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Lowering Cortisol and CVD Risk in Postmenopausal Women: A Pilot Study Using the Transcendental Meditation Program

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Unlike younger women, the risk of cardiovascular disease in older women matches or exceeds that of men. Excessive cortisol may play a role in this increased risk. Here we explore the possibility that the Transcendental Meditation (TM) program may reduce the cortisol response to a metabolic stressor as a way of reducing disease risk in older women. Data from 16 women who were long-term practitioners of transcendental meditation (mean = 23 y) were compared with data from 14 control women matched for age (mean = 75 y, range = 65-92 y). Data on demographics, disease symptoms, and psychological variables were collected, and cortisol response to a metabolic stressor (75 g of glucose, orally) was examined in saliva and urine. Pre-glucose levels of salivary cortisol were identical for the two groups. Post-glucose cortisol rose faster in the controls and was significantly higher than that in the TM women (P < 1 3 10(-4)). Urinary excretion of cortisol during this period was 3 times higher in controls than in the TM women (2.4 +/- 0.17 and 0.83 +/- 0.10 microg/h, respectively; P = 2 x 10(-4)). In addition, the number of months practicing transcendental meditation was inversely correlated with CVD risk factors. Lower cortisol response to metabolic challenge may reflect improved endocrine regulation relevant to the disease-preventing effects of transcendental meditation in older women.
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Ann. N.Y. Acad. Sci. 1032: 211–215 (2004). © 2004 New York Academy of Sciences.
doi: 10.1196/annals.1314.023
Lowering Cortisol and CVD Risk in
Postmenopausal Women
A Pilot Study Using the Transcendental Meditation
Program
KENNETH G. WALTON,a JEREMY Z. FIELDS, DEBRA K. LEVITSKY,
DWIGHT A. HARRIS, NIRMAL D. PUGH,b AND ROBERT H. SCHNEIDER
aInstitute for Natural Medicine and Prevention, College of Maharishi Consciousness-
Based Health Care, Maharishi University of Management, Fairfield, Iowa 52557, USA
bNational Center for Natural Products Research, School of Pharmacy,
University of Mississippi, Oxford, Mississippi 38655, USA
ABSTRACT: Unlike younger women, the risk of cardiovascular disease in older
women matches or exceeds that of men. Excessive cortisol may play a role in
this increased risk. Here we explore the possibility that the Transcendental
Meditation (TM) program may reduce the cortisol response to a metabolic
stressor as a way of reducing disease risk in older w omen. Da ta fro m 16 wome n
who were long-term practitioners of transcendental meditation (mean = 23 y)
were compared with data from 14 control women matched for age (mean =
75 y, range = 65-92 y). Data on demographics, disease symptoms, and psycho-
logical variables were collected, and cortisol response to a metabolic stressor
(75 g of glucose, orally) was examined in saliva and urine. Pre-glucose levels of
salivary cortisol were identical for the two groups. Post-glucose cortisol rose
faster in the controls and was significantly higher than that in the TM women
(P < 1 10-4). Urinary excretion of cortisol during this period was 3 times high-
er in controls than in the TM women (2.4 ± 0.17 and 0.83 ± 0.10 µg/h, respec-
tively; P = 2 10-4). In addition, the number of months practicing
transcendental meditation was inversely correlated with CVD risk factors.
Lower cortisol response to metabolic challenge may reflect improved endo-
crine regulation relevant to the disease-preventing effects of transcendental
meditation in older women.
KEYWORDS: cortisol; cardiovascular disease; menopause; meditation; meta-
bolic syndrome
INTRODUCTION
Cardiovascular disease (CVD) is primarily a disease of the elderly. In the United
States, by age 65, CVD is the major cause of death in women as it is in men.1,2 In
Address for correspondence: Kenneth G. Walton, PhD, 1000 N 4th St., FM 1005, Fairfield, IA
