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Lau ES, Michos ED. Blood Pressure Trajectories Through the Menopause Transition: Different Paths, Same Journey. Circ Res 2022; 130:323-325. [PMID: 35113659 DOI: 10.1161/circresaha.122.320664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emily S Lau
- Cardiology Division, Massachusetts General Hospital, Boston (E.S.L.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (E.D.M.)
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52
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Siegfried JM. Sex and Gender Differences in Lung Cancer and Chronic Obstructive Lung Disease. Endocrinology 2022; 163:6470418. [PMID: 34927202 DOI: 10.1210/endocr/bqab254] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Two highly prevalent pulmonary diseases, lung cancer and chronic obstructive lung disease (COPD), show both sex and gender differences in their presentations and outcomes. Sex differences are defined as biological differences associated with the male vs female genotype, and gender differences are defined as behavioral or social differences that primarily arise because of gender identity. The incidence of both lung cancer and COPD has increased dramatically in women over the past 50 years, and both are associated with chronic pulmonary inflammation. Development of COPD is also a risk factor for lung cancer. In this review, the main differences in lung cancer and COPD biology observed between men and women will be summarized. Potential causative factors will be discussed, including the role of estrogen in promoting pro-growth and inflammatory phenotypes which may contribute to development of both lung cancer and COPD. Response of the innate and adaptive immune system to estrogen is a likely factor in the biology of both lung cancer and COPD. Estrogen available from synthesis by reproductive organs as well as local pulmonary estrogen synthesis may be involved in activating estrogen receptors expressed by multiple cell types in the lung. Estrogenic actions, although more pronounced in women, may also have importance in the biology of lung cancer and COPD in men. Effects of estrogen are also timing and context dependent; the multiple cell types that mediate estrogen action in the lungs may confer both positive and negative effects on disease processes.
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Affiliation(s)
- Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15260, USA
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53
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Wang R, Huang X, Zhou T, Li Y, Ding M, Xu H, Gao Y. Safety and Feasibility of Early Oral Nutrition after Endoscopic Treatment for Patients with Liver Cirrhosis: A Historical-prospective, Comparative-Effectiveness Study. JPEN J Parenter Enteral Nutr 2022; 46:1660-1670. [PMID: 35040175 DOI: 10.1002/jpen.2328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/02/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficacy of early oral nutrition (EON) after endoscopic treatment compared with parenteral nutrition (PN) for patients with gastroesophageal variceal bleeding varices as cirrhotic complications. METHODS This historical-prospective study enrolled patients from Qilu Hospital of Shandong University in China with gastroesophageal varices as cirrhotic complications and undergoing endoscopic therapy. A total of 197 patients who fasted for 4 h after treatment were prospectively enrolled as the oral nutrition group whereas those who fasted for more than 48 h were retrospectively matched in a ratio of 1:1 as the parenteral nutrition group. The primary endpoint was variceal re-bleeding, whereas the secondary endpoints were mortality and adverse events during the 42-day follow-up. Hospitalisation duration and expenses, levels of inflammatory factors, defecation time, and the satisfaction of patients were evaluated. RESULTS During the 42-day follow-up, no significant difference was observed in the rate of variceal re-bleeding (P = 0.586) and morality (P = 1.000) between the oral nutrition group and the parenteral nutrition group. However, the average days of hospitalisation (P < 0.001) and expenses (P < 0.001) were significantly decreased in the oral nutrition group. Furthermore, C-reactive protein lever (P = 0.002) and defecation time (P < 0.001) were lower, whereas the satisfaction rate was higher (P < 0.001) in the oral nutrition group than those in the parenteral nutrition group. Linear regression analysis showed that tissue adhesive dosage was related to diet time (P = 0.038, 95% CI: 0,135-4.516). CONCLUSIONS EON was proven to be safe, feasible, and hence, recommended after endoscopic treatment in patients with cirrhosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Renren Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Xiaoli Huang
- Department of Nutrition, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Tao Zhou
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Yueyue Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Mengmeng Ding
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Huawei Xu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan City, Shandong Province, People's Republic of China
