Lipid profile risk in menopausal women with no significant increase in lipoprotein(a)

Abstract Introduction Biological sex is a significant factor influencing variations in lipid profiles and cardiovascular risk (CVR). Furthermore, menopause induces substantial hormonal changes in women, thereby elevating their CVR. There is controversy in the literature regarding possible variations in lipoprotein (a) [Lp(a)] concentrations due to menopause. Some authors suggest that menopause results in significant increases in Lp(a)(1,2,3), while others report that the changes are minimal or non-existent (4,5). Objective This study compares lipid profiles between sexes and examines lipidogram changes in menopausal women, focusing on Lp(a) levels. Methods A retrospective cross-sectional study was conducted from June 2019 to December 2024 on 7,717 patients from a familial dyslipidemia unit. All patients had a complete lipid profile, including lipoprotein a Lp(a). Lipidogram differences were compared by sex and age group (under and over 50 years), noting that 80% of women over 50 in Spain are menopausal. Serum Lp(a) quantification (nmol/L) was measured(6) using a Cobas c701 autoanalyzer (and other biochemical parameters). The method for Lp(a) is comparable to a monoclonal antibody-based ELISA assay, detecting a specific epitope on Kringle IV type 9 and unaffected by isoform size variability(7,8). No serum sample showed interference from hemolysis, jaundice or lipemia(9), and high levels of rheumatoid factors or Apo B were excluded. The variables studied did not exhibit a normal distribution, so non-parametric tests U-Mann-Whitney (*) were utilized to compare the groups. Results 55.3% of the patients were women, with a median age higher than men. Women had higher significant levels of total cholesterol, LDL-c (direct and calculated), non-HDL-c, HDL-c, apolipoprotein B, and Lp(a) that men; however, they showed statistically lower values than men in HbA1c, triglycerides, and small dense LDL (sdLDL) (Table 1). Women over the age of 50 have higher levels of HbA1c, total cholesterol, HDL-c, non-HDL-c, apolipoprotein B, triglycerides, LDL-c (both direct and calculated), and sdLDL compared to those under 50 years old. Conversely, no significant differences were observed in Lp(a) concentrations between menopausal and non-menopausal women (Table 2). In men, age-related differences were found only for HbA1c, apolipoprotein B, triglycerides, and sdLDL, no significant differences were noted for Lp(a) increase, but the trend became significant when comparing high Lp(a) values >240 nmol/L (6.1% vs. 8.8%, p=0.004). Conclusions In the studied population, women had higher levels of atherogenic lipoproteins in their lipid profiles. These findings indicate the impact of age and menopause on the lipidogram. Although Lp(a) levels rise between menopausal and non-menopausal women, the changes are not significant.Table 1 Table 2