Selección de Resúmenes de Menopausia
Noviembre de 2008
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Semana del 12 al 18 de Noviembre 2008
Climacteric. 2008 Nov
10:1-10. [Epub ahead of print]
Effect of
endogenous estradiol levels on bone resorption and bone mineral density in healthy
postmenopausal women: a prospective study.
Mastaglia
SR, Bagur A, Royer M, Yankelevich
D, Sayegh F, Oliveri B.
Seccion Osteopatias Medicas, Hospital de
Clinicas, Universidad de Buenos Aires.
Objective To
investigate the effect of endogenous estrogens on bone mineral density (BMD)
and bone markers in postmenopausal women over 24 months. Methods Fifty out of
99 postmenopausal women seen previously were re-assessed after 24 months.
Levels of BMD, bone markers, serum estradiol (E(2)) and total testosterone were
determined. Results BMD decreased in the femoral neck ( approximately 2%) (p
< 0.008), but remained stable in the other skeletal areas; E(2) and serum
Crosslaps (sCTX) decreased by 34% (p < 0.001) and 21% (p < 0.003),
respectively. Women aged </= 65 years exhibited decreased BMD only in the
femoral neck (2%, p < 0.01), without changes in bone markers. Women aged
> 65 years exhibited a decrease in sCTX levels and stable BMD values at all
skeletal sites. E(2) levels decreased similarly in both groups ( approximately
35%). Women with baseline E(2) levels >/= 10 pg/ml showed stable BMD in
spite of their E(2) levels decreasing by 42% (p < 0.001); sCTX decreased by
21% (p < 0.01). Women with baseline E(2) levels < 10 pg/ml showed a 2%
decrease (p < 0.001) in femoral neck BMD and a 19% decrease (p < 0.002)
in E(2) levels, without changes in bone markers. Conclusion Although endogenous
E(2) decreased to around 7 pg/ml in these menopausal women, this level would
seem to be sufficient to maintain BMD in almost all skeletal areas, and to be
more effective in older women.
Menopause. 2008 Nov
7. [Epub ahead of print]
Frequency and severity
of hot flashes and sleep disturbance in postmenopausal women with hot flashes.
Ensrud KE, Stone KL, Blackwell
TL, Sawaya GF, Tagliaferri
M, Diem SJ, Grady D.
Veterans Affairs
Medical Center, Minneapolis, MN; USA.
OBJECTIVE:: To
determine whether greater frequency and severity of hot flashes are independently
associated with insomnia symptoms and objective measures of disrupted sleep
among healthy postmenopausal women with hot flashes. DESIGN:: A baseline
cross-sectional analysis of a multicenter, randomized trial in 217 healthy
postmenopausal women aged 40 to 60 years with hot flashes was conducted. Hot
flash frequency and severity were recorded in a daily diary; frequency of
moderate to severe hot flashes was the primary measure. Insomnia symptoms were
assessed with the Insomnia Severity Index (ISI). Hot flash frequency and
severity and objective parameters of sleep-wake patterns (using a wrist
actigraph) were concurrently measured over an average of seven consecutive
24-hour periods in a subcohort of 112 women. RESULTS:: The mean age of participants
was 54 years, and 80% were white; 33% had an ISI score greater than 14,
consistent with at least moderate insomnia. In multivariable analysis, the mean
ISI score showed a stepwise increase in magnitude with higher frequency of
moderate to severe hot flashes (adjusted mean ISI score, 9.5, 11.4, 11.9, and
13.0 for quartiles 1-4, respectively; P for trend = 0.002). Higher frequency of
moderate to severe hot flashes was also independently associated in a graded
manner with greater nighttime wakefulness (P for trend = 0.028) and a higher
number of long wake episodes (P for trend = 0.008) but was not related to sleep
efficiency, total sleep time, or sleep latency. CONCLUSIONS:: Among healthy
postmenopausal women with hot flashes, frequency of moderate to severe hot
flashes was independently associated in a graded manner with severity of
insomnia symptoms and objective measures of nighttime wakefulness and sleep
fragmentation.
J Natl Cancer Inst. 2008 Nov
11. [Epub ahead of print]
Calcium Plus
Vitamin D Supplementation and the Risk of Breast Cancer.
Chlebowski
RT, Johnson KC, Kooperberg
C, Pettinger
M, et al; the
Women's Health Initiative Investigators.
Background
Although some observational studies have associated higher calcium intake and
especially higher vitamin D intake and 25-hydroxyvitamin D levels with lower
breast cancer risk, no randomized trial has evaluated these relationships.
Methods Postmenopausal women (N = 36 282) who were enrolled in a Women's Health
Initiative clinical trial were randomly assigned to 1000 mg of elemental
calcium with 400 IU of vitamin D(3) daily or placebo for a mean of 7.0 years to
determine the effects of supplement use on incidence of hip fracture.
Mammograms and breast exams were serially conducted. Invasive breast cancer was
a secondary outcome. Baseline serum 25-hydroxyvitamin D levels were assessed in
a nested case-control study of 1067 case patients and 1067 control subjects. A
Cox proportional hazards model was used to estimate the risk of breast cancer
associated with random assignment to calcium with vitamin D(3). Associations between
25-hydroxyvitamin D serum levels and total vitamin D intake, body mass index
(BMI), recreational physical activity, and breast cancer risks were evaluated
using logistic regression models. Statistical tests were two-sided. Results
Invasive breast cancer incidence was similar in the two groups (528 supplement
vs 546 placebo; hazard ratio = 0.96; 95% confidence interval = 0.85 to 1.09).
In the nested case-control study, no effect of supplement group assignment on
breast cancer risk was seen. Baseline 25-hydroxyvitamin D levels were modestly
correlated with total vitamin D intake (diet and supplements) (r = 0.19, P <
.001) and were higher among women with lower BMI and higher recreational
physical activity (both P < .001). Baseline 25-hydroxyvitamin D levels were
not associated with breast cancer risk in analyses that were adjusted for BMI
and physical activity. Conclusions Calcium and vitamin D supplementation did
not reduce invasive breast cancer incidence in postmenopausal women. In
addition, 25-hydroxyvitamin D levels were not associated with subsequent breast
cancer risk. These findings do not support a relationship between total vitamin
D intake and 25-hydroxyvitamin D levels with breast cancer risk.
Arch Intern Med.
2008 Nov 10;168(20):2261-7
10-year probability
of recurrent fractures following wrist and other osteoporotic fractures in a
large clinical cohort: an analysis from the Manitoba Bone Density Program.
