Cardiovascular disease and menopause

Cross-sectional and longitudinal associations of Iron biomarkers and cardiovascular risk factors in pre- and postmenopausal women: leveraging repeated measurements to address natural variability

BACKGROUND

The association between iron biomarkers and cardiovascular disease risk factors (CVD-RFs) remains unclear. We aimed to (1) evaluate the cross-sectional and longitudinal associations between iron biomarkers (serum ferritin, transferrin saturation (TSAT), transferrin) and CVD-RFs among women, and (2) explore if these associations were modified by menopausal status.

METHOD

Cross-sectional and longitudinal analyses including 2542 and 1482 women from CoLaus cohort, respectively. Multiple linear regression and multilevel mixed models were used to analyse the associations between Iron biomarkers and CVD-RFs. Variability of outcomes and iron markers between surveys was accessed using intraclass correlation (ICC).

RESULTS

After multivariable adjustment, elevated serum ferritin levels were associated with increased insulin and glucose levels, while higher transferrin levels were linked to elevated glucose, insulin and total cholesterol, and systolic and diastolic blood pressure (p < 0.05). No association was observed between CVD-RFs and TSAT (p > 0.05). Iron biomarkers demonstrated low reliability across reproductive stages but exhibited stronger associations in the perimenopausal group. In longitudinal analysis, we found association only for transferrin with lower glucose levels [β = - 0.59, 95% CI (- 1.10, - 0.08), p = 0.02] and lower diastolic blood pressure [β = - 7.81, 95% CI (- 15.9, - 0.56), p = 0.04].

CONCLUSION

In cross-sectional analysis, transferrin was associated with several CVD-RFs, and the associations did not change according to menopausal status. Conversely, in the longitudinal analyses, changes in transferrin were associated only with lower glucose and diastolic blood pressure levels. These differences might stem from the substantial longitudinal variation of iron biomarkers, underscoring the need for multiple iron measurements in longitudinal analyses.

The burden of non-communicable diseases: A scoping review focus on the context of India

The mortality rate of non-communicable diseases (NCDs) contributes more in low-income and middle-income countries, also among individuals with lower socioeconomic status in high-income countries, making NCDs a big hurdle to minimizing global and national health disparities. Among 55 million fatalities worldwide in 2019, NCDs accounted for about 41 million (71%) deaths. The purpose of this scoping review was to comprehend the available literature on the burden of NCDs in India. This review included the studies that have been published between the period of 2009-2020. For this review, 18 full-text articles have been selected. A preliminary search was done to obtain articles from the search engines such as PubMed, Google Scholar, web of science, and Scopus. Our scoping review was focused on five major NCDs which are cardiovascular, hypertension, diabetes, cancer, and stroke. In 2019, around 17.9 million individuals died from cardiovascular disease (CVD), which is accounting for 32% of all deaths. As compared to Chandigarh and Jharkhand (0.12 million and 0.96 million, respectively) Tamil Nadu and Maharashtra (4.8 million and 9.2 million, respectively) have a higher percentage of the population affected by diabetes. In India, stroke is the fifth-significant cause of disability and the fourth-leading cause of fatality, which is accounting for 3.5 percent of all disabilities. India should construct a higher-level coordinating framework and devise an overarching policy or strategy tailored to NCDs. To limit risk factor exposure, it is necessary to emphasize health promotion and preventive actions.

ET-1 as a Sex-Specific Mechanism Impacting Age-Related Changes in Vascular Function

Aging is a primary risk factor for cardiovascular disease (CVD), which is the leading cause of death in developed countries. Globally, the population of adults over the age of 60 is expected to double by the year 2050. CVD prevalence and mortality rates differ between men and women as they age in part due to sex-specific mechanisms impacting the biological processes of aging. Measures of vascular function offer key insights into cardiovascular health. Changes in vascular function precede changes in CVD prevalence rates in men and women and with aging. A key mechanism underlying these changes in vascular function is the endothelin (ET) system. Studies have demonstrated sex and sex hormone effects on endothelin-1 (ET-1), and its receptors ETA and ETB. However, with aging there is a dysregulation of this system resulting in an imbalance between vasodilation and vasoconstriction. Thus, ET-1 may play a role in the sex differences observed with vascular aging. While most research has been conducted in pre-clinical animal models, we describe more recent translational data in humans showing that the ET system is an important regulator of vascular dysfunction with aging and acts through sex-specific ET receptor mechanisms. In this review, we present translational evidence (cell, tissue, animal, and human) that the ET system is a key mechanism regulating sex-specific changes in vascular function with aging, along with therapeutic interventions to reduce ET-mediated vascular dysfunction associated with aging. More knowledge on the factors responsible for the sex differences with vascular aging allow for optimized therapeutic strategies to attenuate CVD risk in the expanding aging population.

