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Rytz CL, Miranda KT, Ronksley PE, Saad N, Raj SR, Somayaji R, Dumanski SM, Ganshorn H, Greene DN, Collister D, Newbert AM, Peace L, Ahmed SB. Association between serum estradiol and cardiovascular health among transgender adults using gender-affirming estrogen therapy. Am J Physiol Heart Circ Physiol 2024; 327:H340-H348. [PMID: 38578239 DOI: 10.1152/ajpheart.00151.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024]
Abstract
Gender-affirming estrogen therapy (GAET) is commonly used for feminization in transgender and nonbinary (TNB) individuals, yet the optimal rate of change (ROC) in estradiol levels for cardiovascular health is unclear. We examined the association between serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Web of Science were systematically searched (inception-April 2023) for original articles reporting serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Data extraction was completed in duplicate following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Stratified random effect meta-analyses using serum estradiol ROC (serum estradiolbaseline - serum estradiolfollow-up/study duration) was used to assess longitudinal studies (low, 0 < ROC ≤ 1 pg/mL/mo; moderate, 1 < ROC ≤ 3 pg/mL/mo; high, ROC ≥ 3 pg/mL/mo). Thirty-five studies (13 cross-sectional, 19 cohort, and 3 trials) were included. Two studies collectively reported 50 cardiovascular-related deaths, and four collectively reported 23 adverse cardiovascular events. Nineteen studies reporting cardiovascular risk factors were meta-analyzed by ROC stratum (low = 5; moderate = 6; high = 8), demonstrating an association between moderate [0.40, 95% confidence interval (CI): 0.22, 0.59 kg/m2, I2 = 28.2%] and high (0.46, 95% CI: 0.15, 0.78 kg/m2; I2 = 0.0%) serum estradiol ROC and increased body mass index. High (-6.67, 95% CI: -10.65, -2.68 mg/dL; I2 = 0.0%) serum estradiol ROC was associated with decreased low-density lipoproteins. Low (-7.05, 95% CI: -10.40, -3.70 mmHg; I2 = 0.0%) and moderate (-3.69, 95% CI: -4.93, -2.45 mmHg; I2 = 0.0%) serum estradiol ROCs were associated with decreases in systolic blood pressure. In TNB adults using GAET, serum estradiol ROC may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes.NEW & NOTEWORTHY In this systematic review and meta-analysis of 35 studies involving 7,745 participants, high rates of serum estradiol change were associated with small increases in body mass index. Moderate to high rates of change were associated with decreases in low-density lipoprotein. Low rates of change were associated with small decreases in systolic blood pressure. Rate of serum estradiol change in adults using gender-affirming estrogen therapy may influence cardiovascular risk factors, though further research is warranted.
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Affiliation(s)
- Chantal L Rytz
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keila Turino Miranda
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States
| | - David Collister
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Albert, Canada
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2
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Romeo M, Donno V, Spaggiari G, Granata ARM, Simoni M, La Marca A, Santi D. Gonadotropins in the Management of Couple Infertility: Toward the Rational Use of an Empirical Therapy. Semin Reprod Med 2023; 41:258-266. [PMID: 38158195 DOI: 10.1055/s-0043-1777837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Although epidemiology shows that both men and woman can experience infertility, the female partner usually experiences most of the diagnostic and therapeutic burden. Thus, management of couple infertility is a unique example of gender inequality. The use of exogenous gonadotropins in assisted reproductive technology (ART) to induce multifollicular growth is well consolidated in women, but the same is not done with the same level of confidence and purpose in infertile men. Indeed, the treatment of idiopathic male infertility is based on an empirical approach that involves administration of the follicle-stimulating hormone (FSH) in dosages within the replacement therapy range. This treatment has so far been attempted when the endogenous FSH serum levels are within the reference ranges. According to the most recent evidence, a "substitutive" FSH administration may not be effective enough, while a stimulatory approach could boost spermatogenesis over its basal levels without adverse extragonadal effects. This article aims to describe the rationale behind the empirical application of gonadotropins in couple infertility, highlighting the need for a change in the therapeutic approach, especially for the male partner.
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Affiliation(s)
- Marilina Romeo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Valeria Donno
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgia Spaggiari
- Department of Medical Specialties, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Department of Medical Specialties, Unit of Andrology and Sexual Medicine, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Antonio R M Granata
- Department of Medical Specialties, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Department of Medical Specialties, Unit of Andrology and Sexual Medicine, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical Specialties, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Department of Medical Specialties, Unit of Andrology and Sexual Medicine, Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Lynch KM, Sepehrband F, Toga AW, Choupan J. Brain perivascular space imaging across the human lifespan. Neuroimage 2023; 271:120009. [PMID: 36907282 PMCID: PMC10185227 DOI: 10.1016/j.neuroimage.2023.120009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Enlarged perivascular spaces (PVS) are considered a biomarker for vascular pathology and are observed in normal aging and neurological conditions; however, research on the role of PVS in health and disease are hindered by the lack of knowledge regarding the normative time course of PVS alterations with age. To this end, we characterized the influence of age, sex and cognitive performance on PVS anatomical characteristics in a large cross-sectional cohort (∼1400) of healthy subjects between 8 and 90 years of age using multimodal structural MRI data. Our results show age is associated with wider and more numerous MRI-visible PVS over the course of the lifetime with spatially-varying patterns of PVS enlargement trajectories. In particular, regions with low PVS volume fraction in childhood are associated with rapid age-related PVS enlargement (e.g., temporal regions), while regions with high PVS volume fraction in childhood are associated with minimal age-related PVS alterations (e.g., limbic regions). PVS burden was significantly elevated in males compared to females with differing morphological time courses with age. Together, these findings contribute to our understanding of perivascular physiology across the healthy lifespan and provide a normative reference for the spatial distribution of PVS enlargement patterns to which pathological alterations can be compared.
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Affiliation(s)
- Kirsten M Lynch
- Laboratory of Neuro Imaging (LONI), USC Mark and Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, 90033, USA.
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging (LONI), USC Mark and Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, 90033, USA; NeuroScope Inc., New York, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), USC Mark and Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Jeiran Choupan
- Laboratory of Neuro Imaging (LONI), USC Mark and Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, 90033, USA; NeuroScope Inc., New York, USA
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Fleenor BS, Carlini NA, Ouyang A, Du B, Harber MP. Greater aortic perivascular adipose tissue density is associated with aging, aortic stiffness, and central blood pressure in humans. J Appl Physiol (1985) 2023; 134:703-709. [PMID: 36759156 DOI: 10.1152/japplphysiol.00745.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Aging results in aortic perivascular adipose tissue (aPVAT)-mediated aortic stiffening in preclinical animal models to promote cardiovascular dysfunction. We hypothesized that greater human aPVAT density will be associated with aging, higher aortic stiffness, and blood pressure (BP). Fourteen apparently healthy adults (6 M/8 F, age range 20-79 yr) were recruited for this study. Aortic stiffness, assessed by carotid-femoral pulse wave velocity (cfPWV), resting aortic BP via pulse wave analysis, and aPVAT and abdominal visceral adipose tissue (VAT) density by computed tomography attenuation were acquired. aPVAT and epididymal (visceral) fat from young (4-6 mo) and old (27-29 mo) mice were used for ex vivo-conditioned media intrinsic mechanical stiffness experiments. Compared with younger adults, older adults had higher cfPWV (8.6 ± 0.4 vs. 6.2 ± 0.6 m/s, P < 0.05) and greater aPVAT attenuation (-80.2 ± 2.0 vs. -95.9 ± 1.5 HU, P < 0.05), but not VAT attenuation (P > 0.05). aPVAT-conditioned media from old mice compared with young mice increased intrinsic mechanical stiffness of the aorta (4,519 ± 510 vs. 2,325 ± 563 kPa, P < 0.05), which was not observed with epididymal fat-conditioned media from old mice (P > 0.05). aPVAT, but not VAT density, was positively associated with age (r = 0.89), cfPWV (r = 0.56), resting augmentation index normalized to heart rate 75 (AIxHR75; r = 0.67), aortic systolic BP (r = 0.58), and aortic pulse pressure (PP; r = 0.59; P < 0.05, all) and were independent of VAT density (P < 0.05, all). These data herein provide evidence for aPVAT as a novel fat depot and therapeutic target to lower aortic stiffness and future cardiovascular disease risk with aging in humans.NEW & NOTEWORTHY Aortic perivascular adipose tissue (aPVAT) promotes age-related aortic stiffening in preclinical animal models, but the relation between aPVAT density and cardiovascular function in adults is unknown. We demonstrate that aPVAT, but not abdominal visceral adipose tissue density, is positively associated with aging, aortic stiffness, and higher resting aortic blood pressure in apparently healthy adults. These findings provide novel evidence for aPVAT as a viable therapeutic target for improving cardiovascular function in humans.
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Affiliation(s)
- Bradley S Fleenor
- Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Nicholas A Carlini
- Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - An Ouyang
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Bing Du
- Department of Cardiology, First Hospital of Jilin University, Changchun, People's Republic of China
| | - Matthew P Harber
- Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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5
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African Americans and Women Have Lower Functional Gains During Acute Inpatient Rehabilitation After Hemorrhagic Stroke. Am J Phys Med Rehabil 2022; 101:1099-1103. [PMID: 35034054 PMCID: PMC9635050 DOI: 10.1097/phm.0000000000001964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Intracerebral hemorrhage can lead to significant long-term disability. While research in stroke rehabilitation has focused primarily on ischemic strokes, identifying factors that impact recovery in patients with intracerebral hemorrhage is necessary. Our purpose is to identify factors, including racial and sex disparities, associated with functional outcomes in intracerebral hemorrhage patients after inpatient rehabilitation. DESIGN This was a retrospective analysis of consecutive patients with intracerebral hemorrhage admitted to an inpatient rehabilitation facility at an academic tertiary facility in the Southeastern United States from 2016 to 2019. Clinical characteristics, demographics, admission, and discharge Functional Independence Measure scores were collected. RESULTS We evaluated 59 patients (54.4 ± 14.1 yrs, 39% females, 48.2% African American) with a median intracerebral hemorrhage volume of 13.4 (4.2-33.0) and a mean (SD) Functional Independence Measure efficiency of 1.8 ± 1.3. In multiple regression, being female was negatively associated with Functional Independence Measure efficiency (β = -1.13, P = 0.0037) when adjusting for race and intracerebral hemorrhage score. The Functional Independence Measure efficiency was lower in African Americans (β = -0.97, P = 0.0119) when adjusting for sex and intracerebral hemorrhage volume. CONCLUSIONS The results of our study indicate that Functional Independence Measure efficiency was worse for African Americans and female patients with intracerebral hemorrhage. Future research should consider these racial and sex disparities and focus on providing targeted rehabilitation therapy.