Hodsman AB, Leslie WD, Tsang JF, Gamble GD.
Osteoporosis
Program, Department of Medicine, University of Western Ontario, London,
Ontario, Canada.
BACKGROUND: Wrist
fractures are the most prevalent type of fracture occurring in postmenopausal
women. We sought to contrast the probability of recurrent osteoporotic
fractures after a primary wrist fracture with other important primary fracture
sites. METHODS: A historical cohort study comprising 21,432 women 45 years or
older referred for bone mineral density (BMD) testing. Longitudinal health
service records were assessed for the presence of fracture codes before and
after BMD testing (359,737 person-years of observation). RESULTS: A total of
2652 women (12.4%) experienced a primary fracture (wrist, vertebra, humerus,
hip) prior to BMD testing, of which wrist fractures were the largest single
group (1225 [46.2%]). The adjusted hazard ratio (HR) for recurrent osteoporotic
fracture following a primary wrist fracture (HR, 1.58; 95% confidence interval
[CI], 1.29-1.93) was lower than for other primary fractures (HR, 2.66; 95% CI,
2.30-3.08). Primary wrist fractures were not significantly associated with
subsequent hip fractures (adjusted HR, 1.29; 95% CI, 0.88-1.89), whereas other
primary fracture sites were individually and collectively significant
predictors of future hip fractures (HR, 1.72; 95% CI, 1.31-2.26). The 10-year
probability of any recurrent fracture after a primary wrist fracture was 14.2%
(95% CI, 11.9%-16.5%), which was significantly less than for other primary
fractures (spine, 25.7%; hip, 24.9%; humerus, 23.7%; P < .001 for all
comparisons vs wrist) but greater than in those without prior fractures (10.8%;
P < .001). The relationship between BMD and fracture risk was much stronger
after a primary wrist fracture (HR, 2.20 per standard deviation; 95% CI,
1.70-2.80) than after other primary osteoporotic fractures (HR, 1.21; 95% CI,
1.05-1.40), reflecting the dominance of the other fracture information over
BMD. CONCLUSIONS: Wrist fractures are the most common of the clinical
osteoporotic fractures in patients referred for BMD testing. However, the risk
of recurrent fractures in the 10 years following a wrist fracture is substantially
lower than that following other osteoporotic fractures, although it remains
significantly higher than for those who have yet to experience a fracture.
Arch Intern Med.
2008 Nov 10;168(20):2245-53
Inflammatory,
lipid, thrombotic, and genetic markers of coronary heart disease risk in the
women's health initiative trials of hormone therapy.
Rossouw JE, Cushman M, Greenland
P, Lloyd-Jones
DM, Bray P, et
al. Women's Health Initiative Branch.
BACKGROUND:
Clinical trials of postmenopausal hormone therapy (HT) have shown increased
risk of coronary heart disease (CHD) in the first few years after initiation of
therapy and no overall benefit. METHODS: This nested case-control study
evaluates a range of inflammatory, lipid, thrombotic, and genetic markers for
their association with CHD in the 4 years after randomization and assesses
whether any of these markers modified or mediated the initially increased risk
associated with HT in postmenopausal women aged 50 to 79 years at baseline.
Conjugated equine estrogens, 0.625 mg/d, or placebo was given to 10 739
hysterectomized women, and the same estrogen plus medroxyprogesterone acetate,
2.5 mg/d, was given to 16 608 women with an intact uterus. RESULTS: In
multivariate-adjusted analyses of 359 cases and 820 controls in the combined
trials, baseline levels of 12 of the 23 biomarkers studied were associated with
CHD events: interleukin 6, matrix metalloproteinase 9, high-density lipoprotein
cholesterol, low-density lipoprotein cholesterol, total cholesterol,
triglycerides, D-dimer, factor VIII, von Willebrand factor, leukocyte count,
homocysteine, and fasting insulin. Biomarkers tended to be more strongly
associated with CHD in the initial 2 years after randomization. The genetic
polymorphism glycoprotein IIIa leu33pro was significantly associated with CHD.
Baseline low-density lipoprotein cholesterol interacted significantly with HT
so that women with higher levels were at higher risk for CHD when given HT (P =
.03 for interaction). The levels of several biomarkers were changed by HT, but
these changes did not seem to be associated with future CHD events.
CONCLUSIONS: Several thrombotic, inflammatory, and lipid biomarkers were
associated with CHD events in postmenopausal women, but only low-density
lipoprotein cholesterol modified the effect of HT. Further research is needed
to identify the mechanisms by which HT increases the risk of CHD.
Am J Clin Nutr. 2008
Nov;88(5):1304-12
Dietary fat and
breast cancer risk in the European Prospective Investigation into Cancer and
Nutrition.
Sieri S, Krogh V, Ferrari P, Berrino F, Pala V, Thiébaut
AC, Tjřnneland
A, Olsen A, Overvad K, et al
Nutritional
Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan,
Italy.
BACKGROUND:
Epidemiologic studies have produced conflicting results with respect to an association
of dietary fat with breast cancer. OBJECTIVE: We aimed to investigate the
association between fat consumption and breast cancer. DESIGN: We prospectively
investigated fat consumption in a large (n = 319,826), geographically and
culturally heterogeneous cohort of European women enrolled in the European
Prospective Investigation into Cancer and Nutrition who completed a dietary
questionnaire. After a mean of 8.8 y of follow-up, 7119 women developed breast
cancer. Cox proportional hazard models, stratified by age and center and
adjusted for energy intake and confounders, were used to estimate hazard ratios
(HRs) for breast cancer. RESULTS: An association between high saturated fat
intake and greater breast cancer risk was found [HR = 1.13 (95% CI: 1.00, 1.27;
P for trend = 0.038) for the highest quintile of saturated fat intake compared
with the lowest quintile: 1.02 (1.00, 1.04) for a 20% increase in saturated fat
consumption (continuous variable)]. No significant association of breast cancer
with total, monounsaturated, or polyunsaturated fat was found, although trends
were for a direct association of risk with monounsaturated fat and an inverse
association with polyunsaturated fat. In menopausal women, the positive
association with saturated fat was confined to nonusers of hormone therapy at
baseline [1.21 (0.99, 1.48) for the highest quintile compared with the lowest
quintile; P for trend = 0.044; and 1.03 (1.00, 1.07) for a 20% increase in
saturated fat as a continuous variable]. CONCLUSIONS: Evidence indicates a weak
positive association between saturated fat intake and breast cancer risk. This
association was more pronounced for postmenopausal women who never used hormone
therapy.
