Selección de Resúmenes de Menopausia
Febrero 2010
Juan
Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Semanas
del 24 de Febrero al 2 de Marzo de 2010
Hum Reprod
Update. 2010 Mar-Apr;16(2):131-41.
Epub 2009 Sep 30.
Should the
ovaries be removed or retained at the time of hysterectomy for benign disease?
Hickey M, Ambekar M, Hammond I.
BACKGROUND:
Bilateral oophorectomy is commonly performed at the
time of hysterectomy for benign disease. Indications for oophorectomy
vary, but in most cases relatively little high-quality information is available
to inform the surgeon or patient regarding the relative risks and benefits of
ovarian conservation or removal. This review will address the common clinical
situations when oophorectomy may be performed and
will evaluate the evidence for risk and benefit in each of these circumstances.
The aim of this review is to bring together the evidence regarding oophorectomy in pre- and post-menopausal women and to
highlight the areas needing further study. METHODS: We searched the published
literature for studies related to outcomes following surgical menopause,
risk-reducing surgery for ovarian cancer, surgical treatment for endometriosis,
bilateral oophorectomy for benign disease and
treatment for premenstrual syndrome/premenstrual dysphoric
disorder. RESULTS: Rates of oophorectomy at the time
of hysterectomy for benign disease appear to be increasing. There is good
evidence to support bilateral salpingoophorectomy
(BSO) as a risk-reducing surgery for women at high risk of ovarian cancer, but
relatively little evidence to support oophorectomy or
BSO in other circumstances. There is growing evidence from observational
studies that surgical menopause may impact negatively on future cardiovascular,
psychosexual, cognitive and mental health. CONCLUSION: Clinicians and patients
should fully consider the relative risks and benefits of oophorectomy
on an individual basis prior to surgery.
Climacteric. 2010 Apr;13(2):157-70.
The effects of hormone replacement therapy on
myocardial performance in early postmenopausal women.
Duzenli MA, Ozdemir K, Sokmen A, Gezginc K, Soylu A, Celik C, Altunkeser BB, Tokac M.
Objectives
The results of the studies in which the effect of
hormone replacement therapy (HRT) on cardiac function have been evaluated are
rather disputable. In these studies, cardiac function was evaluated with
conventional echocardiographic methods. This study
was planned in order to investigate the effects of HRT on myocardial velocities
and myocardial performance index (MPI) in healthy early postmenopausal women.
Method In a prospective, controlled study, 60 healthy postmenopausal women were
assigned to two groups (32 in the HRT group and 28 in the control group). After
conventional echocardiographic parameters were
measured, tissue Doppler echocardiography recordings were obtained from the
mitral and tricuspid annulus. Systolic myocardial velocity (Sm),
early and late diastolic myocardial velocities (Em
and Am) and time intervals were measured and MPI was calculated. Then the
symptom-limited exercise stress test using the Bruce protocol was performed.
After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen
+ 2.5 mg medroxyprogesterone acetate/day), the same
examinations were repeated. The effects of HRT on myocardial velocities, MPI
and exercise time were evaluated at the 3rd and 6th months. Results The
parameters of the control group remained statistically unchanged during the
study. HRT did not have any effect on segmental and mean left ventricular (
Joint Bone Spine. 2010 Feb 23. [Epub ahead of print]
Calcium intake and the risk of osteoporosis and
fractures in French women.
Fardellone P, Cotté FE, Roux C, Lespessailles
E, Mercier F, Gaudin AF.
Inserm ERI
12, service de rhumatologie, Amiens University Hospital, CHU Nord, France.
OBJECTIVES:
To evaluate dietary calcium intake in postmenopausal women over 45 years of age
and compare intake according to osteoporosis diagnosis and fracture history.
METHODS: A cross-sectional epidemiological survey of osteoporosis in
postmenopausal women over 45 years in the general population was conducted
using a stratified random sampling method and face-to-face interviews.
Information was collected on osteoporosis diagnosis, fracture history and risk
factors. Information on dietary calcium intake was collected using a validated
questionnaire. RESULTS: Two thousand six hundred and thirty-one women (mean
age: 67.9+/-10.0 years) were included. Two hundred and fifty-four (9.7%) had
received a diagnosis of osteoporosis by bone densitometry, of whom 154 (45.3%)
reported at least one previous fracture. Total mean daily dietary calcium
intake was 754mg/day, of which dairy products (milk, cheese and others) were
the principal source. Overall, 37.2% of the sample consumed<600mg/day and
20.1% >1000mg/d. The proportion of women consuming <600mg/day increased
with age (p=0.0028). No difference in mean daily calcium intake was observed
between women with or without a diagnosis of osteoporosis or with or without
fractures. CONCLUSIONS: Mean dietary calcium intake in this population is well
below that recommended in current national guidelines (>/=1500mg/day),
notably in those most at risk for fractures, such as women with a diagnosis of
osteoporosis or those in older age groups. Intake does not appear to be
influenced by osteoporosis diagnosis or fracture experience.
Clin Endocrinol (Oxf). 2010 Feb 23. [Epub ahead of print]
Does
Calcium Supplementation Increase Cardiovascular Risk?
Reid
IR, Bolland MJ, Grey A.
Department of Medicine, Faculty of Medical and Health Sciences,
University of Auckland, New Zealand.
Abstract
Calcium supplementation is widely used for the prevention of osteoporosis in postmenopausal
women and in men. While there has been ongoing debate regarding its
effectiveness in fracture prevention, the underlying assumption has been that,
even if it was not particularly effective, at least it was safe. The recent
finding of the Auckland Calcium Study that myocardial infarctions were more
common in women randomised to calcium, calls this assumption into question, and
consideration of vascular event data from other calcium trials does not refute
the
N Engl J Med.
2010 Feb 25;362(8):686-96.
Lasofoxifene in postmenopausal
women with osteoporosis.
Cummings
SR, Ensrud K, Delmas PD, LaCroix AZ, Vukicevic S, Reid DM,
et al; PEARL Study Investigators.
