Menopause and Cardiovascular Disease

Introduction to Menopause and Cardiovascular Diseases The prevalence and mortality of coronary atherosclerotic heart disease were significantly lower in premenopausal women than in men of the same age group. After menopause, the incidence of coronary heart disease increased rapidly. After the age of 60, it was close to the male level of the same age group. Menopause is an independent risk factor for increased cardiovascular morbidity and mortality. Common cardiovascular diseases in perimenopausal women and postmenopausal women include atherosclerosis (coronary heart disease, myocardial infarction, angina pectoris, etc.), stroke, hypertension, arrhythmia, etc. X syndrome was proposed by Reaven in the 1980s. A unique metabolic disorder syndrome, which has a statistically intrinsic relationship with cardiovascular disease, which is an important risk factor for cardiovascular disease. Syndrome X includes: impaired glucose tolerance, hyperinsulinemia, hyperlipidemia, There is a close intrinsic link between hypertension, obesity, and glucose metabolism, lipid metabolism, and insulin resistance. Early on, people noticed the relationship between menopause and the increase in the incidence of cardiovascular diseases in women. Based on epidemiological investigations, basic research, animal experiments and clinical studies were used to explore estrogen to cardiovascular system. The mechanism of action and estrogen replacement therapy have the role of protecting the cardiovascular system of postmenopausal women. basic knowledge The proportion of sickness: 0.01% Susceptible population: menopausal women Mode of infection: non-infectious Complications: coronary heart disease, hypertension, pulmonary embolism, uremia, sudden death

Menopause and the cause of cardiovascular disease

Causes:

Most patients with coronary artery disease often have more than one risk factor. When multiple risk factors coexist (cluster phenomenon), the cardiovascular risk is much greater than any single risk factor. It is not in arithmetic progression but in multiples. Increase, and therefore the probability of occurrence of CHD and stroke events should be assessed according to the total number of people with relevant risk factors and their severity. The important pathological basis of cardiovascular and cerebrovascular diseases is atherosclerosis and hypertension, and many risk factors are related to arteries. Related to atherosclerosis, the classification of risk factors is conducive to the judgment of patients' prognosis and to determine the correct treatment strategy. According to the proven risk factors, the strength of intervention and the impact of intervention therapy can be divided into the following categories:

Class I risk factors: Factors that have been proven and interventional therapy can reduce atherosclerosis (AS), including hypercholesterolemia, high and low density lipoproteinemia, hypertension, and smoking.

Class II risk factors: refers to factors that are likely to reduce AS after intervention, including diabetes, decreased physical activity, low-density lipoproteinemia, hypertriglyceridemia and high-low-density lipoproteinemia, obesity, menopause After women.

Class III risk factors: If these factors are changed, AS may be reduced, including psychosocial factors, lipoprotein a, and hypercysteinemia.

Class IV risk factors: Unchangeable risk factors, including age, male, low socioeconomic status, and familial early onset AS history.

V Other: Risk factors that are increasingly valued, including plasma fibrinogen, factor VII, endogenous tissue plasminogen activator (tPA), inhibitor of plasminogen activator-1 (PAI-1) , D-Dimer, C-reactive protein, Chlamydia pneumoniae, and the like.

In addition to the age factor, women's hypertension, diabetes, family history of coronary heart disease and obesity are more common than men; smokers are less than men; due to physiological changes in women's menopause and the use of contraceptives For other reasons, the important risk factors of dyslipidemia are different from those of males. Therefore, it is necessary to study the abnormal changes and effects of female blood lipids in the prevention and treatment of CHD.

Pathogenesis:

Estrogen has been shown to have vasoprotective effects. Animal studies and clinical epidemiological statistics show that estrogen can directly or indirectly affect cardiovascular, reduce blood lipids, inhibit platelet adhesion, aggregation, reduce vascular tone, and improve vascular dynamics. Antioxidant, protects the endothelium, inhibits vascular smooth muscle cell proliferation, migration and extracellular matrix synthesis, and attenuates atherosclerotic plaque, thus having anti-atherosclerotic effects. These effects are similar to the vascular effects of nitric oxide (NO). Estrogen may partially contribute to cardiovascular tree protection through the nitric oxide (NO) pathway.