Maturitas. 2008 Nov
7. [Epub ahead of print]
Hormone replacement
therapy use and the risk of stroke.
Renoux C, Dell'aniello
S, Garbe E, Suissa S.
McGill
Pharmacoepidemiology Research Unit, Jewish General Hospital, McGill University,
Montreal. Ca
OBJECTIVES:
Randomised trials reported an increase risk of stroke with an estrogen plus
progestogen formulation of hormone replacement therapy (HRT). A recent trial
also reported an increased risk with tibolone, a selective tissue estrogenic
activity regulator. METHODS: We used the General Practice Research Database to
conduct a case-control study within a cohort of women aged 50-79 between
January 1987 and October 2006, without history of stroke prior to cohort entry.
We identified all cases of stroke occurring during the study period and
selected up to four controls matched to each case on age, general practice and
year of start in the practice. Information on HRT use during the year preceding
the index date was obtained. Conditional logistic regression was used to
estimate the rate ratios of stroke associated with current use of the different
HRTs. RESULTS: The cohort included 870,286 women, of whom 15,710 experienced a
stroke during follow-up and were matched to 59,958 controls. The adjusted rate
ratio of stroke associated with current use of tibolone relative to non-use of
HRT was 1.08 (95% CI: 0.82-1.44). The rate ratios with current use of estrogens
alone and estrogen plus progestogen were 1.26 (95% CI: 1.10-1.45) and 1.19 (95%
CI: 1.05-1.36) respectively. CONCLUSIONS: We found no evidence of an elevated
risk of stroke associated with the use of tibolone, although the low number of
subjects using tibolone does not permit to rule out a small risk. The small
elevated risk of stroke with estrogens or estrogens plus progestogen is consistent
with that reported in randomised trials.
Maturitas. 2008 Nov
7. [Epub ahead of print]
Postmenopausal
hormone drugs and breast and colon cancer: Nordic countries 1995-2005.
Hemminki E, Kyyrönen P, Pukkala E.
National Research
and Development Centre for Welfare and Health (STAKES), Helsinki, Finland.
OBJECTIVES: The
purpose of this study was to utilize the variation in the level and timing of
the change in postmenopausal hormone therapy (HT) use between the Nordic countries
to assess the population-level impact of decline in HT use on the breast and
colon cancer incidences. METHODS: Nationwide HT-sales data in defined daily
doses (DDDs) per 1000 inhabitant in 1995-
Climacteric.
2008;11(6):498-508.
Low- and
standard-estrogen dosage in oral therapy: dose-dependent effects on insulin and
lipid metabolism in healthy postmenopausal women.
Villa P, Sagnella F, Perri C, Suriano R, Costantini B, Macrí F, Ricciardi L, Lanzone A.
Department of
Obstetrics and Gynecology, Universitŕ Cattolica del Sacro Cuore, Rome, Italy.
OBJECTIVE: To
evaluate the influences of different doses of daily oral unopposed
17beta-estradiol compared with placebo, both on glucose tolerance and lipid
metabolism in healthy postmenopausal women. PATIENTS AND METHODS: Forty-eight
normoinsulinemic postmenopausal women were enrolled in the study. Patients were
assigned to receive randomly 1 mg (group A) or 2 mg (group B) of oral
micronized estradiol therapy daily or to the placebo (group C), for 12 weeks.
RESULTS: The low-dose estradiol treatment determined an improvement of the
peripheral insulin sensitivity, made evident by a significant increase both in
the metabolic index and oral glucose insulin sensitivity index (p < 0.01 and
p < 0.05, respectively) as well as a decrease in the homeostasis model
assessment-estimated insulin resistance (p < 0.01). Conversely, in the
standard-dose group, the metabolic index significantly decreased (p < 0.05),
showing a slight deterioration in insulin sensitivity. For lipid metabolism,
the 1 mg dose showed a neutral effect, while 2 mg had a beneficial effect on
low density lipoprotein cholesterol, but caused an increase in triglycerides (p
< 0.01 and p < 0.05, respectively). CONCLUSIONS: The oral low dose of
unopposed estradiol therapy had a favorable effect on glycoinsulinemic
metabolism in healthy postmenopausal women; however, the standard dose caused a
slight but significant deterioration in insulin sensitivity.
Climacteric.
2008;11(6):509-17
Androgens in
relationship to cardiovascular risk factors in the menopausal transition.
Mesch VR, Siseles NO, Maidana PN, Boero LE, Sayegh F, Prada M, Royer M, Schreier L, et
al.
Faculty of
Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina.
OBJECTIVE: To
establish the relationship between androgens and cardiovascular disease (CVD)
risk factors in the menopausal transition. METHODS: A total of 124 women were
divided into four groups: 29 premenopausal (PreM), 35 women in the menopausal
transition still menstruating (MTM), 29 women in the menopausal transition with
3-6 months amenorrhea (MTA), and 31 postmenopausal women (PostM). Levels of
triglycerides, low density lipoprotein (LDL) cholesterol, high density
lipoprotein (HDL) cholesterol, glucose and insulin were assayed in all samples
and waist circumference was measured. In a subgroup of 83 women (19 PreM, 21
MTM, 28 MTA and 15 PostM), levels of total testosterone, androstenedione,
dehydroepiandrosterone sulfate (DHEAS) and estradiol were determined. The free
androgen index, Homeostasis Model Assessment (HOMA) index, Quantitative Insulin
Sensitivity Check Index (QUICKI) and McAuley index, estradiol/total
testosterone and triglyceride/HDL cholesterol ratios were calculated. RESULTS:
Androstenedione was higher in MTA vs. PostM women (p < 0.05); DHEAS was
higher in PreM women vs. the other three groups (p < 0.05). Sex hormone binding
globulin (SHBG) in MTM women was higher than in MTA women (p < 0.05); the
free androgen index was lower in MTM women than in MTA and PostM women. SHBG
and the free androgen index showed negative and positive correlations,
respectively with waist circumference, insulin resistance and lipids. In a
multiple regression analysis, considering waist circumference, neither free
androgen index nor SHBG showed significant differences between groups. The
waist circumference correlated only with SHBG (p = 0.022) and correlations
between SHBG and insulin resistance markers continued to be significant, but
relationships between SHBG and lipoproteins and all correlations found with
free androgen index were lost. CONCLUSIONS: An increment in the androgenic
milieu that correlates with abdominal fat, insulin resistance and atherogenic
lipoproteins becomes evident after the menopausal transition and suggests that
evaluation of cardiovascular disease risk in these women should include
androgens, considering that abdominal obesity is one of the main determinants
of the relationship between androgenic parameters and cardiovascular risk
factors.
