The Impact of Menopause on the Development of Heart Failure and Organ Damage of Hypertension
The Impact of Menopause on the Development of Heart Failure and Organ Damage of Hypertension
Introduction: The average age of menopause in the Polish population is around 50 years. After the occurrence of the last menstruation in the woman's body there are series of hormonal changes that may result in the emergence of new diseases, i.e. osteoporosis or ischemic heart disease. Hypertension is the most important cardiovascular risk factor affecting morbidity and mortality due to cardiovascular disease. It is estimated that there are as many as 34% of adult Poles. The incidence of hypertension increases with age in both women and men, and significantly greater increases are observed in perimenopausal women. An equally important and growing health and economic problem in Poland is heart failure. It is estimated that up to 700,000 patients in our country are struggling with this disease, and the proportion of women in this group is constantly growing. This is the third reason for the death of women in Poland, causing more deaths than cancer. The influence of menopause on the occurrence of heart failure in a group of women with controlled hypertension remains unclear and is the subject of ongoing research. Similarly, there is still no convincing data on the increased risk of organ complications of arterial hypertension in the group of postmenopausal women.
The aim of the study is to assess the effect of menopause on myocardial function indexes, haemodynamic parameters and body mass composition in women aged> 40 years.
Material: about 100 women hospitalized in the Department of Cardiology and Congenital Heart Diseases of Adults > 40 years of age will be enrolled in the study. with controlled hypertension. The population will be divided into two groups: I: 50 women before the onset of menopause and II group: 50 women ≥ 1 year after the onset of menopause.
Methods: Basic laboratory tests and concentrations of ADMA, NT-proBNP, neprilysin, estradiol and FSH will be performed in patients. The other planned examinations are: full clinical examination with BMI assessment, resting ECG test, full echocardiography using tissue doppler, volume and function of the left atrium and vascular stiffness index assessed using the sphygmocor device. In addition, it is planned to analyze the composition of body mass using electrical bioimpedance, intima-media complex measurement and spiroergometric study. One year after the inclusion in the study, a telephone interview will be carried out with the patients, with particular attention to the diagnosed diseases / onset of intervention: heart failure, diabetes, atrial fibrillation, the need for coronary angiography or rehospitalisation. The collected data will be statistically processed.
New values: Studies carried out as part of this work will supplement the current knowledge on the impact of menopause in the population of women with hypertension on the risk of heart failure and complications of organ hypertension. Thanks to the observed relationships, it will be possible to early start the appropriate diagnostic procedure, the selection of personalized treatment and the development of a model of cardiac care for women in the perimenopausal period, and thus improve quality and extend their life.
Introduction:
The average age of menopause in the Polish population is around 50 years. After the last menstruation a number of hormonal changes occur in the female body: estrogen, ovarian androgens (testosterone, androstenedione) and adrenal ones (DHEA, DHEAS), progesterone, growth hormone and insulin-like growth factors decrease. The concentration of gonadotropins gradually increases. These hormonal changes may result in the appearance of osteoporosis, climacteric syndrome, depression, changes in the structure of the skin or stress urinary incontinence in women. It has been documented that the risk of ischemic heart disease increases significantly after the onset of menopause which is reflected in the lowering of estrogen levels. These hormones are responsible for changes both in the lipid profile and in the vascular wall which significantly increases the likelihood of atherosclerotic plaque formation.
Hypertension is the most important cardiovascular risk factor affecting morbidity and mortality due to cardiovascular disease. It is estimated that there are as many as 34% of adult Poles. The incidence of hypertension increases with age in both women and men and significantly greater increases are observed in perimenopausal women.
An equally important and growing health and economic problem in Poland is heart failure. It is estimated that up to 700,000 patients in our country are struggling with this disease and the proportion of women in this group is constantly growing. This is the third reason for the death of women in Poland causing more deaths than cancer.
The influence of menopause on the occurrence of heart failure in a group of women with controlled hypertension remains unclear and is the subject of ongoing research. Similarly, there is still no convincing data on the increased risk of organ complications of arterial hypertension in the group of postmenopausal women.
Research carried out as part of this work will supplement the current knowledge on the impact of menopause in the population of women with hypertension on the risk of heart failure and complications of organ hypertension. Thanks to the observed relationships, it will be possible to early start the appropriate diagnostic procedure, the selection of personalized treatment and the development of a model of cardiac care for women in the perimenopausal period and thus, improve quality and extend their life.
Aim of the study: assessment of the influence of menopause on the ratios of myocardial efficiency, hemodynamic parameters and body composition in women aged > 40 years.
Detailed objectives:
Methods:
The Spearman rank correlation coefficients will be used to assess the dependencies between variables measured on an ordinal scale. Significant variables in the one-dimensional analysis (at the p <0.10 significance level) will be used to build multivariate logistic regression models. The quality of individual models and the usefulness of subsequent markers will be assessed using ROC curves [with the optimal cut-off points for which sensitivity, specificity and negative predictive power will be determined, also odds ratios OR with 95% confidence interval (95% CI) ], reclassification tables, NRI and IDI meters. Analysis of the endpoints will be performed using Kaplan-Meier curves.
Inclusion Criteria:
About 100 women aged> 40 years will be included in the study with diagnosed pharmacologically controlled hypertension, including:
Group I-about 50 women > 40 years before the onset of menopause Group II - approximately 50 women > 1 year after the onset of menopause
Exclusion Criteria:
unstable hypertension;