Síndrome vasomotor: puente de unión entre la disfunción endotelial y la esclerosis arterial / Vasomotor syndrome: meeting point between endothelial dysfunction and atherosclerosis

Resumen Introducción: Los síntomas vasomotores y la disfunción endotelial probablemente resulten del déficit estrogénico postmenopausia; no obstante, la relación de ambos con la progresión de la aterosclerosis es un tema controversial. Objetivo: Identificar en mujeres de edad mediana con disfunción endotelial, la presencia de aterosclerosis subclinica y de cambios cardiometabólicos durante la transición a la menopausia. Método: Estudio observacional de corte transversal, en el que incluyeron 43 mujeres con edad entre 40-59 años, con disfunción endotelial previa y 14 mujeres con función endotelial normal. En cada mujer se identificaron: manifestaciones de rigidez arterial y del grosor de la grasa epicárdica y su relación con variables antropométricas, intensidad de los síntomas vasomotores, etapas del climaterio y niveles de estradiol. Análisis estadístico: Regresión lineal múltiple y regresión logística para identificar asociación entre intensidad de los síntomas vasomotores, parámetros de rigidez arterial y cardiometabólicos (p< 0,05) para significación estadística. Resultados: Los parámetros de rigidez arterial (VLPP, CA, AI), de aterosclerosis (GIMc) y el grosor de la grasa epicárdica no mostraron cambios compatibles con daño arterial. A mayor intensidad de los síntomas vasomotores se encontró mayor probabilidad de incremento de la VLPP. Evolutivamente un subgrupo de mujeres desarrolló cambios metabólicos y disfunción endotelial sin asociación con el hipoestrogenismo, la edad ni la etapa del climaterio. Conclusiones: Una mayor intensidad de los síntomas vasomotores podría constituir un marcador que identifique de manera temprana el riesgo de desarrollar aterosclerosis clínica.

Abstract Introduction: Vasomotor symptoms and endothelial dysfunction probably result in a post-menopausal oestrogen deficiency. However, the relationship of both with the progression of atherosclerosis is a controversial subject. Objective: To identify the presence of sub-clinical atherosclerosis in middle-aged women with endothelial dysfunction, as well as cardiometabolic changes during the transition to the menopause. Method: A cross-sectional, observation study was conducted on 43 women between 40 and 59 years of age, with previous endothelial dysfunction, and 14 women with normal endothelial function. The variables recorded in each woman were, signs of arterial stiffening epicardial fat thickness and their relationship with anthropometric variables, intensity of the vasomotor symptoms, stages of menopause, and oestradiol levels. Statistical analysis: Multiple linear regression and logistic regression was performed in order to identify an association between the intensity of the vasomotor symptoms, arterial stiffness, and cardiometabolic parameters. A P< .05 was significantly significant. Results: The arterial stiffness parameters (pulse wave propagation (PWP), Arterial distensibility, augmentation index), and that of atherosclerosis (carotid intima-media thickness, GIMc), and the thickness of the epicardial fat showed no changes compatible with arterial damage. At a higher intensity of vasomotor symptoms, a higher probability of an increase in PWP was found. Evolutionarily, a sub-group of women developed metabolic changes and endothelial dysfunction with no relationship with low oestrogens, age, or the stage of the menopause. Conclusions: A greater intensity of vasomotor symptoms could be a marker for the early identification of the risk for clinical atherosclerosis.

Association between endothelial dysfunction, epicardial fat and subclinical atherosclerosis during menopause / Interacción de la disfunción endotelial, la grasa epicárdica y la aterosclerosis subclínica durante la menopausia

Background: Menopausal transition is critical for the development of early, subclinical vascular damage. Multiple factors, such as atherosclerosis, increased epicardial fat, and endothelial dysfunction can play a role. Hence, the objective of this study was the comparison of epicardial adipose tissue and carotid intima media thickness in order to establish the best predictor of carotid stiffness in middle-aged women with endothelial dysfunction. Methods: A total of 43 healthy women aged 40-59 years old with endothelial dysfunction previously demonstrated by flow mediated dilation were recruited to have anthropometric, biochemical, hormonal and ultrasound determinations of carotid intima media thickness and epicardial fat thickness. Results: Carotid arterial stiffness parameters (local pulse wave velocity [4.7±0.7 vs 4.8±0.5 vs 5.6±0.5m/s, respectively, p<0.001], pressure strain elastic modulus [55.2±13.4 vs 59.2±11.8 vs 81.9±15.6kPa, respectively, p<0.001], arterial stiffness index β [4.4±1.4 vs 5.0±1.1 vs 6.4±1.3, respectively, p<0.001]) and epicardial fat thickness (2.98±1.4 vs 3.28±1.9 vs 4.70±1.0mm, respectively, p=0.007) showed a significant and proportional increase in the group of late post-menopausal women when compared to early post-menopausal and pre-menopausal groups, respectively. Among body fat markers, epicardial fat was the strongest predictor of local pulse wave velocity, independent of age. Conclusions: In menopausal women with endothelial dysfunction, menopausal transition is associated with increased carotid arterial stiffness and epicardial fat thickness, independent of age. Ultrasound measured epicardial fat was a better independent predictor of arterial stiffness than carotid intima media thickness in these women (AU)

