Women’s Health
Understanding the dynamic relationship between LDL-C and statin therapy through the menopause transition: A time-varying Bayesian analysis of the Study of Women’s Health Across the Nation James Matuk* James Matuk Matuk Matuk Matuk Matuk Matuk Matuk University of Pittsburgh
Background: Low-density lipoprotein cholesterol (LDL-C) increases rapidly during the menopause transition (MT), which is linked to higher cardiovascular disease (CVD) risk. This makes the MT a critical prevention window for initiating lipid-lowering medications such as statins. We investigated the dynamic relationship between timing of statin initiation relative to the final menstrual period (FMP) and longitudinally measured LDL-C, hypothesizing that earlier initiation reduces the MT related increase in LDL-C compared to later initiation.
Methods: We used data from the Study of Women’s Health Across the Nation, a multi-site, multi-racial/ethnic cohort that follows women through the MT to document its health sequelae. We included participants with at least three LDL-C measurements over 18 years, on average, centered on the FMP. We employed a longitudinal Bayesian time-varying coefficient mixed model to flexibly capture MT associated changes in LDL-C and the dynamic effect of statin use.
Results: The 2676 participants’ average age was 46.5 years (2.7 SD) at baseline, 52.4 years (2.8 SD) at the FMP, where 45.9% had an imputed FMP age and 36.8% eventually initiated statins. Our model inferred that later statin initiation resulted in a faster rate of decline in LDL-C levels. However, women initiating statins before the FMP reached lower LDL-C levels earlier compared to women initiating later in life. Eventually, the LDL-C levels of women starting statins prior to the FMP were comparable to those initiating after the FMP (Figure panel A). This model also enabled prediction of how statin initiation prior to FMP could dramatically alter one’s LDL-C trajectory (Figure panel B).
Conclusion: Our findings suggest that perimenopause is a crucial, women-specific period in lipid screening and clinical decision-making, and could extend current guidelines. Future research should determine if early MT initiation of lipid-lowering medication reduces the risk of future CVD events.
Funding Acknowledgment: The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720). The content of this article abstract is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH
