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Archives of Endocrinology and Metabolism

Print version ISSN 2359-3997On-line version ISSN 2359-4292

Arch. Endocrinol. Metab. vol.61 no.2 São Paulo Mar./Apr. 2017  Epub Feb 16, 2017

http://dx.doi.org/10.1590/2359-3997000000253 

Original Article

Prevalence of metabolic syndrome in pre- and postmenopausal women

Ricardo de Marchi1 

Cátia Millene Dell’Agnolo2 

Tiara Cristina Romeiro Lopes1 

Angela Andréia França Gravena1 

Marcela de Oliveira Demitto2 

Sheila Cristina Rocha Brischiliari2 

Deise Helena Pelloso Borghesan1 

Maria Dalva de Barros Carvalho1 

Sandra Marisa Pelloso1  2 

1Departamento de Ciências da Saúde, Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), PR, Brasil.

2Departamento de Enfermagem, Pós-Graduação em Enfermagem, Universidade Estadual de Maringá (UEM), PR, Brasil.

ABSTRACT

Objective

The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS.

Materials and methods

A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III – NCEP-ATP III-2005.

Results

MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL.

Conclusion

MS was more prevalent among postmenopausal women than among premenopausal women.

Key words: Metabolic syndrome; menopause; climacteric; cardiovascular disease

INTRODUCTION

Cardiovascular diseases (CVDs) are the leading cause of death among women in the United States. According to the American Heart Association (AHA), approximately one in three female adults has some form of CVD (1).

The cardiovascular risk profile coincides with menopause and it is characterized by the occurrence or worsening of some risk factors associated with this period such as abdominal obesity, hypertension, and dyslipidemia (2,3). These risk factors, in combination with insulin resistance, hyperinsulinemia, and hyperglycemia, compose metabolic syndrome (MS). Patients with MS are at increased risk of CVD and type 2 diabetes mellitus (2).

Postmenopausal status is associated with an increased incidence of MS and CVD, which is mainly associated with the reduction in the levels of female sex hormones (4). Studies have reported that menopause is an independent predictor of MS in females (5,6).

Several studies have identified risk factors for MS and CVD in menopausal women (7,8). However, few studies address this topic in the Brazilian population. Therefore, the objective of this study was to determine the prevalence of MS and its components in pre- and postmenopausal women, as well as the association between menopausal status and MS.

MATERIALS AND METHODS

This retrospective study was performed in a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Southern Brazil. A total of 958 medical records of women aged 40-65 years evaluated between 2010 and 2014 were analyzed. All of the women seen in the clinic during the study period were included in the study, except for hysterectomized women.

The study consisted of two groups: a premenopausal group composed of women who were still having either regular or irregular menstrual cycles and a postmenopausal group composed of women who had not experienced menstrual cycles in more than one year, according to the definition of the guideline on the diagnosis and management of menopause (9).

The presence of MS is considered a disorder associated with a set of cardiovascular risk factors including abdominal fat deposition, hypertension, low levels of high density lipoprotein cholesterol (HDL-C), elevated levels of low density lipoprotein cholesterol (LDL-C), hypertriglyceridemia, increased fasting glucose levels diagnosed according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III – NCEP-ATP III-2005 (2), and an increased body mass index (BMI) calculated by dividing the body weight (kg) by the height squared (m2). The subjects were classified as non-obese (BMI up to 29.9 kg/m2) and obese (BMI equal to or greater than 30 kg/m2) according to the World Health Organization (WHO) standards (10). According to the NCEP-ATP III, MS represents the combination of three of the following variables (2):

  1. Abdominal obesity: waist circumference ≥ 88 cm;

  2. Hypertriglyceridemia: serum TG levels ≥ 150 mg/dL;

  3. Serum HDL-c, low: < 50 mg/dL;

  4. Hypertension: systolic blood pressure (SBP) ≥ 130 mmHg and/or diastolic blood pressure (DBP) ≥ 85 mmHg or receiving treatment for hypertension; and