Introducción: La transición menopáusica es crítica para el desarrollo de daño vascular subclínico precoz. Múltiples factores como la aterosclerosis, el aumento del tejido adiposo epicárdico (TAE) y la disfunción endotelial pueden desempeñar un papel en este proceso. El objetivo de este estudio fue comparar la medición del TAE y el espesor íntima media carotídeo (IMC) para establecer el mejor predictor de rigidez carotídea en mujeres de mediana edad con disfunción endotelial. Métodos: Se incluyeron 43 mujeres entre 40-50 años con disfunción endotelial demostrada por dilatación mediada por flujo. Se evaluaron variables antropométricas, bioquímicas, hormonales y se determinó por ultrasonografía el espesor de IMC y TAE. Resultados: Los parámetros de rigidez arterial carotídea (velocidad de onda del pulso local [4,7±0,7 vs 4,8±0,5 vs 5,6±0,5m/sec, p<0,001], módulo de elasticidad de deformación de presión [55,2±13,4 vs 59,2±11,8 vs 81,9±15,6 Kpa, p<0,001], índice β de rigidez arterial [4,4±1,4 vs 5,0±1,1 vs 6,4±1,3 p<0,001]) y el espesor del TAE (2,98±1,4 vs 3,28±1,9 vs 4,70±1,0mm, p=0,007) mostraron un incremento significativo y proporcional en el grupo de mujeres en posmenopausia tardía comparado con los grupos de posmenopausia temprana y premenopausia respectivamente. Entre los marcadores de adiposidad el TAE fue el mejor predictor de la velocidad de onda del pulso independientemente de la edad. Conclusiones: En mujeres menopáusicas con disfunción endotelial la transición menopáusica se asoció con un incremento en la rigidez arterial y espesor del TAE, independiente de la edad. El espesor del TAE fue mejor predictor independiente de rigidez arterial que el espesor IMC en estas mujeres (AU)

Association between endothelial dysfunction, epicardial fat and subclinical atherosclerosis during menopause.

BACKGROUND: Menopausal transition is critical for the development of early, subclinical vascular damage. Multiple factors, such as atherosclerosis, increased epicardial fat, and endothelial dysfunction can play a role. Hence, the objective of this study was the comparison of epicardial adipose tissue and carotid intima media thickness in order to establish the best predictor of carotid stiffness in middle-aged women with endothelial dysfunction. METHODS: A total of 43 healthy women aged 40-59 years old with endothelial dysfunction previously demonstrated by flow mediated dilation were recruited to have anthropometric, biochemical, hormonal and ultrasound determinations of carotid intima media thickness and epicardial fat thickness. RESULTS: Carotid arterial stiffness parameters (local pulse wave velocity [4.7±0.7 vs 4.8±0.5 vs 5.6±0.5m/s, respectively, p<0.001], pressure strain elastic modulus [55.2±13.4 vs 59.2±11.8 vs 81.9±15.6kPa, respectively, p<0.001], arterial stiffness index ß [4.4±1.4 vs 5.0±1.1 vs 6.4±1.3, respectively, p<0.001]) and epicardial fat thickness (2.98±1.4 vs 3.28±1.9 vs 4.70±1.0mm, respectively, p=0.007) showed a significant and proportional increase in the group of late post-menopausal women when compared to early post-menopausal and pre-menopausal groups, respectively. Among body fat markers, epicardial fat was the strongest predictor of local pulse wave velocity, independent of age. CONCLUSIONS: In menopausal women with endothelial dysfunction, menopausal transition is associated with increased carotid arterial stiffness and epicardial fat thickness, independent of age. Ultrasound measured epicardial fat was a better independent predictor of arterial stiffness than carotid intima media thickness in these women.