Vascular function in trained females

Cardiovascular disease (CVD) is a leading cause of death in women. Early stages of subclinical atherosclerosis cause functional changes to the vas culature manifesting as endothelial dysfunction. These early functional changes give wa y to structural alterations to the vessel wall that can lead to increased arterial stiffness and i rreversible vascular remodeling, (i.e. altered lumen diameter and increased intima media wall thic kness (IMT)) which can ultimately lead to a cardiac event. Chronic exercise combined with energ y deficiency may lead to a lack of menses or amenorrhea in premenopausal women. This state is ssociated with endothelial dysfunction and is believed to be attributable to hypoestrogeni c mechanisms. Whether there are further detrimental structural changes to the artery in exe rcis -trained amenorrheic women remains unknown. PURPOSE: The primary purpose of this study was to examine in dices of endothelial function, arterial stiffness and vascular remodelin g in exercise-trained amenorrheic women to gain insight into the extent and severity of subcli ni al atherosclerotic CVD risk in this population. HYPOTHESES: It was hypothesized that, exercise-trained amenorrh eic women would have lower endothelial function, higher arter ial stiffness, and unfavorable vascular remodeling (greater femoral IMT and smaller femoral artery diameter) compared with exercisetrained eumenorrheic women and similar levels of en dothelial dysfunction, arterial stiffness, and vascular remodeling compared to sedentary eumenorrh eic women. METHODS: Forty-three women participated in this study: 10 exercise-train ed amenorrheic women (Age 21 ± 3 years, Body Mass Index (BMI) 21.5 ± 2.0 kg/m ), 18 exercise-trained eumenorrheic women (Age 22 ± 3 years, BMI 22.9 ± 2.4 kg/m ), and 15 sedentary eumenorrheic women (Age 23 ± 4 years, BMI 23.9 ± 3.2 kg/m). Flow mediated dilation (FMD) of the brachial artery was used to measure endothelial function. Carotid-femoral Pulse Wave Ve locity (PWV) was used to measure arterial stiffness. Diameters and intima media thickness (IM T) of the superficial femoral artery (SFA) were taken as measures of vascular remodeling, and acquired using ultrasonography. Blood lipids, hematocrit, and hemoglobin were measured us ing a finger stick. A saliva collection was used to measure estradiol. Air displacement plethys mography was used to measure body fat percentage. Maximal oxygen uptake was used to measu re maximal aerobic capacity and a 3-day diet record was administered to measure dietary int ake. RESULTS: FMD in exercise-trained amenorrheic women was not significantly different f rom exercise-trained and sedentary eumenorrheic women (Amenorrheic: 7.15 ± 4.21 mm vs. Exercise-trained Eumenorrheic: 11.10 ± 4.29 mm vs. Sedentary: 0.25 ± 3.86 mm, P = 0.07). There were significant differences between groups in the reactive hyperemia shear rate stimulu s (i.e. Area Under the Curve (AUC)), (Amenorrheic: 808 ± 350.1 aU vs. Exercise-trained E umenorrheic: 862 ± 311.0 aU vs. Sedentary: 1096 ± 311.3 aU, P = 0.05). When FMD was normalized for the shear rate stimulus exercise-trained amenorrheic women had a significan tly lower FMD response compared with eumenorrheic women (Amenorrheic: 6.91 ± 1.33mm vs. Exercise-trained Eumenorrheic: 10.97 ± 0.98mm vs. Sedentary: 10.57 ± 1.11mm, P = 0.05). Aortic PWV in the exercise-trained amenorrheic group was not significantly different f rom the eumenorrheic groups (Amenorrheic: 5.00 ± 1.00 m/s vs. Exercise-trained Eumenorrheic: 4.60 ± 0.50 m/s vs. Sedentary: 5.40 ± 0.80 m/s, P = 0.03). SFA diameters were significantly higher i n the exercise-trained groups compared with the sedentary eumenorrheic group (Amenorrheic: 5.70 ± 0.72 mm vs. Exercise-trained Eumenorrheic: 5.68 ± 0.70 mm vs. Sedentary: 5.10 ± 0.63 mm, P = 0.03) while IMT was significantly lower in the exercise-trained amenorr heic women compared with the sedentary eumenorrheic women (Amenorrheic: 0.31 ± 0.03 mm vs . Exercise-trained Eumenorrheic: 0.35 ± 0.06 mm vs. Sedentary: 0.38 ± 0.07 mm, P = 0.01). 17β-Estradiol levels in exercise-trained amenorrheic women were similar to levels in eumenor rheic women (Amenorrheic: 1.66 ± 0.84 pg/ml vs. Exercise-trained Eumenorrheic: 2.22 ± 1.1 7 pg/ml vs. Sedentary: 2.00 ± 0.81 pg/ml, P = 0.34). Blood lipid and hematological measures, an d 3-day dietary record of nutrients, vitamins and minerals were not significantly different betwe en groups ( P > 0.05). CONCLUSIONS: Exercise-trained amenorrheic women had endothelial dysfunction, but did not have increased arterial stiffness or adverse vascular remodeling w hen compared to their eumenorrheic counterparts. This study suggests that vascular dys function does not extend beyond the endothelium, as arterial stiffness and vascular rem odeling are not affected by the amenorrheic state. VASCULAR FUNCTION IN TRAINED FEMALES by JACQUELINE A. AUGUSTINE B.A. The College of the Holy Cross, 2011 M.S. Syracuse University, 2014 Thesis Submitted in partial fulfillment of the degree of M aster of Science in Exercise Science