  5. Elevated fasting glucose: glucose level > 100 mg/dL or receiving treatment for diabetes.

The following variables were analyzed: age, stratified into age groups (40-45 years, 46-50 years, 51-55 years, and 56-65 years); color (white and non-white); civil status (with or without a partner); paid occupation (yes or no); physical activity (yes or no); tobacco and alcohol use (yes or no); systolic and diastolic blood pressure values; waist circumference (WC); and an analysis of fasting glucose, HDL-C, LDL-C, and triglycerides levels and the BMI (obese or non-obese).

The values for WC, blood pressure and laboratory tests were obtained from the medical records of the participants. The outpatient clinic uses a standardized procedure for measuring blood pressure; namely, after a 5-min rest, blood pressure is measured in the left arm both at the beginning and end of the examination using an aneroid sphygmomanometer, and the patient is in a seated position. The WC corresponds to the midpoint between the lower margin of the last rib and the top of the iliac crest. The laboratory tests were performed in different laboratories, always after a 12-h fasting period.

For the statistical analysis, a descriptive analysis and a crude analysis were performed using the chi-square test. The risk of MS and its components was analyzed with the crude odds ratio (OR) using the chi-square test. The program Epi Info 3.5.1 was used, and a significance level of 5% and confidence interval (CI) of 95% were adopted.

The research project was approved by the Standing Committee on Research Ethics of the State University of Maringa (Universidade Estadual de Maringá – UEM), under decision number 856.300. A waiver of signed informed consent was requested because the data were obtained from medical records without patient identification.

RESULTS

The medical records of 958 climacteric women, including 277 premenopausal women (28.9%) and 681 postmenopausal women (71.1%), were analyzed. The overall mean age was 53.6 ± 7.52 years, with a large percentage of women aged 56-65 years (46.0%). The mean ages of the pre- and postmenopausal women were 44.5 ± 2.9 and 57.3 ± 5.33 years, respectively. According to the socio-demographic variables, 71.3% of the women had a partner, 95.4% were white, and 57.4% had a paid occupation.

MS was observed in 18.5% of women. MS was more prevalent among postmenopausal and the oldest women. A total of 9.4% of premenopausal women presented MS, while 22.2% of postmenopausal women presented this syndrome, with a relative risk of 2.75 (CI 1.76-4.28). Regarding the age groups, MS was more frequent with increasing age (Table 1).

Table 1 Prevalence of metabolic syndrome according to menopausal status, sociodemographic data, and lifestyle. Sarandi, Paraná, Brazil, 2015 

n % MS OR 95% CI p

Yes n (%) No n (%)
Menopausal status 958
Premenopausal 26 (9.4) 251 (90.6) 1
Postmenopausal 151 (22.2) 530 (77.8) 2.75 1.76-4.28 < 0.001
Age group (years) 958
40-45 10 (5.4) 174 (94.6) 1
46-50 20 (12.7) 137 (87.3) 2.54 1.15-5.60 0.01
51-55 36 (19.9) 145 (80.1) 4.32 2.07-9.00 < 0.001
56-65 111 (25.5) 325 (74.5) 5.94 3.03-11.64 < 0.001
Skin color 951
White 166 (18.3) 742 (81.7) 1
Non-white 9 (20.9) 34 (79.1) 1.18 0.55-2.51 0.66
Marital status 937
With partner 125 (18.5) 552 (81.5) 1
Without partner 49 (18.8) 211 (81.2) 1.02 0.71-1.47 0.89
Paid occupation 951
Yes 92 (16.5) 464 (83.5) 1
No 84 (21.3) 311 (78.7) 1.36 0.98-1.89 0.06
Physical activity 294
Yes 24 (16.1) 125 (83.9) 1
No 21 (14.5) 124 (85.5) 0.88 0.46-1.66 0.69
Tobacco use 581
Yes 12 (19.0) 51 (81.0) 1.18 0.60-2.31 0.62
No 86 (16.6) 432 (83.4) 1
Alcohol use 845
Yes 3 (15.8) 16 (84.2) 0.87 0.25-3.08 1.00
No 82 (17.6) 384 (82.4) 1

MS: metabolic syndrome; OR: odds ratio; CI: confidence interval.

