Patterns of Cardiometabolic Health as Midlife Women Transition to Menopause: A Prospective Multiethnic Study
Open accessAbstract
CONTEXT: Cardiometabolic conditions increase in midlife, but early customized prevention strategies are not established for such women. OBJECTIVE: To characterize and identify factors longitudinally related to constellations of cardiometabolic risk components in multiracial/ethnic women in midlife. DESIGN: We conducted a prospective, longitudinal, multiethnic cohort study of 3003 midlife women undergoing menopausal transition (MT). Metabolic syndrome (MetS) was defined as having at least three of five components: high fasting triglyceride (hTG) level, low high-density lipoprotein cholesterol (lHDL-C) level, high fasting plasma glucose (hGluc) level, large waist circumference (abdominal obesity; Ob), and hypertension (HTN). We described the patterns of constellations and estimated hazard ratios (HRs) for constellations at (i) incident MetS and (ii) recovery from MetS, using multivariable-adjusted Cox regression. SETTING: Seven US sites. PARTICIPANTS: In all, 1412 non-Hispanic white, 851 black, 272 Japanese, 237 Hispanic, and 231 Chinese women. EXPOSURES: Race/ethnicity, lifestyle factors, and MT stage. MAIN OUTCOMES MEASURES: Cardiometabolic constellations, incident MetS, and MetS recovery. RESULTS: Central obesity was the most frequent component. Having no components was the most frequent (31%) baseline constellation. Physical activity (HR = 1.68; 95% CI: 1.06, 2.68) and lower caloric intake (HR = 0.96; 95% CI: 0.93, 0.99 per 100 cal/d) were associated with recovery from MetS. Ob/hTG/lHDL-C (18%), Ob/HTN/lHDL-C (16%), and Ob/HTN/hGluc (14%) were frequent incident constellations. Physically active women had 26% to 62% lower hazards of incident MetS than inactive women. CONCLUSIONS: Modifiable lifestyle behaviors were related to recovery from MetS and decreased risk of the most frequent MetS constellations in midlife women.
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PCOS has been recognized recently as a lifelong disease affecting individuals into the postmenopausal years.
“PCOS has been recognized recently as a lifelong disease affecting individuals into the postmenopausal years.35, 36, 37, 38, 39”
From Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort (2024) · cites this paper as [38]
The Abstract describes a study of metabolic syndrome in midlife women undergoing the menopausal transition, not PCOS. Searches for PCOS and polycystic ovary syndrome found no passage addressing whether PCOS persists into the postmenopausal years. Page numbers were not available in our copy. (LLM, conf=0.76)
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Cites
Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,769 · see citing works
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944 · see citing works
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011 · see citing works
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.169404 · Cited by 11,961 · see citing works
Ford, E. S., Giles, W. H., & Dietz, W. H. (2002) · JAMA · doi:10.1001/jama.287.3.356 · Cited by 6,698 · see citing works
A short questionnaire for the measurement of habitual physical activity in epidemiological studies
Baecke, J. A. H., BUREMA, J., & Frijters, J. E. R. (1982) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/36.5.936 · Cited by 3,950 · see citing works
Burt, V. L., Whelton, P., Roccella, E. J., Brown, C., Cutler, J. A., Higgins, M., Horan, M. J., & Labarthe, D. (1995) · Hypertension · doi:10.1161/01.hyp.25.3.305 · Cited by 2,998 · see citing works
A DATA-BASED APPROACH TO DIET QUESTIONNAIRE DESIGN AND TESTING
Block, G., Hartman, A. M., DRESSER, C. M., Carroll, M. D., Gannon, J. G., & Gardner, L. B. (1986) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114416 · Cited by 2,150 · see citing works
Subar, A. F., Thompson, F. E., Kipnis, V., Midthune, D., Hurwitz, P. E., McNutt, S., McIntosh, A., & Rosenfeld, S. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.12.1089 · Cited by 1,401 · see citing works
Epidemiology Standardization Project (American Thoracic Society).