52557. Voice: 641-472-4600, ext. 111; fax: 641-472-4610.
kwalton@mvm.edu
212 ANNALS NEW YORK ACADEMY OF SCIENCES
women, the large increase in CVD risk that occurs during and after menopause is not
entirely due to declines of sex hormones, because hormone replacement therapy
does not remove CVD risk; in some cases it only adds to it.3,4
A more likely candidate for increased postmenopausal risk for CVD and CVD-
related mortality is increased stress or increased stress responsiveness.5–10 Increased
stress responsiveness after menopause has been observed in both cardiovascular and
neuroendocrine systems.9,11–13 Such stress-related alterations appear to be relevant
to the observed differences in hemodynamics, left ventricular structure, and night-
time blood pressure dipping between pre- and postmenopausal women.14,15 Evi-
dence for a deleterious influence of menopause on fat metabolism also exists.16–18
Increased visceral fat is particularly strongly associated with chronic stress, CVD,
and risk factors for CVD, including the cluster of risk factors identified as the “met-
abolic syndrome,”19,20 including three or more of the following: hyperinsulinemia,
hyperglycemia, abdominal obesity, hypertension, and hyperlipidemia.
Excessive levels of the stress-induced hormone cortisol may play a role in this
increased susceptibility to CVD in older women, and some natural medicine
approaches may prevent or reverse this chronic increase of cortisol (see Ref. 21 for
a review). To explore the possibility that such approaches can reduce cortisol
response to stress, we cross-sectionally examined the long-term effects of the Tran-
scendental Meditation program, a component of the traditional system of health care
known as Maharishi Consciousness-Based Health Care, previously reported to
reduce stress, cortisol, and CVD risk.21
METHODS
Data from 16 women (mean age 75 y) who had practiced the Transcendental
Meditation program long-term (mean 23 y) were compared with data from 14 con-
trol women, matched for age, who had practiced no systematic program for stress
reduction. For comparison, male subjects of the same age (10 Transcendental Med-
itation subjects and 11 controls) were also studied. Data on demographics, disease
symptoms, and psychological variables were collected, and cortisol response to a
metabolic stressor (75 g of glucose administered orally) was examined in saliva and
urine. Cortisol was analyzed by radioimmunoassay (Diagnostic Products Corp., Los
Angeles, CA) as previously published,22 with a coefficient of variation of 3.6%. Oth-
er measures used standardized test instruments and procedures.
The testing procedure was as follows. Subjects began arriving at 10:30 AM and
were asked to urinate in the toilet to empty their bladders. They recorded this time
as the starting time for urine collections. Between this time and the end of testing
(3 PM), all urine generated was collected in a single bottle for each subject, with the
last timed urination occurring as close to 3 PM as possible. At 11 AM, all subjects be-
gan salivary collections and filled out questionnaires. Urine and saliva samples were
stored frozen until assay. At 12 noon, subjects consumed 75 g of glucose in water
flavored with the juice of lemon or lime. Blood pressure measurements were con-
ducted throughout the period, with each subject being measured three times at least
15 min apart.
213WALTON et al.: CORTISOL AND CVD RISK AFTER MENOPAUSE
RESULTS
The control and Transcendental Meditation groups of women were not signifi-
cantly different on demographic and lifestyle variables (i.e., age, education, income,
exercise level, smoking, alcohol consumption, and weight) or family history of dis-
ease (i.e., CVD, cancer, and allergies). However, FIGURE 1 shows that the response
of salivary cortisol to the glucose bolus administered at 12 noon was significantly
different for the two groups of women (P = .0001, repeated measures ANOVA), with
the control group rising 7.5 times faster than the Transcendental Meditation group
between the 12:15 and 12:30 PM time points. By contrast, for the men, the control
group responded only weakly to glucose and was significantly less responsive than
the Transcendental Meditation group (not shown). In the Transcendental Meditation
subjects, the cortisol response to glucose was significant for the men and women’s
groups and was of similar magnitude and duration in men and women.
In women, the group differences in urinary excretion of cortisol over the 4-h
period were parallel to those in salivary cortisol. Control women had threefold great-
er cortisol excretion than did the Transcendental Meditation women (2.4 ± 0.17 and
0.83 ± 0.10 µg/h, respectively; P = 2 × 104). The initial rate of glucose-induced rise
in salivary cortisol, as shown by the difference between the 12:15 and 12:30 time
points, correlated highly with urinary cortisol excretion across all women (Pearson
correlation coefficient: r = .82; n = 29, P <5 × 104). On the other hand, cortisol ex-
cretion rates in men appeared not to correlate with the relative increases in salivary
cortisol. Control men had 1.5-fold greater urinary cortisol excretion than did Tran-
scendental Meditation men (1.89 ± .30 vs. 1.26 ± .14 µg/h, respectively; P = .06) de-
spite the higher salivary cortisol response to glucose in the Transcendental
Meditation men than the control men.
