Can premenstrual syndrome affect arterial stiffness or blood pressure?

Are adolescents with premenstrual disorder at risk for cardiac arrhythmias?

BACKGROUND

One of the most commonly experienced symptoms of premenstrual disorder (PMD) is anxiety, and there is a notable rise in sympathomimetic activity in this patient group. Studies have linked fluctuations in systemic autonomic tone to electrocardiography (ECG) changes. This study aims to investigate the relationship between anxiety, a common symptom of PMD, and alterations in QT dispersion (QTd) and P-wave dispersion (Pd) in adolescent females.

METHODS

This cross-sectional study included female adolescents aged 12-18 with regular menstruation for at least 3 months. Participants completed the premenstrual syndrome scale (PMSS) and were divided into two groups, PMD and control, according to the PMSS score. A standard 12-lead body surface ECG was performed and QTd and Pd values were determined in each participant.

RESULTS

Of the 43 participants, 27 were categorized into the PMD group, with a mean age of 15.15 ± 1.43 years. Age at menarche and menstrual cycle patterns were comparable between the PMD and control groups. Statistical analysis revealed significantly higher Pmin (p = 0.010) and Pd values (p < 0.001) in the PMD group compared to controls. A positive correlation between PMSS scores and Pd (p = 0.049) was also observed.

CONCLUSIONS

Changes in atrial conduction and ventricular repolarization due to the pathophysiology of PMD may increase the risk of developing atrial and ventricular tachyarrhythmias over time. Screening patients with PMD using an ECG may be useful in identifying potentially at-risk adolescents.

Network structure of complex interactions of premenstrual syndrome and influencing factors in young adult women

BACKGROUND

In the transition phase from adolescence to adulthood, premenstrual syndrome (PMS) occurs more commonly, with a variety of symptoms. The occurrence of PMS may be the result of a combination of demographic, physiological, psychological and sociological factors. This study aimed to identify the central symptoms of PMS, and explored the complex influencing factors especially the one-to-one inter-relationships factors with specific symptoms.

METHOD

This is a cross-sectional study conducted in mainland China. 3458 young adult women were assessed. Using the Premenstrual Syndrome Scale (PSS) to assess the PMS, and PSS score was over 6 divided into PMS group, and vice versa. Influencing factors were assessed by a set of self-reported questionnaire. Network analysis was used to examined the interplay of PMS, whilst also considering the influencing factors of PMS.

RESULTS

In summary, 1479 participants were in PMS group. Anxiety had the highest strength centrality (1.12/1.09), shown higher centrality in the both network. Swelling of the hands or feet also shown higher strength centrality (0.89) in PMS group. PMS is associated with a higher history of dysmenorrhea, and neurotic personality. Neurotic personality - depressed mood/nervousness (0.27/0.23), history of dysmenorrhea - abdominal distension (0.21), had significantly higher weight than other edges in PMS group.

CONCLUSION

Anxiety was the most central symptom in the network, and was closely associated with other symptoms like depressed mood, which provided additional evidence for the centrality of emotional features in PMS. Moreover, the influencing factors of PMS combined demographic, physiological, psychological, and sociological factors. According to the central symptoms and factors affecting the specific PMS symptoms in young adult women, targeted intervention is helpful to prevent and alleviate PMS.

LIMITATION

Cross-sectional design cannot infer the directionality of the associations between variables. All data is self-reported with recall bias and the edge weights across the constructs of influencing factors and PMS were fairly small.

Premenstrual Disorders, Timing of Menopause, and Severity of Vasomotor Symptoms

Importance

Although premenstrual disorders (PMDs) end at menopause, it is unclear whether they are associated with the timing and symptom severity of menopause.

Objective

To prospectively examine whether women with PMDs have increased risks of early menopause and menopause-related vasomotor symptoms (VMS).

