Estrogen Deficiency and Cardiometabolic Disease at Midlife Underlies a Woman’s Greater Risk for Alzheimer’s Disease

Welcome!

This is your host Ralph Sanchez, and this is episode #20 here at The Alzheimer's Solution Revolution podcast channel.

 

Today we are expanding on and diving a little deeper into two primary risk factors associated with an increased risk for dementia and late-onset Alzheimer's disease (LOAD) in women—cardiometabolic disease and postmenopausal estrogen deficiency in women.

 

In my book, and in episode #10 here on this channel, I covered the critical role that estrogen plays in glucose metabolism and its role in glucose hypometabolism.

 

In that episode I explain why glucose hypometabolism in the brain represents a neuroenergetic abnormality and risk factor for Alzheimer’s disease in aging individuals and how it pertains to postmenopausal women.

 

However, glucose hypometabolism is not the only metabolic derangement that links low estrogen levels to the higher incidence for LOAD in women.

 

The metabolic alterations related to type 2 diabetes, insulin resistance and cardiovascular disease is also linked to falling estrogen levels in perimenopause and postmenopause, which poses a significant risk for dementia and LOAD in women.

 

And if you are not aware of it, my book—The Diabetic Brain in Alzheimer's Disease— details the multifactorial role of cardiometabolic disease as a primary risk factor for vascular dementia and late-onset Alzheimer's disease (LOAD).

 

Indeed, in this episode—part 1 of this two-part episode series— we'll review the compelling research that describes pertinent and critical details with regard to the linkages between decreased estrogen levels after menopause and the increased risk for cardiometabolic disease in women.

 

In fact, apart from postmenopausal estrogen deficiency as a risk factor for LOAD,  cardiometabolic disease is also a very significant risk factor associated with a woman's risk for vascular dementia and LOAD.

 

Regardless, the point today is that steep declines in estrogen in postmenopausal women is strongly associated with the risk for cardiometabolic disease and LOAD, and both factors ARE modifiable.

 

Cardiometabolic disease

 

The alarming rates of cardiometabolic disease worldwide and here in the U.S. (detailed in the podcast)

 

There also sex differences in the prevalence T2D and CVD across a lifespan.

 

The global prevalence of T2D and CVD before midlife is slightly higher in men compared to women.

 

However, there are regional and ethnic differences, and as men and women age, the prevalence of T2D and CVD (cardiometabolic disease) is markedly skewed toward a greater risk for both disease trajectories in women.

 

Before menopause, estrogen exerts a protective effect against CVD and T2D, whereas in postmenopausal women lower levels of estrogen and the loss of estrogen receptors leads to a precipitous decline in the protection against CVD and T2D in postmenopausal women.

 

And a number studies over the past years have found that compared to men, postmenopausal women have higher rates of cardiovascular complications associated with T2D.

 

Those cardiovascular complications include coronary heart disease or atherosclerotic cardiovascular disease, heart failure and stroke, and women have a higher mortality and worse prognosis after acute cardiovascular events.

 

It is also estimated that in women, over the next 3 to 4 decades (2025 to 2060), the prevalence of cardiometabolic disease and the complications just mentioned will continue to outpace men.

 

And again, to clarify the term cardiometabolic for those that are not familiar with it, it refers to metabolic health derangements that are linked to chroni