Climacteric.
2008;11(6):489-97
The effect of
continuous combined conjugated equine estrogen plus medroxyprogesterone acetate
and tibolone on cardiovascular metabolic risk factors.
Skouby SO, Sidelmann
JJ, Nilas L, Gram J, Jespersen
J.
Department of
Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Denmark.
OBJECTIVES:
Hormone treatment (HT) after the menopause affects lipid and carbohydrate
metabolism and inflammation and may modify risk factors relevant for the
clinical expression of the metabolic syndrome and cardiovascular disease.
Tibolone has pharmacodynamic properties different from other hormone
preparations. Here, we compare the effect of combined HT and tibolone on
metabolic risk markers for the development of cardiovascular disease. METHODS:
Postmenopausal women were randomly assigned to 1.25 or 2.5 mg/day of tibolone
or oral continuous combined conjugated equine estrogen plus medroxyprogesterone
acetate (CEE/MPA). Cardiovascular risk factors were determined at baseline and
after 12 months of treatment. RESULTS: Body mass index and blood pressure were
unaffected by the HT. HOMA-IR decreased in the CEE/MPA group (3.69 vs. 3.38; p
= 0.02). Treatment with tibolone increased tissue-type plasminogen activator
activity (0.87 IU/ml vs. 1.21 IU/ml; p = 0.005) and C-reactive protein (0.83
mg/l vs. 1.88 mg/l; p < 0.001), and decreased plasminogen activator
inhibitor activity (6.9 IU/ml vs. 2.0 IU/ml; p < 0.001) and triglycerides
(0.99 vs. 0.87 mmol/l; p = 0.004). Both treatments decreased total cholesterol
significantly. CONCLUSIONS: CEE/MPA and tibolone have comparable effects on
most metabolic risk factors investigated. The effect of tibolone on
fibrinolysis and triglycerides suggests that tibolone has a favorable
pharmacological profile on these risk factors when compared to CEE/MPA.
Semana del 4 al 11 de Noviembre de 2008
N Engl J Med. 2008 Nov 6;359(19):2005-17
Testosterone for low libido in postmenopausal women not taking estrogen.
Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, Braunstein GD, Hirschberg AL, et al. APHRODITE Study Team.
BACKGROUND: The efficacy and
safety of testosterone treatment for hypoactive sexual desire disorder in
postmenopausal women not receiving estrogen therapy are unknown. METHODS: We conducted
a double-blind, placebo-controlled, 52-week trial in which 814 women with
hypoactive sexual desire disorder were randomly assigned to receive a patch
delivering 150 or 300 microg of testosterone per day or placebo. Efficacy was
measured to week 24; safety was evaluated over a period of 52 weeks, with a
subgroup of participants followed for an additional year. The primary end point
was the change from baseline to week
Climacteric. 2008 Oct 31:1-8. [Epub ahead of print
Effects of drospirenone on cardiovascular markers in human aortic
endothelial cells.
Seeger H, Wallwiener D, Mueck AO.
University Women's Hospital,
Section of Endocrinology and Menopause,
Objectives The effect of the
new progestogen drospirenone on biochemical markers in terms of cardiovascular
effects was investigated in the presence and absence of aldosterone and
compared to progesterone and the progestogens medroxyprogesterone acetate (MPA)
and promegestone (R5020), and the antimineralocorticoid spironolactone. Methods
Human female aortic endothelial cells were used for the experiments. The
progestogens were tested alone at 0.1 and 10 mumol/l and in combination with
aldosterone at a concentration of 10 mumol/l. The adhesion molecule E-selectin,
the chemokine monocyte attracting protein-1 (MCP-1) and plasminogen activator
inhibitor-1 (PAI-1) were chosen as markers. Results In combination with
aldosterone, spironolactone, drospirenone, progesterone and R5020 were able to
inhibit the aldosterone-induced increase in MCP-1 concentration, the effect
being greatest for spironolactone. In contrast, MPA did not show any
significant effect. For E-selectin, similar results were found; however, R5020
and MPA were not able to act antagonistically. Spironolactone, drospirenone and
progesterone were able to significantly reduce the aldosterone-induced
stimulation of PAI-1. For MPA and R5020, no significant effect was found.
Conclusions The new progestogen drospirenone seems to have favorable effects on
the cardiovascular system due to its antimineralocorticoid property. Clinical
studies must prove the results of this in vitro experiment.
Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):3116-22.
Migraine in postmenopausal women and the risk of invasive breast cancer.
Mathes RW, Malone KE, Daling JR, Davis S, Lucas SM, Porter PL, Li CI.
BACKGROUND: The frequency of
migraine headache changes at various times of a woman's reproductive cycle.
Menarche, menses, pregnancy, and perimenopause may carry a different migraine
risk conceivably because of fluctuating estrogen levels, and in general,
migraine frequency is associated with falling estrogen levels. Given the strong
relationship between endogenous estrogen levels and breast cancer risk,
migraine sufferers may experience a reduced risk of breast cancer. METHODS: We
combined data from two population-based case-control studies to examine the
relationship between migraine and risk of postmenopausal invasive breast cancer
among 1,199 ductal carcinoma cases, 739 lobular carcinoma cases, and 1,474
controls 55 to 79 years of age. Polytomous logistic regression was used to
estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Women
who reported a clinical diagnosis of migraine had reduced risks of ductal
carcinoma (OR, 0.67; 95% CI, 0.54-0.82) and lobular carcinoma (OR, 0.68; 95%
CI, 0.52-0.90). These associations were primarily limited to hormone
receptor-positive tumors as migraine was associated with a 0.65-fold (95% CI,
0.51-0.83) reduced risk of estrogen receptor-positive (ER(+))/progesterone
receptor-positive (PR(+)) ductal carcinoma. The reductions in risk observed
were seen among migraine sufferers who did and did not use prescription
medications for their migraines. CONCLUSIONS: These data suggest that a history
of migraine is associated with a decreased risk of breast cancer, particularly
among ER(+)/PR(+) ductal and lobular carcinomas. Because this is the first
study to address an association between migraine history and breast cancer
risk, additional studies are needed to confirm this finding.
Arch Gerontol Geriatr. 2008 Nov 4. [Epub
ahead of print
Response of oxidative stress markers and antioxidant parameters to an
8-week aerobic physical activity program in healthy, postmenopausal women.