Cardiometabolic Risk in Pre- and Post-Menopausal Women with Special Reference to Insulin Resistance: A Cross-Sectional Study

Background:

Reduced levels of estrogen have been associated with metabolic alterations and increased insulin resistance (IR) in postmenopausal women, thus predisposing them to cardiometabolic risks. The aim of this study was to assess alterations in parameters of cardiometabolic risk in apparently healthy pre- and post-menopausal women and to study the effect of IR on these metabolic parameters.

Methods:

A cross-sectional study was conducted on randomly selected apparently healthy women (n = 262). These women were categorized as premenopausal (n = 184) and postmenopausal (n = 78). Anthropometric measurements, blood pressure, lipid profile, fasting glucose, and insulin concentrations were estimated on all the participants using standard protocols. Homeostatic model assessment of IR was computed to estimate the level of IR.

Results:

Most lipid parameters, blood pressure, waist circumference, and fat percentage were significantly higher (P < 0.05) in postmenopausal women than premenopausal women. On subcategorizing women with respect to IR (<3, >3), metabolic parameters (e.g., triglyceride – 104.7 ±53.2 mg/dl, Blood Sugar Level Fasting (BSLF) – 103.3 ± 40.1 mg/dl, and fasting serum insulin – 23 ± 12.3 mIU/L) were also higher (P < 0.001) in premenopausal women having IR >3. Significantly higher low-density lipoprotein (132.7 ± 38.7 mg/dl vs. 114.4 ± 25 mg/dl) and total cholesterol (211.3 ± 40.5 vs. 184.8 ± 29.4 mg/dl) were observed in postmenopausal women with IR >3 (P < 0.05) along with higher BSLF (126.6±54.3 mg/dl**) and fasting insulin levels (22.3 ± 12.1 mIU/L) (P < 0.001).

Conclusion:

This study reveals that IR may predispose women to increased cardiometabolic risk. Urgent attention needs to be focused toward metabolic health of women.

Impact of lignans in oilseed mix on gut microbiome composition and enterolignan production in younger healthy and premenopausal women: an in vitro pilot study

BACKGROUND

Dietary lignans belong to the group of phytoestrogens together with coumestans, stilbenes and isoflavones, and themselves do not exhibit oestrogen-like properties. Nonetheless, the gut microbiota converts them into enterolignans, which show chemical similarity to the human oestrogen molecule. One of the richest dietary sources of lignans are oilseeds, including flaxseed. The aim of this pilot study was to determine the concentration of the main dietary lignans in an oilseed mix, and explore the gut microbiota-dependent production of enterolignans for oestrogen substitution in young and premenopausal women. The oilseed mix was fermented in a pH-controlled batch culture system inoculated with women's faecal samples. The lignan content and enterolignan production were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), and the faecal-derived microbial communities were profiled by 16S rRNA gene-based next-generation sequencing.

RESULTS

In vitro batch culture fermentation of faecal samples inoculated with oilseed mix for 24 h resulted in a substantial increase in enterolactone production in younger women and an increase in enterodiol in the premenopausal group. As for the gut microbiota, different baseline profiles were observed as well as different temporal dynamics, mainly related to Clostridiaceae, and Klebsiella and Collinsella spp.

CONCLUSIONS

Despite the small sample size, our pilot study revealed that lignan-rich oilseeds could strongly influence the faecal microbiota of both younger and premenopausal females, leading to a different enterolignan profile being produced. Further studies in larger cohorts are needed to evaluate the long-term effects of lignan-rich diets on the gut microbiota and find out how enterolactone-producing bacterial species could be increased. Diets rich in lignans could potentially serve as a safe supplement of oestrogen analogues to meet the cellular needs of endogenous oestrogen and deliver numerous health benefits, provided that the premenopausal woman microbiota is capable of converting dietary precursors into enterolignans.

