SAT-LB99 Inflammation May Mediate Coronary Artery Disease in Women With Hypothalamic Hypoestrogenemia: Findings From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Background: Among premenopausal women presenting with ischemia, hypothalamic hypoestrogenemia (HHE) has been associated with angiographic coronary artery disease (CAD). Further, serum amyloid-alpha (SAA), a marker of systemic inflammation strongly predicts future adverse cardiovascular events. We sought to relate inflammatory markers to HHE and understand if inflammation mediates relations between HHE and CAD. Methods: We assessed premenopausal women not on exogenous hormones undergoing coronary angiography for suspected ischemia. HHE was defined as estradiol<50 pg/ml, luteinizing hormone<10 IU/l and follicle stimulating hormone<10 IU/l. Serum inflammatory markers, reproductive hormones, and angiographic CAD were measured. Results: Overall, 40 (31%) of the 127 women had HHE with similar age and body mass index compared to no HHE (p=0.48 and p=0.77, respectively). Women with HHE had lower estradiol compared to no HHE (30.4+11.7 vs 112.5+62.4 pg/ml, p<0.0001). There were no significant differences between high sensitivity C-reactive protein (hsCRP) (0.86 ± 1.45 vs 0.65 ± 1.17, p=0.5211) and interleukin 6 (IL-6) (4.95 ± 6.06 vs 3.90 ± 3.90, p=0.2358). However, HHE women had significantly higher SAA compared to no HHE (4.44+13.5 vs 0.94+2.37, p=0.0495). Conclusion: Among premenopausal women undergoing coronary angiography for suspected myocardial ischemia, SAA levels were significantly elevated in women with HHE, suggesting that inflammation may serve as a mediator between HHE and CAD. Further investigation relative to inflammation as a treatment target in this cohort may be warranted.