Selección de Resúmenes de Menopausia
Semana del 28 de Octubre al 3 de Noviembre
de 2009
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Circulation. 2009 Oct 26. [Epub ahead of print]
Anthropometry,
Body Fat, and Venous Thromboembolism. A Danish Follow-Up Study.
Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjřnneland A, Overvad K.
Department of Clinical Epidemiology,
Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; and Institute
of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
BACKGROUND: -Obesity, measured as body
mass index, is associated with venous thromboembolism (VTE). Body mass index is
a marker of excess weight and correlates well with body fat content in adults;
however, it fails to consider the distribution of body fat. We assessed the
association between anthropometric variables and VTE. Methods and Results-From
1993 to 1997, 27 178 men and 29 876 women 50 to 64 years of age were recruited
into a Danish prospective study (Diet, Cancer, and Health). During 10 years of
follow-up, the outcome of VTE events was identified in the Danish National
Patient Registry and verified by review of medical records. Body weight, body
mass index, waist circumference, hip circumference, and total body fat were
measured at baseline. We used Cox proportional hazard models to assess the
association between anthropometry and VTE. Age was used as a time axis, with
further adjustment for smoking, physical activity, height, hypertension,
diabetes mellitus, cholesterol, and, among women, use of hormone replacement
therapy. We verified 641 incident VTE events and found monotonic dose-response
relationships between VTE and all anthropometric measurements in both sexes. In
mutually adjusted analyses of waist and hip circumference, we found that hip
circumference was positively associated with VTE in women but not in men,
whereas waist circumference was positively associated with VTE in men but not
in women. Conclusions-All measurements of obesity are predictors of the risk
for VTE. Positive associations were found between VTE and body weight, body
mass index, waist circumference, hip circumference, and total body fat mass.
Pharmacotherapy. 2009 Nov;29(11):1357-74.
Use of
antidepressants for management of hot flashes.
Department of Pharmacy Practice,
A growing body of evidence suggests that
antidepressant therapies, particularly selective serotonin reuptake inhibitors
and venlafaxine, are effective in the management of hot flash symptoms. Several
of these agents have the support of the
Am J Med. 2009 Nov;122(11):1016-1022.e1.
Bayesian
meta-analysis of hormone therapy and mortality in younger postmenopausal women.
Salpeter SR, Cheng J, Thabane L, Buckley NS, Salpeter EE.
BACKGROUND: There is uncertainty over the
risks and benefits of hormone therapy. We performed a Bayesian meta-analysis to
evaluate the effect of hormone therapy on total mortality in younger
postmenopausal women. This analysis synthesizes evidence from different
sources, taking into account varying views on the issue. METHODS: A
comprehensive search from 1966 through January 2008 identified randomized
controlled trials of at least 6 month's duration that evaluated hormone therapy
in women with mean age <60 years and reported at least one death, and
prospective observational cohort studies that evaluated the relative risk of mortality
associated with hormone therapy after adjustment for confounding variables.
RESULTS: The results were synthesized using a hierarchical random-effects
Bayesian meta-analysis. The pooled results from 19 randomized trials, with
16,000 women (mean age 55 years) followed for 83,000 patient-years, showed a
mortality relative risk of 0.73 (95% credible interval 0.52-0.96). When data
from 8 observational studies were added to the analysis, the resultant relative
risk was 0.72 (credible interval 0.62-0.82). The posterior probability that
hormone therapy reduces total mortality in younger women is almost 1.
CONCLUSIONS: The synthesis of data using Bayesian meta-analysis indicates a
reduction in mortality in younger postmenopausal women taking hormone therapy compared
with no treatment. This finding should be interpreted taking into account the
potential benefits and harms of hormone therapy.
Osteoporos Int. 2009 Oct 30. [Epub ahead of print]
Immune
changes in post-menopausal osteoporosis: the Immunos study.
Breuil V, Ticchioni M, Testa J, Roux CH, Ferrari P, Breittmayer JP, Albert-Sabonnadičre
C, Durant J, De Perreti F, Bernard A, Euller-Ziegler L, Carle GF.
Service de Rhumatologie, CHU de Nice, Hôpital
l'Archet, Route Saint Antoine de Ginestičre,Nice, France.
The phenotypic and functional
characteristics of immune cells of osteoporotic women compared to healthy
controls similar for age and estrogen level showed for the first time
significant changes in several B lymphocytes populations in postmenopausal
osteoporosis, related to bone mineral density (BMD) and fractures, and a
significant lower basal secretion of interferon-gamma (IFN-gamma) by CD4(+).
INTRODUCTION: To investigate the interactions between bone and immune system,
we studied the phenotypic and functional characteristics of immune cells of 26
postmenopausal women with osteoporotic (OP) fractures compared to 24 healthy
controls. METHODS: We analyzed surface markers of peripheral B, CD4(+) and
CD8(+) lymphocytes and cytokine secretion in supernatants of these cells
cultured with or without stimulation. Body composition was assessed by dual
energy X-ray absorptiometry. RESULTS: The two groups were similar for age and
estrogen level. OP women had a significantly lower body mass index, fat mass,
and lean mass. The number of CD19(+), CD19(+)/CD27(+), CD19(+)/CD27(+)/CD5(-)/CD38(+)
and CD19(+)/CD27(+)/RANK(+), CD4(+)/CD27(+)/CD45RA(-)/RANK(+), and
CD4(+)/CD27(+)/CD45RA(-)/CD28(+) was lower in OP women and positively
correlated to BMD. In OP women, under basal conditions, CD4(+) secreted less
IFN-gamma and B lymphocytes more granulocyte macrophage colony-stimulating
factor (GM-CSF). GM-CSF was positively correlated to fracture rate and
negatively to BMD. CONCLUSIONS: Our results suggest that, regardless of age and
estrogen status, postmenopausal OP is associated with immune changes,
highlighting a possible role of IFN-gamma in the pathophysiology of OP and
reporting, for the first time, changes in several B lymphocyte populations.
These alterations may reflect the frailty observed after fracture, providing
new insight into the mechanisms of morbidity and mortality associated with OP
fractures.
Womens Health (Lond Engl). 2009 Nov;5(6):637-47.
Long-term
prevention with hormone-replacement therapy after the menopause: which women
should be targeted?
Alexandersen P, Karsdal MA, Christiansen C.
Center for Clinical & Basic Research
a/s, Ballerup Byvej 222, DK-2750
For decades, hormone-replacement therapy
(HRT) was considered safe and was the first choice in prevention of
postmenopausal osteoporosis induced by estrogen deficiency. Numerous
experimental and epidemiological studies further supported a protective effect
of exogenous female sex hormones on atherogenesis and coronary heart disease
(CHD) in women after the menopause. However, the fact that these promising
results were not translated into lower incidences of CHD events in
hormone-treated women compared with placebo in subsequent, large, randomized
studies of healthy subjects as well as women with known CHD raised a very
intense debate concerning the safety of HRT in terms of cardiovascular risk. A
critical mass of data points toward a protective influence of HRT on
cardiovascular disease end points in early postmenopausal women, but increased
harm in elderly women, especially those with abdominal adiposity or metabolic
syndrome. Once the quasi-hysterical reaction to the largest of the randomized
studies (the Women's Health Initiative) has abated, a future strategy should be
to concentrate on identifying those relatively few individuals who are not
suitable for HRT, as HRT still remains the most thoroughly investigated pharmacological
prevention strategy of osteoporosis.
J Clin Endocrinol Metab. 2009 Oct 26. [Epub ahead of print]
Effect
of Transdermal Teriparatide Administration on Bone Mineral Density in
Postmenopausal Women.
Cosman F, Lane NE, Bolognese MA, Zanchetta JR, Garcia-Hernandez PA, Sees K, Matriano JA, Gaumer K, Daddona PE.
