Abstract
Introduction. Arterial hypertension (AH) and obesity form a common cardiometabolic phenotype, in which hemodynamic overload, dysfunctional adipose tissue, estrogen deficiency, dyslipidemia, endothelial dysfunction, vascular remodeling, and electrophysiological myocardial instability mutually reinforce each other. Metabolically healthy abdominal obesity (MHAO) presents a particular clinical challenge, as despite the relative preservation of some metabolic parameters, these patients may already exhibit signs of subclinical vascular wall damage and cardiac arrhythmia.
Objective. To study the clinical, instrumental, and laboratory characteristics of the cardiometabolic phenotype in women with hypertension and estrogen deficiency depending on the presence of MHAO and to validate a molecular-clinical model for personalized risk stratification.
Material and methods. A total of 177 women with estrogen deficiency and stage I-II hypertension were examined: 85 patients with hypertension without MHAO and 92 patients with hypertension and MHAO. Clinical examination, anthropometry, lipid profile, estradiol and follicle-stimulating hormone levels, 24-hour blood pressure monitoring, 24-hour Holter ECG monitoring, duplex scanning of the common carotid arteries, and vasomotor response assessment were performed.
Results. Patients with hypertension and MHAO, compared with patients without MZAO, had higher values for body mass index, waist circumference, total cholesterol, low-density lipoprotein cholesterol, triglycerides, and atherogenic index. The incidence of arrhythmia in the groups of patients with hypertension and MHAO and without it, according to Holter ECG monitoring, was 70% versus 54%. Women with MHAO were more likely to have supraventricular and ventricular extrasystoles: 62.5% versus 30% and 27% versus 10%, respectively. Patients with MHAO also had increased common carotid artery diameter, thickened intima-media complex, increased stiffness index, decreased compliance coefficient, and a reduced proportion of normal vasomotor response.
Conclusion. MHAO in women with hypertension and estrogen deficiency cannot be considered a favorable or neutral phenotype. It is associated with dyslipidemia, endothelial dysfunction, vascular remodeling, increased vascular stiffness, and cardiac arrhythmias. For these patients, multi-level risk stratification, combining anthropometric, lipid, hormonal, vascular, and electrophysiological parameters, is advisable.
Keywords
Authors and affiliations
https://elibrary.ru/qumykf
M.M. Khabibulina(1), M.D. Shamilov(1), D.B. Tsurtumiya(2), S.P. Salikova(3),
V.N. Fedorets(4), G.D. Sarkisov(5), E.A. Anokhina(5), M. Nosevits(5), D.A. Grebniakova(5)
1-Ural State Medical University, Ministry of Health of the Russian Federation, Repina St., 3, Yekaterinburg, 620028, Russian Federation;
2-North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of the Russian Federation,
Piskarevsky Prospekt, 47, Saint-Petersburg, 195067, Russian Federation; 3-S.M. Kirov Military Medical Academy, Ministry of Defence
of the Russian Federation, Akademika Lebedeva St., 6, Saint-Petersburg, 194044, Russian Federation; 4Saint-Petersburg State
Pediatric Medical University, Ministry of Health of the Russian Federation, Litovskaya St., 2, Saint-Petersburg, 194100, Russian Federation; 5-Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University»
of the Ministry of Health of the Russian Federation, Ostrovityanova St., 1, bldg. 6, Moscow, 117513, Russian Federation
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