Postmenopozal kadınlarda metabolik sendrom ve sistemik inflamasyonun endotel fonksiyonu üzerindeki etkisi

¹Department of Echocardiography, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health
²Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University
³Department of Ultrasound, Shunyi Maternal and Children’s Hospital of Beijng Children’s Hospital
⁴Section of Cardiology, Baylor College of Medicine
⁵Department of Medicine, Indiana University School of Medicine
⁶The Cardiovascular Division Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School

Amaç: Metabolik sendromun (MetS) ve sistemik inflamasyonun endotelyal fonksiyon üzerindeki etkisine ilişkin veriler yetersizdir. Bu çalışmada, postmenopozal kadınlarda MetS ve sistemik inflamasyonun endotel fonksiyonu üzerindeki kombine etkilerini araştırmayı amaçladık.
Yöntemler: Şubat 2019 ile Temmuz 2020 arasında 423 postmenopozal kadın belirlendi. MetS, Uluslararası Diyabet Federasyonu (IDF) kriterlerine göre teşhis edildi ve altta yatan inflamasyonun derecesini değerlendirmek için yüksek hassasiyetli C-reaksiyon proteini (hs-CRP) ölçüldü. Endotel fonksiyonunun ölçümü, bir kolda reaktif hipereminin neden olduğu vazodilatasyonu değerlendirerek ve karşı koldaki
değişiklikleri (reaktif hiperemi indeksi, RHI) ayarlayarak dijital arteriyel tonometri kullanılarak yapıldı.
Bulgular: MetS’li 156 ve MetS’siz 267 hasta vardı. MetS’i olmayan grupla karşılaştırıldığında, MetS’li hastalarda anlamlı olarak daha düşük doğal logaritmik RHI (0.66±0.29’a karşı 0.91±0.31; p<0.001), ancak daha yüksek hs-CRP seviyeleri (0.98 [0.31, 3.54]’e karşı 0.53 [0.20, 2.14]; p<0.001) vardı. Sıralı çok değişkenli analizde, hs-CRP’nin varlığı (ΔR2 =0.047, p=0.004) doğal logaritmik RHI üzerinde anlamlı ve bağımsız bir etkiye sahipti. Ayrıca, hs-CRP*MetS etkileşimi, tam olarak ayarlanmış modelde bile endotel disfonksiyonu ile sinerjistik olarak ilişkiliydi (β=-0.107, %95 CI [-0.161~-0.053], p=0.009).
Sonuç: MetS ve sistemik inflamasyon, postmenopozal kadınlarda endotel disfonksiyonu ile sinerjik olarak ilişkilidir. Bu koşulların her ikisine de sahip olan postmenopozal kadınlar, olumsuz kardiyovasküler olaylar açısından önemli ölçüde daha yüksek risk altında görünmektedir.

Impact of metabolic syndrome and systemic inflammation on endothelial function in postmenopausal women

Hongju Zhang¹, Tao Sun², Yutong Cheng², Jing Zhang³, HaiXia Zhang³, Chayakrit Krittanawong⁴, Edward El-Am⁵, Roukoz Abou Karam⁶, Su Wang², Qian Wang², Ning Ma¹
¹Department of Echocardiography, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health
²Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University
³Department of Ultrasound, Shunyi Maternal and Children’s Hospital of Beijng Children’s Hospital
⁴Section of Cardiology, Baylor College of Medicine
⁵Department of Medicine, Indiana University School of Medicine
⁶The Cardiovascular Division Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School

Objective: Data on the impact of metabolic syndrome (MetS) and systemic inflammation on endothelial function remains scarce. In this study, we aimed to investigate the combined effects of MetS and systemic inflammation on endothelial function in postmenopausal women.
Methods: We identified 423 postmenopausal women from February 2019 through July 2020. MetS was diagnosed according to the International Diabetes Federation (IDF) criteria, and high sensitivity C-reaction protein (hs-CRP) was measured to assess the degree of underlying inflammation. The measurement of endothelial function was using digital arterial tonometry by assessing reactive hyperemia-induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index, RHI).
Results: There were 156 patients with MetS and 267 without MetS. Compared to the group without MetS, patients with MetS had significantly lower natural logarithmic RHI (0.66±0.29 versus 0.91±0.31; p<0.001), but higher levels of hs-CRP (0.98 [0.31, 3.54] versus 0.53 [0.20, 2.14]; p<0.001). In sequential multivariable analysis, the presence of hs-CRP (ΔR2 =0.047, p=0.004) had a significant and independent influence on natural logarithmic RHI. Furthermore, the interaction of hs-CRP*MetS was synergistically associated with endothelial dysfunction even in the fully adjusted model (β=-0.107, 95% CI [-0.161~-0.053], p=0.009).
Conclusion: MetS and systemic inflammation are synergistically associated with endothelial dysfunction in postmenopausal women. Postmenopausal women with both these conditions appear to be at a significantly higher risk for adverse cardiovascular events.

Keywords: Post-menopausal, Metabolic syndrome, Systemic inflammation, Endothelial function

Hongju Zhang, Tao Sun, Yutong Cheng, Jing Zhang, HaiXia Zhang, Chayakrit Krittanawong, Edward El-Am, Roukoz Abou Karam, Su Wang, Qian Wang, Ning Ma. Impact of metabolic syndrome and systemic inflammation on endothelial function in postmenopausal women. . 2022; 50(1): 57-65

Sorumlu Yazar: Ning Ma, China