Menopause with cardiovascular disease and its risk factors among rural Chinese women in Beijing: a population-based study

Objectives

This study was to explore the independent influence of menopause on cardiovascular disease (CVD) and its risk factors in rural Chinese females.

Study design

This cross-sectional population-based study enrolled 2245 premenopausal and 2498 postmenopausal women aged 40–59 years in Fangshan district, Beijing, China. Data was collected by face-to-face interview, physical examination and biochemical examination during 2009 and 2010. General liner models were employed to calculate age-adjusted means of cardiovascular risk factors (CRFs). The comparisons of CVD and it risk factors according to menopausal status, and calculation of adjusted odds ratios/coefficients and their 95% confidence intervals for the associations of quartiles of elapsed time since menopause and age at menopause with CVD and its risk factors was performed by multivariate logistic/liner regression models separately.

Results

After adjustment for age and other confounders, no statistically significant association of menopause with CVD was observed in our participants; however, dyslipidemia prevalence and levels of waist-to-hip ratio, triglycerides, total cholesterol and low-density lipoprotein cholesterol were presented higher in postmenopausal group, compared to the premenopausal one (P < 0.05). Compared to women who had been menopausal for less than1 year, those with the elapsed time since menopause of 2–3 years had higher CHD prevalence, higher triglycerides level and lower high-density lipoprotein cholesterol level (P < 0.05).

Conclusions

Postmenopausal women in rural China had worse CRFs profile than the premenopausal ones, which implied menopause might aggravate the CRFs epidemic beyond effects of aging, and would increase the CVD burden during and after their middle ages.     

Impaired ovarian function and risk factors for atherosclerosis in premenopausal women

Objectives: The aim of the study was to obtain information on the possible relationship between impaired ovarian function and risk factors for cardiovascular disease. Material and methods: Serum lipid levels, plasma fibrinolytic potential and histological and biochemical changes in the intima of the uterine artery were investigated in premenopausal women with irregular menstrual cycles, and the results were compared with those from regularly menstruating women. In addition, the same parameters were studied in postmenopausal women on hormone replacement therapy (HRT) and in postmenopausal women who had never used HRT. In total 64 patients undergoing hysterectomy for benign reasons were included the study. Results: Plasma fibrinogen concentration was significantly higher in irregularly menstruating women as compared with women with regular cycles. In women with irregular cycles thickened or sclerotic arterial intima was a significantly more common finding as compared with regularly menstruating women. A significant positive correlation was observed between plasma fibrinogen concentration and intimal esterified cholesterol content in women with thickened or sclerotic uterine artery. Conclusions: These data suggest an important role for normal ovarian function in the prevention of atherosclerosis.     

Hysterectomy prevalence and cardiovascular disease risk factors in American Indian women

OBJECTIVES: We investigated hysterectomy prevalence and associated demographic and reproductive factors among American Indian women. The association between hysterectomy and cardiovascular disease (CVD) risk factors was also examined. METHODS: Data were from 2689 American Indian women who participated in the first examination of the Strong Heart Study from 1989 to 1992. Odds ratios were estimated for factors related to hysterectomy adjusting for other covariates. The association between hysterectomy and CVD risk factors was examined among 1726 eligible women using analysis of covariance. RESULTS: Hysterectomy prevalence ranged from 24% to 34% across differing age groups and the percent with oophorectomy among those with a hysterectomy ranged from 43% to 63%. Geographic area, more prior pregnancy losses, more education, and less speaking of the native language were associated with increased hysterectomy prevalence. After adjustment for age, the women who had a hysterectomy with intact ovaries had higher total cholesterol and low-density lipoprotein cholesterol levels than those with a natural menopause. CONCLUSIONS: American Indian women have comparable hysterectomy prevalence as non-Hispanic white women. Education and native language speaking related to hysterectomy in this population. Hysterectomy alone may relate to unfavorable changes of lipid profile.     

Vasomotor symptoms,estradiol levels and cardiovascular risk profile in women

Objectives

We investigated whether menopausal vasomotor symptoms (VMS) are related to an adverse cardiovascular risk profile. Furthermore, we examined the association between estradiol levels and VMS, and whether an association between VMS and cardiovascular risk factors can be explained by estradiol levels.

Study design

We used data from a Swedish population-based sample of 5857 women, aged 50–64 years. Data on VMS and potential confounders were collected by questionnaires.

Main outcome measures

Body mass index (BMI), waist hip ratio (WHR), glucose, blood pressure, lipid profile and estradiol levels were measured.

