Arterial Stiffness and Its Clinical Implications in Women

Coutinho, Thais

doi:10.1016/j.cjca.2014.03.020

Cited by 107 publications

(90 citation statements)

References 87 publications

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“…In the search for causes of cardiovascular diseases in women, we have previously shown that proximal aortic stiffness and lower AC are associated with several cardiac derangements such as left ventricular (LV) diastolic dysfunction,10 altered ventricular‐arterial coupling,10 LV concentric remodeling,11 and worse coronary artery microvascular function12 in women, but not in men. These findings support a notion that abnormalities in AC may play a greater role in the pathogenesis of cardiovascular diseases in women than in men 13. Therefore, better understanding the contribution of low AC to CAD may help elucidate the basis for the worse CAD outcomes in women.…”

Section: Introductionsupporting

confidence: 82%

Sex Differences in Associations of Arterial Compliance With Coronary Artery Plaque and Calcification Burden

Coutinho

Yam

Chow

et al. 2017

JAHA

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BackgroundCoronary artery disease is a leading killer of women. Arterial stiffness predicts myocardial infarction, and postmenopausal women have lower arterial compliance (AC) than men. We hypothesized that lower AC would be associated with greater burden of coronary artery plaque and calcification, and that these associations would be stronger in women than men.Methods and ResultsWe evaluated 3639 consecutive adults without coronary artery disease history who had coronary computed tomography between 2006 and 2014. Coronary artery calcification was calculated using the Agatston method. Plaque extent was assessed by the number of arterial segments with visible plaque divided by the number of visualized segments ×100 (percent plaque score). Indexed AC was calculated as stroke volume index/central pulse pressure. We used step‐wise multivariable linear regression to assess associations of log indexed AC with log (percent plaque score+1) and log (coronary artery calcification+1). Sex‐specific models were performed if the interaction sex×AC was significant. Mean age was 57±11 years, 53% were men, and 71% were hypertensive. Interaction term sex×AC was significant for both models (P=0.008 for percent plaque score and 0.022 for coronary artery calcification). Lower indexed AC was associated with higher percent plaque score and coronary artery calcification in women (β±SE: −0.231±0.113, P=0.042 and −0.334±0.166, P=0.044, respectively), but not in men (β±SE: −0.062±0.104, P=0.551 and 0.114±0.173, P=0.510, respectively).ConclusionsLower AC is associated with greater burden of coronary artery plaque and calcification in women, but not in men. Our findings highlight low AC as a correlate of more‐advanced coronary artery disease and as a potential link to the worse cardiovascular outcomes in women.

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Section: Introductionsupporting

confidence: 82%

Sex Differences in Associations of Arterial Compliance With Coronary Artery Plaque and Calcification Burden

Coutinho

Yam

Chow

et al. 2017

JAHA

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“…Furthermore, considerable evidence has suggested the association between sleep disorder with menopause 3, 15 , arterial stiffness with menopause 16 , sleep disorder with arterial stiffness 11–13 . However, few corresponding researches were focusing on the interaction with menopause, sleep disorder and arterial stiffness.…”

Section: Discussionmentioning

confidence: 99%

Sleep disorder, an independent risk associated with arterial stiffness in menopause

Zhou

Yang

et al. 2017

Sci Rep

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As women age and go through menopause, they suffer a higher incidence of sleep disorder, cardiovascular morbidity and mortality. In addition, evidences suggested that sleep disorder was an important pathological indicator for coronary heart disease. However, the relationship between different menopausal status, sleep disorder and cardiovascular diseases was unclear. Thus, we aim to assess the association between sleep disorder with arterial stiffness in females of 40–60 years free of cardiovascular diseases through self-administered Pittsburgh Sleep Quality Index (PSQI) and brachial-ankle pulse wave velocity (baPWV). Logistic regression revealed that sleep disorder (PSQI score ≥ 8) was an independent indicator for higher risk of elevated arterial stiffness (baPWV ≥ 1465.5 cm/s, upper tertile) beyond other established cardiovascular confounders in peri-postmenopause (OR 2.83, 95% confidence interval (CI) 2.00–4.00, p < 0.001), but not in premenopause (OR 1.67, 95% CI 0.71–3.90, p = 0.223). Collectively, it clearly indicates that sleep disorder in menopausal women is of prominent value to predict arterial stiffness.

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“…Women in the oldest age category had the stiffest vessels at baseline, but experienced a similar rate in progression as men over the decade. The advanced stiffness in the oldest women at baseline may reflect higher prevalence of systolic hypertension 21,28 or impaired remodeling due to genetic or hormonal differences. Though we did not observe a significant association between menopause and stiffness progression in women, other studies have found that for post-menopausal women, the loss of estrogenic activity in arterial walls contributes to decreased elasticity and rapid stiffening.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Predictors of Longitudinal Changes in Carotid Artery Stiffness

Stern

Tattersall

Gepner

et al. 2015

ATVB

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Objective To identify sex differences in predictors of longitudinal changes in carotid arterial stiffness in a multi-ethnic cohort. Approach and Results Carotid artery distensibility coefficient (DC) and Young's Elastic Modulus (YEM) were measured in 2650 Multi-Ethnic Study of Atherosclerosis participants (45-84 years old and free of cardiovascular disease) at baseline and after a mean of 9.4 years. Predictors of changes in DC and YEM for each sex were evaluated using multivariable linear regression models. The 1236 men (46.6%) were 60.0 (standard deviation 9.3) years; 40% were White, 22% Black, 16% Chinese, and 22% Hispanic. The 1414 (53.4%) women were 59.8 (9.4) years old with a similar race distribution. Despite similar rates of change in DC and YEM, predictors of changes in distensibility markers differed by sex. In men, Chinese (p=0.002) and Black (p=0.003) race/ethnicity, systolic blood pressure (p=0.012), and diabetes mellitus (p=0.05) were associated with more rapidly decreasing DC (accelerated stiffening). Starting antihypertensive medication was associated with improved DC (p=0.03); stopping anti-hypertensives was associated with more rapid stiffening (increased YEM, p=0.05). In women, higher education was associated with slower stiffening (DC p=0.041; YEM p<0.001) as was use of lipid-lowering medication (p=0.03), whereas baseline use of antihypertensive medications (YEM p=0.01) and systolic blood pressure (DC p=0.02; p=0.04) predicted increasing stiffening in women. Conclusions Longitudinal changes in carotid artery stiffness are associated with systolic blood pressure and antihypertensive therapy in both sexes; however, race/ethnicity (in men) and level of education (in women) may have different contributions between the sexes.

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Arterial Stiffness and Its Clinical Implications in Women

Cited by 107 publications

References 87 publications

Sex Differences in Associations of Arterial Compliance With Coronary Artery Plaque and Calcification Burden

Sex Differences in Associations of Arterial Compliance With Coronary Artery Plaque and Calcification Burden

Sleep disorder, an independent risk associated with arterial stiffness in menopause

Sex Differences in Predictors of Longitudinal Changes in Carotid Artery Stiffness

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