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54
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Pan M, Pan X, Zhou J, Wang J, Qi Q, Wang L. Update on hormone therapy for the management of postmenopausal women. Biosci Trends 2022; 16:46-57. [PMID: 35013031 DOI: 10.5582/bst.2021.01418] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hormone therapy (HT) has been used in postmenopausal women for decades in clinical practice. With further analysis and newer studies, the benefits and risks of HT have been repeatedly verified and discussed. HT is recommended for the treatment of vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM) and the prevention of osteoporosis. However, the precise association between HT and the risks of cardiovascular diseases, venous thromboembolism, neurodegenerative diseases, breast cancer, and endometrial cancer remains controversial. Therefore, determining how to take advantage of and control the risks of HT by adjusting the initiation time, regimen, and duration is crucial. Recent studies have indicated that HT is not related to the risk of all-cause, cardiovascular, or breast cancer mortality although it might increase the incidence of some chronic diseases. For symptomatic postmenopausal women under the age of 60 without contraindications, early initiation of HT is safe and probably has a mortality benefit over the long term. Initiating HT close to menopause at the lowest effective dose is more likely to have maximal benefits and the lowest risks. Transdermal and vaginal HT may have a lower risk, but recent evidence suggests additional clinical benefits of oral HT formulations in relieving VMS and preventing osteoporosis. The pooled cohort risk equation for atherosclerotic cardiovascular disease (ASCVD) and the free app named Menopro can be used to perform individual risk assessments. In addition, Chinese herbal medicines have benefits in alleviating hot flashes, depression, and menopausal symptoms, although further data are needed to strongly support their efficacy. Acupuncture and electroacupuncture have definite efficacy in the treatment of postmenopausal symptoms with few adverse effects, so they are a reasonable option as an alternative therapy for high-risk women. This review discusses the history of, guidelines on, and strategies for HT in order to make suggestions based on the most up-to-date evidence for the management of postmenopausal women.
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Affiliation(s)
- Meijun Pan
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.,Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Xinyao Pan
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Qing Qi
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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55
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Prabakaran S, Vitter S, Lundberg G. Cardiovascular Disease in Women Update: Ischemia, Diagnostic Testing, and Menopause Hormone Therapy. Endocr Pract 2021; 28:199-203. [PMID: 34974184 DOI: 10.1016/j.eprac.2021.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This update will address 3 areas specifically that are essential to improving cardiovascular outcomes for women. METHODS The current literature has been reviewed and three important areas of cardiovascular care in women are highlighted. First is that even though women and men share many traditional risk factors for ischemic heart disease, several of these risk factors affect women disproportionately when it comes to CVD risk and events. There are also unique sex-specific risk factors for women and risk factors that are more common in women than in men. Adverse outcomes of pregnancy and hypertensive disorders of pregnancy are associated with an increased long-term risk of CVD and events. At menopause, cardiovascular risks increase, and lipids become unfavorable. Second is that diagnostic testing for ischemic heart disease presents different specificities and sensitivities between men and women and testing should be determined according to what is best and safest for women. Third is that currently, menopause hormone therapy is approved by the U.S. Food and Drug Administration for the treatment of vasomotor and genitourinary symptoms, prevention of osteoporosis, and estrogen replacement in the setting of surgical menopause, hypogonadism, or premature ovarian insufficiency. It is not recommended for the primary or secondary prevention of CVD and not recommended for women with high atherosclerotic CVD risk. RESULTS Cardiovascular disease (CVD) remains the most common cause of death in women in the United States despite tremendous improvements in cardiovascular care for men and women. The prevention of CVD in women with early detection and implementation of preventive therapies before atherosclerotic CVD develops is critical to improving outcomes for women.
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Affiliation(s)
- Sindhu Prabakaran
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Sophie Vitter
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Gina Lundberg
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Emory Heart and Vascular, Emory Women's Heart Center, Atlanta, Georgia.
