Lack of Association Between Lipid and Lipoprotein
Profile with Menopause Status in Women
with Cardiac Syndrome X

Yousef Rasmi1,2, Esmail Khademy3, Maryam Majidinia4,
MirHossein Seyyed-Mohammadzad5, Reza Hajhosseini3, Fariba Khosravifar3,
Ehsan Saboory6, Sam Seidi-Shirvani3, and Mohammad Rahmati-Yamchi4

1Cellular and Molecular Research Center,
Urmia University of Medical Sciences, Urmia, Iran
2Department of Biochemistry, Faculty of Medicine,
Urmia University of Medical Sciences, Urmia, Iran
3Department of Biology, Tehran Payam-e- Noor University, Tehran, Iran
4Department of Biochemistry, Faculty of Medicine,
Tabriz University of Medical Sciences, Tabriz, Iran
5Department of Cardiology, Faculty of Medicine,
Urmia University of Medical Sciences, Urmia, Iran
6Neurophysiology Research Center, Urmia University of Medical Sciences,
Urmia, Iran

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.



Cardiac syndrome X (CSX, angina pectoris, positive findings on exercise electrocardiography and normal results on coronary angiography) frequently occurs in menopausal women. On the other hand, studies indicated that menopause is associated with alteration in lipid profile and increased risk of cardiovascular diseases. Therefore, we aimed to determine the possible influence of menopause on lipid and lipoprotein profile in women with CSX. Fifty women with CSX (mean age: 52.4±7.65 years) and 50 healthy women as control (50.0±5.62 years) were studied. We divided CSX and control groups as pre- and post-menopause subgroups. The plasma lipid and lipoprotein profile of subjects was estimated colorimetrically. In CSX group, the total cholesterol (TC), triglyceride (TG), lipoprotein A(LP[a]), low density lipoprotein (LDL), high density lipoprotein (HDL), apoprotein A1(APOA1), apoprotein B (APOB) were significantly higher than those of the control group. (TC: 158.2±5.7 vs. 114.5±5.1mg/dl; P=0.001, (TG: 152.1±11.4 vs. 105.9±8.9mg/dl; P=0.002, LP[a]: 44.2±7.9 vs. 22.2±4.3mg/dl; P=0.017, LDL: 88.9±3.7 vs. 66.1±23.4mg/dl; P=0.001, HDL: 36±1.4 vs. 29.3±0.8mg/dl; P=0.001, APOA1: 120.9±1.6 vs. 107.7±1.5mg/dl; P=0.001, and APOB: 95.2±3.4 vs. 74.4±2.6mg/dl; P=0.001). The differences of lipid and lipoprotein profile between pre- and post-menopause CSX was not significant. Plasma lipid disorders play important roles in the development of CSX. Changes that occur in the lipid profile after menopause are not associated with increased CSX.



The occurrence of typical chest pain and ST-segment changes suggestive of myocardial ischemia in patients who otherwise have completely normal coronary arteriograms is called as ‘‘syndrome X’’, as termed by Harvey Kemp in 1973 (Kemp, 1973), or ‘‘cardiac syndrome X’’ [CSX] or microvascular angina . . . . . read more


