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Sex differences in noninvasive vascular function in the community

Schnabel, Renate B.a; Biener, Moritz P.b; Wilde, Sandraa; Sinning, Christoph R.a; Ojeda, Francisco M.a; Zeller, Tanjaa; Lubos, Editha; Lackner, Karl J.d; Warnholtz, Ascanb; Gori, Tommasob; Espinola-Klein, Christineb; Blankenberg, Stefana; Munzel, Thomasb,e,*; Wild, Philipp S.b,c,e,*

doi: 10.1097/HJH.0b013e328360f755
ORIGINAL PAPERS: Blood vessels

Objective: The relation of noninvasive vascular function to sex, sex hormones, and reproductive history in the general population is little understood.

Methods: We simultaneously assessed flow-mediated dilation (FMD) and peripheral arterial tonometry in 454 women (mean age 40.4 ± 16.1 years, age range 19–78 years) and 100 men (mean age 44.7 ± 15.3 years) in a community-based cohort. Plasma estradiol, progesterone, luteinizing hormone, and follicle stimulating hormones were measured, and menstrual cycle and reproductive history were recorded.

Results: Vascular function was blunted in men as compared to women irrespective of menopausal status and adjustment for classical cardiovascular risk factors and hormones. Vascular reactivity changed during the menstrual cycle and correlated with estradiol concentrations for FMD, r = 0.13 and inversely with progesterone for pulse amplitude, r = −0.14, and brachial artery diameter, r = −0.10. Multivariable-adjusted regressions showed a relation of estradiol with FMD, β 0.658, 95% confidence interval (CI) 0.084/1.232, P = 0.025 in women. Age at menarche (β 0.070, 95% CI 0.039/0.101, P < 0.0001) and breastfeeding duration (β −0.006, 95% CI −0.011/−0.001, P = 0.036) were related to brachial artery diameter, age at menarche also to FMD (β −0.455, 95% CI −0.886/−0.023, P = 0.039).

Conclusion: Sex differences in noninvasive conduit and peripheral arterial function with better vascular reactivity in women were not fully explained by female sex hormones and menopausal status. Age at menarche and duration of breastfeeding were also related to vascular function and need further investigation.

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aDepartment of General and Interventional Cardiology, University Heart Center, Hamburg Eppendorf, Hamburg

bDepartment of Medicine 2

cCenter for Thrombosis and Hemostasis

dInstitute of Clinical Chemistry and Laboratory Medicine

eGerman Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany

*Thomas Munzel and Philipp S. Wild contributed equally to the writing of this article.

Correspondence to Renate B. Schnabel, MD, MSc, University Heart Center Hamburg Eppendorf, Department of General and Interventional Cardiology, Martinistr, 52 20246 Hamburg, Germany. Tel: +49 1522 281 6064; fax: +49 40 7410 40163; e-mail:

Abbreviations: CI, confidence interval; FMD; flow-mediated dilation, PAT; peripheral arterial tonometry

Received 18 October, 2012

Revised 19 December, 2012

Accepted 5 March, 2013

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© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins