Selección de Resúmenes de
Menopausia
Diciembre 2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad
de Chile
Semana
del 16 al 22 de Diciembre de 2009
Invest
Ophthalmol Vis Sci. 2009 Dec 17. [Epub ahead of print]
Postmenopausal
Hormone Therapy Increases Retinal Blood Flow and Protects the Retinal Nerve
Fiber Layer.
Deschênes
MC, Descovich D, Moreau M, Granger L, Kuchel GA, Mikkola TS, Fick GH, Chemtob S, Vaucher E, Lesk MR.
Ophthalmology,
University of Montreal, Montreal, Canada.
PURPOSE:
To investigate whether postmenopausal hormone therapy (HT) increases retinal
and optic nerve head (ONH) blood flow, and protects ONH topography and the
function of retinal ganglion cells in postmenopausal women (PMW). The effect of
estradiol (E(2)) treatment on retinal tissue perfusion was also investigated in
ovariectomized rats, an animal model for menopause. METHODS: Sixty-four healthy
PMW were recruited, 29 who never used HT (ØHT) and 35 who used HT (+HT)
continuously since menopause onset. Blood flow of the infero-temporal retinal
artery (ITRA), peripapillary retina, and ONH rim were measured in one eye. The
ONH stereometric parameters and the pattern electroretinogram (PERG) were also
measured. In ovariectomized rats, the retinal tissue perfusion was assessed
using the BF tracer N-Isopropyl-p-[(14)C]-iodoamphetamine ([(14)C]-IMP) in rats
treated with either E(2) (n=7) or placebo (n=5). RESULTS: Compared to the ØHT
group, the +HT group presented significantly greater BF of the ITRA (p=0.006),
greater rim volume for the entire ONH region (p=0.032), and greater rim volume
(p=0.042), height variation contour (p=0.011), mean thickness (p=0.033) and
cross-sectional area (p=0.020) of the retinal nerve fiber layer for the
infero-temporal region of the ONH when adjusted for age, ocular perfusion
pressure and age at menarche. In ovariectomized rats, E(2) treatment
significantly increased the retinal perfusion with a range of 22-45%.
CONCLUSIONS: These findings indicate that estrogens and HT increase retinal
blood flow and protect the retinal nerve fiber layer.
Endocr Rev. 2009 Dec 17. [Epub
ahead of print]
Estrogen
Therapy and Cognition: A Review of the Cholinergic Hypothesis.
The
pros and cons of estrogen therapy for use in postmenopausal women continue to
be a major topic of debate in women's health. Much of this debate focuses on
the potential benefits vs. harm of estrogen therapy on the brain and the risks
for cognitive impairment associated with aging and Alzheimer's disease. Many
animal and human studies suggest that estrogens can have significant beneficial
effects on brain aging and cognition and reduce the risk of Alzheimer's-related
dementia; however, others disagree. Important discoveries have been made, and
hypotheses have emerged that may explain some of the inconsistencies. This
review focuses on the cholinergic hypothesis, specifically on evidence that
beneficial effects of estrogens on brain aging and cognition are related to
interactions with cholinergic projections emanating from the basal forebrain.
These cholinergic projections play an important role in learning and
attentional processes, and their function is known to decline with advanced age
and in association with Alzheimer's disease. Evidence suggests that many of the
effects of estrogens on neuronal plasticity and function and cognitive
performance are related to or rely upon interactions with these cholinergic
projections; however, studies also suggest that the effectiveness of estrogen
therapy decreases with age and time after loss of ovarian function. We propose
a model in which deficits in basal forebrain cholinergic function contribute to
age-related changes in the response to estrogen therapy. Based on this model,
we propose that cholinergic-enhancing drugs, used in combination with an
appropriate estrogen-containing drug regimen, may be a viable therapeutic
strategy for use in older postmenopausal women with early evidence of mild
cognitive decline.
Maturitas. 2009 Dec 15. [Epub
ahead of print]
Hormone
replacement after gynaecological cancer.
Dept of
Gynaecological Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
Treatment
of gynaecological cancer frequently results in the loss of ovarian function and
menopausal symptoms. Symptoms of iatrogenic menopause are usually significantly
more intense than those of natural menopause due to sudden onset of symptoms,
younger age and its effects on common physical and psychological problems of
cancer therapy like body image concerns and sexual dysfunction. The most
effective treatment for menopausal symptoms is hormone replacement therapy
(HRT). However, it is very controversial if HRT is safe in patients after a
gynaecological malignancy. The main concerns are the potential stimulation of
residual cancer and the induction of new hormone-dependent disease. However,
the majority of the most common gynaecological malignancies like squamous cell
carcinomas of the cervix, serous papillary epithelial ovarian carcinomas and
squamous cell carcinomas of the vulva are not oestrogen dependent. Furthermore,
current scientific evidence does not show HRT to adversely affect the outcome
in patients after treatment for hormone sensitive cancers like early stage
endometrioid adenocarcinomas of the endometrium. There are only a small number
of gynaecological malignancies like low grade endometrial stromal sarcomas in
which HRT is an absolute contraindication. Therefore, as maintaining quality of
life and minimising the physical and psychological impact of treatment side
effects is one of the most important factors in cancer care, it is imperative
to give patients unbiased information about their individual cancer which in
most cases will allow them to use HRT without any detrimental effect on their
survival.
Int J Endocrinol. 2010;2010:957174. Epub
2009 Jul 21.
Simvastatin
does not affect vitamin d status, but low vitamin d levels are associated with
dyslipidemia: results from a randomised, controlled trial.
Rejnmark
L, Vestergaard P, Heickendorff L, Mosekilde L.
Department
of Endocrinology and Metabolism C, Aarhus Sygehus, Aarhus University Hospital,
8000 Aarhus, Denmark.
Objectives.
Statin drugs act as inhibitors of the 3-hydroxy-3methylglutaryl coenzyme A
(HMG-CoA) reductase enzyme early in the mevalonate pathway, thereby reducing
the endogenous cholesterol synthesis. In recent studies, it has been suggested
from epidemiological data that statins also may improve vitamin D status, as
measured by increased plasma 25-hydroxyvitamin D (25OHD) levels. We now report
the results from a randomised controlled trial on effects of simvastatin on
plasma 25OHD levels. Design and Methods. We randomised 82 healthy
postmenopausal women to one year of treatment with either simvastatin 40 mg/d
or placebo and performed measurement at baseline and after 26 and 52 weeks of
treatment. The study was completed by 77 subjects. Results. Compared with
placebo, plasma levels of cholesterol and low-density lipoproteins decreased in
response to treatment with simvastatin, but our study showed no effect of
simvastatin on vitamin D status. However, plasma levels of triglycerides were
inversely associated with tertiles of plasma 25OHD levels and changes in plasma
triglycerides levels correlated inversely with seasonal changes in vitamin D
status. Conclusion. Our data do not support a pharmacological effect of statins
on vitamin D status, but do suggest that vitamin D may influence plasma lipid
profile and thus be of importance to cardiovascular health.
Menopause.. [Epub ahead of print]
The
Acupuncture on Hot Flashes Among Menopausal Women study: observational
follow-up results at 6 and 12 months.
Borud
EK, Alraek T, White A, Grimsgaard S.
From
the 1The National Research Center in Alternative and Complementary Medicine,
University of Tromsø, Tromsø, Norway; 2Department of General Practice and
Primary Care, Peninsula Medical School, Universities of Exeter and Plymouth,
Exeter, UK; and 3Clinical Research Center, University Hospital of North Norway,
Tromsø, Norway.
OBJECTIVE::
The previously published Acupuncture on Hot Flashes Among Menopausal Women
study compared the effectiveness of individualized acupuncture treatment plus
self-care versus self-care alone on hot flashes and health-related quality of
life in postmenopausal women. This article reports on the observational
follow-up results at 6 and 12 months. METHODS:: The Acupuncture on Hot Flashes
Among Menopausal Women study was a pragmatic, multicenter randomized controlled
trial with two parallel arms, conducted in 2006 to 2007. The 267 participants
were postmenopausal women experiencing, on average, 12.6 hot flashes per 24 h.
The acupuncture group received 10 individualized acupuncture treatments during
12 weeks and advice on self-care, whereas the control group received only
advice on self-care. Hot flash frequency and intensity (0-10 scale) and hours
of sleep per night were registered in a diary. Health-related quality of life
was assessed by the Women's Health Questionnaire. RESULTS:: From baseline to 6
months, the mean reduction in hot flash frequency per 24 hours was
Climacteric.. [Epub ahead of print]
Optimal
tolerability of ultra-low-dose continuous combined 17beta-estradiol and
norethisterone acetate: laboratory and safety results.
Department
of Obstetrics and Gynecology, Kvinnokliniken, Universitetssjukhuset, Lund,
Sweden.
Objective
To evaluate the influence of two ultra-low doses of oral continuous combined
hormone therapy and placebo on metabolic parameters, and to assess safety
endpoints and overall tolerability in healthy postmenopausal women. Design In a
subpopulation of the Clinical study on Hormone dose Optimisation In Climacteric
symptoms Evaluation (CHOICE) trial, lipids and parameters of glucose metabolism
and hemostasis were analyzed in Nordic women (n = 158) at baseline and after 12
and 24 weeks of treatment with 0.5 mg 17beta-estradiol (E2) + 0.25 mg norethisterone
acetate (NETA), 0.5 mg E2 + 0.1 mg NETA or placebo. Adverse events occurring
from the first trial-related activity, whether related or not related to the
study medication, were recorded for the entire population (n = 575) of the
trial. The seriousness, relationship to treatment and the reason for withdrawal
were reported. Results Both ultra-low-dose combinations were neutral to changes
in lipid and lipoprotein, hemostasis parameters and carbohydrate metabolism
during the trial. The incidence of serious adverse events was only 1% in
respective treatment groups. Adverse events were the reason for withdrawal in
only 2% and 6% of women in the 0.5 mg E2 + 0.25 mg and 0.1 mg NETA groups, and
in 8% in the placebo group. No weight gain or change in blood pressure was
reported during the trial in any of the study groups. Conclusion The treatments
had neutral effects on metabolic parameters in the study population. Excellent
tolerability of both ultra-low doses resulted in high completion rates.
Semana del 9 al 15 de
Diciembre de 2009
Osteoporos Int. 2009 Dec 9. [Epub ahead of print]
Use of
oral bisphosphonates and risk of venous thromboembolism: a population-based
case-control study.
Lamberg AL, Horvath-Puho E, Christensen S, Sørensen HT.
Department
of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45,
8200, Aarhus N, Denmark, al@dce.au.dk.
Oral
bisphosphonates are widely used for fracture prevention, but there is a concern
regarding potential adverse cardiovascular effects of bisphosphonates. In this large,
population-based case-control study, we found no evidence of an association
between bisphosphonate use and risk of venous thromboembolism (VTE).
INTRODUCTION: We examined the relation between the use of oral bisphosphonates
for osteoporosis and the risk of VTE. METHODS: We conducted a population-based
case-control study in Northern Denmark (population, 1.7 million). Using the
Danish National Registry of Patients, we identified all women with a first-time
hospital diagnosis of VTE between 1999 and 2006. For each case, we selected up
to ten female population controls, matched on date of the index VTE event and
age. Data on use of oral bisphosphonates, other medications, and comorbidity
were obtained from medical databases. We used logistic regression to estimate
odds ratios (OR) for VTE associated with bisphosphonate users while adjusting
for potential confounding factors. RESULTS: Four thousand one hundred
ninety-three cases and 41,197 controls were included in the study. One hundred
forty-nine cases (3.6%) and 1,078 controls (2.6%) were current bisphosphonate
users. The adjusted OR for VTE among the current bisphosphonate users compared
with nonusers was 1.03 (95% confidence interval (CI): 0.84-1.26), and when
restricted to cases of unprovoked thromboembolism, the adjusted OR was 1.08
(95% CI: 0.82-1.42). There was no association either for pulmonary embolism or
for deep venous thrombosis. CONCLUSION: We found no evidence of an association
of oral bisphosphonate use with the risk of VTE.
Osteoporos Int. 2009 Dec 9. [Epub ahead
of print]
Pedometer
determined ambulatory activity and bone mass: a population-based longitudinal
study in older adults.
Menzies
Research Institute, University of Tasmania, Hobart, Australia, 7001.
In this
large population-based study, walking was assessed twice yearly for a week,
each time by pedometer, had consistent clinically important associations with
hip areal bone mineral density (aBMD) in both sexes which appears most
important in those over 65 years of age suggesting that walking becomes more
important with increasing age. INTRODUCTION: Walking is advocated as a
preventative strategy for osteoporosis but the evidence is conflicting in
females and lacking in males. The aim of this population-based longitudinal
study in community dwelling older people (n = 875) was to determine the
association between pedometer determined ambulatory activity (PAA) and bone
mass. METHODS: Bone mass was assessed as aBMD at the hip and spine using dual
X-ray absorptiometry. Steps per day were measured using pedometers for 1 week
on four occasions at least 6 months apart. Data were analysed using linear
mixed models. RESULTS: At baseline, PAA was positively associated with hip
aBMD. An age interaction was present with steps having a stronger association
for those aged over 65 years. Longitudinally, the effect of steps on hip aBMD
was constant, but not additive over time. For those over 65 years, the
difference in hip aBMD between the lowest and highest steps quartiles ranged
from 3.1% to 9.4%. With regard to the spine, the relationship between daily
steps and spine aBMD was modified by sex. For males; there was no significant
relationship between steps and spine aBMD. However, for females, higher steps
were associated with higher spine aBMD with the effect being constant over time
but not additive. There was no evidence of a threshold effect. CONCLUSION: In
conclusion, pedometer-determined ambulatory activity has consistent clinically
important associations with hip aBMD in both sexes which appears most important
in those over 65 years of age. The
associations for spine aBMD were both weaker and inconsistent suggesting site
specificity.
Cogn Behav
Neurol. 2009 Dec;22(4):205-14.
Aging,
estrogens, and episodic memory in women.
Departments
of Health Research and Policy (Epidemiology), and of Neurology and Neurological
Sciences, Stanford University, Stanford, CA 94305-5405, USA.
vhenderson@stanford.edu
OBJECTIVE:
To review the relation in midlife and beyond between estrogen exposures and
episodic memory in women. BACKGROUND: Episodic memory performance declines with
usual aging, and impairments in episodic memory often portend the development
of Alzheimer disease. In the laboratory, estradiol influences hippocampal
function and animal learning. However, it is controversial whether estrogens
affect memory after a woman's reproductive years. METHOD: Focused literature
review, including a summary of a systematic search of clinical trials of
estrogens in which outcomes included an objective measure of episodic memory.
RESULTS: The natural menopause transition is not associated with the objective
changes in episodic memory. Strong clinical trial evidence indicates that
initiating estrogen-containing hormone therapy after the age of about 60 years
does not benefit episodic memory. Clinical trial findings in middle-aged women
before the age of 60 years are limited by smaller sample sizes and shorter
treatment durations, but these also do not indicate substantial memory effects.
Limited short-term evidence, however, suggests that estrogens may improve
verbal memory after surgical menopause. Although hormone therapy initiation in
old age increases dementia risk, observational studies raise the question of an
early critical window during which midlife estrogen therapy reduces late-life
Alzheimer disease. However, almost no data address whether midlife estrogen
therapy affects episodic memory in old age. CONCLUSIONS: Episodic memory is not
substantially impacted by the natural menopause transition or improved by the
use of estrogen-containing hormone therapy after the age of 60 years. Further
research is needed to determine whether outcomes differ after surgical
menopause or whether episodic memory later in life is modified by midlife
estrogenic exposures.
Gynecol Obstet Invest. 2009 Dec
7;69(3):145-152. [Epub ahead of print]
Association
between Bone Mineral Density and Metabolic Syndrome in Postmenopausal Korean
Women.
Department
of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Background/Aims:
We investigated the relationship between bone mineral density (BMD) of the
femur neck or lumbar spine and metabolic syndrome or its parameters in
postmenopausal Korean women. Methods: This study included 399 postmenopausal
women, for whom the BMD of their L2s-L4s and femur necks were examined in
association with metabolic syndrome. Results: Subjects with metabolic syndrome
had a higher BMD of the femur neck than those without metabolic syndrome when
adjusted for age (0.85 +/- 0.09 vs. 0.82 +/- 0.12 g/cm(2), p = 0.011), while
there was no statistical difference at lumbar spine. When adjusted for age and
BMI, high-density lipoprotein cholesterol (HDL-C) was weakly and negatively
correlated with BMD of the lumbar and femur neck (r = -0.107, p = 0.033; r =
-0.111, p = 0.028 respectively). Conclusion: Metabolic syndrome was partly
associated with higher BMD in our postmenopausal Korean women. Our study also
showed that HDL-C levels were negatively associated with BMD of the lumbar
spine and femur neck which means that subjects with lower HDL-C levels could
have higher BMD. The results of our retrospective study revealed that metabolic
syndrome could be associated with higher BMD in our postmenopausal Korean
women.
Int J Gynecol
Cancer. 2009 Dec;19(9):1556-9.
Normal
production of human chorionic gonadotropin in perimenopausal and menopausal
women and after oophorectomy.
Cole LA, Khanlian SA, Muller CY.
The
BACKGROUND: The normal pituitary
production of human chorionic gonadotropin (hCG)alongside luteinizing hormone,
and its presence in women after bilateral oophorectomy, during perimenopause
and menopause, as measured in serum and urine, has been known for 30 years and
is described in numerous publications. Last year our group discussed this
finding in a correspondence to the editor in the March 15th issue of
Semana del 2 al 9 de Diciembre de 2009
Osteoporos
Int. 2009 Dec 5. [Epub ahead of print]
Poor
bisphosphonate adherence for treatment of osteoporosis increases fracture risk:
systematic review and meta-analysis.
Imaz I, Zegarra P, González-Enríquez J, Rubio B, Alcazar R, Amate JM.
Agency
for Health Technologies Assessment, Instituto de Salud Carlos III. Science and Innovation Ministry, 5
Monforte de Lemos, Madrid, 28029, Spain, imaz@isciii.es.
Systematic
review of adherence to bisphosphonates for the treatment of osteoporosis finds
suboptimal levels of persistence and compliance. Poor bisphosphonate compliance
increases fracture risk. INTRODUCTION: The objectives of the study were to
measure the persistence and compliance with bisphosphonates for the treatment
of osteoporotic patients, and to estimate the influence of compliance on
fracture risk. METHODS: A systematic review of bisphosphonate adherence in
clinical practise provided new evidence to perform a meta-analysis of the means
of bisphosphonate persistence and compliance, with a subsequent meta-analysis
of fracture risk comparing poorly versus highly compliant patients. RESULTS:
Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most
of the patients were postmenopausal women treated with bisphosphonates. The
3.95% of the patients received hormone replacement therapy, but the rest
received bisphosphonates. The meta-analysis of five articles totalling 236,540
patients, who were followed for 1 year, provided a pooled persistence mean of
184.09 days. The meta-analysis of five articles, totalling 234,737 patients,
who were also followed for 1 year, provided a pooled medication possession
ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063
patients, who were followed for varying periods of time between 1 and 2.5
years, provided a pooled 46% increased fracture risk in non-compliant patients
versus compliant patients. The increased fracture risk was lower for
non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%).
CONCLUSIONS: Persistence and compliance are suboptimal for postmenopausal women
undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of
this low compliance is an increased risk of fracture, which is lower for
non-vertebral than for clinical vertebral fractures.
World J Gastroenterol. 2009 Dec
7;15(45):5693-9.
Hepatic
steatosis in overweight/obese females: New screening method for those at risk.
Tarantino G, Pizza G, Colao A, Pasanisi F, Conca P, Colicchio P, Finelli C, Contaldo F, Di Somma C, Savastano S.
Department of Clinical and Experimental
Medicine, Section of Hepatology in Internal Medicine, Federico II University
Medical School of Naples, Via Sergio Pansini, 5 80131 Naples, Italy. tarantin@unina.it.
AIM: To
identify which parameters could help to distinguish the "metabolically
benign obesity", which is not accompanied by insulin resistance (IR) and
early atherosclerosis. METHODS: Eighty two of 124 overweight/obese females
formed the study population, which was divided into two groups (52 and 30
subjects, respectively) with and without IR according to a HO meostatic
Metabolic Assessment (HOMA) cut-off of 2, and were studied in a cross-sectional
manner. The main outcome measures were waist circumference, serum uric acid,
high-density lipoprotein-cholesterol and triglycerides, alanine
aminotransferase, blood pressure and the two imaging parameters, hepatic
steatosis and longitudinal diameter of the spleen, which were measured in
relation to the presence/absence of IR. RESULTS: A variable grade of visceral
obesity was observed in all subjects with the exception of three. Obesity of a
severe grade was represented more in the group of IR individuals (P = 0.01).
Hepatic steatosis, revealed at ultrasound, was more pronounced in IR than in
non-IR subjects (P = 0.005). The two groups also demonstrated a clear
difference in longitudinal spleen diameter and blood pressure, with raised and
significant values in the IR group. Metabolic syndrome was frequent in the IR
group, and was not modified when adjusted for menopause (P = 0.001). At linear
regression, the beta values of waist circumference and body mass index
predicting HOMA were 0.295, P = 0.007 and 0.41, P = 0.0001, respectively.
Measures of spleen longitudinal diameter were well predicted by body mass index
(BMI) values, beta = 0.35, P = 0.01, and by HOMA, beta = 0.41, P = 0.0001.
Blood pressure was predicted by HOMA values, beta = 0.39, P = 0.0001). HOMA and
hepatic steatosis were highly associated (rho = 0.34, P = 0.002).
Interestingly, IR patients were almost twice as likely to have hepatic
steatosis as non-IR patients. Among the MS criteria, blood pressure was very
accurate in identifying the presence of IR (AUROC for systolic blood pressure
0.66, cut-off
Cerebrovasc Dis. 2009 Dec
1;29(2):130-136. [Epub ahead of print]
Low
Bone Mineral Density Is an Independent Risk Factor for Stroke and Death.
Nordström A, Eriksson M, Stegmayr B, Gustafson Y, Nordström P.
Department
of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå
University, Umeå, Sweden.
Background:
Recent studies suggest a relationship between atherosclerotic disease and
osteoporosis. The aim of the study was to investigate whether bone mineral
density (BMD) was prospectively related to stroke and death. Methods: BMD
(g/cm(2)) was measured in 4,302 men and women (mean age 59 years, range 40-75)
at baseline. The main outcome measures included validated strokes and death.
Results: After a mean follow-up time of 5.6 years (range 0-15.8 years), 139
strokes were registered and 224 subjects had died. After adjustment for age,
sex and body mass index, decreased femoral neck BMD and osteoporosis were found
to be independent predictors of stroke (hazard ratio, HR, for each standard
deviation decrease in BMD = 1.23, 95% CI = 1.01-1.49, and HR for osteoporosis =
1.92, 95% CI = 1.11-3.30). After adjustment for the same variables, the risk of
death during follow-up was related to femoral neck BMD (HR = 1.41, 95% CI =
1.21-1.64) and osteoporosis at baseline (HR = 2.05, 95% CI = 1.28-3.29).
Adjustment also for smoking, hypertension, hyperlipidemia and diabetes did not
change any of these results. Conclusions: We found that decreased BMD as well
as osteoporosis of the femoral neck are independently associated with stroke
and death. Given the impact of osteoporosis and stroke on morbidity and
mortality, this relationship is of high interest for further studies.
Eur J Clin Nutr. 2009 Dec 2. [Epub ahead of print]
Relationship
of 25-hydroxyvitamin D with all-cause and cardiovascular disease mortality in
older community-dwelling adults.
Semba RD, Houston DK, Bandinelli S, Sun K, Cherubini A, Cappola AR, Guralnik JM, Ferrucci L.
Department
of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore,
MD, USA.
Background/Objectives:Vitamin
D deficiency is associated with cardiovascular disease, osteoporosis, poor
muscle strength, falls, fractures and mortality. Although older adults are at a
higher risk of vitamin D deficiency, the relationship of serum
25-hydroxyvitamin D (25(OH)D) with all-cause and cardiovascular disease
mortality has not been well characterized in the elderly. We hypothesized that
low serum 25(OH)D levels predicted mortality in older
adults.Subjects/Methods:Serum 25(OH)D as well as all-cause and cardiovascular
disease mortality were examined in 1006 adults, aged >/=65 years, who
participated in the InCHIANTI (Invecchiare in Chianti, Aging in the Chianti
Area) study, a population-based, prospective cohort study of aging in Tuscany,
Italy. Serum 25(OH)D levels were measured at the time of enrollment in
1998-1999, and participants were followed up for mortality.Results:During 6.5
years of follow-up, 228 (22.7%) participants died, of whom 107 died due to
cardiovascular diseases. Compared with participants in the highest quartile of
serum 25(OH)D (>26.5 ng/ml) (to convert to nmol/l, multiply by 2.496), those
in the lowest quartile (<10.5 ng/ml) had increased risk of all-cause
mortality (Hazard Ratio (H.R.) 2.11, 95% Confidence Interval (95% C.I.):
1.22-3.64, P=0.007) and cardiovascular disease mortality (H.R. 2.64, 95% C.I.:
1.14-4.79, P=0.02), in multivariate Cox proportional hazards models that
adjusted for age, sex, education, season, physical activity and other potential
confounders.Conclusions:Older community-dwelling adults with low serum 25(OH)D
levels are at higher risk of all-cause and cardiovascular disease mortality.
Maturitas. 2009 Dec
5. [Epub ahead of print]
Progestational effects
of dydrogesterone in vitro, in vivo and on the human endometrium.
Institute
for Medical Research and Education, Hufelandstrasse 55, D-45122 Essen, Germany.
Dydrogesterone
has a molecular structure closely related to that of natural progesterone, but
it has enhanced oral availability compared with progesterone. The hormonal
profile and the progestational potency of dydrogesterone has been determined in
vitro, in vivo and in humans, in combination with estrogens or without. It
showed varying affinity for progesterone-binding proteins in uterine tissue in
vitro, depending on the species. It exerted a clear progestational response in
the rabbit in vivo, although the potency was influenced somewhat by the route
of administration. When used in hormone replacement therapy, 10mg
dydrogesterone given sequentially provides adequate protection against
endometrial hyperplasia in postmenopausal women using 2mg estradiol. Similarly,
a dydrogesterone dose of 5mg also protects the endometrium when continuously
combined with 1mg estradiol. Dydrogesterone also has beneficial effects in
women with amenorrhea/oligomenorrhea, dysfunctional uterine bleeding and
irregular cycles. In conclusion, having a similar profile to progesterone but
with better oral availability, dydrogesterone has been used successfully to
treat disorders related to absolute or relative progesterone deficiency.
Int
J Psychiatry Med. 2009;39(3):283-95.
The effects of female
reproductive hormones in generalized social anxiety disorder.
van Veen JF, Jonker BW, van Vliet IM, Zitman FG.
Department
of Psychiatry B1-P, Leiden University Medical Center, The Netherlands.
j.f.van_veen@lumc.nl
OBJECTIVE:
Although generalized social anxiety disorder (gSAD) is more prevalent in women,
the role of female reproductive hormones in gSAD has never been investigated.
Therefore, our aim was to make a first inventory of the influence of female
reproductive hormones on gSAD symptoms. METHOD: Female patients with gSAD who
had previously participated in our research projects in the University Medical
Center Utrecht and the Leiden University Medical Center were recruited. A
self-report survey with questions on the influence of menarche, the periods of
the menstrual cycle, oral contraceptive use, pregnancy, lactation, postpartum
period, and menopause on gSAD symptoms was returned by 46% of 140 women
suffering form gSAD. Non-parametric statistical tests were used to analyze the
data. RESULTS: A subgroup of patients reported an influence of female hormonal
cycle on gSAD symptoms. In this subgroup, statistical differences were found
for the menstrual cycle and pregnancy. In the premenstrual period, patients
reported more severe gSAD symptoms. During pregnancy symptoms decreased, but
postpartum symptom severity returned to the same levels as before pregnancy.
CONCLUSIONS: A subgroup of women with gSAD seemed vulnerable for the influences
of gonadal hormones. Prospective research in women with gSAD, in which the
gonadal hormones are assessed, is warranted.