Annals of Long Term Care

April 16-18, 2008
Atlanta, GA

The Arteriosclerosis, Thrombosis, and Vascular Biology Council is one of the clinical and research sections within the American Heart Association and, as the name suggests, is focused on the research and clinical developments in vascular health. Their annual meeting is sponsored by the AHA and co-sponsored by the National Heart, Blood, and Lung Institute. The program was dominated by bench and basic science research, but there were also interesting clinical and translational research presentations. Highlights from the meeting are presented below, and more conference presentations and abstracts are available at www.my.americanheart.org by following the links to conferences and education, and then to the 2008 ATVB meeting.

Women’s Vascular Health: “To HRT or Not to HRT, That Is the Question”

The large Women’s Health Initiative trial of hormone replacement therapy (HRT) in postmenopausal women indicated that HRT could be deleterious to cardiovascular health, but observational studies of women receiving HRT in perimenopausal years suggest potential benefit. There were a number of presentations at the ATVB meeting exploring this issue.

Abnormal endothelial function is a marker of vascular disease. A research group from Virginia Commonwealth University conducted an observational study on a group of postmenopausal women (N = 127; age 52-54 yr) measuring flow-mediated dilation (FMD) of the brachial artery by ultrasound as an assessment of vascular health. The subjects were categorized into four groups:

Group 1: No CVD risk factors and no HRT (n = 22)
Group 2: At least 1 CVD risk factor and no HRT (n = 47)
Group 3: At least 1 CVD risk factor plus estrogen HRT (n = 37)
Group 4: At least 1 CVD risk factor plus estrogen and progestin HRT (n = 22)

The findings indicated that FMD was improved in those women with HRT and that there was no apparent adverse effect from adding progestin to HRT. There was also a weak correlation (r = 0.32; P = 0.01) in group 1, women with no risk factors and no HRT, between decrement in FMD and increasing years since menopause. The researchers concluded that this study suggests that endothelial function is improved in postmenopausal women with risk factors for CVD when HRT is started early after menopause.

In another study, researchers from the University of Texas, Tyler, used transdermal HRT in 75 peri- and postmenopausal women after first assessing their endogenous levels of the hormones progesterone, estrogen, testosterone, and dehydroepiandrostenedione. They titrated replacement to achieve age-adjusted physiologic ranges for each of the four hormones. Twelve-month measurements compared to baseline showed improvement in C-reactive protein (P = 0.02), systolic blood pressure (BP) (P = 0.001), diastolic BP (P = 0.02), blood glucose (P = 0.001), triglycerides (P = 0.001), Greene Climacteric Scale (P = 0.002), and Hamilton Anxiety Scale (P = 0.001). There were no adverse events associated with HRT. The researchers concluded that an individualized approach to replacing sex hormones to physiologic levels in women at menopause can improve cardiovascular health and improve general well being.

Three studies looking at CVD risk assessment in postmenopausal women were presented. The Framingham Heart Study CVD risk scoring system has been criticized for not being as accurate in assessing women’s risk since it doesn’t take into account variables associated with hormone changes. A study from the Mayo Clinic, Rochester, MN, studied 102 perimenopausal women and found that 40% of the women in the cohort had abnormal or at least questionable FMD, and their Framingham risk scores were no different than the rest of the group who had normal FMD. Researchers concluded that FMD may be a useful additional measure in risk assessment in perimenopausal women, and may help identify those in whom HRT may be beneficial.