20) and reduced total cholesterol (MD=-22.36; 95%CI=-29.67 to -15.05) and low-density lipoprotein cholesterol (LDL-C) levels (MD=-17.86; 95%CI=-25.97 to -9.75), whereas 12 weeks of resistance training increased HDL-C levels (MD=4.20; 95%CI=1.16 to 7.23) and decreased triglycerides (MD=-14.86; 95%CI=-26.62 to -3.09) and LDL-C levels (MD=-16.36; 95%CI=-28.05 to -4.67). Overall, the results showed that physical exercise regulated lipid profiles in perimenopausal and postmenopausal women. Specifically, 12 weeks of resistance exercise and 16 weeks of aerobic exercise improved the lipid profile of obese postmenopausal women.

From physiology to pathology: Emerging roles of GPER in cardiovascular disease

Cardiovascular diseases (CVDs) are among the leading causes of death globally and pose a significant threat to public health. Factors such as prolonged high cholesterol levels, diabetes, smoking, unhealthy diet, and genetic predisposition could contribute to the occurrence and development of CVDs. Common CVDs include hypertension (HTN), atherosclerosis (AS), myocardial infarction (MI), myocardial ischemia-reperfusion injury (MIRI), heart failure (HF) and arrhythmia. Estrogen is recognized for its cardiovascular protective effects, resulting in lower incidence and mortality rates of CVDs in premenopausal women compared to men. The G protein-coupled estrogen receptor (GPER), a G protein-coupled receptor with a seven-transmembrane structure, exhibits unique structural characteristics and widespread tissue distribution. GPER activates intracellular signaling pathways through its interaction with G proteins, mediating estrogen's biological effects and participating in the regulation of cardiovascular function, metabolic balance, and nervous system. Although recent research has highlighted the significant role of GPER in the cardiovascular system, its specific mechanisms remain unclear. Therefore, this review summarizes the latest research on GPER in CVDs, including its fundamental characteristics, physiological functions in the cardiovascular system, and its roles and potential therapeutic applications in common CVDs such as HTN, AS, MI, MIRI, HF and arrhythmia. Exploring GPER's positive effects on cardiovascular health will provide new strategies and research directions for the treatment of CVDs.

The Association of Menopausal Age with Sex Hormones and Anthropometric Measures Among Postmenopausal Women in the Multi-Ethnic Study of Atherosclerosis Study

Introduction: We investigated associations of menopausal age category with body mass index (BMI), waist circumference, waist-hip ratio, and waist-height ratio. We also explored the moderating effect of anthropometric measures on associations of menopausal age category with prespecified sex hormones: estradiol, dehydroepiandrosterone (DHEA), sex hormone-binding globulin, bioavailable testosterone, and total testosterone-estradiol (T/E) ratio. Methods: In this cross-sectional study, we included 2,436 postmenopausal women from the Multi-Ethnic Study of Atherosclerosis who had menopausal age, anthropometric, and sex hormone data at baseline. Menopausal age was categorized as <45 years (early menopause), 45-49 years, 50-54 years (referent), and ≥55 years (late menopause). Linear models were used for analysis. Results: The mean (standard deviation) age was 64.7 (9.2) years. After multivariable adjustment, women who experienced late menopause had higher waist circumference (2.28 cm), waist-hip ratio (0.013 units), and waist-height ratio (0.014 units) but not BMI than those in the referent category. The interaction terms between menopausal age category and anthropometric measures were not significant for prespecified sex hormones (all Pinteraction >0.05). When compared with the referent category, T/E ratio was 21% (4.72 - 39.8%) higher among women with late menopause while DHEA levels were 9% (1 - 16%) higher among women who experienced menopause between 45 and 49 years in multivariable adjusted models. Conclusion: Women with late menopause had higher abdominal adiposity but not generalized adiposity when compared with those who experienced menopause between 50 and 54 years of age. Androgenicity was higher among women who experienced menopause between 45 and 49 years of age and those with late menopause, based on DHEA and T/E ratios, respectively.

Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics

Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.

Promoting Resiliency to Stress in the Vascular Endothelium

By 2050, roughly 60% of the population will have cardiovascular disease. While a substantial amount of data has been generated over the last few decades that has aided in our understanding of cardiovascular disease pathology, less is known about how to increase resiliency to cardiovascular risk factors that individuals are exposed to on a daily basis. The vascular endothelium is considered the first line of defence against circulating noxious stimuli and, when dysfunctional, is an early risk factor for the development of cardiovascular disease. A vast amount of data has been generated demonstrating how external stress impairs the vascular endothelium; however, there is a paucity of knowledge regarding how to amplify protective pathways and ward off stress and the development of disease, which is the focus of this review. Targeting known protective endothelial pathways may be feasible to increase resiliency to vascular stress. Leveraging stress to boost defence mechanisms within the vascular endothelium is also proposed and may help identify novel therapeutic targets to protect individuals from the stress of everyday life.

