Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome
Abstract
OBJECTIVES: Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. METHODS: Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. RESULTS: Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). CONCLUSIONS: HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A crossover study found that arterial stiffness and central blood pressures decreased in older individuals with TS (29 ± 9 years) after they stopped taking 2 mg oral E2.
“A crossover study found that arterial stiffness and central blood pressures decreased in older individuals with TS (29 ± 9 years) after they stopped taking 2 mg oral E2.358”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [358]
Cites
2018 ESC/ESH Guidelines for the management of arterial hypertension
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy339 · Cited by 10,286 · see citing works
Lang, R., Badano, L., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F., Foster, E., Goldstein, S., Kuznetsova, T., et al. (2015) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2014.10.003 · Cited by 10,093 · see citing works
Hulley, S. (1998) · JAMA · doi:10.1001/jama.280.7.605 · Cited by 6,216 · see citing works
Expert consensus document on arterial stiffness: methodological issues and clinical applications
Laurent, S., Cockcroft, J., Van Bortel, L., Boutouyrie, P., Giannattasio, C., Hayoz, D., Pannier, B., Vlachopoulos, C., Wilkinson, I., Struijker-Boudier, H., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl254 · Cited by 6,077 · see citing works
Lorenz, M. W., Markus, H. S., Bots, M. L., Rosvall, M., & Sitzer, M. (2007) · Circulation · doi:10.1161/circulationaha.106.628875 · Cited by 2,977 · see citing works
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001940 · Cited by 2,885 · see citing works
Gravholt, C. H., Andersen, N. H., Conway, G. S., Dekkers, O. M., Geffner, M. E., Klein, K. O., Lin, A. E., Mauras, N., Quigley, C. A., Rubin, K., et al. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0430 · Cited by 1,101 · see citing works
Inflammatory Biomarkers, Hormone Replacement Therapy, and Incident Coronary Heart Disease
Pradhan, A. D., Manson, J. E., Rossouw, J. E., Siscovick, D. S., Mouton, C. P., Rifai, N., Wallace, R. B., Jackson, R. D., Pettinger, M. B., & Ridker, P. M. (2002) · JAMA · doi:10.1001/jama.288.8.980 · Cited by 680 · see citing works
Acute vascular effects of estrogen in postmenopausal women.
Gilligan, D. M., Badar, D. M., Panza, J. A., Quyyumi, A. A., & Cannon, R. O. (1994) · Circulation · doi:10.1161/01.cir.90.2.786 · Cited by 554 · see citing works
Gravholt, C. H., Juul, S., Naeraa, R. W., & Hansen, J. (1998) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(97)00237-0 · Cited by 548 · see citing works
Ikonomidis, I., Aboyans, V., Blacher, J., Brodmann, M., Brutsaert, D. L., Chirinos, J. A., Carlo, M. D., Delgado, V., Lancellotti, P., Lekakis, J. P., et al. (2019) · European Journal of Heart Failure · doi:10.1002/ejhf.1436 · Cited by 396 · see citing works
Self-citationProspective Study of Oral Contraceptives and Hypertension Among Women in the United States
Chasan-Taber, L., Willett, W. C., Manson, J. E., Spiegelman, D., Hunter, D. J., Curhan, G., Colditz, G. A., & Stampfer, M. J. (1996) · Circulation · doi:10.1161/01.cir.94.3.483 · Cited by 328 · see citing works
Cardiovascular Malformations and Complications in Turner Syndrome
Sybert, V. P. (1998) · PEDIATRICS · doi:10.1542/peds.101.1.e11 · Cited by 326 · see citing works
Effect of 17 beta-estradiol on endothelium-dependent responses in the rabbit.
Gisclard, V., Miller, V. M., & Vanhoutte, P. M. (1988) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1016/s0022-3565(25)24250-1 · Cited by 320 · see citing works
Major Vascular Anomalies in Turner Syndrome: Prevalence and Magnetic Resonance Angiographic Features
Ho, V. B., Bakalov, V. K., Cooley, M., Van, P. L., Hood, M. N., Burklow, T. R., & Bondy, C. A. (2004) · Circulation · doi:10.1161/01.cir.0000142290.35842.b0 · Cited by 316 · see citing works
Mortality associated with hormone replacement therapy in younger and older women
Salpeter, S. R., Walsh, J. M. E., Greyber, E., Ormiston, T. M., & Salpeter, E. E. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.30281.x · Cited by 292 · see citing works
Smulyan, H., Marchais, S. J., Pannier, B., Guérin, A. P., Safar, M. E., & London, G. M. (1998) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(98)00056-4 · Cited by 242 · see citing works
Sweetland, S., Beral, V., Balkwill, A., Liu, B. C., Benson, V. S., Canonico, M., Green, J., & REEVES, G. K. (2012) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2012.04919.x · Cited by 208 · see citing works
Ventriculo-arterial coupling: Concepts, assumptions, and applications
Kass, D. A., & Kelly, R. P. (1992) · Annals of Biomedical Engineering · doi:10.1007/bf02368505 · Cited by 180 · see citing works
Ostberg, J. E., Donald, A. E., Halcox, J., Storry, C., McCarthy, C., & Conway, G. S. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0677 · Cited by 149 · see citing works
Lambadiari, V., Pavlidis, G., Kousathana, F., Varoudi, M., Vlastos, D., Maratou, E., Georgiou, D., Andreadou, I., Parissis, J., Triantafyllidi, H., et al. (2018) · Cardiovascular Diabetology · doi:10.1186/s12933-017-0646-z · Cited by 146 · see citing works
Self-citationLandin-Wilhelmsen, K., Bryman, I., & Wilhelmsen, L. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.9.7818 · Cited by 113 · see citing works
Clinical Importance of Endothelial Function in Arteriosclerosis and Ischemic Heart Disease
Egashira, K. (2002) · Circulation Journal · doi:10.1253/circj.66.529 · Cited by 110 · see citing works
Ostberg, J. E., Storry, C., Donald, A. E., Hosseinzadeh‐Attar, M. J., Halcox, J., & Conway, G. S. (2007) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.02772.x · Cited by 106 · see citing works
Pradhan, A. D., Manson, J. E., & Rossouw, J. E. (2003) · ACC Current Journal Review · doi:10.1016/s1062-1458(02)01008-5 · Cited by 94 · see citing works
Blood pressure in women using oral contraceptives
Dong, W., Colhoun, H. M., & Poulter, N. R. (1997) · Journal of Hypertension · doi:10.1097/00004872-199715100-00003 · Cited by 89 · see citing works
Ikonomidis, I., Lekakis, J. P., Stamatelopoulos, K. S., Markomihelakis, N., Kaklamanis, P. G., & Mavrikakis, M. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.10.042 · Cited by 89 · see citing works
Self-citationElsheikh, M., Bird, R., Casadei, B., Conway, G. S., & Wass, J. A. H. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.2.6384 · Cited by 86 · see citing works
The influence of renal and cardiovascular abnormalities on blood pressure in Turner syndrome
Nathwani, Unwin, Brook, & Hindmarsh (2000) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2000.00961.x · Cited by 80 · see citing works
Cintron, D., Rodriguez-Gutierrez, R., Serrano, V., Latortue-Albino, P., Erwin, P. J., & Murad, M. H. (2017) · Endocrine · doi:10.1007/s12020-016-1046-y · Cited by 74 · see citing works
Structural and functional abnormalities of large arteries in the Turner syndrome
Baguet, J.-P., Douchin, S., Pierre, H., Rossignol, A.-M., Bost, M., & Mallion, J.-M. (2005) · Heart · doi:10.1136/hrt.2004.048371 · Cited by 72 · see citing works