Results

Symptoms of flushing/sweats were reported by 55% and sweats by 31% of all women. Estradiol concentrations were significantly lower in women with VMS. After multivariate adjustment, women with symptoms of sweats had a statistically significantly higher BMI, waist hip ratio, total cholesterol level, LDL level, triglycerides level, glucose level, systolic and diastolic blood pressure. These patterns did not change after correction for estradiol. The associations between flushing/sweats combined and cardiovascular risk factors were less pronounced.

Conclusions

Women with VMS have a less favorable cardiovascular risk profile. Although estradiol levels were significantly lower among women with VMS, the increased cardiovascular risk profile cannot be explained by circulating estradiol levels.     

Association of angiotensin-converting enzyme insertion/deletion polymorphism with obesity,cardiovascular risk factors and exercise-mediated changes in Korean women

This study examined whether the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphism is associated with obesity, cardiovascular risk factors and 12-week exercise-mediated changes in Korean women. A total of 105 subjects were divided into three groups as II, ID and DD genotype groups based upon ACE I/D genotypes. Body composition and cardiovascular risk factors were compared among the three groups, and the association of ACE I/D genotypes with obesity and hypertension was evaluated. Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels were higher (P < 0.05) in the DD genotype than in II or ID genotypes. D allele frequency in ACE I/D gene had a higher (P = 0.063) trend in the hypertensive group than the normotensive group. The DD genotype had a trend to develop (odds ratio 4.032, P = 0.086) more hypertension than the II genotype. The II and ID genotypes showed a significant (P < 0.05) decrease in intima media thickness of the carotid artery after an exercise intervention, whereas the DD genotype showed an increase. In conclusion, there is a trend towards association of ACE I/D polymorphism with hypertension but not with obesity. Exercise-mediated changes did not differ significantly among genotypes except IMTCA.     

Do women using hormone replacement treatment have less pre-existing cardiovascular risk

Background: Several studies have suggested that women who choose to use hormone replacement therapy (HRT) already, before starting this therapy, have a better cardiovascular risk profile than those who do not use it. Some of these studies contain factors of confusion and biases, such as HRT users’ greater educational achievement or physical activity, which could have led to wrong conclusions. Aim: To study a cohort, without confounding factors in order to analyse whether the cardiovascular risk profile is different in women who choose to use HRT. Material and methods: Coronary risk factors of 387 women between 45 and 64 were studied. This study was carried out at the Unit for the Preventive Medical Examination of the South Metropolitan Health Service in Santiago (Chile) during the annual check-up. The first evaluation was in 1991–1992; with a second evaluation 5 years later. Of all the women, 174 (45%) never received hormones (Group A), 124 (32%) were HRT users at the time (Group B), and 89 (23%) were former-users (Group C). Results: No differences were found between the three groups for age, body mass index (BMI), educational background, alcohol consumption, smoking or physical activity. Blood pressure was similar in the three groups. No significant differences were found in total cholesterol (A, 221.7±42.2; B, 228.2±47.0; and C, 227.3±44.9 mg/dl); high density lipoprotein (HDL, A, 53.5±13.2; B, 51.8±12.8; and C, 54.0±12.4 mg/dl); low density lipoprotein (LDL, A, 141.7±38.9; B, 148.5±43.1 and C, 148.3±43.8 mg/dl); triglycerides (A, 134.5±67.9; B, 141.0±66.1; and C, 127.3±68.5 mg/dl) and glucose plasma levels (A, 90.5±32.2; B, 87.7±15.3; and C, 85.0±8.8 mg/dl). Conclusions: Our results suggest that women who choose to use HRT have a cardiovascular risk profile, before starting the therapy, similar to those who do not use it.     

Computed tomography imaging of early coronary artery lesions in stable individuals with multiple cardiovascular risk factors

OBJECTIVES:To investigate the prevalence, extent, severity, and features of coronary artery lesions in stable patients with multiple cardiovascular risk factors.METHODS:Seventy-seven patients with more than 3 cardiovascular risk factors were suspected of having coronary artery disease. Patients with high-risk factors and 39 controls with no risk factors were enrolled in the study. The related risk factors included hypertension, impaired glucose tolerance, dyslipidemia, smoking history, and overweight. The characteristics of coronary lesions were identified and evaluated by 64-slice coronary computed tomography angiography.RESULTS:The incidence of coronary atherosclerosis was higher in the high-risk group than in the no-risk group. The involved branches of the coronary artery, the diffusivity of the lesion, the degree of stenosis, and the nature of the plaques were significantly more severe in the high-risk group compared with the no-risk group (all p < 0.05).CONCLUSION:Among stable individuals with high-risk factors, early coronary artery lesions are common and severe. Computed tomography has promising value for the early screening of coronary lesions.     

