Hormone therapy, menopause, and endothelial function
Date
2023
Authors
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Publisher
University of Delaware
Abstract
Cardiovascular diseases (CVD) continue to be the leading cause of death in the United States. The prevalence of CVD is greater in men than women until menopause, where the rates in women then not only reach, but exceed those in men. The loss of estradiol induced by menopause elicits negative consequences to the cardiovascular (CV) system, including endothelial dysfunction. Endothelial dysfunction is a precursor to atherosclerosis and holds important clinical value in terms of evaluating CVD risk. Flow-mediated dilation (FMD) is a commonly used, non-invasive measure to assess endothelial function. FMD is highly reproducible in healthy young adults, however, appears to become less reproducible with aging and presence of CVD risk factors. Furthermore, the majority of current FMD reproducibility studies are >10 years old; recent FMD guideline papers have been published identifying key reproducibility standards that can improve the methodology of FMD. Additionally, there is a lack of inclusion of menopausal women in previous FMD reproducibility studies. Due to menopause being a sex specific CVD risk factor, it is important to assess short term FMD reproducibility across the menopausal transition to determine if the measurement remains stable. Furthermore, tt has been well-established that FMD is lower in postmenopausal women but increases in response to hormone therapy (HT), particularly estradiol. Although effective for managing menopausal symptoms, the use of traditional HT plummeted following the controversial findings of the Women’s Health Initiative that indicated HT increased the risk of heart attack and stroke. A popular therapeutic option that has emerged as an alternative is bioidentical hormone therapy (bioHT). Although popular for its claim of being a natural therapy, the effects of bioHT on the CV system, specifically endothelial function, are not well established in menopausal women. Therefore, the purpose of this study was twofold: 1) to demonstrate the reproducibility of flow-mediated dilation, a measure of endothelial function, in menopausal women within our laboratory and 2) to examine the impact of bioHT on endothelial function in postmenopausal women. We hypothesized that 1) FMD will be strongly reproducible with a coefficient of variance ≤15% amongst menopausal women and 2) 5 weeks of bioHT will improve endothelial function and blood pressure. To evaluate FMD reproducibility, 11 healthy menopausal women (age: 55 ± 4 years) had their brachial artery FMD testing on two occasions over 5 weeks. To examine the impact of bioHT, 5 women (age: 57 ± 4 years) had their brachial artery FMD and blood pressure assessed pre and post hormone pellet insert (5-weeks). In study 1, FMD% remained stable and showed strong reproducibility in menopausal women across 5 weeks (visit 1: 4.73% ± 1.29, visit 2: 4.87% ± 1.66, P = 0.604) (FMD% CV: 13.2%). bioHT did not change FMD after 5 weeks (pre: 5.04% vs. post: 6.26%, P = 0.287). However, 5 weeks of bioHT did significantly decrease diastolic blood pressure (pre: 78mmHg vs. post: 70mmHg, P = 0.023). These findings suggest that bioHT can improve blood pressure after 5 weeks, however future research is needed to fully elucidate the effects of bioHT on endothelial function in postmenopausal women. ☐ Key words: menopause, estrogen, women’s health, vascular function, hormone
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Keywords
Estrogen, Hormones, Menopause, Vascular function, Women's health