Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular risk, obesity, and myocardial blood flow in postmenopausal women

  • Original Articles
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background. This study was designed to determine whether overweight or obese status is independently associated with myocardial flow reserve (MFR), an established predictor of cardiovascular mortality, in a group of postmenopausal women with no previous cardiovascular disease. Postmenopausal women are the largest group of overweight and physically inactive individuals in the United States. Increased body mass index (BMI) is consistently associated with increased cardiovascular mortality in this population. Whether this is because of obesity itself or the accompanying increase in cardiovascular risk factors (CRFs) remains controversial.

Methods. We examined the relationship of myocardial blood flow (MBF), coronary vascular resistance, and MFR to BMI in 60 postmenopausal women with no coronary heart disease. Subjects underwent dynamic N-13 ammonia positron emission tomography for the measurement of MBF and MFR. Baseline demographics, CRF, and hemodynamic parameters were recorded for each subject. Datasets were divided into 3 groups according to BMI: normal (18 to 24), overweight (25 to 29), and obese (≥30).

Results. The overweight and obese groups showed significantly higher resting MBF and lower MFR than the normal-weight group (both P<.001), even after adjusting for CRF. A further analysis of subjects without any CRF (n=35) showed that the MFR remained significantly lower in the obese compared with normal-weight subjects (P=.05). Levels of known markers of vascular inflammation (high-sensitivity C-reactive protein and homocysteine) and high-density lipoprotein cholesterol levels correlated with declining MFR.

Conclusions. These findings provide a mechanistic link between obesity and coronary heart disease in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics—2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115:e69–171.

    Article  PubMed  Google Scholar 

  2. Dionne I, Despres JP, Bouchard C, Tremblay A. Gender difference in the effect of body composition on energy metabolism. Int J Obes Relat Metab Disord 1999;23:312–9.

    Article  PubMed  CAS  Google Scholar 

  3. Tchernof A, Poehlman ET. Weight gain and menopause. Menopause 2000;7:419–21.

    Article  PubMed  CAS  Google Scholar 

  4. Tchernof A, Poehlman ET, Despres JP. Body fat distribution, the menopause transition, and hormone replacement therapy. Diabetes Metab 2000;26:12–20.

    PubMed  CAS  Google Scholar 

  5. Kolehmainen M, Vidal H, Ohisalo JJ, Pirinen E, Alhava E, Uusitupa MI. Hormone sensitive lipase expression and adipose tissue metabolism show gender difference in obese subjects after weight loss. Int J Obes Relat Metab Disord 2002;26:6–16.

    Article  PubMed  CAS  Google Scholar 

  6. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med 1995;333:677–85.

    Article  PubMed  CAS  Google Scholar 

  7. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996;97:2601–10.

    Article  PubMed  CAS  Google Scholar 

  8. Martin JW, Briesmiester K, Bargardi A, Muzik O, Mosca L, Duvernoy CS. Weight changes and obesity predict impaired resting and endothelium-dependent myocardial blood flow in postmenopausal women. Clin Cardiol 2005;28:13–8.

    Article  PubMed  Google Scholar 

  9. Al Suwaidi J, Higano ST, Holmes DR Jr, Lennon R, Lerman A. Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries. J Am Coll Cardiol 2001;37:1523–8.

    Article  PubMed  Google Scholar 

  10. Schindler TH, Nitzsche EU, Schelbert HR, Olschewski M, Sayre J, Mix M, et al. Positron emission tomography-measured abnormal responses of myocardial blood flow to sympathetic stimulation are associated with the risk of developing cardiovascular events. J Am Coll Cardiol 2005;45:1505–12.

    Article  PubMed  Google Scholar 

  11. Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000;101:1899–906.

    PubMed  CAS  Google Scholar 

  12. Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000;101:948–54.

    PubMed  CAS  Google Scholar 

  13. Johnson BD, Shaw LJ, Buchthal SD, Bairey Merz CN, Kim HW, Scott KN, et al. Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: Results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:2993–9.

    Article  PubMed  Google Scholar 

  14. von Mering GO, Arant CB, Wessel TR, McGorray SP, Bairey Merz CN, Sharaf BL, et al. Abnormal coronary vasomotion as a prognostic indicator of cardiovascular events in women: Results from the National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:722–5.

    Article  Google Scholar 

  15. Schwaiger M, Muzik O. Assessment of myocardial perfusion by positron emission tomography. Am J Cardiol 1991;67:35D-43D.

    Article  PubMed  CAS  Google Scholar 

  16. Shah A, Schelbert HR, Schwaiger M, Henze E, Hansen H, Selin C, et al. Measurement of regional myocardial blood flow with N-13 ammonia and positron-emission tomography in intact dogs. J Am Coll Cardiol 1985;5:92–100.

    PubMed  CAS  Google Scholar 

  17. Nitzsche EU, Choi Y, Czernin J, Hoh CK, Huang SC, Schelbert HR. Noninvasive quantification of myocardial blood flow in humans. A direct comparison of the [13N]ammonia and the [15O]water techniques. Circulation 1996;93:2000–6.