BACKGROUND:
The effects of lasofoxifene on the risk of fractures,
breast cancer, and cardiovascular disease are uncertain. METHODS: In this
randomized trial, we assigned 8556 women who were between the ages of 59 and 80
years and had a bone mineral density T score of -2.5 or less at the femoral
neck or spine to receive once-daily lasofoxifene (at
a dose of either 0.25 mg or 0.5 mg) or placebo for 5 years. Primary end points
were vertebral fractures, estrogen receptor (ER)-positive
breast cancer, and nonvertebral fractures; secondary
end points included major coronary heart disease events and stroke. RESULTS: Lasofoxifene at a dose of 0.5 mg per day, as compared with
placebo, was associated with reduced risks of vertebral fracture (13.1 cases
vs. 22.4 cases per 1000 person-years; hazard ratio, 0.58; 95% confidence
interval [CI], 0.47 to 0.70), nonvertebral fracture
(18.7 vs. 24.5 cases per 1000 person-years; hazard ratio, 0.76; 95% CI, 0.64 to
0.91), ER-positive breast cancer (0.3 vs. 1.7 cases per 1000 person-years;
hazard ratio, 0.19; 95% CI, 0.07 to 0.56), coronary heart disease events (5.1
vs. 7.5 cases per 1000 person-years; hazard ratio, 0.68; 95% CI, 0.50 to 0.93),
and stroke (2.5 vs. 3.9 cases per 1000 person-years; hazard ratio, 0.64; 95%
CI, 0.41 to 0.99). Lasofoxifene at a dose of 0.25 mg
per day, as compared with placebo, was associated with reduced risks of
vertebral fracture (16.0 vs. 22.4 cases per 1000 person-years; hazard ratio,
0.69; 95% CI, 0.57 to 0.83) and stroke (2.4 vs. 3.9 cases per 1000
person-years; hazard ratio, 0.61; 95% CI, 0.39 to 0.96) Both the lower and
higher doses, as compared with placebo, were associated with an increase in
venous thromboembolic events (3.8 and 2.9 cases vs.
1.4 cases per 1000 person-years; hazard ratios, 2.67 [95% CI, 1.55 to 4.58] and
2.06 [95% CI, 1.17 to 3.60], respectively). Endometrial cancer occurred in
three women in the placebo group, two women in the lower-dose lasofoxifene group, and two women in the higher-dose lasofoxifene group. Rates of death per 1000 person-years
were 5.1 in the placebo group, 7.0 in the lower-dose lasofoxifene
group, and 5.7 in the higher-dose lasofoxifene group.
CONCLUSIONS: In postmenopausal women with osteoporosis, lasofoxifene
at a dose of 0.5 mg per day was associated with reduced risks of nonvertebral and vertebral fractures, ER-positive breast
cancer, coronary heart disease, and stroke but an increased risk of venous thromboembolic events.
Expert Opin Biol Ther. 2010 Mar;10(3):467-76.
Denosumab--an emerging
treatment for postmenopausal osteoporosis.
Lewiecki EM.
IMPORTANCE
OF THE FIELD: Osteoporosis is a common skeletal disease that is associated with
an imbalance in bone remodeling. Denosumab
is an investigational fully human monoclonal antibody to receptor activator of
NF-kappaB ligand (RANKL), a
cytokine member of the TNF family that is the principal mediator of osteoclastic bone resorption.
AREAS COVERED IN THIS REVIEW: The efficacy and safety of denosumab
in the management of postmenopausal osteoporosis is evaluated by reviewing the
published literature and presentations at scientific meetings through 2009.
WHAT THE READER WILL GAIN: This review focuses on the data on fracture risk
reduction and safety endpoints of denosumab in the
treatment of postmenopausal osteoporosis. TAKE HOME MESSAGE: In postmenopausal
women with osteoporosis, denosumab (60 mg by
subcutaneous injection every 6 months) increased bone mineral density, reduced
bone turnover markers, and reduced the risk of vertebral, hip and non-vertebral
fractures. Denosumab was well tolerated with a safety
profile generally similar to placebo. It is a promising emerging drug for the prevention
and treatment of postmenopausal osteoporosis.
Maturitas. 2010 Mar;65(3):237-243.
Epub 2009 Dec 23.
Menopause
and modifiable coronary heart disease risk factors: A population based study.
Agrinier N, Cournot M, Dallongeville J, Arveiler D, Ducimetière P, Ruidavets JB, Ferrières J.
CHU Nancy,
Epidémiologie et Evaluation Cliniques, Nancy, France.
OBJECTIVES:
The aim of our study was to determine the effect of the menopause on various
coronary heart disease (CHD) risk factors and on the global risk of CHD in a
population based sample of women, making the difference between menopause and
age related effects. STUDY DESIGN: The Third French MONICA cross-sectional
survey on cardiovascular risk included 1730 randomly selected women, aged 35-64
years, representative from the general population.
MAIN OUTCOME MEASURES: Women were defined as post-menopausal (postM; n=696), peri-menopausal (periM; n=183) or pre-menopausal (preM;
n=659) based on the date of last menses. Socio-demographic, clinical and
biological data were collected. Analyses of variance were used to compare
means. RESULTS: PostM women had significantly higher
age-adjusted levels of total cholesterol (6.0mmol/L in postM
vs. 5.7mmol/L in preM, p<0.05) and LDL cholesterol
(3.9mmol/L vs. 3.6mmol/L, p<0.05). There was no difference in HDL
cholesterol or triglyceride levels, glycemia or blood
pressure. Further adjustment on body mass index and hormonal treatments did not
modify the results. No risk factor was significantly different between periM and postM. However, the
Maturitas. 2010 Mar;65(3):272-275.
Epub 2009 Dec 9.
Waist
circumference and serum adiponectin levels in obese
and non-obese postmenopausal women.
Milewicz A, Jędrzejuk D, Dunajska K, Lwow F.
Department. of Endocrinology, Diabetology,
OBJECTIVES:
A proposed missing link between obesity and metabolic disturbances is adiponectin, an adipocyte-derived
peptide. Adiponectin is a potent antidiabetic
hormone and seems to have a beneficial influence on lipid profile as well. The
need to explain the complex physiological roles of this hormone prompted the
authors to study the relationship between adiponectin
level and obesity - related abnormalities in a homogenous population of
postmenopausal women. STUDY DESIGN: The study involved 272 postmenopausal women
aged 50-60 years. Invitations to participate in the study were sent to 4000
randomly chosen women from the
Maturitas. 2010 Mar;65(3):267-271.
Epub 2009 Dec 8.
Exercise
training associated with estrogen therapy induced
cardiovascular benefits after ovarian hormones deprivation.
Flues
K, Paulini J, Brito S, Sanches IC, Consolim-Colombo F, Irigoyen MC, De Angelis K.
Hypertension
Unit, Heart Institute (InCor), University of
Menopause
is recognized as a period of increased risk for coronary heart disease.