Table 2 shows the association between the components of MS according to menopausal status. Postmenopausal women were more likely to have HDL-C levels < 50 mg/dL (OR 1.53; CI 1.08-2.18); SBP values ≥ 130 or DBP values ≥ 85 mmHg (OR 2.47; CI 1.85-3.31); and fasting glucose levels ≥ 100 mg/dL (OR 2.04; CI 1.30-3.21).

Table 2 Presence of metabolic syndrome and its components according to menopausal status. Sarandi, Paraná, 2015 

N Premenopause Postmenopause OR 95% CI p


N % N %
WC ≥ 88 cm 213
Yes 31 23.3 102 76.7 1.32 0.70-1.49 0.37
No 23 28.8 57 71.3 1
TGL ≥ 150 mg/dL 673
Yes 40 21.5 146 78.5 1.44 0.96-3.15 0.07
No 138 28.3 349 71.7 1
HDL-C < 50 mg/dL 661
Yes 71 22.2 249 77.8 1.53 1.08-2.18 0.01
No 104 30.5 237 69.5 1
LDL-C ≥ 130 mg/dL 629
Yes 57 25.6 166 74.4 1.10 0.74-1.62 0.62
No 111 27.3 295 72.7 1
SBP ≥ 130 or DBP ≥ 85 mmHg 932
Yes 134 22.3 468 77.7 2.47 1.85-3.31 < 0.001
No 137 41.5 193 58.5 1
Fasting glucose levels > 100 mg/dL 501
Yes 32 17.2 154 82.8 2.04 1.30-3.21 0.001
No 94 29.8 221 70.2 1
BMI (kg/m2) 204
< 29.9 28 26.7 77 73.3 1
≥ 30 30 30.3 69 69.7 0.84 0.43-1.61 0.56

WC: waist circumference; TGL: triglycerides; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; OR: odds ratio; CI: confidence interval.

DISCUSSION

Few Brazilian studies address the correlation between MS and menopause, which sets the present study apart. However, some study limitations should be considered. Data were obtained from electronic medical records that were entered only once during medical visits and may have been incomplete. In fact, because the present study evaluated medical records, some relevant factors associated with MS were missing, such as lifestyle, physical activity, tobacco use, and obesity. The frequency and intensity of physical activity were not reported. Similarly, the tobacco use data were incomplete, as the time and frequency of use were not collected. Another important limitation of this study is that the sample comprised women who were observed at a reference cardiology outpatient clinic, and thus, they had a greater likelihood of presenting with cardiovascular risk factors and other comorbidities.

In this study, MS was present in 18.5% of the studied women. Another Brazilian study found a higher prevalence (34.7%) of MS in this group of women in the state of Maranhão (11). In studies from different countries, the prevalence of MS in women has ranged from 15.9% in Thai women (12) to 26.4% in Iranian women (5) and 33.8% in Puerto Rican women (13).

Our study found that MS was more prevalent among postmenopausal women (22.2%) than among premenopausal women (9.4%). The prevalence of MS among postmenopausal women has been reported to vary by country, ranging between 16.9% in Thailand (12), 29.0% in Puerto Rico (13), 31.0% in Iran (14), 49.8% in Brazil (11), 53.5% in Iran (5), 55.5% in India (15), and 64.3% in Iran (16). MS is one factor that increases the mortality rate in both men and women (17). A meta-analysis confirmed this information by describing a higher prevalence of MS during the postmenopausal stage than the premenopausal stage, regardless of population (18).

