Cardiovascular Risk In Postmenopausal Women Research Articles

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.

Effects of whole-body vibration exercise training on aortic wave reflection and muscle strength in postmenopausal women with prehypertension and hypertension

Increased wave reflection (augmented pressure (AP) and augmentation index (AIx)) and reduced muscle strength may increase cardiovascular risk in postmenopausal women. We evaluated the effects of whole-body vibration exercise training (WBVET) on aortic haemodynamics and leg muscle strength. Twenty-eight postmenopausal women (age, 56±3 years; brachial systolic blood pressure (SBP) 138±12 mm Hg; body mass index, 33.9±3.7 kg m(-2)) were randomized to 6 weeks of WBVET (n=15) or no-exercise control groups. Aortic SBP, diastolic blood pressure (DBP), pulse pressure (PP), AP, AIx, tension time index (TTI, myocardial oxygen demand) and leg press muscle strength were measured before and after 6 weeks. WBVET significantly (P<0.05) decreased aortic SBP (∼10 mm Hg), DBP (∼5 mm Hg), PP (∼5 mm Hg), AP (∼5 mm Hg), AIx (∼10%) and TTI (∼311 mm Hg s per minute), while increased muscle strength (∼9%) compared with no changes after control. Changes in AP and leg muscle strength were correlated (r=-0.58, P=0.02). Our data demonstrated that WBVET reduced pressure wave reflection magnitude and aortic blood pressure in postmenopausal women with prehypertension or hypertension. Our study suggests that WBVET may decrease cardiovascular risk in postmenopausal women by improving wave reflection and muscle strength.

Vitamin D and cardiovascular risk in postmenopausal women: how to translate preclinical evidence into benefit for patients

Preclinical work indicates that calcitriol restores vascular function by normalizing the endothelial expression of cyclooxygenase-2 and thromboxane-prostanoid receptors in conditions of estrogen deficiency and thus prevents the thromboxane-prostanoid receptor activation-induced inhibition of nitric oxide synthase. Since endothelial dysfunction is a key factor in the pathogenesis of cardiovascular diseases, this finding may have an important translational impact. It provides a clear rationale to use endothelial function in clinical trials aiming to find the optimal dose of vitamin D for the prevention of cardiovascular events in postmenopausal women.

Frequency of private spiritual activity and cardiovascular risk in postmenopausal women: the Women's Health Initiative

PurposeSpirituality has been associated with better cardiac autonomic balance, but its association with cardiovascular risk is not well studied. We examined whether more frequent private spiritual activity was associated with reduced cardiovascular risk in postmenopausal women enrolled in the Women's Health Initiative Observational Study. MethodsFrequency of private spiritual activity (prayer, Bible reading, and meditation) was self-reported at year 5 of follow-up. Cardiovascular outcomes were centrally adjudicated, and cardiovascular risk was estimated from proportional hazards models. ResultsFinal models included 43,708 women (mean age, 68.9 ± 7.3 years; median follow-up, 7.0 years) free of cardiac disease through year 5 of follow-up. In age-adjusted models, private spiritual activity was associated with increased cardiovascular risk (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.02–1.31 for weekly vs. never; HR, 1.25; 95% CI, 1.11–1.40 for daily vs. never). In multivariate models adjusted for demographics, lifestyle, risk factors, and psychosocial factors, such association remained significant only in the group with daily activity (HR, 1.16; 95% CI, 1.03–1.30). Subgroup analyses indicate this association may be driven by the presence of severe chronic diseases. ConclusionsAmong aging women, higher frequency of private spiritual activity was associated with increased cardiovascular risk, likely reflecting a mobilization of spiritual resources to cope with aging and illness.

Markers of Increased Cardiovascular Risk in Postmenopausal Women: Focus on Oxidized-LDL and HDL Subpopulations

Objective. To evaluate the effect of gender and menopause in cardiovascular risk (CVR) in a healthy population based on both classical and nontraditional markers. Methods. 56 men and 68 women (48 pre- and 20 postmenopause) were enrolled in the study. The following markers were analyzed: blood pressure (BP), body mass index (BMI), waist circumference (WC), glucose, total cholesterol (total-c), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-c), oxidized-LDL (Ox-LDL), HDL-c and subpopulations, paraoxonase-1 activity, hsCRP, uric acid, tumor necrosis factor alpha (TNF-α), adiponectin, vascular endothelial growth factor (VEGF), and intercellular adhesion molecular 1 (ICAM1). Results. Relative to the women, men present significantly increased BMI, WC, BP, glucose, total-c, TGs, LDL-c, Ox-LDL, uric acid, and TNF-α and reduced adiponectin and total and large HDL-c. The protective profile of women is lost after menopause with a significantly increased BMI, WC, BP, glucose, LDL-c, Ox-LDL, hsCRP, and VEGF and decreased total and large HDL-c. Significant correlations were found in women population and in postmenopausal women between Ox-LDL and total, large, and small HDL-c and between TNF-α and total, large, and small HDL-c, LDL-c, and Ox-LDL. Conclusions. Men present higher CVR than women who lost protection after menopause, evidenced by nontraditional markers, including Ox-LDL and HDL subpopulations.

Markers of cardiovascular risk in postmenopausal women with type 2 diabetes are improved by the daily consumption of almonds or sunflower kernels: a feeding study.

Dietary guidelines for the treatment of type 2 diabetes advocate the regular consumption of nuts and seeds. Key lipid abnormalities associated with diabetes include raised LDL-C, VLDL-C, and TAG concentrations and decreased concentrations of HDL-C. The fatty acid profiles of nuts and seeds differ and may potentially influence lipid outcomes in people with diabetes differently. To examine the effects of nut or seed consumption on lipid and lipoprotein markers of cardiovascular disease (CVD), we added almonds (AD) or sunflower kernels (SKD) to a recommended diet in a randomised crossover feeding study. Twenty-two postmenopausal women with type 2 diabetes consumed personalised diets, with the addition of 30 g/d of either almonds or sunflower kernels. All food was supplied for two periods of three weeks, separated by a four-week washout. There was a significant reduction in high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TAG), and apolipoprotein (apo) A1 and B100 on the SKD compared to the AD. Total (TC) and low density lipoprotein cholesterol (LDL-C) decreased significantly on both diets from baseline, with no difference between diets. A diet with the addition of either almonds or sunflower kernels has clinically beneficial effects on lipid- and lipoprotein-mediated CVD risk.

Analysis of lipid status, body mass index and waist-hip ratio in post-menopausal women

Introduction: Menopause is the absence of menses in the period longer that one year. It is widely accepted that menopause leads to changes in hormonal status, metabolism and lipid profi le. The aim of this study wasto analyze the infl uence of menopause on the concentrations of lipids, lipoproteins and also the influence of body mass index (BMI) and waist-hip ratio (WHR) on lipid profi le in post-menopausal women.Methods: Sixty post-menopausal women of average age of 52.82 years were compared to a group of 34 pre-menopausal women average age of 47.92 years.Results: Post-menopausal women had higher, but non signifi cant (p&gt;0.05) concentrations of total cholesterol, very low density lipoproteins (VLDL), low density lipoproteins (LDL) and triglycerides than pre-menopausal women. The concentration of high density lipoproteins (HDL) was significantly lower in post-menopausal women than pre-menopausal (p&lt;0.05). The concentration of apolipoprotein B was also signifi cantly higher in post-menopausal women (p&lt;0.05), but the concentrations of apolipoprotein and lipoprotein (a) were lowerbut without signifi cance (p&gt;0.05). There was no difference between body mass index (BMI) and waste-hip ratio (WHR), but the WHR has shown as a signifi cant predictor of the LDL and cholesterol concentrations inpost-menopausal women.Conclusion: We can conclude that menopause leads to changes in lipid profi le by lowering of HDL and increasing the levels of apolipoprotein B, that increases the risk for cardiovascular disease. The WHR is thesignifi cant predictor of cardiovascular risk in post-menopausal women.

Estrogen improved metabolic syndrome through down-regulation of VEGF and HIF-1α to inhibit hypoxia of periaortic and intra-abdominal fat in ovariectomized female rats

Metabolic syndrome (MBS), a cluster of metabolic abnormalities and visceral fat accumulation, increases cardiovascular risks in postmenopausal women. In addition to visceral fat, perivascular adipose tissue has been recently found to play an important role in vascular pathophysiology. Hence, the present study investigates the effects of estrogen on both intra-abdominal fat (visceral fat) and periaortic fat (perivascular fat) accumulation as well as hypoxia in ovariectomized female rats. Female rats were divided into sham operation, ovariectomy and ovariectomy with 17β-estradiol supplementation groups. Twelve weeks later, we found that estrogen improved MBS via reducing body weight gain, the weight of periaortic and intra-abdominal fat, hepatic triglyceride, and total serum cholesterol levels. Estrogen also increased insulin sensitivity through restoring glucose and serum leptin levels. For periaortic fat, western blot showed estrogen inhibited hypoxia by reducing the levels of VEGF and HIF-1α, which is consistent with the results from immunohistochemical staining. The correlation analysis indicated that perivascular fat had a positive correlation with body weight, intra-abdominal fat or serum total cholesterol, but a negative correlation with insulin sensitivity index. For intra-abdominal fat, real-time fluorescent RT-PCR showed estrogen improved fat dysfunction via reducing the levels of relative leptin, MCP-1 but increasing adiponectin mRNA. Estrogen reduced the levels of VEGF and HIF-1α to inhibit hypoxia but restored the levels of PPARγ and Srebp-1c, which are important for lipid capacity function of intra-abdominal fat. These results demonstrated estrogen improved MBS through down-regulating VEGF and HIF-1α to inhibit hypoxia of periaortic and intra-abdominal fat in ovariectomized female rats.

A Review on Metabolic Syndrome

The metabolic syndrome is described by the clustering of several risk factors for Type 2 diabetes and cardiovascular disease. Lipid disorder, obesity, diabetes in general and high blood pressure are collectively defined as risk factors for cardiovascular disease triggered by metabolic syndrome. The metabolic syndromes have a correlation with the variations in genetic susceptibility, nutritional regiment, physical exercise, chronological age and gender which play direct role in the incidence of metabolic syndrome and its side effects. There are several definitions of Metabolic Syndrome in the World: World Health Organization's (WHO), The NCEP Adult Treatment Panel (ATP) III and the International Diabetes Federation (IDF). It appears that the female type 2 diabetic patients need to change their life style to halt the burden of cardiovascular complications in type 2 diabetic patients . Clinicians should significantly consider screening all people regardless of age for abnormalities in glucose level. Early treatment in people with abnormal glucose level constitutes a strategy of preventing type 2 diabetes mellitus and metabolic syndrome. Studies about metabolic syndrome have shown that females were more affected than males. This may be due to the specific characteristics in the lifestyle changes between females and males diabetic patients. Postmenopausal status might be a predictor of metabolic syndrome. Some related factors of metabolic syndrome among postmenopausal women may increase cardiovascular risk in postmenopausal women. doi: http://dx.doi.org/10.4021/jem118e

A Review on Metabolic Syndrome

The metabolic syndrome is described by the clustering of several risk factors for Type 2 diabetes and cardiovascular disease. Lipid disorder, obesity, diabetes in general and high blood pressure are collectively defined as risk factors for cardiovascular disease triggered by metabolic syndrome. The metabolic syndromes have a correlation with the variations in genetic susceptibility, nutritional regiment, physical exercise, chronological age and gender which play direct role in the incidence of metabolic syndrome and its side effects. There are several definitions of Metabolic Syndrome in the World: World Health Organization's (WHO), The NCEP Adult Treatment Panel (ATP) III and the International Diabetes Federation (IDF). It appears that the female type 2 diabetic patients need to change their life style to halt the burden of cardiovascular complications in type 2 diabetic patients . Clinicians should significantly consider screening all people regardless of age for abnormalities in glucose level. Early treatment in people with abnormal glucose level constitutes a strategy of preventing type 2 diabetes mellitus and metabolic syndrome. Studies about metabolic syndrome have shown that females were more affected than males. This may be due to the specific characteristics in the lifestyle changes between females and males diabetic patients. Postmenopausal status might be a predictor of metabolic syndrome. Some related factors of metabolic syndrome among postmenopausal women may increase cardiovascular risk in postmenopausal women. J Endocrinol Metab. 2012;2(4-5):166-170 doi: https://doi.org/10.4021/jem118e

Independent beneficial effects of aged garlic extract intake with regular exercise on cardiovascular risk in postmenopausal women

