Mortality Rates in Women National Center for Health Statistics. 1999:164-167. Coronary Artery Disease Stroke Lung Cancer Breast Cancer Colon Cancer Endometrial Cancer Age (years) Mortality Rate per 100,000 6500 4500 2500 1600 1200 800 400 0 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
020406080100120140160180200 England & Wales Bangladesh India Pakistan West Africa West Indies China & Hong Kong Standardised Mortality Ratio (SMR) Women Men IHD mortality 2001-2003 (ICD 120-125) by country of birth S Wild, unpublished data
Body composition menopause *** ***p<0.001 Ley et al. Am J Clin Nutr 1992; 55: 950-54 Android fatGynoid fat
Menopause and the Metabolic Syndrome SWAN Study 949 women 9 yr. f-u from pre- to post- menopause Janssen I, et al. Arch Intern Med 2008;168:1568 waist circ. FMP
0.980.94Waist/hip ratio 25.725.9BMI (kg/m2) SA n=1420 European n= 1515 Fat is in the wrong place! (Adapted from McKeigue et al, with permission from authors) Other evidence for increase visceral fat mass Other evidence for increase visceral fat mass
30.0Body mass index (kg/m 2 )30.5 0.70Waist to hip ratio1.20 Female A Pear-shaped body Premenopause Female B Apple-shaped body Postmenopause
HRT Some studies suggest that it maintains the ‘gynoid’ fat distribution but this has not been shown conclusively
South AsiansWhite Europeansp N4640 Age (y)54.7±8.553.4±6.40.375 BMI25.8±3.124.8±3.10.13 HbA1c (mmol/mol)37.6±4.133.1±3.5<0.001 Fasting Glucose (mmol/l) 5.01±0.64.9±0.50.45 LDL (mmol/l)3.86±0.853.55±0.920.28 HDL (mmol/l)1.38±0.31.7±0.40.006 SBP (mmHg)125.9±14123.5±14.80.48 Waist to Hip Ratio0.84±0.060.79±0.060.006 Metabolic features of a group of healthy European and South Asian women who reside in the UK
Fat distribution and ethnicity SAs (ethnicity=1) are more centrally obese for the same BMI than Europeans, but fat distribution in the upper or lower body do not differ P<0.001 mm
NEFA, leptin, IL- 6, TNF , resistin release NEFA, leptin, IL- 6, TNF , resistin release Adiponectin release Adiponectin release SKELETALMUSCLE Oxidative capacity Capacity for fatty acid utilisation Evidenced by: - Decreased activities of enzymes regulating oxidative/fatty acid metabolism and increased activities of glycolytic enzymes. Increased muscle LCACoA concentrations Reduced fat oxidation at rest and during exercise Reduced exercise capacity ADIPOSE TISSUE TISSUE INSULINRESISTANCE Effect on muscle metabolism? Innate defect within muscle? Do South Asians metabolize fat less efficiently
Why do women put on Weight? Eat more? Less Exercise? Altered metabolism? Combination of the above?
Flushing and cardiovascular disease In WHI, incident CHD concentrated among older women reporting VSM. Oestrogen withdrawal has significant impact on blood vessel structure and function. Oestrogen improves endothelial function. Oestrogen use is associated with fewer calcified plaques in the coronary arteries. Calcitonin gene-related peptide is released during flushing but not during exercise or sweating. Obesity and smoking are risk factors for heart disease and flushing
Vasomotor Symptoms and CVD Rancho Brando Study (Svartberg et al 2009) HR 0.72(0.55-0.94) in favour of flushing. Gast et al over 10,000 Dutch Women (HR 1.33 (1.06-1.69). Largely explained by cholesterol levels Hot Flushing and Cardiovascular Disease
SWAN Study Study of Women’s Health Across the Nation (SWAN) Study 3302 participants across 7 sites (42-52 years of age). 588 women in ‘Heart’ Study. 491 gave information on flushing (assessed according to number of days on which flushes occurred in previous 14 days) 374 had USS to assess flow-mediated dilatation (FMD) or assessment of coronary artery calcification Heart participants were Caucasian or African-American
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