Carotid Artery Wall Changes in Estrogen-Treated and Untreated Postmenopausal Women (original) (raw)
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Carotid artery wall thickness in women treated with hormone replacement therapy
Maturitas, 1997
Objective: To measure the thickness of the individual layers (externa, media, intima) of the carotid artery in two groups of postmenopausal women. Methods: A high resolution ultrasound (25-MHz Osteoson DIII Minhorst) was used to assess the distal end of the common carotid artery. Forty-six women were on hormone replacement therapy (Premarin 0.625 mg and Norgestrel 1 mg) for more than 1 year. The measurements of the treated group were compared to those of 51 postmenopausal women who acted as controls. Results: No significant difference between the externa and media layers of both groups of women were noted. The media showed a tendency to be thicker in the treated group. The intima of the untreated group was found to be significantly thicker than that of the treated group (P < 0.05). Significant correlations were found between the layers of the carotid artery especially between the externa and media both mainly composed of connective tissue (Collagen Type I and III and elastin). The media/intima ratio of the treated women was significantly higher than that of the untreated group (P ~0.003). Conclusion: It is postulated that the changes observed may be due to the effect of oestrogen on connective tissue. These arterial changes induced by hormone replacement therapy may partially explain the cardioprotective effect this treatment has on postmenopausal women. The increased intimal thickness in untreated women compared to treated ones on the other hand would represent the reduction in atheromatous plaque formation in women on oestrogen replacement therapy. 8 1997 Elsevier Science Ireland Ltd. * Corresponding author. dioprotective effect in postmenopausal women. A reduction in atherosclerotic disease of approximately 50% has been quoted in some of these epidemiological studies [ 1,2]. Moreover myocardial infarction and cerebrovascular accidents are rare in premenopausal women [3,4].
Hormone Replacement Therapy and Intima-Media Thickness of the Common Carotid Artery
Stroke, 1999
Background and Purpose —Observational data suggest that hormone replacement therapy (HRT) reduces morbidity and mortality from cardiovascular disease in healthy postmenopausal women. The mechanisms underlying this protection are not entirely clear but may include inhibition of the atherosclerotic process. Methods —We studied the association between ever use of HRT and intima-media thickness (IMT) of the common carotid artery in 1103 naturally menopausal women, aged 55 to 80 years, in the Rotterdam Study, a community-based cohort study in a suburban area of Rotterdam, Netherlands. Mean and maximum IMT of the common carotid artery were measured noninvasively with B-mode ultrasound. Results —Ever use of HRT for ≥1 year was associated with a decreased mean and maximum IMT compared with never users (mean IMT, 0.719 mm [SE 0.01] versus 0.742 mm [SE 0.004], P =0.03; maximum IMT, 0.952 mm [SE 0.015] versus 0.983 mm [SE 0.006], P =0.04), after adjustment for age, smoking, educational level, ...
Carotid intima-media thickness in surgical menopause: women who received HRT versus who did not
Maturitas, 2002
Objecti6e: The effects of hormone replacement therapy (HRT) in the natural menopausal period have been extensively studied. However, these effects have almost none been studied in purely surgical menopause. The aim of this study was to measure intima-media thickness (IMT) of carotid arteries bilaterally in two groups of surgical menopausal women who received HRT versus who did not. Methods: A B-mode ultrasound unit was used for the measurements of the IMTs of carotid arteries in two groups. Measurements of Group 1 (n=65, untreated group) were compared with those of Group 2 (n=70, treated group), in 2-years of follow-up. Patients in Group 2 received daily doses of 0.625 mg of oral conjugated estrogen preparates. Serum estradiol levels, lipid profiles, and blood pressures were measured, pre and postoperatively. For the statistical analyses in terms of differences of IMTs between two groups, general factorial analysis of variation was used. Results: Among preoperative values of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, systolic and diastolic blood pressures, estradiol, and age, only the estradiol values showed significant difference between both groups. The statistical results concerning the postoperative IMT differences for both groups showed that there was a statistically significant difference when comparing both groups, showing an increase in IMT in Group 1. Conclusion: In surgical menopausal women, the direction of the HRT effect is in agreement with evidence from earlier studies on the effects of HRT in natural menopausal women.
