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Menstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina

Hiroaki Kawano, MD, PhD; Takeshi Motoyama, MD, PhD; Masamichi Ohgushi, MD, PhD; Kiyotaka Kugiyama, MD, PhD; Hisao Ogawa, MD, PhD; and Hirofumi Yasue, MD, PhD
[+] Article and Author Information

From Kumamoto University School of Medicine, Kumamoto Regional Medical Center, and Kumamoto Aging Research Institute, Kumamoto, Japan.


Acknowledgments: The authors thank the patient volunteers for their outstanding patience and generosity, Yasunori Uragari for expert assistance with statistical analysis, and Noriko Kawano for help in many ways.

Grant Support: By a Grant for Clinical Vascular Function and by a Grant-in-Aid for Scientific Research (A12770346) from the Ministry of Education, Science, and Culture, Japan.

Requests for Single Reprints: Hiroaki Kawano, MD, PhD, Department of Cardiovascular Medicine, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto City 860-8556, Japan; e-mail, koumei@gpo.kumamoto-u.ac.jp.

Current Author Addresses: Drs. Kawano, Motoyama, Kugiyama, and Ogawa: Department of Cardiovascular Medicine, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto City 860-8556, Japan.

Dr. Ohgushi: Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto City 860-0811, Japan.

Dr. Yasue: Kumamoto Aging Research Institute, 6-8-1 Yamamuro, Kumamoto City 860-8518, Japan.

Author Contributions: Conception and design: H. Kawano, H. Yasue.

Analysis and interpretation of the data: H. Kawano, T. Motoyama,

Drafting of the article: H. Kawano, H. Yasue.

Critical revision of the article for important intellectual content: H. Kawano.

Final approval of the article: H. Kawano, T. Motoyama, M. Ohgushi, K. Kugiyama, H. Ogawa, H. Yasue.

Provision of study materials or participants: H. Kawano, T. Motoyama, M. Ohgushi, K. Kugiyama, H. Ogawa, H. Yasue.

Statistical expertise: H. Kawano.

Obtaining of funding: H. Kawano, H. Yasue.

Administrative, technical, or logistic support: K. Kugiyama, H. Ogawa, H. Yasue.

Collection and assembly of data: H. Kawano, T. Motoyama, M. Ohgushi.


Ann Intern Med. 2001;135(11):977-981. doi:10.7326/0003-4819-135-11-200112040-00009
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Background: An abundance of ovarian hormones is assumed to be a major contributor to the low incidence of ischemic heart disease in premenopausal women. However, the effects of ovarian hormones remain undetermined.

Objective: To examine whether the variation in ovarian hormone levels throughout a menstrual cycle affects myocardial ischemia in women with variant angina.

Design: Prospective, observational study.

Setting: University medical center in Japan.

Participants: 10 premenopausal women with variant angina.

Measurements: Frequency of spontaneous ischemic episodes, flow-mediated dilation of brachial artery, and serum levels of estradiol and progesterone.

Results: Frequency of ischemic episodes was highest from the end of the luteal phase to the beginning of the menstrual phase and was lowest in the follicular phase. Flow-mediated vasodilation and estradiol levels were lowest from the end of the luteal phase to the beginning of the menstrual phase and were highest in the follicular phase.

Conclusions: In premenopausal women with variant angina, we documented a cyclic variation in endothelial function and the frequency of myocardial ischemia that was associated with the variation in estrogen levels.

Figures

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Figure 1.
Myocardial ischemic episodes and levels of vasodilation, estradiol, and progesterone in study participants, according to menstrual-cycle phase.

In each panel, individual lines represent the 10 participants. For each participant, the days of the three menstrual phases were adjusted to the mean days (menstrual, 6.0 days; follicular, 9.1 days; luteal, 14.1 days). A. The frequency of spontaneous myocardial ischemic episodes per day. B. Flow-mediated (solid lines) and nitroglycerin-induced (dotted lines) vasodilation levels. C. Serum estradiol level. D. Serum progesterone level.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Scatterplots and smooth curves of serum estradiol levels versus myocardial ischemic episodes.

Smooth curves were fit by using kernel estimation.

Grahic Jump Location

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Summary for Patients

Blood Flow to the Heart Varies during the Menstrual Cycle in Premenopausal Women with Heart Disease

The summary below is from the full report titled “Menstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina.” It is in the 4 December 2001 issue of Annals of Internal Medicine (volume 135, pages 977-981). The authors are H Kawano, T Motoyama, M Ohgushi, K Kugiyama, H Ogawa, and H Yasue.

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