Although the benefits of exercise training in lowering cardiovascular risk
factors are well established, the risks and benefits of hormone therapy have
been questioned. The purpose of the present study was to investigate the
effects of estrogen therapy (HT) associated or not
with exercise training (ET) in autonomic cardiovascular control in ovariectomized (OVX) rats. Female rats were divided into:
control, OVX, OVX+HT, OVX+ET and OVX+HT+ET. HT was performed using a 0.25mg
8-weeks sustained release pellet. Trained groups were submitted to an 8-week
exercise training protocol on treadmill. Baroreflex
sensitivity (BRS) was evaluated by heart rate responses to arterial pressure
(AP) changes, and vagal and sympathetic tonus by
pharmacological blockade. Ovariectomy induced an AP
increase (123+/-2mmHg vs. 108+/-2mmHg), BRS impairment (
approximately 69%), sympathetic activation ( approximately 100%) and vagal tonus reduction ( approximately 77%) compared to
controls. HT or ET normalized the changes in parasympathetic tonus. However,
only the association HT+ET was able to promote normalization of AP, BRS and
sympathetic tonus, as compared to controls. These results indicate that ET
induces cardiovascular and autonomic benefits in OVX rats under HT, suggesting
a positive role of this association in the management of cardiovascular risk
factor in postmenopausal women.
Semana del 16 al 23 de Febrero 2010
Menopause. 2010 Feb 12.
[Epub ahead of print]
Estrogen and progestogen use in postmenopausal women: 2010 position
statement of The North American Menopause Society.
OBJECTIVE:: To update for both clinicians
and the lay public the evidence-based position statement published by The North
American Menopause Society (NAMS) in July 2008 regarding its recommendations
for menopausal hormone therapy (HT) for postmenopausal women, with
consideration for the therapeutic benefit-risk ratio at various times through
menopause and beyond. METHODS:: An Advisory Panel of
clinicians and researchers expert in the field of women's health was enlisted
to review the July 2008
Climacteric. 2010 Feb 12.
[Epub ahead of print]
Effect of abrupt discontinuation
versus gradual dose reduction of postmenopausal hormone therapy on hot flushes.
Cunha EP, Azevedo
LH, Pompei LM, Strufaldi R,
Steiner ML, Ferreira JA, Peixoto S, Fernandes CE.
Objective To
compare the effects of the abrupt discontinuation of postmenopausal hormone
therapy (HT) and reduction of the daily dosage of the hormone on climacteric
symptoms. Methods The study included Brazilian
postmenopausal women who were using estrogen-progestogen
hormone therapy in full doses previously prescribed for vasomotor symptoms. The
patients were randomized to receive one of three treatments: placebo for 6
months; estradiol (E2) 1 mg/day + norethisterone
acetate (NETA) 0.5 mg/day for 2 months, followed by placebo for 4 months; or E2
1 mg/day + NETA 0.5 mg/day for 4 months, followed by placebo for 2 months. The
climacteric symptoms were assessed by the Blatt-Kupperman
Menopausal Index at baseline and at 2, 4 and 6 months. Statistical evaluation
was performed using the chi(2) or Fisher's test for
categorical data, the Kruskal-Wallis test for
numerical data, and ANOVA for time and group relationship with the Blatt-Kupperman Menopausal Index. Results We randomized 60 women (20 in each group), and 54 completed
the study. It was observed that both the full Blatt-Kupperman
Menopausal Index and the hot flush score did not change significantly in the HT
group during low-dose therapy compared with baseline; however, the evaluation
performed at 2 months after low-dose-HT cessation showed that the full Blatt-Kupperman Menopausal Index and the hot flush score
were similar to those of the group who stopped HT abruptly and significantly
higher than at baseline (hot flush scores: p < 0.001 for all three groups at
months 2, 4 and 6, respectively, vs. baseline). Conclusion Discontinuation of
HT by reducing the daily dose of estrogen for a period of 2 or 4 months did not
differ in its effect from that of abrupt cessation with regard to vasomotor
symptoms.
J Clin Endocrinol Metab. 2010 Feb 19.
[Epub ahead of print]
Long-Term Use of Bisphosphosphonates in Osteoporosis.
Watts NB, Diab
DL.
Context: Bisphosphonates
have been widely used in the treatment of osteoporosis. Uncommon side effects
have emerged in postapproval use. Because bisphosphonates accumulate in bone and are released for months
or years after treatment is stopped, it is reasonable to consider the clinical
question of how long to treat. Objective: In this personal perspective, we
review the pharmacology and mechanism of action of bisphosphonates
and the clinical studies that support their efficacy. We then review the
literature for longer-term studies and reports of possible side effects that
were not seen in clinical trials. Results: Bisphosphonates
have demonstrated antifracture efficacy in
randomized, placebo-controlled trials of 3 and 4 yr duration and have been
widely used since the initial release of alendronate
in 1995. For zoledronic acid and risedronate,
an early effect (fractures reduced within 6-12 months of starting therapy) has
been shown. A sustained effect for risedronate has
been shown through 5 yr and suggested through 7 yr. Ten-year data with alendronate and 8 yr data with risedronate
indicated good tolerability and safety; it is unlikely that longer-term studies
will be done. Side effects that emerged in clinical trials include esophageal
irritation with oral administration and acute phase response with iv treatment or high-dose oral therapy. Uncommon side
effects that have been noted with wide clinical use include osteonecrosis
of the jaw, musculoskeletal complaints, and atypical fractures. The numbers of
events are small, and a clear cause-and-effect relationship between these
events and bisphosphonate treatment has not been
established. Because bisphosphonates accumulate in
bone, they create a reservoir leading to continued release from bone for months
or years after treatment is stopped. Studies with risedronate
and alendronate suggest that if treatment is stopped
after 3-5 yr, there is persisting antifracture
efficacy, at least for 1-2 yr. Conclusions: Bisphosphonates
are popular and effective for treatment of osteoporosis. Because they
accumulate in bone and provide some residual antifracture
reduction when treatment is stopped, we recommend a drug holiday after 5-10 yr
of bisphosphonate treatment. The duration of
treatment and length of the holiday are based on fracture risk and
pharmacokinetics of the bisphosphonate used. Patients
at mild risk might stop treatment after 5 yr and remain off as long as bone
mineral density is stable and no fractures occur. Higher risk patients should
be treated for 10 yr, have a holiday of no more than a year or two, and perhaps
be on a nonbisphosphonate treatment during that time.