Context: Treatment of osteoporosis with an
anabolic agent, teriparatide [human PTH 1-34 (TPTD)], is effective in reducing
incident fractures, but patient resistance to daily sc injections has limited
its use. A novel transdermal patch, providing a rapid, pulse delivery of TPTD,
may provide a desirable alternative. Objective: The aim of the study was to
determine the safety and efficacy of a novel transdermal TPTD patch compared to
placebo patch and sc TPTD 20-mug injection in postmenopausal women with
osteoporosis. Design: Our study consisted of 6-month, randomized,
placebo-controlled, positive control, multidose daily administration. Patients:
We enrolled 165 postmenopausal women (mean age, 64 yr) with osteoporosis. Interventions:
A TPTD patch with a 20-, 30-, or 40-mug dose or a placebo patch was
self-administered daily for 30-min wear time, or 20 mug of TPTD was injected
daily. Outcomes: The primary efficacy measure was mean percentage change in
lumbar spine bone mineral density (BMD) from baseline at 6 months. Results:
TPTD delivered by transdermal patch significantly increased lumbar spine BMD
vs. placebo patch in a dose-dependent manner at 6 months (P < 0.001). TPTD
40-mug patch increased total hip BMD compared to both placebo patch and TPTD
injection (P < 0.05). Bone turnover markers (procollagen type I N-terminal
propeptide and C-terminal cross-linked telopeptide of type I collagen)
increased from baseline in a dose-dependent manner in all treatment groups and
were all significantly different from placebo patch (P < 0.001). All
treatments were well tolerated, and no prolonged hypercalcemia was observed.
Conclusion: Transdermal patch delivery of TPTD in postmenopausal women with
osteoporosis for 6 months is safe and effective in increasing lumbar spine and
total hip BMD.
Osteoporos Int. 2009 Oct 27. [Epub ahead of print]
Use of
bisphosphonates and raloxifene and risk of deep venous thromboembolism and
pulmonary embolism.
Vestergaard P, Schwartz K, Pinholt EM, Rejnmark L, Mosekilde L.
Department of Endocrinology and Metabolism
C,
Prior studies have associated raloxifene
and strontium ranelate with deep venous thromboembolism and pulmonary embolism.
In a cohort study, we observed an increased risk also with the bisphosphonates.
However, the increase was present already before the start of bisphosphonates
pointing at an effect of the underlying condition. INTRODUCTION: We seek to
study the association between use of drugs against osteoporosis and risk of
deep venous thromboembolism (DVT) and pulmonary embolism (PE). METHODS:
Nationwide register-based cohort study from
Semana del 21 al 27 de Octubre de 2009
Clin Interv Aging. 2009;4:357-65. Epub 2009 Oct 12.
Gastrointestinal
tolerability with ibandronate after previous weekly bisphosphonate treatment.
Derman R, Kohles
JD, Babbitt
A.
Department of Obstetrics and Gynecology,
Data from two open-label trials (PRIOR and CURRENT)
of women with postmenopausal osteoporosis or osteopenia were evaluated to
assess whether monthly oral and quarterly intravenous (IV) ibandronate dosing
improved self-reported gastrointestinal (GI) tolerability for patients who had
previously experienced GI irritation with bisphosphonate (BP) use. In PRIOR,
women who had discontinued daily or weekly BP treatment due to GI intolerance
received monthly oral or quarterly IV ibandronate for 12 months. The CURRENT
subanalysis included women receiving weekly BP treatment who switched to monthly
oral ibandronate for six months. GI symptom severity and frequency were
assessed using the Osteoporosis Patient Satisfaction Questionnaire. In PRIOR,
mean GI tolerability scores increased significantly at month 1 from screening
for both treatment groups (oral: 79.3 versus 54.1; IV: 84.4 versus 51.0; p <
0.001 for both). Most patients reported improvement in GI symptom severity and
frequency from baseline at all post-screening assessments (>90% at Month
10). In the CURRENT subanalysis >60% of patients reported improvements in
heartburn or acid reflux and >70% indicated improvement in other stomach
upset at month 6. Postmenopausal women with GI irritability with daily or
weekly BPs experienced improvement in symptoms with extended dosing monthly or
quarterly ibandronate compared with baseline.
J Clin Endocrinol Metab. 2009 Oct 22. [Epub ahead of print]
Effects of
Conjugated Equine Estrogens on Cognition and Affect in Postmenopausal Women
with Prior Hysterectomy.
Resnick SM, Espeland MA, An Y, Maki PM, Coker LH, Jackson R, Stefanick ML,
Wallace R, Rapp SR.
Context: Different menopausal hormone therapies may
have varied effects on specific cognitive functions. We previously reported
that conjugated equine estrogens (CEE) with medroxyprogesterone acetate had a
negative impact on verbal memory but tended to impact figural memory positively
over time in older postmenopausal women. Objective: The objective of the study
was to determine the effects of unopposed CEE on changes in domain-specific
cognitive function and affect in older postmenopausal women with prior
hysterectomy. Design: This was a randomized, double blind, placebo-controlled
clinical trial. Setting: The study was conducted at 14 of 40 Women's Health
Initiative (WHI) clinical centers. Participants: Participants were 886
postmenopausal women with prior hysterectomy, aged 65 yr and older (mean 74
yr), free of probable dementia, and enrolled in the WHI and WHI Memory Study
(WHIMS) CEE-Alone trial for a mean of 3 yr and followed up for a mean of 2.70
yr. Intervention: Intervention was 0.625 mg of CEE daily or placebo. Main
Outcome Measures: Annual rates of change in specific cognitive functions and
affect, adjusted for time since randomization, were measured. Results: Compared
with placebo, unopposed CEE was associated with lower spatial rotational
ability (P < 0.01) at initial assessment (after 3 yr of treatment), a
difference that diminished over 2.7 yr of continued treatment. CEE did not
significantly influence change in other cognitive functions and affect.
Conclusions: CEE did not improve cognitive functioning in postmenopausal women
with prior hysterectomy. CEE was associated with lower spatial rotational
performance after an average of 3 yr of treatment. Overall, CEE does not appear
to have enduring effects on rates of domain-specific cognitive change in older
postmenopausal women.
J Clin Endocrinol Metab. 2009 Oct 22. [Epub ahead of
print]
The Effect of
Transdermal Testosterone on Mammographic Density in Postmenopausal Women Not
Receiving Systemic Estrogen Therapy.
Davis SR, Hirschberg
AL, Wagner LK, Lodhi I, von Schoultz B.
Procter & Gamble Pharmaceuticals (L.K.W., I.L.), Mason, Ohio 45040.
Context: Greater mammographic density is associated
with increased breast cancer risk and reduced diagnostic mammographic
sensitivity and may be seen with estrogen/progestin therapy (EPT). The effects
of testosterone therapy on mammographic density in postmenopausal women not on
EPT are not known. Objective: Our objective was to compare effects of two doses
of the testosterone transdermal patch (TTP) with placebo in postmenopausal
women without concomitant EPT on mammographic density over 52 wk. Design: We
conducted a randomized, double-blind, placebo-controlled, parallel-group,
multinational trial. Patients: Patients included 279 postmenopausal women
participating in a testosterone and sexual function study with paired
mammograms for baseline and 52 wk/exit. Interventions: Patients were randomized
to placebo, TTP 150 mug/d, or TTP 300 mug/d, stratified by menopause type
(natural or surgical). Main Outcome Measures: Change from baseline to wk
Gend Med. 2009 Sep;6(3):433-43.
Relationship
between serum progesterone concentrations and cardiovascular disease, diabetes,
and mortality in elderly Swedish men and women: An 8-Year prospective study.
Nilsson SE, Fransson E, Brismar K.
Background: The use of synthetic progesterone-like
substances in hormone replacement therapy and birth control pills has been
associated with increases in cardiovascular morbidity and the prevalence of
diabetes. Objectives: The primary aims of this study were to investigate
whether physiologic concentrations of progesterone might also be associated
with cardiovascular disease and diabetes, and to explore potential gender
differences in these associations in elderly Swedish men and women. Methods:
This prospective, longitudinal study was performed in a Swedish
population-based sample of opposite-sex twins aged between 71 and 80 years who
were not receiving sex hormone therapy. Serum concentrations of progesterone,
estradiol, C-reactive protein (CRP), and urea were measured at baseline (1996)
and at 8-year follow-up (2004), and serum concentrations of cystatin and insulin
were measured only at follow-up. The outcomes of interest were cardiovascular
morbidity (myocardial infarction, angina pectoris, peripheral arterial disease,
stroke, congestive heart failure [CHF], cardiac arrhythmia, hypertension, and
thromboembolism), diabetes, and mortality throughout the observation period.
