Selección de Resúmenes de Menopausia
Diciembre de 2007
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad
de Chile
Semana del
19 al 26 de Diciembre de 2007
Int
J Gynaecol Obstet. 2007 Dec 19 [Epub ahead of print]
Brachial
artery responses in menopausal women using tibolone.
Carranza-Lira
S, Cuan-Martínez
JR, Rosales-Ortíz
S.
Hospital de Ginecobstetricia “Luis Castelazo Ayala”,
Instituto Mexicano del Seguro Social, México DF.
OBJECTIVE: To determine the effect of tibolone
treatment on brachial artery pulsatility index (PI), resistance index (RI), and
flux-mediated dilation (FMD) in postmenopausal Mexican women. METHOD: The FMD, PI,
and RI of the right brachial artery were measured in 19 postmenopausal women
before and after they received a hyperemic stimulus, first at baseline and then
following a 6-month treatment with 2.5 mg of tibolone per day. Statistical
analysis was performed using the t test. RESULTS: The mean+/-SD age was
52.2+/-3.9 years; time since menopause was 24.6+/-16.7 months; and treatment
duration was 5.7+/-2.0 months. Compared with prestimulus measurements, a
significant poststimulus increase in arterial diameter and a significant
decrease in PI were observed at baseline. Compared with prestimulus
measurements, a significant poststimulus increase in arterial diameter and a
significant decrease in both PI and RI were observed post-treatment.
CONCLUSION: Tibolone treatment had a favorable effect on brachial artery
responses to hyperemic stimuli.
Int
J Gynecol Pathol. 2008 Jan;27(1):61-67.
Endometrial
Microcalcifications Detected by Ultrasonography: Clinical Associations,
Histopathology, and Potential Etiology.
Truskinovsky
AM, Gerscovich
EO, Duffield CR, Vogt PJ.
Department of Laboratory Medicine and Pathology,
SUMMARY: Endometrial microcalcifications are uncommon,
with alleged clinical implications ranging from innocuous to ominous. We
reviewed the histopathologic slides from 29 patients who had endometrial echogenic
foci on pelvic ultrasound and found many endometrial microcalcifications. The
extent of microcalcifications in each specimen was graded on a semiquantitative
scale from 0 to 3. The mean patient age was 54 years (range, 34-81 years). The
specimens included endometrial biopsies, curettages, and hysterectomies. Most
of the patients had presented with abnormal vaginal bleeding. Fifteen patients
(51.7%) were postmenopausal, 10 (34.5%) were premenopausal, and the rest were
perimenopausal. The most frequent endometrial types were atrophic (39.5%),
inactive (23.3%), and proliferative (14%). Six specimens (14%) showed benign
endometrial polyps. One patient had well-differentiated endometrioid carcinoma
of the endometrium without myometrial invasion. Specimens from 16 patients
(55.2%) had microcalcifications. The patients with calcifications were older
than those without calcifications (mean age, 60 vs. 47 years, respectively; P =
0.017). The extent of microcalcifications positively correlated with the presence
of endometrial polyps (P = 0.00076), postmenopausal state (P = 0.004), atrophic
endometrium (P = 0.002), and hormone replacement therapy (P = 0.013). The
microcalcifications were concentric or amorphous, intraglandular or stromal.
They were focally associated with minute papillary epithelial projections or
with degenerated endometrial glands. Follow-up was available on 26 patients
(89.7%). Except for the patient with endometrioid carcinoma, none has developed
uterine, adnexal, or peritoneal malignancy. In summary, endometrial
microcalcifications are histologically heterogeneous and are associated with
older patient age, postmenopausal state, atrophic endometrium, and endometrial
polyps. Those found incidentally by means of pelvic ultrasonography, in our experience,
did not portend malignancy.
Int
J Gynecol Pathol. 2008 Jan;27(1):45-48.
Endometrial
Hyperplasia and Carcinoma in Endometrial Polyps: Clinicopathologic and Follow-Up
Findings.
From the Department of Pathology,
SUMMARY:: The objectives of this study were: 1) to
evaluate findings in follow-up hysterectomy specimens after a diagnosis of
complex atypical hyperplasia or carcinoma in endometrial polyps (EMPs) for
possible significance in management strategies; and 2)to identify features in
these polyps, that are predictive of the presence of endometrial hyperplasia or
carcinoma in subsequent hysterectomy. Records of all cases of EMPs with
endometrial hyperplasia were retrieved from the files of
J
Am Diet Assoc. 2008 Jan;108(1):125-130.
Predictors
of Diet Quality among Overweight and Obese Postmenopausal Women.
Boynton A, Neuhouser
ML, Sorensen B, McTiernan A, Ulrich CM.
Previous studies have shown that sociodemographic
characteristics can be determinants of healthful eating. However, health
characteristics such as smoking status have not been well studied. The
objective of this research, therefore, was to determine predictors of diet
quality in postmenopausal women. We included 164 overweight or obese
postmenopausal women aged 50 to 75 years living in and around
Med
Sci Sports Exerc. 2007 Dec 4 [Epub ahead of print]
Effect
of Physical Activity on Menopausal Symptoms among Urban Women.
Nelson DB, Sammel MD, Freeman EW, Lin H, Gracia CR, Schmitz KH.
Department of Public Health and Obstetrics and
Gynecology,
PURPOSE:: To determine whether physical activity,
measured by expended kilocalories per week (kcal.wk), decreases the risk of
menopausal symptoms among African American and Caucasian women. METHODS:: Level
of physical activity and menopausal symptoms, including hot flashes,
depression, anxiety, stress, and vasomotor, physiological, and somatic symptom
summaries were measured in 401 women during an 8-yr period. Tertiles of
physical activity at each assessment were defined as kilocalories per week: top
third (>/= 1450 kcal.wk), middle third (< 1450 to 644 kcal.wk), and
bottom third (< 644 kcal.wk). Regression models were used to estimate the
independent effect of physical activity at each time period on menopausal
symptoms after adjusting for covariates and hormone levels. Results were also
stratified by race, smoking status, and menopausal status. RESULTS:: Overall,
only perceived stress was related to level of physical activity, with women in
both the middle and top tertiles of physical activity reporting lower mean
levels of stress compared with women in the lowest tertile of activity. In the
analysis by menopausal stage, active postmenopausal women continued to report
lower mean levels of anxiety, stress, and depressive symptoms compared with
inactive postmenopausal women. We did not find an association between level of
physical activity and reports of hot flashes, even after adjusting for the
variability in the hormonal changes. CONCLUSIONS:: Among a cohort of
community-dwelling women, high levels of physical activity were related to
lower levels of stress during an 8-yr follow-up period. In addition, levels of
anxiety, stress, and depression were lowest among physically active
postmenopausal women compared with inactive women in the same menopausal
grouping
Menopause. 2007 Oct 10 [Epub
ahead of print]
Use of complementary
and alternative medicine during the menopause transition: longitudinal results
from the Study of Women's Health Across the Nation.
Bair YA, Gold EB, Zhang G, Rasor N, Utts J, Upchurch DM, Chyu L, Greendale
GA, Sternfeld B, Adler SR.
Planned Parenthood Affiliates of
OBJECTIVE:: This study examined whether use of
complementary and alternative (
Menopause. 2007 Oct 10 [Epub
ahead of print]
Associations
between mammographic density and body composition in Hispanic and non-Hispanic
white women by menopause status.
Caire-Juvera
G, Arendell LA, Maskarinec
G, Thomson CA, Chen Z.
Nutrition Department, Centro de Investigación en
Alimentación y Desarrollo, Sonora, México.
OBJECTIVE:: To evaluate the associations of body
composition, including percentage of lean and fat mass, with the percentage of
mammographic density and mammographic dense area among pre- and postmenopausal
Hispanic and non-Hispanic white women. DESIGN:: In this cross-sectional study,
a total of 238 women aged 41 to 50 or 56 to 70 years were recruited from local
mammography clinics and community health centers. Postmenopausal status was
defined as an absence of any menstrual cycle within the past 12 calendar months
or having a follicle-stimulating hormone level between 22 and 138 mIU/mL. The
participants' most recent mammograms were used for the mammographic density
analysis. Body composition was measured by dual-energy x-ray absorptiometry.
The associations between the percentage of mammographic density or mammographic
dense area and body composition components were analyzed using logistic regression.
RESULTS:: Mammographic dense areas were similar in Hispanic and non-Hispanic
white women. The percentage of mammographic density varied by ethnicity in
premenopausal (P = 0.023), but not in postmenopausal women. Body composition,
both higher lean mass and lower fat mass, was associated with a higher
percentage of mammographic density (P < 0.05). Interestingly, a higher
percentage of total body fat mass and a lower percentage of total body lean
mass were correlated with larger breast dense areas in premenopausal women but
with lower breast dense areas in postmenopausal women. These relationships
between body composition and mammographic density measurements were not
significantly affected by factors such as age, ethnicity, and body weight.
CONCLUSIONS:: Body composition is highly correlated with mammographic density
and should be examined as a possible confounding factor in studies involving
mammographic density measurements and breast cancer risk.
Evid
Rep Technol Assess (Full Rep). 2007
Aug;(158):1-235.
Effectiveness
and safety of vitamin d in relation to bone health.
Cranney A, Horsley T, O'Donnell S, Weiler HA, Puil L, Ooi DS, Atkinson SA, Ward LM, Moher D, Hanley DA, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze
A, Mamaladze V.
OBJECTIVES: To review and synthesize the literature in
the following areas: the association of specific circulating 25(OH)D
concentrations with bone health outcomes in children, women of reproductive
age, postmenopausal women and elderly men; the effect of dietary intakes (foods
fortified with vitamin D and/or vitamin D supplementation) and sun exposure on
serum 25(OH)D; the effect of vitamin D on bone mineral density (BMD) and
fracture or fall risk; and the identification of potential harms of vitamin D
above current reference intakes. DATA SOURCES: MEDLINE(R) (1966-June Week 3
2006); Embase (2002-2006 Week 25); CINAHL (1982-June Week 4, 2006); AMED (1985
to June 2006); Biological Abstracts (1990-February 2005); and the Cochrane
Central Register of Controlled Trials (2nd Quarter 2006). REVIEW METHODS: Two
independent reviewers completed a multi-level process of screening the
literature to identify eligible studies (title and abstract, followed by full
text review, and categorization of study design per key question). To minimize
bias, study design was limited to randomized controlled trials (RCTs) wherever
possible. Study criteria for question one were broadened to include
observational studies due to a paucity of available RCTs, and question four was
restricted to systematic reviews to limit scope. Data were abstracted in
duplicate and study quality assessed. Differences in opinion were resolved
through consensus or adjudication. If clinically relevant and statistically
feasible, meta-analyses of RCTs on vitamin D supplementation and bone health
outcomes were conducted, with exploration of heterogeneity. When meta-analysis
was not feasible, a qualitative systematic review of eligible studies was
conducted. RESULTS: 167 studies met our eligibility criteria (112 RCTs, 19
prospective cohorts, 30 case-controls and six before-after studies). The
largest body of evidence on vitamin D status and bone health was in older
adults with a lack of studies in premenopausal women and infants, children and
adolescents. The quality of RCTs was highest in the vitamin D efficacy trials
for prevention of falls and/or fractures in older adults. There was fair
evidence of an association between low circulating 25(OH)D concentrations and
established rickets. However, the specific 25(OH)D concentrations associated
with rickets is uncertain, given the lack of studies in populations with
dietary calcium intakes similar to North American diets and the different
methods used to determine 25(OH)D concentrations. There was inconsistent
evidence of an association of circulating 25(OH)D with bone mineral content in
infants, and fair evidence that serum 25(OH)D is inversely associated with
serum PTH. In adolescents, there was fair evidence for an association between
25(OH)D levels and changes in BMD. There were very few studies in pregnant and
lactating women, and insufficient evidence for an association between serum
25(OH)D and changes in BMD during lactation, and fair evidence of an inverse
correlation with PTH. In older adults, there was fair evidence that serum
25(OH)D is inversely associated with falls, fair evidence for a positive
association with BMD, and inconsistent evidence for an association with
fractures. The imprecision of 25(OH)D assays may have contributed to the
variable thresholds of 25(OH)D below which the risk of fractures, falls or bone
loss was increased. There was good evidence that intakes from vitamin
D-fortified foods (11 RCTs) consistently increased serum 25(OH)D in both young
and older adults. Eight randomized trials of ultraviolet (UV)-B radiation
(artificial and solar exposure) were small and heterogeneous with respect to
determination of the exact UV-B dose and 25(OH)D assay but there was a positive
effect on serum 25(OH)D concentrations. It was not possible to determine how
25(OH)D levels varied by ethnicity, sunscreen use or latitude. Seventy-four
trials examined the effect of vitamin D(3) or D(2) on 25(OH)D concentrations.