Postmenopausal due to decreased estrogen, causing dyslipidemia, blood cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) rise, high-density lipoprotein cholesterol (HDL-C) decreased, a large number LDL-C precipitates in the blood vessel wall after entering the blood vessel, making the arterial lumen narrow and hard, prone to atherosclerosis, coronary heart disease, myocardial infarction and stroke. After estrus treatment, TC is reduced and TG is not decreased.

Menopause and cardiovascular disease prevention

In recent years, it has become increasingly clear that secondary prevention can only reduce death or disability. Only primary prevention can really reduce the occurrence of cardiovascular and cerebrovascular diseases. Therefore, the detection and control of relevant risk factors is the key to prevent and treat cardiovascular and cerebrovascular diseases in the future. .

1. Strengthen physical exercise for one hour every day. When the activity is over, the heart rate is not more than 170 and the age difference, or the body is slightly sweaty, do not feel tired, and the body feels relaxed after exercise, and the activity is not less than 5 per week. Heaven, persevere.

2. Smoking cessation and alcohol restriction Long-term smoking and alcoholism can interfere with blood lipid metabolism and increase blood lipids.

3. Avoid mental stress, emotional insomnia, overwork, irregular life, anxiety, depression, these factors can make lipid metabolism disorder. Middle-aged and elderly people should not play mahjong and play chess for a long time, keep calm and be as angry as possible. Try to minimize the use of drugs that interfere with lipid metabolism, such as beta blockers, propranolol, diuretics, hydrochlorothiazide, furosemide, steroids, etc., can increase blood lipids. Actively treat related diseases that affect blood lipid metabolism.

Menopause and cardiovascular complications Complications, coronary heart disease, hypertension, pulmonary embolism, uremia, sudden death

Severe coronary heart disease, high blood pressure, respiratory and renal dysfunction can cause myocardial infarction, stroke, pulmonary embolism, uremia, etc., and some sudden death.

Menopause and cardiovascular disease symptoms common symptoms hypertension menopause tide red tide angina pectoris intracranial hemorrhage myocardial infarction shock

1. Clinical characteristics of female patients with coronary heart disease

At present, most of the analysis of CHD clinical features are male, and there are few reports on women. Female CHD patients often occur after menopause, and the symptoms of peri-menopausal angina are not typical. Spontaneous angina is more common, mainly with coronary artery. It is related to the protective effect of estrogen, but the fixed stenosis is less and lighter, but the number of cases of fixed stenosis increases with age. It is reported that coronary angiography is almost 50% normal in women with clinical diagnosis of angina pectoris. Only 17% of men are normal.

There were 72 cases of clinically suspected CHD (54.6±6.5) years old in China, 32 cases (44.4%) diagnosed by coronary angiography, 9 cases (12.5%) of X syndrome, and 23 cases (71.9%) were single. In vascular lesions, 7 patients (21.9%) had two vascular lesions; 24 patients (75.0%) had left anterior descending artery lesions, and the extent and extent of lesions were lighter than that of domestic males. Of the 32 CHDs, only 9 (28.1%) had In the typical angina pectoris, a comparison of male and female age groups in 1614 patients with acute myocardial infarction (AMI) in Beijing showed that 429 women had a premenopausal rate of 0.9% and a peri-menopausal rate of 7.5%, which were significantly lower than men of the same age. Menopause In the later stage, it was 36.1%, close to men of the same age, 55.5% of the elderly, significantly higher than the older men. The menopause of the infarction site and the previous occurrence occurred in the front, the side wall range, mostly without Q-wave myocardial infarction, Q-wave myocardial infarction after menopause. Compared with men, the incidence of cardiogenic shock and mortality in perimenopausal and elderly women is significantly higher than that in men. The performance of ECG is more than that of men, but the significance is lower than that of men, and the false positive of ECG exercise test. Women can reach 38% to 67%, males 7% to 44%, and false negative women 12% to 22%, males. 12% to 40%.

