Atherogenic Indices and Cardiovascular Risk in Post-Menopausal Women: A Comparative Study of Natural Versus Surgical Menopause
Main Article Content
Keywords
Post-menopause, lipid, atherogenic indices, cardiovascular risk score
Abstract
Background: Menopause is associated with an increased risk of cardiovascular disease (CVD) due to changes in lipid metabolism. The study objective is to compare lipid profile, atherogenic indices, and cardiovascular risk in women with surgical versus natural menopause, and to assess their correlation with Framingham Risk Score (FRS).
Methodology: This observational study included 120 postmenopausal women aged 40–65 years (natural menopause, n=98; surgical menopause, n=22). Demographic and anthropometric data, as well as blood samples, were collected. Lipid profile, atherogenic indices, and FRS were calculated and compared between groups using appropriate statistical analyses.
Results: Atherogenic indices were elevated in the surgical menopause group(p=0.000) versus those with natural menopause. FRS analysis showed 50% of surgical menopause cases had high cardiovascular risk (>20%) compared to 7.2% in natural menopause. Positive correlations existed between FRS and lipid parameters, including total cholesterol (r = 0.513, p < 0.000), non-HDL cholesterol (r = 0.569, p < 0.000), triglycerides (r = 0.235, p = 0.010), CRI I (r = 0.661, p < 0.001), CRI II (r = 0.319, p < 0.001), and AC (r = 0.381, p < 0.001).
Conclusion: Surgical menopause is linked to higher cardiovascular disease risk compared to natural menopause. The strong correlation of lipid ratios with FRS in the present study reinforces their potential utility as practical adjuncts to established risk prediction tools. These findings highlight the importance of menopause type in CVD risk assessment and the need for monitoring women undergoing surgical menopause.
References
1. Dosi R, Bhatt N, Shah P, Patell R. Cardiovascular disease and menopause. J of Clin Diagn Res. 2014;8(2):62–64. http://doi.org/10.7860/JCDR/2014/6457.4009
2. Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA; American Heart Association Cardiovascular Disease and Stroke in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on High Bloo. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey. Circulation.2013;127(11):1254-e29. http://doi.org/10.1161/CIR.0b013e318287cf2f
3. Lerner D J, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J.1986;111(2):383–390. http://doi.org/10.1016/0002-8703(86)90155-9
4. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association.Circulation.2020;142(25):e506–e532.
http://doi.org/ 10.1161/CIR.0000000000000912
5. Matsuura Y, Kanter JE, Bornfeldt KE. Highlighting residual atherosclerotic cardiovascular disease risk. Arterioscler Thromb Vasc Biol.2019;39(1):e1–e9. http://doi.org/ 10.1161/ATVBAHA.118.311999
6. Sheng G, Kuang M, Yang R, Zhong Y, Zhang S, Zou Y. Evaluation of the value of conventional and unconventional lipid parameters for predicting the risk of diabetes in a non-diabetic population. J Transl Med.2022;20(1):266. http://doi.org/ 10.1186/s12967-022-03470-z
7. EUGenMed Cardiovascular Clinical Study Group; Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A et al. Gender in cardiovascular diseases:impact on clinical manifestations, management, and outcomes. Eur Heart J 2016;37(1):24-34. http://doi.org:10.1093/eurheartj/ehv598
8. Ingelsson E, Lundholm C, Johansson AL, Altman D. Hysterectomy and risk of cardiovascular disease: A population-based cohort study. European Heart Journal 2011;32(6):745–750. http:// doi.org:10.1093/eurheartj/ehq477
9. Howard BV, Kuller L, Langer R, Manson JE, Allen C, Assaf A et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the women's health initiative observational study. Circulation. 2005;111 (12):1462–1470. http://doi.org:10.1161/01.CIR.0000159344.21672.FD
10. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: Identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril.1987;47(1):94–100. http://doi.org:10.1016/s0015-0282(16)49942-5
11. Abbas SZ, Sangawan V, Das A, Pandey AK. Assessment of cardiovascular risk in natural and surgical menopause. Indian J of Endocrinol and Metab. 2018 ;22(2):223-228. http://doi:10.4103/ijem.IJEM_620_17
12. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW et al. Executive summary of the stages of reproductive aging workshop +10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97:1159-68. http://doi.org:10.1210/jc.2011-3362
13. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual.Champaign Illionois,Human Kinetics books.1988;55-70.