Unveiling the role of exercise in modulating plasma heat shock protein 27 levels: insights for exercise immunology and cardiovascular health

Cardiovascular disease is one of the leading causes of mortality worldwide, primarily driven by atherosclerosis, a chronic inflammatory condition contributing significantly to fatalities. Various biological determinants affecting cardiovascular health across different age and sex groups have been identified. In this context, recent attention has focused on the potential therapeutic and preventive role of increasing circulating levels of heat shock protein 27 (plasma HSP27) in combating atherosclerosis. Plasma HSP27 is recognized for its protective function in inflammatory atherogenesis, offering promising avenues for intervention and management strategies against this prevalent cardiovascular ailment. Exercise has emerged as a pivotal strategy in preventing and managing cardiovascular disease, with literature indicating an increase in plasma HSP27 levels post-exercise. However, there is limited understanding of the impact of exercise on the release of HSP27 into circulation. Clarifying these aspects is crucial for understanding the role of exercise in modulating plasma HSP27 levels and its potential implications for cardiovascular health across diverse populations. Therefore, this review aims to establish a more comprehensive understanding of the relationship between plasma HSP27 and exercise.

A Systematic Review of Anxiety and Depressive Symptoms Among Women Experiencing Vasomotor Symptoms Across Reproductive Stages in the US

Purpose

Vasomotor symptoms (VMS) due to menopause affect up to 80% of women and are associated with fatigue, depressive symptoms, and anxiety although the exact nature of these associations is not fully understood. This systematic review aimed to examine the existing evidence on the relationship between VMS, fatigue, depressive symptoms, and anxiety among women in any stage of reproductive aging in the United States.

Methods

A comprehensive search of MEDLINE and Embase databases was performed to identify observational studies (2010-2022) that reported on the target population. Exposure of interest was VMS; data related to the outcomes of interest (measures of fatigue, depressive symptoms, and/or anxiety) were extracted and analyzed descriptively.

Results

Twenty-six studies met the inclusion criteria, with 19 reporting on depressive symptom outcomes, 16 on anxiety outcomes, and none on fatigue. The mean age of women with VMS ranged from 41.3 to 62.0 years; 34.8% to 91.1% of women were premenopausal or in the late stage of reproductive aging, 0.6% to 61% were perimenopausal or in menopause transition, and 0% to 49% were postmenopausal. The most frequent comorbidities were hypertension and diabetes. Baseline depressive symptom rates ranged from 1.4% to 58%, with higher rates and more severe symptoms among women with more frequent and severe VMS. Anxiety rates at baseline ranged from 2.2% to 52%, with higher rates reported among women with frequent VMS. Anxiety levels varied, with the highest levels observed among women with sleep disturbances and severe hot flashes. In regression model analyses, VMS were associated with increased risk, duration, frequency, and severity of both depressive symptoms and anxiety.

Conclusion

VMS are strongly and consistently associated with depressive symptoms and anxiety, negatively affecting a woman's health beyond physical discomfort. There is a need to reduce this burden and improve quality of life for women with VMS.

Age of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study

BACKGROUND

Menopause is a timely opportunity to screen for cardiovascular disease (CVD) and intervene with healthier lifestyles. We investigated the association between premature/early menopause and the likelihood of CVD and whether a healthy lifestyle is associated with a lower likelihood of CVD in menopausal woman.

METHODS

The Sax Institute's 45 and Up Study prospectively recruited participants aged ≥45 years (n=267 357) between 2005 and 2009 (New South Wales, Australia). Our study included women without prior CVD and reporting menopausal age at baseline. Primary outcome was new-onset CVD (self-reported heart disease/stroke) based on survey data at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed the associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared with menopause between 50 and 52 years, adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep and diet.

RESULTS

We included 46 238 women (mean age 62.1±8.2 years), with 5416 (11.7%) cases of CVD over 15-year follow-up. After adjustment, the odds of CVD was higher in women with premature menopause (OR 1.36, 95% CIs 1.17 to 1.59; p<0.0001) and early menopause (OR 1.15, 95% CI 1.03 to 1.28; p=0.013) compared with menopause between 50 and 52 years. Among all women, high (score 9-10) versus low (score 0-5) healthy lifestyle adherence led to 23% lower odds of CVD (OR 0.77, 95% CI 0.68 to 0.86; p<0.0001), and in women with premature menopause, led to 52% lower odds of CVD (OR 0.48, 95% CI 0.30 to 0.77, p=0.0022). Lifestyle effect did not significantly differ between menopause categories (interaction, p=0.71).

CONCLUSION

Women with premature/early menopause are at higher likelihood for CVD. Lifestyle modification is associated with consistent reduction of the likelihood of CVD in women and should be encouraged across the life course.

Association between sarcopenia and cardiovascular disease according to menopausal status: findings from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Little is known about the association between sarcopenia and cardiovascular disease (CVD) according to menopausal status, and we conducted cross-sectional as well as longitudinal analyses Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association between sarcopenia and CVD in Chinese women according to menopausal status.

METHOD

The study sample included 5365 (mean age 60.3 ± 9.3 years) female participants from CHARLS 2015 (wave 3). Additionally, 3,882 participants without cardiovascular disease (CVD) were recruited in CHARLS 2015 (Wave 3) and followed up in 2018 (Wave 4). CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. Menopausal status was determined based on self-reported information from questionnaires. Sarcopenia status was assessed using the diagnostic criteria established by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Binary logistic regression analyses were conducted to explore the association between sarcopenia and CVD in both premenopausal and postmenopausal women. Further analyses examined the interaction between sarcopenia and menopausal status to better understand its impact on CVD.

RESULTS

The prevalence of CVD in the total population is 22.5% (1209/5365). Among premenopausal women, the prevalence in no-sarcopenia, possible sarcopenia, and sarcopenia group are 11.3% (86/759), 16.2% (17/105), and 13.9% (5/36), respectively, for postmenopausal women, the prevalence are 19.2% (320/1668), 32.6% (520/1597), and 21.8% (261/1200). Both possible sarcopenia (OR = 1.58; 95% CI: 1.29-1.93) and sarcopenia (OR = 1.34; 95% CI: 1.05,1.72) are associated with CVD in the population of postmenopausal women. There was a significant positive interaction between menopause and sarcopenia on CVD, the RERI = 5.30 (95%CI: 4.63, 5.98), the SI = 2.44 (95%CI: 1.84, 3.63), and the multiplicative effect = 2.18 (95%CI: 1.70, 2.66). In the longitudinal analysis, 514 (13.2%) new cases of CVD were diagnosed. In premenopausal women, sarcopenia was significantly associated with the development of CVD (OR = 2.44, 95% CI: 1.3,4.59). In postmenopausal women, possible sarcopenia (OR = 1.45, 95% CI: 1.28, 1.65) and sarcopenia (OR = 1.42, 95% CI: 1.23, 1.65) were more likely to have new-onset CVD than the postmenopausal no-sarcopenia women.

CONCLUSIONS

Sarcopenia and cardiovascular disease (CVD) risk show significant variations in cross-sectional and longitudinal associations across different menopausal statuses, with higher risks in postmenopausal women. An interaction between menopausal status and sarcopenia on CVD risk was found.

Frailty trajectories after a cardiovascular event among community-dwelling older people

AIMS

Individuals with cardiovascular disease (CVD) are more likely to become frail. However, no study has determined whether an incident CVD event alters frailty trajectories in older individuals. This study aims to determine the extent to which an incident CVD event modifies frailty trajectories and to identify factors that influence those changes.

METHODS

19,111 individuals (56.4%, women) ≥aged 65 years, who had no prior CVD event or other major health conditions at baseline, were followed for up to 11 years. Frailty was measured annually using the 64-item deficit-accumulation frailty index (FI) and Fried phenotype (Fried). Incident CVD events, including stroke, myocardial infarction and hospitalization for heart failure (HHF), were adjudicated by international experts. Linear mixed models were used to measure frailty changes.

RESULTS

Over a median 8.3-year follow-up, frailty trajectories increased over time and 1934 incident CVD events occurred. Following a CVD event, individuals had a short-term increase in both FI (adjusted-betas: 3.65; 95%CI, 3.34 to 3.96) and Fried (adjusted-beta: 0.32; 95%CI, 0.26 to 0.38). Afterwards, only FI continued to increase over time (adjusted-beta: 0.41, 95%CI, 0.21 to 0.62). Among the CVD events, HHF and stroke were associated with the greatest increase in frailty. Of the factors examined, being >80 years, women, living alone, or residing in regional/remote areas were associated with greater frailty burden.