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Abstract
The spectacular success of compounded bioidentical hormone therapy is a product of the unanticipated negative-to-neutral findings of the Women's Health Initiative hormone trial and the peculiarities of their regulatory status. By not having to provide scientific evidence of safety and efficacy, a requirement for all Food and Drug Administration (FDA)-approved hormone therapy products, the industry's relatively unfettered marketing now accounts for about one third of menopausal hormone therapy prescriptions. Clinicians are often caught in the middle between patient beliefs and a desire to practice evidence-based medicine. Strategies are needed to redirect patients towards truly safe and effective treatment for their menopausal symptoms.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Predicting the risk of atherosclerotic cardiovascular disease among adults living with HIV/AIDS in Addis Ababa, Ethiopia: A hospital-based study. PLoS One 2021; 16:e0260109. [PMID: 34843544 PMCID: PMC8629213 DOI: 10.1371/journal.pone.0260109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p<0.049) were found to be independent predictors of reduced risk of ASCVD. Likewise, younger age (40 to 64 years), female gender, and lower systolic blood pressure were significantly associated with lower risk of ASCVD among patients aged 40 to 79 years using both PCE and FRS. Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.
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58
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Gerges SH, El-Kadi AOS. Sex differences in eicosanoid formation and metabolism: A possible mediator of sex discrepancies in cardiovascular diseases. Pharmacol Ther 2021; 234:108046. [PMID: 34808133 DOI: 10.1016/j.pharmthera.2021.108046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
Arachidonic acid is metabolized by cyclooxygenase, lipoxygenase, and cytochrome P450 enzymes to produce prostaglandins, leukotrienes, epoxyeicosatrienoic acids (EETs), and hydroxyeicosatetraenoic acids (HETEs), along with other eicosanoids. Eicosanoids have important physiological and pathological roles in the body, including the cardiovascular system. Evidence from several experimental and clinical studies indicates differences in eicosanoid levels, as well as in the activity or expression levels of their synthesizing and metabolizing enzymes between males and females. In addition, there is a clear state of gender specificity in cardiovascular diseases (CVD), which tend to be more common in men compared to women, and their risk increases significantly in postmenopausal women compared to younger women. This could be largely attributed to sex hormones, as androgens exert detrimental effects on the heart and blood vessels, whereas estrogen exhibits cardioprotective effects. Many of androgen and estrogen effects on the cardiovascular system are mediated by eicosanoids. For example, androgens increase the levels of cardiotoxic eicosanoids like 20-HETE, while estrogens increase the levels of cardioprotective EETs. Thus, sex differences in eicosanoid levels in the cardiovascular system could be an important underlying mechanism for the different effects of sex hormones and the differences in CVD between males and females. Understanding the role of eicosanoids in these differences can help improve the management of CVD.
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Affiliation(s)
- Samar H Gerges
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ayman O S El-Kadi
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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59
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Jalnapurkar S, Xu KH, Zhang Z, Bairey Merz CN, Elkayam U, Pai RG. Changing Incidence and Mechanism of Pregnancy-Associated Myocardial Infarction in the State of California. J Am Heart Assoc 2021; 10:e021056. [PMID: 34668401 PMCID: PMC8751836 DOI: 10.1161/jaha.121.021056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objective of this study was to evaluate the temporal trends in pregnancy-associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for acute myocardial infarction and pregnancy or postpartum admissions; risk factors were analyzed and compared with pregnant patients without myocardial infarction. A total of 341 patients were identified with PAMI from a total of 5 266 380 pregnancies (incidence of 6.5 per 100 000 pregnancies). Inpatient maternal mortality rate was 7%, and infant mortality rate was 3.5% among patients with PAMI. There was a nonsignificant trend toward an increase in PAMI incidence from 2003 to 2011, possibly attributable to higher incidence of spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome. PAMI, when compared with pregnant patients without myocardial infarction, was significant for older age (aged >30 years in 72% versus 37%, P<0.0005), higher preponderance of Black race (12% versus 6%, P<0.00005), lower socioeconomic status (median household income in lowest quartile 26% versus 20%, P=0.04), higher prevalence of hypertension (26% versus 7%, P<0.0005), diabetes (7% versus 1%, P<0.0005), anemia (31% versus 7%, P<0.0001), amphetamine use (1% versus 0%, P<0.00005), cocaine use (2% versus 0.2%, P<0.0001), and smoking (6% versus 1%, P=0.0001). Conclusions There has been a trend toward an increase in PAMI incidence in California over the past decade, with an increasing trend in spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome as mechanisms. These findings warrant further investigation.
