5 Early diagnosis of coronary artery disease in postmenopausal women by arterial stiffness assessment

Abstract

Abstract Aims Arterial stiffness is a marker of cardiovascular disease useful to identify, at an early stage, subjects with increased risk of cardiovascular artery diseases (CADs). Nevertheless, studies on gender-specific interactions of PWV and CAD are lacking. Therefore, the aim of this study is to investigate, in a population of postmenopausal women, the role of PWV in relation to CAD. The goal of our study was to assess the prevalence of CAD, among postmenopausal women affected by increased arterial stiffness, assessed by global pulse wave velocity (gPWV), and with diabetes and/or hypertension on target, distinguishing the different phenotypes. Methods and results We enrolled 632 consecutive women with an increased gPWV, 300 consecutive postmenopausal women with normal gPWV were included as control group (CG). We assessed arterial stiffness by gPWV, performed by pulsed Doppler (3.5 MHz probe) using two-dimensional guidance and ECG trigger. Philips Epiq 7 was used which is an echo-Doppler system equipped with a multifrequency transducer. The gPWV was assessed as normal for a velocity equal or lower than 7.1 m/s. CAD diagnosis was accepted when confirmed by exercise or nuclear stress test, cardiac catheterization, and angiogram or cardiac CT scan. All women were on therapy, with blood pressure < 130/80 mmHg and HbA1c < 7%. 55 (8.8%) women were affected by CAD among 632 with increased gPMW, and 15 (5%) among 300 women of CG, P < 0.04. There was no difference for mean age between the two groups: 58 ± 11 and 56 ± 8, respectively, P = 0.2. 29 (4.5%) women were affected by CAD and hypertensive cardiomyopathy among 632 with increased gPMW, and 6 (2%) among 300 women of CG, P < 0.05. 16 (2.6%) women were affected by CAD and metabolic cardiomyopathy among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P < 0.05. Seventeen (2.7%) women were affected by CAD alone among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P < 0.04. Conclusions We found a higher prevalence of CAD among postmenopausal women with increased gPWV when affected by hypertension and/or diabetes, also if on target therapy; the statistically significant correlation is confirmed also when women are affected by hypertensive or metabolic cardiomyopathy. We conclude that early detection increased gPWV may identify women with higher risk to develop CAD also before they become symptomatic.