Dissertation committee:
Ευθύμιος Δεληγεώρογλου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ειρήνη Λαμπρινουδάκη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παναγιώτης Βάκας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Πανουλής, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κίμων Σταματελόπουλος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Καπαρός, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μακάριος Ελευθεριάδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal function. We also aimed to assess the association of sex hormones with memory function in a subsample of the above postmenopausal women.
Patients and Methods. This prospective cohort study evaluated 141 recently postmenopausal women at baseline and annually thereafter (follow-up time: 1 to 8 years). Blood samples were obtained, and ultrasound evaluations were performed at baseline. A detailed medical history, anthropometric parameters, blood pressure and cardiovascular risk factors were recorded for every woman at each visit. Incident hypertension was defined as first occurrence of office systolic or diastolic blood pressure, measured at 2 different visits within 2 months or history of initiation of antihypertensive medication. Specifically, in the subsample of 44 women with subjective memory complaints, we evaluated Memory performance using the Hopkins Verbal learning test (HVLT), the Brief Visuospatial Memory test (BVMT) and the verbal digits backwards test (VSPAN), to assess verbal, visuospatial and working memory performance, respectively. Menopausal symptoms were assessed using the Green Climacteric Scale.
Results. Incident hypertension was diagnosed in 30 out of 141 women (21.3%). Median time to incident hypertension was 3.5 years. Adiposity, elevated cholesterol and triglyceride levels, insulin resistance and parity were positively associated with incident hypertension. In multivariate analysis, however, obesity and insulin resistance were the only statistically significant variables associated with more than 3-fold and 2-fold respectively increased risk of incident hypertension (HOMA-IR, O.R=1.988, p-value=0.043; obesity, O.R=3.746, pvalue=0.019). At the same time, regarding our subsample of 44 women with memory complaints, VSPAN backwards scores were positively associated with log-transformed free androgen index (logFAI), in models adjusted for age, education, log-transformed free estrogen index (logFEI) and the intensity of menopausal symptoms. BVMT total scores were predicted by logFAI (b-coefficient=0.424, p-value=0.002), education and combined climacteric symptomatology, in a model adjusted for age and logFEI. Women with circulating estradiol above the median value of 10pg/mL had better total HTLV total scores compared to women with estradiol values below the median (HTLV total scores, estradiol≤10pg/mL vs >10pg/mL: 24.2±3.6 vs 30.0±7.9, p-value=0.007 unadjusted). This association was affected by education and remained independent of menopausal symptoms and testosterone levels (Model R2=22.3%; b-coefficient=0.318, p-value=0.024).
Conclusion. A large proportion of women entering the menopause present incident hypertension and this is mostly associated with obesity and insulin resistance. Moreover, endogenous total estradiol is associated with verbal episodic memory, while logFAI is associated with working memory performance and visuospatial episodic memory in this sample of postmenopausal women. These associations were not influenced by age, education or menopausal symptoms. Larger studies are necessary to evaluate the significance of our findings.
