CARDIOVASCULAR STRESS-RESPONSE AND CORONARY-ARTERY DISEASE - EVIDENCEOF AN ADVERSE POSTMENOPAUSAL EFFECT IN WOMEN

Objectives To test the hypothesis that postmenopausal women demonstrat e greater vascular instability, measured by enhanced cardiovascular st ress responses during mental stress, compared with men and premenopaus al women. Background Recent data suggest that estrogen plays a role in regulating vascular tone. The possible consequences of estrogen defic iency during menopause on systemic vascular reactivity is largely unex plored. Methods One hundred subjects (84 men and 16 women) underwent m ental stress testing with radionuclide ventriculography. Study subject s included 19 normal volunteers, 23 control subjects with chest pain s yndromes or hypertension but without coronary artery disease, and 58 c oronary artery disease subjects. The subjects performed a series of th ree mental stress tasks, during which hemodynamic data and radionuclid e ventriculograms were obtained. Results Overall, women demonstrated g reater hemodynamic responses during mental stress measured by changes in heart rate, systolic and diastolic blood pressure, and double produ ct compared with those of men (all p < 0.05). Women with coronary arte ry disease demonstrated greater heart rate, diastolic blood pressure, and double product stress responses than their male counterparts (all p < 0.05). Women of postmenopausal age demonstrated significantly grea ter systolic blood pressure reactivity than men or premenopausal women (p < 0.05). Conclusions Women of postmenopausal age have greater card iovascular responses to stress than men or premenopausal women. These findings suggest an additional mechanism by which estrogen deficiency conveys a poor prognosis in female patients with coronary artery disea se.