Cardio-metabolic risk factors and anemia represent significant public health challenges, particularly among postmenopausal women, who are more vulnerable to these conditions due to various physiological and metabolic changes associated with menopause. The postmenopausal period is marked by a decline in estrogen production, which plays a critical role in regulating lipid metabolism, glucose homeostasis, and antioxidant defense mechanisms.^[1]

This hormonal shift predisposes women to an increased risk of developing cardiovascular diseases, type 2 diabetes, and anemia, all of which contribute to an elevated cardio-metabolic risk profile. Simultaneously, the role of antioxidant status in mitigating these risks has emerged as an area of growing interest, as oxidative stress is considered a common pathway in the pathogenesis of both cardio-metabolic disorders and anemia. ^[2]

The menopausal transition is accompanied by hormonal changes, particularly a decline in estrogen, which contributes to metabolic dysregulation and oxidative stress. This makes postmenopausal women susceptible to cardiovascular diseases, insulin resistance, and anaemia. Oxidative stress, a result of an imbalance between reactive oxygen species (ROS) and antioxidant defenses, plays a pivotal role in the pathophysiology of these conditions. This study investigates how antioxidant status influences cardio-metabolic health and anaemia in postmenopausal women, aiming to provide actionable insights for prevention and management. ^[3]

Cardiovascular disease remains the leading cause of mortality among postmenopausal women, with the risk increasing exponentially following menopause. Studies have demonstrated that the loss of estrogen results in unfavorable changes in lipid profiles, including increased levels of low-density lipoprotein (LDL) cholesterol, triglycerides, and total cholesterol, coupled with decreased high-density lipoprotein (HDL) cholesterol. ^[4]

Estrogen deficiency also impairs vascular function, promoting endothelial dysfunction, arterial stiffness, and inflammation—all of which contribute to the pathogenesis of hypertension and atherosclerosis. Furthermore, menopause is associated with an increase in central adiposity, or visceral fat deposition, which exacerbates insulin resistance, metabolic syndrome, and systemic inflammation. The interplay between these risk factors creates a vicious cycle, ultimately elevating the risk of cardiovascular events and diabetes among postmenopausal women. ^[5].

A cross-sectional study was conducted between 2022 and 2024, involving 120 postmenopausal women aged 45–70 years. Participants were recruited from urban and rural settings in India, ensuring diverse socio-demographic representation.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Healthy women aged 45–70 years.
• Non-smokers and non-alcoholics.
• Not on hormonal replacement therapy or antioxidant supplementation.

Exclusion Criteria:

• Chronic diseases (e.g., diabetes, cancer, thyroid disorders).
• Current pregnancy or lactation.
• History of cardiovascular events.

Data Collection

• Anthropometric Measurements: Height, weight, BMI, waist-hip ratio (WHR).
• Blood Samples: Venous blood was collected for analysis of hemoglobin, lipid profiles, fasting glucose, ferritin, and total antioxidant capacity.
• Blood Pressure and Heart Rate: Recorded using a digital sphygmomanometer.

Statistical Analysis

Descriptive statistics were used to summarize participant characteristics. Pearson’s correlations and multiple regression analyses were performed to evaluate the relationship between antioxidant status, cardio-metabolic risk factors, and anaemia. Significance was set at p < 0.05.

Participant Characteristics

The mean age of participants was 56.3 ± 7.2 years. Anthropometric and biochemical data are summarized in Table 1.

Table 1: Participant Characteristics

Antioxidant Status and Anaemia

Participants with lower antioxidant capacity exhibited higher prevalence and severity of anaemia, as shown in Table 2

.

Table 2: Antioxidant and Anaemia Markers

Cardio-Metabolic Risk Factors

Table 3: Lipid Profiles by Antioxidant Levels

Lower antioxidant levels correlated with higher total cholesterol and LDL, alongside reduced HDL

The study highlights the pivotal role of antioxidant status in mitigating anaemia and cardio-metabolic risk factors in postmenopausal women. Elevated oxidative stress in participants with low antioxidant capacity was linked to worse lipid profiles, higher blood pressure, and reduced hemoglobin levels. ^[6]

In our study, the mean age of the participants was 57.6 ± 6.8 years, with a range of 50 to 69 years. The average BMI was 27.8 ± 5.4 kg/m², indicating that a significant proportion of participants were overweight or obese. Waist Circumference: Mean (91.4 cm) suggests abdominal obesity for many participants. Blood Pressure: Mean systolic (136.2 mmHg) and diastolic (84.1 mmHg) values suggest prehypertension or early hypertension. Table 1 summarizes the baseline characteristics of the study population.

In this study participants were stratified into two groups based on their antioxidant levels (high vs. low). Hemoglobin levels were significantly lower in the group with low antioxidant status (mean Hb: 11.3 ± 1.2 g/dL) compared to the high antioxidant group (mean Hb: 12.8 ± 1.4 g/dL, p < 0.05). Ferritin levels, a marker of iron storage, are higher in the High Antioxidants group compared to the Low Antioxidantsgroup (45.6 vs. 32.4 µg/L). The Total Antioxidant Capacity is notably higher in the High Antioxidants group (1.7 mmol/L) compared to the Low Antioxidants group (1.2 mmol/L). Table 2 details the comparison of antioxidant and anemia markers.

In current study Hemoglobin (g/dL): Mild Anemia shows a hemoglobin level of 11.0 g/dL, which is slightly below the normal range (typically >12 g/dL for adults, depending on sex). Moderate Anemia shows a more significant reduction, with an average of 9.8 g/dL. Severe Anemia shows the lowest average hemoglobin level at 8.2 g/dL, which is much lower than the normal range and likely indicative of a more serious health condition. Non-Anemic individuals have the highest average hemoglobin levels (13.1 g/dL), within the normal range.

Anemia prevalence in postmenopausal women is influenced by multiple factors, including nutritional deficiencies, chronic inflammation, and hormonal changes. This study identified a clear association between low antioxidant levels and reduced hemoglobin concentrations. ^[7-14] Participants with lower antioxidant capacity exhibited a higher prevalence of anemia, particularly moderate and severe forms. These findings align with previous studies suggesting that oxidative stress plays a central role in anemia pathogenesis by disrupting erythropoiesis and increasing hemolysis. ^[15]. 

Improved antioxidant status is associated with reduced anaemia prevalence and enhanced cardio-metabolic profiles in postmenopausal women. Targeted interventions focusing on diet, lifestyle, and supplementation offer promising strategies for mitigating these health risks

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