Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
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Incidence and Risk Factors of Dyslipidemia after Menopause

폐경 후 이상지질혈증 발생양상과 위험요인

  • Received : 2021.09.06
  • Accepted : 2021.12.24
  • Published : 2022.04.30
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Abstract

Purpose: This study was aimed at investigating the incidence and risk factors of dyslipidemia in menopausal women using a Korean community-based longitudinal study. Methods: The subjects were 245 postmenopausal women without dyslipidemia who had participated in the Ansan-Ansung cohort study from 2001~2002 (baseline) to 2015~2016 (seventh follow-up visit). The dyslipidemia incidence was measured as incidence proportion (%) and incidence rate per 100 person-years. The predictors of developing dyslipidemia were analyzed with Cox's proportional hazard model. Results: The incidence of new dyslipidemia during the follow-up period was 78.4% (192 patients), and 11.9 per 100 person-years. Mean duration from menopause to developing dyslipidemia was 5.3 years in new dyslipidemia cases. The triglyceride/high density lipoprotein (TG/HDL-C) ratio at baseline (hazard ratio = 2.20; 95% confidence interval = 1.39~3.48) was independently associated with developing dyslipidemia. Conclusion: Dyslipidemia occurs frequently in postmenopausal women, principally within five years after menopause. Therefore, steps must be taken to prevent dyslipidemia immediately after menopause, particularly in women with a high TG/HDL-C ratio at the start of menopause.

