title: Does angina vary with the menstrual cycle in women with premenopausal coronary artery disease?
abstract: OBJECTIVE
  To determine whether angina in women with established coronary heart disease varies with changes in hormone concentrations during the menstrual cycle.
  
  
  METHODS
  Subjects were prospectively studied once a week for four weeks.
  
  
  METHODS
  Cardiology outpatient department of tertiary referral centre.
  
  
  METHODS
  Nine premenopausal women, mean (SEM) age 38.89 (2.18) years, with established coronary heart disease, symptomatic angina, and a positive exercise test.
  
  
  METHODS
  Myocardial ischaemia as determined by time to 1 mm ST depression during symptom limited exercise testing. Position in the menstrual cycle was established from hormone concentrations.
  
  
  RESULTS
  The early follicular phase, when oestradiol and progesterone concentrations were both low, was associated with the worst exercise performance in terms of time to onset of myocardial ischaemia, at 290 (79) seconds; the best performance (418 (71) seconds) was when oestrogen concentrations were highest in the mid-cycle (p < 0.05). Similar trends were observed in other measured variables. Progesterone concentrations did not influence exercise performance.
  
  
  CONCLUSIONS
  During the menstrual cycle myocardial ischaemia was more easily induced when oestrogen concentrations were low. This may be important for timing the assessment and evaluating treatment in women with coronary heart disease.
authors.affiliation: The Cardiothoracic Centre, St Thomas' Hospital, London, UK. Guy.Lloyd@btinternet.com
authors.forename: G W
authors.initials: GW
authors.lastname: Lloyd
authors.forename: N R
authors.initials: NR
authors.lastname: Patel
authors.forename: E
authors.initials: E
authors.lastname: McGing
authors.forename: A F
authors.initials: AF
authors.lastname: Cooper
authors.forename: D
authors.initials: D
authors.lastname: Brennand-Roper
authors.forename: G
authors.initials: G
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000097:blood / Q000503:physiopathology*; D003327:Coronary Disease / Q000097:blood / Q000503:physiopathology*; D004958:Estradiol / Q000097:blood / Q000502:physiology; D004967:Estrogens / Q000097:blood / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000097:blood / Q000502:physiology*; D011374:Progesterone / Q000097:blood / Q000502:physiology; D011446:Prospective Studies
chemical_list: D004967:Estrogens; D011374:Progesterone; D004958:Estradiol