Bg, F. (1978) · PubMed · Cited by 1,344 · see citing works
Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea
Shamsuzzaman, A. S. M., Winnicki, M., Lanfranchi, P., Wolk, R., Kara, T., Accurso, V., & Somers, V. K. (2002) · Circulation · doi:10.1161/01.cir.0000018948.95175.03 · Cited by 974 · see citing works
Physical Activity Patterns in a Diverse Population of Women
Sternfeld, B., Ainsworth, B. E., & Quesenberry, C. P. (1999) · Preventive Medicine · doi:10.1006/pmed.1998.0470 · Cited by 579 · see citing works
Menopause and the Metabolic Syndrome The Study of Women's Health Across the Nation
Janssen, İ. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.14.1568 · Cited by 513 · see citing works
Block, G., Thompson, F. E., Hartman, A. M., LARKIN, F., & Guire, K. E. (1992) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(21)00707-0 · Cited by 502 · see citing works
FORD, E. S., LI, C., & ZHAO, G. (2010) · Journal of Diabetes · doi:10.1111/j.1753-0407.2010.00078.x · Cited by 471 · see citing works
Evaluation of the Kaiser Physical Activity Survey in women
Ainsworth, B. E., Sternfeld, B., Richardson, M. T., & Jackson, K. L. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200007000-00022 · Cited by 281 · see citing works
Trajectories of Entering the Metabolic Syndrome
Franco, O. H., Massaro, J. M., Civil, J., Cobain, M. R., O’Malley, B., & D’Agostino, R. B. (2009) · Circulation · doi:10.1161/circulationaha.109.855817 · Cited by 174 · see citing works
Sumner, A. E., Vega, G. L., Genovese, D. J., Finley, K. B., Bergman, R. N., & Boston, R. C. (2005) · Metabolism · doi:10.1016/j.metabol.2005.03.001 · Cited by 109 · see citing works
DEVELOPMENT OF EPIDEMIOLOGIC TOOLS FOR MEASURING ENVIRONMENTAL TOBACCO SMOKE EXPOSURE
Coghlin, J., HAMMOND, S. K., & Gann, P. H. (1989) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115391 · Cited by 102 · see citing works
Block, G., Norris, J. C., Mandel, R., & DiSogra, C. (1995) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(95)00048-8 · Cited by 85 · see citing works
Arterial Structure and Function After Recovery From the Metabolic Syndrome
Koskinen, J. M., Magnussen, C. G., Taittonen, L. M., Räsänen, L., Mikkilä, V., Laitinen, T. P., Rönnemaa, T., Kähönen, M. A. P., Viikari, J. S. A., Raitakari, O. T., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.894584 · Cited by 76 · see citing works
Anuurad, E., Chiem, A. T., Pearson, T. A., & Berglund, L. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2007.04.025 · Cited by 29 · see citing works
Obokata, M., Negishi, K., Ohyama, Y., Okada, H., Imai, K., & Kurabayashi, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0133884 · Cited by 28 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
El Khoudary, S. R., Aggarwal, B., Beckie, T. M., Hodis, H. N., Johnson, A. E., Langer, R. D., Limacher, M. C., Manson, J. E., Stefanick, M. L., Allison, M. A., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000912 · Cited by 1,219 · see citing works
Management of menopause: a view towards prevention
Lobo, R. A., & Gompel, A. (2022) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(21)00269-2 · Cited by 180 · see citing works
Metabolic health, menopause, and physical activity—a 4-year follow-up study
Hyvärinen, M., Juppi, H.-K., Taskinen, S., Karppinen, J., Karvinen, S., Tammelin, T., Kovanen, V., Aukee, P., Kujala, U., Rantalainen, T., et al. (2021) · International Journal of Obesity · doi:10.1038/s41366-021-01022-x · Cited by 57 · see citing works
Marlatt, K. L., Redman, L. M., Beyl, R. A., Smith, S. R., Champagne, C. M., Yi, F., & Lovejoy, J. C. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.09.051 · Cited by 54 · see citing works
Vine, D., Ghosh, M., Wang, T., & Bakal, J. (2024) · CJC Open · doi:10.1016/j.cjco.2023.12.010 · Cited by 53 · see citing works
Metabolic syndrome during female midlife: what are the risks?
Chedraui, P. A., & Pérez-López, F. R. (2019) · Climacteric · doi:10.1080/13697137.2018.1561666 · Cited by 33 · see citing works
Follicle-Stimulating Hormone Positively Associates with Metabolic Factors in Perimenopausal Women
Zhang, C., Zhao, M., Li, Z., & Song, Y. (2020) · International Journal of Endocrinology · doi:10.1155/2020/7024321 · Cited by 24 · see citing works
Physiologic and psychosocial changes of the menopause transition in US Latinas: a narrative review
Cortés, Y. I., Mărginean, V., & Berry, D. C. (2020) · Climacteric · doi:10.1080/13697137.2020.1834529 · Cited by 21 · see citing works
Peng, M. Q., Karvonen-Gutierrez, C. A., Herman, W. H., Mukherjee, B., & Park, S. K. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad033 · Cited by 19 · see citing works
Self-citationNapoleone, J. M., Boudreau, R. M., Lange‐Maia, B. S., Khoudary, S. R. E., Ylitalo, K. R., Kriska, A. M., Karvonen-Gutierrez, C. A., & Strotmeyer, E. S. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab188 · Cited by 15 · see citing works
Self-citationHarraqui, K., Oudghiri, D. E., Mrabti, H. N., Hannoun, Z., Lee, L., Assaggaf, H. M., Qasem, A. H., Goh, K. W., Ming, L. C., Tan, C. S., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20031739 · Cited by 12 · see citing works