The purpose of the study was to assess the effects of a 12 weeks aged garlic extract (AGE) regimen with regular exercise on cardiovascular disease (CVD) risk in postmenopausal women. A total of 30 postmenopausal women (54.4 ± 5.4 years) were randomly divided into the following four groups: Placebo (Placebo; n = 6), AGE intake (AGEI; n = 8), exercise and placebo (Ex + Placebo; n = 8), exercise and AGE (Ex + AGE; n = 8) groups. The AGE group consume 80 mg per day, and exercise groups performed moderate exercise (aerobic and resistance) three times per week. After 12 weeks of treatment, body composition, lipid profile, and CVD risk factors were analyzed. Body weight was significantly decreased in AGEI, Ex + Placebo, and Ex + AGE groups compared to baseline. Body fat % was significantly decreased in the AGEI and Ex + Placebo groups. Body mass index (BMI) was significantly decreased in the AGEI, Ex + Placebo, and Ex + AGE groups. Fat-free mass was significantly decreased in the AGEI group. Total cholesterol (TC) was significantly lower in the Ex + Placebo compared to the Placebo group. AGE supplementation or exercise effectively reduced low-density lipoprotein (LDL-C). Triglyceride (TG) was significantly increased in the AGEI group. Malondialdehyde (MDA) levels were significantly decreased in the AGEI, Ex + Placebo, and Ex + AGE compared to the placebo group. AGE supplementation reduced homocysteine levels regardless of whether the women also exercised. The present results suggest that AGE supplementation reduces cardiovascular risk factors independently of exercise in postmenopausal women.

Dietary phytoestrogen supplementation induces sex differences in the myocardial protein pattern of mice: A comparative proteomics study

Elevated cardiovascular risk in postmenopausal women and beneficial actions of estrogen replacement in animal models have been related to protective effects of estrogens. However, randomized trials of hormone replacement therapy with synthetic estrogens in humans failed confirmation and phytoestrogens, natural plant hormones with agonistic properties for estrogen receptors, could represent potential alternatives. The aim of the present study is to characterize an animal model for alternative hormone replacement with genistein as a natural estrogenic compound. We performed a 2-DE/ESI-LC-MS approach in order to identify protein species varying with genistein receipt and sex in their relative abundance in the healthy murine heart (http://www.mpiib-berlin.mpg.de/2D-PAGE). Oral genistein treatment revealed a substantial effect on the relative abundance of both estrogen receptors. Several enzymes of the fatty acid metabolism and their transcriptional regulators varied differentially in male and in female animals, at the transcript and/or the protein species level. Increased levels of enzyme species involved in the oxidative phosphorylation and generation of ROS were accompanied by decreased amounts of antioxidants in male mice receiving genistein compared with control males, which have been previously associated with various pathological conditions. Exposure of female animals to genistein provoked an increased abundance of two species of LIM domain-binding protein and one species of desmin. These proteins have been associated with cardiac hypertrophy and our data warrant caution for the use of them as molecular markers, since the animals did not exhibit any histological signs of cardiac hypertrophy.

Estrogen upregulates hepatic apolipoprotein M expression via the estrogen receptor

Apolipoprotein M (apoM) is present predominantly in high-density lipoprotein (HDL) in human plasma, thus possibly involved in the regulation of HDL metabolism and the process of atherosclerosis. Although estrogen replacement therapy increases serum levels of apoAI and HDL, it does not seem to reduce the cardiovascular risk in postmenopausal women. Therefore, we investigated the effects of estrogen on apoM expression in vitro and in vivo. HepG2 cells were incubated with different concentrations of estrogen with or without the estrogen receptor antagonist, fulvestrant, and apoM expression in the cells was determined. Hepatic apoM expression and serum levels of apoM were also determined in normal and in ovariectomized rats treated with either placebo or estradiol benzoate, using sham operated rats as controls. Estrogen significantly increased mRNA levels of apoM and apoAI in HepG2 cell cultures in a dose- and time-dependent manner; the upregulation of both apolipoproteins was fully abolished by addition of estrogen receptor antagonist. In normal rats, estrogen treatment led to an increase in plasma lipid levels including HDL cholesterol, a marked upregulation of apoM mRNA and a significant increase in serum levels of apoM. The same pattern of regulation was found in ovariectomized rats treated with estrogen. Thus, estrogen upregulates apoM expression both in vivo and in vitro by mechanism(s) involving the estrogen receptor.

Inhibition of Renin-Angiotensin System Reverses Endothelial Dysfunction and Oxidative Stress in Estrogen Deficient Rats