There was a statistically significant relationship between postmenopausal stage and increased age with the presence of MS. Older women (older than 56 years of age) were 5.95 (CI: 3.03-11.64) times more likely than younger women to be diagnosed with MS. Some authors have identified age as the main risk factor for increased MS prevalence (10,19). The prevalence of MS varies among studies; however, several Brazilian (11,20) and international studies (15,16,21) found a greater MS prevalence among postmenopausal women than among premenopausal women. A study performed in women aged 40-65 years in Argentina, another South American country, demonstrated a relative risk of 1.61 (CI: 1.18-2.19) of developing MS during post-menopause (22). The Third National Health and Nutrition Examination Survey (NHANES) III study described the association between MS and increased risk of mortality among postmenopausal women compared to premenopausal women (23).

Unfavorable cardiovascular risk factor levels are observed during menopause, including changes in body fat distribution from a gynaecoid pattern to an android pattern, abnormal blood lipid levels, increased sympathetic tone, endothelial dysfunction, vascular inflammation, and increased blood pressure. Postmenopausal women are at greater risk for CVDs than men (matched by age) due to the failure and reduction of the gonads and steroid production (24). Estrogens play a key role in maintaining adequate levels of HDL-C (8).

In our study, the prevalence of all MS components was higher in postmenopausal women, with a statistically significant association for low HDL-c levels, hypertension, and high fasting glucose levels. These components were also described as prevalent in postmenopausal women in Iran (5,6), South Korea (25), and Poland (26), as well as in Brazil (20). A study conducted in the state of Maranhão revealed that increased blood pressure was also prevalent (73.4%) among postmenopausal women (11). However, a recent study found no significance differences for body weight, BMI, WC, blood pressure, total cholesterol, LDL cholesterol, triglycerides and glucose levels between premenopausal and postmenopausal women (27).

Some researchers consider post-menopause as a period of hyperandrogenism that results from the greater reduction in estrogen, due to ovarian failure, than in androgens, with increased levels of LDL and decreased levels of HDL cholesterol, which characterize an atherogenic profile (28,29), compatible with MS. Estrogen seems to have a positive effect on the inner layer of artery wall, which helps to maintain blood vessels flexible (30). Conversely, the cause of hypertension is not well defined in postmenopausal women. It is believed that an increased androgen/estrogen ratio can alter the renin-angiotensin system (31). Other possible causes for hypertension are increased endothelin levels, oxidative stress, obesity and stimulation of the sympathetic nervous system (32). Whether administered chronically, endothelin causes increases in sodium reabsorption in the kidney and consequent increase in blood pressure (33), and in postmenopausal women, plasma endothelin levels are increased (34), suggesting that endothelin can play a part in increasing blood pressure after menopause (35). In conclusion, both endothelin and angiotensin II may contribute to oxidative stress (36). The oxidative stress markers are increased in women after menopause (37), and oxidative stress has caused the increase of blood pressure by decreasing the bioavailability of vasodilator (36). However, antioxidant therapy did not produce a reduction in blood pressure, in humans (38). The role of oxidative stress in hypertension in women after menopause has not been completely elucidated (35).

However, some authors found that although HDL cholesterol levels decrease with increased visceral fat and total weight, low HDL cholesterol levels are not a main feature of MS in postmenopausal women. HDL cholesterol levels appear to increase, not decrease, with age (27). Moreover, higher HDL cholesterol levels were found in postmenopausal women compared to premenopausal women (27,39).

In our study, we found a higher risk of glucose levels > 100 mg/dL. A study conducted with diabetic women found a high prevalence of MS in both premenopausal (87.5%) and postmenopausal (87.7%) women (24). Insulin resistance is described as a key factor implicated in the pathophysiology of MS (40). It contributes to increased glucose intolerance and diabetes, hypertension, increased triglyceride levels, and reduced HDL levels (41).

Another study revealed that postmenopausal women were more likely to present elevated total cholesterol levels, poor glycemic control (OR = 2.92; 95% CI = 1.32-6.33), and lower HDL levels (OR = 0.36; 95% CI = 0.19-0.68) than premenopausal women (42).

Although the BMI was not correlated with menopausal status in the present study, a previous study demonstrated that a BMI > 30 kg/m2 (obese subjects) had a significant negative effect on blood pressure (increase), triglycerides, and fasting glucose levels, in addition to being associated with low HDL-C levels compared to a normal BMI (non-obese subjects). These data indicate that “obese” individuals have more cardiovascular risk factors (43).

Finally, some authors report that the prevention of metabolic diseases in menopause requires changes in lifestyle, including the performance of moderate physical activity and consumption of a healthy diet, as the main recommendation to prevent metabolic diseases during menopause. In some cases, after an individual evaluation, hormone replacement therapy was recommended (44), which could have a positive effect on lipids by reducing total and LDL cholesterol and by slightly increasing HDL levels, as demonstrated in a meta-analysis (45).

Thus, our data suggest that the prevalence of MS was higher among postmenopausal women than premenopausal women and increased with increasing age. The components of MS that were prevalent in postmenopausal women included low HDL-C levels (< 50 mg/dL), hypertension (SBP values ≥ 130 mmHg or DBP values ≥ 85 mmHg), and high fasting glucose levels (≥ 100 mg/dL).

REFERENCES

1. Sanders GD, Patel MR, Chatterjee R, Ross AK, Bastian LA, Coeytaux RR, et al. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 58. Agency for Healthcare Research and Quality (US). Report No.: 13-EHC072-EF, 2013. [ Links ]

2. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-52. [ Links ]

3. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome: a new world-wide definition: a consensus statement from the International Diabetes Federation. Diabet Med. 2006;23:469-80. [ Links ]

4. Qader SS, Shakir YA, Nyberg P, Samsioe G. Sociodemographic risk factors of metabolic syndrome in middle-aged women: results from a population-based study of Swedish women, The Women’s Health in the Lund Area (WHILA) Study. Climacteric. 2008;11(6):475-82. [ Links ]

5. Eshtiaghi R, Esteghamati A, Nakhjavani M. Menopause is an independent predictor of metabolic syndrome in Iranian women. Maturitas. 2010;65(3):262-6. [ Links ]

6. Ainy E, Mirmiran P, Zahedi AS. Prevalence of metabolic syndrome during menopausal transition in Tehranian women: Tehran Lipid and Glucose Study (TLGS). Maturitas. 2007;58:150-5. [ Links ]

7. Sallam T, Watson KE. Predictors of cardiovascular risk in women. Womens Health (Lond). 2013;9(5):491-8. [ Links ]

8. Dowling NM, Gleason CE, Manson JE, Hodis HN, Miller VM, Brinton EA, et al. Characterization of vascular disease risk in postmenopausal women and its association with cognitive performance. PLoS One. 2013;8(7):e68741. [ Links ]

9. Chaplin S. NICE guideline: diagnosis and management of the menopause. 2016. [ Links ]

10. WHO. World Health Organization. Global database on Body Mass Index. BMI classification, Washington, 2006. Available at: <http://apps.who.int/bmi/index.jsp?introPage=intro_3.html>. Acessed on: Aug. 24, 2009. [ Links ]

11. Figueiredo-Neto AA, Figuerêdo ED, Barbosa JB, Barbosa FF, Costa GRC, Nina VJS, et al. Síndrome metabólica e menopausa: estudo transversal em ambulatório de ginecologia. Arq Bras Cardiol. 2010;91:1-23. [ Links ]

12. Indhavivadhana S, Rattanachaiyanont M, Wongvananurak T, Kanboon M, Techatraisak K, Leerasiri P, et al. Predictors for metabolic syndrome in perimenopausal and postmenopausal Thai women. Climacteric. 2011;14:58-65. [ Links ]

13. Romaguera J, Ortiz AP, Roca FJ, Cólon G, Suárez E. Factors associated with metabolic syndrome in a sample of women in Puerto Rico. Menopause. 2010;17:388-92. [ Links ]

14. Marjani A, Moghasemi S. The metabolic syndrome among postmenopausal women in Gorgan. Int J Endocrinol. 2012;2012:953627. [ Links ]

15. Pandey S, Srinivas M, Agashe S, Joshi J, Galvankar P, Prakasam CP, et al. Menopause and metabolic syndrome: a study of 498 urban women from western India. J Midlife Health. 2010;1:63-9. [ Links ]

16. Heidari R, Sadeghi M, Talaei M, Rabiei K, Mohammadifard N, Sarrafzadegan N. Metabolic syndrome in menopausal transition: Isfahan Healthy Heart Program, a population based study. Diabetol Metab Syndr. 2010;2:59. [ Links ]

17. Meirelles RMR. Menopausa e síndrome metabólica. Arq Bras Endocrinol Metab. 2014;58:2. [ Links ]

18. Mendes CG, Theodoro H, Rodrigues AD, Olinto MTA. Prevalência de síndrome metabólica e seus componentes na transição menopáusica: uma revisão sistemática. Cad Saúde Pública. 2012;28:1423-37. [ Links ]

19. Nakhjavani M, Imani M, Larry M, Aghajani-Nargesi A, Morteza A, Esteghamati A. Metabolic syndrome in premenopausal and postmenopausal women with type 2 diabetes: loss of protective effects of premenopausal status. J Diabetes Metab Disord. 2014;13(1):102. [ Links ]

20. Mendes KG, Theodoro H, Rodrigues AD, Busnello F, Lorenzi DRS de, Olinto MTA. Menopausal status and metabolic syndrome in women in climacteric period treated at a clinic in Southern Brazil. Open J Endocr Metab Dis. 2013:3:31-41. [ Links ]

21. Jouyadeh Z, Nayebzadeh F, Qorbani M, Asadi M. Metabolic syndrome and menopause. J Diabetes Metab Disord. 2013;12:1. [ Links ]

22. Coniglio RI, Nellem J, Gentili R, Sibechi N, Agusti E, Torres M. Metabolic syndrome in employee in Argentina. Medicina (B Aires). 2009;69:246-52. [ Links ]

23. Lin JW, Caffrey JL, Chang MH, Lin YS. Sex, menopause, metabolic syndrome, and all-cause and cause-specific mortality--cohort analysis from the Third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2010;95:4258-67. [ Links ]

24. Narayanaswamy N, Moodithaya S, Halahalli H, Miratkar AM. Assessment of Risk Factor for Cardiovascular Disease Using Heart Rate Variability in Postmenopausal Women: A Comparative Study between Urban and Rural Indian Women Clinical Study. ISRN Cardiol. 2013(2013):ID858921. [ Links ]

25. Sieminska L, Wojciechowska C, Foltyn W, Kajdanivk D, Kos-Kudla B, Marek B, et al. The relation of serum adiponectin and leptin levels to metabolic syndrome in women before and after the menopause. Endokrynol Pol. 2006;57:15-22. [ Links ]

26. Kim HM, Park J, Ryu SY, Kim J. The effect of menopause on the metabolic syndrome among Korean women: the Korean National Health and Nutrition Examination Survey, 2001. Diabetes Care. 2007;30:701-6. [ Links ]

27. Fernandez ML, Murillo AG. Postmenopausal Women have higuer HDL and Decreased Incidence of low HDL than premenopausal women with metabolic syndrome. Healthcare. 2016;4:20. [ Links ]

