Context

Cardiometabolic conditions increase in midlife but early customized prevention strategies are not established for such women.

Objective

To characterize, and identify factors related to, constellations of cardiometabolic risk components longitudinally in multi-racial/ethnic midlife women.

Design

We conducted a prospective longitudinal, multi-ethnic cohort study of 3,003 midlife women, undergoing the menopausal transition (MT). Metabolic syndrome (MetS) meant having at least 3 of 5 components: high fasting triglyceride (hTG), low high density lipoprotein cholesterol (lHDL), high fasting plasma glucose (hGluc), large waist circumference (Ob), and hypertension (HTN). We described the patterns of constellations and estimated hazard ratios (HRs) for constellations at 1) incident MetS and 2) recovery from MetS, using multivariable-adjusted Cox regression.

Setting

Seven U.S. sites

Participants

1412 non-Hispanic White, 851 Black, 272 Japanese, 237 Hispanic, 231 Chinese women

Exposures

Race/ethnicity, lifestyle factors, MT stage

Main Outcomes Measures

Cardiometabolic constellations; incident MetS; MetS recovery

Results

Central obesity was the most frequent component. Having no components was the most frequent (31%) baseline constellation. Physical activity (HR = 1.68, 95% CI: 1.06-2.68) and lower caloric intake (HR = 0.96; 95% CI: 0.93-0.99, per 100 Cal/day) were associated with recovery from MetS. Ob/hTG/lHDL (18%), Ob/HTN/lHDL (16%), and Ob/HTN/hGluc (14%) were frequent incident constellations. Physically active women had 26-62% lower hazards of incident MetS than inactive women.

Conclusions

Modifiable lifestyle behaviors were related to recovery from MetS and/ decreased risk of the most frequent MetS constellations in midlife women.