Climacteric. 2010 Feb 10.
[Epub ahead of print]
Correlates of sexual functioning
in Italian menopausal women.
Sarti CD, Graziottin
A, Mincigrucci M, Ricci E, Chiaffarino
F, Bonaca S, Becorpi A, Cipriani S, Parazzini F.
Associazione Ostetrici
Ginecologi Ospedalieri Italiani (AOGOI),
Objectives To
analyze the sexuality of Italian menopausal women. Design Cross-sectional
study. Population Menopausal women consecutively observed during the study
period in menopause clinics. Methods Women were interviewed about their current
and premenopausal sexual activity: sexual intercourse frequency and self-rated
sexual desire, capacity for orgasm and sexual satisfaction were recorded. Women
were defined as having poor sexual functioning if they had one or less sexual
intercourses per week or answered 'absent/poor' to the questions about the
sexual domains. Results Oral hormone therapy (HT) use (odds ratio (OR) 0.43 for
desire, 0.54 for orgasm and 0.56 for overall sexual satisfaction, all p <
0.001) and transdermal HT (OR 0.38, 0.53 and 0.53,
respectively, all p < 0.001) were significantly associated with lower risk
of poor sexual functioning. Higher physical and mental component scores (PCS
and MCS, range 0-100) of the Short Form-12 are inversely related to poor sexual
functioning (OR by point 0.96, 0.95, 0.95 for PCS and 0.96, 0.96 and 0.95, for
MCS, respectively, all p < 0.001). Pain during and symptoms after sexual
intercourse were significantly related to desire (OR 1.96 and 1.78,
respectively), orgasm (OR 2.22 and 2.06, respectively) and sexual satisfaction
(OR 2.02 and 1.79, respectively). The partner's health problems were associated
with low sexual intercourse frequency (OR 4.18, p < 0.001) and absent/poor
overall satisfaction (OR 2.61, p < 0.001). Conclusions This
study shows that, in menopausal Italian women attending menopause clinics,
sexual function is associated with the quality of sexual life in reproductive
age, partner's health status, current quality of life, HT and occurrence of
pain during and symptoms after sexual intercourse.
Breast. 2010 Feb 20.
[Epub ahead of print]
The rise and fall in menopausal hormone
therapy and breast cancer incidence.
Pelucchi C,
Levi F, La Vecchia C.
Istituto di Ricerche Farmacologiche
"Mario Negri", Milan, Italy.
Studies conducted in different areas of
Ann Intern Med. 2010 Feb 16;152(4):211-7.
Coronary heart disease in postmenopausal
recipients of estrogen plus progestin therapy: does the increased risk ever
disappear? A randomized trial.
Toh S, Hernández-Díaz S, Logan R, Rossouw
JE, Hernán MA.
Background: Estrogen plus progestin
therapy increases the risk for coronary heart disease (CHD) in postmenopausal
women. However, this increased risk might be limited to the first years of use
and to women who start therapy late in menopause. Objective: To estimate the
effect of continuous estrogen plus progestin therapy on CHD risk over time and
stratified by years since menopause. Design: Women's Health Initiative
randomized, double-blinded, placebo-controlled trial. (ClinicalTrials.gov
registration number: NCT00000611) Setting: 40
Arthritis Res Ther. 2010 Feb 19;12(1):R30.
[Epub ahead of print]
Bisphosphonates and risk of atrial
fibrillation: a meta-analysis.
Kim SY, Kim MJ, Cadarette
SM, Solomon DH.
ABSTRACT: INTRODUCTION: Bisphosphonates are the most commonly used drugs for the
prevention and treatment of osteoporosis. Although a recent FDA review of the
results of clinical trials reported no clear link between bisphosphonates
and serious or non-serious atrial fibrillation (AF),
some epidemiologic studies have suggested an association between AF and bisphosphonates. METHODS: We conducted a meta-analysis of
non-experimental studies to evaluate the risk of AF associated with bisphosphonates. Studies were identified by searching
MEDLINE and EMBASE using a combination of the Medical Subject Headings and
keywords. Our search was limited to English language articles. The pooled
estimates of odds ratios (OR) as a measure of effect size were calculated using
a random effects model. RESULTS: Seven eligible studies with 266,761 patients
were identified: three cohort, three case-control, and
one self-controlled case series. Bisphosphonate
exposure was not associated with an increased risk of AF [pooled multivariate
OR 1.04, 95% confidence interval (CI) 0.92-1.16] after adjusting for known risk
factors. Moderate heterogeneity was noted (I-squared score=62.8%). Stratified
analyses by study design, cohort versus case-control studies, yielded similar
results. Egger's and Begg's tests did not suggest an
evidence of publication bias (P=0.90, 1.00 respectively). No clear asymmetry
was observed in the funnel plot analysis. Few studies compared risk between bisphosphonates or by dosing. CONCLUSIONS: Our study did
not find an association between bisphosphonate
exposure and AF. This finding is consistent with the FDA's statement.
Int J Cancer. 2010
Feb 16. [Epub ahead of print]
Endometrial cancer incidence
trends in Norway during 1953-2007 and predictions for 2008-2027.
Lindemann K, Eskild
A, Vatten LJ, Bray F.
Department of Obstetrics and Gynaecology, Akershus University
Hospital, 1478 Lørenskog, Norway.
Endometrial cancer is the most common
cancer of the female genital tract in Western countries. Monitoring the
incidence is important for health care planning and the identification of risk factors.We present an age-period-cohort analysis of
incidence trends of endometrial cancer in
Br J Cancer. 2010 Feb 16.
[Epub ahead of print]
Bisphosphonates for
osteoporosis treatment are associated with reduced breast cancer risk.
Newcomb PA, Trentham-Dietz
A, Hampton JM.
University of Wisconsin Paul P
Carbone Comprehensive Cancer Center, 610 Walnut Street, Madison, WI, USA.
BACKGROUND: Bisphosphanates
are used primarily for the prevention and treatment of osteoporosis, and are
also indicated for osseous complications of malignancy. In addition to their
bone resorption properties, the most commonly used
nitrogen-containing bisphosphonate compounds also
inhibit protein prenylation, and thus may exert anti-tumour properties.METHODS: To
evaluate whether the use of these drugs may be associated with cancer,
specifically breast cancer, we conducted a population-based case-control study
in
Semana del 27 de
Enero al 16 de Febrero 2010
Climacteric. 2010 Feb 5. [Epub ahead of print]
Menopausal symptoms
within a Hispanic cohort: SWAN, the Study of Women's Health Across
the Nation.