Karolkiewicz J, Michalak E, Pospieszna B, Deskur-Śmielecka E, Nowak A, Pilaczyńska-Szcześniak
L.
University School of Physical
Education, Królowej Jadwigi str. 27/39, 61-871 Poznań, Poland.
The aim of the study was to assess
the influence of an 8-week aerobic physical activity program on oxidative
stress markers, antioxidant parameters, and selected metabolic parameters in
healthy, postmenopausal women. The study was carried out in a group of 41
healthy women (mean age 65 years) participating in an 8-week cycle ergometer
physical workout of moderate intensity. Before and after completing the
training program, the following parameters were assessed: total antioxidant
status (TAS) and concentrations of thiobarbituric acid reactive substances
(TBARS) in plasma, serum levels of antibodies against oxidatively modified
low-density lipoproteins (LDL) (oLAB), serum concentrations of glucose,
high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), insulin, and
reduced glutathione (GSH) concentrations in red blood cells (RBC). Atherogenic
index of plasma (AIP) and insulin resistance index (HOMA(IR)) were calculated.
The 8-week aerobic physical activity program resulted in significant decrease
(p<0.01) in serum glucose and LDL-cholesterol (LDL-C) levels, plasma TBARS
concentrations (p<0.05), and in significant decrease of HOMA(IR)
(p<0.01). TAS of plasma and GSH concentrations in RBC increased
significantly (p<0.01) over the study period. The results show that an 8-week
aerobic training enhanced insulin sensitivity, and improved the balance between
oxidants and antioxidants in healthy, postmenopausal women.
Menopause. 2008 Nov 5. [Epub ahead of print
Association of oral but not transdermal estrogen therapy with enhanced
platelet reactivity in a subset of postmenopausal women.
Flaumenhaft R, Nachtigall M, Lowenstein J, Nachtigall L, Nachtigall R, Nachtigall L.
Department of Medicine,
OBJECTIVE:: We sought to
determine the effects of oral versus transdermal estrogen therapy on platelet
function in postmenopausal women. DESIGN:: Blood obtained from 84
postmenopausal women was tested for closure times using the Platelet Function
Analyzer-100 before and after administration of oral or transdermal estrogen
for 8 weeks. RESULTS:: Women with normal closure times at baseline (n = 71)
demonstrated no significant change after receiving estrogen therapy with oral
(n = 29) or transdermal (n = 42) estrogen. Women with borderline closure times
of 61 to 66 seconds (n = 13) showed a significant acceleration of closure times
(P = 0.0008) after oral estrogen therapy (-6.8 +/- 0.7 seconds, n = 5) but no
significant change from baseline after transdermal estrogen therapy (1.1 +/-
0.5 seconds, n = 8). CONCLUSIONS:: An acceleration of closure times as measured
by the Platelet Function Analyzer-
Clin Interv Aging.
2008;3(3):483-9.
Hip fracture protection by alendronate treatment in postmenopausal women
with osteoporosis: a review of the literature.
Iwamoto J, Sato Y, Takeda T, Matsumoto H.
Department of Sports Medicine,
Osteoporosis most commonly
affects postmenopausal women, placing them at a significant risk of fractures.
In particular, hip fractures are an important cause of mortality and morbidity
among postmenopausal women. Anti-resorptive therapies that produce greater
decreases in bone turnover markers together with greater increases in bone
mineral density (BMD) are associated with greater reductions in fracture risk,
especially at sites primarily composed of cortical bone such as the hip. Thus,
treatment with potent anti-resorptive drugs like alendronate is a strategy for
preventing hip fractures in postmenopausal women with osteoporosis. The purpose
of this paper is to discuss the efficacy of alendronate against hip fractures
and the mechanism for this anti-fracture efficacy in postmenopausal women with
osteoporosis. A meta-analysis of randomized controlled trials has shown that
alendronate reduces the risk of hip fractures by 55% in postmenopausal women
with osteoporosis. According to the analyses of the Fracture Intervention
Trial, each 1 standard deviation reduction in a 1-year change in bone-specific
alkaline phosphatase (BSAP) is associated with 39% fewer hip fractures in
alendronate-treated postmenopausal women, and those with at least 30% reduction
in BSAP have a 74% lower risk of hip fractures relative to those with less than
30%. Alendronate is effective in reducing the risk of hip fractures across a
spectrum of ages. The mechanism for this anti-fracture efficacy has been
clarified; alendronate strongly suppresses bone turnover and subsequently
increases hip BMD, decreases cortical porosity, improves parameters of hip
structure geometry (cortical thickness, cross-sectional area, section modulus,
and buckling ratio), and produces more uniform mineralization (increases the
mean degree of mineralization of bone) in cortical bone. A once-weekly regimen
of alendronate administration provides better patient compliance and
persistence with the treatment than the once-daily dosing regimen, leading to
greater efficacy against hip fractures. Thus, the efficacy of alendronate
against hip fractures has been confirmed in postmenopausal women with
osteoporosis, especially with a once-weekly dosing regimen.
Clin Interv Aging.
2008;3(3):445-51.
Once-yearly zoledronic acid in the prevention of osteoporotic bone
fractures in postmenopausal women.
Lambrinoudaki I, Vlachou S, Galapi F, Papadimitriou D, Papadias K.
Department of Obstetrics and
Gynecology,
Zoledronic acid is a
nitrogen-containing, third-generation bisphosphonate that has recently been
approved for the treatment of postmenopausal osteoporosis as an annual
intravenous infusion. Zoledronic acid is an antiresorptive agent which has a
high affinity for mineralized bone and especially for sites of high bone
turnover. Zoledronic acid is excreted by the kidney without further metabolism.
Zoledronic acid administered as a 5 mg intravenous infusion annually increases
bone mineral density in the lumbar spine and femoral neck by 6.7% and 5.1%
respectively and reduces the incidence of new vertebral and hip fractures by
70% and 41% respectively in postmenopausal women with osteoporosis. Most common
side effects are post-dose fever, flu-like symptoms, myalgia, arthralgia, and
headache which usually occur in the first 3 days after infusion and are
self-limited. Rare adverse effects include renal dysfunction, hypocalcemia,
atrial fibrillation, and osteonecrosis of the jaw.
Breast Cancer Res Treat. 2008 Nov 4. [Epub ahead of print
Acupuncture for treating hot flashes in breast cancer patients: a
systematic review.
Lee MS, Kim KH, Choi SM, Ernst E.