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Affiliation(s)
- Sawan Jalnapurkar
- Department of Internal Medicine and CardiologyUniversity of California Riverside School of MedicineRiversideCA
| | - Karen Huaying Xu
- Department of StatisticsUniversity of California RiversideLos AngelesCA
| | - Zhiwei Zhang
- Department of StatisticsUniversity of California RiversideLos AngelesCA
| | | | - Uri Elkayam
- University of Southern CaliforniaLos AngelesCA
| | - Ramdas G. Pai
- Department of Internal Medicine and CardiologyUniversity of California Riverside School of MedicineRiversideCA
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Maiello M, Cecere A, Zito A, Ciccone MM, Palmiero P. Low-dose Aspirin for Primary Prevention of Cardiovascular Events in Postmenopausal Women with Type-2 Diabetes: The Prescriptive Approach in the Real World. Int J Prev Med 2021; 12:140. [PMID: 34912516 PMCID: PMC8631123 DOI: 10.4103/ijpvm.ijpvm_365_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (CV) events in postmenopausal women with type-2 diabetes is controversial. Therefore, it is recommended only on an individual basis, recommendation of grade C. METHODS We enrolled 275 consecutive postmenopausal women with type-2 diabetes, without an increased bleeding risk and without preexisting CV disease as coronary artery disease, stroke, and peripheral vascular disease, but with a high risk assessed by score >10%, aged 60-69 years. All were receiving aspirin (75-100 mg daily), aspirin group (AG). 170 postmenopausal women with type-2 diabetes and without preexisting cardiovascular (CV) disease, but not on aspirin treatment, despite a high risk assessed by score >10%, were control group (CG). Mean age was 66 ± 4 years for AG and 65 ± 7 years for CG. Our goal was to identify the prevalence of low-dose aspirin prescriptions in these populations according to different clinical conditions. RESULTS Women with only high risk were 41/275 (15%) on AG and 72/170 (42.3%) on CG, Chi-squared 41, Odds ratio 0.2, c.i. 95%, P < 0.0001. Women affected by metabolic syndrome were 105/275 (38.1%) on AG and 47/170 (27.6%) on CG, Chi-squared 5.1, Odds ratio 1.6, c.i. 95%, P < 0.02. Women affected by metabolic cardiomyopathy were 111/275 (40.3%) on AG and 44/170 (25.9%) on CG, Chi-squared 8, Odds ratio 1.8, c.i. 95%, P < 0.004. Women affected by diabetic cardiomyopathy were 18/275 (6.6%) on AG and 7/170 (4.2%) on CG, Chi-squared 1.2, Odds ratio 16, c.i. 95%, P < 0.2 n.s. CONCLUSIONS Low-dose aspirin in our population is prescribed preferentially in postmenopausal women with type-2 diabetes when affected by metabolic syndrome or metabolic cardiomyopathy, at the opposite women with only high risk have lower chance to receive aspirin.
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Affiliation(s)
- Maria Maiello
- ASL Brindisi, Department of Cardiology Equipe, District of Brindisi, Brindisi, Italy
| | - Annagrazia Cecere
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (Deto), University of Bari, Bari, Italy
| | - Annapaola Zito
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (Deto), University of Bari, Bari, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (Deto), University of Bari, Bari, Italy
| | - Pasquale Palmiero
- ASL Brindisi, Department of Cardiology Equipe, District of Brindisi, Brindisi, Italy
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Ueda K, Fukuma N, Adachi Y, Numata G, Tokiwa H, Toyoda M, Otani A, Hashimoto M, Liu PY, Takimoto E. Sex Differences and Regulatory Actions of Estrogen in Cardiovascular System. Front Physiol 2021; 12:738218. [PMID: 34650448 PMCID: PMC8505986 DOI: 10.3389/fphys.2021.738218] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Great progress has been made in the understanding of the pathophysiology of cardiovascular diseases (CVDs), and this has improved the prevention and prognosis of CVDs. However, while sex differences in CVDs have been well documented and studied for decades, their full extent remains unclear. Results of the latest clinical studies provide strong evidence of sex differences in the efficacy of drug treatment for heart failure, thereby possibly providing new mechanistic insights into sex differences in CVDs. In this review, we discuss the significance of sex differences, as rediscovered by recent studies, in the pathogenesis of CVDs. First, we provide an overview of the results of clinical trials to date regarding sex differences and hormone replacement therapy. Then, we discuss the role of sex differences in the maintenance and disruption of cardiovascular tissue homeostasis.
