title: Subclinical atherosclerotic risk in endurance-trained premenopausal amenorrheic women.
abstract: OBJECTIVE
  In premenopausal women, amenorrhea contributes to endothelial dysfunction. It is unknown whether this vascular functional change is associated with vascular structural change.
  
  
  METHODS
  This study examined regional and systemic vascular structure and function to gain insight into subclinical atherosclerotic risk in 10 amenorrheic athletes, 18 eumenorrheic athletes, and 15 recreationally active controls. Brachial flow-mediated dilation (FMD) and low flow mediated constriction (L-FMC) were used to measure global endothelial function. Carotid-femoral pulse wave velocity (PWV) was used to measure aortic stiffness. Doppler-ultrasound of the superficial femoral artery (SFA) was used to assess intima-media thickness (IMT) and vessel diameter as indicators of vascular remodeling.
  
  
  RESULTS
  Amenorrheic athletes had significantly lower brachial FMD adjusted for shear stimulus (6.9 ± 1.3%) compared with eumenorrheic athletes (11.0 ± 1.0%) and controls (11.0 ± 1.1%, p = 0.05). Brachial L-FMC (-1.8 ± 4.3%) and aortic PWV (5.0 ± 1.0 m/s) of amenorrheic athletes were similar to those of eumenorrheic athletes (L-FMC, -1.6 ± 4.6%; PWV, 4.6 ± 0.5 m/s) and controls (L-FMC, -1.5 ± 2.8%, p = 0.98; PWV, 5.4 ± 0.7 m/s, p = 0.15). SFA diameters were similar in amenorrheic athletes (5.7 ± 0.7 mm) and eumenorrheic athletes (5.7 ± 0.7 mm), but amenorrheic athletes had larger SFA diameters compared with controls (5.1 ± 0.6 mm, p = 0.04). In amenorrheic athletes, SFA IMT (0.31 ± 0.03 mm) was similar to that of eumenorrheic athletes (0.35 ± 0.07 mm) but significantly thinner compared to that of controls (0.38 ± 0.06, p = 0.01).
  
  
  CONCLUSIONS
  Vascular dysfunction in female amenorrheic athletes is not systemic. Parenthetically, amenorrhea may not prevent favorable peripheral vascular structural adaptations to habitual exercise training.
authors.affiliation: Department of Exercise Science, Syracuse University, Syracuse, NY, USA. Electronic address: Jaimse@syr.edu.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Augustine
authors.affiliation: Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Lefferts
authors.affiliation: SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Jodi N
authors.initials: JN
authors.lastname: Dowthwaite
authors.affiliation: Department of Nutrition, Syracuse University, Syracuse, NY, USA.
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Brann
authors.affiliation: Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
authors.forename: Tom D
authors.initials: TD
authors.lastname: Brutsaert
authors.affiliation: Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Heffernan
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000150:complications* / Q000503:physiopathology; D050197:Atherosclerosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D009518:New York / Q000453:epidemiology; D010807:Physical Endurance / Q000502:physiology*; D010991:Plethysmography; D017697:Premenopause / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D066253:Vascular Remodeling / Q000502:physiology; D059289:Vascular Stiffness / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology*; D055815:Young Adult
keywords: Arterial stiffness; Flow-mediated dilation; Pre-menopausal women; Shear stress; Vascular remodeling