Cardiovascular medicine
Does angina vary with the menstrual cycle in women with
premenopausal coronary artery disease?
G W Lloyd, N R Patel, E McGing, A F Cooper, D Brennand-Roper, G Jackson
The
Cardiothoracic Centre, 6th Floor East Wing, St Thomas' Hospital,
Lambeth Palace Road, London SE1 7EH, UK
Correspondence to: Dr Lloyd email: Guy.Lloyd{at}btinternet.com
Accepted 28 March 2000
OBJECTIVE
To determine whether angina in women with
established coronary heart disease varies with changes in hormone
concentrations during the menstrual cycle.
DESIGNSubjects were prospectively studied once a week
for four weeks.
SETTINGCardiology outpatient department of tertiary
referral centre.
SUBJECTSNine premenopausal women, mean (SEM) age 38.89 (2.18) years, with established coronary heart disease, symptomatic
angina, and a positive exercise test.
MAIN OUTCOME MEASUREMyocardial 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.
RESULTSThe 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.
CONCLUSIONSDuring 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.
Keywords: myocardial ischaemia; exercise testing; oestradiol; progesterone
© 2000 by Heart
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