Long term effects of hormone replacement therapy on heart rate variability, QT interval, QT dispersion and frequencies of arrhytmia

Gökçe, Mustafa; Karahan, Burhan; Yılmaz, Remzi; Örem, Cihan; Erdöl, Cevdet; Özdemir, Şafak

doi:10.1016/j.ijcard.2003.03.030

Cited by 55 publications

(28 citation statements)

References 38 publications

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“…Previous studies have also shown changes in the autonomic control of HR following natural (12)(13)(14)27) or surgical menopause (15). In agreement with the results of these studies, our results show that menopause can cause an imbalance of the autonomic nervous control of the cardiovascular system that shifts toward sympathetic hyperactivity.…”

Section: Resultssupporting

confidence: 92%

“…Therefore, the present findings agree with previous studies (14,15,27), which have reported increased vagal activity and reduced sympathetic drive in postmenopausal women undergoing estrogen therapy. Nevertheless, the mechanism responsible for the beneficial effect of estrogen therapy on autonomic control of HR remains unknown and should be explored in future studies.…”

Section: Discussionsupporting

confidence: 94%

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Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy

Neves¹,

Sá²,

Junior³

et al. 2007

Braz J Med Biol Res

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The aim of the present study was to determine whether estrogen therapy (ET) reduces alterations of the autonomic control of heart rate (HR) due to hypoestrogenism and aging. Thirteen young (24 ± 2.6 years), 10 postmenopausal (53 ± 4.6 years) undergoing ET (PM-ET), and 14 postmenopausal (56 ± 2.6 years) women not undergoing ET (PM) were studied. ET consisted of 0.625 mg/day conjugated equine estrogen. HR was recorded continuously for 8 min at rest in the supine and sitting positions. HR variability (HRV) was analyzed by time (SDNN and rMSSD indices) and frequency domain methods. Power spectral components are reported as normalized units (nu) at low (LF) and high (HF) frequencies, and as LF/HF ratio. Intergroup comparisons: SDNN index was higher in young (median: supine, 47 ms; sitting, 42 ms) than in PM-ET (33; 29 ms) and PM (31; 29 ms) women (P < 0.05). PM showed lower HFnu, higher LFnu and higher LF/HF ratio (supine: 44, 56, 1.29; sitting: 38, 62, 1.60) than the young group in the supine position (61, 39, 0.63) and the PM-ET group in the sitting position (57, 43, 0.75; P < 0.05). Intragroup comparisons: HR was lower in the supine than in the sitting position for all groups (P < 0.05). The HRV decrease from the supine to the sitting position was significant only in the young group. These results suggest that HRV decreases during aging. ET seems to attenuate this process, promoting a reduction in sympathetic activity on the heart and contributing to the cardioprotective effect of estrogen hormones.

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Section: Resultssupporting

confidence: 92%

Section: Discussionsupporting

confidence: 94%

Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy

Neves¹,

Sá²,

Junior³

et al. 2007

Braz J Med Biol Res

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“…Its safety had been reported in several clinical studies to provide an effective glycemic control and could be used in patients who had renal and cardiovascular diseases, without producing renal risk and cardiovascular event39404142. Moreover, vildagliptin did not influence cardiac electrical activity since PR and QRS intervals were not altered during the prescribed treatment for T2DM patients43, therefore it could be a feasible alternative to estrogen therapy which had been known to associate with prolonged QT interval and QT dispersion in postmenopausal individuals who received long-term estrogen therapy4445. However, our findings showed that estrogen treatment showed a significantly decreased mortality rate in both NDO and HFO rats, suggesting the superior efficacy of estrogen on the reduction of cardiac I/R-related mortality.…”

Section: Discussionmentioning

confidence: 99%

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

Sivasinprasasn

Tanajak

Pongkan

et al. 2017

Sci Rep

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Estrogen deprivation aggravates cardiac injury after myocardial ischemia and reperfusion (I/R) injury. Although either estrogen or the dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, reduces myocardial damage following cardiac I/R, their effects on the heart in obese-insulin resistant and estrogen deprived conditions remain unknown. Ovariectomized (O) rats (n = 36) were divided to receive either normal diet (NDO) or high-fat diet (HFO) for 12 weeks, followed by treatment with a vehicle, estrogen or vildagliptin for 4 weeks. The setting of in vivo cardiac I/R injury, 30-min ischemia and 120-min reperfusion, was performed. At 12 weeks after ovariectomy, both NDO and HFO rats exhibited an obese-insulin resistant condition. Both NDO and HFO rats treated with estrogen and vildagliptin showed reduced fasting plasma glucose, insulin and HOMA index. Both treatments improved cardiac function indicated by restoration of heart rate variability and increased %left ventricular ejection fraction (%LVEF). The treatments similarly protected cardiac mitochondrial function against I/R injury, leading to a reduction in the infarct size, oxidative stress and apoptosis in the ischemic myocardium. These findings demonstrate that vildagliptin effectively improves metabolic status, and shares similar efficacy to estrogen in reducing myocardial infarction and protecting cardiac mitochondrial function against I/R injury in estrogen-deprived obese-insulin resistant rats.

