Indexes of aortic wave reflection are not augmented in estrogen‐deficient physically active premenopausal women

Abstract

Background: Hypoestrogenemia due to menopause is associated with increased cardiovascular disease risk, in part due to elevated indexes of aortic wave reflection (AWRI) and central (aortic) blood pressure. We sought to investigate whether AWRI and central blood pressure are also augmented in hypoestrogenic exercise-trained premenopausal women with functional hypothalamic amenorrhea (ExFHA). Methods: In age-(pooled mean ± SEM, 24 ± 1 years), BMI-(21 ± 1 kg/m 2 ), and cardiorespiratory fitness-matched (45 ± 2 ml/kg/min) eumenorrheic ovulatory (ExOv; n = 11) and ExFHA women (n = 10), we assessed aortic blood pressure and waveform characteristics (augmentation index and wave reflection amplitude) obtained from radial pressure waves (applanation tonometry). Doppler ultrasound determined cardiac output (CO) and total peripheral resistance (TPR). Measures were recorded before and 1 hour after 45 minutes of moderate intensity exercise to determine the influence of exercise-induced increases in nitric oxide. Results: Pre-exercise, AIx75, central systolic BP (SBPc), and CO were lower (P < .05) and TPR higher (P < .05) in ExFHA. Post-exercise, AIx75 was unchanged (P > .05) in ExFHA but was lowered (P < .05) in ExOv. Both groups demonstrated increased CO, and lowered SBPc and TPR, yet TPR remained higher (P < .05), and CO and SBPc lower (P < .05) in ExFHA. Conclusions: Despite hypoestrogenemia, functional compliance of the central arteries and central BP is not augmented, yet TPR is higher, in ExFHA versus ExOv. An acute bout of dynamic exercise did not alter AIx75 in ExFHA, suggesting blunted vascular responsiveness to exercise-induced increases in nitric oxide, possibly due to augmented vascular tone. These findings have relevance in understanding the vascular consequences of hypoestrogenemia during the premenopausal years.

Myocardial function: from myofilaments to cardiac pump

“…290,291 In contrast, a growing number of studies have reported that carotid-femoral PWV, 288,291e294 AI x , 293,295 carotid artery stiffness, 294 or carotid and femoral artery compliance 296 are unchanged throughout the menstrual cycle. A similar lack of responsiveness in elastic large-artery stiffness has been reported across different phases of oral contraceptive use, 293,294 while active hypoestrogenic premenopausal women with functional hypothalamic amenorrhea have lower resting systolic arterial pressure, pulse pressure, and AI x @75 compared to fitness-matched eumenorrheic controls 297 in spite of their exaggerated MSNA responses to graded lower body negative pressure. 298 Numerous randomized controlled trials have sought to determine prospectively the effects of estrogen or combined hormone replacement therapy on arterial stiffness in postmenopausal women.…”

Impact of secondary amenorrhea on cardiovascular disease risk in physically active women: a systematic review protocol

“…A study by Hoch et al 17 found evidence of endothelial dysfunction in premenopausal (18- to 35-year-old) runners experiencing athletic amenorrhea. Additionally, a study by O’Donnell et al 18 found higher total peripheral resistance in premenopausal (18- to 35-year-old) exercising women experiencing functional hypothalamic amenorrhea compared with age and exercise-matched eumenorrheic women. Further, they reported that in the amenorrheic women, an acute bout of exercise did not alter their heart rate–corrected augmentation index (Aix75; a composite marker of arterial stiffness), suggesting a blunted vascular response to nitric oxide increases that occur during exercise.…”