IS THERE AN ASSOCIATION BETWEEN ATHLETIC AMENORRHEA AND EARLY CARDIOVASCULAR DISEASE?

Abstract

Menopause is associated with osteoporosis and accelerated cardiovascular disease. Athletic amenorrhea is characterized by reduced levels of circulating estrogens and decreased bone mineral density, a state similar to post menopausal amenorrhea. The purpose of this study is to determine if young females with athletic amenorrhea and oligomenorrhea show signs of early cardiovascular disease manifested by decreased endothelium-dependent dilation of the brachial artery. Methods: Ten women with athletic amenorrhea, eleven with oligomenorrhea and eleven age-matched controls were studied. All ran a minimum of 25 miles/week. Estradiol, progesterone, FSH, TSH, and cholesterol were sampled. Subjects completed a three-day diet history. Bone mineral density and body composition were measured with a Lunar DEXA scanner. A 10 MHz ultrasound probe was used to determine hyperemia-induced vasodilatation (endothelium-dependent) and vasodilatation following 0.4 milligrams of sublingual nitroglycerin (endothelium-independent). Data was analyzed with ANOVA followed by Newman-Keuls post hoc analysis for significant differences. Results: Endothelium-dependent dilation was reduced in the amenorrheic group compared to control (1.5 ± 1.0% vs. 5.42 ± 1.1%; p < 0.05). Bone mineral density measured at the lumbar vertebrae (L2-L4) g/cm2 was lower (p ≤ 0.05) in the amenorrheic (1.12 ± 0.04) and oligomenorrheic (1.17 ± 0.05) groups compared to control (1.22 ± 0.03). There were no differences in serum levels of estradiol, FSH, progesterone, TSH or cholesterol among the three groups. The dietary history showed no differences. The three groups were similar in percentage of body fat, menarche, frequency, duration, intensity and distance of running. Conclusion: Athletic amenorrhea is associated with decreased bone mineral density and reduced endothelium-dependent dilation of the brachial artery. This abnormality may predispose to accelerated development of cardiovascular disease. Supported in part by a grant from the American Academy of PM&R.