Two other correlations were noteworthy. In the Transcendental Meditation group
of women, the number of months practicing the technique correlated negatively with
cortisol excretion (r = .63, P = .015). The number of months practicing the tech-
nique also correlated negatively with the number and severity of symptoms of heart
disease, as determined by a nine-item questionnaire (r = .91; P = 6 × 106) .
FIGURE 1. Response of salivary cortisol to oral glucose in postmenopausal women.
The statistical comparison is for those points after consumption of glucose, that is, from
12:15 onward, covarying for the 12 noon data point.
214 ANNALS NEW YORK ACADEMY OF SCIENCES
DISCUSSION
These findings suggest that long-term practice of the Transcendental Meditation
program reduces the response of the hypothalamic-pituitary-adrenocortical (HPA)
axis to a bolus of glucose in postmenopausal women. Studies in younger subjects,
both men and women, also support a normalizing effect of this program on the HPA
axis.22–24 The present findings are the first to suggest that a meditation technique
can reduce the effects of a metabolic stressor on the HPA axis. Because elevated cor-
tisol may be a causal factor in producing the metabolic syndrome, the apparent abil-
ity of the Transcendental Meditation program to reduce cortisol response to a
metabolic stressor may play a role in the preventive effects of this program on CVD
and coronary disease.25
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Background Altered cortisol dynamics have been associated with increased risk for chronic health problems among midlife and older adults (≥ 45 years of age). Yet, studies investigating the impact of health behavior interventions on cortisol activity in this age group are limited. Objective and Methods The current study examined whether 48 midlife and older adults (50% family caregivers, 69% women) randomized to one of four telephone-based health behavior interventions (stress management (SM), exercise (EX), nutrition (NUT), or exercise plus nutrition (EX+NUT)) showed improvements in their perceived stress, mood, and cortisol dynamics at 4 months post-intervention. Participants collected four salivary cortisol samples (waking, 30 min after waking, 4 p.m., and bedtime) across two collection days at baseline and at 4 months post-intervention to assess for total cortisol, cortisol awakening response (CAR), and diurnal cortisol slope. ResultsParticipants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention. Participants in EX showed lower levels of perceived stress, depression, and anxiety compared with those in NUT or SM. Finally, participants in NUT showed a greater diurnal decline in cortisol and lower levels of anxiety compared with those in SM. Conclusions These findings provide support for the efficacy of telephone-based, health behavior interventions in improving different stress outcomes among chronically stressed midlife and older adults and suggest the need to test the longer-term effects of these interventions for improving health outcomes in this population.
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Objective Cardiometabolic diseases are the number one cause of mortality, accounting for over one third of all deaths in the US. Cardiometabolic risk further increases with psychosocial stress exposure and during menopausal transition in women. Because disease risk and stress burden are associated with aberrant immune signaling, we hypothesized that responses of interleukin-6 (IL-6) to psychosocial stress may predict longitudinal cardiometabolic outcomes in perimenopausal women. Methods We conducted post hoc analyses in 151 perimenopausal or early postmenopausal women participants in a previously completed study. At study onset, participants underwent the Trier Social Stress Test (TSST), and plasma IL-6 was measured repeatedly before and during the one hour post-TSST. Subsequently, participants were randomly assigned to either hormonal treatment (HT) or placebo and followed for 12 months to determine longitudinal changes in cardiometabolic biomarkers. Results Greater IL-6 reactivity to stress, measured with baseline-adjusted area-under-the-curve (AUCadj), predicted 12-month decrease in flow-mediated dilatation of the brachial artery (p=0.0005), a measure of endothelial-dependent vascular function, but not in endothelial-independent function measured with nitroglycerin-mediated dilatation (p=0.17). Greater baseline IL-6 levels predicted 12-month increase in insulin resistance based on the HOMA-IR score (p=0.0045) and in the number of criteria met for metabolic syndrome (p=0.0008). These predictions were not moderated by HT. Conclusions Greater baseline IL-6 levels as well as its reactivity to stress may predict worsening in distinct cardiometabolic biomarkers as women transition to menopause. IL-6 reactivity predicts decline in endothelial-dependent vascular function, whereas baseline IL-6 presages accumulation of metabolic risk.