Green R, Polotsky AJ, Wildman RP, McGinn
AP, Lin J, Derby C, Johnston J, Ram KT, Crandall CJ, Thurston R, Gold E, Weiss
G, Santoro N.
*Department of
Obstetrics, Gynecology & Women's Health.
Introduction Since
the designation of people as Hispanic involves the amalgamation of a number of
different cultures and languages, we sought to test
the hypothesis that menopausal symptoms would differ among Hispanic women,
based upon country of origin and degree of acculturation. Methods A total of 419
women, aged 42-52 years at baseline, were categorized as: Central American (CA,
n = 29) or South American (SA, n = 106), Puerto Rican (PR, n = 56), Dominican
(D, n = 42), Cuban (Cu, n = 44) and non-Hispanic Caucasian (n = 142). We
assessed vasomotor symptoms, vaginal dryness and trouble in sleeping. Hispanics
and non-Hispanic Caucasians were compared using the chi(2)
test, t test or non-parametric alternatives; ANOVA or Kruskal-Wallis
testing examined differences among the five Hispanic sub-groups. Multivariable
regression models used PR women as the reference group. Results Hispanic women
were overall less educated, less acculturated (p < 0.001 for both) than
non-Hispanic Caucasians and more of them reported vasomotor symptoms
(34.1-72.4% vs. 38.3% among non-Hispanic Caucasians; p = 0.0293) and vaginal
dryness (17.9-58.6% vs. 21.1% among non-Hispanic Caucasians, p = 0.0287). Among
Hispanics, more CA women reported vasomotor symptoms than D, Cu, SA, or PR
women (72.4% vs. 45.2%, 34.1%, 50.9%, and 51.8%, respectively). More CA (58.6%)
and D women (38.1%) reported vaginal dryness than PR (17.9%), Cu (25.0%) and SA
(31.4%) women. More PR and D women reported trouble in sleeping (66.1 and
64.3%, respectively) compared to CA (51.7%), Cu (36.4%), and SA (45.3%) women.
Conclusion Symptoms associated with menopause among Hispanic women differed by
country of origin but not acculturation. Central American women appear to be at
greatest risk for both vasomotor symptoms and vaginal dryness.
Maturitas. 2010
Feb 3. [Epub ahead of print]
Assessment
of self-esteem in mid-aged women.
Chedraui P, Pérez-López
FR, Mendoza M, Leimberg ML, Martinez
MA, Vallarino V, Hidalgo L.
Academic and Research Department, Hospital Gineco-Obstétrico Enrique C. Sotomayor, Guayaquil, Ecuador;
Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Ecuador.
OBJECTIVE: To
assess self-esteem and affecting factors in a middle-aged Ecuadorian female
population using the Rosenberg Self-Esteem Scale (RSES). STUDY DESIGN: This was
a cross-sectional study in which 149 women (40-59 years) were requested to fill
out the RSES and a general socio-demographic form containing personal and
partner data. RESULTS: Mean age of sample was 47.6+/-5.5 years, a 67.8% had
less than 12 years of schooling and 33.6% were postmenopausal. At the moment of
the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs.
Mean total RSES score was 26.6+/-3.1 (median 26, range 17-35). A 35.6% and
18.1% of women respectively presented total RSES scores below 26 (median) and
25 (25th percentile) suggesting lower self-esteem. Total scores did not differ
when comparing older age, menopausal phases or time since the menopause.
Logistic regression analysis determined that women with lower parity and an
unhealthy partner were related to lower total RSES scores (below the 25th
percentile) suggesting lower self-esteem. CONCLUSIONS: In this mid-aged series
lower self-esteem was not related to the aging process per se yet to
socio-demographic female/male aspects. More research is needed in this regard
that incorporates other sociological aspects.
Climacteric. 2010 Feb 5. [Epub ahead of print]
Adherence
with hormone replacement therapy in menopause.
Fistonic I, Franic D, Popic J, Fistonic N, Maletic A.
Menopause
Clinic, Zagreb, Croatia.
Objective Lack of
adherence to therapy is a common problem in the treatment of various diseases
and conditions and there are many well-documented reasons for it. This study
was conducted to assess the effect of time spent on medical consultation in
relation to the duration of adherence, as well as the reasons to adhere to or
drop out from hormone replacement therapy (HRT). Design and methods Two methods were used, self-filled questionnaires on a
sample of patients and telephone interviews on a sample of doctors. The
questions dealt with a number of personal and gynecological
history variables. The participants were chosen using random sampling from
population lists. A total of 74 participating offices recruited all postmenopausal
patients, regardless of their HRT use and whether they visited the office for a
specific complaint or just for a routine check-up. The doctors were interviewed
regarding the average time spent with a patient, prescribing dilemmas and
counselling on sexuality. Results The main finding was
that the time spent on consultation and the physicians' interest in postmenopause critically influence the patients' adherence.
The effective time spent with patients was in accordance with the National
Health Insurance guidelines for public sector doctors, but it was twice as long
for private sector doctors. Conclusion This study shows that extended medical
consultation promotes better compliance by lowering patient fears, while
trusted authorities seem to be more convincing to patients on the benefits of
HRT and therefore more effective, even if they do not take more time to talk to
patients.
Maturitas. 2010
Feb 1. [Epub ahead of print]
Bone turnover
markers and bone mineral density in hypertensive postmenopausal women on
treatment.
Olmos JM,
Hernández JL, Martínez J, Castillo J, Valero C, Pérez Pajares I, Nan D, González-Macías J.
Department
of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University
of Cantabria, RETICEF, Santander, Spain.
OBJECTIVE: To
evaluate bone mineral density (BMD) and bone metabolism in hypertensive
postmenopausal women, and to differentiate the effect of thiazides
from that of other antihypertensive agents. SUBJECTS AND METHODS: A
community-based population of 636 postmenopausal women, 293 with hypertension
(160 receiving thiazides, and 133 receiving other
antihypertensive treatments), and 343 control women, were evaluated. Serum
levels of aminoterminal propeptide
of type I collagen (P1NP), C-terminal telopeptide of
type I collagen (beta-CTX), 25-hydroxivitamin D, and intact parathyroid hormone
were measured by electrochemiluminiscence. BMD was
determined by DXA, and heel quantitative ultrasound
measurements (QUS) with a gel-coupled device. RESULTS: BMD expressed as Z-score
was higher in both groups of hypertensive women at all locations. Expressed as
g/cm(2), it was also higher in patients on thiazides at femoral neck and lumbar spine. Only in the
latter site, differences remained significant after adjusting for potential
confounding variables, including BMI. Bone turnover markers were lower in both
groups of hypertensive women, although the difference was greater in those on thiazides. After adjusting for potential confounders,
differences remained significant only in the thiazide
group. CONCLUSIONS: Our results add evidence to the idea that thiazides are beneficial to prevent bone loss.