28. Banks AD. Women and heart disease: missed opportunities. J Midwifery Womens Health. 2008;53:430-9. [ Links ]

29. Weinberg ME, Manson JE, Buring JE, Cook NR, Seely EW, Ridker PM, et al. Low sex hormone-binding globulin is associated with the metabolic syndrome in postmenopausal women. Metabolism. 2006;55:1473-80. [ Links ]

30. American Heart Association. Conditions. Menopause and Heart Disease, 2015. Available at: <http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Menopause-and-Heart-Disease_UCM_448432_Article.jsp#.V7t0s1cmXC4>. Acessed on: Aug. 22, 2016. [ Links ]

31. Fernandez-Vega F, Abellan J, Vegazo O, De Vinuesa SG, Rodriguez JC, Maceira B, et al. Angiotensin II type 1 receptor blockade to control BP in postmenopausal women: influence of hormone replacement therapy. Kidney Int. 2002;(Suppl):S36-41. [ Links ]

32. Reckelhoff JF, Fortepiani LA. Novel mechanisms responsible for postmenopausal hypertension. Hypertension. 2004;43:918-23. [ Links ]

33. Wilkins FC Jr, Alberola A, Mizelle HL, Opgenorth TJ, Granger JP. Systemic hemodynamics and renal function during long-term pathophysiological increases in circulating endothelin. Am J Physiol. 1995;268:R375-81. [ Links ]

34. Komatsumoto S, Nara M. Changes in the level of endothelin-1 with aging. Nihon Ronen Igakkai Zasshi. 1995;32:664-9. [ Links ]

35. Lima R, Wofford M, Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep. 2012;14:254-60. [ Links ]

36. Reckelhoff JF, Romero JC. Role of oxidative stress in angiotensin-induced hypertension. Am J Physiol Regul Integr Comp Physiol. 2003;284:R893-912. [ Links ]

37. Castelao JE, Gago-Dominguez M. Risk factors for cardiovascular disease in women: relationship to lipid peroxidation and oxidative stress. Med Hypotheses. 2008;71:39-44. [ Links ]

38. Yanes LL, Romero DG, Cucchiarelli VE, Fortepiani LA, Gomez-Sanchez CE, Santacruz F, et al. Role of endothelin in mediating postmenopausal hypertension in a rat model. Am J Physiol Regul Integr Comp Physiol. 2005;288:R229-333. [ Links ]

39. Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid changes during the menopause transition in relation to age and weight. Am J Epidemiol. 2009;169:1352-61. [ Links ]

40. Gaspard U. Hyperinsulinaemia, a key factor of the metabolic syndrome in postmenopausal women. Maturitas. 2009;62:362-5. [ Links ]

41. Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation. 2002;106:286-8. [ Links ]

42. Udo T, McKee SA, White MA, Macheb RM, Barnes RD, Grilo CM. Menopause and metabolic syndrome in obese individuals with binge eating disorder. Eating Behaviors. 2014;15:182-5. [ Links ]

43. Bagnoli VR, Fonseca AM, Arie WM, Das Neves EM, Azevedo RS, Sorpreso IC, et al. Metabolic disorder and obesity in 5027 Brazilian postmenopausal women. Gynecol Endocrinol. 2014;30:717-20. [ Links ]

44. Stachowiak G, Pertyński T, Pertyńska-Marczewska M. Metabolic disorders in menopause. Prz Menopauzalny. 2015;14:59-64. [ Links ]

45. Xu Y, Lin J, Wang S, Xiong J, Zhu Q. Combined estrogen replacement therapy on metabolic control in postmenopausal women with diabetes mellitus. Kaohsiung J Med Sci. 2014;30: 350-61. [ Links ]

Received: February 25, 2016; Accepted: October 10, 2016

Correspondence to: Cátia Millene Dell’Agnolo. Av. Colombo, 5790. 87020-900 – Maringá, PR, Brasil. catiaagnolo@gmail.com

Disclosure: no potential conflict of interest relevant to this article was reported.

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