Consequences of subchronic and chronic exposure to intermittent hypoxia and sleep deprivation on cardiovascular risk factors in rats

Since studies suggest that both hypoxia and sleep fragmentation are related to cardiovascular alterations induced by obstructive sleep apnea, the present study was designed to evaluate the effects of hypoxia, sleep deprivation, and their combination on biochemical blood parameters in rats. In subchronic experiments (4 days), rats were exposed to intermittent hypoxia (IH) during the light period (2min room air-2min 10% O(2) for 12h/day) and/or paradoxical sleep deprivation (PSD, 24h/day). Consequences of chronic intermittent hypoxia (CIH) exposure were examined after 21 consecutive days of hypoxia protocol from 10:00 to 16:00 followed by a sleep restriction (SR) period of 18h (16:00-10:00). Rats were randomly assigned to seven treatment groups: (1) control (2) IH (3) PSD (4) IH-PSD (5) SR (6) CIH and (7) CIH-SR. PSD reduced triglycerides and very low-density lipoprotein (VLDL) cholesterol concentrations and increased total cholesterol and high-density lipoprotein (HDL) cholesterol. IH did not alter any of these parameters. The combination of IH-PSD did not modify the values of total cholesterol and HDL compared to control group. In the chronic experiment, the animals exposed to CIH displayed a reduction of Vitamin B(6) and an increase of triglycerides and VLDL. Our findings show a duration-dependent effect of hypoxia on triglycerides. Rats in the SR and CIH-SR groups showed a diminished concentration of triglycerides and VLDL. SR rats showed a reduction in the concentration of homocysteine but the animals in the CIH-SR treatment condition did not display any alterations in this parameter. In this latter group, an augmentation of cysteine concentration was observed. These results suggest that sleep deprivation and hypoxia modify biochemical blood parameters in distinct ways.     

Breast-feeding and maternal cardiovascular function

Two studies examined the effects of breast-feeding on maternal cardiovascular function. In the first experiment, groups of breast-feeding and bottle-feeding women were compared on preejection period (PEP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) recorded for 1-min periods before and during standard laboratory stressors. Compared with bottle-feeders, breast-feeders had higher CO throughout the session, and greater decreases in CO and increases in TPR during cold pressor. In the second experiment, HR and blood pressure (BP) were compared before and after one breast-feeding and one bottle-feeding session in a within-subjects design. Both feeding methods increased BP but decreased HR, and systolic BP was higher for the breast-feeding than the bottle-feeding condition. Both studies support the notion that breast-feeding alters maternal cardiovascular function, possibly through the actions of oxytocin.     

Peroxiredoxin isoforms are associated with cardiovascular risk factors in type 2 diabetes mellitus

The production of oxygen free radicals in type 2 diabetes mellitus contributes to the development of complications, especially the cardiovascular-related ones. Peroxiredoxins (PRDXs) are antioxidant enzymes that combat oxidative stress. The aim of this study was to investigate the associations between the levels of PRDX isoforms (1, 2, 4, and 6) and cardiovascular risk factors in type 2 diabetes mellitus. Fifty-three patients with type 2 diabetes mellitus (28F/25M) and 25 healthy control subjects (7F/18M) were enrolled. We measured the plasma levels of each PRDX isoform and analyzed their correlations with cardiovascular risk factors. The plasma PRDX1, -2, -4, and -6 levels were higher in the diabetic patients than in the healthy control subjects. PRDX2 and -6 levels were negatively correlated with diastolic blood pressure, fasting blood sugar, and hemoglobin A1c. In contrast, PRDX1 levels were positively correlated with low-density lipoprotein and C-reactive protein levels. PRDX4 levels were negatively correlated with triglycerides. In conclusion, PRDX1, -2, -4, and -6 showed differential correlations with a variety of traditional cardiovascular risk factors. These results should encourage further research into the crosstalk between PRDX isoforms and cardiovascular risk factors.     

Cardiovascular risk factors and lifetime risk estimation in HIV-infected patients under antiretroviral treatment in Spain

Background and objectives:

Cardiovascular disease is a major concern in HIV-infected patients. Lifetime risk estimations use the risk of developing it over the course of remaining lifetime, and are useful in communicating this risk to young patients. We aim to describe the prevalence of cardiovascular risk factors among a representative sample of HIV-infected subjects under antiretroviral therapy in Spain, and to estimate their lifetime risk of cardiovascular disease.