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Affiliation(s)
- Kazutaka Ueda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Nobuaki Fukuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Yusuke Adachi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Genri Numata
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Hiroyuki Tokiwa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Masayuki Toyoda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Akira Otani
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Masaki Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Pang-Yen Liu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan
| | - Eiki Takimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyô, Japan.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Schamroth Pravda N, Karny-Rahkovich O, Shiyovich A, Schamroth Pravda M, Rapeport N, Vaknin-Assa H, Eisen A, Kornowski R, Porter A. Coronary Artery Disease in Women: A Comprehensive Appraisal. J Clin Med 2021; 10:jcm10204664. [PMID: 34682787 PMCID: PMC8541551 DOI: 10.3390/jcm10204664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023] Open
Abstract
Coronary artery disease (CAD) is a significant cause of illness and death amongst women. The pathophysiology, manifestations, and outcomes of CVD and CAD differ between sexes. These sex differences remain under-recognized. The aim of this review is to highlight and raise awareness of the burden and unique aspects of CAD in women. It details the unique pathophysiology of CAD in women, cardiovascular risk factors in women (both traditional and sex-specific), the clinical presentation of CAD in women, and the range of disease in obstructive and non-obstructive CAD in women.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Correspondence: ; Tel.: +972-544476243
| | - Orith Karny-Rahkovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | | | | | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Avital Porter
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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Zhu Y, Zhu Y, Chen Y, Yan Q, Baradwan S, Găman MA, Zanghelini F. The effect of tibolone treatment on fasting blood sugar, insulin, insulin resistance and endothelial function in postmenopausal women: A meta-analysis of randomized controlled trials. Exp Gerontol 2021; 155:111586. [PMID: 34627872 DOI: 10.1016/j.exger.2021.111586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/23/2021] [Accepted: 10/03/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The menopause is associated in females with the presence of dysglycemia, insulin resistance and with the development of endothelial dysfunction. Tibolone (TIB) is a synthetic steroid compound with selective oestrogenic and, to a lesser extent, progestogenic and androgenic properties prescribed to postmenopausal women to alleviate the symptoms of the climaterium and to prevent the development of osteoporosis. However, the impact of TIB on fasting blood sugar (FBS), insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) index and flow-mediated dilation (FMD) in women has not been evaluated so far. Thus, to investigate this research question, we conducted the present systematic review and meta-analysis. METHODS Two independent reviewers searched the Scopus, Web of Science, PubMed/Medline and Embase databases up to 20 December 2020. The weighted mean differences (WMDs) and the 95% confidence intervals (CI) were calculated using the DerSimonian and Laird random effects models between the TIB and control groups and included in the forest plot. RESULTS The overall findings were generated from 12 eligible randomized controlled trials. As compared to controls, TIB administration resulted in a significant reduction of FBS (WMD: -3.06 mg/dL, 95% CI: -5.30 to -0.82, P = 0.007), and of the HOMA-IR index (WMD: -0.61, 95% CI: -1.11 to -0.11, P = 0.01). However, treatment with TIB did not lead to significant changes of the FMD (WMD: 0.78%, 95% CI: -0.20 to 1.77, P = 0.12) or of insulin levels (WMD: -0.10 mIU/L, 95% CI: -2.04 to 1.83, P = 0.91). CONCLUSION TIB administration can decrease FBS and the HOMA-IR index in postmenopausal women. However, the use of TIB does not influence insulin levels or FMD.
