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Alterations in Cardiometabolic and Vascular Function Measures during the Menopause Transition

Samargandy, Saad (2021) Alterations in Cardiometabolic and Vascular Function Measures during the Menopause Transition. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: The risk of cardiovascular disease (CVD) in women accelerates after midlife, suggesting a contribution of the menopause transition (MT). A piecewise-linear increase in a CVD predictor close to the final menstrual period (FMP) would be indicative of a menopause contribution.
Objectives: This dissertation included three papers with the following objectives: to determine whether arterial stiffness (paper 1) and abdominal visceral adipose tissue (VAT, paper 2) show piecewise-linear increases close to the FMP, and whether menopause-related VAT changes predict carotid artery intima-media thickness (cIMT, paper 2). In paper 3, we sought to determine whether distinct trajectories of systolic (SBP) and diastolic (DBP) blood pressure over the FMP can be identified, whether any SBP or DBP trajectory shows a piecewise-linear increase close to the FMP, and whether menopause-related factors (age at menopause, vasomotor symptoms, estradiol, and follicle-stimulating hormone [FSH]) predict blood pressure trajectories.
Methods: Participants from the Study of Women’s Health Across the Nation (SWAN; n=3,302, age: 46.3±2.7) and SWAN Heart Ancillary Study (n=362, age: 51.1±2.8 years) who had 2 measures of arterial stiffness and VAT and 17 measures of blood pressure over the MT were included. FMP-anchored piecewise-linear mixed effects models and group-based trajectory modeling were used for the analyses. Models were adjusted for age at the FMP, and demographic, lifestyle, and CVD risk factors.
Results: Over 2.3 years of follow-up, both arterial stiffness and VAT showed a piecewise-linear trajectory with significant accelerated increases close to the FMP. Menopause-related VAT increase predicted greater cIMT. Over 19.1 years of follow-up, women experienced three distinct SBP trajectories with 36% of the SWAN cohort experiencing a piecewise-linear increase trajectory with a significant accelerated increase close to the FMP. The other SBP trajectories and all DBP trajectories did not show menopause-related increases. An older age at menopause and vasomotor symptoms predicted a higher SBP trajectory and higher FSH levels predicted a lower SBP overtime.
Conclusions: The MT is associated with increases in cardiometabolic and vascular function measures beyond aging. It is prudent to timely detect increases in CVD risk factors during the MT and emphasize lifestyle changes with the aim of combating such increases.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Samargandy, Saadsjs173@pitt.edusjs1730000-0002-5875-7386
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairEl Khoudary, Samar
Committee MemberMatthews, Karen
Committee MemberBrooks, Maria
Committee MemberBarinas-Mitchell,
Committee MemberMagnani, Jared
Date: 19 January 2021
Date Type: Publication
Defense Date: 21 October 2020
Approval Date: 19 January 2021
Submission Date: 26 October 2020
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 170
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: menopause transition; arterial stiffness; abdominal visceral adipose tissue; blood pressure
Date Deposited: 19 Jan 2021 20:49
Last Modified: 19 Jan 2022 06:15

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