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“…Hormone replacement therapy (HRT) with estrogen in postmenopausal women prolongs QTc (24-26). Gökçe et al (27) found that QTc was prolonged and QT dispersion increased after the HRT with estrogen but not progestin plus estrogen in postmenopausal women. Vrtovec et al (7) reported that QTc is shorter and serum testosterone level is negatively correlated with QTc duration in patients with PCOS.…”

Section: Discussionmentioning

confidence: 99%

Relationship between QT dispersion with sex hormones and insulin in young women with polycystic ovary syndrome: an observational study

Gazı¹,

Gencer²,

Hancı³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Polycystic ovary syndrome (PCOS) is a common endocrinopathy in reproductive women. Cardiovascular disease risk factors are more frequent in this population. We aimed in this study to investigate presence of QT dispersion and effects of sex hormones and insulin on QT duration in young PCOS patients. Methods: This present study was cross-sectional observational study. A total of 47 women, 25 patients with PCOS and 22 healthy, were included. Serum testosterone, estradiol and insulin levels were studied and electrocardiography was performed at 2 nd or 3 th days of menstrual cycle. The study population was divided into groups according to serum testosterone and estradiol levels. Sub-groups and pairwise groups were compared by Mann-Whitney U or student t-test. The associations of QTc durations with hormone levels were calculated using Spearman rank correlation analysis. The results were evaluated at the p<0.05 significance level. Results: No differences found between groups regarding to demographic parameters. Estradiol and testosterone levels were higher in patients with PCOS (41.12±13.59 vs. 35.57±19.29 pg/mL, p=0.09 and 105±58.5 vs. 17.6±10.9 ng/dL, p=0.01, respectively). QT dispersion was significantly longer in PCOS patients (47.1 vs. 32.7 ms, p=0.01). A positive correlation was found between the serum insulin level and QTc min, QTc max, and QTc mean (r=0. 402, p=0.011; r=0.341, p=0.033; r=0.337, p=0.036; respectively). QT dispersion with serum testosterone and estradiol levels were positively correlated (r=0.525, p=0.001and r=0.326, p=0.046; respectively). Conclusion: Our results suggest that QT dispersion is prolonged and testosterone, estradiol and insulin are associated with QT duration in young PCOS patients. (Anadolu Kardiyol Derg 2013; 13: 772-7) Key words: Electrocardiography, QT dispersion, polycystic ovary syndrome, insulin resistance, insulin Original Investigation Özgün Araşt›rma 772ÖZET Amaç: Polikistik over sendromu (PKOS) reprodüktif dönemdeki kadınlarda sık karşılaşılan bir endokrinopatidir. PCOS hastalarında kardiyovasküler hastalık risk faktörleri sık görülür. Bu çalışmada PCOS tanısı alan genç kadınlarda QT dispersiyonu varlığını ve gonadal hormonlar ve insülinin QT süresi üzerine etkilerini araştırmayı amaçladık. Yöntemler: Gözlemsel ve enine kesitli bu çalışmaya PKOS tanısı alan 25 hasta ve kontrol grubu olarak 22 sağlıklı olmak üzere toplam 47 kadın dahil edildi. Serum testosteron, östrojen ve insülin düzeyleri, elektrokardiyografik ölçümler menstrürasyon döngüsünün 2. veya 3. gününde yapıldı. HOMA-IR hesaplandı. Çalışma olguları östrojen ve testosteron düzeylerine göre gruplara ayrıldı. İkili grupların karşılaştırılmasında student-t veya Mann-Whitney U testi kullanıldı. Testosterone, östrojen, insülin ve HOMA-IR düzeyleri ile QT süreleri arasındaki ilişkinin değer-lendirilmesinde Spearman rank korelasyon analizi kullanıldı. P değeri <0,05 anlamlı kabul edildi. Bulgular: Gruplar arasında demografik özellikler bakımından fark yoktu. Östrojen düzeyi ve testosteron düzeyleri ...

show abstract

Long term effects of hormone replacement therapy on heart rate variability, QT interval, QT dispersion and frequencies of arrhytmia

Cited by 55 publications

References 38 publications

Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy

Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

Relationship between QT dispersion with sex hormones and insulin in young women with polycystic ovary syndrome: an observational study

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