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Salwierz P, Davenport C, Sumra V, Iulita MF, Ferretti MT, Tartaglia MC. Sex and gender differences in dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:179-233. [PMID: 36038204 DOI: 10.1016/bs.irn.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The dementia landscape has undergone a striking paradigm shift. The advances in understanding of neurodegeneration and proteinopathies has changed our approach to patients with cognitive impairment. Firstly, it has recently been shown that the various proteinopathies that are the cause of the dementia begin to build up long before the appearance of any obvious symptoms. This has cemented the idea that there is an urgency in diagnosis as it occurs very late in the pathophysiology of these diseases. Secondly, that accurate diagnosis is required to deliver targeted therapies, that is precision medicine. With this latter point, the realization that various factors of a person need to be considered as they may impact the presentation and progression of disease has risen to the forefront. Two of these factors aside from race and age are biological sex and gender (social construct), as both can have tremendous impact on manifestation of disease. This chapter will cover what is known and remains to be known on the interaction of sex and gender with some of the major causes of dementia.
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Affiliation(s)
- Patrick Salwierz
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Carly Davenport
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Vishaal Sumra
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - M Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain; Women's Brain Project, Guntershausen, Switzerland
| | | | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada; Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
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Kuipers AL, Carr JJ, Terry JG, Nair S, Barinas-Mitchell E, Wheeler V, Zmuda JM, Miljkovic I. Aortic Area as an Indicator of Subclinical Cardiovascular Disease. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2203100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
Outward arterial remodeling occurs early in cardiovascular disease (CVD) and, as such, measuring arterial dimension may be an early indicator of subclinical disease.
Objective:
The objective of our study was to measure area at three aortic locations: The ascending thoracic (ASC), the descending thoracic (DSC), and the abdominal (ABD), and to test for association with traditional CVD risk factors and subclinical CVD throughout the body.
Methods:
We measured ASC, DSC, and ABD using computed tomography (CT) in 408 African ancestry men aged 50-89 years. We assessed prevalent CVD risk factors via participant interview and clinical exam, and subclinical CVD, including carotid atherosclerosis through B-mode carotid ultrasound, vascular calcification via chest and abdominal CT, and arterial stiffness via pulse-wave velocity (PWV).
Results:
As expected, all aortic areas were in correlation with each other (r=0.39-0.63, all p<0.0001) and associated with greater age, greater body size, and hypertension (p≤0.01 for all). After adjustment for traditional CVD risk factors, ASC was positively associated with carotid atherosclerosis (p<0.01). A greater area at each location was associated with greater PWV (p<0.03 for all), with the DSC region showing the most significant association.
Conclusion:
This is the first study to test the association of aortic area measured at multiple points with subclinical CVD. We found that combined CT assessment of ascending and descending aortic area may indicate a high risk of prevalent subclinical CVD elsewhere in the body independent of age, body size, and blood pressure.
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Ottarsdottir K, Tivesten Å, Li Y, Lindblad U, Hellgren M, Ohlsson C, Daka B. Cardiometabolic risk factors and endogenous sex hormones in postmenopausal women: a cross-sectional study. J Endocr Soc 2022; 6:bvac050. [PMID: 35480632 PMCID: PMC9037133 DOI: 10.1210/jendso/bvac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Context It is uncertain which cardiovascular risk factors are associated with sex hormone levels in postmenopausal women. Objective This work aimed to investigate the association between cardiometabolic risk factors and sex hormones in a cross-sectional, observational population study. Methods In this Swedish population study, participants were physically examined from 2002 to 2004, and endogenous sex hormones were analyzed by liquid chromatography–tandem mass spectrometry. Women aged 55 years or older with estradiol levels below 20 pg/mL and not using any hormonal therapy were eligible for inclusion in the study (N = 146). Variable selection and bootstrap stability analyses were performed and linear regression models presented, with each of the 8 hormones as outcome variables. Results Body mass index (BMI) was positively associated with estradiol (β = 0.054, P < .001), but negatively associated with 17-α-hydroxyprogesterone (β = –0.023, P = .028). Waist-to-hip ratio (WHR) was negatively associated with dihydrotestosterone (β = –2.195, P = .002) and testosterone (β = –1.541, P = .004). The homeostatic model assessment of insulin resistance was positively associated with androstenedione (β = 0.071, P = .032), estradiol (β = 0.091, P = .009), estrone (β = 0.075, P = 0.009), and 17-α-hydroxyprogesterone (β = 0.157, P = .001). Age was positively associated with testosterone (β = 0.017, P = .042). C-reactive protein showed an inverse association with progesterone (β = –0.028, P = .037). Lower low-density lipoprotein cholesterol was associated with higher estradiol levels (β = –0.093, P = .049), whereas lower triglycerides were associated with higher concentrations of dihydrotestosterone (β = –0.208, P = .016). Conclusion In postmenopausal women, WHR was strongly inversely associated with androgens, while BMI was positively associated with estrogens.
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Affiliation(s)
- Kristin Ottarsdottir
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Local Research and Development Council Södra Älvsborg, Sweden
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ying Li
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Lindblad
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Hellgren
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Bledar Daka
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O, Smith GN, Rich-Edwards JW, Garovic VD, El Khoudary SR, Honigberg MC. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ Res 2022; 130:652-672. [PMID: 35175837 PMCID: PMC8870397 DOI: 10.1161/circresaha.121.319895] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.
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Affiliation(s)
- Anna C. O’Kelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane V. Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Margo B. Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA,Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH,The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA,Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA
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10
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Harding AT, Heaton NS. The Impact of Estrogens and Their Receptors on Immunity and Inflammation during Infection. Cancers (Basel) 2022; 14:cancers14040909. [PMID: 35205657 PMCID: PMC8870346 DOI: 10.3390/cancers14040909] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Human health is significantly affected by microbial infections. One of the largest determinants of the outcomes of such infections is the host immune response. Too weak of a response can lead to enhanced spread by the pathogen, while an overstimulated response can lead to immune-induced tissue damage. Thus, to effectively treat infected individuals, it is critical to understand the regulators that control inflammatory responses. Recently, it has become widely accepted that estrogens, a class of sex hormones, are capable of dramatically altering the responses of host cells to microbes. In this review, we discuss how estrogens change the host immune response, as well as how these changes can alter the outcome of the infection for the individual. Abstract Sex hormones, such as estrogen and testosterone, are steroid compounds with well-characterized effects on the coordination and development of vertebrate reproductive systems. Since their discovery, however, it has become clear that these “sex hormones” also regulate/influence a broad range of biological functions. In this review, we will summarize some current findings on how estrogens interact with and regulate inflammation and immunity. Specifically, we will focus on describing the mechanisms by which estrogens alter immune pathway activation, the impact of these changes during infection and the development of long-term immunity, and how different types of estrogens and their respective concentrations mediate these outcomes.
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Affiliation(s)
- Alfred T. Harding
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02142, USA;
| | - Nicholas S. Heaton
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Correspondence: ; Tel.: +1-919-684-1351; Fax: +1-919-684-2790
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Foret JT, Dekhtyar M, Cole JH, Gourley DD, Caillaud M, Tanaka H, Haley AP. Network Modeling Sex Differences in Brain Integrity and Metabolic Health. Front Aging Neurosci 2021; 13:691691. [PMID: 34267647 PMCID: PMC8275835 DOI: 10.3389/fnagi.2021.691691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 01/14/2023] Open
Abstract
Hypothesis-driven studies have demonstrated that sex moderates many of the relationships between brain health and cardiometabolic disease, which impacts risk for later-life cognitive decline. In the present study, we sought to further our understanding of the associations between multiple markers of brain integrity and cardiovascular risk in a midlife sample of 266 individuals by using network analysis, a technique specifically designed to examine complex associations among multiple systems at once. Separate network models were constructed for male and female participants to investigate sex differences in the biomarkers of interest, selected based on evidence linking them with risk for late-life cognitive decline: all components of metabolic syndrome (obesity, hypertension, dyslipidemia, and hyperglycemia); neuroimaging-derived brain-predicted age minus chronological age; ratio of white matter hyperintensities to whole brain volume; seed-based resting state functional connectivity in the Default Mode Network, and ratios of N-acetyl aspartate, glutamate and myo-inositol to creatine, measured through proton magnetic resonance spectroscopy. Males had a sparse network (87.2% edges = 0) relative to females (69.2% edges = 0), indicating fewer relationships between measures of cardiometabolic risk and brain integrity. The edges in the female network provide meaningful information about potential mechanisms between brain integrity and cardiometabolic health. Additionally, Apolipoprotein ϵ4 (ApoE ϵ4) status and waist circumference emerged as central nodes in the female model. Our study demonstrates that network analysis is a promising technique for examining relationships between risk factors for cognitive decline in a midlife population and that investigating sex differences may help optimize risk prediction and tailor individualized treatments in the future.
