Metabolic syndrome and menopause
© Jouyandeh et al.; licensee BioMed Central Ltd. 2013
Received: 27 August 2012
Accepted: 25 December 2012
Published: 3 January 2013
The metabolic syndrome is defined as an assemblage of risk factors for cardiovascular diseases, and menopause is associated with an increase in metabolic syndrome prevalence. The aim of this study was to assess the prevalence of metabolic syndrome and its components among postmenopausal women in Tehran, Iran.
In this cross-sectional study in menopause clinic in Tehran, 118 postmenopausal women were investigated. We used the adult treatment panel 3 (ATP3) criteria to classify subjects as having metabolic syndrome.
Total prevalence of metabolic syndrome among our subjects was 30.1%. Waist circumference, HDL-cholesterol, fasting blood glucose, diastolic blood pressure ,Systolic blood pressure, and triglyceride were significantly higher among women with metabolic syndrome (P-value<0.05). Our study shows high abdominal obesity and hypertension are the most prevalent components of metabolic syndrome. 15%, 13.3% and 1.8% of subjects had three, four and five criteria for metabolic syndrome, respectively. There was a significant relationship between number of components of metabolic syndrome and waist circumference.
Our study shows that postmenopausal status is associated with an increased risk of metabolic syndrome. Therefore, to prevent cardiovascular disease there is a need to evaluate metabolic syndrome and its components from the time of the menopause.
Metabolic syndrome is an assemblage of several factors including hypertension, dyslipidemia, insulin resistance, obesity and glucose intolerance that increase subjects' risk to develop cardiovascular disease (CVD) and type 2 diabetes [1, 2]. Diagnostic criteria for metabolic syndrome has been defined by the national cholesterol education program adult treatment panel ΙΠ (ATP ΙΠ), which is easily used for classifying patients . It's estimated that almost 20-30% of the middle-aged population are affected by this syndrome  varies from 8 to 24% in males [5, 6] and from 7 to 46% in females [7, 8]. Many cross-sectional studies have shown an increased risk of metabolic syndrome in postmenopausal women which varies from 32.6% to 41.5% [9–11]. Some studies show an increasing prevalence of metabolic syndrome in developing countries and Asia  and an estimated prevalence in Iran from 35-58% [13, 14]. As there is not enough data on the prevalence of metabolic syndrome among postmenopausal women in Tehran referral hospitals, we decided to establish a study in menopause clinic of Tehran women general hospital to determine the prevalence of metabolic syndrome and its components in postmenopausal women.
This cross-sectional study was performed in menopause clinic of Tehran women general hospital. The study was performed on 118 postmenopausal women from January 2011 to January 2012 in the menopause clinic. Menopause was defined as at least 12 consecutive months of amenorrhea with no other medical cause. Exclusion criteria were considered as surgical menopause and chemo radiotherapy. No other conditions or disease have been considered. The women mostly were visited in the clinic because of hot flashes, mood swing, vaginal dryness, sleep disturbances, night sweat, forgetfulness, urinary symptoms, pain with intercourse, palpitations, anxiety, joint and muscle pain, depression and irritability.
Abdominal obesity: waist circumference≥ 88 cm
Hypertriglyceridemia: serum TG level ≥ 150 mg/dl
Serum HDL: < 50 mg/dl
High blood pressure: SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg or on treatment for hypertension
High fasting glucose: serum glucose level > 110 mg/dl or on treatment for diabetes
Waist circumference was measured at a level midpoint between the lower rib margin and the top of the iliac crest. Blood pressure of the patients was measured twice with a standard barometer in a sitting position, and the average blood pressure had been documented in the sheets. All data were analyzed by SPSS version 16 (SPSS Inc, Chicago, IL, USA). The continuous variables are reported as Mean ± SD and categorical variables are presented as percentage. The distribution of continuous variables was assessed by Kolomogrov-Smirnov test and it demonstrated a normal distribution. A P-value<0.05 was considered statistically significant.
Baseline data of postmenopausal women with and without metabolic syndrome
Subjects without metabolic syndrome
Subjects with metabolic syndrome
Total number of subjects
Prevalence of metabolic syndrome and the components of metabolic syndrome in postmenopausal women
Waist circumference≥88 cm
Systolic blood pressure≥130 mmHg/diastolic blood pressure≥85 mmHg
Fasting blood glucose>110 mg/dl
Number of metabolic syndrome components versus waist circumference
Metabolic syndrome components
We found a statistically significant relationship between waist circumference and number of metabolic syndrome components, which was in agreement with study done by Marjani et al. in Gorgan . Abdominal obesity is a risk factor for cardiovascular disorders [28, 29] and can cause metabolism abnormality and threaten human’s health . Therefore, it is necessary to reduce this risk among postmenopausal women with metabolic syndrome by changing the lifestyle leading to weight loss by a healthy diet and frequent physical activity.
In our study we found that both systolic and diastolic blood pressure was higher among post menopausal women with metabolic syndrome specially DBP. Marjani et al. also showed a significantly high diastolic blood pressure among postmenopausal women in Gorgan .This may suggest us that diastolic blood pressure is a risk factor for CHD in postmenopausal women with metabolic syndrome that should be considered.
A significant difference of impaired fasting glucose was found among postmenopausal women with and without metabolic syndrome in our study. Walton and colleges also report an increase in FBS among postmenopausal women with metabolic syndrome .
Finally, Our findings show low HDL and high TG levels in postmenopausal women with metabolic syndrome, which is in agreement with findings in studies done by Marjani et al.  in Iran and Figueiredo Neto et al.  in Brazil. There are controversial findings about menopausal effect on HDL [32, 33] and TG levels [32, 34]. Our findings about high prevalence of dyslipidemia among postmenopausal women with metabolic syndrome indicate a need to treat metabolic syndrome in postmenopausal women as a target for reducing cardiovascular risks with an special effort on lifestyle changing and daily diets.
A limitation of this study was the small population studied, done as a cross-sectional study which may limit generalization of this study to all parts of Iran. There is a need of further studies to confirm the results found and, then, take actions to prevent metabolic syndrome in postmenopausal women.
Our study has shown a high prevalence of metabolic syndrome among postmenopausal women referring to menopause clinic in Tehran women general hospital that abdominal obesity and hypertension were the most prevalent components of metabolic syndrome among these patients. These components can lead to an increase in cardiovascular diseases. Interventions are needed to modify these risk factors such as abdominal obesity, dyslipidemia, hypertension and glucose intolerance and reduce the risk of cardiovascular events. Therefore, it is important to have more efforts for lipid screening and educational programs to improve women’s knowledge about a healthy lifestyle.
The study was done in menopause clinic of Tehran women general hospital of Tehran University of medical sciences.
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