Syndrome X in women is associated with oestrogen deficiency

Abstract

This study was undertaken to ascertain whether gynaecological history or a reduction in ovarian hormones are triggers of angina in menopausal women with a positive exercise test and normal coronary arteries. The majority of patients with angina pectoris, a positive exercise test and normal coronary arteries are female, suggesting that the female gender may be important in the aetiology. We studied the gynaecological features of 107 women (age 53 +/- 9 years) with syndrome X, taken from a population of 134 patients including 27 males. Cardiological investigations were undertaken and detailed gynaecological history obtained from all the female patients. Menopausal status was confirmed by plasma levels of oestradiol-17 beta < or = 100 pmol.l-1. In 95 of the 107 female patients, chest pain began either during the perimenopausal period (32) or after the menopause (63). Of the 63 menopausal patients, 43 had undergone hysterectomy at an average of 8 +/- 6 years prior to the onset of chest pain. The incidence of hysterectomy in the study population (40%) was four times greater than that of an age-matched population. These findings confirm that the majority of patients with syndrome X are women in whom the chest pain began after the onset of menopause. Ovarian hormone deficiency may, therefore, play a role in the onset of syndrome X in female patients.

Distinct psychosocial differences between women with coronary heart disease and cardiac syndrome X

“…5 Previous studies have reported an average hysterectomy prevalence of 17.4% in British women aged 40-80 years 34 and of 13.6% in a British urban community sample. 35 The higher frequency of hysterectomy found in healthy volunteers in this study (24%) may reflect regional variation, as previous large-scale studies have noted countrywide differences in HRT use and hysterectomy.…”

“…Suggested mechanisms include coronary microvascular dysfunction ('microvascular angina'), 2 perfusion abnormalities, 3 a generalised disorder of vascular function, 4 hormonal irregularities, 5 early signs of abnormal left ventricular function, 6 insulin resistance, 7 or abnormal visceral pain perception. 8 It has also been suggested that at the time of angiography, patients with syndrome X have 'sensitive hearts' 9 while a central, rather than peripheral, locus for the pain sensation has also been proposed.…”

“…Preliminary investigations have identified a possible link between the development of syndrome X and oestrogen deficiency, 5 while 17b-oestradiol reduced angina frequency 11 and esterified oestrogen improved quality of life in postmenopausal women with syndrome X. 12 Suggested mechanistic pathways include its role as a vasodilator 13 and as an analgesic pertaining to an increased pain sensitivity in women.…”

Estrogen Receptor Subtypes Mediate Distinct Microvascular Dilation and Reduction in [Ca2+]i in Mesenteric Microvessels of Female Rat

“…Also, in the uterine artery of diestrous day 1 female rats, ACh activates only EDHF-mediated relaxation, while in estrous, diestrous, day 2, and proestrous rats, ACh releases both EDHF and NO (Dalle Lucca et al, 2000b). The effects of variability in endogenous E2 levels on vascular function are important as spastic disorders, such as migraine headaches (MacGregor et al, 2006), Raynaud's phenomenon (Greenstein et al, 1996), and angina (Rosano et al, 1995), may be influenced by the menstrual cycle. Also, the greater incidence, yet less severity, of pulmonary hypertension in females suggest a complex interaction of E2 and ERs in the pulmonary circulation (Christou and Khalil, 2010).…”

Clinical Implications of Assessing Coronary Flow Velocity Reserve and Plasma Endothelin-1 in Hypertensive Patients

“…In the present study, the percentage of female subjects in the symptomatic group was also higher than that of male subjects. The hypothesis that estrogen deficiency is associated with coronary endothelial dysfunction and abnormal vasomotor control in such women has been supported by evidence from a variety of studies, although the underlying mechanisms are not clearly understood (32).…”