Is There an Association between Athletic Amenorrhea and Endothelial Cell Dysfunction?

Hoch, Anne Z.; Dempsey, Rania L.; Carrera, Guillermo F.; Wilson, Charles R.; Chen, Ellen H.; Barnabei, Vanessa M.; Sandford, Paul; Ryan, Tracey A.; Gutterman, David D.

doi:10.1249/01.mss.0000053661.27992.75

Cited by 86 publications

(19 citation statements)

References 31 publications

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“…The present study adds to a body of literature describing altered cardiovascular function in exercise-trained women with FHA, including impaired conduit 11,35 and resistance 10,11 vessel function and increased regional vascular resistance. 10,11 Similar hemodynamic changes have been documented in older sedentary hypoestrogenic postmenopausal women.…”

Section: Perspectivesmentioning

confidence: 73%

Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women

et al. 2015

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Its prevalence is markedly higher in recreationally and competitively exercising women and women with physically demanding jobs (≈1% to 44%) than in sedentary women (≈2% to 5%).2,3 Hypothalamic-pituitary-ovarian suppression in physically active women with FHA (ExFHA) has been related causally to energy deficiency (ie, caloric deficit) in association with high energy expenditure and insufficient energy intake (ie, low caloric intake). 4Circulating estradiol concentrations in women with ExFHA are chronically low and resemble those observed in postmenopausal women and in men. 5,6 In postmenopausal women, estrogen deficiency is associated with increases in blood pressure (BP) and a marked acceleration in the development and progression of atherosclerosis.7 Cardiovascular consequences of premenopausal hypoestrogenemia in ExFHA women are not yet known, but disruption of the menstrual cycle during the reproductive years is also associated with the premature development and progression of coronary artery disease. 8,9 However, in contrast to postmenopausal women, ExFHA women have lower resting systolic blood pressure (SBP) and heart rate (HR) than age-and fitness-matched estrogen-replete physically active women.10,11 The presence of low arterial BP, despite hypoestrogenemia, suggests that estrogen deficiency may have different consequences for BP regulation in premenopausal and postmenopausal women.The sympathetic nervous system and the renin-angiotensinaldosterone system (RAAS) are cornerstones of BP regulation. Estrogen modulates both. In estrogen-deficient Abstract-Our prior observations in normotensive postmenopausal women stimulated the hypotheses that compared with eumenorrheic women, active hypoestrogenic premenopausal women with functional hypothalamic amenorrhea would demonstrate attenuated reflex renin-angiotensin-aldosterone system responses to an orthostatic challenge, whereas to defend blood pressure reflex increases in muscle, sympathetic nerve activity would be augmented. To test these hypotheses, we assessed, in recreationally active women, 12 with amenorrhea (ExFHA; aged 25±1 years; body mass index 20.7±0.7 kg/m 2 ; mean±SEM) and 17 with eumenorrhea (ExOv; 24±1 years; 20.9±0.5 kg/m 2 ), blood pressure, heart rate, plasma renin, angiotensin II, aldosterone, and muscle sympathetic nerve activity at supine rest and during graded lower body negative pressure (−10, −20, and −40 mm Hg). At baseline, heart rate and systolic blood pressure were lower (P<0.05) in ExFHA (47±2 beats/min and 94±2 mm Hg) compared with ExOv (56±2 beats/min and 105±2 mm Hg), but muscle sympathetic nerve activity and renin-angiotensin-aldosterone system constituents were similar (P>0.05). In response to graded lower body negative pressure, heart rate increased (P<0.05) and systolic blood pressure decreased (P<0.05) in both groups, but these remained consistently lower in ExFHA (P<0.05). Lower body negative pressure elicited increases (P<0.05) in renin, angiotensin II, and aldosterone in ExOv, but not in ExFHA (P>0.05). Muscle sympatheti...