Department of Medical
Research, Korea Institute of Oriental Medicine, Daejeon, 305-811,
The objective of this review
was to assess the effectiveness of acupuncture as a treatment option for hot
flashes in patients with breast cancer. We searched the literature using 14
databases from their inceptions to August 2008, without language restrictions.
We included randomised clinical trials (RCTs) comparing real with sham
acupuncture or another active treatment or no treatment. Their methodological
quality was assessed using the modified Jadad score. Three RCTs compared the
effects of manual acupuncture with sham acupuncture. One RCT showed favourable
effects of acupuncture in reducing hot flash frequency, while other two RCTs
failed to do so. The meta-analysis show significant effects of acupuncture
compared with sham acupuncture (n = 189, weight mean difference, 3.09, 95%
confidence intervals -0.04 to 6.23, P = 0.05) but marked heterogeneity was
observed in this model (chi (2) = 8.32, P = 0.02, I (2) = 76%). One RCT
compared the effects of electroacupuncture (EA) with hormone replacement
therapy. Hormone therapy was more effective than EA. Another RCT compared
acupuncture with venlafaxine and reported no significant intergroup difference.
A further RCT compared acupuncture with applied relaxation and failed to show a
significant intergroup difference. In conclusion, the evidence is not
convincing to suggest acupuncture is an effective treatment of hot flash in
patients with breast cancer. Further research is required to investigate
whether there are specific effects of acupuncture for treating hot flash in patients
with breast cancer.
Minerva Ginecol.
2008 Dec;60(6):475-84.
L-thyroxin treatment and post-menopausal osteoporosis: relevance of the
risk profile present in clinical history.
La Vignera S, Vicari E, Tumino S, Ciotta L, Condorelli R, Vicari LO, Calogero AE.
Department of Biomedical
Sciences,
AIM: Nodular thyroid disease
and osteoporosis share some common factors such as: 1) elevated frequency in
the general population; 2) major prevalence in the female sex; 2) incidence
proportional to the age. There is a wide debate in literature regarding the
real impact of chronic treatment with L-thyroxin (LT4) on the bone mineral
density (BMD), especially in post-menopausal women. The aim of this study was
to undertake to evaluate the effects of LT4 administration for the treatment of
normo-functioning nodular thyroid disease on the BMD in post-menopausal women
after one year of continuative treatment. Particular attention was paid in
examining the role of some anamnestic risk factors for osteoporosis on the
clinical response. METHODS: Ninety nine postmenopausal women of age comprised
between 50 and 56 years were examined before and after 1 year of therapy with a
fixed dose of LT4 for the treatment of nodular thyroid disease by monitoring
the following laboratory parameters: thyroid stimulating hormone (TSH), FT4,
FT3, antithyroglobulin antibodies [AbTG], hyroid peroxidase antibodies [AbTPO],
serum calcium and alkaline phosphatase levels and 24-urinary excretion of
calcium and hydroxyproline. Bone mineral density (BMD) was measured by dual
X-ray absorptiometry of the lumbar vertebrae. RESULTS: The results of this
study showed that the patients on treatment with LT4 have a slight, but
significant reduction of the BMD after 1 year of treatment, associated with
increased serum levels of alkaline phosphatase and urinary excretion of
hydroxyproline. Comparison between patients with unsuppressed (group A) or
suppressed (group B) TSH following LT4 treatment showed that group B patients
had significantly lower BMD. The following risk factors influenced, in a
statistically significant manner, the BMD: 1) Body Mass Index <19 kg/m(2);
2) the onset of menarche after the age of 15 years; 3) history positive for
period of amenorrhoea; 4) nulliparity; 5) surgical menopause; 6) lack of
hormonal replacement therapy; and 7) presence of auto-antibodies against
thyroid antigens. CONCLUSION: LT4 treatment in postmenopausal women reduced
significantly the BMD. This treatment should be therefore prescribed with
caution in this condition and particularly when the following risk factors are
present: surgically driven menopause, constitutional thinness, history of nulliparity,
absence of hormonal treatment, positive history of secondary amenorrhoea during
the reproductive age, autoimmune thyroid disease and delayed menarche.
Semana
del 29 de Octubre al 4 de Noviembre de
2008
Menopause. 2008 Oct 24. [Epub ahead of print]
Transdermal estradiol gel 0.1% for the treatment of vasomotor symptoms
in postmenopausal women.
Hedrick RE, Ackerman RT, Koltun WD, Halvorsen MB, Lambrecht LJ.
OBJECTIVE:: The objective of
this study was to evaluate the efficacy and safety of three doses of estradiol
gel 0.1% (Divigel, a novel formulation consisting of 1 mg estradiol per
Maturitas. 2008 Oct 23. [Epub ahead of print]
The relationship between depression and sexual function in menopause
period.
Yangın HB, Sözer GA, Sengün N, Kukulu K.
OBJECTIVES: Menopause is a
physiological process that is lived universally by every middle age woman. This
study has been made with the aim of determining the relation between depression
situation and sexual function of women in menopause period. METHODS: This study
was made with 300 women in menopause who applied to Akdeniz University Research
and
Menopause. 2008 Oct 27. [Epub ahead of print]
Relative androgen excess during the menopausal transition predicts
incident metabolic syndrome in midlife women: Study of Women's Health Across
the Nation.
Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M, Santoro N.
From the 1Department of
Obstetrics/Gynecology and Women's Health, New Jersey Medical School, University
of Medicine and Dentistry of New Jersey, Newark, NJ.
OBJECTIVE:: During the
menopausal transition, total testosterone (T) remains unchanged, whereas
estrogen decreases markedly, creating a state of relative androgen excess. We
hypothesized that change in the T-to-estradiol (T/E2) ratio during the
menopausal transition would be associated with incident metabolic syndrome.
DESIGN:: The association between incident metabolic syndrome and total E2,
total T, sex hormone-binding globulin, the free androgen index, baseline total
T/E2 ratio, and the change of this ratio over time was evaluated in a
multiethnic cohort of 1,862 premenopausal and perimenopausal women without
diabetes enrolled in the Study of Women's Health Across the Nation. RESULTS::
New cases (n = 257) of metabolic syndrome were identified in the cohort during
6,296 woman-years of follow-up. The age-adjusted total T/E2 ratio increased by
10.1% per year during the 5 years of follow-up. Neither baseline nor change in
E2 was associated with incident metabolic syndrome. Low sex hormone-biding
globulin, free androgen index, and high total T at baseline all increased the
risk of metabolic syndrome, but their change over time did not. Both baseline
total T/E2 ratio (1.41; 95% CI = 1.17-1.69; P < 0.001) and its rate of
change (1.24; 95% CI = 1.01-1.52; P < 0.04) were associated with increased
incident metabolic syndrome independent of ethnicity. CONCLUSIONS:: The
interaction between T and E2 during the menopausal transition, rather than the
individual change of each over time, is a factor in the determination of risk
of developing metabolic syndrome during the menopausal transition. This
relationship was independent of ethnicity and other factors associated with
prevalent metabolic syndrome before the onset of the menopausal transition.