14. Hernandez-Vila E. A review of the JNC 8 blood pressure guideline.Tex Heart Inst J.2015;42(3):226-8. http://doi.org:10.14503/THIJ-15-5067
15. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.
16. Virani SS. Non-HDL cholesterol as a metric of good quality of care: opportunities and challenges. Tex Heart Inst J.2011;38(2):160-162.
17. Lepor NE, Vogel RE; National Cholesterol Education Program Adult Treatment Panel III. Summary of the third report of the National Cholesterol Education Program Adult Treatment Panel III. Rev Cardiovasc Med. 2001;2(3):160-165.
18. Sasikala T, Goswami K. Castelli risk index-1 and atherogenic coefficient are better predictors of cardiometabolic risk in patients with hypothyroidism. Int J Clin Biochem Res. 2020;7(2):254-259. https://doi.org/10.18231/j.ijcbr.2020.055
19. Zhou H, Zhang C, Ni J, Han X. Prevalence of cardiovascular risk factors in non-menopausal and postmenopausal inpatients with type 2 diabetes mellitus in China. BMC Endocr Disord.2019;19(1):98. https://doi.org/:10.1186/s12902-019-0427-7
20. Demir O, Ozalp M, Sal H, Aran T, Osmanağaoğlu MA. The relationship of menopausal symptoms with the type of menopause and lipid levels. Prz Menopauzalny. 2020 ;19(1):6-10. https://doi.org/:10.5114/pm.2020.95300
21. Dąbrowska-Galas M, Dąbrowska J, Ptaszkowski K, Plinta R. High Physical Activity Level May Reduce Menopausal Symptoms. Medicina (Kaunas). 2019;55(8):466. https://doi.org/:10.3390/medicina55080466
22. Mahajan N, Kumar D, Fareed P. Comparison of menopausal symptoms and quality of life after natural and surgical menopause. Int J of Sci Stud. 2016;3(11):74–77. https://doi.org/: 10.17354/ijss/2016/60
23. Ozdemir S, Celik C, Gokemli H, Kiyici A, Kaya B. Compared effects of surgical and natural menopause on climacteric symptoms, osteoporosis, and metabolic syndrome. Int J Gynaecol Obstet.2009;106(1):57-61. https://doi.org/: 10.1016/j.ijgo.2009.03.016
24. de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJ, Broekmans FJ, Van der Schouw YT. Erratum to: Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med. 2017;15(1):74. https://doi.org/: 10.1186/s12916-017-0841-5
25. Price MA, Alvarado BE, Rosendaal NTA, Câmara SMA, Pirkle CM, Velez MP. Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging. Menopause. 2021 ;28(5):484-490.
https://doi.org/: 10.1097/GME.0000000000001729
26. van Beresteyn EC, Hof MA v t, De Waard H. Contributions of ovarian failure and aging to blood pressure in normotensive perimenopausal women: a mixed longitudinal study. Am J Epidemiol.1989;129(5):947–955.
https://doi.org/: 10.1093/oxfordjournals.aje.a115227
27. Paul J, Khanam RA, Mirza TT, Saha MK, Halim MA,Basher MS et al. Lipid profile status in natural and surgical menopausal women: a comparative study. Mymensingh Med J.2020;29(2):254-262.
28. Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid changes during the menopause transition in relation to age and weight: The study of women’s health across the nation. Am J Epidemiol.2009;169 (11):1352–1361. https://doi.org/: 10.1093/aje/kwp043
29. Zago V, Sanguinetti S, Brites F, Berg G, Verona J, Basilio F et al. Impaired high density lipoprotein antioxidant activity in healthy postmenopausal women. Atherosclerosis.2004;177(1):203–210
https://doi.org/: 10.1016/j.atherosclerosis.2004.07.011
30. Zhou JL, Lin SQ, Shen Y, Chen Y, Zhang Y, Chen FL. Serum lipid profile changes during the menopausal transition in Chinese women: A community-based cohort study. Menopause 2010;17(5):997–1003.
https://doi.org/: 10.1097/gme.0b013e3181dbdc30
31. Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: Study of Women’s Health Across the Nation. Menopause 2009;16(2):257–264.
https://doi.org/: 10.1097/gme.0b013e318185e249
32. Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: The Study of Women’s Health Across the Nation (SWAN) fat patterning study. Obesity( Silver spring) 2010;18:604–610.
https://doi.org/:10.1038/oby.2009.251
33. Guo Q, Zhou S, Feng X, Yang J, Qiao J, Zhao Y et al. The sensibility of the new blood lipid indicator--atherogenic index of plasma (AIP) in menopausal women with coronary artery disease. Lipids Health Dis. 2020;19(1):27.
https://doi.org/:10.1186/s12944-020-01208-8
34. Zhou K, Qin Z, Tian J, Cui K, Yan Y, Lvu S. The atherogenic index of plasma: a powerful and reliable predictor for coronary artery disease in patients with type 2 diabetes. Angiology. 2021; 72(10):934–941.
https://doi.org/: 10.1177/00033197211012129
35. Bhardwaj S, Bhattacharjee J, Bhatnagar MK, Tyagi S. Atherogenic index of plasma ,Castelli risk index and atherogenic coefficient-new parameters in assessing cardiovascular risk. Int J of Pharm Bio Sci. 2013;3:359-364.
36. Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL et al. Association of premature natural and surgical menopause with incident cardiovascular disease.JAMA.2019;322(24):2411-2421. https://doi.org/: 10.1001/jama.2019.19191
37. Zhu D, Chung HF, Dobson AJ, Pandeya N, Brunner EJ, Kuh D et al. Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Hum Reprod.2020 ;35(8):1933-1943. https://doi.org/: 10.1093/humrep/deaa124
38. Dam V, van der Schouw YT, Onland-Moret NC, Groenwold RHH, Peters SAE, Burgess S et al. Association of menopausal characteristics and risk of coronary heart disease: a pan-European case-cohort analysis. Int J Epidemiol. 2019;48(4):1275-1285. https://doi.org/: 10.1093/ije/dyz016
39. Pardhe BD, Ghimire S, Shakya J, Pathak S, Shakya S, Bhetwal A et al. Elevated cardiovascular risks among postmenopausal women: a community based case control study from Nepal. Biochem Res Int. 2017;2017:3824903. https://doi.org/: 10.1155/2017/3824903
2. Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA; American Heart Association Cardiovascular Disease and Stroke in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on High Bloo. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey. Circulation.2013;127(11):1254-e29. http://doi.org/10.1161/CIR.0b013e318287cf2f
3. Lerner D J, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J.1986;111(2):383–390. http://doi.org/10.1016/0002-8703(86)90155-9
4. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association.Circulation.2020;142(25):e506–e532.
http://doi.org/ 10.1161/CIR.0000000000000912
5. Matsuura Y, Kanter JE, Bornfeldt KE. Highlighting residual atherosclerotic cardiovascular disease risk. Arterioscler Thromb Vasc Biol.2019;39(1):e1–e9. http://doi.org/ 10.1161/ATVBAHA.118.311999
6. Sheng G, Kuang M, Yang R, Zhong Y, Zhang S, Zou Y. Evaluation of the value of conventional and unconventional lipid parameters for predicting the risk of diabetes in a non-diabetic population. J Transl Med.2022;20(1):266. http://doi.org/ 10.1186/s12967-022-03470-z
7. EUGenMed Cardiovascular Clinical Study Group; Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A et al. Gender in cardiovascular diseases:impact on clinical manifestations, management, and outcomes. Eur Heart J 2016;37(1):24-34. http://doi.org:10.1093/eurheartj/ehv598
8. Ingelsson E, Lundholm C, Johansson AL, Altman D. Hysterectomy and risk of cardiovascular disease: A population-based cohort study. European Heart Journal 2011;32(6):745–750. http:// doi.org:10.1093/eurheartj/ehq477
9. Howard BV, Kuller L, Langer R, Manson JE, Allen C, Assaf A et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the women's health initiative observational study. Circulation. 2005;111 (12):1462–1470. http://doi.org:10.1161/01.CIR.0000159344.21672.FD
10. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: Identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril.1987;47(1):94–100. http://doi.org:10.1016/s0015-0282(16)49942-5
11. Abbas SZ, Sangawan V, Das A, Pandey AK. Assessment of cardiovascular risk in natural and surgical menopause. Indian J of Endocrinol and Metab. 2018 ;22(2):223-228. http://doi:10.4103/ijem.IJEM_620_17
12. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW et al. Executive summary of the stages of reproductive aging workshop +10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97:1159-68. http://doi.org:10.1210/jc.2011-3362
13. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual.Champaign Illionois,Human Kinetics books.1988;55-70.
14. Hernandez-Vila E. A review of the JNC 8 blood pressure guideline.Tex Heart Inst J.2015;42(3):226-8. http://doi.org:10.14503/THIJ-15-5067
15. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.
16. Virani SS. Non-HDL cholesterol as a metric of good quality of care: opportunities and challenges. Tex Heart Inst J.2011;38(2):160-162.
17. Lepor NE, Vogel RE; National Cholesterol Education Program Adult Treatment Panel III. Summary of the third report of the National Cholesterol Education Program Adult Treatment Panel III. Rev Cardiovasc Med. 2001;2(3):160-165.
18. Sasikala T, Goswami K. Castelli risk index-1 and atherogenic coefficient are better predictors of cardiometabolic risk in patients with hypothyroidism. Int J Clin Biochem Res. 2020;7(2):254-259. https://doi.org/10.18231/j.ijcbr.2020.055
19. Zhou H, Zhang C, Ni J, Han X. Prevalence of cardiovascular risk factors in non-menopausal and postmenopausal inpatients with type 2 diabetes mellitus in China. BMC Endocr Disord.2019;19(1):98. https://doi.org/:10.1186/s12902-019-0427-7
20. Demir O, Ozalp M, Sal H, Aran T, Osmanağaoğlu MA. The relationship of menopausal symptoms with the type of menopause and lipid levels. Prz Menopauzalny. 2020 ;19(1):6-10. https://doi.org/:10.5114/pm.2020.95300
21. Dąbrowska-Galas M, Dąbrowska J, Ptaszkowski K, Plinta R. High Physical Activity Level May Reduce Menopausal Symptoms. Medicina (Kaunas). 2019;55(8):466. https://doi.org/:10.3390/medicina55080466
22. Mahajan N, Kumar D, Fareed P. Comparison of menopausal symptoms and quality of life after natural and surgical menopause. Int J of Sci Stud. 2016;3(11):74–77. https://doi.org/: 10.17354/ijss/2016/60
23. Ozdemir S, Celik C, Gokemli H, Kiyici A, Kaya B. Compared effects of surgical and natural menopause on climacteric symptoms, osteoporosis, and metabolic syndrome. Int J Gynaecol Obstet.2009;106(1):57-61. https://doi.org/: 10.1016/j.ijgo.2009.03.016
24. de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJ, Broekmans FJ, Van der Schouw YT. Erratum to: Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med. 2017;15(1):74. https://doi.org/: 10.1186/s12916-017-0841-5
25. Price MA, Alvarado BE, Rosendaal NTA, Câmara SMA, Pirkle CM, Velez MP. Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging. Menopause. 2021 ;28(5):484-490.
https://doi.org/: 10.1097/GME.0000000000001729
26. van Beresteyn EC, Hof MA v t, De Waard H. Contributions of ovarian failure and aging to blood pressure in normotensive perimenopausal women: a mixed longitudinal study. Am J Epidemiol.1989;129(5):947–955.
https://doi.org/: 10.1093/oxfordjournals.aje.a115227
27. Paul J, Khanam RA, Mirza TT, Saha MK, Halim MA,Basher MS et al. Lipid profile status in natural and surgical menopausal women: a comparative study. Mymensingh Med J.2020;29(2):254-262.
28. Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid changes during the menopause transition in relation to age and weight: The study of women’s health across the nation. Am J Epidemiol.2009;169 (11):1352–1361. https://doi.org/: 10.1093/aje/kwp043
29. Zago V, Sanguinetti S, Brites F, Berg G, Verona J, Basilio F et al. Impaired high density lipoprotein antioxidant activity in healthy postmenopausal women. Atherosclerosis.2004;177(1):203–210
https://doi.org/: 10.1016/j.atherosclerosis.2004.07.011
30. Zhou JL, Lin SQ, Shen Y, Chen Y, Zhang Y, Chen FL. Serum lipid profile changes during the menopausal transition in Chinese women: A community-based cohort study. Menopause 2010;17(5):997–1003.
https://doi.org/: 10.1097/gme.0b013e3181dbdc30
31. Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: Study of Women’s Health Across the Nation. Menopause 2009;16(2):257–264.
https://doi.org/: 10.1097/gme.0b013e318185e249
32. Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: The Study of Women’s Health Across the Nation (SWAN) fat patterning study. Obesity( Silver spring) 2010;18:604–610.
https://doi.org/:10.1038/oby.2009.251
33. Guo Q, Zhou S, Feng X, Yang J, Qiao J, Zhao Y et al. The sensibility of the new blood lipid indicator--atherogenic index of plasma (AIP) in menopausal women with coronary artery disease. Lipids Health Dis. 2020;19(1):27.
https://doi.org/:10.1186/s12944-020-01208-8
34. Zhou K, Qin Z, Tian J, Cui K, Yan Y, Lvu S. The atherogenic index of plasma: a powerful and reliable predictor for coronary artery disease in patients with type 2 diabetes. Angiology. 2021; 72(10):934–941.
https://doi.org/: 10.1177/00033197211012129
35. Bhardwaj S, Bhattacharjee J, Bhatnagar MK, Tyagi S. Atherogenic index of plasma ,Castelli risk index and atherogenic coefficient-new parameters in assessing cardiovascular risk. Int J of Pharm Bio Sci. 2013;3:359-364.
36. Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL et al. Association of premature natural and surgical menopause with incident cardiovascular disease.JAMA.2019;322(24):2411-2421. https://doi.org/: 10.1001/jama.2019.19191
37. Zhu D, Chung HF, Dobson AJ, Pandeya N, Brunner EJ, Kuh D et al. Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Hum Reprod.2020 ;35(8):1933-1943. https://doi.org/: 10.1093/humrep/deaa124
38. Dam V, van der Schouw YT, Onland-Moret NC, Groenwold RHH, Peters SAE, Burgess S et al. Association of menopausal characteristics and risk of coronary heart disease: a pan-European case-cohort analysis. Int J Epidemiol. 2019;48(4):1275-1285. https://doi.org/: 10.1093/ije/dyz016
39. Pardhe BD, Ghimire S, Shakya J, Pathak S, Shakya S, Bhetwal A et al. Elevated cardiovascular risks among postmenopausal women: a community based case control study from Nepal. Biochem Res Int. 2017;2017:3824903. https://doi.org/: 10.1155/2017/3824903
Article Sidebar
Published
Apr 2, 2026
Article Details
How to Cite
Sharma, S., Bamniya, S., Jain, A., Bhardwaj, S., Gupta, A., & Garg, V. (2026). Atherogenic Indices and Cardiovascular Risk in Post-Menopausal Women: A Comparative Study of Natural Versus Surgical Menopause. Nigerian Medical Journal, 67(1), 171–182. https://doi.org/10.71480/nmj.v67i1.1218
Section
Original Articles
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.