Most trials used vitamin D(3), and the majority enrolled older adults. In three
trials, there was a greater response of serum 25(OH)D concentrations to vitamin
D(3) compared to vitamin D(2), which may have been due to more rapid clearance
of vitamin D(2) in addition to other mechanisms. Meta-analysis of 16 trials of
vitamin D(3) was consistent with a dose-response effect on serum 25(OH)D when comparing
daily doses of <400 IU to doses >/= 400 IU. An exploratory analysis of
the heterogeneity demonstrated a significant positive association comparable to
an increase of 1 - 2 nmol/L in serum 25(OH)D for every 100 additional units of
vitamin D although heterogeneity remained after adjusting for dose. Vitamin
D(3) in combination with calcium results in small increases in BMD compared to
placebo in older adults although quantitative synthesis was limited due to
variable treatment durations and BMD sites. The evidence for fracture reduction
with vitamin D supplementation was inconsistent across 15 trials. The combined
results of trials using vitamin D(3) (700 - 800 IU daily) with calcium (500 -
1,200 mg) was consistent with a benefit on fractures although in a subgroup
analysis by setting, benefit was primarily in elderly institutionalized women
(fair evidence from two trials). There was inconsistent evidence across 14 RCTs
of a benefit on fall risk. However, a subgroup analysis showed a benefit of
vitamin D in postmenopausal women, and in trials that used vitamin D(3) plus
calcium. In addition, there was a reduction in fall risk with vitamin D when
six trials that adequately ascertained falls were combined. Limitations of the
fall and fracture trials included poor compliance with vitamin D
supplementation, incomplete assessment of vitamin D status and large losses to
follow-up. We did not find any systematic reviews that addressed the question
on the level of sunlight exposure that is sufficient to maintain serum 25(OH)D
concentrations but minimizes risk of melanoma and non-melanoma skin cancer.
There is little evidence from existing trials that vitamin D above current
reference intakes is harmful. In most trials, reports of hypercalcemia and
hypercalciuria were not associated with clinically relevant events. The Women's
Health Initiative study did report a small increase in kidney stones in
postmenopausal women aged 50 to 79 years whose daily vitamin D(3) intake was
400 IU (the reference intake for 50 to 70 years, and below the reference intake
for > 70 years) combined with 1000 mg calcium. The increase in renal stones
corresponded to 5.7 events per 10,000 person-years of exposure. The women in
this trial had higher calcium intakes than is seen in most post-menopausal
women. CONCLUSIONS: The results highlight the need for additional high quality
studies in infants, children, premenopausal women, and diverse racial or ethnic
groups. There was fair evidence from studies of an association between
circulating 25(OH)D concentrations with some bone health outcomes (established
rickets, PTH, falls, BMD). However, the evidence for an association was
inconsistent for other outcomes (e.g., BMC in infants and fractures in adults).
It was difficult to define specific thresholds of circulating 25(OH)D for
optimal bone health due to the imprecision of different 25(OH)D assays.
Standard reference preparations are needed so that serum 25(OH)D can be
accurately and reliably measured, and validated. In most trials, the effects of
vitamin D and calcium could not be separated. Vitamin D(3) (>700 IU/day)
with calcium supplementation compared to placebo has a small beneficial effect
on BMD, and reduces the risk of fractures and falls although benefit may be
confined to specific subgroups. Vitamin D intake above current dietary
reference intakes was not reported to be associated with an increased risk of
adverse events. However, most trials of higher doses of vitamin D were not
adequately designed to assess long-term harms.
Horm
Metab Res. 2007 Dec 18 [Epub ahead of print]
Treatment
of Subclinical Hypothyroidism Reduces Atherogenic Lipid Levels in a
Placebo-controlled Double-blind Clinical Trial.
Teixeira PF, Reuters VS, Ferreira MM, Almeida CP, Reis FA, Melo BA, Buescu A, Costa AJ, Vaisman M.
Endocrinology Service of Clementino Fraga Filho
University Hospital, Federal University
of Rio de Janeiro, Brazil.
Many studies have found clinical and metabolic
alterations in subclinical hypothyroidism, however, there are disagreements
about the benefits of levothyroxine therapy. The objective of the present study
was to analyze the effects of 6 months of treatment on the lipid profile of
patients with subclinical hypothyroidism. A randomized double blind,
placebo-controlled clinical assay was conducted. Sixty patients were enrolled
in stratified random allocation by TSH levels that generated similar groups in
average: free thyroxine levels, lipid levels, age, clinical score, and
sedentary. At 6 months, 18 patients in the levothyroxine and
Semana del
5 al 11 de Diciembre de 2007
Life Sci. 2007 Nov 7 [Epub ahead of print]
Mental stress induces sustained elevation of
blood pressure and lipid peroxidation in postmenopausal women.
Morimoto K, Morikawa M, Kimura H, Ishii N, Takamata A, Hara Y, Uji M, Yoshida KI.
