Arterial Stiffness In Postmenopausal Women Research Articles

Daily Blueberry Consumption Improves Blood Pressure and Arterial Stiffness in Postmenopausal Women with Pre- and Stage 1-Hypertension: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

BackgroundPostmenopausal women have a high prevalence of hypertension and often develop arterial stiffness thereby increasing cardiovascular disease risk. Although antihypertensive drug therapies exist, increasing numbers of people prefer natural therapies. In vivo studies and a limited number of clinical studies have demonstrated the antihypertensive and vascular-protective effects of blueberries. ObjectiveTo examine the effects of daily blueberry consumption for 8 weeks on blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension. DesignThis was an 8-week, randomized, double-blind, placebo-controlled clinical trial. Participants/settingForty-eight postmenopausal women with pre- and stage 1-hypertension recruited from the greater Tallahassee, FL, area participated. InterventionParticipants were randomly assigned to receive either 22 g freeze-dried blueberry powder or 22 g control powder. Main outcome measuresResting brachial systolic and diastolic blood pressures were evaluated and arterial stiffness was assessed using carotid-femoral pulse wave velocity and brachial-ankle pulse wave velocity. C-reactive protein, nitric oxide, and superoxide dismutase were measured at baseline, 4 weeks, and 8 weeks. Statistical analyses performedStatistical analysis was performed using a split plot model of repeated measures analysis of variance. ResultsAfter 8 weeks, systolic blood pressure and diastolic blood pressure (131±17 mm Hg [P<0.05] and 75±9 mm Hg [P<0.01], respectively) and brachial-ankle pulse wave velocity (1,401±122 cm/second; P<0.01) were significantly lower than baseline levels (138±14 mm Hg, 80±7 mm Hg, and 1,498±179 cm/second, respectively), with significant (P<0.05) group×time interactions in the blueberry powder group, whereas there were no changes in the group receiving the control powder. Nitric oxide levels were greater (15.35±11.16 μmol/L; P<0.01) in the blueberry powder group at 8 weeks compared with baseline values (9.11±7.95 μmol/L), whereas there were no changes in the control group. ConclusionsDaily blueberry consumption may reduce blood pressure and arterial stiffness, which may be due, in part, to increased nitric oxide production.

Renal Function Is Associated with Bone Mineral Density and Arterial Stiffness in Healthy Postmenopausal Women

Background/Aims: This study aimed to investigate the effect of renal function on bone mineral density (BMD) and arterial stiffness in postmenopausal women. Methods: This is a retrospective cross-sectional study. We studied 252 postmenopausal women who visited a health promotion center for a medical checkup. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault (CG) formula and the modification of diet in renal disease (MDRD) formula. Areal BMD measurements were performed using dual-energy X-ray absorptiometry, and arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). Results: The eGFR according to the CG formula was significantly correlated with age, BMI, follicle-stimulating hormone, thyroid-stimulating hormone, high-density lipoprotein cholesterol, baPWV, and BMD at the lumbar spine, femoral neck, and total hip sites. However, the eGFR according to the MDRD formula was significantly correlated with age and baPWV but not with BMD at the lumbar spine, femoral neck, and total hip sites. Decreased renal function (eGFR <60 ml/min/1.73 m² according to the CG formula) was independently associated with decreased BMD at the femoral neck site and with increased baPWV (>1,500 cm/s) after adjusting for confounding variables. Conclusion: Postmenopausal women with decreased renal function are more likely to have a decreased BMD and greater arterial stiffness.

Relationship between vitamin D levels and carotid arterial stiffness in postmenopausal women with hypertension

Relationship between vitamin D levels and carotid arterial stiffness in postmenopausal women with hypertension

Urine 6-sulfatoxymelatonin levels are inversely associated with arterial stiffness in post-menopausal women