Obstetrics & Gynecology, 1998
To compare the long-term effects of oral and transdermal hormone replacement therapy (HRT) on carotid and uterine vascular impedance. Methods: Sixty-three postmenopausal women were randomized to 1 year's treatment with oral or transdermal sequential combined HRT. Carotid and uterine artery pulsatility indices (PIs) were assessed by color Doppler at baseline, and after 2, 6, and 12 months of treatment. Fiftyeight women completed the trial, 27 in the oral and 31 in the transdermal group. In a subgroup of 30 women, we also performed Doppler measurements in the estrogen-progestin combined phase. The study had 90% power to detect a difference between treatment groups of 0.05 in the carotid artery and of 0.25 in uterine artery PI at the 5% significance level. Results: The carotid PI decreased significantly (P < < < .001) and similarly during both regimens. This drop was already clearly detectable during the second month, from 0.97 (0.95, 1.01) (mean and 95% confidence intervals [CI]) to 0.94 (0.91, 0.97) in the oral and from 0.98 (0.94, 1.00) to 0.92 (0.89, 0.95) in the transdermal group, but it continued up to 12 months (0.85 [0.82, 0.88], 13% of baseline values in the oral group and 0.84 [0.81, 0.87], 14% in the transdermal group). In the uterine arteries, the drop in PI was steeper and greater and reached its maximum at 6 months (39% and 40%, respectively). Drops in carotid and uterine PI correlated positively with baseline PI values, but were not affected by patient age, time from menopause, previous HRT and smoking. Addition of norethisterone acetate did not counteract drops in carotid and uterine PI in either group. Conclusion: Oral and transdermal sequential HRT are similarly effective at 1 year in reducing impedance to flow in carotid and uterine circulation. This long-term vascular effect might explain how HRT protects women from cardiovascular disease.
Journal of the American College of Cardiology, 2000
The study objective was to clarify in a randomized, controlled, observer-blind trial whether hormone replacement therapy (HRT) improves elastic properties of the common carotid artery in women with signs of subclinical atherosclerosis, especially in subgroups with increased risk, and whether less progestin enhances the effect. BACKGROUND Previous observational studies have yielded conflicting results on the influence of HRT on central arteries. Some studies reported improvement of distensibility by estrogen alone or in the subgroup of smokers. METHODS A total of 321 postmenopausal women were randomized to 1 mg 17-estradiol plus 0.025 mg gestodene for 12 days every month (HRT 1), or 1 mg 17-estradiol plus 0.025 mg gestodene for 12 days every third month (HRT 2), or no-HRT, during 48 weeks. In 173 women, distensibility of the common carotid artery was determined before and after therapy by M-mode ultrasound and brachial blood pressure measurement. RESULTS Change of distensibility was small and similar in the three treatment groups. In the subgroup of current smokers, HRT 2 (low progestin) increased distensibility by 32% (HRT 2: 8.2 Ϯ 11.7; HRT 1: 0.6 Ϯ 6.0; no HRT: Ϫ1.8 Ϯ 6.8 ϫ 10 Ϫ3 /kPa, p ϭ 0.025 for no-HRT vs. HRT 2). In the subgroups with elevated blood pressure, high low density lipoprotein (LDL) cholesterol, or high age, no effect of HRT was detected. CONCLUSIONS This randomized intervention study demonstrates that long-term HRT with estrogen and progestin does not substantially influence distensibility of central arteries. Yet, in currently smoking postmenopausal women, HRT with low progestin seems to improve distensibility; this merits further study in a specifically designed trial.
Maturitas, 2004
Objective: To compare the short-term effects of oral hormone replacement therapy (HRT) and placebo on carotid and uterine vascular impedance. Methods: 80 postmenopausal women selected from the outpatient clinic of the Hospital Leonor Mendes de Barros in São Paulo, Brazil, were randomized to oral HRT (estradiol 2 mg/norethisterone acetate 1mg-Kliogest r ) or placebo. Carotid and uterine arteries pulsatility indices (PIs) were assessed by color Doppler at baseline, after 4 and 12 weeks of treatment. Seventy-six women completed the trial, 38 in each group. Results: The carotid PI did not decrease significantly in either group. In the uterine arteries, the drop in PI was steeper and greater for HRT women. Drops occurred despite the supposed counteracting effect of norethisterone acetate. In placebo group, there was no significant difference between 4 and 12 weeks of treatment compared with the baseline. The results did not change when analyzed in a real treatment approach. Conclusion: Oral continuous HRT are effective at 12 weeks in reducing impedance to flow in uterine, but not in carotid circulation. These results suggest that the effects of HRT vary by vascular site, and do not have a detectable short-term vascular effect in the carotid area.
