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Vascular mechanical properties and endothelial function with special reference to pregnancy and hormonal influences

Brodszki, Jana LU (2004)
Abstract (Swedish)
Popular Abstract in Swedish

Hjärt-kärlsjukdomar är en ledande orsak av sjuklighet och dödlighet. Med hjälp av dagens moderna ultraljudsteknik är det möjligt att påvisa även begynnande, mycket diskreta kärlförändringar. En tidig upptäckt av dessa kan bli av betydelse för individens framtida hälsa. I ett antal studier har vi med hjälp av ultraljud undersökt kärlens styvhet och förmåga att vidgas (endotelets funktion) hos för övrigt friska individer. Dessa individer befann sig antingen i ett tillstånd med möjligt inflytande på hjärt-kärlsystemet eller har tidigare utsatts för ett sådant. Dessutom undersöktes kärlsystemet hos en grupp hjärtfriska patienter med en bindvävsjukdom, systemisk lupus erythematosus (SLE).

... (More)
Popular Abstract in Swedish

Hjärt-kärlsjukdomar är en ledande orsak av sjuklighet och dödlighet. Med hjälp av dagens moderna ultraljudsteknik är det möjligt att påvisa även begynnande, mycket diskreta kärlförändringar. En tidig upptäckt av dessa kan bli av betydelse för individens framtida hälsa. I ett antal studier har vi med hjälp av ultraljud undersökt kärlens styvhet och förmåga att vidgas (endotelets funktion) hos för övrigt friska individer. Dessa individer befann sig antingen i ett tillstånd med möjligt inflytande på hjärt-kärlsystemet eller har tidigare utsatts för ett sådant. Dessutom undersöktes kärlsystemet hos en grupp hjärtfriska patienter med en bindvävsjukdom, systemisk lupus erythematosus (SLE).



Ett tillstånd med stort inflytande på kärlsystemet är graviditeten. Motståndet i kärlen som försörjer livmodern minskar för att kunna möta det växande barnets behov av näring och syre. Hos vissa gravida förblir motståndet i livmoderns kärl högt och dessa kvinnor löper större risk för att drabbas av komplikationer under graviditeten. Både hos kvinnor som fortsatte att ha normalt blodtryck och hos dem som utvecklade preeklampsi (havandeskapsförgifning) har vi kunnat påvisa en påverkan av kärlens funktion – en nedsättning av endotelfunktionen. Kärlens styvhet var dock opåverkad. Ökat motstånd i livmoderns kärl tycks också kunna ha följder för fostrets kärlsystem. I en uppföljningsstudie av tonåringar som varit utsatta för s.k. intrauterin tillväxthämning fann vi mindre kärldiametrar relativt till deras kroppsstorlek och ökad puls i vila. Dessa fynd tyder på en påverkan av kärlens tillväxt och funktion.



I nästa studie undersöktes effekten av hormonbehandlingen i övergångsåldern på kärlväggen. Efter sex månaders behandling har vi inte kunnat påvisa en påtaglig effekt på kärlens styvhet. Däremot hade hormonanvändare bland kvinnor med systemisk lupus erythematosus, mindre styva kärl jämfört med icke-användare. Dessutom visades att själva sjukdomen leder till en ökad styvhet av kärlen.



Fynd av kärlförändringar hos för övrigt hjärt-kärlfriska individer kan vara av stor vikt för deras framtida kardiovaskulära hälsa eftersom en tidig identifikation möjliggör preventiva åtgärder. (Less)
Abstract
Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity. Early recognition of vascular changes, both structural and functional, may help to identify individuals at risk for CVD. Using modern ultrasound techniques – the echo-tracking technique for assessment of stiffness in large arteries and flow-mediated dilatation of the brachial artery as an indicator of endothelial function, we could demonstrate vascular changes in subjects who were otherwise healthy and who were or have been subjected to conditions with potential impact on their cardiovascular system. Furthermore, vessel wall properties were studied in female patients with Systemic Lupus Erythematosus (SLE) who were void of manifest CVD.

... (More)
Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity. Early recognition of vascular changes, both structural and functional, may help to identify individuals at risk for CVD. Using modern ultrasound techniques – the echo-tracking technique for assessment of stiffness in large arteries and flow-mediated dilatation of the brachial artery as an indicator of endothelial function, we could demonstrate vascular changes in subjects who were otherwise healthy and who were or have been subjected to conditions with potential impact on their cardiovascular system. Furthermore, vessel wall properties were studied in female patients with Systemic Lupus Erythematosus (SLE) who were void of manifest CVD.