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Stress has been implicated in both somatic and mental disorders. The mechanisms by which stress leads to poor health are largely unknown. However, studies in animals suggest that chronic stress causes high basal cortisol and low cortisol response to acute stressors and that such changes may contribute to disease. Previous studies of the Transcendental Mediation® (TM) technique as a possible means of countering effects of stress have reported altered levels of several hormones both during the practice and longitudinally after regular practice of this technique. In this prospective, random assignment study, changes in baseline levels and acute responses to laboratory stressors were examined for four hormones—cortisol, growth hormone, thyroid-stimulating hormone and testosterone—before and after 4 months of either the TM technique or a stress education control condition. At pre- and post-test, blood was withdrawn continuously through an indwelling catheter, and plasma or serum samples were frozen for later analysis by radioimmunoassay. The results showed significantly different changes for the two groups, or trends toward significance, for each hormone over the 4 months. In the TM group, but not in the controls, basal cortisol level and average cortisol across the stress session decreased from pre- to post-test. Cortisol responsiveness to stressors, however, increased in the TM group compared to controls. The baselines and/or stress responsiveness for TSH and GH changed in opposite directions for the groups, as did the testosterone baseline. Overall, the cortisol and testosterone results appear to support previous data suggesting that repeated practice of the TM technique reverses effects of chronic stress significant for health. The observed group difference in the change of GH regulation may derive from the cortisol differences, while the TSH results are not related easily to earlier findings on the effects of chronic stress.
Article
Psychosocial characteristics may be associated with an increased risk of coronary heart disease (CHD). Whether hostility predicts recurrent coronary events is unknown. A total of 792 women in the Heart and Estrogen/ progestin Replacement Study (HERS) were evaluated prospectively to determine the role of hostility as a risk factor for secondary CHD events (nonfatal myocardial infarction and CHD death). The mean age of study participants was 67 years, and the average length of follow-up was 4.1 years. The study was conducted between 1993 and 1998, and all study sites were in the United States. High Cook-Medley hostility scores were associated with greater body mass index (p = 0.01) and higher levels of serum triglycerides (p = 0.05), and they were inversely associated with high density lipoprotein cholesterol (p = 0.04), self-rated general health (p < 0.001), age (p = 0.05), and education (p = 0.001). Compared with women in the lowest hostility score quartile, women in the highest quartile were twice as likely to have had a myocardial infarction (relative hazard = 2.03, 95% confidence interval: 1.02, 4.01). The relation between hostility and CHD events was not mediated or confounded by the biologic, behavioral, and social risk factors studied. In this study, hostility was found to be an independent risk factor for recurrent CHD events in postmenopausal women. coronary disease; hostility; postmenopause; risk factors; women Abbreviations: CHD, coronary heart disease; CI, confidence interval; HERS, Heart and Estrogen/progestin Replacement Study; HMG-CoA, 3-hydroxy-3-methylglutaryl coenzyme A; RH, relative hazard. Epidemiologic evidence suggests that psychological behaviors may be associated with coronary heart disease (CHD) risk. Hostility, a construct that includes cynicism, anger, mistrust, and aggression (1), has been correlated with carotid atherosclerosis (2, 3), angiographic coronary artery disease (4, 5), exercise-induced ischemia (6), and restenosis after mechanical revascularization in women (7). High hostility scores have also been associated with an increased risk of nonfatal myocardial infarction among older women (8, 9) but not with fatal events in patients with documented
Article
Objective: To determine the changes in cardiovascular risk factors and psychological and physical symptoms that occur during the perimenopause.Design: Cohort study of 541 healthy middle-aged premenopausal women followed up through the menopause.Setting: General community.Participants: After a baseline evaluation taken at study entry, 152 women ceased menstruating for 3 months (not due to surgery) and were not using hormone replacement therapy, and were reevaluated in a similar protocol (perimenopausal examination); 105 of the 152 were evaluated a third time when they had ceased menstruating for 12 months and were not using hormone replacement therapy (postmenopausal examination). One hundred nine premenopausal women who were repeatedly tested constituted a comparison group.Main Outcome Measures: Levels of lipids and lipoproteins, triglycerides, fasting glucose and insulin, blood pressure, weight, height, and standardized measures of psychological symptoms.Results: Women who became perimenopausal showed increased levels of cardiovascular risk factors, which were similar in magnitude to those experienced by the comparison group of premenopausal women. Perimenopausal women reported a greater number of symptoms, especially hot flashes, cold sweats, joint pain, aches in the skull and/or neck, and being forgetful; reports of hot flashes at the perimenopausal examination were associated with low concentrations of serum estrogens. Menopausal status was not associated with depressive symptoms. Perimenopausal women who became postmenopausal showed a decline in the level of high-density lipoprotein-2 cholesterol (means, 0.53 to 0.43 mmol/L [20.6 to 16.7 mg/dL]) and a gradual increase in the level of low-density lipoprotein cholesterol (means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereas symptom reporting declined.Conclusions: During mid-life, women experience adverse changes in cardiovascular risk factors and a temporary increase in total number of reported symptoms, with no change in depression. Preventive efforts to reduce the menopause-induced increase in cardiovascular risk factors should begin early in the menopausal transition.(Arch Intern Med. 1994;154:2349-2355)