Am J Geriatr Psychiatry. 2010 Feb;18(2):177-86.
Psychiatric
disorders and cognitive dysfunction among older, postmenopausal women: results
from the Women's Health Initiative Memory Study.
Colenda CC, Legault C, Rapp SR, DeBon MW,
Hogan P, Wallace R, Hershey L, Ockene J, Whitmer R, Phillips LS, Sarto GE.
OBJECTIVE: To
estimate the frequency of depressive symptoms and selected psychiatric
disorders in the Women's Health Initiative Memory Study (WHIMS) cohort and
related them to cognitive syndromes. DESIGN: WHIMS was a randomized,
double-blinded, placebo-controlled prevention clinical trial examining whether
opposed and unopposed hormone therapy reduced the risk of dementia in healthy
postmenopausal women. Participants scoring below a designated cutpoint on a cognitive screener received a comprehensive
neuropsychiatric workup and adjudicated outcome of no cognitive impairment,
mild cognitive impairment, or probable dementia. PARTICIPANTS: Seven thousand
four hundred seventy-nine WHIMS participants between age 65 and 79 years and
free of dementia at the time of enrollment in WHIMS.
Five hundred twenty-one unique participants contributed complete data required
for these analyses. MEASURES: Depressive symptoms were measured with the
15-item Geriatric Depression Scale and the presence of selected psychiatric
disorders (major depression, generalized anxiety, and panic and alcohol abuse)
was made using the PRIME-MD. RESULTS: The 18% of women had at least one
psychiatric disorder with depression being the most common (16%) followed by
general anxiety or panic (6%) and alcohol abuse (1%). Depression and the presence
of a psychiatric disorder were associated with impaired cognitive status.
Participants having a psychiatric disorder were more than twice as likely to be
diagnosed with cognitive impairment as those with no psychiatric disorder (odds
ratio = 2.06, 95% confidence interval = 1.17-3.60). Older age, white race, and
diabetes were also associated with cognitive impairment. CONCLUSION: The
frequency of a psychiatric disorder is associated with poorer cognitive
functioning among older women enrolled in WHIMS. That approximately one in five
women had a probable psychiatric disorder, most
typically depression, highlights the need for greater detection and treatment
efforts in this population.
Biochim Biophys Acta. 2010 Jan 25. [Epub ahead of print]
The critical period
hypothesis of estrogen effects on cognition: Insights
from basic research.
Daniel JM, Bohacek J.
Department of
Psychology, Tulane University, New Orleans, LA 70118, USA; Program in
Neuroscience, Tulane University, New Orleans, LA 70118, USA.
BACKGROUND: In
addition to its primary role in reproduction estrogen
impacts brain areas important for cognition, including the hippocampus and
prefrontal cortex. It has been hypothesized that decline in estrogen
levels in women following menopause is associated with, or can exacerbate,
age-related cognitive decline. However, clinical evidence to support a role for
estrogen in preventing cognitive decline in women as
they age is equivocal. The critical period hypothesis of estrogen
effects on cognition, which proposes that estrogen
administration has to be initiated within a critical time period following the
loss of ovarian function in order for it to exert positive effects on the
central nervous system, is offered as one explanation for inconsistencies across
studies. SCOPE OF REVIEW: This review details results from basic research using
rodent models investigating the effects of estrogen
on cognition in the aging female. Emphasis is placed on work investigating
effects of timing of initiation of estrogen administration
on its subsequent efficacy. MAJOR CONCLUSIONS: Results of basic research
provide support for the critical period hypothesis. Furthermore, results of
work in rodent models suggest mechanisms by which the response to estrogen is altered if treatment is initiated following
long-term ovarian hormone deprivation. GENERAL SIGNIFICANCE: Understanding if
and under what conditions hormone administration following the loss of ovarian
function positively affects the brain and behavior
could have important implications with regard to female cognitive aging.
Results of basic research can contribute to this understanding and provide
insight into the complex mechanisms by which estrogen
affects cognition.
Joint
Bone Spine. 2010 Jan 22.
[Epub ahead of print]
Critical
reappraisal of vitamin D deficiency.
Audran M, Briot K.
Inserm U 922, Unam, service de
rhumatologie, CHU d'Angers, faculté de médecine, pôle ostéoarticulaire, Angers,
France.
The current surge of
interest in vitamin D is fuelled not only by evidence that vitamin D
supplementation decreases the risk of osteoporotic fractures but also by vast
observational studies indicating a variety of beneficial extraskeletal
effects (including decreases in the risks of cancer, inflammatory diseases, and
even death). Serum 25-hydroxyvitamin D (25(OH)D) assay
is now a highly reliable method for evaluating vitamin D stores in individual
patients. Nevertheless, the normal or desirable 25(OH)D
range for patients seen in everyday clinical practice needs to be more
accurately defined. Maintaining serum 25(OH)D above
75nmol/L is currently recommended to ensure optimal bone health, but higher
levels may be required to obtain some of the extraskeletal
benefits. Naturally occurring vitamin D is by far the most widely used form for
correcting vitamin D deficiency, and the hydroxylated
derivatives have only a few highly specific indications. However, controversy
persists about the optimal modalities of natural vitamin D supplementation in
terms of the type of vitamin (D2 or D3), schedule (once daily or at wider
intervals), and route (oral or injectable). For
chronic supplementation to protect against bone loss, a daily dosage of at
least 800IU seems required. Higher dosages (e.g., 100,000 to 200,000IU every
2months for 6months) may be needed to correct established vitamin D deficiency;
a repeat 25(OH)D assay after 4 to 6months may help to
assess the treatment response and to adjust the subsequent vitamin D dosage.
The current emphasis is on the detection of vitamin D deficiency in the general
population and in subgroups at risk for osteoporosis followed by an assessment
of severity and the initiation of appropriate treatment. From a public health
perspective, supplying at least 800IU per day seems useful and safe.
Am J Obstet Gynecol. 2010 Jan 21. [Epub
ahead of print]
Prevalence,
incidence, and natural history of simple ovarian cysts among women >55 years
old in a large cancer screening trial.