Results: At baseline, the study sample included 230 men and 195 women (mean
[SD] age, 74.6 [2.6] years). At follow-up, 132 men and 145 women (mean age,
82.4 [2.5] years) met the inclusion criteria, of whom 128 men and 112 women did
so at both baseline and follow-up. Serum progesterone concentrations, which did
not differ significantly from reported concentrations for the age group, were
significantly associated with mortality across the observation period (P <
0.001). At follow-up, higher serum progesterone was significantly associated
with the occurrence of CHF (P < 0.01); this association remained robust
after adjustment for CRP, cystatin, and insulin levels. Conclusion: In these
elderly Swedish men and women, increased physiologic concentrations of
progesterone were found to be associated with an increased prevalence of CHF,
independent of inflammatory factors, markers of renal function, and insulin
metabolism.
Climacteric. 2009 Oct 22. [Epub ahead of print]
Comparative
effects of continuous combined hormone therapy and tibolone on body composition
in postmenopausal women.
Ziaei S, Moaya M, Faghihzadeh S.
Departments of Obstetrics & Gynecology.
ObjectiveTo compare the effects of tibolone with
those of continuous combined hormone replacement therapy (HT) on body
composition in postmenopausal women. MethodsOne hundred and fifty
postmenopausal women were enrolled in a randomized, controlled trial to compare
the effects of tibolone with continuous combined HT on body composition.
Patients were randomly allocated into three groups and followed for 9 months.
Of the subjects included, 50 women received 2.5 mg tibolone plus one Cal+D
tablet (500 mg calcium and 200 IU vitamin D) daily, 50 women received 0.625 mg
conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA)
plus one Cal+D tablet daily, and the rest (50 women) received only one Cal+D
tablet and served as a control group. Body composition was evaluated with
measurements of body mass index (BMI), weight, waist-to-hip ratio (WHR), fat
mass and fat-free mass (FFM) before and after the intervention. Measurements of
body fat mass percentage, fat mass, body fat-free mass percentage and fat-free
mass (FFM) were assessed by measurement of skin-fold thickness. Results
Tibolone significantly increased weight, BMI and FFM and decreased WHR after
the treatment in comparison with baseline (p < 0.05). However, only weight
and BMI increased significantly in the CEE/MPA group after the treatment (p
< 0.05). There were significant increases in weight, BMI and fat mass in the
control group after 9 months. In the comparison of the parameters after the
treatment between the three groups, tibolone significantly increased FFM
compared with the control and CEE/MPA groups (p < 0.01). Conclusions The
effect of tibolone on body composition is favorable and therefore tibolone may
be regarded as an alternative to continuous combined hormone therapy in
postmenopausal women.
J Clin Endocrinol Metab. 2009 Oct 21. [Epub ahead of
print]
Higher Serum Testosterone
Concentration in Older Women is Associated with Insulin Resistance, Metabolic
Syndrome, and Cardiovascular Disease.
Patel SM, Ratcliffe SJ, Reilly MP, Weinstein R,
Bhasin S, Blackman MR, Cauley JA, et al.
Context: Early postmenopausal women with higher
testosterone (T) levels have increased insulin resistance (IR) and
cardiovascular risk factors, but whether this translates into increased
cardiovascular disease later in life is unknown. Objective: The objective of
the study was to determine whether higher T levels are associated with IR, the
metabolic syndrome (MetSyn), and coronary heart disease (CHD) in elderly women.
Design: Total T and free T by equilibrium dialysis were measured using
ultrasensitive assays in 344 women aged 65-98 yr enrolled in the Cardiovascular
Health Study. Cross-sectional analyses were performed to examine the
associations between total and free T and IR, MetSyn, and CHD. Results: There
was a stepwise increase in the homeostasis model assessment of insulin
resistance with increasing total (P = 0.0.003) and free T (P = 0.02) level and
a corresponding decrease in Quantitative Insulin Sensitivity Check Index (P
< 0.001 and P = 0.002, respectively). In adjusted models, higher levels of
both total and free T were strongly associated with abdominal obesity and high
fasting glucose, the two MetSyn components most strongly linked to IR. After
adjustment, women in the top quartile of total T levels had a 3-fold greater
odds of MetSyn (odds ratio 3.15, 95% confidence interval 1.57-6.35) than those
in the bottom quartile and a 3-fold greater odds of CHD (odds ratio 2.95, 95%
confidence interval 1.2-7.3) than those in second quartile, whereas free T was
not significantly associated with MetSyn or CHD. Conclusions: Higher levels of
T are associated with IR, MetSyn, and CHD in elderly women. Whether T is a
marker or mediator of cardiovascular disease in this population merits further
investigation.
J Vasc Surg. 2009 Oct 16. [Epub ahead of print]
Aggressive
lipid-lowering is more effective than moderate lipid-lowering treatment in
carotid plaque stabilization.
Kadoglou NP, Sailer N, Moumtzouoglou A, Kapelouzou
A, Gerasimidis T, Liapis CD.
Department of Vascular Surgery, University of
Athens, Thessaloniki, Greece and Athens, Greece.
OBJECTIVE: Atherosclerotic plaque stabilization is
a promising strategy to prevent cerebrovascular events in patients with carotid
atherosclerosis. Vascular calcification inhibitors, known osteopontin (OPN) and
osteoprotegerin (OPG), have emerged as novel cardiovascular biomarkers. This
open-label, prospective study aimed to examine whether aggressive lipid-lowering
therapy with atorvastatin is more effective than moderate lipid-lowering in
increasing carotid plaque echogenicity, assessed by Gray-Scale Median (GSM)
score and suppressing serum OPN and OPG levels in patients with moderate
carotid stenosis. METHODS: One hundred forty patients (64 males, 76 females),
aged 50 to 75 years, with carotid stenosis (North American Symptomatic Carotid
Endarterectomy Trial [NASCET]: 30%-60% for symptomatic and 30%-70% for
asymptomatic), but without indications for surgical intervention, were
enrolled. Patients with coronary heart disease, renal failure, hypothyroidism,
osteoporosis, and ongoing use of statins were excluded. Patients were randomly
assigned to: Group A (N = 70): Moderate lipid-lowering therapy with low-dose of
atorvastatin (10 mg-20 mg) to target LDL-C <100 mg/dL. Group B (N = 70):
Aggressive lipid-lowering therapy with high-dose of atorvastatin (80 mg) to
target LDL-C <70 mg/dL. Blood pressure, lipid and glycemic indexes, hsCRP,
serum OPN, and OPG were measured at baseline and after 12 months as well as the
GSM score. Independent samples t test, paired samples t test, Pearson
correlation, and multiple regression analysis were used (P < .05). RESULTS:
There were no significant differences between groups at baseline. Three
patients in group A experienced either cerebrovascular or cardiac ischemic
attacks, while two patients in group B underwent coronary angioplasty during
follow-up. Group B showed a more pronounced improvement in total cholesterol
and LDL-cholesterol compared with group A (P < .05). Moreover, atorvastatin
treatment suppressed serum hsCRP, OPN, and OPG levels from baseline in both
groups (P < .001). Notably, aggressive treatment decreased OPN (P = .012)
and OPG (P = .025) levels to a greater degree compared with moderate treatment.
Similarly, GSM score was remarkably increased in both groups, but that
augmentation was greater in group B (from 66.39 +/- 23.66 to 100.4 +/- 25.31)
than in group A (from 64.4 +/- 23.62 to 85.39 +/- 20.21) (P = .024). No change
in the degree of carotid stenosis was noted in both treatment arms.
Importantly, the aforementioned reduction in OPN (r = -0.517, P = .024) and OPG
(r = -0.312, P = .008) levels was inversely associated with GSM score changes
in univariate and standard multiple regression analysis (R(2) = 0.411, P =
.021). CONCLUSIONS: Among patients with moderate carotid stenosis, an
aggressive atorvastatin regimen enhanced carotid plaque echogenicity and
reduced serum OPN and OPG levels to a greater extent than respective moderate
atorvastatin therapy. Most importantly, those atorvastatin-induced effects were
associated with OPN and OPG suppression in a dose-dependent manner.
Cancer Causes Control. 2009 Oct 21. [Epub ahead of print]
Screening
mammography intervals among postmenopausal hormone therapy users and nonusers.
Onega T, Mackenzie
T, Weiss J, Goodrich M, Titus-Ernstoff L.
Department of Community and Family Medicine, Dartmouth
Medical School, Hanover, NH, USA.