Article
Context Although postmenopausal hormone replacement therapy (HRT) is widely used in the United States, new evidence about its benefits and harms requires reconsideration of its use for the primary prevention of chronic conditions.Objective To assess the benefits and harms of HRT for the primary prevention of cardiovascular disease, thromboembolism, osteoporosis, cancer, dementia, and cholecystitis by reviewing the literature, conducting meta-analyses, and calculating outcome rates.Data Sources All relevant English-language studies were identified in MEDLINE (1966-2001), HealthSTAR (1975-2001), Cochrane Library databases, and reference lists of key articles. Recent results of the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS) are included for reported outcomes.Study Selection and Data Extraction We used all published studies of HRT if they contained a comparison group of HRT nonusers and reported data relating to HRT use and clinical outcomes of interest. Studies were excluded if the population was selected according to prior events or presence of conditions associated with higher risks for targeted outcomes.Data Synthesis Meta-analyses of observational studies indicated summary relative risks (RRs) for coronary heart disease (CHD) incidence and mortality that were significantly reduced among current HRT users only, although risk for incidence was not reduced when only studies that controlled for socioeconomic status were included. The WHI reported increased CHD events (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.02-1.63). Stroke incidence but not mortality was significantly increased among HRT users in the meta-analysis and the WHI. The meta-analysis indicated that risk was significantly elevated for thromboembolic stroke (RR, 1.20; 95% CI, 1.01-1.40) but not subarachnoid or intracerebral stroke. Risk of venous thromboembolism among current HRT users was increased overall (RR, 2.14; 95% CI, 1.64-2.81) and was highest during the first year of use (RR, 3.49; 95% CI, 2.33-5.59) according to a meta-analysis of 12 studies. Protection against osteoporotic fractures is supported by a meta-analysis of 22 estrogen trials, cohort studies, results of the WHI, and trials with bone density outcomes. Current estrogen users have an increased risk of breast cancer that increases with duration of use. Endometrial cancer incidence, but not mortality, is increased with unopposed estrogen use but not with estrogen with progestin. A meta-analysis of 18 observational studies showed a 20% reduction in colon cancer incidence among women who had ever used HRT (RR, 0.80; 95% CI, 0.74-0.86), a finding supported by the WHI. Women symptomatic from menopause had improvement in certain aspects of cognition. Current studies of estrogen and dementia are not definitive. In a cohort study, current HRT users had an age-adjusted RR for cholecystitis of 1.8 (95% CI, 1.6-2.0), increasing to 2.5 (95% CI, 2.0-2.9) after 5 years of use.Conclusions Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain. Harms include CHD, stroke, thromboembolic events, breast cancer with 5 or more years of use, and cholecystitis. Approximately 38% of postmenopausal women in the United States in 1995 used hormone replacement therapy (HRT), estrogen with or without progestin, to treat symptoms of menopause and prevent chronic conditions such as cardiovascular disease and osteoporosis.1 Although treatment of symptoms of menopause, such as hot flashes and urogenital atrophy, among others, is a common indication for short-term use, potential preventive effects of HRT on long-term health outcomes have become an increasingly important consideration. In 1996, the second US Preventive Services Task Force (USPSTF) determined that there was insufficient evidence to recommend for or against HRT for all women but thought that individual decisions should be based on patient risk factors, an understanding of the probable benefits and harms, and personal preferences.2 Many studies have been published since these recommendations were released, including the first report from the Women's Health Initiative (WHI),3 a large randomized primary prevention trial, and the Heart and Estrogen/progestin Replacement Study (HERS),4 a secondary prevention trial reporting multiple outcomes.4- 6 This review was initiated to aid the current USPSTF in making new recommendations that will be released this fall. The focus of the USPSTF is to develop recommendations on screening, counseling, and chemoprophylaxis for asymptomatic populations. We conducted systematic searches of the literature on postmenopausal HRT use and its effectiveness for primary prevention of chronic conditions and its effects on harmful outcomes. Treatment of symptoms of menopause and use of HRT for treatment of a preexisting condition are outside the scope of the USPSTF recommendation, and this literature was not reviewed. We focused on primary outcomes such as myocardial infarction (MI) rather than intermediate outcomes such as lipid levels. To provide an overview of benefits and harms, we conducted several meta-analyses and used these results, as well as those from selected published articles, to calculate numbers of events prevented or caused by HRT in a hypothetical population of postmenopausal women.
