New research presented at the 2021 North American Menopause Society (NAMS) Annual Meeting in Washington, DC, held September 22–25, 2021, highlighted how many of the conditions and symptoms experienced in menopause are linked, and how they may impact our health as we age.
Belly Fat Density May Matter More Than the Amount of Fat
New data identified a link between the density of the fat around the heart and cognitive function in midlife women, and how it might affect Black women differently.
The findings provide further clues on how the declining cardiovascular health that happens after menopause may contribute to the increased prevalence of dementia in women. Nearly two-thirds of Americans with Alzheimer’s are women, according to the Alzheimer’s Association.
What’s new We know that fat around the midsection, including the heart, isn’t good, says Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Rochester, Minnesota. “Waist circumference alone is an important marker for cardiovascular disease; even normal-weight women who have a thicker waistline are at higher risk,” she says.
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Research details In this new study, investigators used data from SWAN (Study of Women’s Health Across the Nation) to assess the associations of heart fat volume and radiodensity (the density of fat measured with a special machine) with future cognitive performance among midlife women.
Of the nearly 500 participants, 30.6 percent were post-menopausal and 35.9 percent were Black. Racial differences in the associations were specifically analyzed to further investigate a seeming contradiction; on average, Black Americans have lower cardiovascular fat volume but have a higher risk of heart disease and a higher prevalence of Alzheimer’s disease compared with white Americans, according to the researchers.
Study results showed that a higher perivascular adipose tissue (PVAT) radiodensity (higher density) was significantly associated with a worse performance in working memory. Researchers also found a significant interaction between fat around the heart and race. A higher baseline PVAT radiodensity at midlife was associated with lower future performance in verbal episodic memory among Black women, but not white women. Those associations remained even after researchers controlled for the volume of heart fat, as well as waist circumference and other known confounders.
Why it matters This study is furthering our understanding about fat around the heart, says Dr. Faubion, who is also the medical director of the North American Menopause Society (NAMS). “It’s not just how much fat, but also the quality of fat around the heart that could determine health risk, and not just for heart disease; now we’re seeing it connected to dementia risk, too. It’s all tied together,” she says.
A higher vascular risk is bad for the brain because a lot of dementia risk really has to do with blood vessel health, adds Faubion.
The results suggest that the density of fat around the heart could serve as a novel biomarker of cognitive function status in women later in life, says Samar El Khoudary, PhD, MPH, a researcher at the University of Pittsburgh School of Public Health and a lead author of the study. Dr. El Khoudary has published other studies that look at heart fat accumulation in women and how it impacts the arteries.
“We still need more research to better understand what we have reported. At this stage, we can only stress the importance of thinking about risk factors of heart diseases, including visceral fat around vasculature, as shared risk factors that could also be related to brain health,” she says. Interventions that address these shared risk factors may benefit both the heart and the brain, adds El Khoudary.
Right now, we don’t know why higher density fat is worse, says Faubion. “It may be because it’s more active,” she says.
Is fat density modifiable or is it more like breast tissue density and can’t be changed? “That’s a good question. I don’t know if you can change the density of the fat,” says Faubion. Given what we currently know, the goal should be to have a healthy amount of fat, she says.
Fragmented Sleep, Not Lack of Sleep, May Lead to Depression, Weight Gain
Even if you spend eight or nine hours in bed, you may still accrue poor-sleep-related outcomes unless you fix your “WASO,” said Hadine Joffe, MD, the executive director of the Connors Center for Women’s Health and Gender Biology, who presented on the topic during a symposium at NAMS.
What’s new WASO, short for “wake time after sleep onset,” is associated with adverse consequences for mental health, daytime well-being, and metabolic health for women during midlife, said Dr. Joffe, who is also the director of the Women’s Hormone and Aging Research Program at Brigham and Women’s Hospital and Harvard Medical School, during her presentation.
Research details Data suggests that menopause-pattern sleep fragmentation may impact metabolism and contribute to an increase in body fat, which happens in about half of all women during and after menopause, she said.
“The focus has always been on getting enough sleep; we always ask, ‘Have you been getting at least seven hours of sleep?’” says Kristi Tough DeSapri, MD, an assistant professor of medicine at Northwestern University and a physician at the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.
“That’s often the public service message that is out there — get enough sleep — but during the menopause transition it may be more beneficial to focus on sleep quality,” she says. Finding ways to improve sleep efficiency, less waking during the night, whether that’s from menopause symptoms or other reasons, are important to consider, rather than simply the number of hours we sleep,” says Dr. DeSapri.