Impaired endothelial function was present in normotensive pregnant women with bilateral uterine artery notches (sign of increased resistance in the uteroplacental circulation). Pregnant women with preeclampsia showed endothelial dysfunction as compared to controls; the dysfunction was most pronounced in women with bilateral uterine artery notches. Arterial stiffness was unaffected in both above mentioned groups. In adolescents who as fetuses suffered from intrauterine growth restriction with abnormal blood flow smaller vessel diameters of larger arteries, increased resting heart rate and a lower buffering capacity of the aorta were found, indicating both an alteration of vascular growth and function.



No major effect of six months of combined hormone therapy (HT) on arterial stiffness of healthy postmenopausal women could be demonstrated. Yet HT-users among women with SLE had a lower aortic stiffness than non-users. Furthermore, vascular changes, as manifested by increased arterial stiffness and vessel enlargement, were present in SLE patients who were void of CVD and significant atherosclerotic lesions.



The findings of vascular changes in the above mentioned groups of subjects may be of importance for the future cardiovascular health of these individuals since early identification provides a possibility for preventive interventions. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Wladimiroff, Juriy, Erasmus Universiteit Rotterdam
organization
publishing date
type
Thesis
publication status
published
subject
keywords
gynaecology, andrology, reproduction, sexuality, Obstetrik, gynekologi, andrologi, reproduktion, sexualitet, Obstetrics, systemic lupus erythematosus, hormone therapy, preeclampsia, pregnancy, endothelial function, arterial stiffness, vessels, ultrasound, cardiovascular disease
pages
156 pages
publisher
Department of Obstetrics and Gynecology, Lund University
defense location
Department of Obstetrics and Gynecology
defense date
2004-05-07 10:15
ISBN
91-628-6071-2
language
English
LU publication?
yes
id
833b32d4-85bb-4128-ab03-98da2d4fd557 (old id 466868)
date added to LUP
2007-08-09 14:17:51
date last changed
2016-09-19 08:45:12
@misc{833b32d4-85bb-4128-ab03-98da2d4fd557,
  abstract     = {Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity. Early recognition of vascular changes, both structural and functional, may help to identify individuals at risk for CVD. Using modern ultrasound techniques – the echo-tracking technique for assessment of stiffness in large arteries and flow-mediated dilatation of the brachial artery as an indicator of endothelial function, we could demonstrate vascular changes in subjects who were otherwise healthy and who were or have been subjected to conditions with potential impact on their cardiovascular system. Furthermore, vessel wall properties were studied in female patients with Systemic Lupus Erythematosus (SLE) who were void of manifest CVD.<br/><br>
<br/><br>
Impaired endothelial function was present in normotensive pregnant women with bilateral uterine artery notches (sign of increased resistance in the uteroplacental circulation). Pregnant women with preeclampsia showed endothelial dysfunction as compared to controls; the dysfunction was most pronounced in women with bilateral uterine artery notches. Arterial stiffness was unaffected in both above mentioned groups. In adolescents who as fetuses suffered from intrauterine growth restriction with abnormal blood flow smaller vessel diameters of larger arteries, increased resting heart rate and a lower buffering capacity of the aorta were found, indicating both an alteration of vascular growth and function.<br/><br>
<br/><br>
No major effect of six months of combined hormone therapy (HT) on arterial stiffness of healthy postmenopausal women could be demonstrated. Yet HT-users among women with SLE had a lower aortic stiffness than non-users. Furthermore, vascular changes, as manifested by increased arterial stiffness and vessel enlargement, were present in SLE patients who were void of CVD and significant atherosclerotic lesions.<br/><br>
<br/><br>
The findings of vascular changes in the above mentioned groups of subjects may be of importance for the future cardiovascular health of these individuals since early identification provides a possibility for preventive interventions.},
  author       = {Brodszki, Jana},
  isbn         = {91-628-6071-2},
  keyword      = {gynaecology,andrology,reproduction,sexuality,Obstetrik,gynekologi,andrologi,reproduktion,sexualitet,Obstetrics,systemic lupus erythematosus,hormone therapy,preeclampsia,pregnancy,endothelial function,arterial stiffness,vessels,ultrasound,cardiovascular disease},
  language     = {eng},
  pages        = {156},
  publisher    = {ARRAY(0x9b6ca08)},
  title        = {Vascular mechanical properties and endothelial function with special reference to pregnancy and hormonal influences},
  year         = {2004},
}