ObjectThe secretion of melatonin, a pleiotropic hormone mainly synthesized by the pineal gland, typically decreases with age and may be associated with the development of aging-related pathologic conditions such as cardiovascular disease. Atherosclerosis is an aging-related disease, the pathogenesis of which involves chronic inflammation and increased oxidative stress. Since melatonin has both anti-oxidant and anti-inflammatory properties, it may be associated with atherosclerosis. Therefore, we investigated the relationship between urine concentrations of 6-sulfatoxymelatonin (aMT6s) and arterial stiffness in post-menopausal women. MethodsA total of 66 post-menopausal women participated in the study. Melatonin secretion was estimated by measuring aMT6s levels in first morning urine samples. The cardio-ankle vascular index (CAVI) was used as an indicator of arterial stiffness. ResultsEstimated mean CAVI decreased gradually with increasing aMT6s quartiles. The multivariate logistic regression analysis showed that the fourth aMT6s quartile was associated with a high CAVI with an adjusted odds ratio of 0.03 (95% confidence interval, 0.01–0.47). ConclusionOur study revealed an inverse relationship between urine aMT6s and arterial stiffness as determined by CAVI. Although it is impossible to determine causality, our results suggest that melatonin may have a beneficial role in the pathogenesis of atherosclerosis. Further prospective studies are required to establish the clinical significance of our study.

Relationship between body composition and arterial stiffness in postmenopausal women (391.8)

Menopause is associated with age‐related increases in blood pressure (BP) and arterial stiffness and has also been linked to increased fat mass (FM), decreased bone mineral density (BMD) and content (BMC) and decreased lean body mass (LBM). Thus, the goal of this cross‐sectional study was to investigate the relationship between body composition and arterial stiffness. In 81 pre‐ and stage 1‐hypertensive postmenopausal women (age: 59 ± 5 years; BMI: 31 ± 6; SBP: 140 ± 15 mmHg) BMD, BMC, LBM, and FM were assessed by dual X‐ray absorptiometry and arterial stiffness was evaluated by brachial pulse wave velocity (baPWV) using applanation tonometry. No significant correlations were found between BMD, LBM, or FM and baPWV yet BMC tended to negatively correlate with baPWV (p = 0.07, r = ‐ 0.202) which remained true after adjusting for systolic BP and treatment for hypertension or with statins. However, a significant correlation between BMC and baPWV was observed after adjusting for mean arterial pressure (MAP; p = 0.04, r = ‐ 0.227). Multiple regression analysis showed that baPWV was significantly and independently associated with age, MAP, and weight (p = 0.000, R² = 0.270) which was unchanged after exclusion of statins users (p = 0.000, R² = 0.251). Nonetheless, a subsequent multiple regression analysis in which women on anti‐hypertensive medications were excluded revealed that MAP, age, and BMD are independent predictors of baPWV (p = 0.001, R² = 0.433). Our findings suggest that lower BMD and BMC may be related to increased arterial stiffness and a greater risk of cardiovascular diseases and osteoporosis in postmenopausal women.

Whole-body vibration exercise training reduces arterial stiffness in postmenopausal women with prehypertension and hypertension

The purpose of this study was to examine the impact of whole-body vibration (WBV) exercise training on arterial stiffness (pulse wave velocity [PWV]), blood pressure (BP), and leg muscle function in postmenopausal women. Twenty-five postmenopausal women with prehypertension and hypertension (mean [SE]; age, 56 [1] y; systolic BP, 139 [2] mm Hg; body mass index, 34.7 [0.8] kg/m2) were randomized to 12 weeks of WBV exercise training (n = 13) or to the no-exercise control group. Systolic BP, diastolic BP, mean arterial pressure, heart rate, carotid-femoral PWV, brachial-ankle PWV, femoral-ankle PWV (legPWV), leg lean mass, and leg muscle strength were measured before and after 12 weeks. There was a group-by-time interaction (P < 0.05) for arterial stiffness, BP, and strength as brachial-ankle PWV (-1.3 [0.3] m/s, P < 0.01), legPWV (-0.81 [0.22] m/s, P < 0.01), systolic BP (-12 [3] mm Hg, P < 0.01), diastolic BP (-6 [2] mm Hg, P < 0.01), and mean arterial pressure (-9 [3] mm Hg, P < 0.01) decreased and as strength increased (21.0% [2.2%], P < 0.001) after WBV exercise training compared with no change after control. Heart rate decreased (-3 [1] beats/min, P < 0.05) after WBV exercise training, but there was no interaction (P > 0.05). Leg lean mass and carotid-femoral PWV were not significantly (P > 0.05) affected by WBV exercise training or control. Our findings indicate that WBV exercise training improves systemic and leg arterial stiffness, BP, and leg muscle strength in postmenopausal women with prehypertension or hypertension. WBV exercise training may decrease cardiovascular and disability risks in postmenopausal women by reducing legPWV and increasing leg muscle strength.

