The relationship between arterial stiffness, Framingham cardiovascular risk score and joint mobility in women transitioning through menopause
Creators: name: Latif, Sarah
Publisher: name: University of the Sunshine Coast, Queensland
Year: 2024
Subjects: arterial stiffness
cardiovascular risk
menopause
perimenopause
joint mobility
Framingham risk score
Cardiovascular medicine and haematology
Medical physiology

description: Cardiovascular disease (CVD) is the leading cause of mortality for women and was responsible for 35% of total deaths in women in the year 2019 (1). There is an inequity between men and women in the detection of CVD due to the majority of clinical trials being conducted in male participants (2). Under representation of women in cardiovascular clinical trials impacts understanding of how female sex hormones, such as oestrogen, contribute to cardiovascular health and how menopause influences disease progression (1, 3). Oestrogen is a cardiometabolic protector (4-6) and during menopause, reduced oestrogen availability may increase CVD risk for women (7, 8). Arterial stiffness is an early indicator of CVD (9-12). Arterial stiffness is higher in postmenopausal women compared to premenopausal women but the influence of oestrogen availability on arterial stiffness is unclear for perimenopause women. (4, 13-16). This is important, because data indicate that 40% of health care professionals are misdiagnosing or delaying appropriate cardiovascular health care in younger women, reflecting the lack of clear guidelines for women of perimenopause status (1, 7, 8, 17). Facilitating appropriate treatment and management earlier is likely to reduce the increasing CVD burden that women face in their postmenopause years. There are a number of methods to assess CVD risk (18, 19). This thesis investigates two methods: measuring arterial stiffness via carotid-femoral pulse wave velocity (the gold standard method) (20), and predicting disease risk in perimenopause women using the Framingham cardiovascular risk score (FRS) (21). The first aim of this study is to explore the relationship between arterial stiffness and FRS in women transitioning through menopause. The study hypothesises that there will be discrepancies between the risk predicted by the two testing methods. One factor which may cause such discrepancies is that menopause status is not considered within the FRS calculation. This thesis will also discuss the relationship between oestrogen and joint mobility. The second aim of this study is to explore the relationship between arterial stiffness and joint mobility in women transitioning through menopause. The study hypothesises that as women transition through menopause (ie: oestrogen levels decrease), joint mobility will also decrease. Ligaments and arteries share similar structural components which are: collagen, elastin and fibrillin (22, 23). Therefore, if oestrogen influences arterial stiffness, it may also influence joint mobility (24, 25). Whilst oestrogen is considered cardioprotective (13, 26), the influence of the menopause transition on CVD risk has not been clearly defined and is therefore not included in risk calculators such as the FRS (13). This thesis suggests two potential solutions to improve risk prediction for women: (1) re-calibrating the FRS to better align with arterial stiffness measures, and (2) determining if joint mobility is also influenced by oestrogen. If joint mobility and arterial stiffness are both influenced by oestrogen availability due to similar structural components, then this may provide mechanistic insight for further research for reducing the CVD burden women face in their postmenopausal years.