Abstract 16020: Narrowing Sex Differences in Lipoprotein Cholesterol Subclasses Following Menopause: Insights From the Very Large Database of Lipids (VLDL-10B)
Introduction: Women have a decreased risk of atherosclerotic cardiovascular disease relative to men up until mid-life, when the gap begins to close subsequent to menopause. However, sex differences throughout life in non-HDL-C, HDL-C, and lipoprotein subclasses are incompletely characterized.
Hypothesis: We hypothesized that the lipid profile of women becomes less favorable compared to men after menopause.
Methods: This Very Large Database of Lipids 10B (VLDL 10B) study examined 1,350,908 records of subjects clinically referred from 2009 to 2011 for advanced lipoprotein testing by ultracentrifugation (Atherotech, Birmingham, AL). By sex, we determined the median, 25th and 75th percentiles. Ratio variables were created for density subclasses of HDL-C, LDL-C, and VLDL-C.
Results: Men show higher non-HDL-C than women for decades 3 to 5 (greatest difference in decade 4: 150 mg/dL in men vs 134 mg/dL in women); however, women consistently have greater median values after menopause (decade 9: 128 mg/dL in women vs 112 mg/dL in men). After menopause, women experience an increase in total LDL-C (14% from decade four to six), primarily driven by a 16% increase in denser LDL-C subfractions. Total HDL-C is unchanged for both sexes but men show a 27% increase in HDL2-C while women experience a 9% increase. HDL3-C is unchanged in men but decreases 19% in women. Women have more buoyant HDL-C and LDL-C phenotypes throughout life, but the gap closes with advancing age. In contrast, women have a generally denser VLDL-C phenotype leading into mid-life, and then the gap progressively closes after menopause, until the VLDL-C density phenotype approximates that of men by the 7th to 8th decade of life.
Conclusion: The narrowing of the cardiovascular disease risk sex differential after middle age may be partly attributed to an increase in total atherogenic lipoprotein cholesterol burden in women and a simultaneous shift towards the lipoprotein phenotype characteristic of men.
- © 2013 by American Heart Association, Inc.