Effect of ultra-low-dose estradiol and dydrogesterone on arterial stiffness in postmenopausal women

Background Ultra-low-dose estradiol is known to improve menopausal symptoms and increase bone mineral density. However, the effect of ultra-low-dose estradiol on vascular function has not been clarified.Objectives We examined the effects of ultra-low-dose estradiol on brachial-ankle pulse wave velocity (baPWV) and circulating markers of cardiovascular risk.Patients and methods Twenty-eight postmenopausal women were enrolled in this study. Fourteen women received oral estradiol (0.5 mg) and dydrogesterone (5 mg) every day for 12 months (ultra-low-dose group) as hormone replacement therapy (HRT) and 14 women as a control group did not receive HRT. The baPWV, lipid profiles, homeostasis model assessment of insulin resistance (HOMA-IR) and vascular inflammatory markers were measured.Results The baPWV level significantly decreased in the ultra-low-dose group (p = 0.037), while the baPWV level did not significantly change in the control group. HOMA-IR tended to decrease in the ultra-low-dose group (p = 0.076). Systolic blood pressure and diastolic blood pressure did not change significantly in either group.Conclusion An HRT regimen using oral ultra-low-dose estradiol and dydrogesterone has an effect on arterial stiffness and insulin resistance.

Aerobic exercise training increases plasma Klotho levels and reduces arterial stiffness in postmenopausal women

The Klotho gene is a suppressor of the aging phenomena, and the secretion as well as the circulation of Klotho proteins decrease with aging. Although habitual exercise has antiaging effects (e.g., a decrease in arterial stiffness), the relationship between Klotho and habitual exercise remains unclear. In the present study, we investigated the effect of habitual exercise on Klotho, with a particular focus on arterial stiffness. First, we examined the correlation between plasma Klotho concentration and arterial stiffness (carotid artery compliance and β-stiffness index) or aerobic exercise capacity [oxygen uptake at ventilatory threshold (VT)] in 69 healthy, postmenopausal women (50-76 years old) by conducting a cross-sectional study. Second, we tested the effects of aerobic exercise training on plasma Klotho concentrations and arterial stiffness. A total of 19 healthy, postmenopausal women (50-76 years old) were divided into two groups: control group and exercise group. The exercise group completed 12 wk of moderate aerobic exercise training. In the cross-sectional study, plasma Klotho concentrations positively correlated with carotid artery compliance and VT and negatively correlated with the β-stiffness index. In the interventional study, aerobic exercise training increased plasma Klotho concentrations and carotid artery compliance and decreased the β-stiffness index. Moreover, the changes in plasma Klotho concentration and arterial stiffness were found to be correlated. These results suggest a possible role for secreted Klotho in the exercise-induced modulation of arterial stiffness.