Sex Differences in Cardiovascular Disease Risk by Socioeconomic Status (SES) of Workers Using National Health Information Database

The socioeconomic status (SES) and health behaviors of workers are associated with the risks of developing obesity, diabetes, hypertension, hyperlipidemia, and other cardiovascular diseases. Herein, we investigated the factors influencing cardiovascular disease (CVD) risk based on the SES of male and female workers. This cross-sectional analysis used the National Health Information Database to assess the associations between gender, SES (income level, residential area), health behaviors, and CVD-related health status of workers, through multinomial logistic regression. Upon analysis of a large volume of data on workers during 2016, the smoking and drinking trends of male and female workers were found to differ, causing different odds ratio (OR) tendencies of the CVD risk. Also, while for male workers, higher ORs of obesity or abdominal obesity were associated with higher incomes or residence in metropolitan cities, for female workers, they were associated with lower incomes or residence in rural areas. Additionally, among the factors influencing CVD risk, lower income and residence in rural areas were associated with higher CVD risk for male and female workers. The study findings imply the importance of developing gender-customized intervention programs to prevent CVD, due to gender-specific associations between CVD-related health status and health behaviors according to SES.

Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus in Western China assessed by logistic regression combined with a decision tree model

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes (T2DM). Carotid intima-media thickness (CIMT) is considered a preclinical stage of atherosclerosis. Therefore, it is necessary to identify the related risk factors for CIMT to facilitate the early prevention of CVD. Previous studies have shown that visceral fat area (VFA) is a risk factor for T2DM and CVD. However, few studies have focused on the effects of VFA on CIMT associated with T2DM. Moreover, considering that the body fat distribution shows regional and racial heterogeneity, the purpose of this study was to investigate the predictive value of VFA and other risk factors for CIMT associated with T2DM in Western China.

METHODS

In a cross-sectional study, a total of 1372 patients with T2DM were divided into the CIMT (-) group (n = 965) and the CIMT (+) group (n = 407) based on CIMT values. In addition to the univariate analyses, logistic regression analysis and a decision tree model were simultaneously performed to establish a correlation factor model for CIMT.

RESULTS

Univariate analyses showed that sex, smoking status, age, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), height, weight, body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, VFA, subcutaneous fat area, and the levels of 2-h C-peptide, serum creatinine, urea nitrogen and uric acid were significantly different between the two groups (all p < 0.05). Smoking, increased VFA, female sex and increased BMI were risk factors in the logistic regression analyses (OR = 5.759, OR = 1.364, OR = 2.239, OR = 1.186, respectively). In the decision tree model, smoking was the root node, followed by sex, waist circumference, VFA and chronic kidney disease (CKD) in order of importance.

CONCLUSIONS

In addition to smoking, sex and BMI, VFA has a significant effect on CIMT associated with T2DM in the Chinese Han population in Western China. In addition, the decision tree model could help clinicians make more effective decisions, with its simplicity and intuitiveness, making it worth promoting in future medical research.Trial registration ChiCTR, ChiCTR1900027739. Registered 24 November 2019-Retrospectively registered, http://www.chictr.org.cn/index.aspx.

Clinical characteristics of patients with premature acute coronary syndrome and adverse cardiovascular events after PCI

Few studies have compared the clinical manifestations of patients with premature acute coronary syndrome (ACS) and late-onset ACS as well as the adverse cardiovascular events following percutaneous coronary intervention (PCI). To investigate the clinicopathological characteristics of patients with premature ACS and adverse cardiovascular events following PCI, a total of 726 patients with ACS undergoing PCI were divided into two groups: A premature ACS group and a late-onset ACS group. Following discharge, all patients were followed-up for an average of 23.5±5.3 months. Clinical characteristics, Gensini scores, vascular lesions and adverse cardiovascular events were compared between the two groups. There were no significant differences in smoking, diabetes, ACS composition ratio, baseline treatment of coronary heart disease, high-density lipoprotein level and C-reactive protein levels between the two groups. Sex and hypertriglyceridemia were determined to be independent risk factors of premature ACS, while age, hypertension and a high Gensini score were independent risk factors for adverse cardiovascular events in patients with ACS following PCI. Furthermore, the prevalence of premature ACS was significantly higher in females. Although serum levels of fasting blood glucose, total cholesterol, triglycerides and low-density lipoprotein were also significantly higher in patients with premature ACS compared with patients with late-onset ACS, patients with premature ACS exhibited fewer vascular lesions compared with patients with late-onset ACS. Furthermore, the incidence of adverse cardiovascular events in patients with ACS following PCI did not differ significantly between premature and late-onset ACS groups. Taken together, these results suggest that female patients should be closely observed for early risk factors of premature ACS to prevent and reduce the occurrence of adverse cardiovascular events in patients with ACS following PCI.

The Bone-Vasculature Axis: Calcium Supplementation and the Role of Vitamin K

Calcium supplements are broadly prescribed to treat osteoporosis either as monotherapy or together with vitamin D to enhance calcium absorption. It is still unclear whether calcium supplementation significantly contributes to the reduction of bone fragility and fracture risk. Data suggest that supplementing post-menopausal women with high doses of calcium has a detrimental impact on cardiovascular morbidity and mortality. Chronic kidney disease (CKD) patients are prone to vascular calcification in part due to impaired phosphate excretion. Calcium-based phosphate binders further increase risk of vascular calcification progression. In both bone and vascular tissue, vitamin K-dependent processes play an important role in calcium homeostasis and it is tempting to speculate that vitamin K supplementation might protect from the potentially untoward effects of calcium supplementation. This review provides an update on current literature on calcium supplementation among post-menopausal women and CKD patients and discusses underlying molecular mechanisms of vascular calcification. We propose therapeutic strategies with vitamin K2 treatment to prevent or hold progression of vascular calcification as a consequence of excessive calcium intake.

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh

OBJECTIVES

There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting.

METHODS

This cross-sectional study recruited 265 postmenopausal women aged 40-70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the 'noncommunicable disease risk factors survey Bangladesh 2010'. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis.

RESULTS

Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist-hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = -1.044, p < 0.001), and metabolic equivalent of tasks (β = -0.171, p = 0.003) showed a significant association with AIP.

CONCLUSION

High AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.

Postconditioning-like effect of exercis: new paradigm in experimental menopause

The progression of coronary artery diseases in premenopausal women is lower than in age-matched men; however, its probability increases rapidly after menopause. The aim of our study was to investigate the postconditioning-like effects of voluntary physical exercise on postmenopausal cardiovascular outcomes after myocardial infarction. We used fertile Wistar females [control (CTRL)] and pharmacologically induced estrogen-deficient (POVX; 750 µg/kg triptorelin im, every 4th week) rats. CTRL and POVX animals were randomly assigned to receive an injection of 0.1 mg isoproterenol (ISO)/kg. At the 20th hour after ISO injection, serum markers of myocardial injury, such as lactate dehydrogenase (LDH) and myoglobin, were measured. After a 3-wk resting period, ISO-treated and untreated animals were further divided into subgroups on the basis of 6 wk of physical exercise. At the end of the experiment, cardiac activity and content of the antioxidative heme oxygenase (HO) enzyme, levels of GSH and GSH + GSSG, activity of myeloperoxidase, as well as the concentration of TNF-α were determined. At the end of the experimental period, we observed a significant decrease in the activity and content of HO enzymes in POVX and POVX/ISO rats, whereas physical exercise significantly improved HO and GSH values in both CTRL and POVX rats. Furthermore, our training protocol significantly reduced the pathological levels of myeloperoxidase and TNF-α. Our findings clearly demonstrate that modulation of the HO system by voluntary physical exercise is a key process to decrease inflammatory parameters and ameliorate the antioxidative status in estrogen-deficient conditions postmyocardial injury. NEW & NOTEWORTHY We used a noninvasive rat model of estrogen deficiency and myocardial infarction. The long-term effects of isoproterenol treatment revealed reduced heme oxygenase enzyme activity and expression and decreased glutathione levels. Isoproterenol treatment enhanced the myeloperoxidase enzyme activity. Voluntary physical exercise ameliorated the antioxidative status by increasing of the heme oxygenase enzyme system. Voluntary physical exercise is a potential therapeutic tool to improve cardiac antioxidant status in menopausal women postmyocardial injury.