Pulse wave velocity to global longitudinal strain ratio in hypertension
Ikonomidis, I., Katsanos, S., Triantafyllidi, H., Parissis, J., Tzortzis, S., Pavlidis, G., Trivilou, P., Makavos, G., Varoudi, M., Frogoudaki, A., et al. (2018) · European Journal of Clinical Investigation · doi:10.1111/eci.13049 · Cited by 69 · see citing works
Self-citationIkonomidis, I., Pavlidis, G., Katsimbri, P., Andreadou, I., Triantafyllidi, H., Tsoumani, M. E., Varoudi, M., Vlastos, D., Makavos, G., Kostelli, G., et al. (2019) · Clinical Research in Cardiology · doi:10.1007/s00392-019-01443-9 · Cited by 59 · see citing works
Self-citationGiordano, R., Forno, D., Lanfranco, F., Manieri, C., Ghizzoni, L., & Ghigo, E. (2011) · European Journal of Endocrinology · doi:10.1530/eje-11-0002 · Cited by 56 · see citing works
Blood Pressure Effects of the Oral Contraceptive and Postmenopausal Hormone Therapies
Boldo, A., & White, W. B. (2011) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2011.01.008 · Cited by 54 · see citing works
Ikonomidis, I., Tzortzis, S., Papaioannou, T. G., Protogerou, A. D., Stamatelopoulos, K., Papamichael, C. M., Zakopoulos, N. A., & Lekakis, J. (2008) · Journal of Human Hypertension · doi:10.1038/jhh.2008.39 · Cited by 49 · see citing works
Self-citationZhu, X., Bonet, B., Gillenwater, H. H., & Knopp, R. H. (1999) · Proceedings of The Society for Experimental Biology and Medicine · doi:10.1046/j.1525-1373.1999.d01-138.x · Cited by 43 · see citing works
Pulsatile Hemodynamics and Clinical Outcomes in Acute Heart Failure
Sung, S., Yu, W. C., Cheng, H., Chuang, S., Wang, K.-L., Huang, C.-M., & Chen, C. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2011.26 · Cited by 43 · see citing works
Increased aortic stiffness in prepubertal girls with Turner syndrome
De Groote, K., Devos, D., Van Herck, K., De Wolf, D., Van der Straaten, S., Rietzschel, E., Raes, A., Vandekerckhove, K., Panzer, J., De Wilde, H., et al. (2017) · Journal of Cardiology · doi:10.1016/j.jjcc.2016.03.006 · Cited by 41 · see citing works
Subclinical left ventricular dysfunction in normotensive women with Turner’s syndrome
Andersen, N. H., Hjerrild, B. E., Sørensen, K., Pedersen, E. M., Stochholm, K., Gormsen, L. C., Hørlyck, A., Christiansen, J. S., & Gravholt, C. H. (2006) · Heart · doi:10.1136/hrt.2005.081471 · Cited by 36 · see citing works
Vasculopathy in the Young Turner Syndrome Population
Lawson, S. A., Urbina, E. M., Gutmark‐Little, I., Khoury, P. R., Gao, Z., & Backeljauw, P. F. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1140 · Cited by 31 · see citing works
Major vascular anomalies in Turner syndrome: Prevalence and magnetic resonance angiographic features
Ho, V., Bakalov, V. K., & Cooley, M. (2005) · ACC Current Journal Review · doi:10.1016/j.accreview.2004.12.006 · Cited by 30 · see citing works
Devos, D. G. H., De Groote, K., Babin, D., Demulier, L., Taeymans, Y., Westenberg, J. J., Van Bortel, L., Segers, P., Achten, E., De Schepper, J., et al. (2016) · Journal of Cardiovascular Magnetic Resonance · doi:10.1186/s12968-017-0331-0 · Cited by 29 · see citing works
Ikonomidis, I., Frogoudaki, A., Vrettou, A., Andreou, I., Palaiodimou, L., Katogiannis, K., Liantinioti, C., Vlastos, D., Zervas, P., Varoudi, M., et al. (2019) · Thrombosis and Haemostasis · doi:10.1055/s-0039-1694752 · Cited by 27 · see citing works
Self-citationImpaired Vascular Function of the Aorta in Adolescents with Turner Syndrome
An, H. S., Baek, J. S., Kim, G. B., Lee, Y. A., Song, M. K., Kwon, B. S., Bae, E. J., & Noh, C. I. (2016) · Pediatric Cardiology · doi:10.1007/s00246-016-1478-4 · Cited by 23 · see citing works
Left ventricular thickness is increased in nonhypertensive Turner's syndrome