Department of Environmental Health, Faculty of Life
Science and Human Technology, Nara Women's University, Kita-Uoya Nishi-machi,
Mental stress is thought to underlie cardiovascular
events, but there is information on oxidative stress induced by mental stress
in association with cardiovascular responses in women. Using a sensitive assay
for plasma 4-hydroxy-2-nonenal (HNE), as a marker for oxidative stress, we
addressed the relation between pressor responses and oxidative stress induced
by mental or physical stress in premenopausal and postmenopausal women. Healthy
subjects (7 postmenopausal and 8 premenopausal women, in early and late
follicular phases) were subjected to mental and physical stress evoked by a
Color Word Test (CWT) and isometric handgrip, respectively. The CWT induced a
rapid elevation of diastolic blood pressure (DBP), at a higher level in the
postmenopausal than in the premenopausal women (p<0.01), and this higher DBP
was sustained during the CWT and recovery (p<0.01). The CWT induced a significant
elevation in plasma noradrenaline in premenopausal women in the early
follicular phase and in postmenopausal women (p<0.05). Plasma nitric oxide
metabolites were higher in postmenopausal than in the premenopausal women in
the late follicular phase (p<0.05), but did not change during exposure to
the two types of stress in either group. Plasma HNE was increased during
recovery from the CWT, but not the handgrip, in postmenopausal women (2.4
times, p<0.05). There was a significant difference in the time course of the
CWT-induced HNE response between the postmenopausal and premenopausal women
(p<0.05). These findings suggest that mental, but not physical, stress
causes sustained diastolic blood pressure elevation in postmenopausal women,
accompanied by heightened oxidative stress.
Arterioscler
Thromb Vasc Biol. 2007 Dec 6 [Epub ahead of print]
Time
Since Menopause Influences the Acute and Chronic Effect of Estrogens on Endothelial
Function.
Vitale C, Mercuro G, Cerquetani
E, Marazzi G, Patrizi R, Volterrani
M, Fini M, Collins P, Rosano GM.
Department of Internal Medicine, IRCCS San Raffaele,
Objetive: We evaluated whether time since menopause
influences the acute and chronic effect of Estradiol (E) on vascular
endothelial function. Methods and Results: We studied flow-mediated dilatation
(FMD) in 134 postmenopausal women (PMW) before and after acute and chronic E
administration. At baseline FMD was inversely associated to time from menopause
(r=-0.67, P<0.001) and age (r=-0.43, P<0.05), in exogenous estrogen naïve
but not in previous users. Acute and chronic E improved endothelial function in
all women. E administration improved FMD more in women within 5 years since
menopause than in those with more than 5 years since menopause (76% and 74%
versus 45% and 48%, acute and chronic E, respectively; P<0.05). Among women
with more than 5 years since menopause acute and chronic E increased FMD more
in previous E users than in nonusers (59% and 63% versus 31% and 38%, acute and
chronic E, respectively; P<0.01). Multivariate analysis showed that time
from menopause was a predictor of impaired FMD and of its improvement after
acute and chronic E. CONCLUSIONS: Time from menopause influences FMD in PMW.
The acute and chronic effect of E on FMD is time dependent and is reduced by a
longer time since menopause.
Maturitas. 2007 Dec 1 [Epub
ahead of print]
Ultra low-dose
hormone replacement therapy and bone protection in postmenopausal women.
Gambacciani
M, Cappagli B, Ciaponi M, Pepe A, Vacca F, Genazzani
AR.
Department of Obstetrics and Gynecology,
OBJECTIVES: The aim of the present study was to
evaluate the effects of low doses of hormone replacement therapy (HRT) in
normal young postmenopausal women. METHODS: In an open trial healthy, non-obese
postmenopausal women received for 2 years a low-dose continuous combined HRT
(LD-HRT) containing 1mg estradiol+0.5mg norethisterone acetate each pill for 28
days, or 0.5mg of 17beta-estradiol and 0.25mg of norethisterone acetate (Ultra
low dose, Ultra-LD-HRT) along with 1000mg of calcium per day. Control group
consisted of women receiving only 1000mg of calcium per day, for 2 years.
Menopausal symptoms were evaluated by the Green climacteric scale for the first
12 weeks of the study while bleeding profiles, bone mineral density (BMD) and
bone turnover were assessed for 24 months. RESULTS: LD-HRT and Ultra-LD-HRT
were effective in reducing menopausal clinical symptoms. In the control group,
BMD significantly (P<0.05) decreased at the spine (-2.8+/-0.2%), and femoral
neck (-2.8+/-0.7%). In LD-HRT treated group BMD showed a significant
(P<0.05) increase at the spine (5.2+/-0.7%), and femoral neck (2.8+/-0.4%)
after 24 months. In the Ultra-LD-HRT treated women spine and femoral neck BMD
showed a significant (P<0.05) increase (2.0+/-0.3 and 1.8+/-0.3%,
respectively) after 24 months. In these women treated with LD-HRT and
Ultra-LD-HRT the BMD values were significantly (P<0.05) different from those
measured in calcium-treated women. CONCLUSIONS: LD-HRT and Ultra-LD-HRT can
alleviate subjective symptoms providing an effective protection against the
postmenopausal decrease of BMD.
Int
J Cardiol. 2007 Dec 4 [Epub ahead of print]
No added value of
age at menopause and the lifetime cumulative number of menstrual cycles for
cardiovascular risk prediction in postmenopausal women.
Atsma F, van der
Schouw YT, Grobbee DE, Hoes AW, Bartelink
ML.
BACKGROUND: The aim of the present study was to
investigate the added value of age at menopause and the lifetime cumulative
number of menstrual cycles in cardiovascular risk prediction in postmenopausal
women. METHODS: This study included 971 women. The ankle-arm index was used as
a proxy for cardiovascular morbidity and mortality. The ankle-arm index was
calculated for each leg by dividing the highest ankle systolic blood pressure
by the highest brachial systolic blood pressure. A cut-off value of 0.95 was
used to differentiate between low and high risk women. Three cardiovascular
risk models were constructed. In the initial model all classical predictors for
cardiovascular disease were investigated. This model was then extended by age
at menopause or the lifetime cumulative number of menstrual cycles to test
their added value for cardiovascular risk prediction. Differences in
discriminative power between the models were investigated by comparing the area
under the receiver operating characteristic (ROC) curves. RESULTS: The mean age
was 66.0 (+/-5.6) years. The 6 independent predictors for cardiovascular
disease were age, systolic blood pressure, total to HDL cholesterol ratio,
current smoking, glucose level, and body mass index >/=30 kg/m(2). The ROC
area was 0.69 (0.64-0.73) and did not change when age at menopause or the
lifetime cumulative number of menstrual cycles was added. CONCLUSIONS: The
findings in this study among postmenopausal women did not support the view that
age at menopause or a refined estimation of lifetime endogenous estrogen
exposure would improve cardiovascular risk prediction as approximated by the
ankle-arm index.
Appl
Physiol Nutr Metab. 2007 Dec;32(6):1210-1.
Associations
between abdominal adiposity, exercise, morbidity, and mortality.
The increasing prevalence of abdominal obesity
worldwide poses a serious public health problem and thus presents a target for
research designed to improve the assessment or treatment of abdominal obesity.
Specifically, the first study in this thesis investigated the influence of age
and gender on visceral (VAT) and abdominal (ASAT) subcutaneous adipose tissue
for a given waist circumference (WC) in 481 men and women varying widely in age
and body mass index (BMI). Significant gender differences in VAT and ASAT for a
given WC were observed; however, only the relationship between WC and VAT was
substantially influenced by age. The second study examined whether the
associations between VAT, ASAT, and the metabolic syndrome (MetS) were altered
depending on the measurement methodology used to assess VAT and ASAT. The odds
ratio (OR) for MetS was higher for total VAT volume (OR = 7.26), and for
partial volumes at T12-L1 (OR = 7.46) and L1-L2 (OR = 8.77) compared with the
classic L4-L5 (OR = 3.94) measurement. The OR for MetS was not substantially
different among the ASAT measures (OR~2.6). Measurement site for VAT, but not
ASAT, has a substantial influence on the magnitude of the association with
MetS. The third study examined the independent associations between VAT, ASAT,
liver fat, and all-cause mortality in 291 men (97 decedents and 194 controls,
mortality follow-up of 2.2 +/- 1.3 y). In a model including VAT, ASAT, liver
fat, age, and length of follow-up, only VAT (1.93 (1.15-3.23)) remained a
significant predictor of mortality. We concluded that VAT is a strong,
independent predictor of all-cause mortality in men. The purpose of the final
study was to determine the effect of aerobic exercise dose (energy expenditure)
on WC in sedentary, overweight or obese postmenopausal women (n = 424). The
women were randomly assigned to a control group or one of three aerobic
exercise groups that exercised at energy expenditures of 4, 8, or 12 kcal.kg
body mass-1.week-1. On comparison with controls, there were significant
reductions in WC in the exercise groups (~3 cm, p < 0.05), which were
independent of weight loss. However, the amount of exercise performed was not
associated with reductions in WC in a dose-dependent manner.
J
Thromb Thrombolysis. 2007 Dec 4 [Epub ahead of print]
Assessment
of hypercoagulability markers and lipid levels in postmenopausal women undergoing
either oral or transdermal hormone replacement therapy.
Guimarães
DA, das Graças
Carvalho M, Cardoso J, de Oliveira
Sousa M, Franco RM, de Almeida
Franco H, Alvim TC, da Silva
Teixeira G, Dusse LM, Fernandes
AP.
Faculty of Pharmacy, Federal University of Minas
Gerais, Av. Antonio Carlos, 6627,
Background This study investigated the effect of
either oral or transdermal hormone replacement therapy (HRT) on haemostatic,
fibrinolytic and lipid profiles in a group of Brazilian women 3 months after
beginning treatment by comparing these results with those obtained immediately
before HRT. Methods Plasma levels of TAT, DDi, F1+2, PC, PS, AT, PAI-1 and
serum lipids were determined in blood samples collected from 24 women
undergoing oral HRT and from 11 women undergoing transdermal HRT. Results
Significant increases in DDi and F1+2 plasma levels were observed after 3
months of oral HRT, while PS levels decreased. After transdermal HRT, a
significant decrease was observed only for AT levels. Conclusion After 3 months
of oral HRT and in the absence of major genetic and acquired risk factors,
women displayed a predisposition for activation of blood coagulation, and an
increased activity of the fibrinolytic system. Oral HRT seemed to be more
effective in predisposing haemostatic changes as compared to transdermal.
Fertil
Steril. 2007 Dec 3 [Epub ahead of print]
Increased
insulin-like growth factor-1 after oophorectomy in postmenopausal women.
Fogle RH, Chang L, Patel SK, Stanczyk FZ, Paulson RJ.
IGF-1 levels increased, and IGF-2 and IGFBP-3 levels
remained unchanged, in postmenopausal women following oophorectomy. The
increase in IGF-1 likely results from decreased ovarian steroidogenic
precursors resulting from removal of the hormonally active ovary. This finding
raises concerns, given the association between increased IGF-1 and elevated
colon cancer risk, and adds to the literature suggesting a potential benefit
from ovarian preservation.
Appl
Physiol Nutr Metab. 2007 Dec;32(6):1089-1096.
Relationship
between insulin sensitivity and the triglyceride-HDL-C ratio in overweight and
obese postmenopausal women: a MONET study.
Karelis AD, Pasternyk
SM, Messier L, St-Pierre
DH, Lavoie JM, Garrel D, Rabasa-Lhoret
R.
Department of Kinanthropology, Université du Québec à
Montréal,
The objective of this cross-sectional study was to
examine the relationship between the triglyceride-HDL-cholesterol ratio
(TG:HDL-C) and insulin sensitivity in overweight and obese sedentary
postmenopausal women. The study population consisted of 131 non-diabetic
overweight and obese sedentary postmenopausal women (age; 57.7 +/- 5.0 y; body
mass index (BMI), 32.2 +/- 4.3 kg/m2). Subjects were characterized by dividing
the entire cohort into tertiles based on the TG:HDL-C (T1 < 0.86 vs. T2=
0.86 to 1.35 vs. T3 > 1.35, respectively). We measured (i) insulin
sensitivity (using the hyperinsulinenic-euglycemic clamp and homeostasis model
assessment (HOMA)), (ii) body composition (using dual-energy X-ray absorptiometry),
(iii) visceral fat (using computed tomography), (iv) plasma lipids, C-reactive
protein, 2 h glucose concentration during an oral glucose tolerance test (2 h
glucose), as well as fasting glucose and insulin, (v) peak oxygen consumption,
and (vi) lower-body muscle strength (using weight training equipment).
Significant correlations were observed between the TG:HDL-C and the
hyperinsulinemic-euglycemic clamp (r = -0.45; p < 0.0001), as well as with
HOMA (r = 0.42; p < 0.0001). Moreover, the TG:HDL-C significantly correlated
with lean body mass, visceral fat, 2 h glucose, C-reactive protein, and muscle
strength. Stepwise regression analysis showed that the TG:HDL-C explained 16.4%
of the variation in glucose disposal in our cohort, which accounted for the
greatest source of unique variance. Other independent predictors of glucose
disposal were 2 h glucose (10.1%), C-reactive protein (CRP; 7.6%), and peak
oxygen consumption (5.8%), collectively (including the TG:HDL-C) explaining
39.9% of the unique variance. In addition, the TG:HDL-C was the second
predictor for HOMA, accounting for 11.7% of the variation. High levels of
insulin sensitivity were associated with low levels of the TG:HDL-C. In
addition, the TG:HDL-C was a predictor for glucose disposal rates and HOMA
values in our cohort of overweight and obese postmenopausal women.
Osteoporos
Int. 2007 Dec 6 [Epub ahead of print]
Wrist fracture
as a predictor of future fractures in younger versus older postmenopausal
women: results from the National Osteoporosis Risk Assessment (NORA).
Barrett-Connor
E, Sajjan SG, Siris ES, Miller PD, Chen YT, Markson LE.
Department of Family and Preventive Medicine,
University of California, San Diego, Stein Clinical Research Building, Room 349,
9500 Gilman Drive, Mail Code: 0607, La Jolla, CA, 92093-0607, USA,
ebarrettconnor@ucsd.edu.
The short-term association between wrist-fracture
history and future fracture has not been simultaneously compared between
younger and older postmenopausal women. This 3-year follow-up study of 158,940
women showed a similar future fracture risk in younger and older women with
wrist-fracture history. INTRODUCTION: We examined the association between prior
wrist fracture and future osteoporosis-related fractures within 3 years in
younger and older postmenopausal women. METHODS: In the National Osteoporosis
Risk Assessment (NORA) study, 158,940 postmenopausal women, aged 50-98 (median
63) years, provided information on fracture history since age 45, and responded
to follow-up surveys 1 or 3 years later when new fractures were queried. Cox
regression models were used to obtain relative risk (RR) and 95% confidence
interval (CI) estimates. RESULTS: Of the 158,940 participants, 8,665 reported a
history of wrist fracture at baseline; 4,316 women reported at least one new
fracture within three years. The RR for any subsequent clinical fracture,
adjusted for covariates and baseline BMD T-score, was 2.4 (2.0, 2.9) for
younger and 2.1 (1.9, 2.3) for older women. A prior wrist fracture increased
the risk of a future wrist fracture about 3-fold and doubled the risk of any
osteoporotic fracture. CONCLUSIONS: Prior wrist fracture strongly predicts
three-year risk of any future osteoporotic fracture for older and younger
postmenopausal women, independent of baseline BMD and common osteoporosis risk
factors. More consideration should be given to evaluating and managing
osteoporosis in younger and older women with a history of wrist fracture,
independent of their BMD.
Gynecol
Endocrinol. 2007 Oct;23 Suppl
Progestins
and breast cancer.
Hormones and Cancer Research Unit, Institut de
Puériculture et de Périnatalogie, Paris, France.
Progestins exert their progestational activity by
binding to the progesterone receptor (form A, the most active and form B, the
less active) and may also interact with other steroid receptors (androgen,
glucocorticoid, mineralocorticoid, estrogen). They can have important effects
in other tissues besides the endometrium, including the breast, liver, bone and
brain. The biological responses of progestins cover a very large domain:
lipids, carbohydrates, proteins, water and electrolyte regulation, hemostasis,
fibrinolysis, and cardiovascular and immmunological systems. At present, more
than 200 progestin compounds have been synthesized, but the biological response
could be different from one to another depending on their structure,
metabolism, receptor affinity, experimental conditions, target tissue or cell
line, as well as the biological response considered. There is substantial
evidence that mammary cancer tissue contains all the enzymes responsible for
the local biosynthesis of estradiol (E(2)) from circulating precursors. Two
principal pathways are implicated in the final steps of E(2) formation in
breast cancer tissue: the 'aromatase pathway', which transforms androgens into
estrogens, and the 'sulfatase pathway', which converts estrone sulfate (E(1)S)
into estrone (E(1)) via estrone sulfatase. The final step is the conversion of
weak E(1) to the potent biologically active E(2) via reductive
17beta-hydroxysteroid dehydrogenase type 1 activity. It is also well
established that steroid sulfotransferases, which convert estrogens into their
sulfates, are present in breast cancer tissues. It has been demonstrated that
various progestins (e.g. nomegestrol acetate, medrogestone, promegestone) as
well as tibolone and their metabolites can block the enzymes involved in E(2)
bioformation (sulfatase, 17beta-hydroxysteroid dehydrogenase) in breast cancer
cells. These substances can also stimulate the sulfotransferase activity which
converts estrogens into the biologically inactive sulfates. The action of
progestins in breast cancer is very controversial; some studies indicate an increase
in breast cancer incidence, others show no difference and still others a
significant decrease. Progestin action can also be a function of combination
with other molecules (e.g. estrogens). In order to clarify and better
understand the response of progestins in breast cancer (incidence, mortality),
as well as in hormone replacement therapy or endocrine dysfunction, new
clinical trials are needed studying other progestins as a function of the dose
and period of treatment.
Obstet Gynecol. 2007 Dec;110(6):1290-6.
Physical
functioning and menopause States.
Sowers M, Tomey K, Jannausch M, Eyvazzadeh
A, Nan B, Randolph J
Jr.
Departments of Epidemiology, School of Public Health,
Obstetrics/Gynecology, and Biostatistics,
OBJECTIVE: To assess whether losses in physical
functioning are related to the natural menopause, hysterectomy, or calendar
time during midlife, after adjustment for body size and smoking. METHODS: A
longitudinal assessment of physical functioning was conducted from 2000/01
through 2005/06 in a population-based sample of 544 women at midlife enrolled
in the Michigan Bone Health and Metabolism Study. Longitudinal mixed models
were used to relate menopausal status to measures of physical functioning.
Perception of physical functioning was assessed with the Medical Outcomes Study
Short-Form 36 questionnaire. Eight performance-based measures of physical
functioning were also included. RESULTS: Women with hysterectomy (with or
without estrogen from ovarian conservation or exogenous replacement) had
reduced levels of functioning and greater rates of change in the 2-lb lift
(P<.005), sit-to-stand (P<.01), timed stair climb (P<.01), timed walk
(P<.01), velocity (P<.05), and perception of physical functioning
(P<.01) compared with premenopausal and perimenopausal women after
adjustment for time since baseline, body size, and smoking. Diminished
functioning in postmenopausal women was observed in hand grip (P<.005), 2-lb
lift (P<.05), sit-to-stand (P<.05), velocity (P<.05), and perceived
physical functioning (P<.05). Based on regression analyses, there was
greater loss in women with hysterectomy compared with natural menopause. Level
of functioning among postmenopausal women with exogenous hormone replacement was
similar to premenopausal women on eight of nine physical functioning measures.
CONCLUSION: Hysterectomy, even with availability of an estrogen source, seems
to be a "risk" state for diminishing physical function at midlife,
and this may initiate a vulnerable stage for future compromised quality of
life.
Fertil
Steril. 2007 Nov 28 [Epub ahead of print]
Randomized,
multicenter, double-blind, placebo-controlled trial to evaluate the efficacy
and safety of synthetic conjugated estrogens B for the treatment of
vulvovaginal atrophy in healthy postmenopausal women.
Simon JA, Reape KZ, Wininger S, Hait H.
Obstetrics and Gynecology,
OBJECTIVE: To evaluate the safety and efficacy of
synthetic conjugated estrogens B (SCE-B; 0.3 mg/d) for 12 weeks in the
treatment of vulvovaginal atrophy in symptomatic, postmenopausal women. DESIGN:
Prospective, randomized, multicenter, double-blind, placebo-controlled trial.
SETTING: Forty-two participating sites in the
Semana del
28 de Noviembre al 4 de Diciembre de 2007
Neurology. 2007 Nov 13;69(20):1921-30.
Dietary
patterns and risk of dementia: the Three-City cohort study.
Barberger-Gateau
P, Raffaitin C, Letenneur L, Berr C, Tzourio C, Dartigues
JF, Alpérovitch
A.
INSERM, U593, University Victor
Dietary fatty acids and antioxidants may contribute to
decrease dementia risk, but epidemiologic data remain controversial. The aim of
our study was to analyze the relationship between dietary patterns and risk of
dementia or Alzheimer disease (AD), adjusting for sociodemographic and vascular
risk factors, and taking into account the ApoE genotype. Methods: A total of
8,085 nondemented participants aged 65 and over were included in the Three-City
cohort study in Bordeaux, Dijon, and Montpellier (France) in 1999-2000 and had
at least one re-examination over 4 years (rate of follow-up 89.1%). An
independent committee of neurologists validated 281 incident cases of dementia
(including 183 AD). RESULTS: Daily consumption of fruits and vegetables was
associated with a decreased risk of all cause dementia [HR] 0.72, 95% CI 0.53
to 0.97) in fully adjusted models. Weekly consumption of fish was associated
with a reduced risk of AD (HR 0.65, 95% CI 0.43 to 0.994) and all cause
dementia but only among ApoE epsilon 4 noncarriers (HR 0.60, 95% CI 0.40 to
0.90). Regular use of omega-3 rich oils was associated with a decreased risk of
borderline significance for all cause dementia (HR 0.46, 95% CI 0.19 to 1.11).
Regular consumption of omega-6 rich oils not compensated by consumption of
omega-3 rich oils or fish was associated with an increased risk of dementia (HR
2.12, 95% CI 1.30 to 3.46) among ApoE epsilon 4 noncarriers. Conclusion:
Frequent consumption of fruits and vegetables, fish, and omega-3 rich oils may
decrease the risk of dementia and AD, especially among ApoE epsilon 4
noncarriers.
Climacteric. 2007
Dec;10(6):508-26.
Management
of cardiovascular risk in the perimenopausal women: a consensus statement of
European cardiologists and gynecologists.
Collins P, Rosano G, Casey C, Daly C, Gambacciani
M, Hadji P, Kaaja R, Mikkola T, Palacios S, Preston R, Simon T, Stevenson J, Stramba-Badiale
M.
Cardiovascular risk is poorly managed in women,
especially during the menopausal transition when susceptibility to cardiovascular
events increases. Clear gender differences exist in the epidemiology, symptoms,
diagnosis, progression, prognosis and management of cardiovascular risk. Key
risk factors that need to be controlled in the perimenopausal woman are
hypertension, dyslipidemia, obesity and other components of the metabolic
syndrome, with the avoidance and careful control of diabetes. Hypertension is a
particularly powerful risk factor and lowering of blood pressure is pivotal.
Hormone replacement therapy is acknowledged as the gold standard for the
alleviation of the distressing vasomotor symptoms of the menopause, but the
findings of the Women's Health Initiative study generated concern for the
detrimental effect on cardiovascular events. Thus, hormone replacement therapy
cannot be recommended for the prevention of cardiovascular disease. Whether the
findings of WHI in older postmenopausal women can be applied to younger
perimenopausal women is unknown. It is increasingly recognized that hormone
therapy is inappropriate for older postmenopausal women no longer displaying
menopausal symptoms. Both gynecologists and cardiovascular physicians have an
important role to play in identifying perimenopausal women at risk of
cardiovascular morbidity and mortality, and should work as a team to identify
and manage risk factors, such as hypertension.
Climacteric. 2007
Dec;10(6):480-90.
The
influence of smoking on uterine bleeding during continuous and interrupted oral
hormone therapy.
Bjarnason
NH, Jorgensen
HL, Byrjalsen I, Alexandersen
P, Christiansen
C.
To study the influence of smoking on uterine bleeding
patterns during continuous and interrupted oral hormone therapy (HT). Methods
Using a post-hoc strategy, we included five oral HT groups from three studies.