Bone metabolism regulators and arterial stiffness in postmenopausal women

BackgroundOsteoprotegerin (OPG), osteopontin (OPN) and matrix Gla protein (MGP) are markers of bone metabolism but they are also involved in vascular calcification. However, their precise role is not completely understood. Arterial stiffness is considered an independent predictor of cardiovascular events and it may be one of the causes of the increased cardiovascular risk associated with postmenopausal status. Medial and intimal calcification may increase arterial stiffness. The aim of our study was to assess the relationship of OPG, OPN and MGP with aortic pulse wave velocity (aPWV) as a marker of arterial stiffness in postmenopausal women. Materials and methodsCirculating OPG, OPN and serum total MGP were measured in 144 postmenopausal women using the enzyme-linked immunosorbent assay method. Aortic PWV was determined by an oscillometric method. ResultsOsteoprotegerin correlated with age (p<0.001, r=0.27), aPWV (p<0.001, r=0.32) and hypersensitive C reactive protein (hsCRP) (p<0.001, r=0.37), OPN correlated directly with hsCRP (p<0.001, r=0.39) and inversely with high density lipoprotein cholesterol (p=0.02, r=−0.02). No significant association was found between total MGP and clinical, biochemical and vascular parameters. The correlation between OPG and aPWV persisted even after the adjustment for various potential confounders (p=0.02, r=0.19). In multiple regression analysis in the whole study population the most important predictors of aPWV were OPG (β=0.230, p=0.006), hsCRP (β=0.212, p=0.01) and systolic blood pressure (β=0.163, p=0.04). After exclusion of patients treated with statins the independent predictors were hsCRP (β=0.275, p=0.005) and OPG (β=0.199, p=0.04). ConclusionCirculating OPG, but not OPN and total MGP, is associated with aPWV and may be a marker of the increased arterial stiffness and cardiovascular risk in postmenopausal women.

The relationship between inhibitors of the Wnt signalling pathway (Dickkopf-1(DKK1) and sclerostin), bone mineral density, vascular calcification and arterial stiffness in post-menopausal women

Epidemiological studies have shown an association between bone loss/osteoporosis and vascular calcification (VC). Recent studies have implicated the Wnt signalling pathway in the pathogenesis of VC. We investigated the association between circulating concentrations of Wnt inhibitors; DKK1 and sclerostin with bone mineral density (BMD), abdominal aortic calcification (AAC) and arterial stiffness in post-menopausal women. One hundred and forty six post-menopausal women aged (mean [SD]) 61.5[6.5] years were studied. Sclerostin and DKK1 were measured in serum. BMD was measured at the lumbar spine (LS), femoral neck (FN), total hip (TH). AAC was detected by Vertebral Fracture Assessment (VFA) imaging and quantified using an 8- and 24- point scoring methods. Arterial stiffness was determined by aortic pulse wave velocity (PWV). A significant positive correlation was observed between sclerostin and BMD at the FN (r=0.166, p=0.043) and TH (r=0.165, p=0.044). The association remained significant at the FN (p=0.045) and TH (p=0.026) following adjustment for confounders. No significant correlation was observed between DKK1 and BMD. In contrast, there was a significant negative correlation between log DKK1 and AAC (24-point score: r=−0.25, p=0.008 and 8-point score: r=−0.21, p=0.024). Subjects with AAC score of 1 or less had significantly higher DKK1 (p=0.01). The association between DKK1 and AAC remained significant following correction for age, blood pressure, cholesterol (24-point score: p=0.017, 8-point score: p=0.044). In adjusted linear regression analysis, sclerostin was positively associated with AAC (24-point score: p=0.048, 8-point score: p=0.031). Subjects with a PWV>9m/s had significantly higher sclerostin than those with PWV <9m/s: 23.8[12.3], vs 29.7 [14] pmol/l, p=0.03). No association was observed between DKK1 and PWV. The opposite association between AAC and the 2 Wnt signaling inhibitors is of interest and merits further investigations. Future longitudinal studies are needed to establish the precise role of sclerostin and DKK1 in the pathogenesis of VC.

Osteoprotegerin and arterial stiffness in postmenopausal women

Osteoprotegerin and arterial stiffness in postmenopausal women

Relationships between serum uric acid, adiponectin and arterial stiffness in postmenopausal women