Design, Setting, and Participants

This population-based cohort study was nested in the Nurses' Health Study II (data collected from questionnaire sent between June 1991 and June 2017). Analysis of menopause timing included participants who did not have natural or surgical menopause before study entry, while the analysis of VMS was restricted to women who provided information on VMS. Data were analyzed from August 2022 to March 2023.

Exposures

PMDs were identified by self-reported diagnosis and confirmed with symptom questionnaires from 1991 to 2005. Participants were age-matched to women without PMD diagnoses and confirmed absence of or minimal premenstrual symptoms.

Main Outcomes and Measures

During follow-up through 2017, timing of natural menopause was assessed biennially, and VMS were assessed in 2009, 2013, and 2017. The association of PMDs with early menopause was assessed by Cox proportional hazards models and with VMS by logistic regression models.

Results

Of 1220 included women with PMDs, the median (IQR) age was 40.7 (37.3-43.8) years; of 2415 included women without PMDs, the median (IQR) age was 41.7 (38.3-44.8) years. The median (IQR) follow-up in this study was 20.3 (17.8-22-2) years. Early natural menopause (menopause before age 45 years) was reported by 17 women with PMDs (7.1 per 1000 person-years) and 12 women without PMDs (2.7 per 1000 person-years; adjusted hazard ratio, 2.67; 95% CI, 1.27-5.59). In addition, 795 women with PMDs (68.3%) and 1313 women without PMDs (55.3%) reported moderate or severe VMS (adjusted odds ratio, 1.68; 95% CI, 1.32-2.14). There was no observed association between PMDs and mild VMS (adjusted odds ratio, 0.99; 95% CI, 0.76-1.28).

Conclusions and Relevance

In this cohort study of US women, PMDs were associated with increased risks of early menopause and moderate or severe VMS. PMDs may be indicative of underlying physiology linked to early menopause and VMS, suggesting a phenotype observable during the reproductive years that may allow clinicians to target women at risk of earlier menopause and subsequent health risks later in the life course.

A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations

Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.

Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

The relationship between physical activity and premenstrual syndrome in senior high school students: a prospective study

Reproductive-aged women experience somatic and affective symptoms of premenstrual syndrome (PMS) which affect their daily life and work, but there are limited tracking data on senior high school-age female students. To investigate the characteristics and incidence of PMS, and to detect the relationship between physical exercise participation and PMS in female students of senior high school. A prospective study was conducted among senior high school female students aged 14-16 years. The participant was asked to finish two questionnaires. One questionnaire collected information about demographic data and PMS symptoms which were recorded on a daily calendar named Daily Record of Severity of Problems (DRSP) per day. Another questionnaire was physical exercises participation questionnaire, collecting times of physical education (PE) class participation, exercise times, exercise type participation in morning exercise and recess exercise, times of morning exercise, times of recess exercise per week, recess exercise time, and autonomous exercise participation of students. The data were prospectively recorded for three consecutive months. Odds ratio (OR) with 95% confidence intervals (CI) was performed for results of the multivariate logistic regression analysis model. A total of 233 participants completed the prospective study, 78 (33.5%) participants experienced PMS. The incidence of the participants with mild PMS was 20.2% while moderate PMS was 11.6% and severe PMS was 1.7%. The most common somatic symptom was fatigue while the most common affective symptom was cannot concentrate. Participants with PE classes less than 2 times per week were 4.43 times (OR 4.43, 95% CI 1.18-16.6, p < 0.05) more possible to experience PMS than those with 2 times PE classes per week. PMS is a frequent phenomenon in senior high school female students. Female students with 2 times PE classes per week show a lower incidence of PMS. This study encouraged senior high school-age females to take more physical exercises per week and could be helpful to create a no-pharmacology coping strategy.

