Severe pulmonary hypertension in postmenopausal obese women

Abstract

Context: Severe pulmonary hypertension (PH) is a rare disorder triggered by a variety of factors and disease conditions and characterized by a shared pathophysiology. Two decades ago it was widely held that "primary" (idiopathic) pulmonary hypertension (PPH) is a disease of young women. However, we noticed recently in the UCHSC Pulmonary Hypertension Center that women with severe PH are frequently postmenopausal and overweight or obese.

Objectives: To determine whether severe PH is a disease not only of young women but also of postmenopausal women who are overweight or obese.

Design, setting, and participants: The medical records of 541 postmenopausal female patients at the UCHSC Pulmonary Hypertension Center were reviewed. The patients were divided into two groups based on their diagnosis of either primary or secondary PH.

Main outcome measures: The medical records of postmenopausal women with severe PH were further reviewed for history of diabetes, systemic hypertension, and the use of anti-depressants, hormone replacement therapy, combination of anti-depressants and hormone replacement therapy, as well as anorexigens. Laboratory data such as elevated cholesterol, elevated uric acid, and elevated C-reactive protein (CRP) were recorded in these patients, as well as physical exam data to determine the body-mass index (BMI) of the patients.

Results: 56% of all pulmonary hypertensive women who were patients at the UCHSC Pulmonary Hypertension Center were postmenopausal. 39% of postmenopausal women with PPH and 48% with secondary severe PH were obese. In addition, postmenopausal obese women frequently had systemic hypertension and were on hormone replacement therapy as well as antidepressant medication.

Conclusions: Obesity, hormone replacement therapy and anti-depressant therapy may contribute to the development of severe PH in genetically predisposed women. Further investigation, in the form of a prospective, case-control study, is needed to determine whether these factors exert a causative effect in postmenopausal women.