Greenlee RT, Kessel B, Williams CR, Riley TL, Ragard
LR, Hartge P, Buys SS, Partridge EE, Reding DJ.
OBJECTIVE: The
purpose of this study was to measure the occurrence and natural history of
simple ovarian cysts in a cohort of older women. STUDY DESIGN: Simple cysts
were ascertained among a cohort of 15,735 women from the intervention arm of
the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial through 4
years of transvaginal ultrasound screening. RESULTS:
Simple cysts were seen in 14% of women the first time that their ovaries were
visualized. The 1-year incidence of new simple cysts was 8%. Among ovaries with
1 simple cyst at the first screen, 54% retained 1 simple cyst, and 32% had no
cyst 1 year later. Simple cysts did not increase risk of subsequent invasive
ovarian cancer. CONCLUSION: Simple ovarian cysts are fairly common among
postmenopausal women, and most cysts appear stable or resolve by the next
annual examination. These findings support recent recommendations to follow unilocular simple cysts in postmenopausal women without
intervention.
J Neuroimmunol. 2010 Jan 20. [Epub ahead of print]
Ovariectomy, a
model of menopause in rodents, causes a premature aging of the nervous and immune
systems.
Baeza I, De
Castro NM, Giménez-Llort L, De la Fuente M.
Department
of Physiology, Faculty of Biology, Complutense
University of Madrid, Madrid, Spain.
Ovariectomy in
rodents is a good model for mimicking human ovarian hormone loss. This work
studies the consequences of ovariectomy on the
nervous and immune systems in the context of biological aging. Ovariectomy accelerates the process of aging by impairing
the sensorimotor abilities (with loss of muscular vigor and impaired equilibrium and traction capacities) and
the exploratory capacities (with reduction of vertical exploratory activity).
It also leads to a premature immunosenescence with
regard to chemotaxis index, lymphoproliferative
response and natural killer activity, parameters investigated in the spleen and
axillary nodes. Therefore, ovariectomy
deteriorates homeostasis and may be a model of premature aging.
Aging
Male. 2010 Feb 9. [Epub ahead of print]
Clinical
efficacy of Japanese traditional herbal medicine (Kampo)
in patients with late-onset hypogonadism.
Amano T, Imao T, Takemae K.
Department
of Urology, Nagano Red Cross Hospital, Nagano, Japan.
Introduction. In
addition to hormone replacement therapy, non-hormonal therapy, particularly
Japanese traditional herbal medicine (Kampo), has
been used to alleviate the various symptoms of female menopause. The efficacy
and safety of Japanese traditional herbal medicine for male late-onset hypogonadism (LOH) are investigated. Methods.
One hundred fifty-one patients with LOH were treated via the administration of
Japanese traditional herbal medicine. The most appropriate Japanese traditional
herbal medicine was administered to patients according to their pathogenic
alteration. After 4 weeks, the clinical efficacy was evaluated based on
improvement of LOH symptoms and the score of the simplified menopausal index
(SMI). Additionally, predictive factors of efficacy of Japanese traditional
herbal medicine were analyzed. Results. Among 151
patients with LOH, 63 (41.8%) achieved both relief from LOH symptoms and
normalized SMI score (Excellent response group), whereas 44 (29.1%) achieved
either relief from LOH symptoms or normalized SMI score (Fair). However, 44
(29.1%) patients displayed neither relief from LOH symptoms nor normalized SMI
score (Poor). Adverse reactions were observed only in four (2.6%) patients.
Patients displaying excess conditions and mild LOH symptoms appeared to be
superior candidates for Japanese traditional herbal medicine. Conclusion. Japanese traditional herbal medicine is an
effective and safe treatment for LOH.
Menopause. 2010 Feb 5. [Epub ahead of print]
Appetitive
hormones, but not isoflavone tablets, influence
overall and central adiposity in healthy postmenopausal women.
Matvienko OA, Alekel DL, Genschel U, Ritland L, Van Loan MD, Koehler KJ.
From the 1School
of Health, Physical Education, and Leisure Services, University of Northern
Iowa, Cedar Falls; 2Nutrition & Wellness Research Center,
Department of Food Science & Human Nutrition, and 3Department of Statistics,
Iowa State University, Ames, IA; and 4US Department of Agriculture,
Agricultural Research Service, Western Human Nutrition Research Center, University of California, Davis, CA.
OBJECTIVE:: One of the multiple health benefits of soy protein or its
isoflavones may be their purported favorable effect on body composition. We examined the
effect of isoflavones extracted from soy protein on
overall and regional body composition, taking into account appetitive hormones
as potential mediators, as well as the direct effect on appetitive hormones.
METHODS:: This randomized, double-blind,
placebo-controlled multicenter trial included 229 healthy postmenopausal women
(age, 45.8-65 y; body mass index, 24.9 +/- 3.0 kg/m) who consumed placebo or
soy isoflavone (80 or 120 mg/d) tablets for 12
months. We used intent-to-treat analysis to examine changes in body composition
(whole-body lean mass, whole-body fat mass, androidal
fat mass, and androidal-to-gynoidal
fat mass ratio) and appetitive hormones (insulin, leptin,
ghrelin, and adiponectin)
in response to treatment. RESULTS:: Repeated-measures
analysis of variance indicated that soy isoflavone
treatment did not exert a significant effect on body composition measures (P
value from 0.36 to 0.79) or appetitive hormone concentrations; the inclusion of
covariates in statistical models did not alter these results. Independently of
treatment, leptin and ghrelin
related inversely to each body composition measure (P values from 0.044 to
</=0.0001). Adiponectin related inversely to all
fat measures (P values from 0.0004 to <0.0001). Time since last menstrual
period related directly to all fat measures (P values from 0.06 to 0.0055).
Dietary fat contributed to whole-body (P = 0.028) and androidal
(P = 0.017) fat mass. CONCLUSIONS:: Our findings do
not support a favorable effect of soy isoflavone tablets on body composition in healthy
postmenopausal women.
Arch Neurol. 2010
Feb;67(2):195-201.
Prospective
Study of Endogenous Circulating Estradiol and Risk of
Stroke in Older Women.
Lee JS, Yaffe K, Lui LY, Cauley J, Taylor B, Browner W, Cummings S; for the Study of
Osteoporotic Fractures Group.
