Associations between menopause, cardiac remodeling, and diastolic function: the CARDIA study

Wendy Ying, Wendy S. Post, Erin D. Michos, Vinita Subramanya, Chiadi E. Ndumele, Pamela Ouyang, Bharath Ambale-Venkatesh, Henrique Doria De Vasconcellos, Chike C. Nwabuo, Pamela J. Schreiner, Cora E. Lewis, Jared Reis, Donald Lloyd-Jones, Stephen Sidney, Joao A.C. Lima, Dhananjay Vaidya

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Heart failure with preserved ejection fraction (HFpEF) affects more women than men. Menopause may influence HFpEF development in women. We assessed cross-sectional and longitudinal associations between menopause and echocardiographic measures of left ventricular (LV) function and cardiac remodeling. METHODS: We studied 1,723 women with available echo data from at least two of: year 5 (Y5) (1990-1991), Y25 (2010-2011), or Y30 (2015-2016) in the Coronary Artery Risk Development in Young Adults study. Cardiac structure and function were measured using 2D and Doppler echocardiography. Cross-sectional associations between menopausal status and repeated echo measures at Y25 and Y30 were analyzed using linear mixed models. Two-segmented models were used to compare longitudinal changes in echocardiographic measures in the premenopausal period to changes in the postmenopausal period. RESULTS: Mean ± SD age (years) at enrollment was 27 ± 3 in those with menopause by Y25, 25 ± 3 in those with menopause between Y25 and Y30, and 21 ± 3 in those premenopausal at Y30. There were no significant differences in race, body mass index, systolic blood pressure, or diabetes between the groups. Postmenopausal women had higher early diastolic mitral inflow (E) to annular (e') velocity ratio than premenopausal after adjusting for demographics and risk factors (P < 0.05). Menopause was associated with relative increases in the rates of change in LV mass and left atrial volume, even after adjustment. Change in E/e' ratio was similar before and after menopause. CONCLUSIONS: Menopause is associated cross-sectionally with worse diastolic function and longitudinally with adverse LV and left atrial remodeling. This may contribute to the increased HFpEF risk in postmenopausal women.

Original languageEnglish (US)
Pages (from-to)1166-1175
Number of pages10
JournalMenopause (New York, N.Y.)
Issue number10
StatePublished - Jun 14 2021

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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