BACKGROUND: The recent decline in
Cancer Epidemiol Biomarkers Prev. 2009 Oct 20. [Epub ahead of
print]
Colorectal
Cancer Incidence and Postmenopausal Hormone Use by Type, Recency, and Duration
in Cancer Prevention Study II.
Hildebrand JS, Jacobs
EJ, Campbell PT, McCullough ML, Teras LR,
Thun MJ, Gapstur SM.
Department of Epidemiology, American Cancer
Society, Atlanta, Georgia.
The Women's Health Initiative randomized trials showed
a reduction in colorectal cancer risk with the use of estrogen plus
progesterone (E + P), but not with estrogen alone (E-only), after intervention
periods <7 years. Using data from the Cancer Prevention Study II Nutrition
Cohort, we examined associations of colorectal cancer risk with E-only and E +
P, including analyses by recency and duration of hormone use. During 13.2 years
of follow-up, 776 cases of invasive colorectal cancer occurred among 67,412
postmenopausal women participants. Cox proportional hazards models were used to
estimate multivariate-adjusted relative risks (RR) and 95% confidence intervals
(95% CI) of colorectal cancer for current and former hormone users according to
hormone type and duration of use. Relative to women who never used
postmenopausal hormones, current, but not former, use of E-only was associated
with a reduced risk of colorectal cancer (RR 0.76; 95% CI, 0.59-0.97). Among
current E-only users, duration of use was inversely and linearly associated
with risk (P(trend) = 0.01). Use of E-only for <5 years was not associated
with reduced risk, whereas use for >/=20 years was associated with a 45%
reduction in risk (RR, 0.55; 95% CI, 0.36-0.86). There were no statistically
significant associations between E + P and colorectal cancer risk. Our results
suggest a strong inverse association of long-term use of E-only with colorectal
cancer risk, underscoring the importance of collecting data on duration of
hormone use in epidemiologic studies of postmenopausal hormones and risk of
disease.
Semana
del 14 al 20 de Octubre de 2009
Arterioscler
Thromb Vasc Biol. 2009 Oct 15. [Epub ahead of print]
Postmenopausal
Hormone Therapy and Risk of Idiopathic Venous Thromboembolism. Results From the
E3N Cohort Study.
Canonico M, Fournier A, Carcaillon L, Olié V, Plu-Bureau G, Oger E, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F, Scarabin PY.
Inserm Unit 780, Cardiovascular Epidemiology Section, Cedex, France;
University Paris-South 11, Cedex, France; Inserm ERI20/University Paris-South
11, Villejuif, France; University Paris Descartes, Paris, France; and Centre
Régional de PharmacoVigilance, Service de Pharmacologie, CHU de Rennes, France.
OBJECTIVE: Oral estrogen therapy increases venous
thromboembolism risk among postmenopausal women. Although recent data showed
transdermal estrogens may be safe with respect to thrombotic risk, the impact
of the route of estrogen administration and concomitant progestogens is not
fully established. METHODS AND RESULTS: We used data from the E3N French
prospective cohort of women born between 1925 and 1950 and biennially followed
by questionnaires from 1990. Study population consisted of 80 308
postmenopausal women (average follow-up: 10.1 years) including 549 documented
idiopathic first venous thromboembolism. Hazard ratios (HR) and 95% confidence
intervals (CI) were estimated using Cox proportional models. Compared to
never-users, past-users of hormone therapy had no increased thrombotic risk
(HR=1.1; 95% CI: 0.8 to 1.5). Oral not transdermal estrogens were associated
with increased thrombotic risk (HR=1.7; 95% CI: 1.1 to 2.8 and HR=1.1; 95% CI:
0.8 to 1.8; homogeneity: P=0.01). The thrombotic risk significantly differed by
concomitant progestogens type (homogeneity: P<0.01): there was no
significant association with progesterone, pregnanes, and nortestosterones
(HR=0.9; 95% CI: 0.6 to 1.5, HR=1.3; 95% CI: 0.9 to 2.0 and HR=1.4; 95% CI: 0.7
to 2.4). However, norpregnanes were associated with increased thrombotic risk
(HR=1.8; 95% CI: 1.2 to 2.7). CONCLUSIONS: In this large study, we found that
route of estrogen administration and concomitant progestogens type are 2
important determinants of thrombotic risk among postmenopausal women using
hormone therapy. Transdermal estrogens alone or combined with progesterone
might be safe with respect to thrombotic risk.
Eur J Nutr. 2009 Oct 13. [Epub ahead of print]
Alcohol consumption and the risk of coronary heart
disease in postmenopausal women with diabetes: Women's Health Initiative
Observational Study.
Rajpathak SN, Freiberg
MS, Wang
C, Wylie-Rosett
J, Wildman
RP, Rohan
TE, Robinson
JG, Liu
S, Wassertheil-Smoller
S.
Department of Epidemiology and Population Health,
Albert Einstein College of Medicine, Bronx, NY, 10461, USA, swapnil.rajpathak@einstein.yu.edu.
BACKGROUND: Although several observational studies
have consistently reported an inverse association between moderate alcohol
consumption and risk of coronary heart disease (CHD), it is yet not well
established if this association also exists among people with type 2 diabetes.
The aim of this study is to evaluate the association between the frequency and
quantity of alcohol intake and the risk of developing CHD among postmenopausal
women with diabetes. METHODS: We conducted a prospective cohort study, which included
3,198 women with self-reported diabetes and without any history of
cardiovascular disease at baseline, in the Women's Health Initiative
Observational Study. Alcohol intake was assessed by a semiquantitative food
frequency questionnaire. The primary outcome of this study was CHD, which was
validated by medical record review. Cox proportional hazards regression was
used to estimate the hazard ratio (HR) for the association of alcohol intake
and risk of incident CHD while adjusting for several potential confounders.
RESULTS: During the 22,546 person-years of follow-up, there were 336 incident
cases of CHD. Both frequency and quantity of alcohol intake were inversely
associated with the risk of developing CHD. Compared to nondrinkers, the
multivariable HRs across categories of frequency of alcohol consumption
(</=0.5, 0.5-2 and >/=2 drinks/week) were 0.89 (95% confidence intervals
[CI]: 0.63, 1.26), 0.84 (95% CI: 0.56, 1.25) and 0.65 (95% CI: 0.43, 0.99),
respectively (p for trend: 0.04). This association did not appear to differ
based on the type of the alcoholic beverage consumed. CONCLUSIONS: Moderate
alcohol consumption of postmenopausal women with type 2 diabetes may have a
benefit on CHD similar to that seen in postmenopausal nondiabetic women. The potential
risks of alcohol on noncardiac outcomes may need consideration when
recommending alcohol to women with diabetes.
Am J Epidemiol. 2009 Oct 14. [Epub ahead of print]
Postmenopausal Breast Cancer Risk and Dietary
Patterns in the E3N-EPIC Prospective Cohort Study.
Cottet V, Touvier
M, Fournier
A, Touillaud
MS, Lafay
L, Clavel-Chapelon
F, Boutron-Ruault
MC.
Drs. Vanessa Cottet and Mathilde Touvier
contributed equally to this article, and their names are given in alphabetical
order.
Since evidence relating diet to breast cancer risk
is not sufficiently consistent to elaborate preventive proposals, the authors
examined the association between dietary patterns and breast cancer risk in a
large French cohort study. The analyses included 2,381 postmenopausal invasive
breast cancer cases diagnosed during a median 9.7-year follow-up period
(1993-2005) among 65,374 women from the E3N-EPIC cohort. Scores for dietary
patterns were obtained by factor analysis, and breast cancer hazard ratios were
estimated by Cox proportional hazards regression for the highest quartile of
dietary pattern score versus the lowest. Two dietary patterns were identified:
"alcohol/Western" (essentially meat products, French fries,
appetizers, rice/pasta, potatoes, pulses, pizza/pies, canned fish, eggs,
alcoholic beverages, cakes, mayonnaise, and butter/cream) and
"healthy/Mediterranean" (essentially vegetables, fruits, seafood,
olive oil, and sunflower oil). The first pattern was positively associated with
breast cancer risk (hazard ratio = 1.20, 95% confidence interval (CI): 1.03,
1.38; P = 0.007 for linear trend), especially when tumors were estrogen
receptor-positive/progesterone receptor-positive. The "healthy/Mediterranean"
pattern was negatively associated with breast cancer risk (hazard ratio = 0.85,
95% CI: 0.75, 0.95; P = 0.003 for linear trend), especially when tumors were
estrogen receptor-positive/progesterone receptor-negative. Adherence to a diet
comprising mostly fruits, vegetables, fish, and olive/sunflower oil, along with
avoidance of Western-type foods, may contribute to a substantial reduction in
postmenopausal breast cancer risk.