Methods:

Cross-sectional survey about cardiovascular risk factors in 10 HIV units across Spain. Lifetime risk assessed according to Barry was classified in two major categories: low and high lifetime risk.

Results:

We included 895 subjects, 72% men, median age 45.7?years; median CD4 lymphocyte count 598?cells/μl, median time since HIV diagnosis 11?years, median time on antiretroviral treatment 6.3?years, 87% had undetectable HIV viral load. Tobacco smoking was the most frequent risk factor (54%), followed by dyslipidemia (48.6%) and hypertension (38.6%). Estimated 10-year coronary risk (Framingham/Regicor Risk Score) risk was low (?Conclusions:

Modifiable cardiovascular risk factors in this population are very common. There are significant disparities between the low 10-year risk estimated with the Framingham/Regicor score and the higher lifetime risk in HIV patients on antiretroviral therapy. A more aggressive management of modifiable cardiovascular risk factors in these patients seems advisable.     

Risk factors for cardiovascular disease in women

Management of women's health seldom includes cardiovascular disease (CVD) prevention in spite of CVD being the most common cause of death in females being even more common than cancer, HIV/AIDS, malaria and tuberculosis combined. According to the World Heart Federation, CVD is indisputably the most serious, neglected health problem for women in both the developing and the developed worlds. A possible reason may be that CVD has traditionally been perceived as a ‘man's illness’. Since 6 out of 10 deaths from CVD can be prevented, it is of utmost importance that there is more general awareness about CVD in women. The most important factors for developing CVD are dyslipidaemia, hypertension, smoking, stress, diabetes, obesity (especially abdominal fat distribution), physical inactivity, poor eating habits and possibly excessive alcohol intake. Some unique risk factors for CVD exist in women; of which older age at presentation is a major one as they are more likely to suffer from co-morbidities such as diabetes and hypertension.     

Effects of a short health education intervention on physical activity,arterial stiffness and cardiac autonomic function in individuals with moderate-to-high cardiovascular risk

ObjectiveThis study evaluated the effects of a short health education and counseling intervention program, in a primary healthcare setting, on daily physical activity (PA), arterial stiffness, and cardiac autonomic function in individuals with moderate-to-high risk of cardiovascular disease.MethodsThis was a parallel-group study with a 4-month-long intervention, plus 8 months of follow-up. 164 individuals with moderate-to-high cardiovascular risk were allocated to either an intervention (n = 87) or a control group (n = 77). The intervention consisted of 3 walking and face-to-face group sessions plus text messages. Primary outcome was daily PA (sedentary time, light and moderate-to-vigorous PA, all in min/day); secondary outcomes were arterial stiffness i.e., carotid-femoral pulse wave velocity (cfPWV, m/s)] and cardiac autonomic function [(i.e., standard deviation of all N-N intervals (SDNN, ms) and absolute high frequency (HF, ms²)].ResultsThere were not significant group*time interactions for sedentary time [−7.4 (7.6); p = 0.331)], light PA [4.4 (6.4); p = 0.491] or moderate-to-vigorous PA [0.1 (2.6); p = 0.938]. Considering secondary outcomes, there were not significant group*time interactions for cfPWV [0.09 (0.18); p = 0.592], Ln_SDNN [0.09 (0.06); p = 0.148], or Ln_HF [0.16 (0.14); p = 0.263].ConclusionThe program did not improve daily PA, arterial stiffness, or the autonomic cardiac function.Practice ImplicationsPrimary care staff should consider longer or other types of intervention to improve daily PA.     

Hot flashes and blood pressure in midlife women

Objectives

Recent epidemiological studies suggest that hot flashes may have a detrimental impact on the cardiovascular system. The purpose of this study was to examine the associations between hot flashes and blood pressure among women aged 45–54 years who had never used hormone therapy.

Study design

Data were analyzed from 603 women who participated in the Midlife Health Study, a cross-sectional study conducted in the Baltimore Metropolitan region.

Main outcome measures

All participants came to the clinic where systolic and diastolic blood pressures were measured, height and weight were assessed, and a questionnaire was administered that ascertained detailed data on history of hot flashes and participant demographics and health habits.

