Abdominal visceral adipose tissue over the menopause transition and carotid atherosclerosis: the SWAN heart study.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study evaluating trajectories and subclinical cardiovascular markers over time.
PubMed 33651741 · doi:10.1097/GME.0000000000001755
What was done
Researchers evaluated the trajectory of abdominal visceral adipose tissue (VAT) relative to the final menstrual period (FMP) and tested its association with common carotid artery intima-media thickness (cIMT) and internal carotid artery intima-media thickness (ICA-IMT). The study included 362 women (mean age 51.1 ± 2.8 years; 61% White, 39% Black) free of cardiovascular disease from the Study of Women's Health Across the Nation (SWAN) Heart study, with up to two longitudinal measurements of VAT and carotid IMT. Spline modeling established three time segments relative to FMP: segment 1 (>2 years before FMP), segment 2 (2 years before FMP to FMP), and segment 3 (after FMP). Multivariable random-effects models adjusted for age at FMP, body mass index, sociodemographic factors, lifestyle factors, and cardiovascular disease risk factors.
What was found
VAT showed no significant change in segment 1, but increased significantly by 8.2% per year (95% CI: 4.1% to 12.5%) during segment 2 and by 5.8% per year (95% CI: 3.7% to 7.9%) in segment 3. During segment 2, each 20% higher VAT was associated with a 2.0% (95% CI: 0.8% to 3.1%) higher ICA-IMT. VAT was not an independent predictor of ICA-IMT in the other time segments, nor did it independently predict average common carotid artery IMT measures after multivariable adjustment.
Why it matters
Accelerated visceral fat accumulation begins roughly two years prior to the final menstrual period rather than solely postmenopause. This specific transition window is independently linked to subclinical atherosclerosis progression in the internal carotid artery.
Limits
Participants had at most two imaging timepoints, limiting granularity in trajectory tracking. The cohort included only White and Black women without baseline cardiovascular disease, limiting generalizability to other populations. Findings rely on subclinical imaging surrogates rather than hard clinical cardiovascular endpoints, and residual confounding cannot be excluded in an observational design.
Cited by
- supports The SWAN study found that women experience an accelerated increase in visceral fat starting two years prior to their final menstrual period.