Beckman, John

Objective Preeclampsia, a hypertensive pregnancy disorder, increases the risk for cardiovascular disease including coronary artery calcification (CAC) as women age. Controversy exists regarding the relationship between bone mineral density (BMD) and CAC in menopausal women. This study was designed to determine and compare the relationship between BMD and CAC in postmenopausal women with defined histories of either normotensive or preeclamptic pregnancies. Methods Women who gave birth in Olmsted County, MN between 1976 and 1982 were identified from their medical record as having a preeclamptic pregnancy (PE, n=40) and were age/parity‐matched with women having normotensive pregnancies (NP, n=40). The study was approved by the IRB at Mayo Clinic and all participants gave written informed consent. Quantitative Computed Tomography was used to assess vertebral (T7‐9) BMD and CAC. Statistical analyses included linear regression with general estimating equation (GEE) to correct for within‐subject correlations. Results Women averaged 35 years since the index pregnancy and were 60 years of age at the time of the study. CAC was significantly greater in women of the PE group (median (25 th , 75 th percentiles: 0 (0, 0.3) NP and 0 (0, 25) PE, P=0.026). There were no significant differences in cortical, trabecular or central BMD between PE and NP groups. However, there was a positive correlation between cortical BMD and CAC in the PE group (ρ=0.336, P=0.042) and a negative correlation between central BMD and CAC in the NP group (ρ=−0.392, P=0.017). Conclusions Although CAC was greater in women with a history PE, BMD did not differ from women with a history of NP. Associations between cortical and central BMD with CAC differed by pregnancy history suggesting that there may be underlying differences in calcium metabolism associated with PE. Support or Funding Information This work was funded by grants from the NIH AG44170, AG034676, UL1 TR000135 and the Mayo Foundation.

Orexin A (OxA) is a hypothalamic neuropeptide involved in regulation of feeding behavior, metabolism, sleep‐wakefulness and emotion. Plasma levels of this peptide increase with age in both men and women. However, little is known about changes in circulating OxA levels during age‐associated, sex‐ specific hormonal changes, such as menopause, or the effect of menopausal hormone therapy (MHT) on OxA levels. No studies have assessed changes of OxA levels after discontinuation of MHT. The objective of this study was to assess plasma OxA during and three years after cessation of either oral conjugated equine estrogen (o‐CEE, n = 17), transdermal 17β‐estradiol (t‐E2; n= 20), or placebo pills and patches (n = 22) in healthy recently menopausal women (> 6 months < 3 years from their menses) who participated in the Kronos Early Estrogen Prevention Study. The plasma OxA was measured by enzyme‐linked immune absorbent assay prior to randomization to treatment (Baseline) and at 12 months, 24 months, 36 months, 48 months after randomization and at 36 months after cessation of study MHT. Data are presented as median with 25 th and 75 th percentile. Baseline plasma levels of OxA did not differ among groups (o‐CEE: 3.02 (2.2–4.4) ng/mL, t‐E2=4.09 (3.6–4.5) ng/mL, Placebo= 3.15 (2.5–6.2) ng/mL. During MHT treatment, women randomized to o‐CEE had higher OxA levels when compared to their baseline values at 24, 36 and 48 months of exposure (4.4 ng/mL (2.5–6.3), 4.1 ng/mL(2.5–7.3), 4.2 ng/mL(3.1–6.5), respectively). Changes of OxA levels in the t‐E2 and placebo groups were variable and did not show a consistent trend over the MHT treatment period. Three years after cessation of MHT, only the o‐CEE group showed significantly higher Ox A levels than during the treatment phase of the trial (treatment 3 year discontinuation median – 48 month treatment median =1.369 ng/mL). Our study suggests that the formulation of MHT, in particular o‐CEE (contain metabolites of estrogen) increases plasma OxA. This is the first study to assess Ox A levels for a period of more than 6 months under MHT and after years of discontinuation. If plasma levels of OxA reflect those in the brain, these results may explain in part the beneficial effects of o‐CEE on mood and other menopausal symptoms in women of KEEPS. An increase in OxA driven by o‐CEE could be a mechanism by which MHT helps women regulate energy metabolism and emotional behavior responses. Support or Funding Information This project was supported by the Mayo Clinic Office of Health Disparities Research and NIH AG 44170. In addition DC was supported by the CTSA Grant Number TL1 TR000137 from the National Center for Advancing Translational Science, a component of the National Institutes of Health.