CONCLUSION

Our findings provide evidence that incident CVD event increases frailty burden, highlighting the need for targeted intervention to minimise frailty-related clinical complications for those most at risk.

Sex-related differences in the clinical course of aortic root and ascending aortic aneurysms: the DisSEXion Study

BACKGROUND AND AIMS

To explore male-female differences in aneurysm growth and clinical outcomes in a two-centre retrospective Dutch cohort study of adult patients with ascending aortic aneurysm (AscAA).

METHODS

Adult patients in whom imaging of an AscAA (root and/or ascending: ≥40 mm) was performed between 2007 and 2022 were included. Aneurysm growth was analysed using repeated measurements at the sinuses of Valsalva (SoV) and tubular ascending aorta. Male-female differences were explored in presentation, aneurysm characteristics, treatment strategy, survival, and clinical outcomes.

RESULTS

One thousand eight hundred and fifty-eight patients were included (31.6% female). Median age at diagnosis was 65.4 years (interquartile range: 53.4-71.7) for females and 59.0 years (interquartile range: 49.3-68.0) for males (P < .001). At diagnosis, females more often had tubular ascending aortic involvement (75.5% vs. 70.2%; P = .030) while males more often had SoV involvement (42.8% vs. 21.6%; P < .001). Maximum absolute aortic diameter, at any location, at diagnosis did not differ between females (45.0 mm) and males (46.5 mm; P = .388). In females, tubular ascending growth was faster (P < .001), whereas in males, SoV growth was faster (P = .005), corrected for covariates. Unadjusted 10-year survival was 72.5% [95% confidence interval (CI) 67.8%-77.6%] for females and 78.3% (95% CI 75.3%-81.3%) for males (P = .010). Twenty-three type A dissections occurred, with an incidence rate of 8.2/1000 patient-years (95% CI 4.4-14.1) in females and 2.4/1000 patient-years (95% CI 1.2-4.5) in males [incidence rate ratio females/males: 3.4 (95% CI 1.5-8.0; P = .004)].

CONCLUSIONS

In patients having entered a diagnostic programme, involvement of aortic segments and age- and segment-related growth patterns differ between women and men with AscAA, particularly at an older age. Unravelling of these intertwined observations will provide a deeper understanding of AscAA progression and outcome in women and men and can be used as an evidence base for patient-tailored clinical guideline development.

Effects of Age and Sex on Systemic Inflammation and Cardiometabolic Function in Individuals With Type 2 Diabetes

BACKGROUND

Systemic inflammation, aging, and type 2 diabetes (T2D) lead to varying degrees of cardiovascular dysfunction and impaired aerobic exercise capacity. This study evaluates the impact of inflammation and sex differences on coronary and peripheral vascular function and exercise capacity in older individuals with and without T2D.

METHODS

Older individuals (aged≥65 years) underwent biochemical and tissue inflammatory phenotyping, cardiopulmonary exercise testing, cardiovascular magnetic resonance imaging, and vascular reactivity testing. Correlation and regression analyses determined the effects of systemic inflammation, older age, and sex on cardiovascular health, stratified by T2D status.

RESULTS

For the 133 recruited individuals (44% women; median age, 71±7 years, 41% with T2D), the presence of T2D most significantly increased the white blood cell count (P=0.004; P.adj.=0.140) among markers of systemic inflammation. White blood cell count was comparable in men and women. Hyperemic myocardial blood flow and flow-mediated and flow-independent nitroglycerin-induced brachial artery dilation were significantly impaired in men but not women with T2D. Peak oxygen consumption during exercise was lower with T2D (P=0.021), and overall reduced in women compared with men (P=0.002). Across all participants, both peak oxygen consumption during exercise and hyperemic myocardial blood flow were significantly impaired with increased white blood cell count. Women showed more adverse myocardial remodeling assessed by extracellular volume than men (P=0.008), independently of T2D status.

CONCLUSIONS

The pathophysiological manifestations of T2D on vascular function and aerobic exercise capacity are distinct in older men and women, and this may reflect underlying differences in vascular and myocardial aging in the presence of T2D.

Identification of specific risk factors and predictive analytics for cardio-cerebral arterial stenosis: a comparative study utilizing framingham risk stratification insights

Atherosclerotic diseases are systemic, and stroke patients often present with both intracranial artery stenosis (ICAS) and coronary artery stenosis (COAS). This study aimed to investigate the prevalence of ICAS and COAS among ischemic stroke patients across different risk strata and to construct a predictive model for assessing atherosclerosis risk. This retrospective study included patients admitted for ischemic stroke at the Affiliated Hospital of Xuzhou Medical University from December 2020 to December 2021. All patients underwent CTA, with significant stenosis defined as exceeding 50% for both cerebral and coronary arteries.Patients were categorized into low-, moderate-, and high-risk groups on the basis of the Framingham risk scale. A total of 5,816 patients were included, with a mean age of 66.54 years. Dual arterial stenosis was found in 2,258 patients (38.8%), single ICAS in 399 (6.8%), and single COAS in 3,159 (54.3%). The moderate- and high-risk groups had significantly lower risks of single ICAS and COAS. Comparing the differences in risk factors between single arterial stenosis and dual arterial stenosis, the key risk factors included hyperlipidemia, smoking, hypertension, and diabetes, with a model accuracy of 73.61% and an AUC values of 0.8562 for dual stenosis. Significant differences in age, sex, and the risk factors were observed among risk groups. The predictive model demonstrated high accuracy, highlighting the importance of personalized medicine in clinical decision-making.

Dynamic Importance of Genomic and Clinical Risk for Coronary Artery Disease Over the Life Course

BACKGROUND

Earlier identification of high coronary artery disease (CAD) risk individuals may enable more effective prevention strategies. However, existing 10-year risk frameworks are ineffective at earlier identification. We sought to understand how the variable importance of genomic and clinical factors across life stages may significantly improve lifelong CAD event prediction.

METHODS

A longitudinal study was performed using data from 2 cohort studies: the FOS (Framingham Offspring Study) with 3588 participants aged 19 to 57 years and the UKB (UK Biobank) with 327 837 participants aged 40 years to 70 years. A total of 134 765 and 3 831 734 person-time years were observed in FOS and UKB, respectively. Hazard ratios for CAD were calculated for polygenic risk score (PRS) and clinical risk factors at each age of enrollment. The relative importance of PRS and pooled cohort equations in predicting CAD events was also evaluated by age groups.

RESULTS

The importance of CAD PRS diminished over the life course, with a hazard ratio of 3.58 (95% CI, 1.39-9.19) at the age of 19 years in FOS and a hazard ratio of 1.51 (95% CI, 1.48-1.54) by the age of 70 years in UKB. Clinical risk factors exhibited similar age-dependent trends. PRS significantly outperformed pooled cohort equations in identifying subsequent CAD events in the 40- to 45-year age group, with 3.2-fold more appropriately identified events. Overall, adding PRS improved the area under the receiving operating curve of the pooled cohort equations by an average of +5.1% (95% CI, 4.9%-5.2%) across all age groups; among individuals <55 years, PRS augmented the area under the receiver operater curve (ROC) of the pooled cohort equations by 6.5% (95% CI, 5.5%-7.5%; P<0.001).

CONCLUSIONS

Genomic and clinical risk factors for CAD display time-varying importance across the lifespan. The study underscores the added value of CAD PRS, particularly among individuals younger than 55 years, for enhancing early risk prediction and prevention strategies. All results are available at https://surbut.github.io/dynamicHRpaper/index.html.

The association between metabolic dysfunction-associated steatotic liver disease diagnosis and vasomotor symptoms in midlife women

OBJECTIVE

Metabolic dysfunction-associated steatotic liver disease (MASLD) and vasomotor symptoms (VMS) are associated with increased cardiovascular disease risk. Although visceral adiposity has been linked to MASLD and VMS independently, this study aimed to evaluate associations between the two in midlife women.

METHODS

A cross-sectional study of women aged 45-60 years receiving primary care at one of four sites was conducted from March 1 through June 30, 2021. MASLD diagnosis was obtained utilizing the International Classification of Diseases , Ninth Revision and Tenth Revision codes. VMS burden was evaluated with the Menopause Rating Scale and categorized as severe/very severe versus none/mild/moderate. Logistic regression models were used to assess the association between VMS and diagnosed MASLD both univariately and after individually adjusting for several risk factors.

RESULTS

A total of 4,599 women were included in the final analysis, 304 (7%) of whom had an MASLD diagnosis. On univariate analysis, women with an MASLD diagnosis were more likely to have severe/very severe VMS (odds ratio [OR], 1.50; 95% CI, 1.08-2.08; P = 0.015). However, the association between MASLD diagnosis and severe/very severe VMS was no longer statistically significant after individually adjusting for body mass index (adjusted OR, 1.36; 95% CI, 0.97-1.92) and hypertension (adjusted OR, 1.38; 95% CI, 0.99-1.93).

CONCLUSIONS

The relationship between MASLD and VMS appears to be best explained by other variables including BMI and hypertension. Although they do not appear to be directly linked, given the prevalence of bothersome VMS in midlife women, addressing VMS may enable greater adherence to lifestyle modifications as part of MASLD management.

Effects of a therapeutic lifestyle modification intervention on health-related quality of life and sexual functioning and cardiometabolic health in perimenopausal Chinese women: a randomized controlled trial

OBJECTIVE

This study aimed to evaluate the effects of a therapeutic lifestyle modification (TLM) intervention on health-related quality of life, sexual functioning and cardiometabolic health in perimenopausal Chinese women.

METHOD

The study was a randomized controlled trial (registration number: ChiCTR2300070648). Ninety-four perimenopausal women aged between 40 and 55 years were randomly assigned in a 1:1 ratio to receive the TLM intervention or usual care for 12 weeks. Menopause-specific Quality of Life (MENQOL), Female Sexual Function Index (FSFI), pelvic floor muscle strength (PFMS) and composite cardiometabolic indicators were evaluated at baseline and post intervention.

RESULTS

After 12 weeks, linear mixed-effects models showed that the TLM intervention led to a statistically significant improvement in MENQOL (-0.60, 95% confidence interval [CI] - 0.80 to -0.41), FSFI (3.82, 95% CI 2.03 to 5.61), resting heart rate (-5.44, 95% CI -10.40 to -0.48), waist circumference(-3.14, 95% CI -4.15 to -2.13) and body fat percentage (-4.25, 95% CI -6.92 to -1.58) compared to the control group. There were also statistically significant differences between the intervention (TLM) group and the control group in the proportions of PFMS (p = 0.006).

CONCLUSION

The TLM intervention effectively improved menopause-specific quality of life in midlife women, supported by enhancements in female sexual functioning and cardiometabolic health status.

The effect of probiotic administration on the severity of menopausal symptoms and mental health of postmenopausal women: a triple-blind randomized controlled trial in the West of Iran

OBJECTIVE

Menopausal symptoms are a reproductive health issue for women. Some studies have suggested that the use of probiotics may alleviate the severity of menopausal symptoms and mental health status. This study aimed to evaluate the effect of probiotic administration on the severity of menopausal symptoms and improve mental health in postmenopausal women in Hamadan, Western Iran.

METHODS

A triple-blind randomized controlled trial was conducted from February 20, 2023, to August 23, 2023, at the Comprehensive Health Service Centers in Hamadan City, Western Iran. Participants were randomized to intervention and control groups. The participants in the intervention group were administered probiotic supplements in 200 mg daily capsules for 6 weeks, and those in the control group received 200 mg daily capsules containing starch powder for 6 weeks. The primary outcomes were measured using the Menopausal Rating Scale and Depression Anxiety and Stress Scale questionnaires at baseline, week 3, and week 6.

RESULTS

A total of 84 women took part in the study, with 42 individuals assigned to each of the intervention and control groups, respectively. The findings indicated no significant differences in baseline characteristics between the study groups ( P > 0.05). The results indicated that the study outcomes changed differently over time between the two groups. The participants in the intervention group exhibited greater improvements in depressive symptoms, anxiety, and stress symptoms, as well as in physical, psychological, and urogenital symptoms at both week 3 and week 6, compared with the control group ( P < 0.05).

CONCLUSIONS

This study provides evidence regarding potential treatment effects of probiotics consumption in alleviating physical and mental symptoms related to menopause. Further multicenter and large-scale clinical trials with longer follow-up are recommended.

Centenarians-the way to healthy vascular ageing and longevity: a review from VascAgeNet

The prevalence of centenarians, people who lived 100 years and longer, is steadily growing in the last decades. This exceptional longevity is based on multifaceted processes influenced by a combination of intrinsic and extrinsic factors such as sex, (epi-)genetic factors, gut microbiota, cellular metabolism, exposure to oxidative stress, immune status, cardiovascular risk factors, environmental factors, and lifestyle behavior. Epidemiologically, the incidence rate of cardiovascular diseases is reduced in healthy centenarians along with late onset of age-related diseases compared with the general aged population. Understanding the mechanisms that affect vascular ageing in centenarians and the underlying factors could offer valuable insights for developing strategies to improve overall healthy life span in the elderly. This review discusses these key factors influencing vascular ageing and how their modulation could foster healthy longevity.