Age-Related Deterioration in Arterial Structure and Function in Postmenopausal Women

Impact of Hormone Replacement Therapy

From the Department of Medicine, Monash University, Monash Medical Centre, Clayton (B.P.M., Y.-L.L., H.T., L.M.S.); the Department of Biomedical Engineering, La Trobe University, Bundoora (J.D.C.); and Baker Medical Research Institute, Prahran, Melbourne (A.D.), Australia.

Correspondence to Associate Professor Barry McGrath, Cardiovascular Research Unit, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, 3168 Australia. E-mail barry.mcgrath{at}med.monash.edu.au

Abstract—Epidemiological evidence suggests that hormone replacement therapy (HRT) reduces morbidity and mortality from cardiovascular diseases in postmenopausal women. In this study, indices of arterial function [total systemic arterial compliance (SAC) and carotid arterial distensibility coefficient (DC)], structure [carotid intima-media thickness (IMT)], and lipid profiles were compared in postmenopausal women on long-term HRT and aged-matched controls. One hundred nine women aged 44 to 77 years taking HRT and an age-matched group of 108 female controls were entered into the study. The two groups were similar for body mass index, smoking status, exercise level, alcohol intake, and blood pressure. Fasting cholesterol, low density lipoprotein, and lipoprotein(a) were reduced and high density lipoprotein increased in the HRT group. IMT increased with age; SAC and DC were reduced with age in both groups. The HRT group had a higher mean SAC (0.42±0.02 versus 0.34±0.02 U/mm Hg, P=0.0001) and a lower mean IMT (0.67±0.01 versus 0.74±0.02 mm, P=0.006) than did controls. Subgroup analysis for estrogen versus estrogen plus progestin revealed no differences for SAC and IMT; DC, however, was greater in estrogen-only users. Smokers on HRT had a higher mean SAC (0.41±0.02 versus 0.31±0.01 U/mm Hg, P=0.008) and a lower IMT (0.65±0.02 versus 0.75±0.03 mm, P=0.002) than did smokers not taking such therapy. A protective effect of long-term estrogen therapy on age-related changes in arterial structure and function in postmenopausal women was evident in smokers and nonsmokers alike. Progestin appeared to counteract the effects of estrogen on carotid compliance only. Long-term controlled trials are needed to determine the significance of these findings.

Key Words: arterial compliance • carotid intima-media thickness • estrogen • progestins • postmenopausal

This article has been cited by other articles:

				B Jani and C Rajkumar Ageing and vascular ageing. Postgrad. Med. J., June 1, 2006; 82(968): 357 - 362. [Abstract] [Full Text] [PDF]

				K. Hayashi, M. Miyachi, N. Seno, K. Takahashi, K. Yamazaki, J. Sugawara, T. Yokoi, S. Onodera, and N. Mesaki Variations in carotid arterial compliance during the menstrual cycle in young women Exp Physiol, March 1, 2006; 91(2): 465 - 472. [Abstract] [Full Text] [PDF]

				K. L. Moreau, K. M. Gavin, A. E. Plum, and D. R. Seals Ascorbic Acid Selectively Improves Large Elastic Artery Compliance in Postmenopausal Women Hypertension, June 1, 2005; 45(6): 1107 - 1112. [Abstract] [Full Text] [PDF]

				G. V. Nair, L. A. Chaput, E. Vittinghoff, D. M. Herrington, and for the Heart and Estrogen/Progestin Replacement S Pulse Pressure and Cardiovascular Events in Postmenopausal Women With Coronary Heart Disease Chest, May 1, 2005; 127(5): 1498 - 1506. [Abstract] [Full Text] [PDF]

				R. K. Dubey, B. Imthurn, M. Barton, and E. K. Jackson Vascular consequences of menopause and hormone therapy: Importance of timing of treatment and type of estrogen Cardiovasc Res, May 1, 2005; 66(2): 295 - 306. [Abstract] [Full Text] [PDF]

				G. V. Nair, D. Waters, W. Rogers, G. J. Kowalchuk, T. D. Stuckey, and D. M. Herrington Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women Hypertension, January 1, 2005; 45(1): 53 - 57. [Abstract] [Full Text] [PDF]

				M. S. Seelig, B. M. Altura, and B. T. Altura Benefits and Risks of Sex Hormone Replacement in Postmenopausal Women J. Am. Coll. Nutr., October 1, 2004; 23(5): 482S - 496S. [Abstract] [Full Text] [PDF]

				D. P. Germain, P. Boutouyrie, B. Laloux, and S. Laurent Arterial Remodeling and Stiffness in Patients With Pseudoxanthoma Elasticum Arterioscler Thromb Vasc Biol, May 1, 2003; 23(5): 836 - 841. [Abstract] [Full Text] [PDF]

				K. L Moreau, A. J Donato, D. R Seals, C. A DeSouza, and H. Tanaka Regular exercise, hormone replacement therapy and the age-related decline in carotid arterial compliance in healthy women Cardiovasc Res, March 1, 2003; 57(3): 861 - 868. [Abstract] [Full Text] [PDF]

