Cerrahi Erken Menopoz Geçiren Hastalarda Damar Sertliği Artar mı?

Yıl 2021, , 290 - 296, 27.08.2021

Murat Akçay , Metin Çoksevim , Ömer Gedikli , Hasan Ulubaşoğlu , Özcan Yılmaz

https://doi.org/10.35440/hutfd.948505

Öz

Amaç: Cerrahi erken menopoz, doğal yaşlanma sürecinden ziyade tıbbi nedenlerle meydana gelen erken menopozdur. Nabız dalga hızı (NDH) ve büyütme indeksi (Augmentasyon indeksi, AIx), arteryel sertliğin değerlendirilmesi için basit ve invazif olmayan parametrelerdir. Bu çalışmanın amacı, cerrahi erken menopoz hastalarında arteryel sertliği araştırmaktır.
Materyal ve Metod: Çalışmaya cerrahi erken menopozlu 40 hasta ve 40 sağlıklı kontrol dahil edildi. Hastaların arter sertliği ve hemodinamik parametreleri, Mobil-O-Graph NG (IEM GmbH, Stolberg, Almanya) 24 saatlik ambulatuvar kan basıncı monitör arteriyografisi ile ölçüldü.
Bulgular: Başlangıç demografik, laboratuvar ve ekokardiyografik parametrelerde gruplar arasında fark yoktu. Cerrahi erken menopozlu hastalarda (n=40) etiyoloji değerlendirildiğinde 27 hastada (% 67.5) malignite, 11 hastada (%27.5) miyom ve 2 hastada (%5) kanama idi. Nabız dalga hızı (NDH), erken menopoz grubunda (6.5 m/s, (4,7-8,2) 5.6 m/s'ye (4,5-9,0 m/s) karşı anlamlı olarak daha yüksekti; P<0,001), ancak Alx'te istatistiksel olarak anlamlı bir fark yoktu (%28.3±10.9'a karşı %27.4±9.0; P=0.69). Ayrıca kardiyak hemodinamik parametreler ve santral aort basınçları açısından istatistiksel olarak anlamlı bir fark yoktu.
Sonuç: Cerrahi erken menopoz hastalarında arteryel sertlik, diğer risk faktörlerinden bağımsız olarak sağlıklı bireylerle karşılaştırıldığında önemli ölçüde artmıştır.

Anahtar Kelimeler

Arteryel sertlik, Nabız dalga hızı, Cerrahi erken menopoz

Does Arterial Stiffness Increase in Patients with Surgical Early Menopause?

Öz

Background
Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.
Material and Method
We included 40 patients with surgical early menopause and 40 healthy controls for the study. The patients’ arterial stiffness and hemodynamic parameters were measured with Mobil-O-Graph NG (IEM GmbH, Stolberg, Germany) 24-hour ambulatory blood pressure monitor arteriography.
Result
There was no difference between the groups in baseline demographic, laboratory, and echocardiographic parameters. In patients with surgical early menopause (n=40), the etiology was malignancy in 27 (67.5%), myoma in 11 (27.5%) and bleeding in 2 (5%) patients. PWV was significantly higher in the early menopause group (6.5 m/s, (4.7-8.2) versus 5.6 m/s, (4.5-9.0 m/s); P<0.001), but there was no statistically significant difference in Alx (28.3±10.9% versus 27.4±9.0%; P=0.69). Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures.
Conclusion
Arterial stiffness is significantly increased in surgical early menopause patients compared with healthy subjects independent of other risk factors.

Anahtar Kelimeler

Arterial stiffness, pulse-wave velocity (PWV), surgical early menopause

Kaynakça

• 1. Siniscalchi M, De Franciscis P, Palomba S, Di Palo C, Colacurci N, Nappi C, et al. Effects of surgical menopause and estrogen replacement therapy on atrio-ventricular conduction and ventricular repolarization. Maturitas 2001; 40; 1: 47-51.
• 2. Cabrera-Rego JO, Navarro-Despaigne D, Staroushik-Morel L, Díaz-Reyes K, Lima-Martínez MM, Iacobellis G. Association between endothelial dysfunction, epicardial fat and sub-clinical atherosclerosis during menopause. Clin Investig Arterioscler 2018; 30; 1: 21-27.
• 3. Oliver JJ, Webb DJ. Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events. Arterioscler Thromb Vasc Biol 2003: 23(4); 554-566.
• 4. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27; 21: 2588-2605.
• 5. Sünbül M, Çinçin A, Bozbay M, Mammadov C, Ataş H, Özşenel EB, et al. Arterial stiffness parameters associated with vitamin D deficiency and supplementation in patients with normal cardiac functions. Turk Kardiyol Dern Ars 2016; 44; 4: 281-288.
• 6. Hametner B, Wassertheurer S, Kropf J, Mayer C, Eber B, Weber T. Oscillometric estimation of aortic pulse wave velocity: comparison with intra-aortic catheter measurements. Blood Press Monit 2013; 18; 3: 173-176.
• 7. Franssen PM, Imholz BP. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit 2010; 15(4): 229-231.
• 8. Weiss W, Gohlisch C, Harsch-Gladisch C, Tölle M, Zidek W, van der Giet M. Oscillometric estimation of central blood pressure: validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Press Monit 2012; 17; 3: 128-131.
• 9. Sari N, Engin-Ustun Y, Kiyak Çağlayan E, Göçmen AY, Polat MF. Evaluation of cardiovascular disease risk in women with surgically induced menopause. Gynecol Endocrinol 2016; 32(6): 498-501.
• 10. Yoshida T, Takahashi K, Yamatani H, Takata K, Kurachi H. Impact of surgical menopause on lipid and bone metabolism. Climacteric 2011; 14(4): 445-452.
• 11. Kodaman PH. Early menopause: primary ovarian insufficiency and surgical menopause. Semin Reprod Med. 2010; 28(5): 360-369.
• 12. Verhoeven MO, van der Mooren MJ, Teerlink T, Verheijen RHM, Scheffer PG, Kenemans P. The influence of physiological and surgical menopause on coronary heart disease risk markers. Menopause 2009; 16(1): 37-49.
• 13. Appiah D, Schreiner PJ, Bower JK, Sternfeld B, Lewis CE, Wellons MF. Is Surgical Menopause Associated with Future Levels of Cardiovascular Risk Factor Independent of Antecedent Levels? The CARDIA Study. Am J Epidemiol. 2015; 182(12): 991-999.
• 14. Tuna V, Alkiş I, Safiye AS, Imamoglu N, Bayram N, Ali Ismet T. Variations in blood lipid profile, thrombotic system, arterial elasticity and psychosexual parameters in the cases of surgical and natural menopause. Aust N Z J Obstet Gynaecol 2010; 50; 2: 194-199.
• 15. Atsma F, Bartelink MLEL, Grobbee DE, Van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 2006; 13:265-279.
• 16. Lobo RA. Surgical menopause and cardiovascular risks. Menopause 2007; 14: 562-566.
• 17. Rodriguez M, Shoupe D. Surgical menopause. Endocrinol Metab Clin North Am. 2015; 44(3): 531-542.
• 18. Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000; 133: 933–41.
• 19. Prentice RL, Manson JE, Langer RD, Anderson GL, Pettinger M, Jackson RD, et al. Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause. Am J Epidemiol 2009; 170: 12–23.
• 20. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321–333.
• 21. Oylumlu M, Yuksel M, Yildiz A, Bilik MZ, Akil MA, Ozler A, et al. A simple method for the assessment of arterial stiffness in pre-eclamptic patients. Clin Exp Hypertens 2014; 36; 8: 531-537.
• 22. Lebrun CE, van der Schouw YT, Bak AA, de Jong FH, Pols HA, Grobbee DE, et al. Arterial stiffness in postmenopausal women: determinants of pulse wave velocity. J Hypertens 2002; 20; 11: 2165-2172.
• 23. Zaydun G, Tomiyama H, Hashimoto H, Arai T, Koji Y, Yambe M, et al. Menopause is an independent factor augmenting the age-related increase in arterial stiffness in the early phase. Atheosclerosis 2006; 184; 1; 137-42.
• 24. Takahashi K, Miura S, Mori-Abe A, Kawagoe J, Takata K, Ohmichi M, et al. Impact of menopause on the augmentation of arterial stiffness with aging. Gynecol Obstet Invest 2005; 60: 162–166.
• 25. Ohmichi M, Kanda Y, Hisamoto K, Morishige K, Takahashi K, Sawada K, et al. Rapid changes of flow-mediated dilatation after surgical menopause. Maturitas 2003; 44: 125–131.
• 26. Gavin KM, Jankowski C, Kohrt WM, Stauffer BL, Seals DR, Moreau KL. Hysterectomy is associated with large artery stiffening in estrogen-deficient postmenopausal women. Menopause 2012; 19; 9: 1000-1007.
• 27. Mack WJ, Slater CC, Xiang M, Shoupe D, Lobo RA, Hodis HN. Elevated subclinical atherosclerosis associated with oophorectomy related to time since menopause rather than type of menopause. Fertil Steril 2004; 82; 2: 391–397.