ObjectivesCardiovascular disease (CVD) is a leading cause of death in postmenopausal women. Elevated serum uric acid levels, hypoadiponectinemia and arterial stiffness are strongly associated with cardiovascular diseases. We investigated the relationships among uric acid, adiponectin and arterial stiffness in postmenopausal women. Study design9555 subjects who had the routine health check-ups, 841 postmenopausal women aged 50years or older who had not had a menstrual period for more than 12 consecutive months were included in this study. Main outcome measuresBMI, WC, and serum concentrations of uric acid, adiponectin, glucose, lipids (total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol) were measured. Insulin resistance was estimated by the insulin resistance index of homeostasis model assessment (HOMA-IR). Pulse wave velocity (PWV) was evaluated to assess arterial stiffness. ResultsThe subjects were stratified into three groups according to uric acid values. PWV values gradually increased and adiponectin level decreased with uric acid tertiles. Serum uric acid levels in postmenopausal women correlated significantly with age, BMI, WC, TG, HDL-C, insulin, HOMA-IR, adiponectin and PWV. Multiple regression analysis showed that WC (β=0.141, P<0.01), HOMA (β=0.137, P<0.01), adiponectin (β=−0.104, P<0.01), and PWV (β=0.129, P<0.01) were independently correlated with uric acid levels. In multiple logistic regression analysis after adjusting for risk factors, uric acid was a significant contributor to increased PWV. ConclusionsThese findings indicate that serum uric acid is independently associated with adiponectin and arterial stiffness in postmenopausal women.

Effects of bench step exercise on arterial stiffness in post-menopausal women: Contribution of IGF-1 bioactivity and nitric oxide production

ObjectiveTo examine the effect of bench step exercise on arterial pulse wave velocity (PWV) and the associated contribution of insulin-like growth factor (IGF)-1 bioactivity and nitric oxide (NO). DesignTwenty-six elderly (post-menopausal) women were randomly allocated to a bench step exercise group or a control group. The participants in the bench step exercise group practiced a 12-week home-based bench step exercise for 10–20min, 3 times daily (i.e., for a total of 140min/week at the intensity level of lactate threshold (LT)). In addition to conventional risk factors of atherosclerosis, PWV, IGF-1/IGF binding protein (IGFBP)-3 molar ratio (an index for IGF-1 bioactivity), and urinary nitrite/nitrate (NOx) excretion were measured before and after the intervention. ResultsBMI, systolic blood pressure, fasting plasma glucose, low-density lipoprotein cholesterol, LT, and PWV were significantly improved in the bench step exercise group. A significant positive correlation between changes in PWV and IGF-1/IGFBP-3 molar ratio, and a significant negative correlation between changes in IGF-1/IGFBP-3 molar ratio and urinary NOx excretion were found in the bench step exercise group. ConclusionThe bench step exercise leads to improvements in not only the classical risk factors of atherosclerosis but also the arterial stiffness in elderly women, partly through NO production via IGF-1 bioactivity.

Association of Parathyroid Hormone and 25-OH-Vitamin D Levels with Arterial Stiffness in Postmenopausal Women with Vitamin D Insufficiency

Vitamin D insufficiency and increased parathyroid hormone (PTH) levels have been suggested as prognostic indices for cardiovascular disease. Arterial stiffness, a surrogate marker for cardiovascular disease, is often increased in patients with primary hyperparathyroidism. PTH levels increase in patients with low 25-OH-vitamin D levels, but the influence of such an increase on arterial stiffness has not been investigated in postmenopausal women with reduced 25-OH-vitamin D levels. We therefore investigated the association between PTH and aortic stiffness in postmenopausal women with reduced 25-OH-vitamin D levels. One hundred fifty postmenopausal women with 25-OH-vitamin D insufficiency (<30 ng/mL) were recruited. Aortic pulse wave velocity (aPWV), a measure of arterial stiffness, PTH and 25-OH-vitamin D levels were measured. Cardiovascular risk factors and markers of bone formation were evaluated. The 25-OH-vitamin D levels were associated with aPWV (rho=-0.23, p=0.006), but the association was not significant when controlling for PTH. Significant correlates of aPWV included age, body mass index, mean arterial pressure and PTH (rho=0.39, p<0.001). Arterial stiffness was predicted by logarithmically transformed PTH levels (β=0.23, p=0.007), independent of traditional cardiovascular risk factors and factors involved in bone formation. Increased PTH levels (>62 pg/mL) were associated with a 3.0-5.4-fold increased probability of having a mild-severe increase in aortic stiffness, irrespective of confounders. Among postmenopausal women with reduced 25-OH-vitamin D levels, elevated PTH levels were a significant predictor of aortic stiffness, irrespective of cardiovascular risk factors and of factors involved in bone formation. PTH accounted for the association between 25-OH-vitamin D levels and aortic stiffness.