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Affiliation(s)
- Janelle T. Foret
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Maria Dekhtyar
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - James H. Cole
- Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Drew D. Gourley
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Marie Caillaud
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Andreana P. Haley
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
- Biomedical Imaging Center, The University of Texas at Austin, Austin, TX, United States
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12
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Zhang Y, Wang J, Shui W, Zhang Z, Li J, Ma J. Different clinical parameters inform epicardial fat thickness in pre- and post-menopausal women with obstructive sleep apnea. BMC WOMENS HEALTH 2021; 21:239. [PMID: 34116655 PMCID: PMC8193883 DOI: 10.1186/s12905-021-01384-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a sleep-related disorder with breathing difficulties. Previous studies revealed that epicardial fat thickness (EFT) correlates with OSA severity. Interestingly, female patients display a stronger EFT-OSA correlation than males. The purpose of this study is to investigate the relationship between EFT and different clinical characteristics in pre- and post-menopausal women diagnosed with OSA. METHODS Patients diagnosed with OSA were divided into pre/early peri-menopausal (Group 1) and post/late peri-menopausal (Group 2) according to the menopause status. EFT was obtained from parasternal long-axis echocardiographic images. We also collected general clinical characteristics of patients involved in this study, and performed spearman correlation analysis to explore the correlations between EFT and the general clinical characteristics. We further applied Multiple stepwise linear regression analysis to explore the predictors for EFT in both groups. RESULTS A total number of 23 and 59 patients were enrolled in Group 1 and Group 2 respectively. EFT in Group 2 was significantly higher than that of Group 1. In both groups, EFT was positively correlated with apnea-hypopnea index (AHI), percentage of total sleep time when blood oxygen saturation was less than 90% (T90), oxygen desaturation index (ODI) and glucose; while EFT was negatively correlated with mean and lowest SaO2 (oxygen saturation) levels. However, EFT was positively correlated with total cholesterol (TC) only in Group 1 and body mass index (BMI) only in Group2, respectively. Multiple stepwise linear regression analysis showed that AHI was independently associated with EFT in Group 1. However, both AHI and BMI were independent predictors of EFT in Group 2. CONCLUSION EFT was notably correlated with menopausal status in women with OSA. AHI was the independent predictor of EFT in women with OSA. BMI was the independent predictor of EFT in post/late peri-menopausal women with OSA.
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Affiliation(s)
- Yong Zhang
- Medical Imaging College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Department of Ultrasound, First Hospital of Shanxi Medical University, No.85, South Jiefang Road, Yingze District, Taiyuan, 030001, Shanxi, China
| | - Jian Wang
- Department of Ultrasound, First Hospital of Shanxi Medical University, No.85, South Jiefang Road, Yingze District, Taiyuan, 030001, Shanxi, China.
| | - Wen Shui
- Medical Imaging College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Zhenxia Zhang
- Department of Respiratory, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Juan Li
- Medical Imaging College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jin Ma
- Medical Imaging College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
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Cano-Marquina AJ, García-Pérez MÁ, Tarín JJ, Maceira AM, Cosín-Sales J, Cano A. Variants translating reduced expression of the beta estrogen receptor gene were associated with increased carotid intima media thickness: A cross-sectional study in late postmenopausal women. Medicine (Baltimore) 2021; 100:e26216. [PMID: 34115005 PMCID: PMC8202648 DOI: 10.1097/md.0000000000026216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
There is debate on the role of estrogens in modulating the risk for atherosclerosis in women. Our purpose was to investigate whether the size of the estrogenic impact was independently associated with variation of carotid intima-media thickness (IMT) in healthy late postmenopausal women. The levels of circulating estrogens have been used in previous studies but the influence of SNPs of the estrogen receptors (ER) α and β have not been investigated.We performed a crossed-sectional study of 91 women in a university hospital. We used a double approach in which, in addition to the measurement of estradiol levels by ultrasensitive methods, genetic variants (SNPs) associated with differing expression of the ER α and β genes were assessed. Multivariable analysis was used to examine the association of candidate factors with the value of IMT and plaque detection at both the carotid wall and the sinus.A genotype combination translating reduced gene expression of the ERβ was directly associated with IMT at both the carotid wall (P = .001) and the sinus (P = .002). Other predictors of IMT were the levels of glucose, positively associated with IMT at both the carotid wall (P < .001) and the sinus (P = .001), age positively associated with IMT at the sinus (P = .003), and levels of vitamin D, positively associated with IMT at the carotid wall (P = .04).Poorer estrogenic impact, as concordant with a SNP variant imposing reduced expression of the ERβ, was directly associated with IMT at both the carotid wall and the sinus. Glucose level, vitamin D only for the carotid wall, and age only for the sinus, also emerged as independent factors in the IMT variance.
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Affiliation(s)
| | - Miguel-Ángel García-Pérez
- Department of Genetics and INCLIVA Biomedical Research Institute, University of Valencia, Av Menéndez y Pelayo, Valencia
| | - Juan J. Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, University of Valencia, Burjassot
| | - Alicia M. Maceira
- Cardiovascular Unit, ASCIRES, Valencia and Department of Medicine, Health Sciences School, CEU Cardenal Herrera, Av Seminari, s/n, Alfara del Patriarca
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau Vilanova, Valencia and Department of Medicine, Health Sciences School, CEU Cardenal Herrera, Av Seminari, s/n, Alfara del Patriarca
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and Service of Obstetrics and Gynecology, INCLIVA, Av Menéndez y Pelayo, Valencia, Spain
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Anemia Is a Risk Factor for the Development of Ischemic Stroke and Post-Stroke Mortality. J Clin Med 2021; 10:jcm10122556. [PMID: 34207841 PMCID: PMC8226740 DOI: 10.3390/jcm10122556] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk of ischemic stroke and the risk of death after ischemic stroke. METHODS The study included patients from National Health Insurance Service cohort, from January 2005 to December 2015. Anemia patients were defined as those with confirmed diagnostic codes and related medications in the sample cohort, and patients under the age of 18 were excluded. To perform a comparative analysis with the control group, twice as many patients were extracted by propensity score matching. The effects of anemia on the development of ischemic stroke were analyzed. RESULTS A total of 58,699 patients were newly diagnosed with anemia during the study period. In anemia group, the rate of ischemic stroke occurring within 1 year was 0.550%, and the rate was 0.272% in the control group. The odds ratio of anemia related to ischemic stroke was 1.602 (95% confidence intervals (CI) 1.363-1.883). During the follow-up period, 175 out of 309 (56.6%) died in anemia group, and 130 out of 314 (41.4%) died in control group. The anemia group showed a higher risk of death than the control group (Hazard ratio 1.509, 95% CI 1.197-1.902). CONCLUSION Analysis of the nationwide health insurance data revealed that anemia is one of the risk factors for the development of ischemic stroke, and also an independent prognostic factor affecting post-stroke mortality.
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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology. Biomolecules 2021; 11:biom11050708. [PMID: 34068722 PMCID: PMC8151888 DOI: 10.3390/biom11050708] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.
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Association of cytochrome P450 1B1 gene polymorphisms and environmental biomarkers with hypertension in Slovak midlife women. ACTA ACUST UNITED AC 2021; 27:1287-1294. [PMID: 33110045 DOI: 10.1097/gme.0000000000001605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study investigated the association of the Leu432Val and Asn453Ser CYP1B1 polymorphisms and selected environmental biomarkers with hypertension (HT) in Slovak midlife women. METHODS We studied 575 women. Divided according to their blood pressure status: 255 with HT and 320 without HT. All data was obtained by using standard anthropometric, genetic methods and analyzed by regression models to adjust for HT risk factors such as age, obesity, smoking, and level of education. RESULTS Our findings revealed that CYP1B1 Leu432Val polymorphism was associated with HT, whereas no association was found between Asn453Ser polymorphism and HT. Women with at least one Val allele had significantly higher odds of HT compared to women with the Leu/Leu genotype in the total sample (Exp(B) = 1.82, CI 1.16-2.84, P = 0.009). After dividing women by menopausal status and the presence of HT environmental risk factor, the association between CYP1B1 polymorphism and HT was observed in pre/perimenopausal women (Exp(B), 2.36; 95% CI 1.13-4.92; P = 0.02), smokers (Exp(B), 3.40; 95% CI 1.48-7.82; P = 0.004), abdominal obesity (Exp(B), 2.41; 95% CI 1.23-4.75; P = 0.01) and in women with only basic education (Exp(B), 4.20, 95% CI 1.12-15.71; P = 0.03). However, general linear models did not reveal a statistically significant interactions between CYP1B1, menopausal status, and HT risk factors and their common association with HT (P > 0.05). CONCLUSIONS In this pilot study, we have provided novel data that supports the significant association of CYP1B1 Leu432Val gene polymorphism with HT in Slovak midlife women.