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Section: Perspectivesmentioning

confidence: 73%

Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women

et al. 2015

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“…[34] The case did not come into this extreme category as her BMI and body fat percentage, although low, were within the normal range; additionally, her cTnI levels were within the normal reference range at rest. However, Hoch et al [35,36] have shown that females who have symptoms of the Female Triad syndrome demonstrate increased prevalence of endothelium dysfunction. This suggests there exists an unknown number in the population who are asymptomatic, with subclinical eating disorders, and who may demonstrate this unexpected cTnI response to very short-duration exercise.…”

Section: Discussionmentioning

confidence: 99%

“…However, other data collected in this work support the existence of an energy deficit. Future work should determine energy balance using more accurate methods for example, accelerometers and more closely controlled dietary analysis like that in Hoch et al [35] Other biomarkers of cardiac function, for example, B-type natriuretic peptide (BNP) or N-Terminal pro-BNP and echocardiography images collected after exercise would assist in any possible diagnosis. This would be necessary to examine the interaction between high-intensity exercise and low-energy availability in young active females where calorie deficit may exist.…”

Section: Discussionmentioning

confidence: 99%

Evidence of direct cardiac damage following high-intensity exercise in chronic energy restriction

et al. 2017

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Rationale:Following prolonged endurance events such as marathons, elevated levels of cardiospecific biomarkers are commonly reported. Although transiently raised levels are generally not considered to indicate clinical myocardial damage, comprehension of this phenomenon remains incomplete. The popularity of high-intensity interval training highlights a paucity of research measuring cardiac biomarker response to this type of exercise. This a posteriori case report discusses the elevation of cardiac troponins (cTn) associated with short interval, high-intensity exercise.Patient concerns:In this case report, an apparently healthy 29-year-old recreationally active female presented clinically raised cardiac troponin I (cTnI) levels (>0.04 ng/mL), after performing high-intensity cycle ergometer sprints. As creatine kinase (CK) is expressed by multiple organs (e.g., skeletal muscle, brain, and myocardium), cTnI assays were performed to determine any changes in total serum CK levels not originating from skeletal muscle damage.Diagnosis:A posteriori the individual's daily energy expenditure indicated chronically low-energy availability. Psychometric testing suggested that the individual scored positive for disordered eating, highly for fatigue levels, and low in mental health components.Outcomes:The current case report provides novel evidence of elevated cTnI occurring as a result of performing short duration, high intensity, cycle ergometer exercise in an individual with self-reported chronically depleted energy balance. A schematic to identify potentially “at risk” individuals is presented.Lessons:Considering this as a case report, results cannot be generalized; however, the main findings suggest that individuals who habitually restrict their calorie intake below their bodies’ daily energy requirements, may have elevated biomarkers of exercise induced myocardial stress from performing high-intensity exercise.

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“…Individuals with eating disorder symptoms, poor coping mechanisms, and mood disorders are all susceptible to HA. Studies have linked HA to impaired bone health and more recently to an altered cardiovascular phenotype, due to adaptations in vascular function and autonomic regulation (Zeni-Hoch et al, 2003;O'Donnell et al, 2009).…”

Section: Risk Factorsmentioning

confidence: 99%

Pre-participation cardiac screening in young athletes: Models and criteria

Ingle

2010

British Journal of Cardiac Nursing

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In young people, especially females, a high importance is placed on body image and physical appearance. Unfortunately, misperceptions of the ideal body shape can encourage a pre-occupation with weight loss strategies. Long-term, these strategies may lead to ill-healthanorexia nervosa (AN) is a condition where there is evidence of low body weight, a refusal to maintain body weight, a distorted body image, and menstrual dysfunction. This review focuses on screening techniques for identifying cardiovascular risk in patients with AN.Predictors of cardiac risk have not been robustly investigated in AN, consequently health professionals involved in cardiovascular risk screening may be reliant on screening methodologies that are based on anecdotal evidence. The current inability to accurately predict cardiac events and sudden cardiac death in chronically ill patients with enduring AN is a concern that requires greater national attention

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Is There an Association between Athletic Amenorrhea and Endothelial Cell Dysfunction?

Abstract: Athletic amenorrhea is associated with reduced endothelium-dependent dilation of the brachial artery. This may predispose to accelerated development of cardiovascular disease.

Cited by 86 publications

References 31 publications

Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women

Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women

Evidence of direct cardiac damage following high-intensity exercise in chronic energy restriction

Pre-participation cardiac screening in young athletes: Models and criteria

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