Combined Exercise Training Decreases Blood Pressure and Arterial Stiffness in Postmenopausal Women

Combined Exercise Training Decreases Blood Pressure and Arterial Stiffness in Postmenopausal Women

Vascular adaptations to hypobaric hypoxic training in postmenopausal women

The objective of this study was to examine the effects of exercise training in hypoxia on arterial stiffness and flow-mediated vasodilation (FMD) in postmenopausal women. Sixteen postmenopausal women (56±1 years) were assigned to a normoxic exercise group (Normoxic group, n=8) or a hypoxic exercise group (Hypoxic group, n=8). The Hypoxic group performed exercise under hypobaric hypoxic conditions corresponding to 2000 m above sea level, and was exposed to these conditions for 2 h per session. Aquatic exercise was performed at an intensity of around 50% peak oxygen uptake for 30min, 4days per week, for 8 weeks. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV), and FMD was evaluated by peak diameter of the popliteal artery during reactive hyperemia. After the 8 weeks of training, the Normoxic group showed no significant changes. In contrast, baPWV (P < 0.05) was significantly reduced and peak diameter (P<0.05) and %FMD (P<0.01) were significantly increased in the Hypoxic group after training. These results suggest that exercise training under mild intermittent hypoxic conditions could more effectively reduce arterial stiffness in postmenopausal women, compared with exercise training performed at the same relative intensity under normoxic conditions. Our data also indicate that hypoxic exercise training may induce vascular functional adaptation, for example an increase in FMD response. These findings therefore could have important implications for the development of a new effective exercise prescription program.

Osteoprotegerin as an independent marker of subclinical atherosclerosis in osteoporotic postmenopausal women

Osteoprotegerin (OPG) appears to represent the molecular link between bone resorption and vascular calcification, and may help to explain the high prevalence of atherosclerosis and osteoporosis in postmenopausal women. We investigated a possible association between serum OPG levels and arterial stiffness in postmenopausal women with osteoporosis. 70 postmenopausal women with osteoporosis and cardiovascular risk factors but without coronary artery disease were evaluated for metabolic, inflammatory parameters and serum OPG levels. Pulse wave velocity (PWV) and augmentation index (AIx) were performed as a simple noninvasive recording of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). Serum OPG levels were significantly, positively associated with AIx ( r = 0.39, p = 0.003) and with PWV ( r = 0.81, p < 0.0001). No association between OPG levels and hemodynamic variables or measures of glucose metabolism was observed. Among inflammatory markers, OPG was significantly, positively associated with fibrinogen ( r = 0.323, p = 0.015). In a multiple linear regression analysis, OPG was independent predictor of PWV (standardized beta = 0.75, p < 0.0001) and AIx (standardized beta = 0.41, p = 0.01). Serum OPG is potentially an independent predictor of early vascular adverse changes in osteoporotic postmenopausal women.

Conjugated equine estrogen, raloxifene and arterial stiffness in postmenopausal women

Methods We analyzed the influence of conjugated equine estrogen (CEE) and raloxifene on arterial stiffness. Sixty-seven healthy, normotensive women 1–10 years into menopause were assigned to receive oral placebo, conjugated equine estrogen 0.625 mg, or raloxifene 60 mg. Arterial stiffness was evaluated by measuring the carotid–femoral and femoral–dorsalis pedis pulse wave velocity (CF PWV, FP PWV). Systolic pressure augmentation index (AI) at the carotid artery was obtained with applanation tonometry.Results Arterial stiffness was not affected by any treatment regimen: placebo (CF PWV before vs. after: 644 vs. 626 cm/s, p = 0.09; FP PWV before vs. after: 1006 vs. 1012 cm/s,p = 0.77; AI before vs. after = 30 vs. 29%, p = 0.55), CEE (CF PWV before vs. after: 642 vs. 600 cm/s, p = 0.11; FP PWV before vs. after: 952 vs. 971 cm/s, p = 0.66; AI before vs. after: 25 vs. 32%, p = 0.82), and raloxifene (CF PWV before vs. after: 636 vs. 601 cm/s, p = 0.12; FP PWV before vs. after: 964 vs. 941 cm/s, p = 0.62; AI before vs. after: 25 vs. 25%, p = 0.65). A correlation occurred between basal stiffness and the degree of reduction in indexes measured, indicating that the higher the basal stiffness, the greater the degree of reduction, particularly in the CEE group: CF PWV (r = − 0.602, p = 0.001); FP PWV (r = − 0.455, p = 0.022); AI (r = − 0.410, p = 0.042).Conclusions Conjugated equine estrogen and raloxifene do not seem to affect arterial stiffness of healthy normotensive women less than 10 years since menopause. Reduction in arterial stiffness seems related to its basal level.

