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Artery Wall Imaging and Effects of Postmenopausal Estrogen Therapy
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postmenopausal estrogen therapy, initiated early in the menopause, seems to protect against development of atherosclerosis and cardiovascular diseases. This thesis concerns studies of artery wall thickness and arterial stiffness estimated by noninvasive ultrasound techniques in long-term estrogen treated postmenopausal women who initiated therapy at the time of the menopause.

A noninvasive 25 MHz high-frequency ultrasound technique was validated in the imaging of superficial arteries by using an animal model. Ultrasound estimates of the artery wall layers obtained in vivo in the pig were compared to ex-vivo histomorphometry. Valid estimates of total artery wall and media thickness were found for the most superficial arteries. Adventitia thickness was underestimated and intima thickness overestimated in this animal model when non-atherosclerotic vessels were imaged.

To validate the clinical usefulness of separately estimating the artery wall layers in the human, the carotid artery wall was imaged in elderly subjects. Separate estimates of intima thickness, media thickness and intima/media ratio differed significantly between subjects with and without atherosclerosis and CVD, indicating that this noninvasive high-frequency ultrasound method might be a strong tool in monitoring changes in artery wall morphology associated with aging and development of atherosclerosis.

The investigation of intima thickness, media thickness and intima/media ratio of the carotid and femoral arteries in long-term estrogen treated postmenopausal women showed a maintenance of a thin intima and a preservation of media thickness and intima/media ratio at values similar to those obtained in women of fertile age. By comparing estrogen-users with age-matched postmenopausal nonusers, long-term estrogen therapy initiated at the time of the menopause seemed to counteract the increase in intima and decrease in media thickness associated with aging and development of atherosclerosis. The preservation of the artery wall morphology into older age might be a mechanism for the well-documented cardioprotective effects of estrogen when therapy is initiated early after menopause. However, long-term estrogen therapy showed no substantial effects on the age-related changes in arterial stiffness estimated at the aorta, carotid and femoral arteries, suggesting that any long-term cardioprotective effect that estrogen therapy may have is unlikely to be mediated by an impact on arterial stiffness.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2005. , p. 51
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 23
Keywords [en]
Medicine, artery wall thickness, tunica media, tunica intima, arterial stiffness, carotid, aorta, cardiovascular disease, atherosclerosis, menopause, estrogen, hormone therapy, ultrasound
Keywords [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:uu:diva-5722ISBN: 91-554-6193-X (print)OAI: oai:DiVA.org:uu-5722DiVA, id: diva2:166083
Public defence
2005-04-28, Rosénsalen, Kvinnokliniken, Akademiska Sjukhuset ing 95-96, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-04-07 Created: 2005-04-07Bibliographically approved
List of papers
1. Validation of in vivo noninvasive high-frequency ultrasonography of the arterial wall layers
Open this publication in new window or tab >>Validation of in vivo noninvasive high-frequency ultrasonography of the arterial wall layers
2001 In: Ultrasound in Medicine and Biology, ISSN 0301-5629, Vol. 27, no 6, p. 751-756Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-92785 (URN)
Available from: 2005-04-07 Created: 2005-04-07Bibliographically approved
2. Thicker carotid intima layer and thinner media layer in subjects with cardiovascular diseases: An investigation using noninvasive high-frequency ultrasound
Open this publication in new window or tab >>Thicker carotid intima layer and thinner media layer in subjects with cardiovascular diseases: An investigation using noninvasive high-frequency ultrasound
2006 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 189, no 2, p. 393-400Article in journal (Refereed) Published
Abstract [en]

Background: The thickness of the arterial intima increases and that of the media decreases with increasing age and degree of atherosclerosis. Separate estimates of the individual intima and media layers might therefore be more appropriate than the commonly used method estimating the combined intima-media thickness (IMT).

Methods and results: One hundred consecutive 70-year-old subjects from the PIVUS study were investigated. Separate estimates of the thickness of the carotid artery intima and media wall layers were carried out noninvasively using 25 MHz high-frequency ultrasound. Subjects with a diagnosis of cardiovascular disease (CVD), coronary heart disease (CHD), myocardial infarction (MI) or stroke had a significantly thicker intima layer (all P < 0.0001) and a thinner media layer (all P < 0.05) than healthy subjects. The intima/media thickness ratio also differed significantly between subjects with and without a diagnosis of CVD (0.43 +/- 0.20 versus 0.75 +/- 0.48, P = 0.0002). Subjects with hypertension or hyperlipidemia also had a thicker carotid intima than subjects without these diagnoses (P < 0.0005 for both). None of the corresponding intima + media thickness values differed significantly. Similar results were obtained in women and men.

Conclusion: Separate assessment of carotid artery intima and media thickness using noninvasive high-frequency ultrasound appears to be of potential value. as a striking difference in intima thickness and the intima/media thickness ratio was found between subjects with and without CVD.

Keywords
carotid artery wall, intima-media thickness (IMT), cardiovascular disease, atherosclerosis, high-frequency ultrasound
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92786 (URN)10.1016/j.atherosclerosis.2006.02.020 (DOI)000242305800020 ()16530771 (PubMedID)
Available from: 2005-04-07 Created: 2005-04-07 Last updated: 2017-12-14Bibliographically approved
3. Menopausal estrogen therapy counteracts normal aging effects on intima thickness, media thickness and intima/media ratio in carotid and femoral arteries: An investigation using noninvasive high-frequency ultrasound
Open this publication in new window or tab >>Menopausal estrogen therapy counteracts normal aging effects on intima thickness, media thickness and intima/media ratio in carotid and femoral arteries: An investigation using noninvasive high-frequency ultrasound
2006 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 189, no 2, p. 387-392Article in journal (Refereed) Published
Abstract [en]

Background: Estrogen therapy that is started at the time of menopause seems to protect against the development of atherosclerosis and cardiovascular diseases, in contrast to the initial increased cardiovascular risk when hormone therapy is initiated in older women. With increased aging and degree of atherosclerosis, the thickness of the artery intima increases and that of the media decreases. These changes can be noninvasively estimated using high-frequency ultrasound.

Methods and results: The thickness of carotid and femoral artery intima and media was assessed, using noninvasive high-frequency ultrasound (25 MHz). Long-term estrogen users (mean treatment duration 20 years) had a significantly thinner mean carotid intima layer (-25%; P=0.0002), a thicker media layer (+74%; P=0.0002) and a substantially lower intima/media thickness ratio (-54%; P < 0.0001) than 17 age-matched nonusers, with values closer to those in 20 premenopausal women. Similar but less pronounced differences between the postmenopausal groups were found for the femoral artery.

Conclusions: A preserved thin artery wall intima and a low intima/media thickness ratio, at values close to those in young women might be partially responsible for the beneficial cardiovascular effects of estrogen therapy when it is initiated at the time of menopause.

Keywords
artery wall, intima/media thickness ratio, menopausal estrogen therapy, aging, high-frequency ultrasound
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92787 (URN)10.1016/j.atherosclerosis.2005.12.023 (DOI)000242305800019 ()16460740 (PubMedID)
Available from: 2005-04-07 Created: 2005-04-07 Last updated: 2017-12-14Bibliographically approved
4. Arterial stiffness is not improved in long-term use of estrogen
Open this publication in new window or tab >>Arterial stiffness is not improved in long-term use of estrogen
2002 In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, Vol. 186, no 2, p. 189-194Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-92788 (URN)
Available from: 2005-04-07 Created: 2005-04-07Bibliographically approved

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