Menopause Tied to Increased Cardiovascular Fat

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Peri- and postmenopausal women have a greater volume of fat around their hearts than premenopausal women.

When compared with premenopausal women, peri- and postmenopausal women have greater volumes of fat around their hearts, according to data published in the Journal of Clinical Endocrinology & Metabolism.

“Cardiovascular disease is the leading cause of death in women, and it increases after age 50 — the average age when a woman is going through menopause,” lead study author Samar R. El Khoudary, PhD, MPH, assistant professor in the University of Pittsburgh Graduate School of Public Health’s Department of Epidemiology, said in a press release.

“By showing that menopause appears to be associated with a shift in fat deposits that leads to more fat around the heart, we’ve uncovered a new potential contributor to increased risk of cardiovascular disease in women.”

While age, as opposed to menopause itself, is primarily responsible for weight gain among peri- and postmenopausal women, changes in body fat composition and distribution do occur as a result of hormonal fluctuations across the menopausal transition, according to background information in the study.

Previous studies, however, have not assessed how these changes in fat distribution during menopause affect cardiovascular fat, which can significantly affect risk for CVD.

To learn more, El Khoudary and colleagues evaluated clinical data, blood samples and cardiac CT scans of 456 women (mean age, 50.75 years) who were enrolled in the Study of the Women’s Health Across the Nation (SWAN). Sixty-two percent of the women were premenopausal or in early menopause, and 38% were in late menopause or postmenopausal.

Compared with premenopausal or early perimenopausal women, late peri- or postmenopausal women had 9.88% more epicardial adipose tissue, 20.72% more paracardial adipose tissue and 11.69% more total heart adipose tissue volumes (P<.05).

Aortic perivascular adipose tissue, however, was not associated with menopausal status.

Results also revealed a link between lower estradiol concentrations and increased paracardial and total heart adipose tissue (P<.05). Women who experienced the greatest reduction in estradiol concentrations from baseline had greater volumes of paracardial adipose tissue than those with who experienced the least reduction in estradiol concentration from baseline (P=.02).

The findings held true after accounting for age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases.

“Developing prevention strategies to reduce cardiovascular fat in women at midlife may reduce their heart disease risk, especially knowing that the menopausal transition puts women at risk for excess fat around their hearts,” El Khoudary said.

“Previous studies suggest that reducing heart fat is feasible through weight loss or weight management, but these studies only looked at small numbers of people and there have been no clinical trials linking cardiovascular outcomes with heart fat changes due to weight management interventions. Clearly there is a need for larger scale studies to determine the best intervention strategies to help postmenopausal women reduce fat near the heart.”


  1. El Khoudary SR et al. J Clin Endocrinol Metab. 2015;doi:10.1210/JC.2015-2110.