Comparison of temporomandibular disorders between menopausal and non-menopausal women

Objectives

Hormonal changes during menopause alter a woman's susceptibility to some disorders. Information regarding the prevalence of temporomandibular disorder (TMD) in menopausal women is limited in the literature. In this study, the prevalence and severity of TMDs were compared between menopausal and non-menopausal women.

Materials and Methods

The study included 140 women (69 premenopausal and 71 postmenopausal) 45 to 55 years of age that were examined in Shiraz Dental School, Shiraz in Iran. The Helkimo clinical dysfunction index (Di) was used to evaluate temporomandibular joint (TMJ) dysfunction. The data were analyzed using chi-square and Fisher's exact tests.

Results

Occurrence of TMD was significantly higher in menopausal than non-menopausal women (P<0.001). All the TMD criteria based on Helkimo Di except range of mandibular movement were significantly more common in menopausal women. The range of mandibular movement was not significantly different between menopausal and non-menopausal women (P=0.178).

Conclusion

The results from this study show that TMD can be considered more common and severe in menopausal than non-menopausal women. This finding indicates that, similar to other conditions in menopausal women such as arthritis and osteoporosis, TMD should be taken into consideration by dental and medical professionals.

G protein-coupled estrogen receptor (GPER) deficiency induces cardiac remodeling through oxidative stress

Oxidative stress has been implicated in the unfavorable changes in cardiac function and remodeling that occur after ovarian estrogen loss. Using ovariectomized rat models, we previously reported that the cardioprotective actions of estrogen are mediated by the G protein-coupled estrogen receptor (GPER). Here, in 9-month-old, female cardiomyocyte-specific GPER knockout (KO) mice vs sex- and age-matched wild-type (WT) mice, we found increased cardiac oxidative stress and oxidant damage, measured as a decreased ratio of reduced glutathione to oxidized glutathione, increased 4-hydroxynonenal and 8-hydroxy-2'-deoxyguanosine (8-oxo-DG) staining, and increased expression of oxidative stress-related genes. GPER KO mice also displayed increased heart weight, cardiac collagen deposition, and Doppler-derived filling pressure, and decreased percent fractional shortening and early mitral annular velocity compared with WT controls. Treatment of GPER KO mice for 8 weeks with phosphonium [10-(4,5-dimethoxy-2-methyl 3,6-dioxo-1,4-cyclohexadien-1-yl)decyl] triphenyl-,mesylate (MitoQ), a mitochondria-targeted antioxidant, significantly attenuated these measures of cardiac dysfunction, and MitoQ decreased 8-oxo-DG intensity compared with treatment with an inactive comparator compound, (1-decyl)triphenylphosphonium bromide (P <0.05). A real-time polymerase chain reaction array analysis of 84 oxidative stress and antioxidant defense genes revealed that MitoQ attenuates the increase in NADPH oxidase 4 and prostaglandin-endoperoxide synthase 2 and the decrease in uncoupling protein 3 and glutathione S-transferase kappa 1 seen in GPER KO mice. Our findings suggest that the cardioprotective effects of GPER include an antioxidant role and that targeted strategies to limit oxidative stress after early noncancerous surgical extirpation of ovaries or menopause may help limit alterations in cardiac structure and function related to estrogen loss.

Aging-Induced Biological Changes and Cardiovascular Diseases

Aging is characterized by functional decline in homeostatic regulation and vital cellular events. This process can be linked with the development of cardiovascular diseases (CVDs). In this review, we discussed aging-induced biological alterations that are associated with CVDs through the following aspects: (i) structural, biochemical, and functional modifications; (ii) autonomic nervous system (ANS) dysregulation; (iii) epigenetic alterations; and (iv) atherosclerosis and stroke development. Aging-mediated structural and biochemical modifications coupled with gradual loss of ANS regulation, vascular stiffening, and deposition of collagen and calcium often disrupt cardiovascular system homeostasis. The structural and biochemical adjustments have been consistently implicated in the progressive increase in mechanical burden and functional breakdown of the heart and vessels. In addition, cardiomyocyte loss in this process often reduces adaptive capacity and cardiovascular function. The accumulation of epigenetic changes also plays important roles in the development of CVDs. In summary, the understanding of the aging-mediated changes remains promising towards effective diagnosis, discovery of new drug targets, and development of new therapies for the treatment of CVDs.