Sozen, A. B., Cefle, K., Kudat, H., Ozturk, S., Oflaz, H., Akkaya, V., Palanduz, S., Demirel, S., Ozcan, M., Goren, T., et al. (2009) · Echocardiography · doi:10.1111/j.1540-8175.2009.00902.x · Cited by 19 · see citing works
Uçar, A., Öz, F., Baş, F., Oflaz, H., Nişli, K., Tuğrul, M., Yetim, A., Darendelıler, F., Saka, N., Poyrazoğlu, Ş., et al. (2014) · Clinical Endocrinology · doi:10.1111/cen.12626 · Cited by 18 · see citing works
Czarnecka, D., Kawecka−Jaszcz, K., Olszanecka, A., Dembinska-Kiec, A., Malczewska-Malec, M., Zdzienicka, A., & Guevara, I. (2004) · PubMed · Cited by 11 · see citing works
Evaluation of function and structure of arterial wall in girls and young women with Turner syndrome
Radetti, G., Mazzanti, L., Somma, C. D., Salerno, M. C., Gottardi, E., Capalbo, D., Tamburrino, F., & Colao, A. (2015) · Journal of Endocrinological Investigation · doi:10.1007/s40618-015-0268-9 · Cited by 9 · see citing works
Abnormal Aortic Wall Properties in Women with Turner Syndrome
Bons, L. R., van den Hoven, A. T., Malik, M. I., van den Bosch, A. E., McGhie, J. S., Duijnhouwer, A. L., Siebelink, H. J., Hirsch, A., Devos, D., Rietzschel, E. R., et al. (2020) · Aorta · doi:10.1055/s-0040-1714384 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
Vascular function: a key player in hypertension
Tomiyama, H. (2023) · Hypertension Research · doi:10.1038/s41440-023-01354-3 · Cited by 46 · see citing works
Challenges Waiting for an Adult with DSD
Nowotny, H. F., & Reisch, N. (2022) · Hormone Research in Paediatrics · doi:10.1159/000527433 · Cited by 22 · see citing works
Hypertension in Turner syndrome: a review of proposed mechanisms, management and new directions
Jones, L., Blair, J., Hawcutt, D. B., Lip, G. Y. H., & Shantsila, A. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003321 · Cited by 13 · see citing works
Groote, K. D., Patel, S. R., Mortensen, K. H., Witvrouwen, I., Duijnhouwer, A. L., Brown, N. M., Grewal, J., Chatfield, K. C., Dorfman, A. T., & Prakash, S. K. (2025) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32139 · Cited by 6 · see citing works
Diddhenipothage, S. A. D. M., Beck, K. J., Amiyangoda, C. G. K., Bryce, J., Cima, L., Groote, K. D., Deyanova, Y., Globa, E., Herrmann, G., Juul, A., et al. (2025) · Endocrine Connections · doi:10.1530/ec-24-0477 · Cited by 5 · see citing works
Refractory hypertension complicated with Turner syndrome: A case report
Hu, S., Liu, J., Tang, H., Xie, X., & Wei, Y. (2024) · Open Life Sciences · doi:10.1515/biol-2022-0934 · Cited by 1 · see citing works
- Authors
- Peppa, M., Pavlidis, G., Mavroeidi, I., Katogiannis, K., Varoudi, M., Thymis, J., Kostelli, G., Vlastos, D., Plotas, P., Bamias, A., Parissis, J., & Ikonomidis, I.
- Affiliations
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center
- 2nd Department of Cardiology
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Ikonomidis, Ignatios
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2021-06-04
- Volume
- 39
- Issue
- 10
- Pages
- 2051-2057
- ISSN
- 0263-6352 (ISSN-L)
- 1473-5598
- OpenAlex
- W3172850352
- Cited by
- 7
- References
- 50
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- hormone replacement therapy, estrogen therapy, endothelial function, arterial stiffness, myocardial deformation, flow-mediated dilation, pulse wave velocity, carotid intima-media thickness, aortic stiffness, left ventricular global longitudinal strain, cardiovascular risk, central systolic blood pressure, women's health, speckle tracking echocardiography, carotid-femoral pulse wave velocity
- MeSH terms
- Female, Humans, Turner Syndrome, Hormone Replacement Therapy, Carotid Intima-Media Thickness, Vascular Stiffness, Pulse Wave Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