Arch Intern Med. 2009 Oct 12;169(18):1684-91
New-onset breast tenderness after initiation of
estrogen plus progestin therapy and breast cancer risk.
Crandall CJ, Aragaki
AK, Chlebowski
RT, McTiernan
A, Anderson
G, Hendrix
SL, Cochrane
BB, Kuller
LH, Cauley
JA.
Department of Medicine, David Geffen School of
Medicine at University of California, UCLA Medicine/GIM, Los Angeles, CA 90024,
USA. ccrandall@mednet.ucla.edu
BACKGROUND: Estrogen plus progestin therapy
increases breast cancer incidence and breast tenderness. Whether breast
tenderness during estrogen plus progestin therapy is associated with breast
cancer risk is uncertain. METHODS: We analyzed data from the Women's Health
Initiative Estrogen + Progestin Trial, which randomized postmenopausal women
with an intact uterus to receive daily conjugated equine estrogens, 0.625 mg,
plus medroxyprogesterone acetate, 2.5 mg (n = 8506), or placebo (n = 8102). At
baseline and annually, participants underwent mammography and clinical breast
examination. Self-reported breast tenderness was assessed at baseline and at 12
months. The incidence of invasive breast cancer was confirmed by medical record
review (mean follow-up of 5.6 years). RESULTS: Of women without baseline breast
tenderness (n = 14,538), significantly more assigned to receive conjugated
equine estrogens plus medroxyprogesterone vs placebo experienced new-onset
breast tenderness after 12 months (36.1% vs 11.8%, P < .001). Of women in
the conjugated equine estrogens plus medroxyprogesterone group, breast cancer risk
was significantly higher in those with new-onset breast tenderness compared
with those without (hazard ratio, 1.48; 95% confidence interval, 1.08-2.03; P =
.02). In the placebo group, breast cancer risk was not significantly associated
with new-onset breast tenderness (P = .97). CONCLUSIONS: New-onset breast
tenderness during conjugated equine estrogens plus medroxyprogesterone therapy
was associated with increased breast cancer risk. The sensitivity and
specificity of the association between breast tenderness and breast cancer were
similar in magnitude to those of the Gail model.
J Bone Miner Res. 2009 Oct 12. [Epub ahead of
print]
Obesity and Fractures in Postmenopausal Women.
Premaor MO, Pilbrow
L, Tonkin
C, Parker
R, Compston
J.
Abstract Low BMI is a recognized risk factor for
fragility fracture whilst obesity is widely believed to be protective. As part
of a clinical audit of guidance from the National Institute of Health and
Clinical Excellence (NICE) we have documented the prevalence of obesity and
morbid obesity in postmenopausal women aged < 75 years presenting to our
Fracture Liaison Service (FLS). Between January 2006 and December 2007 1005
postmenopausal women aged < 75 years with a low trauma fracture were seen in
the FLS. 805 of these women (80%) underwent assessment of bone mineral density
(BMD) by dual energy X-ray absorptiometry (DXA) and values for body mass index
(BMI were available in 799. The prevalence of obesity (BMI 30-34.9 kg/m(2)) and
morbid obesity (BMI >/= 35 kg/m(2)) in this cohort was 19.3% and 8.4%
respectively. 59.1% of obese and 73.1% of morbidly obese women had normal BMD,
and only 11.7% and 4.5% respectively had osteoporosis (p<0.0001). Multiple
regression analysis revealed significant negative associations between hip
T-score and age (p<0.0001), and significant positive associations with BMI
(p<0.0001) and previous fracture (p=0.001). Our results demonstrate a
surprisingly high prevalence of obesity in postmenopausal women presenting to a
FLS with low trauma fracture. The majority of these women had normal BMD as
measured by DXA. Our findings have important public health implications in view
of the rapidly rising increase in obesity in many populations and emphasise the
need for further studies to establish the pathogenesis of fractures in obese
individuals and to determine appropriate preventive strategies.
Cochrane Database
Syst Rev. 2009 Oct
7;(4):CD001405.
Oestrogen therapy for urinary incontinence in
post-menopausal women.
Cody JD, Richardson
K, Moehrer
B, Hextall
A, Glazener
CM.
Cochrane Incontinence Review Group, University of
Aberdeen, 1st Floor, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25
2ZD.
BACKGROUND: It is possible that oestrogen
deficiency may be an aetiological factor in the development of urinary
incontinence in women. OBJECTIVES: To assess the effects of local and systemic
oestrogens used for the treatment of urinary incontinence. SEARCH STRATEGY: We
searched the Cochrane Incontinence Group Specialised Register of trials (2
April 2009) and the reference lists of relevant articles. SELECTION CRITERIA:
Randomised or quasi-randomised controlled trials that included oestrogens in at
least one arm, in women with symptomatic or urodynamic diagnoses of stress,
urgency or mixed urinary incontinence or other urinary symptoms post-menopause.
DATA COLLECTION AND ANALYSIS: Trials were evaluated for methodological quality
and appropriateness for inclusion by the review authors. Data were extracted by
at least two authors and cross checked. Subgroup analyses were performed
grouping participants under local or systemic administration. Where
appropriate, meta-analysis was undertaken. MAIN RESULTS: Thirty- three trials
were identified which included 19,313 (1,262 involved in trials of local
administration) incontinent women of whom 9417 received oestrogen therapy.
Sample sizes ranged from 16 to 16,117. The trials used varying combinations of
type of oestrogen, dose, duration of treatment and length of follow up. Outcome
data were not reported consistently and were available for only a minority of
outcomes.Systemic administration (of oral oestrogens) resulted in worse
incontinence than on placebo (RR 1.32, 95% CI 1.17 to 1.48). This result is
heavily weighted by a subgroup of women from the Hendrix trial, which had large
numbers of participants and a longer follow up of one year; all the women had
had a hysterectomy and the treatment used was conjugated equine oestrogen. The
result for women with an intact uterus where oestrogen and progestogen combined
were used also showed a statistically significant worsening of incontinence (RR
1.11, 95% CI 1.04 to 1.18).There was some evidence that oestrogens used locally
(for example vaginal creams or tablets) may improve incontinence (RR 0.74, 95%
CI 0.64 to 0.86). Overall, there were around one to two fewer voids in 24 hours
and nocturnal voids amongst women treated with local oestrogen, and there was
less frequency and urgency. No serious adverse events were reported although
some women experienced vaginal spotting, breast tenderness or nausea.Women who
were continent and received systemic oestrogen replacement, with or without
progestogens, for reasons other than urinary incontinence were more likely to
report the development of new urinary incontinence in one large study.The data
were too few to address questions about oestrogens compared with or in
combination with other treatments, different types of oestrogen or different
modes of delivery. AUTHORS' CONCLUSIONS: Local oestrogen treatment for
incontinence may improve or cure it, but there was little evidence from the
trials on the period after oestrogen treatment had finished and none about
long-term effects. However, systemic hormone replacement therapy, using
conjugated equine oestrogen, may make incontinence worse. There were too few
data to reliably address other aspects of oestrogen therapy, such as oestrogen
type and dose, and no direct evidence on route of administration. The risk of endometrial
and breast cancer after long-term use suggests that oestrogen treatment should
be for limited periods, especially in those women with an intact uterus.
Semana
del 7 al 13 de Octubre de 2009
Maturitas. 2009 Oct 6. [Epub ahead of print]
Effects of sleep
disturbance on the quality of life of Turkish menopausal women: A
population-based study.
OBJECTIVES: The
purpose of this study was to investigate sleep disturbances among menopausal
women: their prevalence, risk factors for them and the quality of life of women
who have them. DESIGN: A population-based sample of 887 Turkish women aged
45-59 years and living in
Vascul Pharmacol. 2009 Oct 5. [Epub ahead of print]
Alendronate
affects calcium dynamics in cardiomyocytes in vitro.
Kemeny-Suss N, Kasneci A, Rivas D, Afilalo J, Komarova SV, Chalifour LE, Duque G.
Faculty of
Dentistry, McGill University, Montreal, Quebec, Canada, H3A 2B2.
Therapy with
bisphosphonates, including alendronate (ALN), is considered a safe and effective
treatment for osteoporosis. However, recent studies have reported an unexpected
increase in serious atrial fibrillation (AF) in patients treated with
bisphosphonates. The mechanism that explains this side effect remains unknown.
Since AF is associated with an altered sarcoendoplasmic reticulum calcium load,
we studied how ALN affects cardiomyocyte calcium homeostasis and protein
isoprenylation in vitro. Acute and long-term (48h) treatment of atrial and
ventricular cardiomyocytes with ALN (10(-8)-10(-6)M) was performed. Changes in
calcium dynamics were determined by both fluorescence measurement of cytosolic
free Ca(2+) concentration and western blot analysis of calcium-regulating
proteins. Finally, effect of ALN on protein farnesylation was also identified.
In both atrial and ventricular cardiomyocytes, ALN treatment delayed and
diminished calcium responses to caffeine. Only in atrial cells, long-term
exposure to ALN induced transitory calcium oscillations acutely, and led to
development of oscillatory component in calcium responses to caffeine. Changes
in calcium dynamics were accompanied by changes in expression of proteins
controlling sarcoendoplasmic reticulum calcium. In contrast, ALN minimally
affected protein isoprenylation in these cells. In summary, treatment of atrial
cardiomyocytes with ALN induced abnormalities in calcium dynamics consistent
with induction of a self-stimulatory, pacemaker-like behavior, which may
contribute to development of cardiac side effects associated with these drugs.
N Engl J Med. 2009 Oct 8;361(15):1459-65.
Osteoporosis
associated with neutralizing autoantibodies against osteoprotegerin.
Riches PL, McRorie E, Fraser WD, Determann C, van't Hof R, Ralston SH.
Rheumatic
Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh,
Western General Hospital, Edinburgh, United Kingdom.
Autoantibodies
against osteoprotegerin, which block the inhibitory effect of osteoprotegerin
on signaling by the receptor activator of nuclear factor (NF)-kappaB (RANK),
were identified in a man with celiac disease who presented with severe
osteoporosis and high bone turnover. The osteoporosis did not respond to the
treatment of his celiac disease but was completely reversed by bisphosphonate
therapy. Autoantibodies against osteoprotegerin were detected in three
additional patients with celiac disease. Such autoantibodies may be associated
with the development of high-turnover osteoporosis, but whether autoantibodies
against osteoprotegerin commonly contribute to the pathogenesis of osteoporosis
in patients with celiac disease remains to be determined.
Am J Physiol
Regul Integr Comp Physiol. 2009 Oct 7. [Epub ahead of print]
Estrogen replacement
restores flow-induced vasodilation in coronary arterioles of aged and
ovariectomized rats.
Leblanc AJ, Reyes R, Kang LS, Dailey RA, Stallone JN, Moningka NC, Muller-Delp JM.
The risk for
cardiovascular disease (CVD) increases with advancing age; however, the age at
which CVD risk increases significantly is delayed by more than a decade in
women compared to men. This cardioprotection, which women experience until
menopause, is presumably due to the presence of ovarian hormones, in particular
estrogen. The purpose of this study was to determine how age and ovarian
hormones affect flow-induced vasodilation in the coronary resistance
vasculature. Coronary arterioles were isolated from young (6 mos), middle-aged
(14 mos), and old (24 mos) intact, ovariectomized (OVX) and ovariectomized +
estrogen replaced (OVE) female Fischer-344 rats to assess flow-induced
vasodilation. Advancing age impaired flow-induced dilation of coronary
arterioles (Young: 50 +/- 4 vs. Old: 34 +/- 6; % relaxation). Ovariectomy
reduced flow-induced dilation in arterioles from young females and estrogen
replacement restored vasodilation to flow. In aged females, flow-induced
vasodilation of arterioles was unaltered by OVX; however, estrogen-replacement
improved flow-induced dilation by ~ 160%. The contribution of NO to
flow-induced dilation, assessed by nitric oxide synthase (NOS) inhibition with
L-NAME, declined with age. L-NAME did not alter flow-induced vasodilation in
arterioles from OVX rats, regardless of age. In contrast, L-NAME reduced
flow-induced vasodilation of arterioles from estrogen-replaced rats at all
ages. These findings indicate that the age-induced decline of flow-induced, NO-mediated
dilation in coronary arterioles of female rats is related, in part, to a loss
of ovarian estrogen and estrogen supplementation can improve flow-induced
dilation, even at an advanced age.
J Clin Endocrinol
Metab. 2009 Oct 6.
[Epub ahead of print]
Influence of Age
and Obesity on Serum Estradiol, Estrone, and Sex Hormone Binding Globulin
Concentrations following Oral Estrogen Administration in Postmenopausal Women.
Karim R, Mack WJ, Hodis HN, Roy S, Stanczyk FZ.
Department of
Pediatrics (R.K.), Department of Preventive Medicine (R.K., W.J.M., H.N.H),
Atherosclerosis Research Unit (R.K., W.J.M., H.N.H), Department of Medicine
(H.N.H.), and Department of Obstetrics and Gynecology (S.R., F.Z.S.),
University of Southern California, Los Angeles, California 90033.
Objective:
Hormone therapy (HT) increases the risk of venous thrombosis and stroke. Risk
of venous thrombosis and stroke is higher in older, overweight, and obese women
using HT. However, the impact of age and obesity on estrogen concentrations
among HT users is not well defined. Method: We measured serum levels of
estrone, total and free estradiol, and SHBG in 180 postmenopausal women
participating in the Estrogen in the Prevention of Atherosclerosis Trial
(EPAT), 91 receiving estradiol therapy (ET) and 89 taking placebo, every 6
months over 2 yr. Mean on-trial levels of estrogens and SHBG were compared
across age, body mass index (BMI), and waist to hip ratio categories among ET
users and placebo separately. Results: Among the ET users, total (P = 0.01) and
free estradiol (P = 0.002) were significantly directly associated with BMI
adjusted for age. SHBG was inversely related to waist to hip ratio adjusted for
age (P = 0.005). Age was not associated with any of the estrogen or SHBG
concentrations in ET or placebo groups. BMI was positively associated with
estrone concentrations among older but not younger ET users (P for interaction
= 0.03). Conclusion: Overweight and obese women using ET attain greater
concentrations of estrogen compared to women with normal BMI, whereas ET users
with abdominal obesity attain lower SHBG levels. Obese older women using ET
have the highest concentration of estrone. It may be useful to consider age and
obesity when prescribing HT to minimize the risk of venous thrombosis or stroke
in postmenopausal women. Further research regarding relationships among
circulating hormone levels and risk for these conditions is required to
substantiate this conclusion.
Climacteric 2009;
12: 445 - 453
Risk of
cardiovascular outcomes in users of estradiol/dydrogesterone or other HRT
preparations
C.
Schneider; S. S. Jick; C. R. Meier
Background. Use of postmenopausal hormone replacement therapy
(HRT) used to be promoted to reduce the risk of ischemic cardiovascular
diseases, a concept which has been challenged by results of the large Women's
Health Initiative trial in users of estrogen and progestin. It is postulated
that the type of progestin used in HRT affects the cardiovascular risk. Methods We used the UK-based General
Practice Research Database to conduct a follow-up study with a nested
case-control analysis. We assessed and compared the risk of developing
myocardial infarction, thrombotic stroke or venous thromboembolism in
estradiol/dydrogesterone users, users of other HRT, or non-users of HRT. Results The incidence rates of
myocardial infarction, thrombotic stroke and venous thromboembolism in
estradiol/dydrogesterone users were 0.40 (95% confidence interval (CI)
0.18-0.76), 0.27 (95% CI 0.10-0.58) and 0.31 (95% CI 0.13-0.64) per 1000
person-years, respectively. As compared to non-users of HRT, the adjusted
relative risk estimates (odds ratios) in the nested case-control analysis for
estradiol/dydrogesterone users or users of other HRT were 1.06 (95% CI
0.48-2.36) and 1.12 (95% CI 0.84-1.51) for myocardial infarction, 0.50 (95% CI
0.21-1.22) and 1.18 (95% CI 0.94-1.48) for thrombotic stroke, and 0.84 (95% CI
0.37-1.92) and 1.42 (95% CI 1.10-1.82) for venous thromboembolism,
respectively. Conclusion The
study provides evidence that estradiol/dydrogesterone use of several months to
a few years is not associated with a higher risk of cardiovascular events than
use of other HRT.
