Vascular mechanical properties and endothelial function with special reference to pregnancy and hormonal influences

Sammanfattning: Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity. Early recognition of vascular changes, both structural and functional, may help to identify individuals at risk for CVD. Using modern ultrasound techniques – the echo-tracking technique for assessment of stiffness in large arteries and flow-mediated dilatation of the brachial artery as an indicator of endothelial function, we could demonstrate vascular changes in subjects who were otherwise healthy and who were or have been subjected to conditions with potential impact on their cardiovascular system. Furthermore, vessel wall properties were studied in female patients with Systemic Lupus Erythematosus (SLE) who were void of manifest CVD. Impaired endothelial function was present in normotensive pregnant women with bilateral uterine artery notches (sign of increased resistance in the uteroplacental circulation). Pregnant women with preeclampsia showed endothelial dysfunction as compared to controls; the dysfunction was most pronounced in women with bilateral uterine artery notches. Arterial stiffness was unaffected in both above mentioned groups. In adolescents who as fetuses suffered from intrauterine growth restriction with abnormal blood flow smaller vessel diameters of larger arteries, increased resting heart rate and a lower buffering capacity of the aorta were found, indicating both an alteration of vascular growth and function. No major effect of six months of combined hormone therapy (HT) on arterial stiffness of healthy postmenopausal women could be demonstrated. Yet HT-users among women with SLE had a lower aortic stiffness than non-users. Furthermore, vascular changes, as manifested by increased arterial stiffness and vessel enlargement, were present in SLE patients who were void of CVD and significant atherosclerotic lesions. The findings of vascular changes in the above mentioned groups of subjects may be of importance for the future cardiovascular health of these individuals since early identification provides a possibility for preventive interventions.