Female sex Hormones do not Influence Arterial wall Properties during the Normal Menstrual Cycle
Clinical Science, 1997
1. In previous studies, the elastic properties of the common carotid artery were found to differ between men and women. In these studies, however, the phase of the menstrual cycle was not taken into consideration. It was the aim of the present study to investigate the effect of changing ovarian hormone levels during the normal menstrual cycle on the arterial wall properties of female large arteries. 2. We investigated the elastic right common carotid artery and the muscular right common femoral artery of normotensive young (18–35 years) female subjects (n = 12). The arterial distensibility and cross-sectional compliance coefficients were determined by the use of a specially designed ultrasonic wall-tracking device and measurements of automatic brachial artery cuff blood pressure. The phase of the menstrual cycle was assessed by ultrasonographic evaluation and measurement of 17β-oestradiol and progesterone blood plasma levels. 3. The distensibility coefficient and the cross-sectional...
Association of menopause and hormone replacement therapy with large artery remodeling
Fertility and Sterility, 2011
Objective: To evaluate the remodeling of large arteries according to age at menopause, duration of menopause, and use of hormone therapy (HT). Design: A cross-sectional study consisting of baseline measurements of a multicentric randomized trial were used to evaluate arterial parameters. Setting: The study was conducted in France, Belgium, and the Netherlands in academic hospitals and private clinics. Patient(s): Postmenopausal women (n ¼ 538) with mild hypercholesterolemia. Intervention(s): None. Main Outcome Measure(s): Common carotid artery intima-media thickness (CCA-IMT), central pulse pressure, and aortic stiffness (carotid-femoral pulse wave velocity) were measured and centrally controlled for quality. Multivariate regression analysis was used to assess the possible covariates associated with arterial parameters. Result(s): Women were 58 AE 6 (mean AE SD) years of age with an age of 50 AE 5 at menopause and a mean duration of menopause of 8 AE 7 years. Lower age at menopause, time since menopause, and absence of HT use were independently associated with worsening of the arterial parameters. After multivariate analysis, HT was associated with a lower CCA-IMT (À40 mm [range À64 to À1]), whereas lower age at menopause and menopause duration were respectively associated with a CCA-IMT increase (25 mm/5 y and 27 mm/5 y). Similarly, values of central pulse pressure and pulse wave velocity were lower in HT users (À3.1 mm Hg [À5.1 to À0.9] and À0.31 m/s [À0.63 to À0.02], respectively) but worsened with age at menopause and menopause duration. Conclusion(s): The age at menopause, the time since menopause, and the use of HT are independently associated with the thickening and stiffening of the large arteries.
Associations of endogenous sex hormones with the vasculature in menopausal women
Menopause, 2008
Objective-As associations between endogenous sex hormones and the vasculature are not well characterized, the objective was to examine the cross-sectional associations of menopausal status and endogenous sex hormones with vascular characteristics. Design-Common carotid artery adventitial diameter and intima-media thickness were determined using B-mode ultrasound among 483 middle-aged women enrolled in the Pittsburgh and Chicago sites of the Study of Women's Health Across the Nation. Results-Sixty-two percent of women were pre-or early perimenopausal (<3 months amenorrhea), 12% were late perimenopausal (3-12 months amenhorrhea), and 27% were
Atherosclerosis, 2003
Background: Information on the impact of hormone replacement therapy (HRT) on carotid atherosclerosis is limited. Moreover, transdermal estrogens have not been investigated. Methods: We examined association of HRT use with ultrasonographically assessed carotid atherosclerotic plaque occurrence and mean common carotid artery intima-media thickness (CCA Á/IMT) progression. Within the Vascular Aging (EVA) Study, a community-based cohort, 815 postmenopausal women aged 59 Á/71 have been followed during 4 years. Among these women, 166 had already used HRT. Results: Women who had ever used HRT experienced a lower occurrence of plaques (8.6 versus 19.1%, P0/0.003). After adjustment for the main cardiovascular risk factors, odds-ratio for plaque occurrence was 0.41 (95% confidence interval 0.21 Á/0.78, P0/0.01) among ever users of HRT compared with never users. When transdermal route of estrogen administration was used, adjusted odds-ratio was 0.66 (95% confidence interval 0.47 Á/0.99, P 0/0.04). The progression of IMT, which was measured at a plaque-free site and adjusted on initial levels of CCA Á/IMT did not differ between ever and never users of HRT. It was 0.011 mm per year among ever users and 0.012 mm per year among never users (P0/0.61). Conclusion: These data suggest that HRT use may prevent the development of atherosclerotic plaques in postmenopausal women, especially when estrogens are administered by transdermal route. #