In vivo arterial stiffness, but not isolated artery endothelial function, varies with the mouse estrous cycle

With the increasing appreciation for sex as a biological variable and the inclusion of female mice in research, it is important to understand the influence of the estrous cycle on physiological function. Sex hormones are known to modulate vascular function, but the effects of the mouse estrous cycle phase on arterial stiffness, endothelial function, and arterial estrogen receptor expression remain unknown. In 23 female C57BL/6 mice (6 mo of age), we determined the estrous cycle stage via vaginal cytology and plasma hormone concentrations. Aortic stiffness, assessed by pulse wave velocity, was lower during the estrus phase compared with diestrus. In ex vivo assessment of isolated pressurized mesenteric and posterior cerebral arteries, the responses to acetylcholine, insulin, and sodium nitroprusside, as well as nitric oxide-mediated dilation, were not different between estrous cycle phases. In the aorta, expression of phosphorylated estrogen receptor-α was higher for mice in estrus compared with mice in proestrus. In the cerebral arteries, gene expression for estrogen receptor-β (Esr2) was lowest for mice in estrus compared with diestrus and proestrus. These results demonstrate that the estrus phase is associated with lower in vivo large artery stiffness in mice. In contrast, ex vivo resistance artery endothelial function is not different between estrous cycle phases. Estrogen receptor expression is modulated by the estrus cycle in an artery-dependent manner. These results suggest that the estrous cycle phase should be considered when measuring in vivo arterial stiffness in young female mice.NEW & NOTEWORTHY To design rigorous vascular research studies using young female rodents, the influence of the estrous cycle on vascular function must be known. We found that in vivo aortic stiffness was lower during estrus compared with the diestrus phase in female mice. In contrast, ex vivo mesenteric and cerebral artery endothelial function did not differ between estrous cycle stages. These results suggest that the estrous cycle stage should be accounted for when measuring in vivo arterial stiffness.

Differences between Elite Male and Female Badminton Athletes Regarding Heart Rate Variability, Arterial Stiffness, and Aerobic Capacity

Cardiovascular health and aerobic capacity play crucial roles in determining the performance of athletes in the highly competitive sport of badminton. Few studies have directly compared heart rate variability (HRV), arterial stiffness, and aerobic capacity between male and female athletes, especially among badminton athletes. This study investigated sex differences in HRV, arterial stiffness, and aerobic capacity in badminton athletes. Elite badminton athletes were recruited and divided into male (n = 20, 21.0 ± 1.8 years old) and female (n = 16, 21.2 ± 2.3 years old) groups. Both groups performed an incremental treadmill running test for the evaluation of maximal oxygen consumption (V.O2max), anaerobic threshold, and time to exhaustion. They started exercising at a treadmill speed of 2.7 km/h and an inclination of 10% gradient for 3 min, and the speed and inclination were gradually increased every 3 min until they were exhausted or fatigued volitionally. HRV was examined using the Polar heart rate monitor over a period of 5 min at rest in the supine position. Subsequently, the index of arterial stiffness was examined under the same condition. Our results revealed significant differences between the male and female athletes in V.O2max (men: 60.38 ± 8.98 mL/kg/min, women: 48.13 ± 7.72 mL/kg/min, p < 0.05), anaerobic threshold (men: 41.50 ± 7.26 mL/kg/min, women: 32.51 ± 6.19 mL/kg/min, p < 0.05), time to exhaustion (men: 902.15 ± 120.15 s, women: 780.56 ± 67.63 s, p < 0.05), systolic blood pressure (men: 125.27 ± 7.76 mmHg, women: 107.16 ± 11.09 mmHg, p < 0.05), and arterial stiffness index (men: 63.56 ± 12.55, women: 53.83 ± 8.03, p < 0.05). However, no significant differences in HRV measures were observed between the two groups. These findings suggested that the male badminton athletes demonstrated significantly higher aerobic capacity than did the female athletes, but there were no significant differences in HRV measures. The female athletes exhibited superior arterial function, compared with their male counterparts.