Dickins, K. A., & Looby, S. E. D. (2020) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001650 · Cited by 12 · see citing works
Beydoun, H. A., Ng, T. K. S., Beydoun, M. A., Shadyab, A. H., Jung, S. Y., Costanian, C., Saquib, N., Ikramuddin, F. S., Pan, K., Zonderman, A. B., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.004 · Cited by 5 · see citing works
Nicolau, J., Anesto, J. B., Bonet, A., Félix-Jaume, J. J., & Gil, A. (2025) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2024.0124 · Cited by 4 · see citing works
Cha, B. (2020) · Journal of Korean Academy of Fundamentals of Nursing · doi:10.7739/jkafn.2020.27.3.310 · Cited by 4 · see citing works
Schneider-Matyka, D., Szkup, M., Owczarek, A. J., Stanisławska, M., Knyszyńska, A., Lubkowska, A., Grochans, E., & Jurczak, A. (2020) · Medicina · doi:10.3390/medicina56080384 · Cited by 3 · see citing works
Commentary on Indian menopause society guidelines
Paul, T., Cherian, K., & Kapoor, N. (2020) · Journal of Mid-life Health · doi:10.4103/jmh.jmh_153_20 · Cited by 3 · see citing works
Marapo, L., Matsela, L. M., Chabalala, M. E., & Towobola, O. A. P. (2025) · AJOG Global Reports · doi:10.1016/j.xagr.2025.100560 · Cited by 1 · see citing works
Priyankaa, Y., Prabhu, J. K., Kabilan, V. R., & Madhan, R. (2026) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2026.102334 · Cited by 1 · see citing works
Бериханова, Р. Р., Minenko, I. A., & Bondarev, S. (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-3804 · Cited by 1 · see citing works
МЕНОПАУЗАЛЬНИЙ МЕТАБОЛІЧНИЙ СИНДРОМ: ПОГЛЯД ЕНДОКРИНОЛОГА
Чернявська, І., & Mykytyuk, M. (2021) · PROBLEMS OF ENDOCRINE PATHOLOGY · doi:10.21856/j-pep.2021.2.16 · Cited by 1 · see citing works
Sex-Specific Thermoregulatory Effects of Estrogen Signaling in Reprimo Lineage Cells
Park, J. W., Cortes, L. R., Sandoval, N. P., Vree, A. R., Baron, A. G., Vranich, K. A., Fideles, H. J., Martinez, R. M., Dilday, E. A., Hansen, M. R., et al. (2025) · Endocrinology · doi:10.1210/endocr/bqaf177 · Cited by 1 · see citing works
Environmental factors and menopause
Andreeva, E. N., Sheremetyeva, E. V., & Grigoryan, O. R. (2020) · Russian Journal of Human Reproduction · doi:10.17116/repro20202604114 · Cited by 1 · see citing works
Jo, H., & Kang, Y.-H. (2021) · Journal of the Korea Society of Computer and Information · doi:10.9708/jksci.2021.26.01.201
Effect of Health-Related Behavior and Nutrition Intake on the Blood Lipids Levels
Lee, J.-E. (2023) · Current Research in Nutrition and Food Science Journal · doi:10.12944/crnfsj.11.1.15
Self-citationCherenack, E. M., Feaster, D. J., Kempf, M.-C., Collins, L. F., Floris-Moore, M., Chandran, A., Cohen, M. H., Philbin, M. M., Kassaye, S. G., Wilson, T. E., et al. (2026) · Journal of Health Psychology · doi:10.1177/13591053261436558
Exercise during perimenopause: a window of opportunity for cardiometabolic disease prevention
Salvadores, C. R., Kupraty, A. E., Rahmani, R., Kirkham, A. A., & Gillen, J. B. (2026) · Translational Exercise Biomedicine · doi:10.1515/teb-2026-0010
Managing the transition without hormones
Stute, P., Pavicic, E., Richina, S. F., & Thurston, R. C. (2026) · Climacteric · doi:10.1080/13697137.2026.2742071
- Authors
- Ward, E., Gold, E. B., Johnson, W. O., Ding, F., Chang, P.-Y., Song, P., El Khoudary, S. R., Karvonen-Gutierrez, C., Ylitalo, K. R., & Lee, J. S.
- Affiliations
- University of California, Irvine (US)
- University of California, Davis (US)
- Stanford Medicine (US)
- Santa Clara Valley Medical Center (US)
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
- University of Michigan (US)
- Baylor University (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Lee, Jennifer S
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-10-25
- Volume
- 104
- Issue
- 5
- Pages
- 1404-1412
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC6426833
- OpenAlex
- W2898331363
- Cited by
- 29
- References
- 23
- Citations by year
- 2026: 4 · 2025: 4 · 2023: 5 · 2022: 1 · 2021: 4 · 2020: 9 · 2019: 2
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (1R21AG040568)
- National Institute of Nursing Research
- Office of Research on Women’s Health
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- metabolic syndrome, perimenopause, middle-aged women, cardiometabolic risk, abdominal obesity, physical activity, energy intake, lifestyle factors, racial and ethnic differences, hypertension, dyslipidemia, fasting blood glucose
- MeSH terms
- Adult, Asian, Black or African American, Blood Glucose, Energy Intake, Female, Hispanic or Latino, Humans, Hypertension, Cholesterol, HDL, Longitudinal Studies, Menopause, Middle Aged, Prospective Studies, Triglycerides, United States, Cohort Studies, Exercise, Incidence, Proportional Hazards Models, Recovery of Function, Metabolic Syndrome, White People, Dyslipidemias, Waist Circumference, Obesity, Abdominal
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