In post-menopausal women, the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events.

These prospective data indicate a significant increase in the relative risk of hypertension with each unit decrease of flow-mediated dilation that is independent of age and baseline systolic and diastolic pressure values. This could suggest that an impaired endothelial vasomotor function precedes and predicts the future development of hypertension in postmenopausal women.

OBJECTIVE -Both postmenopausal state and diabetes are associated with endothelial dysfunction and are well-known risk factors for atherosclerosis. However, the relationship of endothelium-dependent vasodilation and diabetes has never been prospectively evaluated. This study provided the opportunity to assess the association between endothelial vasodilation function and the incidence of diabetes in a cohort of apparently healthy postmenopausal women.RESEARCH DESIGN AND METHODS -We conducted a prospective cohort study that began in 1997 with 840 apparently healthy, nonobese, postmenopausal women, aged 53 Ϯ 6 years, initially with normal glucose tolerance at the oral glucose tolerance test. All participants were followed up for a mean period of 3.9 Ϯ 0.7 years (range 0.5-6.9). Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery, using high-resolution ultrasound.RESULTS -There were no significant differences in demographic, blood pressure, and biochemical profiles among each tertile group at baseline or at follow-up review. During follow-up, 102 women developed type 2 diabetes. The adjusted relative risk (RR) for women with FMD Յ4.3 (lowest tertile) was 5.87 (95% CI 4.34 -8.10) versus women with FMD Ն5.6 (highest tertile reference). Each 1-unit decrease of FMD was associated with a significant 32% (22-48%) increase in the multiple-adjusted RR of incident diabetes.CONCLUSIONS -These prospective data indicate a significant increase in the RR of diabetes with each unit decrease of FMD. This could suggest that an impaired endothelial function may play a fundamental role in diabetogenesis in postmenopausal women. Diabetes Care 28:702-707, 2005P ostmenopause is a physiological condition known to be associated with endothelial dysfunction. It is due to a lack of estrogen that is typical in this phase of a woman's life (1,2). There is considerable evidence that the impairment of endothelial function is a predicting factor in the development of atherosclerosis (3).Type 2 diabetes represents a very important public health problem in all industrialized countries, mainly in the U.S. (4,5), that involves conspicuous cardiovascular consequences and high costs in terms of mortality, morbidity, and financial resources (6). Endothelial dysfunction is a very frequent occurrence among diabetic patients (7-10).Because endothelial dysfunction is also present in nondiabetic postmenopausal women (1,2), it is not clear whether endothelial dysfunction is a consequence or rather the cause of diabetes, thus preceding its onset. Although there are both references relating to the fact that endothelial dysfunction may precede insulin resistance (11,12) and unique recent work concerning the relationship between the spillover markers of endothelial dysfunction and incident diabetes (13), a clear relationship between endothelium-dependent vasodilation and diabetes has, to our knowledge, never been demonstrated. This study provided the opportunity to prospectively assess the association between endothelial vasodi...

Abstract-Metabolic syndrome is increasingly recognized as an important cardiovascular risk factor in hypertension, but its influence on the cardiovascular risk profile in hypertensive postmenopausal women has not been studied. The aim of the present study was to investigate the impact of metabolic syndrome on the cardiovascular risk profile and the response to treatment. We enrolled 350 hypertensive postmenopausal women, 55Ϯ6 years of age (range 47 to 60 years of age). Patients were divided into 2 groups according to the presence of metabolic syndrome. Compared with those without, women with metabolic syndrome had higher waist circumference, body mass index, and levels of glucose, triglycerides, and HDL cholesterol, as would be expected, based on definition. In addition, patients with metabolic syndrome had a cardiovascular risk profile less favorable, characterized by a significantly higher highly sensitive C-reactive protein (2.2Ϯ0.6 versus 1.7Ϯ0.7 ng/L; PϽ0.01), a more compromised endothelial function (flow-mediated vasodilation 2.4Ϯ2.2 versus 4.4Ϯ2.5%; Pϭ0.01), and a significantly higher left ventricular mass (44Ϯ15 versus 41Ϯ16 g/m 2.7 ). Also, antihypertensive treatment induced a more modest improvement of both endothelial dysfunction and subclinical inflammation in women with metabolic syndrome. The results of our study show that in postmenopausal women, there are 2 different forms of hypertension: that which is isolated, and that which is associated with metabolic syndrome. This last form is related to a more severe risk profile, and response to therapy is less favorable. Key Words: women Ⅲ metabolic syndrome Ⅲ hypertension Ⅲ cardiovascular diseases Ⅲ drugs Ⅲ risk factors H ypertension is highly prevalent in postmenopausal women, and the postmenopausal period is a wellestablished risk factor for cardiovascular disease in women. 1 As one example of this phenomenon, the prevalence of hypertension is higher in males 30 to 45 years of age than in females of similar age, whereas the prevalence of hypertension in females after this age increases to levels similar to 2 or exceeding that 3 in males. Hypertension can be considered an isolated disease or part of the metabolic syndrome (MS). MS, a clustering of lipid and nonlipid cardiovascular risk factors, is estimated to affect Ϸ20% to 30% of the middle-aged population, 4 and the prevalence of the disorder appears to be increasing in the US population. 5 Postmenopausal status is associated with a 60% increased risk of MS, even after adjusting for confounding variables. 6 MS is increasingly recognized as an independent predictor of cardiovascular disease in hypertension. 7 Moreover, in those studies in which the prognostic impact of MS has been examined separately in men and women, the coronary or cardiovascular morbidity/mortality hazard ratios associated with MS were almost invariably found to be higher in the female sex. 8 -10 Therefore, the risk of cardiovascular disease attributed to MS appears to be especially high in women, and it is estimated that half o...