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Affiliation(s)
- Yinghong Zhu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China.
| | - Yingbin Zhu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Yan Chen
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Qingxin Yan
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Fernando Zanghelini
- Postgraduate Program in Therapeutic Innovation, University Federal of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco, Brazil
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Elesawy BH, F. Sakr H, M. Abbas A. Synergistic Protective Effects of Resveratrol and Estradiol on Estrogen Deficiency-Induced Osteoporosis Through Attenuating RANK Pathway. INT J PHARMACOL 2021. [DOI: 10.3923/ijp.2021.217.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause 2021; 28:973-997. [PMID: 34448749 DOI: 10.1097/gme.0000000000001831] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review evidence regarding osteoporosis screening, prevention, diagnosis, and management in the past decade and update the position statement published by The North American Menopause Society (NAMS) in 2010 regarding the management of osteoporosis in postmenopausal women as new therapies and paradigms have become available. DESIGN NAMS enlisted a panel of clinician experts in the field of metabolic bone diseases and/or women's health to review and update the 2010 NAMS position statement and recommendations on the basis of new evidence and clinical judgement. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees. RESULTS Osteoporosis, especially prevalent in older postmenopausal women, increases the risk of fractures that can be associated with significant morbidity and mortality. Postmenopausal bone loss, related to estrogen deficiency, is the primary contributor to osteoporosis. Other important risk factors for postmenopausal osteoporosis include advanced age, genetics, smoking, thinness, and many diseases and drugs that impair bone health. An evaluation of these risk factors to identify candidates for osteoporosis screening and recommending nonpharmacologic measures such as good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption are appropriate for all postmenopausal women. For women at high risk for osteoporosis, especially perimenopausal women with low bone density and other risk factors, estrogen or other therapies are available to prevent bone loss. For women with osteoporosis and/or other risk factors for fracture, including advanced age and previous fractures, the primary goal of therapy is to prevent new fractures. This is accomplished by combining nonpharmacologic measures, drugs to increase bone density and to improve bone strength, and strategies to reduce fall risk. If pharmacologic therapy is indicated, government-approved options include estrogen agonists/antagonists, bisphosphonates, RANK ligand inhibitors, parathyroid hormone-receptor agonists, and inhibitors of sclerostin. CONCLUSIONS Osteoporosis is a common disorder in postmenopausal women. Management of skeletal health in postmenopausal women involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of osteoporosis or fracture. For women with osteoporosis, lifelong management is necessary. Treatment decisions occur continuously over the lifespan of a postmenopausal woman. Decisions must be individualized and should include the patient in the process of shared decision-making.
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Seeland U, Nemcsik J, Lønnebakken MT, Kublickiene K, Schluchter H, Park C, Pucci G, Mozos I, Bruno RM. Sex and Gender Aspects in Vascular Ageing - Focus on Epidemiology, Pathophysiology, and Outcomes. Heart Lung Circ 2021; 30:1637-1646. [PMID: 34452844 DOI: 10.1016/j.hlc.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022]
Abstract
Sex and gender are important modifiers of cardiovascular system physiology, pathophysiology, and disease development. The atherosclerosis process, together with the progressive loss of arterial elasticity with age, is a major factor influencing the development of overt cardiovascular, renal, and cerebrovascular disease. While differences between women and men in epidemiology and pathophysiology of vascular ageing are increasingly reported, sex-disaggregated data are still scarcely available for prospective studies. A better knowledge of sex differences in physiological ageing as well as in disease-related changes in vascular ageing trajectories is crucial to avoid misdiagnosis and mistreatment. This review presents key concepts and knowledge gaps identified in vascular ageing due to gonadal function, vascular physiology, pathophysiology, psychosocial factors, pregnancy, and prognostic relevance. Gender roles determine the effectiveness of any cardiovascular preventive strategy and acceptance for non-invasive or invasive diagnostics and therapeutics. Gender differences in health behaviour, also due to sociocultural norms conditioned by society, contribute to behaviours that may lead to premature arterial vascular ageing. These include differences in risk behaviours like smoking, diet, exercise, and in stress, but also conditions such as housing, noise pollution, poverty, disability, and any kind of stigmatisation. The VascAgeNet Gender Expert Group aims to advance the use of non-invasive vascular ageing measures in routine clinical settings by providing facts to fill in the gaps concerning sex and gender differences at each step of this process, and to search for solutions.
