STRUCTURAL AND FUNCTIONAL CHANGES OF BLOOD VESSELS IN WOMEN IN EARLY POSTMENOPAUSE, THE POSSIBILITY OF CORRECTION OF THE REVEALED VIOLATIONS

摘要

Aim. To evaluate severity and pattern of structural and functional changes of vascular wall in early postmenopausal women receiving chronic treatment with a low-dose combination of 1713-estradiol (E2) 1 mg and drospirenone 2 mg (DRSP). Evaluation of structural and functional arterial remodeling might be important for assessment of cardiovascular risk in postmenopausal women. Materials and methods. The study included 162 early postmenopausal women with postmenopausal syndrome. The women were divided into two groups. The main group consisted of 84 patients receiving the postmenopausal hormonal therapy (PMHT) with E21 mg/DRSP 2 mg (Angeliq, Bayer) and the control group included 78 women not receiving PMHT. The follow-up duration was 5.2 years. 24-h blood pressure monitoring with evaluation of arterial stiffness (RWTT, Aix, ASI, AASI, (dP/dt)(max)) was performed. Endothelium-dependent dilation of the brachial artery was measured using the reactive hyperemia test. Aortic pulse wave velocity (aPWV) and common carotid intima-media thickness (ccIMT) were measured ultrasonically. Results. At baseline, increased aPWV was observed in 15 (21.4%) women of the main group and 19 (24.3%) women of the control group (p=0.4). At the end of study, increased aPWV was observed in both groups but the increase was more pronounced in the control group. Increased pulse blood pressure (PBP) was observed in 27 (32.1%) patients of the main group and 26 (33.3%) patients of the control group (p=0.87). At the end of study, PBP decreased from 47.2 +/- 7.2 to 45.3 +/- 6.9 mm Hg (p0.01) in the main group and remained unchanged in the control group. Aix was significantly increased in the control group and unchanged in the main group. ASI values changed in opposite directions at the end of study; they were decreased from 132.0 (121.0; 142.0) to 127.0 (115.5; 137.0) units in the main group and increased from 133.0 (111.0; 155.0) to 148.0 (134.2; 171.0) units in the control group (p0.01). At the end of study, AASI values decreased in the main group from 0.379 (0.320; 0.463) to 0.264 (0.203; 0.329) units (p0.001) and remained unchanged in the control group. The endothelial function improved in the main group; endothelium-dependent vasodilation of the brachial artery was increasing throughout the follow-up period while it remained unchanged in the control group. An increased ccIMT was found in one third of examined women. In the main group, ccIMT did not change during the follow-up period while in the control group, ccIMT was increased at the end of study (p0.05). Conclusion. Evaluation of arterial structural and functional remodeling might be important for assessment of cardiovascular risk in postmenopausal women. The combination treatment with E21 mg/DRSP 2 mg PMHT was associated with beneficial changes in the arterial wall structure and function.