Hormone Replacement Therapy and Atherosclerosis in Postmenopausal Women

Despite the clear-cut epidemiological evidence of protective effects of endogenous estrogens in premenopausal women,1,2 the results of randomized clinical trials using conjugated equine estrogens and medroxyprogesterone acetate instead of natural hormones have led to a paradigm shift in the usefulness of hormone treatment in postmenopausal women.3,4 One of the main criticisms in addition to the types of drugs chosen for treatment was the age of the patients. Indeed, in both WHI trial and HERS study, treatment of patients was initiated in women many years beyond menopause.5 In fact, the number of years since menopause was an independent indicator for nonfatal myocardial infarction or coronary related death.5 In this context, it appears of interest that heart disease may contribute to menopausal age and that menopausal age actually may be an indicator of cardiovascular risk.6,7 See page 1782 It was noted as early as 1952 that the natural endogenous estrogen 17β-estradiol inhibits experimental atherosclerosis,8 and oral estrogens were even unsuccessfully evaluated to treat coronary artery disease in male patients.9–11 However, at the time little was known about the mechanisms by which sex steroid hormones affect vascular homeostasis and thrombogenesis. During the past 2 decades, considerable advances were made in the understanding of how natural estrogens act on the vasculature. 17β-estradiol causes rapid and endothelium-independent dilation of coronary arteries of men and women,12 and chronic treatment with 17β-estradiol inhibits experimental atherosclerosis in males and females.13,14 On the other hand, treatment with conjugated equine estrogens, which contain more than 30 different steroid compounds including testosterone and substances of still undefined vascular activity (Table), have shown less favorable effects,2–4 as has been reported for the synthetic progestin medroxyprogesterone acetate.15 With the identification of molecular targets of 17β-estradiol and other estrogens it now appears that …

Physical Activity Duration, Intensity, and Arterial Stiffening in Postmenopausal Women

Aerobic exercise training is associated with lower central arterial stiffness, but little information exists on the effects of physical activity intensity or duration on central arterial stiffness. Using a cross-sectional and interventional approach, we tested the hypothesis that both moderate and vigorous physical activity reduce central arterial stiffness in postmenopausal women. Carotid arterial stiffness (via ultrasound and applanation tonometry) and duration of physical activity at low, moderate, and vigorous intensities (via electronic accelerometer) were measured in 103 apparently healthy sedentary or recreationally active women 47 to 82 years of age. Moderate intensity physical activity was defined as 4.0 to 6.0 metabolic equivalents (MET) in subjects aged <65 years and as 3.0 to 5.0 MET in subjects >or=65 years. A subgroup of 17 sedentary subjects was randomly assigned to moderate (n = 8) or vigorous (n = 9) intensity cycling exercise training (900 kcal/week, three to five sessions per week, for 12 weeks). Carotid arterial stiffness was measured before and after training. Carotid beta-stiffness index was significantly correlated with the duration of moderate and vigorous intensity physical activity (r = -0.25 and r = -0.22) even after adjustment for age, height, and mean BP. Carotid beta-stiffness index significantly decreased after moderate and vigorous intensity cycling training. There were no significant group differences in the magnitude of beta-stiffness index change even after adjustment for expected confounders (eg, baseline beta-stiffness index, height, body mass index, heart rate, and post-training body mass, body mass index, and mean BP). These results suggest that both moderate and vigorous physical activities have favorable effects on central arterial stiffness in postmenopausal women.