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Veldhuis-Vlug AG, Woods GN, Sigurdsson S, Ewing SK, Le PT, Hue TF, Vittinghoff E, Xu K, Gudnason V, Sigurdsson G, Kado DM, Eiriksdottir G, Harris T, Schafer AL, Li X, Zaidi M, Rosen CJ, Schwartz AV. Serum FSH Is Associated With BMD, Bone Marrow Adiposity, and Body Composition in the AGES-Reykjavik Study of Older Adults. J Clin Endocrinol Metab 2021; 106:e1156-e1169. [PMID: 33326040 PMCID: PMC7947831 DOI: 10.1210/clinem/dgaa922] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Follicle-stimulating hormone (FSH) concentrations increase during the perimenopausal transition and remain high after menopause. Loss of bone mineral density (BMD) and gain of bone marrow adiposity (BMA) and body fat mass also occur during this time. In mice, blocking the action of FSH increases bone mass and decreases fat mass. OBJECTIVE To investigate the associations between endogenous FSH levels and BMD, BMA, and body composition in older adults, independent of estradiol and testosterone levels. DESIGN, SETTING, AND PARTICIPANTS Older adults from the AGES-Reykjavik Study, an observational cohort study. MAIN OUTCOME MEASURES Areal BMD, total body fat, and lean mass were measured with dual-energy x-ray absorptiometry. Lumbar vertebral BMA was measured by 1H-magnetic resonance spectroscopy. Volumetric BMD and visceral and subcutaneous adipose tissue (VAT, SAT) areas were measured with quantitative computed tomography. The least squares means procedure was used to determine sex hormone-adjusted associations between quartiles of serum FSH and BMD, BMA, and body composition. RESULTS In women (N = 238, mean age 81 years), those in the highest FSH quartile, compared with the lowest quartile, had lower adjusted mean spine integral BMD (-8.6%), lower spine compressive strength index (-34.8%), higher BMA (+8.4%), lower weight (-8.4%), lower VAT (-17.6%), lower lean mass (-6.1%), and lower fat mass (-11.9%) (all P < 0.05). In men, FSH level was not associated with any outcome. CONCLUSIONS Older postmenopausal women with higher FSH levels have higher BMA, but lower BMD and lower fat and lean mass, independent of estradiol and testosterone levels. Longitudinal studies are needed to better understand the underlying mechanisms.
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Affiliation(s)
- Annegreet G Veldhuis-Vlug
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA
- Center for Bone Quality, Department of Endocrinology, Leiden University Medical Center, ZA Leiden, The Netherlands
- Correspondence: A.G. Veldhuis-Vlug, MD, PhD, Center for Bone Quality, department of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. ; G.N. Woods, MD, Department of Medicine, UC San Diego, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111G San Diego, CA 92116.
| | - Gina N Woods
- Department of Medicine, UC San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Correspondence: A.G. Veldhuis-Vlug, MD, PhD, Center for Bone Quality, department of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. ; G.N. Woods, MD, Department of Medicine, UC San Diego, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111G San Diego, CA 92116.
| | | | - Susan K Ewing
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Phuong T Le
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kaipin Xu
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Deborah M Kado
- Department of Medicine, UC San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | | | - Tamara Harris
- National Institute on Aging, National Institutes of Health (NIA, NIH), Bethesda, MD, USA
| | - Anne L Schafer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Mone Zaidi
- The Mount Sinai Bone Program and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Kumar RS, Goyal N. Estrogens as regulator of hematopoietic stem cell, immune cells and bone biology. Life Sci 2021; 269:119091. [PMID: 33476629 DOI: 10.1016/j.lfs.2021.119091] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
Hematopoietic stem cells provide continuous supply of all the immune cells, through proliferation and differentiation decisions. These decisions are controlled by local bone marrow environment as well as by long-range signals for example endocrine system. Sex dependent differential immunological responses have been described under homeostasis and disease conditions. Females show higher longevity than male counterpart that seems to depend on major female sex hormone, estrogen. There are four estrogens - Estrone (E1), estradiol (E2), Estriol (E3) and Estetrol (E4) that spatially and temporarily present during different female reproductive phases. In this review, we discussed recent updates describing the effects of estrogen on HSC, immune cells and in bone biology. Estradiol (E2) being a major/abundant estrogen is extensively investigated, while effects of other estrogens E1, E3 and E4 are started to unravel recently. Furthermore, clinical effect of estrogen as hormone therapy is discussed in HSC and immune cells perspectives. The data presented in this review is compiled by searches of PubMed, database of American Cancer Society (ACS). We have included article from September 1994 to March 2020 as covering all article in chronological order is not fissile so we included relevant article with substantial information in this specific area of research by using the search term (alone or in combination) estrogen, hematopoietic stem cell, immune cells, gender difference, estrone, estriol, estetrol, therapeutic application, pregnancy, effect on bone.
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Affiliation(s)
- Rupali Sani Kumar
- CSIR-Central Drug Research Institute, Sector-10, Jankipuram Extension, Sitapur Road, Lucknow 226031, Uttar Pradesh, India.
| | - Neena Goyal
- CSIR-Central Drug Research Institute, Sector-10, Jankipuram Extension, Sitapur Road, Lucknow 226031, Uttar Pradesh, India
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Moreau KL, Hildreth KL, Klawitter J, Blatchford P, Kohrt WM. Decline in endothelial function across the menopause transition in healthy women is related to decreased estradiol and increased oxidative stress. GeroScience 2020; 42:1699-1714. [PMID: 32770384 PMCID: PMC7732894 DOI: 10.1007/s11357-020-00236-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 01/22/2023] Open
Abstract
Endothelial function declines progressively across stages of the menopause transition; however, the mechanisms contributing to this decline are unknown. We hypothesized that differences in endothelial function among pre-, peri, and postmenopausal women are related to differences in estradiol and oxidative stress. Brachial artery flow-mediated dilation (FMD) was measured in 87 healthy women categorized by menopause stage (24 premenopausal, 17 early and 21 late perimenopausal, and 25 postmenopausal) before and after 3 days of ovarian hormone suppression (gonadotropin releasing hormone antagonist [GnRHant]) alone, and an additional 3 days of GnRHant with concurrent transdermal estradiol or placebo add-back treatment. In 82 women, FMD during acute vitamin C (antioxidant) infusion was measured before and after GnRHant + add-back. Before GnRHant, FMD was different among groups (p < 0.005; reduced across stages of menopause). Vitamin C increased FMD in late peri- and post- (p < 0.005) but not pre- or early perimenopausal women (p > 0.54). After GnRHant alone, FMD decreased in pre- and peri- (p < 0.01), but not postmenopausal women, and was restored to premenopausal levels by estradiol add-back in the pre- and perimenopausal groups. Vitamin C improved FMD in pre-, peri-, and postmenopausal women on GnRHant + placebo. There was no effect of vitamin C on FMD in women on GnRHant + estradiol. These observations support the concept that the decline in endothelial function across the menopause transition is related to the loss of ovarian estradiol. The decline in estradiol may alter redox balance, thereby increasing oxidative stress and impairing endothelial function.
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Affiliation(s)
- Kerrie L Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., Mail Stop B179, Aurora, CO, 80045, USA.
- Veterans Affairs Eastern Colorado Geriatric Research, Education and Clinical Center, Denver, CO, USA.
| | - Kerry L Hildreth
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., Mail Stop B179, Aurora, CO, 80045, USA
| | - Jelena Klawitter
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Blatchford
- Veterans Affairs Eastern Colorado Geriatric Research, Education and Clinical Center, Denver, CO, USA
- Colorado Biostatistical Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., Mail Stop B179, Aurora, CO, 80045, USA
- Veterans Affairs Eastern Colorado Geriatric Research, Education and Clinical Center, Denver, CO, USA
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Li X, Wang T, Feng D, Xu Z, Xu X, Gao H, Chen G. Sex-Specific Associations of Smoking with Spontaneous Subarachnoid Hemorrhage: Findings from Observational Studies. J Stroke Cerebrovasc Dis 2020; 29:105144. [PMID: 32912496 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Some studies have reported that women are at higher risk for spontaneous subarachnoid hemorrhage (SAH) compared with men, and smoking is the most important lifestyle risk factor for spontaneous SAH. However, it is still unknown whether the risk of SAH from smoking and smoking status is differential for women and men. We performed a meta-analysis to estimate the effect of smoking on SAH in women compared with men. METHODS PubMed (January 1, 1966 to February 19, 2020) and EMBASE (January 1, 1980 to February 19, 2020) were systematically searched. Studies that estimated sex-specific relative risks (RRs) of SAH were selected. We pooled sex-specific RRs, comparing women with men using random-effects meta-analysis. RESULTS Data from 20 observational studies that included 1,387,204 participants (563,898 women) and 7,838 SAHs (3,977 women) were analyzed. The combined women-to-men RRs of former smokers versus never smokers for SAH were 1.08 (95% confidence interval [CI] 0.62-1.89, p = 0.78). The pooled women-to-men RRs of current smokers versus never smokers were 1.39 (95% CI 1.05-1.83, p = 0.02). The combined women-to-men RRs of total smokers versus never smokers RRs were 1.15 (95% CI 0.88-1.52, p = 0.30). CONCLUSIONS Our study shows there is not enough evidence to suggest that women who smoke have a greater risk for SAH than men; however, women who persistently smoke have a greater risk. Smoking seems to be more susceptible in the increased SAH risk in women.
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Affiliation(s)
- Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Tianyi Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dongxia Feng
- Department of Neurosurgery, Baylor Scott & White Medical Center, Texas A&M University College of Medicine, Temple 76508, USA
| | - Zhongmou Xu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiang Xu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, Jiangsu Province, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Buie JNJ, Zhao Y, Burns S, Magwood G, Adams R, Sims-Robinson C, Lackland DT. Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study. Ethn Dis 2020; 30:339-348. [PMID: 32346280 PMCID: PMC7186057 DOI: 10.18865/ed.30.2.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery. Methods We examined Health and Retirement Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000-2014. Analysis of 1,002 first-time, non-Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily living (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes. Results Black stroke survivors were younger compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comorbidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of having increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites. Conclusion Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.
