IJCS | Volume 31, Nº3, May/ June 2018

206 Fonseca et al. Metabolic Syndrome and Insulin Resistance International Journal of Cardiovascular Sciences. 2018;31(3)201-208 Original Article Table 4 – Association between insulin resistance and metabolic syndrome in premenopausal and postmenopausal women treated in a Gynecological Outpatient Clinic. São Luís (MA), Brazil, 2015. Insulin Resistance Premenopausal p value* Postmenopausal p value Metabolic syndrome Metabolic syndrome Absent Present Absent Present n % n % n % n % Absent 46 90.20 19 79.17 0.190 39 92.86 18 54.55 < 0.001† Present 5 9.80 5 20.83 3 7.14 15 45.55 * chi-square test; † p < 0.05 Fisher’s exact test. prevalence of IR in 13.3% premenopausal and 24% postmenopausal women, with no statistically significant association. Lejsková et al., 22 studying 909 pre- and postmenopausal women in the Czech Republic, found a slight increase in HOMA-IR values after menopause, but no significant association with menopausal status. These findings are corroborated by the study by Toth et al., 23 which evaluated the association between menopausal status and insulin sensitivity through the direct and more reliable method to evaluate IR – the glycemic clamp – and demonstrated that menopause is not an independent risk factor for the development of IR. Thepresenceof IRwas associatedwith thedevelopment of MS in the pre- and post-menopause, and it was observed that IR behaved as a direct predictor of MS only in the group of women who had already undergone the menopausal transition. This observation is consistent with what was found in the Czech study carried out by Lejsková et al. 22 . However, in a European study, the association occurred only in those women who already had a high HOMA-IR index in the reproductive period. These findings indicate that the menopausal transition alone did not result in an IR increase, and that the IR only determined MS in postmenopausal women. This thesis is reinforced by the finding of Manco et al. 24 study, carried out in several European countries, with 523 participants, which analyzed IR in men and women of different ages. They observed that IR proportionally increases in both genders frommiddle age on, suggesting that menopause does not significantly affect IR. 24 Among the components of theMS, the associationwith IR occurs in the premenopausal period onlywith elevated triglyceride levels andwith altered glycemic levels. In the postmenopausal period, IR is an independent risk factor only for the reduction of HDL-cholesterol. No similar data were found in the recent articles on MS and IR for the studied population. This study had as limitation a non-probabilistic sample with a relatively small number of assessed individuals, and further studies with larger sample sizes are necessary. Conclusion In the analyzed sample, menopause was not considered a risk factor for the development of metabolic syndrome, as well as for insulin resistance. However, the menopausal status was shown to be an independent risk predictor for fasting blood glucose and blood pressure components. Insulin resistance was considered a risk factor for the development of metabolic syndrome only in the postmenopausal period. Acknowledgements We are grateful to Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and to Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) for the financial support provided and to Hospital Universitário da Universidade Federal do Maranhão for authorizing the study performance in the Gynecology Outpatient Clinic and for the support of the clinical analysis laboratory.