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References

  1. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. European Heart Journal. 2020;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455
  2. Statistics Korea. 2019 causes of death statistics [Internet]. Daejeon: Statistics Korea; c2020 [cited 2021 Jul 28]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&bSeq=&aSeq=385219&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=.
  3. Lu Y, Wang P, Zhou T, Lu J, Spatz ES, Nasir K, et al. Comparison of prevalence, awareness, treatment, and control of cardiovascular risk factors in China and the United States. Journal of the American Heart Association. 2018;7(3):e007462. https://doi.org/10.1161/JAHA.117.007462
  4. Halcox JP, Banegas JR, Roy C, Dallongeville J, De Backer G, Guallar E, et al. Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovascular Disorders. 2017;17(1):160. https://doi.org/10.1186/s12872-017-0591-5
  5. Xing L, Jing L, Tian Y, Yan H, Zhang B, Sun Q, et al. Epidemiology of dyslipidemia and associated cardiovascular risk factors in northeast China: A cross-sectional study. Nutrition, Metabolism, and Cardiovascular Diseases. 2020;30(12):2262-2270. https://doi.org/10.1016/j.numecd.2020.07.032
  6. Ministry of Health and Welfare (MOHW), Korean Disease Control and Prevention Agency (KDCA). Korea health statistics 2019: Korea National Health and Nutrition Examination Survey (KNHANES VIII-1). Cheongju: KDCA; 2020 Dec. Report No.: 11-1351159-000027-10. 311 p.
  7. Boo S, Yoon YJ, Oh H. Evaluating the prevalence, awareness, and control of hypertension, diabetes, and dyslipidemia in Korea using the NHIS-NSC database: A cross-sectional analysis. Medicine. 2018;97(51):e13713. https://doi.org/10.1097/MD.0000000000013713
  8. Anagnostis P, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, et al. Menopause symptom management in women with dyslipidemias: An EMAS clinical guide. Maturitas. 2020;135:82-88. https://doi.org/10.1016/j.maturitas.2020.03.007
  9. Stefanska A, Bergmann K, Sypniewska G. Metabolic syndrome and menopause: Pathophysiology, clinical and diagnostic significance. Advances in Clinical Chemistry. 2015;72:1-75. https://doi.org/10.1016/bs.acc.2015.07.001
  10. Pu D, Tan R, Yu Q, Wu J. Metabolic syndrome in menopause and associated factors: A meta-analysis. Climacteric. 2017;20(6):583-591. https://doi.org/10.1080/13697137.2017.1386649
  11. Choi Y, Chang Y, Kim BK, Kang D, Kwon MJ, Kim CW, et al. Menopausal stages and serum lipid and lipoprotein abnormalities in middle-aged women. Maturitas. 2015;80(4):399-405. https://doi.org/10.1016/j.maturitas.2014.12.016
  12. Franco OH, Muka T, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, et al. Vasomotor symptoms in women and cardiovascular risk markers: Systematic review and meta-analysis. Maturitas. 2015;81(3):353-361. https://doi.org/10.1016/j.maturitas.2015.04.016
  13. Cagnacci A, Cannoletta M, Caretto S, Zanin R, Xholli A, Volpe A. Increased cortisol level: A possible link between climacteric symptoms and cardiovascular risk factors. Menopause. 2011;18(3):273-278. https://doi.org/10.1097/gme.0b013e3181f31947
  14. Ley SH, Li Y, Tobias DK, Manson JE, Rosner B, Hu FB, et al. Duration of reproductive life span, age at menarche, and age at menopause are associated with risk of cardiovascular disease in women. Journal of the American Heart Association. 2017;6(11):e006713. https://doi.org/10.1161/JAHA.117.006713
  15. Cho GJ, Lee JH, Park HT, Shin JH, Hong SC, Kim T, et al. Postmenopausal status according to years since menopause as an independent risk factor for the metabolic syndrome. Menopause. 2008;15(3):524-529. https://doi.org/10.1097/gme.0b013e3181559860
  16. Kim Y, Han BG; KoGES group. Cohort profile: The Korean Genome and Epidemiology Study (KoGES) consortium. International Journal of Epidemiology. 2017;46(2):e20. https://doi.org/10.1093/ije/dyv316
  17. Fonseca MIH, de Almeida-Pititto B, Bensenor IM, Toth PP, Jones SR, Blaha MJ, et al. Changes in lipoprotein subfractions following menopause in the Longitudinal Study of Adult Health (ELSA-Brasil). Maturitas. 2019;130:32-37. https://doi.org/10.1016/j.maturitas.2019.09.005
  18. Kane SP. Sample size calculator [Internet]. USA: ClinCalc; c2014 [cited 2021 Oct 21]. Available from: https://clincalc.com/Stats/SampleSize.aspx.
  19. Ohta T, Nagashima J, Sasai H, Ishii N. Relationship of cardiorespiratory fitness and body mass index with the incidence of dyslipidemia among Japanese women: A cohort study. International Journal of Environmental Research and Public Health. 2019;16(23):4647. https://doi.org/10.3390/ijerph16234647
  20. Korean Academy of Medical Sciences (KAMS), Korea Disease Control and Prevention Agency (KDCA). Evidence-based guideline for dyslipidemia in primary care. 3rd rev. ed. Seoul: KAMS; 2019. p. 30.
  21. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry. 1972;18(6):499-502. https://doi.org/10.1093/clinchem/18.6.499
  22. Zhang M, Deng Q, Wang L, Huang Z, Zhou M, Li Y, et al. Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: A nationally representative survey of 163,641 adults. International Journal of Cardiology. 2018;260:196-203. https://doi.org/10.1016/j.ijcard.2017.12.069
  23. Cho SMJ, Lee HJ, Shim JS, Song BM, Kim HC. Associations between age and dyslipidemia are differed by education level: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort. Lipids in Health and Disease. 2020;19(1):12. https://doi.org/10.1186/s12944-020-1189-y
  24. Rodriguez-Colon SM, Mo J, Duan Y, Liu J, Caulfield JE, Jin X, et al. Metabolic syndrome clusters and the risk of incident stroke: The atherosclerosis risk in communities (ARIC) study. Stroke. 2009;40(1):200-205. https://doi.org/10.1161/STROKEAHA.108.523035
  25. Korean Statistical Information Service (KOSIS). Monthly average household balance per household by number of household members [Internet]. Daejeon: Statistics Korea; 2020 [cited 2021 Jun 22]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1L6A003&vw_cd=MT_OTITLE&list_id=G_A21&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K2&path=%252Fcommon%252Fmeta_onedepth.jsp.
  26. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean Society for the Study of Obesity guideline for the management of obesity in Korea. Journal of Obesity & Metabolic Syndrome. 2019;28(1):40-45. https://doi.org/10.7570/jomes.2019.28.1.40
  27. Korea Centers for Disease Control and Prevention (KCDC). The Korean Genome and Epidemiology Study (KoGES): Nutrition examination. Cheongju: KCDC; 2011. p. 14.
  28. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, et al. Validation and reproducibility of food frequency questionnaire for Korean Genome Epidemiologic Study. European Journal of Clinical Nutrition. 2007;61(12):1435-1441. https://doi.org/10.1038/sj.ejcn.1602657
  29. Cho NH, Oh TJ, Kim KM, Choi SH, Lee JH, Park KS, et al. Neck circumference and incidence of diabetes mellitus over 10 years in the Korean Genome and Epidemiology Study (KoGES). Scientific Reports. 2015;5:18565. https://doi.org/10.1038/srep18565
  30. Huh JH, Yadav D, Kim JS, Son JW, Choi E, Kim SH, et al. An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study. Metabolism. 2017;67:54-61. https://doi.org/10.1016/j.metabol.2016.11.003
  31. Han SJ, Kim HJ, Kim DJ, Lee KW, Cho NH. Incidence and predictors of type 2 diabetes among Koreans: A 12-year follow up of the Korean Genome and Epidemiology Study. Diabetes Research and Clinical Practice. 2017;123:173-180. https://doi.org/10.1016/j.diabres.2016.10.004
  32. Son JW, Lee SS, Kim SR, Yoo SJ, Cha BY, Son HY, et al. Low muscle mass and risk of type 2 diabetes in middle-aged and older adults: Findings from the KoGES. Diabetologia. 2017;60(5):865-872. https://doi.org/10.1007/s00125-016-4196-9
  33. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-419. https://doi.org/10.1007/BF00280883
  34. Hong SB, Shin KA. Significance of non HDL-cholesterol and triglyceride to HDL-cholesterol ratio as predictors for metabolic syndrome among Korean elderly. Korean Journal of Clinical Laboratory Science. 2018;50(3):245-252. https://doi.org/10.15324/kjcls.2018.50.3.245
  35. Opoku S, Gan Y, Fu W, Chen D, Addo-Yobo E, Trofimovitch D, et al. Prevalence and risk factors for dyslipidemia among adults in rural and urban China: Findings from the China National Stroke Screening and Prevention Project (CNSSPP). BMC Public Health. 2019;19(1):1500. https://doi.org/10.1186/s12889-019-7827-5
  36. Sadeghi M, Talaei M, Oveisgharan S, Rabiei K, Dianatkhah M, Bahonar A, et al. The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study. Advanced Biomedical Research. 2014;3:242. https://doi.org/10.4103/2277-9175.145749
  37. Latifi SM, Karandish M, Shahbazian HB, Chinipardaz R, Sabet A, Pirani N. A survey of the incidence of dyslipidemia and its components in people over 20 years old in Ahvaz: A cohort study 2009-2014. Diabetes & Metabolic Syndrome. 2017;11 Suppl 2:S751-S754. https://doi.org/10.1016/j.dsx.2017.05.010
  38. Fingeret M, Marques-Vidal P, Vollenweider P. Incidence of type 2 diabetes, hypertension, and dyslipidemia in metabolically healthy obese and non-obese. Nutrition, Metabolism, and Cardiovascular Diseases. 2018;28(10):1036-1044. https://doi.org/10.1016/j.numecd.2018.06.011
  39. Riediger ND, Lukianchuk V, Bruce SG. Incident diabetes, hypertension and dyslipidemia in a Manitoba First Nation. International Journal of Circumpolar Health. 2015;74:27712. https://doi.org/10.3402/ijch.v74.27712
  40. Kim J, Park S. Association between age at natural menopause and prevalence of obesity, hypertension, diabetes, and hypercholesterolemia. Korean Public Health Research. 2021;47(1):1-9. https://doi.org/10.22900/kphr.2021.47.1.001
  41. Muka T, Oliver-Williams C, Kunutsor S, Laven JS, Fauser BC, Chowdhury R, et al. Association of age at onset of menopause and time since onset of menopause with cardio-vascular outcomes, intermediate vascular traits, and allcause mortality: A systematic review and meta-analysis. JAMA Cardiology. 2016;1(7):767-776. https://doi.org/10.1001/jamacardio.2016.2415
  42. Jia L, Long S, Fu M, Yan B, Tian Y, Xu Y, et al. Relationship between total cholesterol/high-density lipoprotein cholesterol ratio, triglyceride/high-density lipoprotein cholesterol ratio, and high-density lipoprotein subclasses. Metabolism. 2006;55(9):1141-1148. https://doi.org/10.1016/j.metabol.2006.04.004
  43. El Khoudary SR. HDL and the menopause. Current Opinion in Lipidology. 2017;28(4):328-336. https://doi.org/10.1097/MOL.0000000000000432
  44. Ko SH, Kim HS. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women. Nutrients. 2020;12(1):202. https://doi.org/10.3390/nu12010202
  45. Jung D, Choi HJ, Shim YN, Jo MS, Oh HJ. Predictors of serum low-density lipoprotein cholesterol level in postmenopausal women. Korean Journal of Family Practice. 2020;10(5):393-397. https://doi.org/10.21215/kjfp.2020.10.5.393
  46. Penson PE, Pirro M, Banach M. LDL-C: Lower is better for longer-even at low risk. BMC Medicine. 2020;18(1):320. https://doi.org/10.1186/s12916-020-01792-7
  47. Carr SS, Hooper AJ, Sullivan DR, Burnett JR. Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment. Pathology. 2019;51(2):148-154. https://doi.org/10.1016/j.pathol.2018.11.006
  48. Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids in Health and Disease. 2017;16(1):132. https://doi.org/10.1186/s12944-017-0515-5
  49. Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411-2421. https://doi.org/10.1001/jama.2019.19191