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HDL-C and menopause in women: the contribution of estradiol and inflammation

Swabe, Gretchen (2020) HDL-C and menopause in women: the contribution of estradiol and inflammation. Master's Thesis, University of Pittsburgh. (Unpublished)

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Recent studies suggest a reversal in the protective association of HDL-C and cardiovascular disease (CVD) in women transitioning through menopause. Decreasing estrogen levels during the transition may explain this reversal, altering the structure and function of HDL particles and consequently increasing CVD risk. Inflammation may also contribute to this risk. We aimed to determine whether either estradiol concentration or C-reactive protein (CRP) concentration modifies the association between HDL-C and two measures of subclinical CVD: aortic calcification (AC) and coronary artery calcification (CAC).
Participants from the Study of Women’s Health Across the Nation (SWAN) Heart ancillary study of either Black or White race, who had CAC/AC, estradiol, and CRP measures available were evaluated. AC and CAC presence were defined as Agatston score =>100 or =>10, respectively. Logistic regression was used to assess effect modification of estradiol and CRP levels on the relationship between HDL-C and AC/CAC presence, controlling for age, study site, race, hormone therapy use, waist circumference, triglycerides, and smoking status.
Of the 342 included women, 203 (59%) were pre/early perimenopausal and 139 (41%) were late peri-/postmenopausal. Average age of women was 51.2 (SD=2.8) years, and the sample was 38% Black. In unadjusted models, HDL-C was associated with a 3.7% lower odds of AC (95% CI: 0.943, 0.983) and 4.0% lower odds of CAC (95% CI: 0.940, 0.981). In adjusted models, we found a significant interaction between HDL-C and estradiol with respect to AC but not CAC (p=0.0104 and 0.3172, respectively). For every one log-unit higher in estradiol concentration, the estimated OR between HDL-C and AC presence was 0.964 (95% CI: 0.938, 0.992). We found no statistically significant interaction between CRP and HDL-C with either outcome.
The protective cardiovascular association between AC and higher HDL-C levels was stronger at higher levels of estradiol, adjusting for confounders. Therefore, estradiol levels may impact the association of HDL-C and AC. However, we did not find evidence that inflammation impacts this association. These findings may have implications for public health in understanding factors which could contribute to CVD among midlife women.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Swabe, Gretchengrs63@pitt.edugrs63
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorEl Khoudary, Samar R.elkhoudarys@edc.pitt.eduelkhoudarys
Committee MemberBrooks, Maria M.mbrooks@pitt.edumbrooks
Committee MemberMatthews, Karen A.matthewska@upmc.edumatthewska
Committee MemberWang, Norman C.wangnc@upmc.eduwangnc
Date: 30 January 2020
Date Type: Publication
Defense Date: 6 November 2019
Approval Date: 30 January 2020
Submission Date: 12 December 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 75
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: CVD HDL-C menopause estradiol
Date Deposited: 30 Jan 2020 16:35
Last Modified: 01 Jan 2022 06:15

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  • HDL-C and menopause in women: the contribution of estradiol and inflammation. (deposited 30 Jan 2020 16:35) [Currently Displayed]


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