Results

The data showed that 56.9% of the participants reported ever experiencing hot flashes. In the age-adjusted analyses, both systolic and diastolic blood pressures were significantly and positively associated with hot flashes. However, the estimates were markedly attenuated and not statistically significant after adjustment for age, race, smoking status, current alcohol use, body mass index, and use of an anti-hypertensive agent or a cholesterol-lowering medication. Similar results were observed for moderate or severe hot flashes, hot flashes experienced for one or more years, and hot flashes experienced within the previous 30 days.

Conclusions

These findings indicate that hot flashes are not significantly associated with blood pressure during midlife.     

Effects of health coaching on behavioral modification among adults with cardiovascular risk factors: Systematic review and meta-analysis

ObjectivesThis meta-analysis examined effects of health coaching on physical activities, dietary behaviors, health responsibility, stress management, and smoking behaviors among populations with cardiovascular risk factors.MethodsMultiple electronic databases were searched for randomized controlled trials utilizing health coaching for people with cardiovascular risk factors to lead behavioral changes. The included studies were pooled to estimate the effect size for health coaching interventions on each of the health behaviors.ResultsThis meta-analysis included 15 randomized trials. Motivational interviewing and education sessions were common coaching interventions with telephone calls or face-to-face contacts as the main contact methods. Health coaching for health behaviors showed small but significant effect sizes on physical activities, dietary behaviors, health responsibility, and stress management except for smoking behaviors.ConclusionThe study findings support that health coaching can induce positive behavioral changes among individuals with cardiovascular risk factors. Health coaching delivered by either expert or peer coaches would be easy to apply in clinical settings.Practical implicationsHealth care professionals should be aware that health coaching could provide effective motivation strategies to improve compliance of those who need to initiate and maintain their health behaviors. Health coaching could be easily delivered via telephone calls, text messages, or short-term face-to-face coaching.     

Facial flushing during provocation in women.

Facial flushing was studied in 38 young women who scored high or low on trait anger. To induce anger in the subjects, their task was to solve a difficult puzzle, with or without harassment from a female research assistant. Facial blood flow increased in response to provocation, together with increases in cardiovascular and electrodermal activity. Flushing was associated with large increases in electrodermal activity and small increases in diastolic blood pressure. Subjects high in trait anger reported most anger and embarrassment, but physiological activity did not differ from subjects with low trait anger. The findings suggest that sympathetically mediated vasodilatation in facial blood vessels competes with cutaneous vasoconstriction during anger. Unpleasant sensations of facial warmth might heighten aversive emotional experiences, but dilatation of facial blood vessels could also act as a type of "safety valve" by opposing increases in blood pressure. An angry predisposition may influence the subjective experience of anger in women, but does not seem to have a major influence on physiological reactivity to mild provocation.     

Vascular hyperpolarization in human physiology and cardiovascular risk conditions and disease

Hyperpolarization causing smooth muscle relaxation contributes to the maintenance of vascular homeostasis, particularly in small‐calibre arteries and arterioles. It may also become a compensatory vasodilator mechanism upregulated in states with impaired nitric oxide (NO) availability. Bioassay of vascular hyperpolarization in the human circulation has been hampered by the complexity of mechanisms involved and the limited availability of investigational tools. Firm evidence, however, supports the notion that hyperpolarization participates in the regulation of resting vasodilator tone and vascular reactivity in healthy subjects. In addition, an enhanced endothelium‐derived hyperpolarization contributes to both resting and agonist‐stimulated vasodilation in a variety of cardiovascular risk conditions and disease. Thus, hyperpolarization mediated by epoxyeicosatrienoic acids (EETs) and H₂O₂ has been observed in coronary arterioles of patients with coronary artery disease. Similarly, ouabain‐sensitive and EETs‐mediated hyperpolarization has been observed to compensate for NO deficiency in patients with essential hypertension. Moreover, in non‐hypertensive patients with multiple cardiovascular risk factors and in hypercholesterolaemia, K_Ca channel‐mediated vasodilation appears to be activated. A novel paradigm establishes that perivascular adipose tissue (PVAT) is an additional regulator of vascular tone/function and endothelium is not the only agent in vascular hyperpolarization. Indeed, some PVAT‐derived relaxing substances, such as adiponectin and angiotensin 1‐7, may exert anticontractile and vasodilator actions by the opening of K_Ca channels in smooth muscle cells. Conversely, PVAT‐derived factors impair coronary vasodilation via differential inhibition of some K⁺ channels. In view of adipose tissue abnormalities occurring in human obesity, changes in PVAT‐dependent hyperpolarization may be relevant for vascular dysfunction also in this condition.