    PubMed  CAS  Google Scholar 

  18. Dorbala S, Hassan A, Heinonen T, Schelbert HR, Di Carli MF. Coronary vasodilator reserve and Framingham risk scores in subjects at risk for coronary artery disease. J Nucl Cardiol 2006;13:761–7.

    Article  PubMed  Google Scholar 

  19. Martin JW, Briesmiester K, Bargardi A, Muzik O, Mosca L, Duvernoy CS. Weight changes and obesity predict impaired resting and endothelium-dependent myocardial blood flow in postmenopausal women. Clin Cardiol 2005;28:13–8.

    Article  PubMed  Google Scholar 

  20. Hutchins GD, Schwaiger M, Rosenspire KC, Krivokapich J, Schelbert H, Kuhl DE. Non-invasive quantification of regional myocardial blood flow in the human heart using [13N]ammonia and dynamic positron emission tomography imaging. J Am Coll Cardiol 1990;15:1032–42.

    Article  PubMed  CAS  Google Scholar 

  21. Prior JO, Quinones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005;111:2291–8.

    Article  PubMed  CAS  Google Scholar 

  22. Lteif AA, Han K, Mather KJ. Obesity, insulin resistance, and the metabolic syndrome: Determinants of endothelial dysfunction in whites and blacks. Circulation 2005;112:32–8.

    Article  PubMed  CAS  Google Scholar 

  23. Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. J Am Coll Cardiol 2006;47:1188–95.

    Article  PubMed  CAS  Google Scholar 

  24. Sinaiko AR, Steinberger J, Moran A, Prineas RJ, Vessby B, Basu S, et al. Relation of body mass index and insulin resistance to cardiovascular risk factors, inflammatory factors, and oxidative stress during adolescence. Circulation 2005;111:1985–91.

    Article  PubMed  CAS  Google Scholar 

  25. Munzel T, Daiber A, Ullrich V, Mulsch A. Vascular consequences of endothelial nitric oxide synthase uncoupling for the activity and expression of the soluble guanylyl cyclase and the cGMP-dependent protein kinase. Arterioscler Thromb Vasc Biol 2005;25:1551–7.

    Article  PubMed  CAS  Google Scholar 

  26. Schindler TH, Nitzsche EU, Munzel T, Olschewski M, Brink I, Jeserich M, et al. Coronary vasoregulation in patients with various risk factors in response to cold pressor testing: Contrasting myocardial blood flow responses to short- and long-term vitamin C administration. J Am Coll Cardiol 2003;42:814–22.

    Article  PubMed  Google Scholar 

  27. Gillum RF. The epidemiology of resting heart rate in a national sample of men and women: Associations with hypertension, coronary heart disease, blood pressure, and other cardiovascular risk factors. Am Heart J 1988;116:163–74.

    Article  PubMed  CAS  Google Scholar 

  28. Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann NY Acad Sci 2006;1083:129–52.

    Article  PubMed  CAS  Google Scholar 

  29. Esler M, Straznicky N, Eikelis N, Masuo K, Lambert G, Lambert E. Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension 2006;48:787–96.

    Article  PubMed  CAS  Google Scholar 

  30. Pausova Z. From big fat cells to high blood pressure: A pathway to obesity-associated hypertension. Curr Opin Nephrol Hypertens 2006;15:173–8.

    Article  PubMed  Google Scholar 

  31. Wildman RP, Farhat GN, Patel AS, Mackey RH, Brockwell S, Thompson T, et al. Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension 2005;45:187–92.

    Article  PubMed  CAS  Google Scholar 

  32. Seals DR, Gates PE. Stiffening our resolve against adult weight gain. Hypertension 2005;45:175–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.

    Apurva A. Motivala MD, Patricia A. Rose BA, Robert D. Brook MD & Claire S. Duvernoy MD, FACC

  2. Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Mich.

    H. Myra Kim

  3. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich.

    Yolanda R. Smith MD

  4. Department of Radiology, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, Mich.

    Otto Muzik PhD

  5. Cardiology Section, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Box 111a, 48105-2399, Ann Arbor, MI

    Catherine Bartnik & Claire S. Duvernoy MD, FACC

Authors
  1. Apurva A. Motivala MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia A. Rose BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Myra Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yolanda R. Smith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine Bartnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert D. Brook MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Otto Muzik PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Claire S. Duvernoy MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claire S. Duvernoy MD, FACC.

Additional information

This study was funded by a Veterans Health Administration MERIT Review Award.

C.S.D. is on the Speaker’s Bureau at Pfizer, Inc., and has received grant support from Pfizer, Inc., Eli Lilly & Co., and the Veterans Health Administration.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Motivala, A.A., Rose, P.A., Kim, H.M. et al. Cardiovascular risk, obesity, and myocardial blood flow in postmenopausal women. J Nucl Cardiol 15, 510–517 (2008). https://doi.org/10.1016/j.nuclcard.2008.02.020

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.nuclcard.2008.02.020

Key Words

Search

Navigation