School of Sport and Exercise Health Sciences, National Centre of Sports and Exercise Medicine, Loughborough University, Loughborough, UK.
Department of Medicine, Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada.
Scand J Med Sci Sports. 2020 Jun;30(6):1054-1063. doi: 10.1111/sms.13647. Epub 2020 Mar 30.
Hypoestrogenemia due to menopause is associated with increased cardiovascular disease risk, in part due to elevated indexes of aortic wave reflection (AWRI) and central (aortic) blood pressure. We sought to investigate whether AWRI and central blood pressure are also augmented in hypoestrogenic exercise-trained premenopausal women with functional hypothalamic amenorrhea (ExFHA).
In age- (pooled mean ± SEM, 24 ± 1 years), BMI- (21 ± 1 kg/m ), and cardiorespiratory fitness-matched (45 ± 2 ml/kg/min) eumenorrheic ovulatory (ExOv; n = 11) and ExFHA women (n = 10), we assessed aortic blood pressure and waveform characteristics (augmentation index and wave reflection amplitude) obtained from radial pressure waves (applanation tonometry). Doppler ultrasound determined cardiac output (CO) and total peripheral resistance (TPR). Measures were recorded before and 1 hour after 45 minutes of moderate intensity exercise to determine the influence of exercise-induced increases in nitric oxide.
Pre-exercise, AIx75, central systolic BP (SBPc), and CO were lower (P < .05) and TPR higher (P < .05) in ExFHA. Post-exercise, AIx75 was unchanged (P > .05) in ExFHA but was lowered (P < .05) in ExOv. Both groups demonstrated increased CO, and lowered SBPc and TPR, yet TPR remained higher (P < .05), and CO and SBPc lower (P < .05) in ExFHA.
Despite hypoestrogenemia, functional compliance of the central arteries and central BP is not augmented, yet TPR is higher, in ExFHA versus ExOv. An acute bout of dynamic exercise did not alter AIx75 in ExFHA, suggesting blunted vascular responsiveness to exercise-induced increases in nitric oxide, possibly due to augmented vascular tone. These findings have relevance in understanding the vascular consequences of hypoestrogenemia during the premenopausal years.
由于绝经导致的低雌激素血症与心血管疾病风险增加有关，部分原因是主动脉波反射指数（AWRI）和中心（主动脉）血压升高。我们试图研究在功能性下丘脑性闭经（ExFHA）的低雌激素运动训练的绝经前妇女中，AWRI 和中心血压是否也会增加。
在年龄（平均±SEM，24±1 岁）、BMI（21±1kg/m）和心肺适能匹配（45±2ml/kg/min）的月经正常排卵（ExOv；n=11）和 ExFHA 女性（n=10）中，我们评估了从桡动脉压力波（平板张力测定法）获得的主动脉血压和波形特征（增强指数和波反射幅度）。多普勒超声确定心输出量（CO）和总外周阻力（TPR）。在 45 分钟中等强度运动后 1 小时内记录测量值，以确定运动引起的一氧化氮增加的影响。
运动前，ExFHA 组的 AIx75、中心收缩压（SBPc）和 CO 较低（P<0.05），TPR 较高（P<0.05）。运动后，ExFHA 组的 AIx75 无变化（P>0.05），而 ExOv 组则降低（P<0.05）。两组均表现出 CO 增加，SBPc 和 TPR 降低，但 TPR 仍较高（P<0.05），CO 和 SBPc 较低（P<0.05）。
尽管存在低雌激素血症，但 ExFHA 中中心动脉和中心血压的功能性顺应性没有增加，而 TPR 较高。急性动态运动并未改变 ExFHA 中的 AIx75，这表明血管对运动引起的一氧化氮增加的反应性减弱，可能是由于血管张力增加所致。这些发现对于理解绝经前几年低雌激素血症的血管后果具有重要意义。
