Menopausal Transition Linked to a Higher Burden of Hypercholesterolaemia and Multimorbidity

A large real-world study has found that the menopausal transition is associated with a marked increase in hypercholesterolaemia diagnoses and a greater burden of comorbidities in women compared with men, particularly across cardiovascular, metabolic, endocrine, neurologic, musculoskeletal, and mental health conditions.

Study Overview

Researchers conducted a multicentre observational cohort study using population-based healthcare data collected between 2016 and 2022. The analysis included 557,034 adults diagnosed with hypercholesterolaemia, comprising 329,200 women and 227,834 men.

To explore the impact of menopause, age 50 years was used as a proxy for postmenopausal status. Patterns of hypercholesterolaemia diagnosis and associated comorbidities were compared between women and men before and after this age threshold.

Key Findings

Women were diagnosed with hypercholesterolaemia at a later age than men (mean age: 59.1 vs 56.0 years). However, the incidence of new diagnoses rose sharply among women between 50 and 55 years of age and remained higher than in men throughout older age groups.

Among individuals aged 50 years or older, women experienced a significantly greater burden of comorbid conditions, including cardiovascular disease, metabolic disorders, endocrine diseases, mental health conditions, musculoskeletal disorders, neurologic diseases, liver disorders, and cancer.

Several conditions were particularly more common in women than men after age 50:

• Hypertension (WMIR 1.63)
• Anxiety disorders (WMIR 1.38)
• Osteoarthritis and spondylosis (WMIR 1.19)

Women also demonstrated a more pronounced increase in:

• Gout and crystal-induced arthropathies (WMIR 4.65)
• Organic mental disorders (WMIR 4.02)
• Autism spectrum disorder (WMIR 3.44)

All differences were statistically significant (P < .001).

Clinical Implications

The findings highlight the menopausal transition as a critical period for cardiovascular and metabolic risk assessment. The authors suggest that routine lipid screening and reassessment of cardiovascular risk factors during midlife may help improve early identification and management of hypercholesterolaemia in women.

Study Limitations

The study used age 50 as a surrogate marker for menopause, which may have resulted in some misclassification. In addition, the observational design prevents conclusions about causality, and residual confounding cannot be excluded due to incomplete clinical data.

Source

Esteban-Medina A, et al. BMJ Open. Published online June 9, 2026.