Impact of the menstrual cycle on peripheral vascular function in premenopausal women: systematic review and meta-analysis

Fluctuations in endogenous hormones estrogen and progesterone during the menstrual cycle may offer vasoprotection for endothelial and smooth muscle (VSM) function. While numerous studies have been published, the results are conflicting, leaving our understanding of the impact of the menstrual cycle on vascular function unclear. The purpose of this systematic review and meta-analysis was to consolidate available research exploring the role of the menstrual cycle on peripheral vascular function. A systematic search of MEDLINE, Web of Science, and EMBASE was performed for articles evaluating peripheral endothelial and VSM function across the natural menstrual cycle: early follicular (EF) phase versus late follicular (LF), early luteal, mid luteal, or late luteal. A meta-analysis examined the effect of the menstrual cycle on the standardized mean difference (SMD) of the outcome measures. Analysis from 30 studies (n = 1,363 women) observed a "very low" certainty of evidence that endothelial function increased in the LF phase (SMD: 0.45, P = 0.0001), with differences observed in the macrovasculature but not in the microvasculature (SMD: 0.57, P = 0.0003, I2 = 84%; SMD: 0.21, P = 0.17, I2 = 34%, respectively). However, these results are partially explained by differences in flow-mediated dilation [e.g., discrete (SMD: 0.86, P = 0.001) vs. continuous peak diameter assessment (SMD: 0.25, P = 0.30)] and/or menstrual cycle phase methodologies. There was a "very low" certainty that endothelial function was largely unchanged in the luteal phases, and VSM was unchanged across the cycle. The menstrual cycle appears to have a small effect on macrovascular endothelial function but not on microvascular or VSM function; however, these results can be partially attributed to methodological differences.

The association between menstrual symptoms and hypertension among young women: A prospective longitudinal study

OBJECTIVES

To investigate whether menstrual symptoms are associated with increased risk of hypertension among young women, and whether the relationship is bi-directional.

STUDY DESIGN

We included 7729 women participating in the Australian Longitudinal Study on Women's Health, aged 22-27 years in 2000 and who were followed up every 3 years until 2015. Premenstrual syndrome, painful (dysmenorrhoea), heavy (menorrhagia), and irregular menstrual periods over the previous 12 months were self-reported and recorded as 'never', 'rarely', 'sometimes', or 'often'. Questions regarding physician-diagnosed hypertension were asked, specifically for other than during pregnancy (defined as chronic hypertension) and during pregnancy (hypertensive disorder in pregnancy, HDP). Longitudinal data were analysed with generalised estimating equation time-lagged models to estimate relative risks (RRs) and 95 % confidence intervals (CI), adjusted for time-varying covariates.

MIAN OUTCOME MEASURES

Chronic hypertension, HDP, and menstrual disorders.

RESULTS

Over 15 years of follow-up, 757 women (9.8 %) reported having been diagnosed with chronic hypertension. Among 4473 parous women, 483 (10.8 %) reported a diagnosis of HDP. Women who often experienced heavy periods had an increased risk of incident chronic hypertension (RR 1.53, 1.13-2.09), compared with those who had not experienced heavy periods. We also found that women with chronic hypertension had an increased risk of incident heavy (RR 1.23, 1.02-1.50) and irregular periods (RR 1.42, 1.17-1.72). However, there was no apparent association between any menstrual symptoms and subsequent risk of HDP.

CONCLUSIONS

The association between heavy periods (menorrhagia) and chronic hypertension may be bi-directional in young women. Chronic hypertension may also be associated with subsequent risk of irregular periods.

Sex differences in mechanisms of arterial stiffness

Arterial stiffness progressively increases with aging and is an independent predictor of cardiovascular disease (CVD) risk. Evidence supports that there are sex differences in the time course of aging-related arterial stiffness and the associated CVD risk, which increases disproportionately in postmenopausal women. The association between arterial stiffness and mortality is almost twofold higher in women versus men. The differential clinical characteristics of the development of arterial stiffness between men and women indicate the involvement of sex-specific mechanisms. This review summarizes the current literature on sex differences in vascular stiffness induced by aging, obesity, hypertension, and sex-specific risk factors as well as the impact of hormonal status, diet, and exercise on vascular stiffness in males and females. An understanding of the mechanisms driving sex differences in vascular stiffness has the potential to identify novel sex-specific therapies to lessen CVD risk, the leading cause of death in males and females. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.