Article
We studied acute plasma cortisol and testosterone concentration changes during the practice known as "transcendental meditation" (TM) and during control rest. Three groups of normal, young adult volunteers were studied: a group of controls, these same controls restudied as practitioners after 3 to 4 months of TM practice, and a group of long-term, regular TM practitioners (3 to 5 years of practice). No change was found in controls during rest. Cortisol declined, but not significantly, in restudied controls, while cortisol decreased significantly in long-term practitioners during meditation and remained somewhat low afterward. No change in testerone concentration was noted during either rest or TM. Apparently, the practice of TM becomes associated with psychophysiologic response(s) which acutely inhibit pituitary-adrenal activity.
Article
Our purpose was to determine the pattern of reactivity to stress in premenopausal and postmenopausal women and to assess the effects of estrogen. A behavioral stress test was given to premenopausal (n = 13) and postmenopausal women (n = 36). Biophysical and neuroendocrine responses were measured during and on completion of the stress test. The postmenopausal women were then randomized to placebo or transdermal estradiol treatment for 6 weeks, at which time another behavioral stress test was given. Stress reactivity to math and speech tasks elicited significantly greater systolic blood pressure responses in postmenopausal women compared with premenopausal women (p < 0.05). On retesting, significant biophysical responses that were present during the initial stress testing were still present (p < 0.05) in the placebo group but were blunted with estrogen treatment. Plasma corticotropin, cortisol, androstenedione, and norepinephrine increased during testing to a similar degree in premenopausal and postmenopausal women; this response was maintained after placebo treatment. Postmenopausal women treated with estrogen had blunted responses. Significant differences in responses to psychologic stress exist in premenopausal and postmenopausal women. The lack of adaptation may account in part for the increased risk of cardiovascular disease in postmenopausal women. Estrogen appears to blunt the stress-induced response.
Article
Middle-aged (45-51 years) women performed four tasks while their heart rate, blood pressure, and plasma catecholamines were measured. The tasks were serial subtraction, mirror image tracing, speech, and postural tilt. The speech task was considered to be particularly relevant to women because of its emphasis on social skills. Fifteen premenopausal women reported menstruating regularly and were tested in the early follicular phase. Sixteen postmenopausal women reported not menstruating for at least 12 months and their hormonal status was verified by serum levels of follicle-stimulating hormone. Results showed that postmenopausal women exhibited greater increases from baseline in heart rate during all tasks, relative to premenopausal women, with a particularly pronounced increase during the speech task. Postmenopausal women exhibited greater increases from baseline in systolic blood pressure and epinephrine, relative to premenopausal women, during the speech task only. Explanations for the stressor-specific effect of menopausal status were discussed. The results suggest that reproductive hormones may interact with stressor characteristics to determine middle-aged women's physiological responses to stress.
