Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women's Health Initiative era  Faustino R. Pérez-López, M.D., Ph.D., Peter Chedraui, M.D., M.Sc., Juan J. Gilbert, M.D., Gonzalo Pérez-Roncero, R.N.  Fertility and Sterility  Volume 92, Issue 4, Pages 1171-1186 (October 2009) DOI: 10.1016/j.fertnstert.2009.06.032 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 The menopause transition is associated with a decline in ovarian steroid secretion and very frequently with a progressive increase in body weight that is likely related to fat mass as an endocrine organ. The increase in fat mass (visceral fat) produces an increase in free fatty acids (FFA), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), leptin, and resistin, and reduces the adiponectin secretion. Low ovarian steroid secretion increases endothelial dysfunction, inflammatory reactions, oxidative stress, and alters blood lipid levels. Low vitamin D levels and E2, and increased body fat central mass contribute to insulin resistance, the metabolic syndrome, hypertension, and atherosclerosis. A number of co-morbid conditions are also very frequent, including sleep disorders, depression, stress and psychological factors, vitamin D insufficiency, sexual dysfunction, and rheumatoid arthritis, that contribute to alter the neuroendocrine system and the immune system, which at the same time aggravate the health status. Biopsychological and social health equilibrium is the key to reduce cardiovascular risk. Menopause is not the only cause of all of these derangements, although low estrogen levels may exacerbate symptoms and complaints. The algebraic sum (the final result) is a significant increase in cardiovascular risk. LDL-C = low-density lipoprotein cholesterol. Fertility and Sterility 2009 92, 1171-1186DOI: (10.1016/j.fertnstert.2009.06.032) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions