Abstract
BACKGROUND: Women show a rise in high-density lipoprotein cholesterol efflux capacity (CEC) as they traverse menopause. Whether this rise is associated with a lower risk of cardiovascular disease overtime is not clear. OBJECTIVES: The authors tested whether CEC association with subclinical vascular health, measured using a composite subclinical vascular health score based on levels of carotid intima-media thickness, carotid-femoral pulse wave velocity, and presence of coronary artery calcium score (>10), varies by time relative to the final menstrual period (FMP). METHODS: 279 women (baseline age 51 ± 2.8 years; 68.5% White) who had CEC and outcome measures were included. The subclinical vascular health measures were related to CEC through a Bayesian hierarchical linear mixed effects model using the latent composite measure as the outcome, and time relative to FMP, CEC, and their interaction as explanatory variables. Differences by racial subgroups were explored. RESULTS: Higher CEC was associated with a lower composite subclinical measure of vascular health at the time of the FMP. In both unadjusted and adjusted models, the inferred interaction effect (posterior probability >0.99) implies that the pre-FMP protective association of CEC diminishes after FMP. This was consistent across all components of the composite score. In Black women, the protective association of CEC diminished more rapidly compared to White women (posterior probability >0.90). CONCLUSIONS: In women, higher CEC is associated with a lower risk of subclinical vascular health only before menopause. Higher CEC is not a consistent indicator of greater cardiovascular disease protection in women traversing menopause.