The therapies consisted of continuous estrogen (estradiol, estradiol valerate
or piperazine estrone sulfate) in combination with continuous progestogen
(cyproterone acetate, gestodene or norethisterone acetate) or in combination
with interrupted progestogen (norethisterone) given on days 4-6, 10-12, 16-18,
22-24 and 28-
Climacteric. 2007
Dec;10(6):466-70.
False
alarm: postmenopausal hormone therapy and ovarian cancer.
Dpt of Family Medicine and Public Health, University
of Cape Town Medical School, Cape Town, South Africa.
Background In a follow-up study of 948 576 women,
based on respective relative risk (RR) estimates of 1.23 and 1.20 for incident
and fatal ovarian cancer among current users of postmenopausal hormone therapy
(HT), the Million Women Study investigators have estimated that, since 1991, HT
has resulted in 1300 additional cases and 1000 deaths. Critique The association
was almost entirely confined to hysterectomized women, some of whom would not
have been at risk because their ovaries had been removed; the findings in that
group were uninterpretable. Among non-hysterectomized women, the RR was 1.12
and compatible with chance.The response rate to a follow-up questionnaire was
only 64%, and HT-exposed women who developed ovarian cancer may selectively
have responded. The risk of ovarian cancer was no longer increased once women
stopped using HT, an effect that was pathologically and clinically incompatible
with causation. Symptoms of as yet undiagnosed ovarian cancer may have caused
HT use, rather than the reverse. The histological classification of the tumors
was not centrally adjudicated. A meta-analysis of nine studies of current HT
use, for which the aggregated RR was 1.28, was acknowledged by the
investigators to be defective. Only the findings among non-hysterectomized
women were to some limited extent interpretable and, among them, there was
virtually no evidence to suggest that current HT use increases the risk of
ovarian cancer. It follows that the estimated numbers of additional cases of
incident and fatal ovarian cancer that were attributed to HT use were spurious,
and arbitrary extrapolation back to 1991, which was many years before the
Million Women Study, had no scientific rationale.
Int
J Equity Health. 2007 Nov 23;6(1):19
[Epub ahead of print]
The
Alver K, Sogaard AJ, Falch JA, Meyer HE.
Based on previously reported differences in fracture
incidence in the socioeconomic less affluent Oslo East compared to the more
privileged West, our aim was to study bone mineral density (BMD) in the same
socioeconomic areas in
Arch Intern Med. 2007 Nov 26;167(21):2329-36.
Low bone
mass in premenopausal women with depression.
Eskandari F, Martinez PE, Torvik S, Phillips TM, Sternberg
EM, Mistry S, Ronsaville
D, Wesley R, et al
MHSc, Building 10, Clinical
An increased prevalence of low bone mineral density
(BMD) has been reported in patients with major depressive disorder (MDD),
mostly women. Methods: Study recruitment was conducted from
Climacteric. 2007
Dec;10(6):448-65.
Influence
of menopause on mood: a systematic review of cohort studies.
Vesco KK, Haney EM, Humphrey L, Fu R, Nelson HD.
Objective This systematic evidence review evaluates
the independent influence of the menopausal transition on mood including
depression, anxiety, and other psychological symptoms. Methods Community-based,
prospective cohort studies of mid-life women transitioning through menopause
that assessed at least one mood symptom on two or more occasions were
identified by searches of MEDLINE (1966-2007) and PsycINFO (1974-2007)
databases. Articles were selected based on predetermined inclusion and
exclusion criteria. Each study was quality-rated by three authors; poor quality
studies were excluded. Results Nine studies met inclusion criteria. They varied
broadly in design, outcome measures, statistical methodology, and in
consideration of and adjustment for important confounders. Five found no
association between the menopausal transition and depression, negative mood,
major depressive disorder, other psychological symptoms, and general mental
health. Three found that women entering or completing the menopausal transition
were more likely than premenopausal women to be depressed. One found that
well-being increased from the early to late menopausal transition. Conclusion
There is no demonstrated pattern of an adverse independent influence of the
menopausal transition on mood symptoms in mid-life women. However, the
available studies are too methodologically diverse to be definitive.
Curr
Med Res Opin. 2007 Nov 28 [Epub ahead of print]
Ibandronate
and the risk of non-vertebral and clinical fractures in women with postmenopausal
osteoporosis: results of a meta-analysis of phase III studies.
Harris ST, Blumentals
WA, Miller PD.
The marketed doses of ibandronate, 150 mg once-monthly
oral and 3 mg quarterly intravenous (IV) injection, produce greater increases
in lumbar spine bone mineral density than treatment with the 2.5 mg oral daily
dose. This meta-analysis assessed whether these doses also reduce fracture risk
relative to placebo.Study design and methods: Individual patient data from the
intent-to-treat populations of the BONE, IV fracture prevention, MOBILE, and
DIVA studies were grouped into three dose levels based on annual cumulative
exposure (ACE), defined as the annual dose (mg) x bioavailability (0.6%, oral; 100%,
IV) or placebo. Six key non-vertebral fractures (NVFs) (clavicle, humerus,
wrist, pelvis, hip, and leg), all NVFs, and all clinical fractures were
examined. Results: This meta-analysis included 8710 patients. Cox
proportional-hazards models estimated the adjusted relative risk (RR) for
fracture with ibandronate versus placebo, and time to fracture was compared
using log-rank tests. The high-dose group (ACE >/= 10.8 mg) showed
significant reductions in the adjusted RR of key NVFs (34.4%, p=0.032), all NVFs
(29.9%, p = 0.041), and clinical fractures (28.8%, p=0.010) relative to
placebo. The high-dose group also had significantly longer time to fracture
versus placebo for key NVFs (p = 0.031), all NVFs (p=0.025), and clinical
fractures (p = 0.002). Study limitations included: not all studies were
placebo-controlled; a limited number of baseline characteristics were available
for multivariate analyses. Conclusion: Ibandronate at dose levels of ACE >/=
10.8 mg, which includes the marketed 150 mg once-monthly oral and 3 mg
quarterly IV injection regimens, may provide significant non-vertebral and
clinical fracture efficacy.