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  2. Keyword: Estrogens
Figure 1
ABC
Review Article

Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction

Allan Kardec Nogueira de Alencar et al. Hao Wang Gláucia Maria Moraes de Oliveira Xuming Sun … Gisele Zapata-Sudo Leanne Groban

Abstract

The prevalence of obesity and heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women. Although obesity is a risk factor for left ventricular diastolic dysfunction (LVDD), the mechanisms that link the cessation of ovarian hormone production, and particularly estrogens, to the development of obesity, LVDD, and HFpEF in aging females are unclear. Clinical, and epidemiologic studies show that postmenopausal women with abdominal obesity (defined by waist circumference) are at greater risk for developing HFpEF than men or women without abdominal obesity. The study presents a review of clinical data that support a mechanistic link between estrogen loss plus obesity and left ventricular remodeling with LVDD. It also seeks to discuss potential cell and molecular mechanisms for estrogen-mediated protection against adverse adipocyte cell types, tissue depots, function, and metabolism that may contribute to LVDD and HFpEF.

  • Adiposity
  • body mass index
  • Echocardiography/methods
  • Estrogens
  • Heart Failure
  • Menopause
  • Obesity
  • Overweight
  • Stroke Volume
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Creative Commons Attribution (CC BY) Creative Commons license
08/10/2021 DOI: 10.36660/abc.20200855
Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women
IJCS
Original Article

Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women

Ricardo Quental Coutinho et al. Ulisses Ramos Montarroyos Isly Maria Lucena de Barros Maria José Bezerra Guimarães … Ana Paula Dornelas Leão Laura Olinda Bregieiro Fernandes Costa Ana Kelley de Lima Medeiros Maria de Fátima Monteiro Moacir de Novaes Lima Ferreira William Azem Chalela Rodrigo Pinto Pedrosa

Abstract

Background

Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable.

Objective

To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers.

Methods

This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05).

Results

According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity 0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score.

Conclusion

Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

  • Atherosclerosis
  • Estrogens
  • Exercise Test
  • Heredity
  • Hypertension
  • middle aged
  • Myocardial Infarction
  • Obesity
  • Risk Factor
  • Sudden Death
  • Women
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Creative Commons Attribution (CC BY) Creative Commons license
16/07/2021 DOI: 10.36660/ijcs.20200414 Views 1

How to cite this article

EndNote RIS

Electronic Document Format (Vancouver)

Alencar AKN, Wang H, Oliveira GMM, Sun X, Zapata-Sudo G, Groban L. Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction. Arquivos Brasileiros de Cardiologia 2021;117(6):1191-20.

Electronic Document Format (ABNT)

Alencar, Allan Kardec Nogueira de; Wang, Hao; Oliveira, Gláucia Maria Moraes de; Sun, Xuming; Zapata-Sudo, Gisele; Groban, Leanne. Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction. Arquivos Brasileiros de Cardiologia, v. 117, n. 6, p. 1191-1201, Oct. 2021.

Electronic Document Format (APA)

Alencar, A. K. N. , Wang, H., Oliveira, G. M. M. , Sun, X., Zapata-Sudo, G., & Groban, L. (2021). Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction. Arquivos Brasileiros de Cardiologia, 117(6), 1191-1201.

Electronic Document Format (ISO)

Alencar, Allan Kardec Nogueira de and Wang, Hao and Oliveira, Gláucia Maria Moraes de and Sun, Xuming and Zapata-Sudo, Gisele and Groban, Leanne. Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction. Arquivos Brasileiros de Cardiologia [online]. 2021, vol. 117, n. 6, [cited 2026-10-14], pp. 1191-1201. Available from: <https://journals.cardiol.br/en/article/crossroads-between-estrogen-loss-obesity-and-heart-failure-with-preserved-ejection-fraction/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

Coutinho RQ, Montarroyos UR, Barros IML, Guimarães MJB, Leão APD, Costa LOBF, Medeiros AKL, et al. Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women. International Journal of Cardiovascular Sciences 2021;34(4):383-92.

Electronic Document Format (ABNT)

Coutinho, Ricardo Quental; Montarroyos, Ulisses Ramos; Barros, Isly Maria Lucena de; Guimarães, Maria José Bezerra; Leão, Ana Paula Dornelas; Costa, Laura Olinda Bregieiro Fernandes; Medeiros, Ana Kelley de Lima; Monteiro, Maria de Fátima; Ferreira, Moacir de Novaes Lima; Chalela, William Azem; Pedrosa, Rodrigo Pinto. Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women. International Journal of Cardiovascular Sciences, v. 34, n. 4, p. 383-392, Jul. 2021.

Electronic Document Format (APA)

Coutinho, R. Q., Montarroyos, U. R., Barros, I. M. L. , Guimarães, M. J. B., Leão, A. P. D., Costa, L. O. B. F., Medeiros, A. K. L., Monteiro, M. F., Ferreira, M. N. L., Chalela, W. A., & Pedrosa, R. P. (2021). Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women. International Journal of Cardiovascular Sciences, 34(4), 383-392.

Electronic Document Format (ISO)

Coutinho, Ricardo Quental and Montarroyos, Ulisses Ramos and Barros, Isly Maria Lucena de and Guimarães, Maria José Bezerra and Leão, Ana Paula Dornelas and Costa, Laura Olinda Bregieiro Fernandes and Medeiros, Ana Kelley de Lima and Monteiro, Maria de Fátima and Ferreira, Moacir de Novaes Lima and Chalela, William Azem and Pedrosa, Rodrigo Pinto. Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women. International Journal of Cardiovascular Sciences [online]. 2021, vol. 34, n. 4, [cited 2026-10-14], pp. 383-392. Available from: <https://journals.cardiol.br/en/article/exercise-testing-family-history-and-subclinical-atherosclerosis-markers-for-cardiovascular-risk-reclassification-in-middle-aged-women/>. ISSN 2359-4802

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