Endothelial Function Tests Among Women Referred for the Heart Clinic: A Glance to Women`s Specific Risk Factors

Background: Endothelial dysfunction is an early manifestation of atherosclerosis. We have previously shown that complicated pregnancies (e.g. gestational diabetes mellitus /hypertension/pre-eclampsia) are related to reduce endothelial function. History of complicated pregnancies (HCP), and malignant breast disease (HMBD) are strongly correlated with future cardiovascular disease in women. We hypothesized that women with remote HCP or HMBD will have reduced endothelial function compared to women without such medical history.

Methods & Results: Between February 2014 to 8/2015, 116 women referred to our Women`s Cardiology Clinic, underwent systematic endothelial function testing (EFT). Assessment of EFT was done using digital pulse amplitude tonometry (ENDOPAT, Itamar Medical, Caesarea, Israel). Reactive hyperemia index (RHI) of ≤1.67 was considered abnormal. Ninety nine women (85.34%) were not pregnant, of them 30 (30.30%) at a mean age of 54.5+ 10.4, had history of HCP. We had data on HMBD in 97 non- pregnant women of them 6 (6.2%) at a mean age of 57.8+9.9 had HMBD, in 5 of them (83.33%) we had data regarding current LV function. Of the women with HCP nearly 60% were hypertensive, 40% had hyperlipidemia and 33% diabetes mellitus. EFT (RHI 2.26+0.76 HCP/ RHI 2.06+0.7 no HCP, p=0.21) did not differ between women with and without HCP.

Among women with and without HMBD, although age and risk factors did not differ, EFT was statistically significant lower, (table 1).

All women with HMBD had current normal LV function.

Conclusions & Implications: In non-pregnant women, we observed that HCP was not associated to impaired EFT results, perhaps due to the small cohort and the shot-term follow- up. On the other hand, women with HMBD, although comparable in age and risk profile to women without such history, and with normal heart function, had significantly reduced EFT. These finding raise the importance of women- specific cardiovascular risk factors.