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Affiliation(s)
- Joy N. J. Buie
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
| | - Yujing Zhao
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Suzanne Burns
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- School of Occupational Therapy, Texas Women’s University, Denton, TX
| | - Gayenell Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- College of Nursing Medical University of South Carolina, Charleston, SC
| | - Robert Adams
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
| | | | | | - WISSDOM Research Center Study Group
- WISSDOM Center, Medical University of South Carolina, Charleston, SC
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
- School of Occupational Therapy, Texas Women’s University, Denton, TX
- College of Nursing Medical University of South Carolina, Charleston, SC
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22
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Moreau KL, Babcock MC, Hildreth KL. Sex differences in vascular aging in response to testosterone. Biol Sex Differ 2020; 11:18. [PMID: 32295637 PMCID: PMC7161199 DOI: 10.1186/s13293-020-00294-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
Large elastic arterial stiffening and endothelial dysfunction are phenotypic characteristics of vascular aging, a major risk factor for age-associated cardiovascular diseases. Compared to men, vascular aging in women appears to be slowed until menopause, whereafter vascular aging accelerates to match that seen in men. These sex differences in vascular aging have been attributed to changes in sex hormones that occur with aging. Although the role of estradiol in vascular aging in women has been highlighted in recent aging research, little is known about the impact of declining testosterone concentrations in both sexes. Importantly, while androgen concentrations generally decline with age in men, there are data that indicate reductions in androgen concentrations in women as well. Evidence suggests that low testosterone is associated with impaired endothelial function and increased arterial stiffness in men, although the effect of androgens on vascular aging in women remains unclear. Testosterone may modulate vascular aging by mitigating the effects of oxidative stress and inflammation, although there is sex specificity to this effect. The purpose of this review is to present and summarize the research regarding sex differences in vascular aging in response to androgens, specifically testosterone. Because exercise is a potent lifestyle factor for slowing and reversing vascular aging, we briefly summarize the available literature regarding the regulatory function of testosterone on vascular adaptations to exercise training.
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Affiliation(s)
- Kerrie L Moreau
- University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., PO Box 6511, Aurora, CO, 80045, USA. .,Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Aurora, 80045, CO, USA.
| | - Matthew C Babcock
- University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., PO Box 6511, Aurora, CO, 80045, USA
| | - Kerry L Hildreth
- University of Colorado Anschutz Medical Campus, Bldg. L15 Rm 8111, 12631 East 17th Ave., PO Box 6511, Aurora, CO, 80045, USA
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23
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Samargandy S, Matthews KA, Brooks MM, Barinas-Mitchell E, Magnani JW, Janssen I, Hollenberg SM, El Khoudary SR. Arterial Stiffness Accelerates Within 1 Year of the Final Menstrual Period: The SWAN Heart Study. Arterioscler Thromb Vasc Biol 2020; 40:1001-1008. [PMID: 31969013 DOI: 10.1161/atvbaha.119.313622] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Menopause may augment age-dependent increases in arterial stiffness, with black women having greater progression in midlife compared with white women. We sought to determine whether and when women experience changes in arterial stiffness relative to the final menstrual period (FMP) and whether these changes differ between black and white midlife women. Approach and Results: We evaluated 339 participants from the SWAN (Study of Women's Health Across the Nation) Heart Ancillary study (Study of Women's Health Across the Nation). Women had ≤2 carotid-femoral pulse-wave velocity (cfPWV) exams over a mean±SD of 2.3±0.5 years of follow-up. Annual percentage changes in cfPWV were estimated in 3 time segments relative to FMP and compared using piecewise linear mixed-effects models. At baseline, women were 51.1±2.8 years of age and 36% black. Annual percentage change (95% CI) in cfPWV varied by time segments: 0.9% (-0.6% to 2.3%) for >1 year before FMP, 7.5% (4.1% to 11.1%) within 1 year of FMP, and -1.0% (-2.8% to 0.8%) for >1 year after FMP. Annual percentage change in cfPWV within 1 year of FMP was significantly greater than the other 2 time segments; P<0.05 for both comparisons. Adjusting for concurrent cardiovascular disease risk factors explained part of the change estimates but did not eliminate the difference. Black women had greater increase in cfPWV compared with white women in the first segment; P for interaction, 0.04. CONCLUSIONS The interval within 1 year of FMP is a critical period for women when vascular functional alterations occur. These findings underscore the importance of more intensive lifestyle modifications in women transitioning through menopause.
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Affiliation(s)
- Saad Samargandy
- From the Department of Epidemiology, Graduate School of Public Health (S.S., M.M.B., E.B.-M., S.R.E.), University of Pittsburgh, PA
| | | | - Maria M Brooks
- From the Department of Epidemiology, Graduate School of Public Health (S.S., M.M.B., E.B.-M., S.R.E.), University of Pittsburgh, PA
| | - Emma Barinas-Mitchell
- From the Department of Epidemiology, Graduate School of Public Health (S.S., M.M.B., E.B.-M., S.R.E.), University of Pittsburgh, PA
| | - Jared W Magnani
- Department of Medicine (J.W.M.), University of Pittsburgh, PA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University, Chicago, IL (I.J.)
| | | | - Samar R El Khoudary
- From the Department of Epidemiology, Graduate School of Public Health (S.S., M.M.B., E.B.-M., S.R.E.), University of Pittsburgh, PA
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25
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Farahmand M, Ramezani Tehrani F, Khalili D, Cheraghi L, Bahri Khomami M, Azizi F. Association between duration of endogenous estrogen exposure and cardiovascular outcomes: A population - based cohort study. Life Sci 2019; 221:335-340. [PMID: 30763578 DOI: 10.1016/j.lfs.2019.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
Abstract
AIMS Duration of endogenous estrogen exposure is apparently associated with risk of cardiovascular disease, the longer durations being more cardiovascular disease protective in women. We aimed to investigate the association of cumulative duration of endogenous estrogen exposure over women's reproductive lifespans with cardiovascular disease outcomes. MAIN METHODS For the purpose of the present study, of 10,192 female participants, after excluding those using HRT (n = 84), 3656 women, aged ≥30 years, who met eligibility criteria were selected and divided into three groups based on tertiles (T1, T2, T3) of exposure durations to endogenous estrogen. Cox proportional hazards regression model was used to estimate associations between exposure durations and cardiovascular disease outcomes. KEY FINDINGS Cardiovascular events occurred in 352 participants over a median follow-up of 14.2 (13.5, 14.6) years (7.7 per 1000 person years; 95% CI: 6.9-8.5). Incidence of outcome was 10.9 per 1000 person years (CI, 9.4-12.8) in T1, 7.2 per 1000 person years (CI, 6.0-8.7) in T2, and 5.1 per 1000 person years (CI, 4.1-6.4) in T3. The hazard ratio of cardiovascular events in T1 was significantly higher than that inT3, before and after adjustment for confounding variables. Before adjustment, women in T2 had a 40% higher risk of CVD, compared to T3; after adjustment however the risk was similar to that of women in T3. SIGNIFICANCE Shorter durations of exposure to endogenous estrogen may increase the risk of cardiovascular diseases among these women later in life. Future studies should target women with short duration of exposure for timely screening and implementation of preventative interventions.
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Affiliation(s)
- Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Robison LS, Gannon OJ, Salinero AE, Zuloaga KL. Contributions of sex to cerebrovascular function and pathology. Brain Res 2018; 1710:43-60. [PMID: 30580011 DOI: 10.1016/j.brainres.2018.12.030] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Sex differences exist in how cerebral blood vessels function under both physiological and pathological conditions, contributing to observed sex differences in risk and outcomes of cerebrovascular diseases (CBVDs), such as vascular contributions to cognitive impairment and dementia (VCID) and stroke. Throughout most of the lifespan, women are protected from CBVDs; however, risk increases following menopause, suggesting sex hormones may play a significant role in this protection. The cerebrovasculature is a target for sex hormones, including estrogens, progestins, and androgens, where they can influence numerous vascular functions and pathologies. While there is a plethora of information on estrogen, the effects of progestins and androgens on the cerebrovasculature are less well-defined. Estrogen decreases cerebral tone and increases cerebral blood flow, while androgens increase tone. Both estrogens and androgens enhance angiogenesis/cerebrovascular remodeling. While both estrogens and androgens attenuate cerebrovascular inflammation, pro-inflammatory effects of androgens under physiological conditions have also been demonstrated. Sex hormones exert additional neuroprotective effects by attenuating oxidative stress and maintaining integrity and function of the blood brain barrier. Most animal studies utilize young, healthy, gonadectomized animals, which do not mimic the clinical conditions of aging individuals likely to get CBVDs. This is also concerning, as sex hormones appear to mediate cerebrovascular function differently based on age and disease state (e.g. metabolic syndrome). Through this review, we hope to inspire others to consider sex as a key biological variable in cerebrovascular research, as greater understanding of sex differences in cerebrovascular function will assist in developing personalized approaches to prevent and treat CBVDs.
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Affiliation(s)
- Lisa S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Olivia J Gannon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Abigail E Salinero
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Kristen L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
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27
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Gannon OJ, Robison LS, Custozzo AJ, Zuloaga KL. Sex differences in risk factors for vascular contributions to cognitive impairment & dementia. Neurochem Int 2018; 127:38-55. [PMID: 30471324 DOI: 10.1016/j.neuint.2018.11.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
Abstract
Vascular contributions to cognitive impairment and dementia (VCID) is the second most common cause of dementia. While males overall appear to be at a slightly higher risk for VCID throughout most of the lifespan (up to age 85), some risk factors for VCID more adversely affect women. These include female-specific risk factors associated with pregnancy related disorders (e.g. preeclampsia), menopause, and poorly timed hormone replacement. Further, presence of certain co-morbid risk factors, such as diabetes, obesity and hypertension, also may more adversely affect women than men. In contrast, some risk factors more greatly affect men, such as hyperlipidemia, myocardial infarction, and heart disease. Further, stroke, one of the leading risk factors for VCID, has a higher incidence in men than in women throughout much of the lifespan, though this trend is reversed at advanced ages. This review will highlight the need to take biological sex and common co-morbidities for VCID into account in both preclinical and clinical research. Given that there are currently no treatments available for VCID, it is critical that we understand how to mitigate risk factors for this devastating disease in both sexes.
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Affiliation(s)
- O J Gannon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA.
| | - L S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA.
| | - A J Custozzo
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA.
| | - K L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA.
