Endothelial activation and stress index links to cardiovascular disease in postmenopausal women mediated by arterial stiffness: A cross-sectional study of National Health and Nutrition Examination Survey 1999-2018.

ObjectiveTo investigate the association between the endothelial activation and stress index and cardiovascular disease prevalence among postmenopausal women and to evaluate whether arterial stiffness, assessed by estimated pulse wave velocity, statistically accounts for part of this association.MethodsWe conducted a cross-sectional analysis of 9877 postmenopausal women from the National Health and Nutrition Examination Survey (1999-2018). Endothelial activation and stress index was log-transformed (LnEASIX), and arterial stiffness was assessed using estimated pulse wave velocity. Logistic regression was used to evaluate associations with cardiovascular disease after adjusting for demographic, lifestyle, and clinical factors. Nonlinear trends were explored using restricted cubic splines, and mediation analysis were performed to assess the contribution of estimated pulse wave velocity.ResultsHigher LnEASIX was associated with greater cardiovascular disease prevalence (adjusted odds ratio per unit = 1.62, 95% confidence interval: 1.35-1.95). Risk increased sharply above an LnEASIX threshold of -0.97 (endothelial activation and stress index of approximately 0.38; odds ratio = 2.16, 95% confidence interval: 1.71-2.72). Estimated pulse wave velocity statistically accounted for 4.82% of this association. Associations were stronger in women with diabetes.ConclusionElevated endothelial activation and stress index is associated with increased cardiovascular disease risk in postmenopausal women, with arterial stiffness partially mediating this relationship. These findings highlight the potential utility of endothelial activation and stress index as a practical biomarker for cardiovascular risk assessment and prevention.