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Doctoral Thesis
DOI
10.11606/T.5.2005.tde-03102014-143049
Document
Author
Full name
Altamiro Ribeiro Dias Júnior
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2005
Supervisor
Committee
Melo, Nilson Roberto de (President)
Fernandes, César Eduardo
Petti, Domingos Auricchio
Salomao, Antonio Jorge
Wajngarten, Mauricio
Title in Portuguese
Efeitos das terapêuticas com estrogênios eqüinos conjugados ou raloxifeno sobre a rigidez arterial em mulheres na menopausa
Keywords in Portuguese
Complacência
Pós-menopausa/efeitos de drogas
Raloxifeno/uso terapêutico
Terapia de reposição hormonal/efeitos adversos
Terapia de reposição hormonal/métodos
Transtornos cerebrovasculares/patologia
Abstract in Portuguese
INTRODUÇÃO: A rigidez arterial é fator de risco cardiovascular pouco estudado e importante determinante de sobrecarga cardiovascular, estando associada ao envelhecimento. Analisou-se a ação das terapêuticas com estrogênios eqüinos conjugados (EEC) ou raloxifeno sobre os índices de rigidez, com o intuito de se observar a influência destas medicações na rigidez arterial, bem como se as mesmas são capazes de influenciar o envelhecimento vascular bem sucedido. MÉTODOS: Realizou-se estudo duplo cego, randomizado, placebo-controlado, que envolveu sessenta e sete mulheres saudáveis, normotensas e com 1 a 10 anos de menopausa, divididas em três grupos de 24, 25 e 18 mulheres. Estas receberam placebo, 0,625 mg EEC ou 60 mg de raloxifeno, respectivamente, 1 comprimido por dia, por 4 meses consecutivos. Analisou-se a rigidez arterial, através da avaliação das velocidades de onda de pulso carótida-femoral (VOP CF), fêmoro-pediosa (VOP FP), e do índice de amplificação (IA) da pressão sistólica na artéria carótida. RESULTADOS: Não se observou qualquer alteração dos índices de rigidez arterial associada às intervenções farmacológicas no grupo placebo (VOP CF pré x pós: 644 x 626 cm/s, p= 0,09; VOP FP pré x pós: 1006 x 1012 cm/s, p= 0,77; IA pré x pós = 30 x 29%, p= 0,55), no grupo EEC (VOP CF pré x pós: 642 x 600 cm/s, p= 0,11; VOP FP pré x pós: 952 x 971 cm/s, p= 0,66; IA pré x pós: 25 x 32%, p= 0,82) e no grupo raloxifeno (VOP CF pré x pós: 636 x 601 cm/s, p= 0,12; VOP FP pré x pós: 964 x 941 cm/s, p= 0,62; IA pré x pós:25 x 25%, p= 0,65). Apesar da ausência de ação das drogas sobre a rigidez arterial, houve uma correlação significativa entre o grau de rigidez arterial basal e a resposta à intervenção farmacológica, particularmente no grupo EEC, de tal maneira que a redução dos índices de rigidez neste grupo foi proporcional ao nível de rigidez basal, apresentando as seguintes relações: VOP CF (r= -0,602, p= 0,001); VOP FP (r= -0,455, p= 0,022); IA (r= -0,410, p= 0,042). CONCLUSÃO: EEC e raloxifeno não parecem afetar a rigidez arterial de mulheres sadias e normotensas com menos de 10 anos de menopausa
Title in English
Effects of therapies with conjugated equine estrogens or raloxifene on arterial stiffiness in post menopausal women
Keywords in English
Cerebrovascular disease/pathology
Complacence
Hormone replacement therapy /adverse effects
Hormone replacement therapy/methods
Post-menopause/drugs effects
Raloxifene/therapeutic use
Abstract in English
INTRODUCTION: Arterial stiffness has been recognized as a cardiovascular risk factor, an important determinant of the left ventricular overload and a marker of cardiovascular aging. However, the clinical impact of arterial stiffness and how it is affected by hormone therapy has not been fully investigated. This study analyzed the influence of conjugated equine estrogens (CEE) or raloxifene on arterial stiffness and how the may influence successful cardiovascular aging. METHODS: Sixty-seven healthy and normotensive women with 1 to 10 years of menopause were randomly assigned to one of three groups, with 24, 25, and 18 participants. They were given oral placebo, 0,625 mg of conjugated equine estrogen, or 60 mg of raloxifene, respectively, for 4 consecutive months. Arterial stiffness was evaluated by measurement of the carotid-femoral pulse wave velocity (PWV CF) and femoral-dorsalis pedis pulse wave velocity (PWV FP), and the systolic pressure augmentation index (AI) at the carotid artery obtained by applanation tonometry. RESULTS: None of the treatment regimens affected arterial stiffness: placebo (PWV CF before x after: 644 x 626 cm/s, p= 0.09; PWV FP before x after : 1006 x 1012 cm/s, p= 0.77; AI before x after = 30 x 29%, p= 0.55), CEE (PWV CF before x after: 642 x 600 cm/s, p= 0.11; PWV FP before x after: 952 x 971 cm/s, p= 0.66; AI before x after: 25 x 32%, p= 0.82) and raloxifene (PWV CF before x after: 636 x 601 cm/s, p= 0.12; PWV FP before x after: 964 x 941 cm/s, p= 0.62; AI before x afer:25 x 25%, p= 0.65). Despite the absence of statistically significant reduction in arterial stiffness with treatment, there was a significant correlation between basal stiffness and the degree of reduction in the indexes measured, indicating that the higher the basal stiffness, the greater the degree of reduction, particularly in the CEE group: PWV CF (r= -0.602, p= 0.001); PWV FP (r= -0.455, p= 0.022); AI (r= -0.410, p= 0.042). CONCLUSIONS: Conjugated equine estrogen and raloxifene do not seem to affect arterial stiffness of healthy normotensive women with less than 10 years of menopause
 
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Publishing Date
2014-10-03
 
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