J Sex Med. 2009 Oct;6(10):2690-2697.
The Relationship between Self-Reported Sexual Satisfaction and General
Well-Being in Women.
Davison SL, Bell RJ, Lachina M, Holden SL, Davis SR.
Women's Health Program,
Department of Medicine, Central and Eastern Clinical School, Monash University,
Alfred Hospital, Prahran, Vic., Australia;
Introduction. The extent to
which low sexual function or sexual dissatisfaction in women impacts on
well-being remains uncertain, yet this is a critical issue in the controversy
as to the benefits of pharmacotherapy for women seeking treatment for female
sexual dysfunction. Aim. To explore the relationship between well-being and
self-perceived satisfaction with sexual function in women and to determine if
there is an independent effect of menopausal status or age. Design. A
community-based cross-sectional study. Patients. A total of 421 women, aged 18
to 65 years were recruited from the community. Women were required to
self-identify at study outset as being either satisfied or dissatisfied with
their sexual life and be premenopausal or postmenopausal. Main Outcome
Measures. Scores from the Psychological General Well-Being Index (PGWB), the
Beck Depression Index (BDI) and a daily diary of sexual function. Results. A
group of 349 women were included in the analysis. Total PGWB and domain scores
of positive well-being and vitality were lower in dissatisfied women compared
to satisfied women. PGWB total and domain scores of depressed mood, positive
well-being and vitality were higher in older women. Menopause did not have an
independent effect on well-being. Conclusions. Women who self-identify as
having sexual dissatisfaction have lower psychological general well-being.
These findings reinforce the importance of addressing sexual health and
well-being in women as an essential component of their health care.
Semana del 30 de Septiembre al 6 de Octubre de 2009
Obesity (Silver
Spring). 2009 Oct 1.
[Epub ahead of print]
Metabolic Syndrome and Changes in Body Fat From a
Low-fat Diet and/or Exercise Randomized Controlled Trial.
Camhi SM, Stefanick ML, Katzmarzyk PT, Young DR.
Population Science, Pennington Biomedical Research
Center, Baton Rouge, Louisiana, USA.
It is difficult to identify the successful
component(s) related to changes in metabolic syndrome (MetS) from lifestyle
interventions: the weight loss, the behavior change, or the combination. The
purpose of this study is to determine the effects of a weight-stable randomized
controlled trial of low-fat diet and exercise, alone and in combination, on
MetS. Men (n = 179) and postmenopausal women (n = 149) with elevated
low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein
cholesterol (HDL-C) were randomized into a 1-year, weight-stable trial with
four treatment groups: control (C), diet (D), exercise (E), or diet plus
exercise (D+E). MetS was defined using a continuous score. Changes in MetS
score (DeltaMetS) were compared between groups using analysis of covariance,
stratified by gender and using two models, with and without baseline and change
in percent body fat (DeltaBF) as a covariate. In men, DeltaMetS was higher for
D vs. C (P = 0.04), D+E vs. C (P = 0.0002), and D+E vs. E (P = 0.02). For
women, DeltaMetS was greater for D vs. C (P = 0.045), E vs. C (P = 0.02), and
D+E vs. C (P = 0.004). After adjusting for DeltaBF, all differences between
groups were attenuated and no longer significant. DeltaMetS were associated
with DeltaBF for both men (P < 0.0001) and women (P = 0.004). After
adjustment for DeltaBF, low-fat diet alone and in combination with exercise had
no effect on MetS. The key component for MetS from low-fat diet and/or
increased physical activity appears to be body fat loss.
J Bone Joint Surg
Am. 2009
Oct;91(10):2376-80.
Patients with wrist fractures are less likely to be
evaluated and managed for osteoporosis.
Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH.
Department of Orthopaedic Surgery, Seoul National
University Bundang Hospital, Seoul National University College of Medicine, 300
Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
BACKGROUND: Although osteoporosis is being
evaluated and treated increasingly in elderly patients with fragility
fractures, some studies have suggested that physicians may be missing important
opportunities, especially in patients with nonvertebral fractures. The purpose
of the present study was to determine whether specialists responsible for
treating fractures at various locations have different propensities for
evaluating and treating osteoporosis after a fracture in female patients over
the age of fifty years. METHODS: A retrospective nationwide cohort study was
performed with use of data collected during 2007 by the Korean Health Insurance
Review Agency, which covers 97% of the population. The incidences of fractures
around the hip, spine, and wrist in female patients more than fifty years of
age and the frequencies of bone density scans for osteoporosis and the use of
medications for its treatment were analyzed and compared. RESULTS: The database
identified 31,540 hip fractures, 58,291 spine fractures, and 61,234 wrist
fractures in female patients who were more than fifty years of age in
BMC Cancer. 2009 Oct 1;9(1):349. [Epub ahead of print]
Intensity and timing of physical activity in
relation to postmenopausal breast cancer risk: the prospective NIH-AARP Diet
and Health Study.
Peters TM, Moore SC, Gierach GL, Wareham NJ, Ekelund U, Hollenbeck AR, Schatzkin A, Leitzmann MF.
ABSTRACT: BACKGROUND: Despite strong evidence of an
inverse association of physical activity with postmenopausal breast cancer
risk, whether a certain intensity or time of life of physical activity is most
effective for lowering breast cancer risk is not known. METHODS: In 118,899 postmenopausal
women in the prospective NIH-AARP Diet and Health Study, we examined the
relations of light and moderate-to-vigorous intensity physical activity during
four periods of life ("historical": ages 15-18, 19-29, 35-39 years;
"recent": past 10 years) to postmenopausal breast cancer risk.
Physical activity was assessed by self-report at baseline, and 4287 incident
breast cancers were identified over 6.6 years of follow-up. RESULTS: In
age-adjusted and multivariate Cox regression models, >7 hours/week of
moderate-to-vigorous activity during the past 10 years was associated with 16%
reduced risk of postmenopausal breast cancer (RR:0.84; 95%CI:0.76,0.93)
compared with inactivity. The association remained statistically significant
after adjustment for BMI (RR:0.87; 95%CI:0.78,0.96). Neither
moderate-to-vigorous intensity activity during other periods of life nor light
intensity activity during any period of life was related to breast cancer risk,
and associations did not vary by tumor characteristics. CONCLUSIONS: A high
level of recent, but not historical, physical activity of moderate-to-vigorous
intensity is associated with reduced postmenopausal breast cancer risk. More
precise recall of recent physical activity than activity in the distant past is
one possible explanation for our findings.
Calcif Tissue
Int. 2009 Oct 1.
[Epub ahead of print]
Minimum Required Vitamin D Level for Optimal
Increase in Bone Mineral Density with Alendronate Treatment in Osteoporotic
Women.
Ishijima M, Sakamoto Y, Yamanaka M, Tokita A, Kitahara K, Kaneko H, Kurosawa H.
Department of Orthopaedics, Juntendo University
School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo.
Vitamin D insufficiency and deficiency are common
in the elderly. Most previous studies using alendronate have used vitamin D
supplementation regardless of individual vitamin D status. However, the minimum
required vitamin D levels for the efficacy of alendronate treatment of
osteoporosis remain unclear. Fifty-two postmenopausal women, diagnosed with
osteoporosis, were enrolled in this prospective study, in which they took 5 mg
of alendronate daily for 6 months without any supplements. Associations between
baseline factors and their changes during the treatment and the change in the
lumbar spine bone mineral density (LS-BMD) were examined. The most appropriate
cut-off level of 25-hydroxyvitamin D (25[OH]D) for the optimal increase in
LS-BMD with alendronate was determined using the Akaike information criterion
statistical criterion. Overall, alendronate treatment significantly increased
LS-BMD by 4.7%. The basal serum 25(OH)D and change in urinary NTX were
significantly associated with the increase in LS-BMD. The increase in LS-BMD
between the two groups was not different when comparing those with baseline
25(OH)D above vs. below 30 ng/ml. However, 25(OH)D of 25 ng/ml was determined
to be the minimum required vitamin D level for an adequate effect of
alendronate. Vitamin D status may affect the increase in LS-BMD with
alendronate treatment in individuals being treated for osteoporosis, and a
25(OH)D level >25 ng/ml appears to be required for an optimal LS-BMD
response.
