Journal of Nuclear Cardiology

, Volume 15, Issue 4, pp 510–517

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

  • Apurva A. Motivala
  • Patricia A. Rose
  • H. Myra Kim
  • Yolanda R. Smith
  • Catherine Bartnik
  • Robert D. Brook
  • Otto Muzik
  • Claire S. Duvernoy
Original Articles

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 

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References

  1. 1.
    Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics—2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115:e69–171.PubMedCrossRefGoogle Scholar
  2. 2.
    Dionne I, Despres JP, Bouchard C, Tremblay A. Gender difference in the effect of body composition on energy metabolism. Int J Obes Relat Metab Disord 1999;23:312–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Tchernof A, Poehlman ET. Weight gain and menopause. Menopause 2000;7:419–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Tchernof A, Poehlman ET, Despres JP. Body fat distribution, the menopause transition, and hormone replacement therapy. Diabetes Metab 2000;26:12–20.PubMedGoogle Scholar
  5. 5.
    Kolehmainen M, Vidal H, Ohisalo JJ, Pirinen E, Alhava E, Uusitupa MI. Hormone sensitive lipase expression and adipose tissue metabolism show gender difference in obese subjects after weight loss. Int J Obes Relat Metab Disord 2002;26:6–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med 1995;333:677–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996;97:2601–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Martin JW, Briesmiester K, Bargardi A, Muzik O, Mosca L, Duvernoy CS. Weight changes and obesity predict impaired resting and endothelium-dependent myocardial blood flow in postmenopausal women. Clin Cardiol 2005;28:13–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Al Suwaidi J, Higano ST, Holmes DR Jr, Lennon R, Lerman A. Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries. J Am Coll Cardiol 2001;37:1523–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Schindler TH, Nitzsche EU, Schelbert HR, Olschewski M, Sayre J, Mix M, et al. Positron emission tomography-measured abnormal responses of myocardial blood flow to sympathetic stimulation are associated with the risk of developing cardiovascular events. J Am Coll Cardiol 2005;45:1505–12.PubMedCrossRefGoogle Scholar
  11. 11.
    Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000;101:1899–906.PubMedGoogle Scholar
  12. 12.
    Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000;101:948–54.PubMedGoogle Scholar
  13. 13.
    Johnson BD, Shaw LJ, Buchthal SD, Bairey Merz CN, Kim HW, Scott KN, et al. Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: Results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:2993–9.PubMedCrossRefGoogle Scholar
  14. 14.
    von Mering GO, Arant CB, Wessel TR, McGorray SP, Bairey Merz CN, Sharaf BL, et al. Abnormal coronary vasomotion as a prognostic indicator of cardiovascular events in women: Results from the National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004;109:722–5.CrossRefGoogle Scholar
  15. 15.
    Schwaiger M, Muzik O. Assessment of myocardial perfusion by positron emission tomography. Am J Cardiol 1991;67:35D-43D.PubMedCrossRefGoogle Scholar
  16. 16.
    Shah A, Schelbert HR, Schwaiger M, Henze E, Hansen H, Selin C, et al. Measurement of regional myocardial blood flow with N-13 ammonia and positron-emission tomography in intact dogs. J Am Coll Cardiol 1985;5:92–100.PubMedGoogle Scholar
  17. 17.
    Nitzsche EU, Choi Y, Czernin J, Hoh CK, Huang SC, Schelbert HR. Noninvasive quantification of myocardial blood flow in humans. A direct comparison of the [13N]ammonia and the [15O]water techniques. Circulation 1996;93:2000–6.PubMedGoogle Scholar
  18. 18.
    Dorbala S, Hassan A, Heinonen T, Schelbert HR, Di Carli MF. Coronary vasodilator reserve and Framingham risk scores in subjects at risk for coronary artery disease. J Nucl Cardiol 2006;13:761–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Martin JW, Briesmiester K, Bargardi A, Muzik O, Mosca L, Duvernoy CS. Weight changes and obesity predict impaired resting and endothelium-dependent myocardial blood flow in postmenopausal women. Clin Cardiol 2005;28:13–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Hutchins GD, Schwaiger M, Rosenspire KC, Krivokapich J, Schelbert H, Kuhl DE. Non-invasive quantification of regional myocardial blood flow in the human heart using [13N]ammonia and dynamic positron emission tomography imaging. J Am Coll Cardiol 1990;15:1032–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Prior JO, Quinones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005;111:2291–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Lteif AA, Han K, Mather KJ. Obesity, insulin resistance, and the metabolic syndrome: Determinants of endothelial dysfunction in whites and blacks. Circulation 2005;112:32–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. J Am Coll Cardiol 2006;47:1188–95.PubMedCrossRefGoogle Scholar
  24. 24.
    Sinaiko AR, Steinberger J, Moran A, Prineas RJ, Vessby B, Basu S, et al. Relation of body mass index and insulin resistance to cardiovascular risk factors, inflammatory factors, and oxidative stress during adolescence. Circulation 2005;111:1985–91.PubMedCrossRefGoogle Scholar
  25. 25.
    Munzel T, Daiber A, Ullrich V, Mulsch A. Vascular consequences of endothelial nitric oxide synthase uncoupling for the activity and expression of the soluble guanylyl cyclase and the cGMP-dependent protein kinase. Arterioscler Thromb Vasc Biol 2005;25:1551–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Schindler TH, Nitzsche EU, Munzel T, Olschewski M, Brink I, Jeserich M, et al. Coronary vasoregulation in patients with various risk factors in response to cold pressor testing: Contrasting myocardial blood flow responses to short- and long-term vitamin C administration. J Am Coll Cardiol 2003;42:814–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Gillum RF. The epidemiology of resting heart rate in a national sample of men and women: Associations with hypertension, coronary heart disease, blood pressure, and other cardiovascular risk factors. Am Heart J 1988;116:163–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann NY Acad Sci 2006;1083:129–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Esler M, Straznicky N, Eikelis N, Masuo K, Lambert G, Lambert E. Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension 2006;48:787–96.PubMedCrossRefGoogle Scholar
  30. 30.
    Pausova Z. From big fat cells to high blood pressure: A pathway to obesity-associated hypertension. Curr Opin Nephrol Hypertens 2006;15:173–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Wildman RP, Farhat GN, Patel AS, Mackey RH, Brockwell S, Thompson T, et al. Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension 2005;45:187–92.PubMedCrossRefGoogle Scholar
  32. 32.
    Seals DR, Gates PE. Stiffening our resolve against adult weight gain. Hypertension 2005;45:175–7.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2008

Authors and Affiliations

  • Apurva A. Motivala
    • 1
  • Patricia A. Rose
    • 1
  • H. Myra Kim
    • 2
  • Yolanda R. Smith
    • 3
  • Catherine Bartnik
    • 5
  • Robert D. Brook
    • 1
  • Otto Muzik
    • 4
  • Claire S. Duvernoy
    • 1
    • 5
  1. 1.From the Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn Arbor
  2. 2.Center for Statistical Consultation and ResearchUniversity of MichiganAnn Arbor
  3. 3.Department of Obstetrics and GynecologyUniversity of MichiganAnn Arbor
  4. 4.Department of RadiologyChildren’s Hospital of Michigan, Detroit Medical Center, Wayne State UniversityDetroit
  5. 5.Cardiology Section, Veterans Affairs Ann Arbor Healthcare SystemAnn Arbor

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