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28
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El Khoudary SR, Thurston RC. Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. Obstet Gynecol Clin North Am 2018; 45:641-661. [PMID: 30401548 DOI: 10.1016/j.ogc.2018.07.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, USA.
| | - Rebecca C Thurston
- Departments of Psychiatry and Epidemiology, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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29
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Khan ZA, Janssen I, Mazzarelli JK, Powell LH, Dumasius A, Everson-Rose SA, Barinas-Mitchell E, Matthews K, El Khoudary SR, Weinstock PJ, Hollenberg SM. Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation). Am J Cardiol 2018; 122:1161-1168. [PMID: 30077316 DOI: 10.1016/j.amjcard.2018.06.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023]
Abstract
Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.
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30
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Thurston RC, Bhasin S, Chang Y, Barinas-Mitchell E, Matthews KA, Jasuja R, Santoro N. Reproductive Hormones and Subclinical Cardiovascular Disease in Midlife Women. J Clin Endocrinol Metab 2018; 103:3070-3077. [PMID: 29788255 PMCID: PMC6276700 DOI: 10.1210/jc.2018-00579] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Reproductive hormones are important to the pathophysiology of cardiovascular disease (CVD) in women. However, standard estradiol (E2) and testosterone (T) assays lack sensitivity at the levels of postmenopausal women. OBJECTIVE Investigate relations of mass spectrometry-assessed estrone (E1), E2, and T and SHBG and subclinical CVD in women. DESIGN, SETTING, AND PARTICIPANTS Three hundred and four perimenopausal and postmenopausal women aged 40 to 60 years underwent subclinical CVD measurements. E1, E2, and T were assayed using liquid chromatography-tandem mass spectrometry; free T (FT) was estimated using ensemble allostery models. Regression models were adjusted for CVD risk factors. MAIN OUTCOME MEASURES Carotid artery intima media thickness, interadventitial diameter (IAD), and plaque; brachial flow mediated dilation (FMD). RESULTS Higher E1 was related to higher FMD [β(SE) = 0.77 (0.37), P = 0.04], indicating better endothelial function. Higher E2 was related to lower IAD [β(SE) = -0.07 (0.02), P = 0.004], indicating less carotid remodeling. Higher SHBG was related to higher FMD [β(SE) = 1.31 (0.40), P = 0.001], yet higher IAD [β(SE) = 0.15 (0.06), P = 0.02] and plaque [OR (95% CI) = 1.84 (1.16 to 2.91), P = 0.009]; FT showed a similar yet inverse pattern of relations as SHBG. Thus, higher SHBG and lower FT were associated with better endothelial function, yet greater carotid remodeling and plaque. CONCLUSIONS Endogenous E1 levels were related to endothelial function and E2 to vascular remodeling, suggesting distinct roles of these estrogens. SHBG and FT have complex roles depending on the vessel under study.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
- Correspondence and Reprint Requests: Rebecca C. Thurston, PhD, University of Pittsburgh, 3811 O’Hara Street,
Pittsburgh, Pennsylvania 15213. E-mail:
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper
Older Americans Independence Center, Harvard Medical School, Brigham and Women’s Hospital,
Boston, Massachusetts
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
| | - Ravi Jasuja
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper
Older Americans Independence Center, Harvard Medical School, Brigham and Women’s Hospital,
Boston, Massachusetts
- Function Promoting, LLC, Waltham, Massachusetts
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of
Medicine, Denver, Colorado
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31
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Zhu D, Li X, Macrae VE, Simoncini T, Fu X. Extragonadal Effects of Follicle-Stimulating Hormone on Osteoporosis and Cardiovascular Disease in Women during Menopausal Transition. Trends Endocrinol Metab 2018; 29:571-580. [PMID: 29983231 DOI: 10.1016/j.tem.2018.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 01/16/2023]
Abstract
The risk of osteoporosis and cardiovascular disease increases significantly in postmenopausal women. Until recently, the underlying mechanisms have been primarily attributed to estrogen decline following menopause. However, follicle-stimulating hormone (FSH) levels rise sharply during menopausal transition and are maintained at elevated levels for many years. FSH receptor has been detected in various extragonadal sites, including osteoclasts and endothelial cells. Recent advances suggest FSH may contribute to postmenopausal osteoporosis and cardiovascular disease. Here, we review the key actions through which FSH contributes to the risk of osteoporosis and cardiovascular disease in women as they transition through menopause. Advancing our understanding of the precise mechanisms through which FSH promotes osteoporosis and cardiovascular disease may provide new opportunities for improving health-span for postmenopausal women.
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Affiliation(s)
- Dongxing Zhu
- Guangzhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital; Key Laboratory of Cardiovascular Diseases, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China
| | - Xiaosa Li
- Guangzhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital; Key Laboratory of Cardiovascular Diseases, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China
| | - Vicky E Macrae
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, UK.
| | - Tommaso Simoncini
- Molecular and Cellular Gynecological Endocrinology Laboratory (MCGEL), Department of Reproductive Medicine and Child Development, University of Pisa, Pisa 56100, Italy.
| | - Xiaodong Fu
- Guangzhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital; Key Laboratory of Cardiovascular Diseases, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China.
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32
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Soleimani A, Pourmoghaddas A, Sadeghi M, Roohafza H, Talaei M, Dianatkhah M, Oveisgharan S, Soleimani M, Sarrafzadegan N. Risk and Age of Cardiovascular Event in Women with Metabolic Syndrome: Menopause Age in Focus. Metab Syndr Relat Disord 2018; 16:127-134. [DOI: 10.1089/met.2017.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Azam Soleimani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Pourmoghaddas
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Minoo Dianatkhah
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Oveisgharan
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Maryam Soleimani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Trenti A, Tedesco S, Boscaro C, Trevisi L, Bolego C, Cignarella A. Estrogen, Angiogenesis, Immunity and Cell Metabolism: Solving the Puzzle. Int J Mol Sci 2018; 19:ijms19030859. [PMID: 29543707 PMCID: PMC5877720 DOI: 10.3390/ijms19030859] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
Estrogen plays an important role in the regulation of cardiovascular physiology and the immune system by inducing direct effects on multiple cell types including immune and vascular cells. Sex steroid hormones are implicated in cardiovascular protection, including endothelial healing in case of arterial injury and collateral vessel formation in ischemic tissue. Estrogen can exert potent modulation effects at all levels of the innate and adaptive immune systems. Their action is mediated by interaction with classical estrogen receptors (ERs), ERα and ERβ, as well as the more recently identified G-protein coupled receptor 30/G-protein estrogen receptor 1 (GPER1), via both genomic and non-genomic mechanisms. Emerging data from the literature suggest that estrogen deficiency in menopause is associated with an increased potential for an unresolved inflammatory status. In this review, we provide an overview through the puzzle pieces of how 17β-estradiol can influence the cardiovascular and immune systems.
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Affiliation(s)
- Annalisa Trenti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy.
| | - Serena Tedesco
- Venetian Institute of Molecular Medicine, 35129 Padua, Italy.
| | - Carlotta Boscaro
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy.
| | - Lucia Trevisi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy.
| | - Chiara Bolego
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy.
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Free androgen index as a determinant of arterial stiffness in menopause: a mediation analysis. Menopause 2018; 24:635-644. [PMID: 28141664 DOI: 10.1097/gme.0000000000000822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Associations of endogenous androgens in menopause with blood pressure (BP) and indices of arterial stiffness are reported, but directional relationships are not clear. Structural equation modeling is a contemporary statistical method, which allows assessment of such relationships and improves pathway understanding. METHODS We recruited 411 consecutive apparently healthy postmenopausal women who underwent noninvasive vascular evaluation. This included pulse wave analysis (aortic pressures and arterial wave reflections [augmentation index]), measurement of aortic stiffness by pulse wave velocity (PWV), stiffness index (SI), and flow-mediated dilatation. A cumulative marker combining PWV and SI (combined local and aortic arterial stiffness [CAS]) was also assessed. Free androgen index (FAI) was calculated from circulating total testosterone and sex hormone-binding globulin. RESULTS FAI was an independent determinant of systolic BP (SBP) (P = 0.032), SI (P = 0.042), and PWV (P = 0.027). Under structural equation modeling analysis, FAI was a direct predictor for PWV (beta = 0.149, P = 0.014), SI (beta = 0.154, P = 0.022), and CAS (beta = 0.193, P = 0.02), whereas SBP was a parallel mediator of androgen's vascular effects on PWV (beta = 0.280, P < 0.001) and CAS (beta = 0.248, P = 0.004), but not SI (beta = 0.024, P = 0.404). FAI-induced increase in arterial stiffness via flow-mediated dilatation was not established. FAI was not a determinant of augmentation index. CONCLUSIONS In healthy postmenopausal women, FAI was directly associated with PWV, SI, and CAS. FAI also directly correlated with SBP, which in turn concurrently increased PWV and CAS. The directional correlations found herein, imply that endogenous androgens may be causally associated with indices of arterial stiffness both directly and indirectly. This hypothesis should be confirmed in further studies with causal design.
