Background: Menopause and aging deteriorate the metabolic profile, but little is known about how they independently contribute to structural changes in coronary arteries. We compared a broad cardiometabolic risk profile of women according to their menopausal status and investigated if menopause per se is associated with presence of coronary artery calcium (CAC) in the ELSA-Brasil.
Materials and Methods: All participants, except perimenopausal women, who had menopause <40 years or from non-natural causes or reported use of hormone therapy were included. Sample was stratified according to menopause and age categories (premenopause ≤45 years, premenopause >45 years, and postmenopause); their clinical profile and computed tomography-determined CAC were compared using Kruskal–Wallis and chi squared test for frequencies. Associations of CAC (binary variable) with menopause categories adjusted for traditional and nontraditional covariables were tested using logistic regression.
Results: From 2,047 participants 51 ± 9 years of age, 1,175 were premenopausal (702 ≤ 45 years) and 872 were postmenopausal women. Mean values of anthropometric variables, blood pressure, lipid and glucose parameters, branched-chain amino acids (BCAA), and homeosthasis model assessment (HOMA-IR), as well as frequencies of morbidities, were more favorable in premenopausal, particularly in younger ones. In crude analyses, CAC >0 was associated with triglyceride-rich lipoprotein remnants, dense low-density lipoprotein, BCAA, and other variables, but not with HOMA-IR. Menopause was independently associated with CAC >0 (odds ratios 2.37 [95% confidence interval 1.17–4.81]) when compared to the younger premenopausal group.
Conclusion: Associations of menopause with CAC, independent of traditional and nontraditional cardiovascular risk factors, suggest that hormonal decline per se may contribute to calcium deposition in coronary arteries.

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Published In

cover image Journal of Women's Health
Journal of Women's Health
Volume 31Issue Number 1January 2022
Pages: 23 - 30
PubMed: 34520264


Published online: 12 January 2022
Published in print: January 2022
Published ahead of print: 14 September 2021


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Marília I.H. Fonseca, MD, PhD
Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
Bianca de Almeida-Pititto, MD, PhD
Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
Department of Preventive Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
Márcio S. Bittencourt, MD, PhD
Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil.
Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, Brazil.
Isabela M. Bensenor, MD, PhD
Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil.
Paulo A. Lotufo, MD, PhD
Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil.
Sandra R.G. Ferreira, MD, PhD [email protected]
Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.


Address correspondence to: Sandra R.G. Ferreira, MD, PhD, Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904, Brazil [email protected]

Authors' Contributions

M.I.H.F. and B.d.A.-P.: conceptualization, methodology, analysis, visualization, and writing/revision. M.S.B., I.M.B., and P.A.L.: writing/revision. S.R.G.F.: conceptualization, visualization, writing/revision, and supervision. All authors contributed to the revision of this article. All authors read and approved the final article.

Author Disclosure Statement

M.I.H.F., B.d.A.-P., I.M.B., P.A.L., and S.R.G.F. declare no conflicts of interest for this article. M.S.B. reports grants from Sanofi, other from GE HealthCare, and other from Boston Scientific, outside the submitted work.

Funding Information

The ELSA-Brasil is supported by the Brazilian Ministry of Health (Department of Science and Technology) and Ministry of Science, Technology and Innovation (FINEP, Projects and Studies Finance), Grant Nos. 01 06 0010.00; 01 06 0212.00; 01 06 0300.00; 01 06 0278.00; 01 06 0115.00; and 01 06 0071.00 and CNPq (the National Council for Scientific and Technological Development). No funding for this specific analysis has been provided.

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