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Objective: Peripheral flow-mediated reactive hyperemia (PRH) may indicate early endothelial dysfunction. This study tested the hypothesis that endothelial dysfunction could identify early cardiovascular risk in early menopausal women.
Methods: A subset of women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial to determine impact of hormone therapy on progression of cardiovascular disease in early (<3 year) menopause, were evaluated prior to randomization to treatment for conventional risk factors as well as CIMT by ultrasound, CAC by 64 slice CT scanner (Siemens), and PRH by ENDOPAT®.
Results: One hundred and two women participated. All were Caucasian and none were diabetic. Twelve women had positive CAC scores (range 0.6-32 Agatston Units) and two women had CIMT lesions >40%. There was no difference in conventional risk factor profiles between women with vascular lesions compared to those without. PHR was inconclusive or abnormal in 40% of the entire cohort. Women with inconclusive or abnormal PRH could not be distinguished using conventional risk factors (see Table; data presented as mean±SEM). PRH was abnormal in four women but normal in eight women whose CAC scores ranged from 1.2-31.6 and 0.7-30.2 Agatston Units, respectively.
Conclusions: 1) Thirteen percent of women in this fairly low risk group exhibited quantifiable vascular lesions. 2) In a subset of early menopausal women in whom standard assessment algorithms did not detect risk, PRH may provide an additional reference point to assess early disease processes and possibly identify those for whom hormonal therapy may be beneficial.
Endothelial Function and Cardiovascular Risk in Early Menopausal Women
Virginia M. Miller, Sharon L. Mulvagh, Thomas Behrenbeck, Philip A. Araoz, Teresa G. Zais, MAYO CLINIC ROCHESTER, Rochester, MNObjective: Peripheral flow-mediated reactive hyperemia (PRH) may indicate early endothelial dysfunction. This study tested the hypothesis that endothelial dysfunction could identify early cardiovascular risk in early menopausal women.
Methods: A subset of women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial to determine impact of hormone therapy on progression of cardiovascular disease in early (<3 year) menopause, were evaluated prior to randomization to treatment for conventional risk factors as well as CIMT by ultrasound, CAC by 64 slice CT scanner (Siemens), and PRH by ENDOPAT®.
Results: One hundred and two women participated. All were Caucasian and none were diabetic. Twelve women had positive CAC scores (range 0.6-32 Agatston Units) and two women had CIMT lesions >40%. There was no difference in conventional risk factor profiles between women with vascular lesions compared to those without. PHR was inconclusive or abnormal in 40% of the entire cohort. Women with inconclusive or abnormal PRH could not be distinguished using conventional risk factors (see Table; data presented as mean±SEM). PRH was abnormal in four women but normal in eight women whose CAC scores ranged from 1.2-31.6 and 0.7-30.2 Agatston Units, respectively.
Conclusions: 1) Thirteen percent of women in this fairly low risk group exhibited quantifiable vascular lesions. 2) In a subset of early menopausal women in whom standard assessment algorithms did not detect risk, PRH may provide an additional reference point to assess early disease processes and possibly identify those for whom hormonal therapy may be beneficial.
| n | Smoking status | BMI (Kg/m2) | Total Cholesterol (mg/dL) | LDL (mg/dL) | HDL (mg/dL) | Triglycerides (mg/dL) | Mean Systolic BP (mmHg) | |
| Total cohort | 102 | Current 4 Past 25 Never 73 | 27.1±4.2 | 217.6±30.7 | 135.8±30.1 | 61.1±15.3 | 95.8±48.7 | 122.6±14.0 |
| Negative tests (CIMT,CAC or PRH all negative) | 50 | Current 2 Past 12 Never 36 | 26.7±4.0 | 219.7±30.5 | 131.5±29.5 | 62.9±15.3 | 95.3±48.7 | 121.3±13.4 |
| Inconclusive PRH (1.71-2.1) | 24 | Current 1 Past 4 Never 19 | 27.5±4.4 | 225.4±34.6 | 145.8±30.9 | 60.5±10.8 | 87.0±33.2 | 123.3±14.7 |
| Positive tests (one or more CIMT, CAC, PRH) | 28 | Current 1 Past 9 Never 18 | 28.0±4.7 | 213.8±31.8 | 137.7±27.7 | 56.3±13.9 | 102.4±50.7 | 121.3±14.3 |
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