Original Articles

Journal of Nuclear Cardiology

, Volume 15, Issue 4, pp 510-517

First online:

Cardiovascular risk, obesity, and myocardial blood flow in postmenopausal women

  • Apurva A. MotivalaAffiliated withFrom the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan
  • , Patricia A. RoseAffiliated withFrom the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan
  • , H. Myra KimAffiliated withCenter for Statistical Consultation and Research, University of Michigan
  • , Yolanda R. SmithAffiliated withDepartment of Obstetrics and Gynecology, University of Michigan
  • , Catherine BartnikAffiliated withCardiology Section, Veterans Affairs Ann Arbor Healthcare System
  • , Robert D. BrookAffiliated withFrom the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan
  • , Otto MuzikAffiliated withDepartment of Radiology, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University
  • , Claire S. DuvernoyAffiliated withFrom the Division of Cardiovascular Medicine, Department of Internal Medicine, University of MichiganCardiology Section, Veterans Affairs Ann Arbor Healthcare System Email author 

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Abstract

Background. This study was designed to determine whether overweight or obese status is independently associated with myocardial flow reserve (MFR), an established predictor of cardiovascular mortality, in a group of postmenopausal women with no previous cardiovascular disease. Postmenopausal women are the largest group of overweight and physically inactive individuals in the United States. Increased body mass index (BMI) is consistently associated with increased cardiovascular mortality in this population. Whether this is because of obesity itself or the accompanying increase in cardiovascular risk factors (CRFs) remains controversial.

Methods. We examined the relationship of myocardial blood flow (MBF), coronary vascular resistance, and MFR to BMI in 60 postmenopausal women with no coronary heart disease. Subjects underwent dynamic N-13 ammonia positron emission tomography for the measurement of MBF and MFR. Baseline demographics, CRF, and hemodynamic parameters were recorded for each subject. Datasets were divided into 3 groups according to BMI: normal (18 to 24), overweight (25 to 29), and obese (≥30).

Results. The overweight and obese groups showed significantly higher resting MBF and lower MFR than the normal-weight group (both P<.001), even after adjusting for CRF. A further analysis of subjects without any CRF (n=35) showed that the MFR remained significantly lower in the obese compared with normal-weight subjects (P=.05). Levels of known markers of vascular inflammation (high-sensitivity C-reactive protein and homocysteine) and high-density lipoprotein cholesterol levels correlated with declining MFR.

Conclusions. These findings provide a mechanistic link between obesity and coronary heart disease in this population.

Key Words

Cardiovascular risk obesity myocardial blood flow postmenopausal women