Hormonal patterns in the genesis of heart failure with preserved ejection fraction in postmenopausal women

Background. Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex condition with various pathophysiological mechanisms that are based on different combinations of age-related changes in the hypothalamic-pituitary-adrenal-gonadal axis, the component of which is a follicle-stimulating hormone (FSH). The relationship between FSH and other sex hormones (SH) for HFpEF in postmenopausal women has not been well studied, which makes our study relevant.

Objective. To evaluate the clinical and echocardiographic parameters of postmenopausal women with different levels of FSH in relation to other SH and biomarkers of immune and sympathetic-adrenal function, as well as fiber formation.

Design and methods. We examined 98 postmenopausal women (67,0 ± 5,2 years old). Using a diastolic stress test, we identified groups with and without HF. In each group the FSH median level was determined. Based on this level, the participants were divided into four subgroups: 1) without HF and FSH level below the median (n = 18), 2) without HF but with FSH above the median (n = 19), 3) with HF and FSH below the median (n = 30), and 4) with HF and FSH above the median (n = 31). Reproductive factors, SH, biomarkers of inflammation, fibrosis and catecholamines were also studied. A correlation analysis between SH and echocardiographic parameters and biomarkers was performed.

Results. Various hormonal patterns in subgroups associated with reproductive factors, heart remodeling, sympathetic-adrenal, immune and fibrotic activity were identified. The best remodeling was observed in the first subgroup with the lowest number of pregnancies, while the worst was seen in the fourth subgroup with late menarche and the lowest reproductive period. An important role of testosterone, progesterone in the genesis of HFpEF was noted. Correlations between SH and echocardiographic and biochemical parameters were also identified.

Conclusion. There is a wide range of circulating sex hormones that determine the variety of phenotypic and clinical manifestations associated with varying degrees of myocardial remodeling, sympathoadrenal, immune and fibrotic activity. The study of the hormonal profile in postmenopausal women contributes to the verification of HFpEF and the timely implementation of personalized preventive therapy.

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