The cardioprotective association of high-density lipoprotein cholesterol (HDL-C) may vary by menopause stage or estradiol level. We tested whether associations of comprehensive HDL metrics [HDL subclasses, phospholipid and triglyceride content and HDL cholesterol efflux capacity (HDL-CEC)] with coronary artery calcium (CAC) score and density vary by menopause stage or estradiol level in women transitioning through menopause. Participants [N=294; mean age(SD): 51.3 (2.9)] had data on HDL metrics and CAC measures at one or two time points during the menopause transition. Generalized estimating equations were used for analyses. Effect modifications by menopause stage or estradiol level were tested in multivariable models. In adjusted models, menopause stage modified the associations of specific HDL metrics with CAC measures. Higher small HDL particles (HDL-P) concentrations (p-interaction=0.008) and smaller HDL size (p-interaction=0.02) were associated with greater odds of CAC presence in late perimenopause than in pre/early perimenopause stage. Women in the highest estradiol tertile, but not the lower tertiles, showed a protective association of small HDL-P with CAC presence (p-interaction=0.007). Lower large HDL-P concentrations (p-interaction=0.03) and smaller HDL size (p-interaction=0.03) were associated with lower CAC density in late perimenopause than in postmenopause stage. Associations of HDL phospholipid and triglyceride content and HDL-CEC with CAC measures did not vary by menopause stage or estradiol level. We concluded that HDL subclasses may impact the likelihood of CAC presence and the stability of coronary plaque differently over the menopause transition. Endogenous estradiol levels may contribute to this observation.

中文翻译：

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高密度脂蛋白指标与更年期女性冠状动脉钙化评分和密度的关联。

高密度脂蛋白胆固醇 (HDL-C) 的心脏保护作用可能因绝经期或雌二醇水平而异。我们测试了综合 HDL 指标 [HDL 亚类、磷脂和甘油三酯含量以及 HDL 胆固醇流出能力 (HDL-CEC)] 与冠状动脉钙 (CAC) 评分和密度的关联是否因绝经期或过渡到更年期的女性雌二醇水平而异。参与者 [N=294; 平均年龄（SD）：51.3（2.9）] 在绝经过渡期间的一两个时间点有关于 HDL 指标和 CAC 指标的数据。广义估计方程用于分析。在多变量模型中测试了更年期或雌二醇水平的效果修饰。在调整后的模型中，绝经期改变了特定 HDL 指标与 CAC 指标的关联。较高的小 HDL 颗粒 (HDL-P) 浓度 (p-相互作用 = 0.008) 和较小的 HDL 大小 (p- 相互作用 = 0.02) 与围绝经后期相比围绝经前/围绝经早期阶段 CAC 存在的几率更大。雌二醇最高三分位数的女性，但不是较低的三分位数，显示出小 HDL-P 与 CAC 存在的保护性关联（p-相互作用=0.007）。较低的大 HDL-P 浓度（p-相互作用=0.03）和较小的 HDL 大小（p-相互作用=0.03）与围绝经后期的 CAC 密度低于绝经后阶段相关。HDL 磷脂和甘油三酯含量以及 HDL-CEC 与 CAC 测量值的关联不会因绝经期或雌二醇水平而异。我们得出结论，HDL 亚类可能会在更年期过渡期间以不同方式影响 CAC 存在的可能性和冠状动脉斑块的稳定性。内源性雌二醇水平可能有助于这一观察。