The menopausal transition and multiple physiologic measures of early brain health in the Coronary Artery Risk Development in Young Adults study.

Objective: This study proposed to investigate the cross-sectional and longitudinal associations of menopausal status with physiologic brain magnetic resonance imaging measures.

Methods: The sample included women from the Coronary Artery Risk Development in Young Adults study who self-reported their reproductive histories and participated in the brain magnetic resonance imaging substudies at the year 25 (n = 292) and year 30 (n = 258) follow-up examinations. Menopausal status was classified based on natural menstrual cycle regularity/cessation at both time points. Gray matter cerebrovascular reactivity (CVR) was calculated as mean percent change in blood oxygen level-dependent signals in activated voxels following a breath-hold challenge. Gray matter cerebral blood flow (CBF) was assessed using pseudo-continuous arterial spin labeling. Linear regression models were used to examine cross-sectional and longitudinal associations of menopausal status with gray matter CVR and CBF after adjustment for potential age-related covariates.

Results: Women were mean age 50 years at year 25; 37% were Black; and 46% were postmenopausal. Relative to premenopause or perimenopause, postmenopause was associated with lower gray matter CVR at year 30 cross-sectionally (1.86% vs 1.69%, P = 0.03, respectively) and longitudinally for women who were postmenopausal at both time points (-0.32% [95% CI, -0.63% to -0.02%]) after covariate adjustment. Mean CVR values were also lower for these women when compared with women who remained premenopausal or perimenopausal (1.71% compared with 2.04%, respectively). Menopausal status was unrelated to either concurrent or longitudinal gray matter CBF.

Conclusions: These findings suggest that the ability of vessels to adapt in response to hypercapnia may be impaired during menopause, even within a relatively short time window.