Eur J Pharmacol. 2008 Oct 21. [Epub
ahead of print]
Opposing effects of bisphosphonates and advanced glycation end-products
on osteoblastic cells.
Gangoiti MV, Cortizo AM, Arnol V, Felice JI, McCarthy AD.
Bioquímica Patológica, Facultad de Ciencias Exactas,
Universidad Nacional de
Patients with long-standing
Diabetes mellitus can develop osteopenia and osteoporosis. We have previously
shown that advanced glycation endproducts reduce the bone-forming activity of
osteoblasts. Bisphosphonates are used for the treatment of various bone disorders,
since they reduce osteoclastic function and survival, and stimulate
osteoblastic bone-forming capacity. In this work we have investigated whether
bisphosphonates are able to revert advanced glycation endproducts-induced
deleterious effects in osteoblasts. MC3T3E1 and UMR106 osteoblastic cells were
incubated with control or advanced glycation endproducts-modified bovine serum
albumin, in the presence or absence of different doses of the bisphosphonates
Alendronate, Pamidronate or Zoledronate. After 24-72 h of culture, we evaluated
their effects on cell proliferation and apoptosis, type-1 collagen production,
alkaline and neutral phosphatase activity, and intracellular reactive oxygen
species production. Advanced glycation endproducts significantly decreased
osteoblast proliferation, alkaline phosphatase activity and type 1 collagen
production, while increasing osteoblastic apoptosis and reactive oxygen species
production. These effects were completely reverted by low doses (10(-8) M) of
bisphosphonates. High doses of bisphosphonates (10(-4)-10(-5) M) were toxic for
osteoblasts. Nifedipine (L-type calcium channel blocker) did not affect the
advanced glycation endproducts-induced decrease in osteoblastic proliferation,
although it blocked the reversion of this effect by 10(-8) M Alendronate. Both
advanced glycation endproducts and Alendronate inhibited the activity of
intracellular neutral phosphatases. In conclusion, we show that bisphosphonates
revert the deleterious actions of advanced glycation endproducts on
osteoblastic cells, and that these effects of bisphosphonates depend on: (a)
Ca(2+) influx through L-type voltage-sensitive channels, and (b) blockage of
advanced glycation endproducts-induced reactive oxygen species generation.
COPD.
2008 Oct;5(5):291-7.
African Americans and men with severe COPD have a high prevalence of
osteoporosis.
Li L, Brennan KJ, Gaughan JP, Ciccolella DE, Kuzma AM, Criner GJ.
Division of Pulmonary and
Critical Care,
Osteoporosis is a
non-pulmonary manifestation whose true prevalence is uncertain in severe
chronic obstructive pulmonary disease (COPD). We describe the prevalence and
risk factors for osteoporosis in a large, well characterized COPD cohort. Dual
energy x-ray absorptiometry of the lumbar spine and hip, full pulmonary
function testing, cardiopulmonary exercise test, 6 minute walk distance and
demographics were performed in 179 non-selected COPD patients. Patients were 59
+/- 7 years old, smoked 53 +/- 32 pack years, FEV(1) 26% +/- 9.8, and 45% were
currently taking prednisone. Bone mineral density measurements were abnormal in
97%; 66% had dual energy X-ray absorptiometry defined osteoporosis, while 31%
had osteopenia. The prevalence of osteoporosis in males versus females was 70%
versus 62% (p = 0.33); both groups had similar fracture rates. The prevalence
of osteoporosis in African Americans versus Caucasians was 69% versus 65% (p = 0.78).
Caucasians had a significantly lower Ward's Triangle T score than African
Americans (-2.52 +/- -0.96 vs. -2.16 +/- -0.91, p = 0.04). Those with bone
fractures took higher doses of prednisone than those without fractures.
Univariate analysis identified BMI and FVC% as predictors for osteoporosis (p =
0.03 OR 0.934 p = 0.006 OR 0.974). Multivariate analysis revealed only FVC% as
a significant predictor (p = 0.006, OR 0.974). Osteoporosis is highly prevalent
in severe COPD, and affects males and African Americans to a similar degree as
females and Whites. Osteoporosis should be considered in severe COPD regardless
of race or gender.
Menopause. 2008 Oct 27. [Epub ahead of print]
Hysterectomy and
weight gain.
Fitzgerald DM, Berecki-Gisolf J, Hockey RL, Dobson AJ.
Faculty of Health Sciences,
OBJECTIVE:: To investigate
whether overweight women are more likely to have a hysterectomy and whether
hysterectomy leads to increased weight gain. DESIGN:: Survey data of
middle-aged women participating in the Australian Longitudinal Study on Women's
health in 1996 (ages 45-50 y; n = 13,125), 1998 (n = 10,612), 2001 (n =
10,293), and 2004 (n = 9309) included self-reported height, weight, and
hysterectomy. First, we conducted a cohort analysis, comparing body mass index
(BMI) of women categorized according to hysterectomy status. Second, we used a
nested case-control analysis to compare weight gain between women who underwent
hysterectomy and women who did not have a hysterectomy, matched for
prehysterectomy weight, height, menopause status, and educational level.
RESULTS:: At survey 1, the mean BMI of women who subsequently had a
hysterectomy was greater than that of women without a hysterectomy by survey 2
(difference, 1.1 kg/m; 95% CI, 0.5-1.6). Results were similar for surveys 2 to
3 (BMI difference, 0.8 kg/m; 95% CI, 0.3-1.3) and surveys 3 to 4 (BMI
difference, 0.8 kg/m; 95% CI, 0.1-1.4).Having a hysterectomy between surveys 1
and 2 was not associated with percentage of weight gain over the 3 or 6 years
after survey 2 (odds ratio, 0.98 [95% CI, 0.96-1.01] and 0.99 [95% CI,
0.97-1.01], respectively). Having a hysterectomy between surveys 2 and 3 was
weakly associated with percentage of weight gain over 3 years (odds ratio, 1.03
[95% CI, 1.00-1.05]). CONCLUSIONS:: Among women older than 45 to 50 years, hysterectomy
did not lead to greater weight gain but was more likely to be performed in
heavier women.