Article
To determine the changes in cardiovascular risk factors and psychological and physical symptoms that occur during the perimenopause. Cohort study of 541 healthy middle-aged premenopausal women followed up through the menopause. General community. After a baseline evaluation taken at study entry, 152 women ceased menstruating for 3 months (not due to surgery) and were not using hormone replacement therapy, and were reevaluated in a similar protocol (perimenopausal examination); 105 of the 152 were evaluated a third time when they had ceased menstruating for 12 months and were not using hormone replacement therapy (postmenopausal examination). One hundred nine premenopausal women who were repeatedly tested constituted a comparison group. Levels of lipids and lipoproteins, triglycerides, fasting glucose and insulin, blood pressure, weight, height, and standardized measures of psychological symptoms. Women who became perimenopausal showed increased levels of cardiovascular risk factors, which were similar in magnitude to those experienced by the comparison group of premenopausal women. Perimenopausal women reported a greater number of symptoms, especially hot flashes, cold sweats, joint pain, aches in the skull and/or neck, and being forgetful; reports of hot flashes at the perimenopausal examination were associated with low concentrations of serum estrogens. Menopausal status was not associated with depressive symptoms. Perimenopausal women who became postmenopausal showed a decline in the level of high-density lipoprotein-2-cholesterol (means, 0.53 to 0.43 mmol/L [20.6 to 16.7 mg/dL]) and a gradual increase in the level of low-density lipoprotein cholesterol (means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereas symptom reporting declined. During mid-life, women experience adverse changes in cardiovascular risk factors and a temporary increase in total number of reported symptoms, with no change in depression. Preventive efforts to reduce the menopause-induced increase in cardiovascular risk factors should begin early in the menopausal transition.
Article
Frequent and large cardiovascular and neuroendocrine responses to psychological stress are thought to enhance an individual's risk for cardiovascular diseases. Preliminary data suggest that levels of reproductive hormones affect the magnitude of stress responses, perhaps contributing to the protective effect of ovarian hormones on premenopausal women's rates of coronary heart disease. Healthy middle-aged men and premenopausal and postmenopausal women performed a series of standardized mental and physical challenges while blood pressure, heart rate, plasma catecholamines, lipids, and lipoproteins were measured. Subjects then wore an ambulatory blood pressure monitor during two consecutive workdays. Results showed that postmenopausal women had larger mean +/- SEM stress-induced increases in systolic blood pressure (24.7 +/- 2.2 mm Hg) and diastolic blood pressure (14.3 +/- 1.0 mm Hg) compared with either premenopausal women (16.9 +/- 1.3 and 10.2 +/- 0.9 mm Hg) or men (17.7 +/- 1.5 and 10.9 +/- 1.1 mm Hg, respectively). Postmenopausal women and men had higher mean +/- SEM ambulatory diastolic blood pressure levels (75.5 +/- 3.2 and 76.4 +/- 1.8 mm Hg) than did premenopausal women (69.9 +/- 2.2 mm Hg). Large blood pressure responses during public speaking were associated with high cholesterol levels and low educational attainment. Menopause is associated with enhanced stress-induced cardiovascular responses and elevated ambulatory blood pressure during the workday. These effects may contribute to the risk of cardiovascular morbidity and mortality after the menopause.
Article
Coronary heart disease has traditionally been considered a problem which predominantly affects men—its extent and poor prognosis in women have only recently been identified. As shown in the Framingham study,1 women are more likely than men to die after myocardial infarction; this is now also evident after coronary artery bypass graft surgery and coronary angioplasty. However, the prognosis is currently also influenced by access to coronary diagnostic procedures and treatments, which may in turn be affected by factors such as women's and their doctors' decisions about diagnostic procedures and treatments, by the allocation of health care resources, and by society's perceptions of the importance of coronary heart disease in women. Coronary heart disease is more dependent on age in women than in men: women are usually 10 years older than men when any coronary manifestations first appear, and myocardial infarction occurs as much as 20 years later.1 One in 8 or 9 American women aged 45-64 years has clinical evidence of coronary heart disease and this increases to 1 in 3 in women older than 65 years (fig 1). Coronary heart disease is the leading cause of death in women in the United States; it is responsible for over 250 000 deaths annually (fig 2).2 With the aging of the population, more women than men now die of coronary heart disease each year in the United States. A white postmenopausal woman in the United States is 10 times more likely to die of heart disease than of breast cancer.3 But most women do not understand the coronary threat. Studies show that women do not usually list heart disease among the health problems they consider most important.4 5 Morbidity from coronary heart disease in older women is also considerable; 36% of American women aged 55-64 …