Menopausal Women Accumulate Fat…..Around Their Hearts

Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Graduate School of Public Health Department of Epidemiology University of Pittsburgh Interview with:
Samar R. El Khoudary, Ph.D., M.P.H.

Assistant professor
Graduate School of Public Health Department of Epidemiology
University of Pittsburgh

Medical Research: What is the background for this study?

Dr. El Khoudary: Cardiovascular disease is the leading cause of death in women, and it increases after age 50 – the average age when a woman is going through menopause. Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.

No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events. My team and I investigated whether there may be a link between menopause and cardiovascular fat using data from 456 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.

Medical Research: What are the main findings?

Dr. El Khoudary: Our study is the first to find that  late- and post-menopausal women have significantly greater volumes of fat around their hearts than their pre-menopausal counterparts. As concentrations of the sex hormone estradiol – the most potent estrogen – declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after my colleagues and I took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases.

Medical Research: What should clinicians and patients take away from your report?

Dr. El Khoudary: There is mounting evidence that changes during menopause put women at greater risk for heart disease. Doctors need to be aware of this and monitor their menopausal patients for signs and symptoms of heart disease. And women should always strive for a healthy lifestyle. They should discuss with their doctors the best diet and level of physical activity to keep them healthy, particularly as they transition through menopause.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. El Khoudary:  Developing prevention strategies to reduce cardiovascular fat in women at midlife may reduce their heart disease risk, especially knowing that the menopausal transition puts women at risk for excess fat around their hearts. Previous studies suggest that reducing heart fat is feasible through weight loss or weight management, but these studies only looked at small numbers of people and there have been no clinical trials linking cardiovascular outcomes with heart fat changes due to weight management interventions. Clearly there is a need for larger scale studies to determine the best intervention strategies to help post-menopausal women reduce fat near the heart.

My team is also seeking more funds to evaluate whether cardiovascular fat volumes progress over time in midlife women, and, if so, whether this progression will be associated with greater evolution in atherosclerosis and more cardiovascular events in post-menopausal women.


Samar R. El Khoudary, Kelly J. Shields, Imke Janssen, Carrie Hanely, Matthew Budoff, Emma Barinas-Mitchell, Susan A. Everson-Rose, Lynda H. Powell, Karen A. Matthews. Cardiovascular Fat, Menopause and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study. The Journal of Clinical Endocrinology & Metabolism, 2015; JC.2015-2110 DOI: 10.1210/JC.2015-2110

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Samar R. El Khoudary, Ph.D., M.P.H. (2015). Menopausal Women Accumulate Fat…..Around Their Hearts

Last Updated on July 24, 2015 by Marie Benz MD FAAD