There are few reports on the treatment of female CHD, but it is generally believed that women use nitrates, calcium antagonists, sedatives, diuretics and other antihypertensive drugs more than men, and the efficacy is worse than men, women with aspirin for primary prevention Some people think it is harmful, it may be to protect the vascular endothelium from damage. ISIS 2 study confirmed that the protective effect of low-dose aspirin on AMI is the same between men and women. Female AMI patients, due to most older patients, admission time Late, there are more comorbidities, so the chance of thrombolysis is significantly lower than that of men. The efficacy of thrombolysis is similar between men and women, but the complications after thrombolysis and the mortality rate during hospitalization are higher than that of men. Women are an independent risk factor for intracranial hemorrhage after thrombolysis, but thrombolytic therapy is still an effective method for treating women with CHD and reducing mortality. Because women have narrow coronary arteries, narrow lumens, older age, and more comorbidities. Other factors, percutaneous coronary angioplasty and coronary artery bypass surgery, women are not as effective as men, complications and mortality are higher than men, but if the surgery is successful, long-term pre- The sexes are similar.

2. Characteristics of female hypertension

Postmenopausal hypertension refers to the increase of blood pressure after physiological menopause in women. The incidence of hypertension in premenopausal women is significantly lower than that of men of the same age, but the incidence is significantly higher after menopause. Women's blood pressure, especially systolic blood pressure, is The increase in age is markedly increased, while systolic hypertension is a direct burden on the heart and resistance arteries. Increased systolic blood pressure is one of the important risk factors for coronary heart disease and cardiovascular mortality.

The risk of hypertension in postmenopausal women is higher than that in premenopausal women. The investigation of death causes of elderly people over 60 years old in China from 1988 to 1992 found that cerebrovascular diseases accounted for the first place, and hypertension was an important risk factor for cerebrovascular diseases. Among the deaths from vascular diseases, 52.7% were hypertension, 54.3% were women, and more than 50% were postmenopausal hypertension in elderly women with hypertension.

The incidence of hypertension in postmenopausal women is higher than that of men of the same age who are matched by conditions. One of the reasons may be related to the reduction of estrogen. The pathophysiological changes of postmenopausal hypertension are complex, including hemodynamics, metabolism, and sympathetic. Changes in nerve activity, blood vessel wall, sex hormones, etc.

Compared with age-matched men with similar blood pressure levels, women with premenopausal hypertension have a faster resting heart rate, left ventricular ejection time, increased cardiac output index and pulse pressure, and lower total peripheral vascular resistance. Low characteristics, while postmenopausal women with hypertension are characterized by increased peripheral vascular resistance, low or normal plasma flow, and a tendency to low renin.

Studies have found that in women with menstrual disorders, increased testosterone levels are positively correlated with elevated systolic blood pressure, and also related to basal metabolism. The most obvious is that when testosterone is 1.4nmol/L, the systolic blood pressure is significantly increased. High; when testosterone levels are greater than 10 times normal, systolic blood pressure must rise (>125mmHg), so testosterone can be considered as a screening tool to predict whether menstrual dysfunction women will develop into hypertensive patients, and determine whether these patients Need to monitor blood pressure and early treatment.

Menopause and cardiovascular disease examination

1. Hormone level detection.

2. Examination of vaginal secretions, urine routine (lower urine specific gravity when kidney function is reduced, phenol red excretion rate is reduced, blood creatinine and urea nitrogen are increased, urea or endogenous creatinine clearance rate is lower than normal).

3. Blood sugar, blood lipids, kidney function test, thyroid biochemical examination.

4. ECG

Reflects the electrical activity of the heart.

5. Dynamic electrocardiogram

Because DCG can continuously record the electrocardiogram of patients in daily life without the influence of receptor position, it can capture short-term arrhythmia and transient myocardial ischemia that cannot be recorded by patients with conventional electrocardiogram.

6. ECG exercise test

This test increases the load of the heart by exercise and increases the oxygen consumption of the heart. When the exercise reaches a certain load, the myocardial blood flow of patients with coronary artery stenosis does not increase with the amount of exercise, that is, myocardial ischemia occurs, and corresponding changes appear on the electrocardiogram. For the diagnosis of asymptomatic myocardial ischemia, the prognostic evaluation of acute myocardial infarction, differential diagnosis is meaningful.

