Cerebrovascular reactivity after cessation of menopausal hormone treatment

Abstract

Objective: Women who are currently using menopausal hormone therapy (MHT) have higher cerebrovascular reactivity when compared with postmenopausal women who are not taking MHT; however, the effect of cessation of MHT on cerebrovascular reactivity is not known. Given that MHT can have structural and activational effects on vascular function, this study was performed to characterize cerebrovascular reactivity following cessation of MHT in women at low risk for cerebrovascular disease. Methods: Cerebrovascular reactivity was measured in a subset of women from the Kronos Early Estrogen Prevention Study (KEEPS) 3 years after cessation of the study drug (oral conjugated equine estrogen, transdermal 17β-estradiol, or placebo [PLA]).

Results: Age, body mass index, and blood pressure were comparable among groups. At rest, the middle cerebral artery velocity (MCAv), cerebrovascular conductance index, mean arterial pressure, and cerebral pulsatility index did not differ among groups. Slope-based summary measures of cerebrovascular reactivity did not differ significantly among groups. However, utilizing repeated-measures modeling, there was a significant upward shift in MCAv responses (p = 0.029) in the combined MHT group compared with the PLA group.

Conclusion: MHT has a marginal sustained effect on cerebrovascular reactivity when measured 3 years after cessation of hormone treatment.

摘要

目的：目前使用绝经后激素治疗(MHT)的妇女与未使用MHT的绝经后妇女相比, 脑血管反应性更高；然而, 停止使用MHT对脑血管反应活性的影响尚不清楚。考虑到MHT对血管功能具有结构和激活作用, 本研究旨在描述低脑血管疾病风险的妇女停止使用MHT后的脑血管反应。

方法：对克罗诺斯的一组妇女进行了早期雌激素预防性研究(KEEPS)(口服结合马雌激素、经皮17β-雌二醇或安慰剂[PLA])停药3年后的脑血管反应性测定。

结果：年龄、体重指数和血压在各组之间具有可比性。静息状态下, 大脑中动脉流速(MCAv)、脑血管电导指数、平均动脉压和各组间脑搏动指数无差异。以斜坡为基础的脑血管反应性总体测量在各组之间没有显著差异。然而, 利用重复测量建模, 与安慰剂组相比, MCAv反应在联合MHT组有显著向上转变(p=0.029)。

结论：停止激素治疗3年后, MHT对脑血管反应性有微弱的持续性影响。

Keywords:

• Cerebral hemodynamics
• menopause
• estrogen
• blood pressure
• sex hormones

Acknowledgements

The authors would like to thank the volunteers who participated in the study. In addition, the authors thank Lynne T. Shuster, Kim Jensen, Shelly K. Roberts, Sarah Wolhart, and Christopher P. Johnson for their technical assistance.

Conflict of interest

None.

Additional information

Funding

NIH [grant AG044170]; [grant HL118154]; [grant HL83497].