Clinical usefulness of metabolic risk factors to identify young asymptomatic women adults with subclinical atherosclerosis: A cross-sectional study

Interventions of cardiovascular disease should be implemented in early ages. But most studies were performed in middle aged or elderly adults because of the low prevalence in young, especially for women. We investigate the association between metabolic risk factors and subclinical atherosclerosis in young asymptomatic women adults, using carotid intima-media thickness (CIMT) as a marker of the atherosclerotic process.We performed a cross-sectional study of 950 Chinese young asymptomatic women adults (37.28 ± 5.16 years) who underwent a routine health screening examination. Triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), fasting blood glucose (FBG), homocysteine (HCY), gamma glutamyltransferase (GGT), uric acid, and CIMT were measured.Out of 950 subjects, 16 (1.7%) were detected with increased CIMT. Significant differences existed in the indicators including age, body mass index (BMI), TC, TG, LDL-C, LDL-C/HDL-C, non-HDL-C, and TC/HDL-C. Although TG, LDL-C, non-HDL-C, TC/HDL-C, and TG/HDL-C were the significant indicators when adjusted for age only, age, LDL-C/HDL-C, FBG, and GGT were the only independent relative indicators of increased CMIT that entered the multivariate model. The area under receiver operating characteristic curve for a linear combination of age, LDL-C/HDL-C, FBG, and GGT was 0.809 (95% confidence interval = 0.712-0.906), superior to any of the variables taken alone (age, AUC = 0.707; FBG, AUC = 0.710; LDL-C/HDL-C, AUC = 0.695; GGT, AUC = 0.648).The combined assessment of age, LDL-C/HDL-C, FBG, and GGT contributes to an early detection for subclinical atherosclerosis, providing guidance to clinicians for women's early interventions of latent cardiovascular disease. Neither of the above four individual indicators is qualified alone.

Relationship between Serum Levels of Metalloproteinase-8 and Tissue Inhibitor of Metalloproteinases-1 and Exercise Test Results in Postmenopausal Women

Physical activity as a part of the lifestyle is a significant factor influencing health condition. Exercises that require stamina are of particular importance. Oxygen metabolism, which is a significant part of all longer training processes, has an influence on cardiovascular and respiratory system functioning as well as all the processes taking part in maintenance of efficient homeostasis. Presentation of the correlation between exercise test results and MMP-8 (metalloproteinase-8) and TIMP-1 (tissue inhibitor of metalloproteinases-1) levels was attempted in this work. MMP-8 is a proteolytic enzyme taking part in progression of diseases related to process of ageing. 62 healthy women in postmenopausal period were qualified for the study (mean age: 54 ± 3.6). There was exercise test on the treadmill according to Bruce's protocol performed. MMP-8 and TIMP-1 serum levels were measured. There was statistically important correlation between increased level of MMP-8 and increased level of TIMP-1 with lower results of exercise test observed. The conducted study provides further biochemical arguments for prophylactic role of physical activity, which lowers the risk of noninfectious diseases, typical for middle adulthood, by influencing physical capacity.

Atherogenic index of plasma and risk of cardiovascular disease among Cameroonian postmenopausal women

Background

The paucity of data regarding the relationship between atherogenic index of plasma (AIP) and risk of cardiovascular disease (CVD) in postmenopausal women living in sub-Saharan Africa prompted us to conduct this study which aimed at assessing the interplay between AIP and risk of CVD among Cameroonian postmenopausal women.

Methods

This was a cross-sectional study conducted among 108 postmenopausal women in Yaoundé, Cameroon. Risk of CVD was calculated using the Framingham risk score, (FRS), and the AIP was derived as log (triglycerides/high-density lipoproteins cholesterol).