BackgroundEstrogen deficiency increases the cardiovascular risks in postmenopausal women. Inhibition of the renin-angiotensin system (RAS) and associated oxidative stress confers a cardiovascular protection, but the role of RAS in estrogen deficiency-related vascular dysfunction is unclear. The present study investigates whether the up-regulation of RAS and associated oxidative stress contributes to the development of endothelial dysfunction during estrogen deficiency in ovariectomized (OVX) rats.Methodology/Principal FindingsAdult female rats were ovariectomized with and without chronic treatment with valsartan and enalapril. Isometric force measurement was performed in isolated aortae. The expression of RAS components was determined by immunohistochemistry and Western blotting method while ROS accumulation in the vascular wall was evaluated by dihydroethidium fluorescence. Ovariectomy increased the expression of angiotensin-converting enzyme (ACE), angiotensin II type 1 receptor (AT1R), NAD(P)H oxidase, and nitrotyrosine in the rat aorta. An over-production of angiotensin II and ROS was accompanied by decreased phosphorylation of eNOS at Ser1177 in OVX rat aortae. These pathophysiological changes were closely coupled with increased oxidative stress and decreased nitric oxide bioavailability, culminating in markedly impaired endothelium-dependent relaxations. Furthermore, endothelial dysfunction and increased oxidative stress in aortae of OVX rats were inhibited or reversed by chronic RAS inhibition with enalapril or valsartan.Conclusions/SignificanceThe novel findings highlight a significant therapeutic benefit of RAS blockade in the treatment of endothelial dysfunction-related vascular complications in postmenopausal states.

Oral contraceptive use, iron stores and vascular endothelial function in healthy women

Background Increased iron stores are associated with greater cardiovascular risk in postmenopausal women. Oral contraceptive pill (OCP) use decreases the volume of menstrual blood loss and increases iron stores, but the link between OCP use, iron stores and cardiovascular risk in premenopausal women has not been characterized. Study Design We conducted a cross-sectional study of 23 healthy OCP users to determine the association between type and duration of OCP exposure, iron stores, and vascular endothelial function [flow-mediated dilation (FMD) in the brachial artery]. Results Median duration of OCP use was 45 months. FMD in the brachial artery was significantly associated with progestin type used (estranes/gonanes vs. drospirenone) and duration of OCP use (both p<.05) but not iron stores. In multivariate analysis, progestin type was the only independent predictor of FMD. Conclusions Use of OCP containing drospirenone was independently associated with greater FMD in the brachial artery and, thus, a potentially more favorable cardiovascular risk profile, when compared with use of OCP containing estranes/gonanes.

Elevated oxidized low-density lipoprotein concentrations in postmenopausal women with the metabolic syndrome

BackgroundLow-density lipoprotein cholesterol (LDL-C) and oxidized low-density lipoprotein (ox-LDL) are probably associated with atherosclerosis and coronary artery disease. The influence of LDL-C and ox-LDL on metabolic syndrome among healthy, postmenopausal women has not been well studied. The aim of this study was to assess the association between LDL-C, ox-LDL, and metabolic syndrome in postmenopausal women. MethodsThe study design was a cross-sectional study. A total of 1309 postmenopausal women (355 with metabolic syndrome and 954 without metabolic syndrome) aged 60–79years were included. Lipid profiles, glucose, ox-LDL, adiponectin, interleukin (IL)-1β, IL-6, and tumor necrosis factor-α concentrations were measured. ResultsPlasma ox-LDL levels were higher in subjects with metabolic syndrome, when compared without metabolic syndrome subjects. A multiple linear regression analysis revealed that ox-LDL was significantly associated with high-density lipoprotein cholesterol, LDL-C, triglycerides, and adiponectin. After a multivariable adjustment, the odds ratios for the second, third, and fourth quartiles of ox-LDL in metabolic syndrome compared with the lowest quartile were 1.76 (95% confidence interval [CI], 1.15–2.70), 2.45 (95% CI, 1.58–3.79), and 3.98 (95% CI, 2.52–6.28), respectively. LDL levels were not significantly associated with metabolic syndrome. ConclusionsOx-LDL concentration was associated with metabolic syndrome in postmenopausal women. These findings suggest that high ox-LDL levels are associated with high cardiovascular risk in postmenopausal women with metabolic syndrome.

Osteopenia and endothelin-1-mediated vasconstrictor tone in postmenopausal women

Low bone mineral density is highly prevalent in postmenopausal women. Osteopenia in postmenopausal women is a predictor of adverse cardiovascular events. A potential mechanism contributing to the increased cardiovascular risk in postmenopausal women with osteopenia is endothelial vasomotor dysfunction. Endothelin (ET)-1 is a potent vasoconstrictor peptide that is associated with endothelial vasomotor dysfunction and increased cardiovascular risk. Currently, there is no information on osteopenia and ET-1 vasoconstrictor activity in postmenopausal women. We tested the hypothesis that ET-1 mediated vasoconstrictor activity is greater in postmenopausal women with osteopenia compared with those without. Forearm blood flow responses to intra-arterial infusion of BQ-123 (100 nmol/min for 60 min), a selective ET A receptor antagonist, were determined in postmenopausal women: 10 with osteopenia (age: 56 ± 1 yr, lumbar spine T-score between -1.5 and -2.5) and 12 without osteopenia (age: 60 ± 2 yr, T-score > -1.5). In women with osteopenia, forearm blood flow increased approximately 25% (P < 0.05) in response to BQ-123. However, in the women without osteopenia, resting forearm blood flow was not significantly changed. In conclusion, these results suggest that osteopenia is associated with greater ET-1-mediated vasoconstrictor tone. Increased ET-1 vasoconstrictor activity may contribute to the elevated cardiovascular risk in postmenopausal women with osteopenia.

RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND DIASTOLIC FUNCTION IN POST-MENOPAUSAL WOMEN: PP.31.228

Objective: Cardiovascular risk in post-menopausal women is related not only to the prevalence of traditional risk factors but also to the incidence of alterations in cardiovascular function and structure. Arterial stiffness can represent a mechanism involved in development of cardiac alterations. The aim of this study is to evaluate the relationship between arterial stiffness and left ventricular diastolic function in a group of post-menopausal women entering the prevention program “Woman and Heart”. Design and Methods: In 149 women with no previous cardiovascular events (age 56 ± 6 years, blood pressure-BP 129 ± 17/76 ± 9 mmHg, 38% hypertensives, 30% smokers, 27% hypercholesterolemic, 20% obese, 8% with impaired glucose tolerance or diabetes), carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry (Sphygmocor, Atcor Medical). Moreover, a trans-toracic echocardiographic study was carried out to measure mitral inflow pattern, left ventricular mass index (LVMI) and relative wall thickness (RWT). Results: In the total population, carotid-femoral PWV was 7.2 ± 1.3m/s. Left ventricular hypertrophy (LVMI >51 g/m2,7) was found in 30% of the population, RWT was>0.42 in 12%, while impaired left ventricular relaxation (E/A ratio < 0.8, deceleration time>200ms) was found in 24%. An increased PWV was associated with the presence of impaired left ventricular relaxation (PWV 7.72 vs 7.15 m/s, p<0.01), but not with left ventricular hypertrophy or concentric remodeling. The only risk factors associated with increased PWV were age, hypertension and altered glucose tolerance. Logistic regression analysis, adjusted for these 3 risk factors, showed that a PWV greater than the median value of 7.1 m/sec was associated with a 2.9-fold greater risk (confidence limits 5–95% 1.11–7.79) of having impaired left ventricular relaxation. Conclusions: In a post-menopausal female population, evaluated in a primary prevention setting, carotid to femoral PWV is associated to mild diastolic dysfunction even after correction for the most important confounders. These data suggest that an increased aortic stiffness could contribute to left ventricular diastolic dysfunction and possibly to diastolic heart failure in post-menopausal women.

Antidepressant Use and Cardiovascular Risk in Postmenopausal Women

More than 10% of U.S. women use antidepressants — typically, selective serotonin reuptake inhibitors (SSRIs) or, less commonly, tricyclic

Arterial Stiffness and Endothelial Function

Functional assessment of the blood pressure waveform helps us to obtain an estimation of the arterial stiffness or its converse, arterial elasticity.1 Several epidemiological studies have clearly demonstrated that arterial stiffness is a significant predictor of cardiovascular disease incidence in the general population.2 There is clear evidence now that decreased arterial elasticity or increased arterial stiffness in normotensive and prehypertensive subjects induces increased risk for the development of arterial hypertension. In vitro and in vivo experiments have shown that the vascular endothelium plays a crucial role in vascular tone and consequently in arterial stiffness. However, there are no data available regarding the endothelial pathways involved in the adaptation of arterial mechanics during changes in blood flow. The elegant study by Bellien et al3 in this issue of Hypertension studied the endothelial pathways involved in the adaption of arterial mechanics during changes in blood flow. Besides identifying the “endothelial-derived relaxing factor” nitric oxide (NO) as important in this biological process, a unique aspect found in their study was the “endothelial-hyperpolarizing factor” EDHF. Endothelium-dependent relaxation/vasodilation in response to neurohumoral mediators and physical forces, such as the shear stress caused by blood flow, is generally attributed to the release of NO and/or prostacyclin. However, NO and prostacyclin cannot fully explain these endothelium-mediated vasodilator responses. The relaxations observed in the presence of NO synthase and cyclooxygenase inhibitors are often associated with hyperpolarization of the vascular smooth …