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Bertone-Johnson ER, Virtanen JK, Nurmi T, Niskanen L, Mursu J, Voutilainen S, Ronkainen K, Kauhanen J, Tuomainen TP. Follicle-Stimulating Hormone Levels and Subclinical Atherosclerosis in Older Postmenopausal Women. Am J Epidemiol 2018; 187:16-26. [PMID: 29309514 DOI: 10.1093/aje/kwx174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/17/2017] [Indexed: 12/28/2022] Open
Abstract
Recent studies of perimenopausal women suggest that follicle-stimulating hormone (FSH) levels may be associated with atherosclerosis, independent of estradiol. Whether FSH is related to atherosclerosis in older postmenopausal women, who have completed the menopausal transition, remains unknown. We assessed the relationship of serum FSH and estradiol levels with carotid artery intima-media thickness (IMT) among 587 postmenopausal participants in the Kuopio Ischemic Heart Disease Risk Factor Study (Kuopio, Finland). Participants were aged 53-73 years and not using hormone therapy at baseline (1998-2001). Mean IMT was measured via high-resolution ultrasonography. We observed a significant inverse association between FSH levels and IMT. Mean IMTs among women in quartiles 1-4 of FSH were 0.94 mm, 0.91 mm, 0.87 mm, and 0.85 mm, respectively (P-trend < 0.001). After adjustment for age, estradiol, testosterone, body mass index (weight (kg)/height (m)2), lipids, and other factors, FSH levels remained significantly associated with IMT (regression coefficients for quartiles 2-4 vs. quartile 1 were -0.038, -0.045, and -0.062, respectively; P-trend = 0.01). Findings were strongest in women aged 64-73 years (P-trend = 0.006) and did not vary by body mass index. In contrast, estradiol levels were not related to IMT. In summary, high postmenopausal FSH levels were associated with a lower atherosclerotic burden, independent of estradiol, adiposity, and other factors. Our findings warrant replication and the further exploration of potential underlying mechanisms.
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Affiliation(s)
- Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tarja Nurmi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Mursu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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El Khoudary SR. Gaps, limitations and new insights on endogenous estrogen and follicle stimulating hormone as related to risk of cardiovascular disease in women traversing the menopause: A narrative review. Maturitas 2017; 104:44-53. [PMID: 28923176 DOI: 10.1016/j.maturitas.2017.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
While it is known that estrogen protects heart health in women prior to menopause, its role after menopause and during the menopause transition is far less apparent. Previous reviews summarizing the literature on the impact of endogenous estrogen on risk of cardiovascular disease (CVD) have focused on postmenopausal women and have not come to a clear conclusion. No previous review has summarized the associations between follicle stimulating hormone (FSH), a proxy measure of the menopause transition, and CVD risk. The main purpose of this narrative review is to highlight gaps and limitations in the literature on endogenous estrogen and FSH as related to CVD risk. Future directions are addressed in light of recent findings in the field. When studying the relationship of estrogen to cardiovascular risk, it is critical to separate endogenously produced estrogen from exogenously administered estrogen. Moreover, other reproductive hormones such as FSH should be assessed, since growing evidence suggests a potential contribution of this hormone. Evaluation of estrogen changes over time allows a separation of women based on their hormone trajectories. These individual trajectories correlate with subclinical CVD and thus indicate that it is much more important to observe a woman over time rather than ascribe risk to a single determination at a single time point. As women progress through menopause and the ovary stops producing estradiol, the nature of the relationship between estrogens and subclinical CVD markers also appears to undergo a switch. Studies are needed to examine the midlife course of endogenous estradiol, FSH and CVD risk. These studies should also consider other hormones, including androgens, with an eye towards helping women modify their cardiovascular risk in midlife, when prevention is most likely possible.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA.
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Panwar B, Judd SE, Warnock DG, McClellan WM, Booth JN, Muntner P, Gutiérrez OM. Hemoglobin Concentration and Risk of Incident Stroke in Community-Living Adults. Stroke 2016; 47:2017-24. [PMID: 27382006 DOI: 10.1161/strokeaha.116.013077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE In previous observational studies, hemoglobin concentrations have been associated with an increased risk of stroke. However, these studies were limited by a relatively low number of stroke events, making it difficult to determine whether the association of hemoglobin and stroke differed by demographic or clinical factors. METHODS Using Cox proportional hazards analysis and Kaplan-Meier plots, we examined the association of baseline hemoglobin concentrations with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults aged ≥45 years. RESULTS A total of 518 participants developed stroke over a mean 7±2 years of follow-up. There was a statistically significant interaction between hemoglobin and sex (P=0.05) on the risk of incident stroke. In Cox regression models adjusted for demographic and clinical variables, there was no association of baseline hemoglobin concentration with incident stroke in men, whereas in women, the lowest (<12.4 g/dL) and highest (>14.0 g/dL) quartiles of hemoglobin were associated with higher risk of stroke when compared with the second quartile (12.4-13.2 g/dL; quartile 1: hazard ratio, 1.59; 95% confidence interval, 1.09-2.31; quartile 2: referent; quartile 3: hazard ratio, 0.91; 95% confidence interval, 0.59-1.38; quartile 4: hazard ratio, 1.59; 95% confidence interval, 1.08-2.35). Similar results were observed in models stratified by hemoglobin and sex and when hemoglobin was modeled as a continuous variable using restricted quadratic spline regression. CONCLUSIONS Lower and higher hemoglobin concentrations were associated with a higher risk of incident stroke in women. No such associations were found in men.
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Affiliation(s)
- Bhupesh Panwar
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - Suzanne E Judd
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - David G Warnock
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - William M McClellan
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - John N Booth
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - Paul Muntner
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.)
| | - Orlando M Gutiérrez
- From the Departments of Medicine (B.P., D.G.W., J.N.B., P.M., O.M.G.), Biostatistics (S.E.J.), and Epidemiology (J.N.B., P.M., O.M.G.), University of Alabama at Birmingham; and Departments of Epidemiology and Medicine, Emory University, Atlanta, GA (W.M.M.).
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Shufelt C, Elboudwarej O, Johnson BD, Mehta P, Bittner V, Braunstein G, Berga S, Stanczyk F, Dwyer K, Merz CNB. Carotid artery distensibility and hormone therapy and menopause: the Los Angeles Atherosclerosis Study. Menopause 2016; 23:150-7. [PMID: 26308234 PMCID: PMC4731269 DOI: 10.1097/gme.0000000000000510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Observational studies have suggested that arterial distensibility decreases during menopause; however, its relationship with hormone therapy use remains controversial. We prospectively studied distensibility and hormone therapy use at different menopause stages. METHODS One hundred sixty-one women (aged between 42 and 61 y) without cardiovascular disease underwent carotid artery measurements by ultrasound to calculate distensibility index at baseline and 3 years later. Menopause stage was classified at each visit as premenopausal, perimenopausal, and postmenopausal. Across 3 years of prospective observation, women were classified as remaining premenopausal, remaining postmenopausal, or transitioning (defined as change from premenopausal to perimenopausal, from premenopausal to postmenopausal, from perimenopausal to perimenopausal, or from perimenopausal to postmenopausal). RESULTS Distensibility declined across time at all menopause stages (P < 0.0001). Compared with postmenopausal women, premenopausal and transitioning/no hormone therapy women had more than twice the decline in distensibility index (P = 0.06 and P = 0.016, respectively), whereas transitioning/hormone therapy women did not differ in distensibility decline (P = 0.28). In a multivariate model, change in systolic blood pressure (P < 0.0001) and change in pulse pressure (P = 0.004) were independent predictors of distensibility index change and served as effect modulators. In an adjusted model, women in the premenopausal and transitioning/no hormone therapy groups had a significantly faster decline in distensibility index (P = 0.002 and P = 0.001, respectively) compared with postmenopausal women, whereas the transitioning/hormone therapy group did not (P = 0.21). CONCLUSIONS These findings confirm that the menopausal transition is associated with reduced vascular compliance. Hormone therapy is associated with better arterial distensibility only during the menopausal transition. Additional prospective studies are needed to confirm these findings and to determine whether hormone therapy use beyond the menopausal transition is related to distensibility.
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Affiliation(s)
- Chrisandra Shufelt
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Omeed Elboudwarej
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Puja Mehta
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Glenn Braunstein
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah Berga
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine
| | - Frank Stanczyk
- Departments of Obstetrics and Gynecology and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kathleen Dwyer
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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El Khoudary SR, Shields KJ, Janssen I, Hanley C, Budoff MJ, Barinas-Mitchell E, Everson-Rose SA, Powell LH, Matthews KA. Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study. J Clin Endocrinol Metab 2015; 100:3304-12. [PMID: 26176800 PMCID: PMC4570161 DOI: 10.1210/jc.2015-2110] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular risk increases in women after menopause. Mounting evidence demonstrates a role of cardiovascular fat (CF) in the pathogenesis of coronary heart disease, but no research has examined CF in relation to sex hormones or menopausal status in women. OBJECTIVE The objective was to determine the relationship between CF depots, menopausal status, and endogenous sex hormones. DESIGN Cross-sectional and longitudinal study designs were used. SETTING The setting included the Study of Women's Health Across the Nation (SWAN) Heart and Cardiovascular Fat Ancillary Study. PARTICIPANTS A total of 456 women (mean age, 50.75 y); 62% premenopausal/early perimenopausal, and 38% late peri-/postmenopausal. INTERVENTION Menopausal status, endogenous sex hormones measured simultaneously with CF volumes, and circulating estradiol available 4.80 years (median) before CF measures. MAIN OUTCOME MEASURES Volumes of CF (epicardial adipose tissue [EAT], paracardial adipose tissue [PAT], total heart adipose tissue [TAT = EAT + PAT], and aortic perivascular adipose tissue [PVAT]). RESULTS In final models, late peri-/postmenopausal women had 9.88% more EAT, 20.72% more PAT, and 11.69% more TAT volumes than pre-/early perimenopausal women (P < .05). PVAT was not associated with menopausal status. In final models, lower estradiol concentrations were associated with greater volumes of PAT and TAT (P < .05). Women with the greatest reduction in estradiol since baseline had greater volumes of PAT compared to women with the least reduction (P = .02). CONCLUSIONS Late peri-/postmenopausal women have greater volumes of heart fat compared with pre-/early perimenopausal women independent of age, obesity, and other covariates. Endogenous sex hormones are associated with CF. Perhaps CF plays a role in the higher risk of coronary heart disease reported in women after menopause.
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Affiliation(s)
- Samar R El Khoudary
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Kelly J Shields
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Imke Janssen
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Carrie Hanley
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Matthew J Budoff
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Emma Barinas-Mitchell
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Susan A Everson-Rose
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Lynda H Powell
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Karen A Matthews
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
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Liyanage L, Lee NJ, Cook T, Herrmann HC, Jagasia D, Litt H, Han Y. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis. Int J Cardiovasc Imaging 2015; 32:173-9. [DOI: 10.1007/s10554-015-0752-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
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Maturana MA, Franz RF, Metzdorf M, da Silva TR, Spritzer PM. Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score. Maturitas 2015; 81:311-6. [DOI: 10.1016/j.maturitas.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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Niemczyk NA, Catov JM, Barinas-Mitchell E, McClure CK, Roberts JM, Tepper PG, Sutton-Tyrrell K. Nulliparity is associated with less healthy markers of subclinical cardiovascular disease in young women with overweight and obesity. Obesity (Silver Spring) 2015; 23:1085-91. [PMID: 25866258 PMCID: PMC4414732 DOI: 10.1002/oby.21044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Higher parity is associated with increased subclinical cardiovascular disease (CVD) in mid-life and older women and with increased CVD risk overall. The relationship between parity, subclinical CVD, and infertility in young women with overweight and obesity has been infrequently evaluated. METHODS Reproductive histories were obtained in 191 (66%) young women with overweight and obesity (BMI 25-39.9 kg/m(2) ) participating in a weight loss trial. Baseline carotid intima-media thickness (IMT) and inter-adventitial diameter (IAD) were assessed via B-mode ultrasound. Linear regression was used to estimate the relationship between parity and carotid measures, adjusted for demographic, cardiovascular, and reproductive risk factors. RESULTS Nulliparous women (n = 70, age 34.9 ± 7.1) had increased common carotid IAD (0.230 mm, SE 0.08, P = 0.003) and mean common carotid artery (CCA) IMT (0.031 mm, SE 0.01, P = 0.007) compared with parous women (n = 102, age 39.5 ± 4.9), persisting after adjustment for age, race, and CVD risk factors. No other reproductive factors were statistically significantly associated. CONCLUSIONS Nulliparity is associated with markers of less healthy carotid arteries in a sample of disease-free 25- to 45-year-old women with overweight or obesity. This may represent a beneficial effect of pregnancy or indicate overall better health in women with overweight/obesity who are capable of childbearing.
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Affiliation(s)
- Nancy Anderson Niemczyk
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA; Midwifery Institute of Philadelphia University, Pennsylvania, USA
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Hoyt LT, Falconi AM. Puberty and perimenopause: reproductive transitions and their implications for women's health. Soc Sci Med 2015; 132:103-12. [PMID: 25797100 DOI: 10.1016/j.socscimed.2015.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This scoping review synthesizes existing research on two major transitions in females' lives: puberty and perimenopause. These two periods of vast physiological change demarcate the beginning and the end of the reproductive life cycle and are associated with major neuroendocrine reorganization across two key systems, the hypothalamic-pituitary-gonadal (HPG) axis the hypothalamus-pituitary-adrenal (HPA) axis. Despite growing evidence suggesting that the timing and experience of puberty and perimenopause are related to various physical and mental health outcomes (e.g., mood disorders, metabolism, cardiovascular health, autoimmune conditions, and cancer), these two processes are rarely examined together. In this paper, we bridge these disparate literatures to highlight similarities, isolate inconsistencies, and identify important areas for future research in women's health.
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Affiliation(s)
- Lindsay Till Hoyt
- Robert Wood Johnson Foundation Health & Society Scholar at the University of California, San Francisco and Berkeley, 3333 California St., Suite 465, San Francisco, CA 94143, USA.
| | - April M Falconi
- School of Public Health, University of California, Berkeley, 13A University Hall, Berkeley, CA 94720, USA.
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Oxidative stress contributes to large elastic arterial stiffening across the stages of the menopausal transition. Menopause 2015; 21:624-32. [PMID: 24149926 DOI: 10.1097/gme.0000000000000116] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It is unclear how changes in ovarian hormones during the menopausal transition contribute to age-associated arterial stiffening. We sought to evaluate differences in arterial stiffness and the role of oxidative stress across the stages of the menopausal transition in healthy women. METHODS Arterial stiffness (carotid artery compliance and ultrasound) was measured during immediate infusions of saline (control) and ascorbic acid (experimental model to immediately decrease oxidative stress) in 97 healthy women (22-70 y) classified as premenopausal (n = 24; mean [SD] age, 33 [7] y), early perimenopausal (n = 21; 49 [3] y) or late perimenopausal (n = 21; 50 [4] y), or postmenopausal (n = 31; 57 [5] y). RESULTS Basal carotid artery compliance was different among the groups (P < 0.001). Mean [SD] compliance was highest in premenopausal women (1.31 [0.25] mm/mm Hg × 10), with progressive decrements in perimenopausal (early perimenopausal, 0.98 [0.31] mm/mm Hg × 10; late perimenopausal, 0.90 [0.25] mm/mm Hg × 10) and postmenopausal (0.75 [0.24] mm/mm Hg × 10) women. Ascorbic acid infusion improved compliance in late perimenopausal (15% [18%] increase, P = 0.001) and postmenopausal (17% [26%] increase, P = 0.002) women but not in early perimenopausal or premenopausal women. CONCLUSIONS Arterial stiffening worsens across the stages of the menopausal transition in healthy women. This seems to be mediated, in part, by oxidative stress, particularly during the late perimenopausal and postmenopausal periods. It remains uncertain whether this is specifically caused by loss of ovarian function or aging.
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Effect of menopausal status on carotid intima-media thickness and presence of carotid plaque in Chinese women generation population. Sci Rep 2015; 5:8076. [PMID: 25627797 PMCID: PMC4308700 DOI: 10.1038/srep08076] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022] Open
Abstract
Menopause is an important physiological stage in women's life. The potential association of menopause with carotid intima-media thickness as well as with occurrence and stability of carotid plaque in Chinese female population is unclear. We conducted a population-based, cross-sectional study by recruiting 2,131 participants aged above 40 years from northeast of China. Carotid intima-media thickness (CIMT), presence of carotid plaque and its stability were evaluated by carotid duplex sonography. Among the participants, 1,133 (53.2%) were identified to be postmenopausal. After adjusting for potential confounding factors, presence of CIMT at 50th- 75th and ≥75th percentiles, carotid plaque and its unstable status were found to be significantly associated with the postmenopausal status (P < 0.001). When matched the participants by age, post-menopausal status was still associated with a higher risk of having unstable plaque. Moreover, our data show that postmenopausal status is a risk factor for intracranial arterial stenosis when compared with premenopausal status in the univariate analysis (OR = 1.314, P = 0.043), and such relationship is lost when the confounding factors are adjusted (OR = 0.828, P = 0.225). In conclusion, the vascular risk factors increase as the menopausal status changes. Compared with premenopausal status, postmenopausal status is associated with higher morbidity of CIMT, carotid plaque and its unstable status.
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Vascular function and cardiovascular risk factors in women with severe flushing. Maturitas 2015; 80:379-83. [PMID: 25704326 DOI: 10.1016/j.maturitas.2015.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
Abstract
Cardiovascular disease is the leading cause of death in women of postmenopausal age worldwide. It is a relatively rare occurrence before the menopause and the increase in incidence coincides with the most common symptom associated with menopausal transition, hot flushing. Interest in cardiovascular disease post-menopause has largely focused on the effect of hormone therapy on risk of coronary events and stroke, with vasomotor symptoms considered merely a nuisance symptom, but recent work suggests that the presence of flushing may be a marker of underlying cardiovascular disease.
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Calderon-Margalit R, Siscovick D, Merkin SS, Wang E, Daviglus ML, Schreiner PJ, Sternfeld B, Williams OD, Lewis CE, Azziz R, Schwartz SM, Wellons MF. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study. Arterioscler Thromb Vasc Biol 2014; 34:2688-94. [PMID: 25359859 DOI: 10.1161/atvbaha.114.304136] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). APPROACH AND RESULTS At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. CONCLUSIONS In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD.
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Affiliation(s)
- Ronit Calderon-Margalit
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.).
| | - David Siscovick
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Sharon S Merkin
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Erica Wang
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Martha L Daviglus
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Pamela J Schreiner
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Barbara Sternfeld
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - O Dale Williams
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Cora E Lewis
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Ricardo Azziz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Stephen M Schwartz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Melissa F Wellons
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
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Evaluation of clinical and inflammatory markers of subclinical carotid atherosclerosis in postmenopausal women. Menopause 2014; 21:982-9. [DOI: 10.1097/gme.0000000000000199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Vascular aging, featuring endothelial dysfunction and large artery stiffening, is a major risk factor for developing cardiovascular disease (CVD). In women, vascular aging appears to be accelerated during the menopause transition, particularly around the late perimenopausal period, presumably related to declines in ovarian function and estrogen levels. The mechanisms underlying endothelial dysfunction and large artery stiffening with the menopause transition are not completely understood. Oxidative stress and the proinflammatory cytokine tumor necrosis factor-α contribute to endothelial dysfunction and large artery stiffening in estrogen-deficient postmenopausal women. Habitual endurance exercise attenuates the age-related increase in large artery stiffness in estrogen-deficient postmenopausal women and can reverse arterial stiffening to premenopausal levels in estrogen-replete postmenopausal women. In contrast, estrogen status appears to play a key permissive role in the adaptive response of the endothelium to habitual endurance exercise in that endothelial improvements are absent in estrogen-deficient women but present in estrogen-replete women. We review here the current state of knowledge on the biological defects underlying vascular aging across the menopause transition, with particular focus on potential mechanisms, the role of habitual exercise in preserving vascular health, and key areas for future research.
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Relationship between circulating serum osteoprotegerin and total receptor activator of nuclear κ-B ligand levels, triglycerides, and coronary calcification in postmenopausal women. Menopause 2014; 21:702-10. [DOI: 10.1097/gme.0000000000000127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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