Curr Opin Endocrinol Diabetes Obes. 2008 Dec;15(6):502-7.
Osteoporosis: how long should we treat?
University of South Florida, Tampa, Florida 34684,
USA. asebba@tampabay.rr.com
PURPOSE OF REVIEW:
Bisphosphonates are the most commonly used treatment for osteoporosis. The
pharmacology of bisphosphonates suggests the possibility of discontinuing treatment
for a period, and patients frequently ask about this. In an attempt to help
answer these questions, this review will consider recent data relevant to
continuing and discontinuing long-term bisphoshonate therapy and other
osteoporosis therapy. RECENT FINDINGS: Morphometric vertebral fracture
protection continues for 1 year after discontinuation of risedronate for 3
years and there are now similar bishosphonate data for hip fractures.
Nonvertebral fractures -in high-risk women - and perhaps clinical vertebral
fractures may be reduced in women treated for 10 years with alendronate
compared with those who stopped treatment after 5 years. After discontinuing
bisphosphonates, bone mineral density appears to deplete more rapidly in the
spine than in the hip and biochemical markers appear to increase. These changes
occur very rapidly after discontinuing denosumab. Fractures at unusual sites
have been reported with long-term bisphosphonate use. SUMMARY: It appears that
a drug holiday can be considered in many patients, although high-risk patients
may benefit from continued bisphosphonate therapy. Recent unusual fracture
cases need to be considered in making long-term treatment decisions.
Best Pract Res Clin Endocrinol Metab. 2008 Aug;22(4):615-23.
The endocrine prevention of breast cancer.
CRUK Department of Medical
Oncology,
Breast cancer incidence is
increasing in all parts of the world. Although in Western countries death rates
are declining, there is a need to make attempts to prevent the disease in order
to reduce the trauma of diagnosis and treatment. Endocrine approaches to breast
cancer prevention have been the most successful approach to cancer prevention
to date. Studies with tamoxifen were initiated when it was noted that, during
adjuvant treatment after surgery to prevent relapse, the incidence of new
contralateral cancers was reduced by half. Four trials of >/=5 years of
tamoxifen compared with placebo in women at increased risk of breast cancer
were initiated in the 1980s and showed a similar reduction in breast cancer,
but only in oestrogen-receptor-positive disease. Recent follow-up indicated
that there is a carry-over effect of tamoxifen after the completion of
treatment at 5 years so that the preventive effect at 10 years is significantly
great than at 5. The selective oestrogen receptor modulator (SERM) raloxifene
has also been assessed as a preventive agent in two major international
randomized trials compared with placebo and shows a protective effect similar
to that of tamoxifen. An American study subsequently compared tamoxifen and
raloxifene in a trial of nearly 20,000 women at increased risk (the STAR trial)
and demonstrated that the two agents were equally effective but that the
toxicity of raloxifene was less. Adjuvant trials comparing tamoxifen and the
modern potent aromatase inhibitors (anastrozole, letrozole and exemestane)
indicate that they are superior to tamoxifen and reduce contralateral breast
cancer by approximately 70%. This observation has led to the initiation of two
trials in postmenopausal women comparing anastrozole (the IBISII trial) or
exemestane (the MAP-3 trial) with placebo. Currently it is recommended that
tamoxifen is used to prevent breast cancer in premenopausal women and
raloxifene for postmenopausal women (it is not effective in the premenopausal
group),and we await the results of the aromatase inhibitor trials.
Diabetes Care. 2008 Oct 28. [Epub ahead of print]
Circulating Levels of Resistin and Risk of Type 2 Diabetes in Men and
Women: Results from Two Prospective Cohorts.
Chen BH, Song Y, Ding EL, Roberts CK, Manson JE, Rifai N, Buring JE, Gaziano JM, Liu S.
Program on Genomics and
Nutrition, Department of Epidemiology,
Objective: To investigate the
role of circulating resistin levels in the development of type 2 diabetes using
two prospective cohorts of well-characterized men and women. Research design
and methods: We conducted two prospective case-control studies nested in the
Women's Health Study (WHS) and Physicians' Health Study II (PHS II). In the
WHS, during a median of 10-years follow-up, 359 postmenopausal women apparently
healthy at baseline, who later developed type 2 diabetes, were prospectively
matched with 359 healthy controls. In the PHS II, with 8 years total follow-up,
170 men apparently healthy at baseline, who later developed type 2 diabetes,
were matched with 170 healthy controls. Controls were matched by age, race, and
time of blood draw. Results: Resistin levels at baseline were significantly
higher in women than in men (p<0.001) and in cases than controls in both
women (p<0.001) and men (p=0.07). After adjustment for matching factors,
physical activity, alcohol intake, smoking, and family history of diabetes, the
RR of type 2 diabetes comparing the highest to the lowest quartile of resistin
in women was 2.23 (95%CI=1.33-3.75; p(trend)=0.002). This association was
attenuated after further adjusting for BMI (RR=1.51, 95%CI=0.86-2.65;
p(trend)=0.21) or CRP (RR=1.19, 95%CI=0.68-2.09; p(trend)=0.59). A similar yet
weaker pattern was observed in men. Conclusions: Elevated levels of circulating
resistin were significantly related to increased risk of type 2 diabetes, which
appears to be partially accounted for by adiposity and the inflammatory
process.
Horm Metab Res. 2008 Oct 27. [Epub
ahead of print]
Sex Hormone Binding Globulin and Aging.
New and more active concepts
of steroid binding globulin action are emerging from recent research. As a
result, examination of steroid levels in aging humans and the role of steroid
binding globulins need to be re-visited. This review will discuss the
possibility that sex hormone binding globulin (SHBG) plays an active role in
the aging process. It will discuss the changes in blood levels of SHBG in aging
humans in association with sexual activity, prostate hypertrophy and cancer,
uterine leiomyoma, breast cancer, obesity and particularly the relationship
between SHBG and HDL-cholesterol, Alzheimer's disease, osteoporosis, and
cardiovascular disease. Starting with the idea that SHBG is an active
participant in steroid action demands a re-evaluation of data demonstrating a
primary change in blood SHBG levels in association with various pathologies.
Here we discuss the postulate that SHBG may act at its own receptor at the
plasma membrane level to influence other receptors such as scavenger receptors
and HDL-cholesterol receptors. We will also suggest that SHBG is a critical
marker for mating and thus may be an important physiological molecule in
control of aging.