Hum Reprod Update. 2009 Sep 30. [Epub ahead of print]
Should the ovaries be removed or retained at the
time of hysterectomy for benign disease?
Hickey M, Ambekar M, Hammond I.
School of Women's and Infants' Health, University
of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco,
WA 6008, Australia.
BACKGROUND Bilateral oophorectomy is commonly
performed at the time of hysterectomy for benign disease. Indications for
oophorectomy vary, but in most cases relatively little high-quality information
is available to inform the surgeon or patient regarding the relative risks and
benefits of ovarian conservation or removal. This review will address the
common clinical situations when oophorectomy may be performed and will evaluate
the evidence for risk and benefit in each of these circumstances. The aim of
this review is to bring together the evidence regarding oophorectomy in pre-
and post-menopausal women and to highlight the areas needing further study.
METHODS We searched the published literature for studies related to outcomes
following surgical menopause, risk-reducing surgery for ovarian cancer,
surgical treatment for endometriosis, bilateral oophorectomy for benign disease
and treatment for premenstrual syndrome/premenstrual dysphoric disorder.
RESULTS Rates of oophorectomy at the time of hysterectomy for benign disease
appear to be increasing. There is good evidence to support bilateral
salpingoophorectomy (BSO) as a risk-reducing surgery for women at high risk of
ovarian cancer, but relatively little evidence to support oophorectomy or BSO
in other circumstances. There is growing evidence from observational studies
that surgical menopause may impact negatively on future cardiovascular,
psychosexual, cognitive and mental health. CONCLUSION Clinicians and patients
should fully consider the relative risks and benefits of oophorectomy on an
individual basis prior to surgery.
Hypertension. 2009 Sep 28. [Epub ahead of print]
Effect of Cardiorespiratory Fitness on Vascular
Regulation and Oxidative Stress in Postmenopausal Women.
Pialoux V, Brown AD, Leigh R, Friedenreich CM, Poulin MJ.
Departments of Physiology and Pharmacology,
Medicine, and Clinical Neurosciences, Hotchkiss Brain Institute, and Libin
Cardiovascular Institute of Alberta, Faculty of Medicine, and Faculty of
Kinesiology, University of Calgary, Calgary, Alberta, Canada; Alberta Health
Services, Calgary, Alberta, Canada.
Increasing evidence exists suggesting an important
role for oxidative stress in the pathogenesis and progression of hypertension
in women via a decrease of NO production after menopause. Regular physical
training has been shown to upregulate antioxidant enzymatic systems, which may
slow down the usual increase of oxidative stress in postmenopausal women. The
aims of this study were to determine the impact of fitness status on enzymatic
antioxidant efficiency, oxidative stress, and NO production and to determine the
associations among oxidative stress, enzymatic antioxidant and NO production,
mean arterial blood pressure (MABP), and cerebrovascular conductance (CVC) in
postmenopausal women (n=40; 50 to 90 years old). Physical fitness, physical
activity, resting MABP, and CVC were measured. End product of NO, lipid
peroxidation (malondialdehyde and 8-iso-prostaglandin F2alpha), DNA oxidation
(8-hydroxy-2'-deoxyguanosine), protein nitration (nitrotyrosine), antioxidant
glutathione peroxidase, and catalase activities were measured in plasma. We
identified significant negative associations between oxidative stress and
indices of physical fitness (malondialdehyde: r=-0.33, P<0.05;
8-iso-prostaglandin F2alpha: r=-0.39, P<0.05; 8-hydroxy-2'-deoxyguanosine:
r=-0.35, P<0.05) and physical activity (malondialdehyde: r=-0.30, P<0.05;
8-iso-prostaglandin F2alpha: r=-0.41, P<0.01; 8-hydroxy-2'-deoxyguanosine:
r=-0.39, P<0.05). Conversely, glutathione peroxidase was positively
correlated with fitness level (r=0.55; P<0.01). Finally, MABP and CVC were
significantly associated with 8-hydroxy-2'-deoxyguanosine (MABP: r=0.36,
P<0.05; CVC: r=-0.36, P<0.05), nitrotyrosine (MABP: r=0.39, P<0.05;
CVC: r=-0.32, P<0.05), and the end product of NO (MABP: r=-0.57, P<0.01;
CVC: r=0.44, P<0.01). These findings demonstrate that, after menopause,
fitness level and regular physical activity mediate against oxidative stress by
maintaining antioxidant enzyme efficiency. Furthermore, these results suggest
that oxidative stress and NO production modulate MABP and CVC.
J Psychiatr Res. 2009 Sep 24. [Epub ahead of print]
Suicide attempts among women during low
estradiol/low progesterone states.
Baca-Garcia
E, Diaz-Sastre
C, Ceverino
A, Perez-Rodriguez
MM, Navarro-Jimenez
R, et al.
Department of
Psychiatry at the New York State Psychiatric Institute and Columbia University,
NY, USA; Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Autonoma
University of Madrid, Spain; Centro de Investigación Biomédica en Red en el
área de Salud Mental (CIBERSAM), Madrid, Spain.
The relationship between the menstrual cycle and
risk for suicidal behaviors is not clear. The aim of this study is to determine
whether perimenstrual phases in fertile women are associated with acute risk
for suicide attempt and explore whether risk is elevated during low
estradiol/low progesterone states. Women (N=431) recruited within 24h of a
suicide attempt were assessed for psychopathology, suicidal behavior and LH,
FSH, estradiol and progesterone blood levels. Among fertile women (N=281/431),
suicide attempts were more likely to occur during menses (26%, 72/281 observed
vs. 15%, 43/281 expected attempts; p<0.001). Compared to women whose
attempts occurred during other phases, women who attempted suicide during low
estradiol/low progesterone states (menstrual phase, amenorrhea and menopause)
reported severe suicide intent, a measure that may be predictive of eventual
suicide death. Suicide attempts among women are more likely when estrogen and
progesterone levels are low and attempts made under these conditions are
associated with greater severity. Low gonadal hormone levels may constitute a
key factor in the neurobiological basis of suicidal behavior among women,
suggesting a novel, testable hypothesis regarding the underpinnings of suicidal
acts.
Maturitas. 2009 Sep 23. [Epub ahead of print]
When, why and for whom there is a relationship
between physical activity and menopause symptoms.
McAndrew LM, Napolitano MA, Albrecht A, Farrell NC, Marcus BH, Whiteley JA.
Dept. of Veterans Affairs NJ Healthcare System, War
Related Illness and
OBJECTIVES: The relationship between enhanced
physical activity and decreased menopause symptoms is equivocal. In this study
we sought to better understand this relationship by examining the association
of physical activity to different symptom domains and by examining mediating
and moderating variables. STUDY DESIGN: Women participating in a randomized
control trial on physical activity were given a menopause symptom measure
(MENQOL) at follow-up. Of the 280 women participating, 113 (mean age=52)
reported having symptoms they attributed to menopause. Regression analyses were
run to examine if change in physical activity predicted fewer symptoms.
Exercise self-efficacy was examined as a mediator and depressive symptoms as a
moderator. RESULTS: An increase in physical activity from baseline was found to
be related to reporting fewer total menopause symptoms (beta=-0.22, p=.02).
When the total menopause symptoms score was examined by domain, increased
physical activity was found to be related to reporting fewer general symptoms
attributed to menopause (psychosocial (beta=-0.18, p=.05) and physical
(beta=-0.23, p=.01)), but had no effect on specific symptoms of menopause
(vasomotor and sexual). Exercise self-efficacy was found to mediate the
relationship between increased physical activity and total, physical and
psychosocial menopause symptoms. Finally, for individuals with high depressive
symptoms, those who increased physical activity the most reported fewer sexual
symptoms of menopause. CONCLUSION: This study suggests that physical activity
participation is associated with lower general symptom reporting as opposed to
specifically impacting menopause symptoms. Further, exercise self-efficacy mediates
the relationship between physical activity and general menopause symptoms,
suggesting a psychological pathway.
Hear Res. 2009 Sep 22. [Epub ahead of print]
The menopause triggers hearing decline in healthy
women.
Hederstierna C, Hultcrantz M, Collins A, Rosenhall U.
Division of Otorhinolaryngology and Hearing,
Karolinska Institute, Stockholm, Sweden.
BACKGROUND: Epidemiological studies have shown that
women have better high-frequency thresholds than men in virtually all age
groups, and that age-related hearing decline starts after