7. X-ray chest

It can show pulmonary congestion, pulmonary edema and cardiac-left ventricular enlargement secondary to myocardial ischemia and/or myocardial infarction, and is important for the assessment of disease and prognosis. For some mechanical complications such as ventricular aneurysm, Interventricular septal perforation (rupture) and diagnosis of dysfunction or fracture of the papillary muscles are also helpful.

8. Coronary angiography (including left ventricular angiography)

It is still a reliable method for diagnosing coronary heart disease and selecting indications for surgical and interventional treatment of patients with coronary heart disease. The catheter is inserted into the coronary artery through the catheter of the coronary artery and the contrast agent is directly injected into the left artery. The right coronary artery shows the anatomy of the coronary artery and its branches, the location of the lesion and the extent of the lesion.

9. Cardiac CT, magnetic resonance imaging, multi-slice spiral CT coronary angiography, MRI is a non-invasive examination technique.

10. Echocardiography

It is an indispensable means for diagnosing coronary heart disease. It is widely used in clinical diagnosis, intraoperative observation, postoperative and drug treatment evaluation in terms of simplicity, non-invasiveness and reproducibility.

11. Radionuclide imaging

Radionuclide myocardial perfusion imaging is the most valuable non-invasive method for screening coronary angiography. Negative myocardial perfusion imaging can basically exclude coronary lesions. Myocardial ischemia alone can be seen along the coronary artery in the myocardial imaging of the load. The myocardial segment has obvious radioactive sparse (reduced) or defective area. On the resting imaging, the local part is radioactively filled, which proves that the myocardial segment is ischemic. Such patients should have coronary angiography. In the coronary stenosis, the treatment plan is determined. In addition, this method is also important for the diagnosis of myocardial infarction, myocardial infarction and ventricular aneurysm; evaluation of viable myocardium, evaluation of the efficacy of revascularization and prognosis of patients with coronary heart disease are also important. Inspection means.

12. Fundus examination

Visible retinal artery spasm and (or) sclerosis, severe bleeding and exudation, optic disc edema.

13. Arterial blood pressure monitoring

The rapid development of new diagnostic techniques in the past 10 years has helped diagnose hypertension and determine treatment outcomes.

Diagnosis of menopause and cardiovascular disease

Typical hot flashes are characteristic symptoms of perimenopausal and postmenopausal, and are an important basis for the diagnosis of menopause. Clinical manifestations of cardiovascular disease after menopause, such as atrial arrhythmia before atrial contraction, electrocardiogram showing myocardial blood supply Insufficient changes, the rhythm returned to normal after supplementation with estrogen, indicating that it is related to hormone reduction, and can be diagnosed based on laboratory tests and auxiliary examinations.

Differential diagnosis

1. The heart rate caused by hyperthyroidism is accelerated, the arrhythmia is different, and the sweat is differentiated. This disease can occur at any age. When the older person is sick, the symptoms are often atypical. For example, the thyroid is not swollen and the appetite is not. Hyperthyroidism, heart rate is not fast, not showing excitement and showing depression, apathy, suspiciousness, anxiety, etc., identification method: determination of thyroid function indicators, such as TSH is lower than normal, T4 is elevated, T3 is normal high limit or even normal, it should be diagnosed Hyperthyroidism.

2. Coronary atherosclerotic heart disease

The identification method is careful physical examination, electrocardiogram, coronary angiography, angina pectoris caused by decreased hormone levels, angiography is often less than 50%, when the identification is difficult, estrogen test can be used, but should pay attention to whether there is coronary heart disease .

3. Hypertension or pheochromocytoma

When headache, blood pressure fluctuations or sustained high blood pressure should be considered, the identification method is repeated blood pressure measurement and pheochromocytoma related examination, such as whether there is a mass in the abdomen, whether the blood pressure is increased when the mass is squeezed? Headache, palpitation, sweating and other symptoms, blood catecholamine determination, blood pressure changes associated with menopause are often mild, blood pressure decreased and stabilized after the application of estrogen.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.