Cardiorenal disturbances in perimenopausal women
Authors: Tolstov S. N. , Mychka V. B. , Salov I. A. , Prokhorova Yu. V. , Vyshivanyuk V. A. 
Published: October 2019

Aim. To identify early signs of renal dysfunction; to investigate the associations between renal function and vascular remodelling; to evaluate the role of metabolic and hydrodynamic disturbances in the development of cardiorenal syndrome among perimenopausal women; and to assess the potential of hormone replacement therapy (17β-estradiol 1 mg and drospirenone 2 mg) for the correction of the above-mentioned disturbances. Material and methods. In total, 69 perimenopausal women were divided into two groups. Group I included 69 premenopausal women, while Group II consisted of 43 women in early postmenopause. Mean age in Group I was 49,0 years (95% CI 48,0-51,0 years); in Group II, it was 54,0 (50,0-56,0) years (p<0,01). Age at menopause reached 50,3 (48,0-52,0) years, with median duration of menopause of 3,5 (2,0-5,0) years. All participants underwent biochemical blood tests (creatinine (Cr), uric acid (UA), lipid profile, and glucose tolerance test (GTT)). Large elastic artery remodelling was assessed by intima-media thickness (IMT) of common carotid artery (CCA). Non-invasive assessment of endothelial vasoregulatory function involved the measurement of brachial artery (BA) endothelium-dependent vasodilatation (EDVD) in the reactive hyperemia test (RHT). Renal function was assessed by glomerular filtration rate (GFR) and Cr clearance (CrC). Monoalbuminuria (MAU) was qualitatively assessed with a urine strip test. Postmenopausal women were additionally divided into two groups: 23 patients were administered HRT (17β-estradiol 1 mg and drospirenone 2 mg; Angelique medication), while 20 women not receiving HRT comprised a control group. At the end of the study, after 12 months, the assessment of metabolic status, body mass dynamics, endothelial vasoregulatory function, and CCA IMT was repeated. Results. In most postmenopausal women, lipid and carbohydrate metabolism disturbances were observed, which were typical for metabolic syndrome (MS). Lipid metabolism disturbances were observed as early as in premenopause, but reached their maximum during early postmenopause. Postmenopausal women, compared to their peers in premenopause, had significantly higher fasting and postprandial levels of blood glucose. Structural and functional changes in vascular wall were more severe in postmenopausal vs. premenopausal women (p<0,001). While blood flow velocity in the RHT was comparable in both groups, postmenopausal women did not demonstrate a comparable increase in BA EDVD, in contrast to premenopausal females. This could point to the decrease in BA sensitivity to endothelial shear stress among women in postmenopause. Reduced GFR was observed only in postmenopausal women. MAU was registered in premenopausal women with normal GFR, as well as in postmenopausal females. These data on independent role of MAU and reduced GFR suggest an increase in the proportion of women with subclinical renal injury, as a manifestation of target organ damage. Conclusion. The associations between vascular structure and function, renal function, and main MS components were demonstrated. HRT (17β-estradiol 1 mg and drospirenone 2 mg) had beneficial effects on BP dynamics, visceral obesity, metabolic status, and arterial structure and function.