ABDEALLA AM, AHMED H, MODAWE GA. 2011. Assessment of Plasma Lipids in Menopausal Sudanese women. Sudanese J Public Health 6(4): 150-2.
BANKS K, LO M, KHERA A. 2010. Angina in Women without Obstructive Coronary Artery Disease. Curr Cardiol Rev 6: 71-81.
BERG A, MESCH V, BOERO L, SAYEGH F, PRADA M, ROYER M, MUZZIO ML, SCHREIER L, SISELES N, BENENCIA H. 2004. Lipid and Lipoprotein profile in menopausal transition. Effects of hormones, age and fat distribution. Horm Metab Res 36: 215-20.
BOUTHON-KOPP C, SCARABIN PY, DARNE B, MALMEJAC A, GUIZE L. 1990. Menopause related changes in lipoproteins and some other cardiovascular risk factors. Int J Epidemiol 19:42-8.
BURGER EF, KUSTIN AA, BARON DC. 2002. Endocinology and metabolism. Ann Int Med 251:872 - 942.
CARR MC, KIM KH, ZAMBON A, MITCHELL ES, WOODS NF, CASAZZA CP, PURNELL JQ, HOKANSON JE, BRUNZELL JD, SCHWARTS RS. 2000. Changes in LDL density across the menopausal transition. J Investig Med 48: 245-50.
DALLONGEVILLE J, MARECAUX N, ISOREZ D, ZYLBERGBERG G, FRUCHART JC, AMOUYEL P. 1995. Multiple coronary heart disease risk factors are associated with menopause and influenced by substitutive hormonal therapy in a cohort of French women. Atherosclerosis 118: 123-33.
DE ALOYSIO D, GAMBACCIANI M, MESCHIA M, PANSINI F, BACCHI MA, BOLIS PF, MASSOBRIO M, MAIOCCHI G, PERUZZI E. 1999. The effect of menopause on blood lipid and lipoprotein levels. The Icarus Study Group. Athrosclerosis 147: 147-53.
DO KA, GREEN A, GUTHRIE JR, DUDLEY EC, BURGER HG, DENNERSTEIN L. 2000.  Longitudinal study of risk factors for coronary heart disease across the menopausal transition. Am J Epidemiol 151: 584-93.
GAST GC, GROBBEE DE, POP VG, KEYZER JJ, WIJNANDS-van GENT CJ, SAMSIOE GN, NILSSON PM, Van Der SCHOUW YT. 2008. Menopausal complaints are associated with cardiovascular risk factors. Hypertension 51: 1492-8.
GRADY D, RUBIN SM, PETITTI DB, FOX CS, BLACK D, ETTINGER B, ERNESTER VL, CUMMINGS SR. 1992.  Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Int Med 117: 202-352.
GRIFFIN B, FARISH E, WALSH D, BARNES J, CASLAKE M, SHEPHERD J, HART D. 1993. Response of plasma low-density lipoprotein sub fractions to estrogen replacement therapy following surgical menopause. Clin Endocrinol (Oxf) 39: 463-8.
HULLEY S, GRADY D, BUSH T. 1998. For the Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 280: 605.
KEMP HG. 1973. Left ventricular function in patients with angina syndrome and normal coronary arteriograms. Am J Cardiol 32:375-6.
LIP GY, BLANN AD, JONES AF, BEEVERS DG. 1997. Effect of hormone replacement therapy on hemostatic factors, lipid factors and endothelial function in women undergoing surgical menopause: implications for prevention of atherosclerosis. Am. Heart J 134: 764-771.
LIU Q, ZHOU SH, QI SS, ZHAO SH, MINGHUIB L. 2008. Significance of the lipid profile and endothelium- dependent vasodilatation in the pathogenesis of microvascular angina. Cardiol J. 15(4): 324-8.
MESSA C, NOTARNICOLA, M, RUSSO F, CAVALLINI A, PALLOTTINI V, TRENTALANCE A, BIFULCO M, LAEZZA C, GABRIELLA-CARUSO M. 2005. Estrogenic regulation of cholesterol biosynthesis and cell growth in DLD-1 human colon cancer cells. Scand J Gastroenterol  40: 1454-61.
NELSON HD. Menopause. Lancet 2008; 371: 760-70.
POEHLMAN ET, TOTH MJ, GARDNER AW. 1995. Changes in energy balance and body composition at menopause: a controlled longitudinal study. Ann Int Med 123: 673-675.
ROSANO GM, COLLINS P, KASKI JC, LINDSAY DC, SARREL PM, POOLE-WILSON PA. 1995. Syndrome X in women is associated with oestrogen deficiency. Eur Heart J 16: 610-4.
SARREL PM. 1990. Ovarian hormone and the menopause. JAMA 287: 387-498.
STAMPFER MJ, WILLET WC, COLDITZ GA, SPEIZER FE, HENNEKENS CH. 1985. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med 313: 1044-9.
STEVENSON JC, CROOK D, GODSLAND IF. 1993. Influence of age and menopause in serum lipid and lipoproteins in healthy women. Atherosclerosis 98: 83-90.
TREMOLLIERES FA, POULILLES JM, CAUNEILLE C, RIBOT C. 1999. Coronary heart disease risk factors and menopause: a study in 1684 French women. Atherosclerosis 142: 415-23.
WAKATSUKI A, SAGARA Y. 1995. Lipoprotein metabolism in postmenopausal and Oophorectomized women. Obstet Gynecol 85: 523-28.
WENGER NK, SPEROFF L, PACKARD B. 1993. Cardiovascular health and disease in women. New Engl J Med 329: 247-56.