Results

Mean age of participants equaled 56.4 ± 6.9 years. AIP values ranged from -0.40 to 0.85 with a mean of 0.21 ± 0.27. There was a positive and significant correlation between AIP and body mass index (r = 0.234; p = 0.015), systolic blood pressure (r = 0.350; p < 0.001), diastolic blood pressure (r = 0.365; p < 0.001), fasting plasma glucose (r = 0.314; p = 0.001), uric acid (r = 0.374; p < 0.001), and total cholesterol (r = 0.374; p < 0.001), but not with age (r = -0.104; p = 0.284). The FRS varied between 1.2 % and >30 % with a mean of 13.4 ± 8.7 %. In univariable model, AIP significantly influenced the risk of CVD (β = 11.94; p < 0.001; R² = 0.136). But in the multivariable model, after adjusting for confounders, AIP did not impact the risk of CVD anymore (adjusted β = 1.98; p = 0.487; R² = 0.486).

Conclusion

AIP may not be an independent factor impacting the risk of CVD among Cameroonian postmenopausal women. More studies are needed to better elucidate the interaction between AIP and risk of CVD in our setting.

Age of menopause and determinants of menopause age: A PAN India survey by IMS

Introduction:

Age of menopause is a very important biomarker of not only the loss of fertility but also an increased risk for various mid-life diseases and problems. Many of these diseases can be prevented by timely intervention of lifestyle modification, menopausal hormone therapy, or other supplementations such as calcium, Vitamin D, and micronutrients. In India age of menopause is less than our counterparts in the Western world. This means that the fertility potential of Indian women starts compromising early, so we need to start with the preventive measures much early. Earlier studies in India have been done on a limited population, and small sample size and not all the determinants of menopause age were considered.

Materials and Methods:

Survey was conducted in 21 chapters of Indian Menopause Society and all regions South, West, East and North were covered. There were 23 Medical practitioners who participated. Consent was taken and inclusion and exclusion criteria was set. Set questions were asked The questionnaire comprised of identification of the participants’ religion, education, and various socioeconomic parameters. They were also inquired about their marital and parity status, abortion, or contraceptive use. The menopausal women were asked their menopause age and whether it was natural or surgical. The perimenopausal women were asked to enlist the date of their last period. All women with <1 year to menopause were classified as perimenopausal. The height, weight, and waist circumference were noted for all the women, and body mass index (BMI) was calculated. The women were also inquired about their food habits and social habits including alcohol consumption or smoking. Hence, this study was planned as a PAN India study.

Results:

Average age of menopause of an Indian woman is 46.2 years much less than their Western counter parts (51 years). A definite rural and urban division was also seen. There was a correlation between the age of menopause and social and economic status, married status, and parity status.

Network pharmacological identification of active compounds and potential actions of Erxian decoction in alleviating menopause-related symptoms

BACKGROUND

Erxian decoction (EXD) is used to treat menopause-related symptoms in Chinese medicine. This study aims to identify the bioactive compounds and potential actions of EXD by network pharmacological analysis.

METHODS

Two databases, the Traditional Chinese Medicine Systems Pharmacology database and TCM Database@Taiwan, were used to retrieve literature of phytochemicals of EXD. STITCH 4.0 and the Comparative Toxicogenomics Database were used to search for compound-protein and compound-gene interactions, respectively. DAVID Bioinformatics Resources 6.7 and Cytoscape 3.01 with Jepetto plugin software were used to perform a network pharmacological analysis of EXD.

RESULTS

A total of 721 compounds were identified in EXD, of which 155 exhibited 2,656 compound-protein interactions with 1,963 associated proteins determined by STITCH4.0 database, and of which 210 had 14,893 compound-gene interactions with 8,536 associated genes determined by Comparative Toxicogenomics Database. Sixty three compounds of EXD followed the Lipinski's Rule with OB ≥30% and DL index ≥0.18, of which 20 related to 34 significant pathway- or 12 gene- associated with menopause.

CONCLUSIONS

Twenty compounds were identified by network pharmacology as potential effective ingredients of EXD for relieving menopause with acceptable oral bioavailability and druggability.