Division of
Endocrinology, Clinical Nutrition, and Vascular Medicine, Department of
Internal Medicine, University of California Davis, PSSB, Ste G400, 4150 V St,
Sacramento, CA 95817. jswlee@ucdavis.edu.
OBJECTIVE: To test
the hypothesis that circulating endogenous estradiol
is associated with stroke risk in older postmenopausal women. Stroke incidence
increases after menopause, when endogenous estrogen
levels fall, yet exogenous estrogen increases strokes
in older postmenopausal women. The relation between endogenous estrogen and stroke is unclear. DESIGN: Prospective
case-control study. SETTING: Study of Osteoporotic Fractures. Patients or Other
PARTICIPANTS: Women at least age 65 years (99% follow-up) who were not taking estrogen at baseline. MAIN OUTCOME MEASURES: Free estradiol index (FEI) was calculated by dividing total estradiol by sex hormone-binding globulin concentrations
measured in banked baseline serum. Using logistic regression, odds ratios were
estimated for a first-ever atherothrombotic stroke
associated with endogenous FEI in 196 women who had a subsequent validated
stroke (median follow-up, 8 years) compared with 219 randomly selected women
who did not. Potential mediators were assessed in multivariable models.
RESULTS: The age-adjusted odds of atherothrombotic
stroke increased with increasing FEI quartiles (P(trend)
= .007). Women in the highest FEI quartile had an age-adjusted 2.31-fold (odds
ratio, 2.31; 95% confidence interval, 1.28-4.17) higher odds than women in the
lowest quartile. Women with greater central adiposity had a suggestively
stronger association (P = .08). Atherogenic dyslipidemia, type 2 diabetes mellitus, and C-reactive
protein level were potential mediators of this relation. CONCLUSIONS:
Endogenous estradiol level is an indicator of stroke
risk in older postmenopausal women, especially in those with greater central
adiposity. Potential mediators, including atherogenic
dyslipidemia, insulin resistance, and inflammation,
might underlie this association. Whether estradiol,
independent of atherogenic adiposity, influences such
mediators and stroke risk needs to be determined. Estrogen-altering
agents might be harmful or beneficial depending on endogenous estradiol levels, especially in women with greater central
adiposity.
Thorax. 2010 Feb 8. [Epub ahead of print]
Postmenopausal
hormone therapy and asthma onset in the E3N cohort.
Romieu I,
Fabre A, Fournier A, Kauffmann F, Varraso R, Mesrine S, Leynaert B, Clavel-Chapelon F.
National
Instituto of Public Health, Cuernavaca, Mexico.
Background
Epidemiological studies have suggested that female hormones might play a role
in asthma and that menopausal hormone therapy (MHT or hormone replacement
therapy (HRT)) might increase the risk of asthma in postmenopausal women. The
only prospective study addressing this issue reports an increase in the risk of
developing asthma which was similar for oestrogen alone and oestrogen/progestagen treatment. Methods The association between the
use of different types of MHT and the risk of asthma onset in postmenopausal
women was investigated prospectively from 1990 to 2002 by biennial
questionnaires as part of the French E3N cohort study. Asthma onset was
considered to be the time of medical diagnosis of asthma cases occurring during
the follow-up of women who were asthma free at baseline. Cox proportional
hazards models were used, adjusting for potential confounding factors. Results
Among 57 664 women free of asthma at menopause, 569 incident cases of asthma
were identified during 495 448 years of follow-up. MHT was related to an
increased risk of asthma onset (HR=1.20, 95% CI 0.98 to 1.46) among recent
users. The increase in risk of asthma onset was only significant among women
reporting the use of oestrogen alone (HR=1.54, 95% CI 1.13 to 2.09)
particularly in never smokers (HR=1.80, 95% CI 1.15 to 2.80) and women
reporting allergic disease prior to asthma onset (HR=1.86, 95% CI 1.18 to
2.93). A small increase in the risk of asthma onset associated with the use of
oestrogen/progestagen was also observed in these
subgroups. Conclusion Postmenopausal use of oestrogen alone was associated with
an increased rate of newly diagnosed asthma in menopausal women.
Med Sci Sports Exerc. 2010 Feb 4. [Epub ahead of print]
Effect of Exercise
on Oxidative Stress: A 12-Month Randomized, Controlled Trial.
1Department of
Epidemiology, American Cancer Society, Atlanta, GA 2Division of Public Health
Sciences, Fred Hutchinson Cancer Research Center,
Seattle, WA 3Division of Epidemiology and Department of Lab Pathology,
University of Minnesota School of Medicine, Minneapolis, MN 4Center for
Clinical Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine, Philadelphia, PA.
PURPOSE:: This study examined the effect of a yearlong exercise
intervention on F2-isoprostane, a specific marker of lipid peroxidation
and a general marker of oxidative stress. METHODS:: In
a randomized, controlled trial, 173 overweight or obese, postmenopausal,
sedentary women were randomized to an aerobic exercise intervention (60-75%
observed maximal heart rate) for >/= 45 min.d, 5 d.wk (n = 87), or to a stretching control group (n = 86),
on an intent-to-treat basis. Baseline and 12-month measures included: urinary
F2-isoprostane, maximal O2 uptake, body weight, body fat percentage, waist
circumference, and intra-abdominal fat surface area. Urine samples were
available from 172 and 168 women at baseline and 12-months, respectively.
RESULTS:: Over the 12-month study, controls minimally
changed maximal O2 uptake (+0.2%) and body weight (+0.1 kg), whereas exercisers
increased maximal O2 uptake (+13.6%; p-value < 0.0001 versus controls) and
decreased body weight (-1.3 kg; p-value = 0.007 versus controls).
F2-isoprostane increased slightly among controls (+3.3%) and decreased in
exercisers (-6.2%), although the effect was not statistically significant
(p-value = 0.26). In planned subgroup analyses, F2-isoprostane decreased
linearly with gain in maximal O2 uptake (ptrend =
0.005) relative to controls; exercisers who increased maximal O2 uptake >15%
decreased F2-isoprostane 14.1% (pvalue = 0.005 versus
controls). A borderline statistically significant trend was observed between
decreased waist circumference and F2-isoprostane (p-value = 0.06). Similar
subgroup analyses by 12-month changes in body fat percentage, weight, and
intra-abdominal fat were not statistically significant. CONCLUSION:: These findings suggest that aerobic exercise, when
accompanied by relatively marked gains in aerobic fitness, decreases oxidative
stress among previously sedentary older women, and that these effects occur
with minimal change in mass or body composition.