Pulse Wave Variation during the Menstrual Cycle in Women with Menstrual Pain

Objective. This study is performed to obtain objective diagnostic indicators associated with menstrual pain using pulse wave analysis. Methods. Using a pulse diagnostic device, we measured the pulse waves of 541 women aged between 19 and 30 years, placed in either an experimental group with menstrual pain (n = 329) or a control group with little or no menstrual pain (n = 212). Measurements were taken during both the menstrual and nonmenstrual periods, and comparative analysis was performed. Results. During the nonmenstrual period, the experimental group showed a significantly higher value in the left radial artery for the radial augmentation index (RAI) (p = 0.050) but significantly lower values for pulse wave energy (p = 0.021) and time to first peak from baseline (T1) (p = 0.035) in the right radial artery. During the menstrual period, the experimental group showed significantly lower values in the left radial artery for cardiac diastole and pulse wave area during diastole and significantly higher values for pulse wave area during systole, ratio of systolic phase to the full heartbeat, and systolic-diastolic ratio. Conclusion. We obtained indicators of menstrual pain in women during the menstrual period, including prolonged systolic and shortened diastolic phases, increases in pulse wave energy and area of representative pulse wave, and increased blood vessel resistance.

Association of Premenstrual Syndrome with Blood Pressure in Young Adult Women

OBJECTIVE

The prevalence of hypertension in premenopausal women is increasing. There is substantial need for novel strategies to identify women who would benefit from increased screening and early interventions. Several mechanisms likely contributing to premenstrual syndrome (PMS) are also involved in hypertension, including renin-angiotensin-aldosterone system dysfunction and micronutrient deficiencies. However, it is unknown whether young women with PMS have elevated blood pressure.

MATERIALS AND METHODS

We evaluated the association of blood pressure, PMS, and premenstrual symptoms in a cross-sectional study of 409 young women (mean age 21 years), conducted from 2006 to 2014. Our analysis included 78 cases (19%) who met established criteria for clinically significant PMS and 88 controls (22%) experiencing few symptoms. Blood pressure was measured during the mid-luteal phase. Lifestyle, diet, anthropometry, and other factors were measured by questionnaire and/or direct measurement.

RESULTS

After adjustment for smoking, body mass index, and other factors, mean diastolic blood pressure in PMS cases was 72.3 versus 69.1 mm Hg in controls (p = 0.02). Diastolic blood pressure was also significantly higher in women reporting specific symptoms; for example, mean diastolic blood pressure in women reporting moderate or severe premenstrual nausea was 77.7 mm Hg compared with 71.0 mm Hg in women without nausea (p = 0.007). Systolic blood pressure did not vary by PMS status.

CONCLUSIONS

To our knowledge, this is among the first studies to suggest that diastolic blood pressure is elevated in young adult women experiencing PMS. Prospective studies are needed to determine whether PMS may be a useful sentinel for future hypertension risk in young women.

Premenstrual Syndrome and Subsequent Risk of Hypertension in a Prospective Study

The prevalence of hypertension is increasing among younger women, and new strategies are needed to identify high-risk women who should be targets for early intervention. Several mechanisms underlying hypertension might also contribute to premenstrual syndrome (PMS), but whether women with PMS have a higher risk of subsequently developing hypertension has not been assessed. We prospectively evaluated this possibility in a substudy of the Nurses' Health Study II. Participants were 1,257 women with clinically significant PMS (1991-2005) and 2,463 age-matched comparison women with few menstrual symptoms. Participants were followed for incident hypertension until 2011. Over 6-20 years, hypertension was reported by 342 women with PMS and 541 women without. After adjustment for age, smoking, body mass index, and other risk factors for hypertension, women with PMS had a hazard ratio for hypertension of 1.4 (95% confidence interval: 1.2, 1.6) compared with women without PMS. Risk was highest for hypertension that occurred before 40 years of age (hazard ratio = 3.3; 95% confidence interval: 1.7, 6.5; P for interaction = 0.0002). The risk associated with PMS was not modified by use of oral contraceptives or antidepressants but was attenuated among women with high intakes of thiamine and riboflavin (P < 0.05). These results suggest that PMS might be associated with future development of hypertension and that this risk may be modifiable.