				T. Simon, P. Boutouyrie, J.M. Simon, B. Laloux, C. Tournigand, A.I. Tropeano, S. Laurent, and P. Jaillon Influence of Tamoxifen on Carotid Intima-Media Thickness in Postmenopausal Women Circulation, December 3, 2002; 106(23): 2925 - 2929. [Abstract] [Full Text] [PDF]

				K. L. Moreau, A. J. Donato, D. R. Seals, F. A. Dinenno, S. D. Blackett, G. L. Hoetzer, C. A. Desouza, and H. Tanaka Arterial intima-media thickness: site-specific associations with HRT and habitual exercise Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1409 - H1417. [Abstract] [Full Text] [PDF]

				R. Tatchum-Talom, C. Martel, and A. Marette Influence of estrogen on aortic stiffness and endothelial function in female rats Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H491 - H498. [Abstract] [Full Text] [PDF]

				H. N. Hodis, W. J. Mack, R. A. Lobo, D. Shoupe, A. Sevanian, P. R. Mahrer, R. H. Selzer, C.-r. Liu, C.-h. Liu, S. P. Azen, et al. Estrogen in the Prevention of Atherosclerosis: A Randomized, Double-Blind, Placebo-Controlled Trial Ann Intern Med, December 4, 2001; 135(11): 939 - 953. [Abstract] [Full Text] [PDF]

				A. H. FRIEDLANDER and L. ALTMAN Carotid artery atheromas in postmenopausal women: Their prevalence on panoramic radiographs and their relationship to atherogenic risk factors J Am Dent Assoc, August 1, 2001; 132(8): 1130 - 1136. [Abstract] [Full Text] [PDF]

				H. J. Teede, F. S. Dalais, D. Kotsopoulos, Y.-L. Liang, S. Davis, and B. P. McGrath Dietary Soy Has Both Beneficial and Potentially Adverse Cardiovascular Effects: A Placebo-Controlled Study in Men and Postmenopausal Women J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 3053 - 3060. [Abstract] [Full Text] [PDF]

				D. Brighouse Hormone replacement therapy (HRT) and anaesthesia Br. J. Anaesth., May 1, 2001; 86(5): 709 - 716. [Abstract] [Full Text] [PDF]

				A. M. Dart and B. A. Kingwell Pulse pressure--a review of mechanisms and clinical relevance J. Am. Coll. Cardiol., March 15, 2001; 37(4): 975 - 984. [Abstract] [Full Text] [PDF]

				Y.-L. Liang, L. M. Shiel, H. Teede, D. Kotsopoulos, J. McNeil, J. D. Cameron, and B. P. McGrath Effects of Blood Pressure, Smoking, and Their Interaction on Carotid Artery Structure and Function Hypertension, January 1, 2001; 37(1): 6 - 11. [Abstract] [Full Text] [PDF]

				S. Vehkavaara, J. Westerbacka, T. Hakala-Ala-Pietilä, A. Virkamäki, O. Hovatta, and H. Yki-Järvinen Effect of Estrogen Replacement Therapy on Insulin Sensitivity of Glucose Metabolism and Preresistance and Resistance Vessel Function in Healthy Postmenopausal Women J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4663 - 4670. [Abstract] [Full Text]

				P. Angerer, W. Kothny, S. Stork, and C. von Schacky Hormone replacement therapy and distensibility of carotid arteries in postmenopausal women: a randomized, controlled trial J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1789 - 1796. [Abstract] [Full Text] [PDF]

				A. Harris, M. Harris, J. Biller, H. Garzozi, D. Zarfty, T. A. Ciulla, and B. Martin Aging Affects the Retrobulbar Circulation Differently in Women and Men Arch Ophthalmol, August 1, 2000; 118(8): 1076 - 1080. [Abstract] [Full Text] [PDF]

				H. Teede and B. McGrath Reply J. Am. Coll. Cardiol., March 1, 2000; 35(3): 815 - 816. [Full Text] [PDF]

				I. C. D. Westendorp, B. A. I.’t Veld, M. L. Bots, J. M. Akkerhuis, A. Hofman, D. E. Grobbee, and J. C. M. Witteman Hormone Replacement Therapy and Intima-Media Thickness of the Common Carotid Artery : The Rotterdam Study Stroke, December 1, 1999; 30(12): 2562 - 2567. [Abstract] [Full Text] [PDF]

				E. J. Giltay, J. Lambert, L. J. G. Gooren, J. M. H. Elbers, M. Steyn, and C. D. A. Stehouwer Sex Steroids, Insulin, and Arterial Stiffness in Women and Men Hypertension, October 1, 1999; 34(4): 590 - 597. [Abstract] [Full Text] [PDF]

				H. J. Teede, Y.-L. Liang, L. M. Shiel, J. J. McNeil, and B. P. McGrath Hormone replacement therapy in postmenopausal women protects against smoking-induced changes in vascular structure and function J. Am. Coll. Cardiol., July 1, 1999; 34(1): 131 - 137. [Abstract] [Full Text] [PDF]

				P. J. Nestel, S. Pomeroy, S. Kay, P. Komesaroff, J. Behrsing, J. D. Cameron, and L. West Isoflavones from Red Clover Improve Systemic Arterial Compliance But Not Plasma Lipids in Menopausal Women J. Clin. Endocrinol. Metab., March 1, 1999; 84(3): 895 - 898. [Abstract] [Full Text]