Characterization of symptoms and edema distribution in premenstrual syndrome

Background

Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized.

Objective

To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period.

Subjects and methods

Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28) and menstrual period (between days 1 and 3), and the collected data included body mass, height, biotype (body-fat distribution), face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student’s t-test and the test for equality of two proportions (P≤0.05).

Results

Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33%) and physical symptoms, including swelling (65%), and anxiety (58.3%). Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume.

Conclusion

In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal upper limb, and proximal lower limb.

Selective serotonin reuptake inhibitors and endothelial function in women

BACKGROUND

Among women worldwide, major depression (MDD) and heart disease rank first and second, respectively, in burden of disease. Although selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed, possible inhibition of nitric oxide (NO) function has caused concerns about their effects on protective vascular mechanisms. Our study aimed to determine the effect of SSRIs on flow-mediated vascular dilatation (FMD), platelet aggregation, and platelet NO production among women.

METHODS

Women (n=28) without known cardiovascular disease were recruited prior to undergoing SSRI treatment for MDD, postpartum depression (PPD), or premenstrual dysphoric disorder (PMDD). Symptoms were quantified using the Hamilton Depression/Anxiety and Beck Depression scales. FMD, platelet aggregation, and platelet NO production were measured before and after 1 month of SSRI (sertraline, fluoxetine, or paroxetine) therapy.

RESULTS

Depression and anxiety symptoms decreased significantly with SSRI treatment (ps <0.01). FMD and platelet aggregation did not differ between pre- and posttreatment, although FMD rose to the normal range (≥ 8%) in two of three women with abnormal FMD prior to SSRI treatment. We observed a 21% decrease (p=0.024) in platelet NO production.

CONCLUSIONS

SSRI treatment had little effect on FMD or platelet aggregation. The health impact of decreased NO production is unclear, particularly in this relatively young group of women without cardiovascular disease, but should be considered in future studies focusing on SSRI safety in patients with cardiovascular disease.

Self-reported sitting time is associated with higher pressure from wave reflections independent of physical activity levels in healthy young adults

BACKGROUND

Time spent in sedentary pursuits such as sitting (SIT) is associated with an increased risk of cardiovascular disease independent of physical activity (PA). The purpose of this study was to examine the associations of PA and SIT with central hemodynamic burden in young adults.

METHODS

Aortic pressure waveforms were obtained using radial applanation tonometry and a generalized transfer function in 70 young healthy men (n = 41) and women (n = 29) (mean age = 23±1 years; body mass index = 24±1kg/m(2)). A wave separation technique that uses a physiologic pseudoaortic flow waveform was used to derive incident/forward wave pressure (Pf) and reflected/backward wave pressure (Pb). Levels of PA (metabolic equivalent, minutes per week) and SIT (sitting time per day) were obtained by self-report using the International Physical Activity Questionnaire.

RESULTS

A negative correlation existed between PA and Pf (r = -0.30; P < 0.05) and Pb (r = -0.36; P < 0.05). A positive correlation existed between SIT and Pf (r = 0.39; P < 0.05) and Pb (r = 0.44; P < 0.05). According to results from multiple regression, after adjusting for potential confounders (age, sex, height, heart rate, mean pressure) and PA, associations between SIT and Pf (P < 0.05) and SIT and Pb (P < 0.05) remained.

CONCLUSIONS

SIT is associated with higher forward wave pressure and backward wave pressure, 2 novel hemodynamic correlates of cardiovascular disease risk and target organ damage, in young apparently healthy men and women. This association is independent of PA.