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Affiliation(s)
- Ute Seeland
- Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - János Nemcsik
- Semmelweis University, Department of Family Medicine and Health Service of Zuglo (ZESZ), Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Karolina Kublickiene
- Institution for Clinical Science, Intervention & Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Schluchter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital - Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ioana Mozos
- Department of Functional Sciences - Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Rosa-Maria Bruno
- University of Paris and Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital and Cardiovascular Research Center - PARCC INSERM, Paris, France
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Kim M, Kim JH, Hong S, Kwon B, Kim EY, Jung HS, Sohn Y. Effects of Melandrium firmum Rohrbach on RANKL‑induced osteoclast differentiation and OVX rats. Mol Med Rep 2021; 24:610. [PMID: 34184080 PMCID: PMC8258467 DOI: 10.3892/mmr.2021.12248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/26/2021] [Indexed: 11/06/2022] Open
Abstract
Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density (BMD), which results in an increased risk of fracture. Melandrium firmum (Siebold & Zucc.) Rohrbach (MFR), 'Wangbulryuhaeng' in Korean, is the dried aerial portion of Melandrii Herba Rohrbach, which is a member of the Caryophyllaceae family and has been used to treat several gynecological conditions as a traditional medicine. However, to the best of our knowledge, the effect of MFR on osteoclast differentiation and osteoporosis has not been assessed. To evaluate the effects of MFR on osteoclast differentiation, tartrate‑resistant acid phosphatase staining, actin ring formation and bone resorption assays were used. Additionally, receptor activator of nuclear factor‑κB ligand‑induced expression of nuclear factor of activated T cell, cytoplasmic 1 (NFATc1) and c‑Fos were measured using western blotting and reverse transcription‑PCR. The expression levels of osteoclast‑related genes were also examined. To further investigate the anti‑osteoporotic effects of MFR in vivo, an ovariectomized (OVX) rat model of menopausal osteoporosis was established. Subsequently, the femoral head was scanned using micro‑computed tomography. The results revealed that MFR suppressed osteoclast differentiation, formation and function. Specifically, MFR reduced the expression levels of osteoclast‑related genes by downregulating transcription factors, such as NFATc1 and c‑Fos. Consistent with the in vitro results, administration of MFR water extract to OVX rats reduced BMD loss, and reduced the expression levels of NFATc1 and cathepsin K in the femoral head. In conclusion, MFR may contribute to alleviate osteoporosis‑like symptoms. These results suggested that MFR may exhibit potential for the prevention and treatment of postmenopausal osteoporosis.
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Affiliation(s)
- Minsun Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jae-Hyun Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sooyeon Hong
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Boguen Kwon
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Eun-Young Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hyuk-Sang Jung
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Youngjoo Sohn
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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Violi A, Fortunato V, D'Amuri A, Zuliani G, Basili S, Passaro A, Corica B, Raparelli V. Rethinking of osteoporosis through a sex- and gender-informed approach in the COVID-19 era. Minerva Obstet Gynecol 2021; 73:754-769. [PMID: 34328298 DOI: 10.23736/s2724-606x.21.04893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Standards and models of reference for osteoporosis (OP) have been developed for female individuals as they are more likely to be affected by the disease. Nonetheless, OP is also responsible for one-third of hip fractures in male individuals suggesting that a sexblinded approach to OP may lead to miss opportunities for equity in bone health. OPrelated fractures, especially hip fractures, are a matter of immediate concern as they are associated with limited mobility, chronic disability, loss of independence, and reduced quality of life in both sexes. When it comes to sociocultural gender, the effect of gender domains (i.e., identity, roles, relations, and institutionalized gender) on development and management of OP is largely overlooked despite risk factors or protective conditions are gendered. Clinical trials testing the efficacy and safety of anti-OP drugs as well as non-pharmacological interventions have been conducted mainly in female participants, limiting the generalizability of the findings. The present narrative review deals with the sex and gender-based challenges and drawbacks in OP knowledge and translation to clinical practice, also considering the impact of coronavirus disease 2019 pandemic.
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Affiliation(s)
- Alessandra Violi
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Valeria Fortunato
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Andrea D'Amuri
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefania Basili
- Internal Medicine Clinic, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Angelina Passaro
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Bernadette Corica
- Internal Medicine Clinic, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Raparelli
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy - .,Faculty of Nursing, University of Alberta, Edmonton, Canada.,⁴ University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
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Abstract
The incidence of osteoporosis and cardiovascular disease increases with age, and there are potentially shared mechanistic associations between the two conditions. It is therefore highly relevant to understand the cardiovascular implications of osteoporosis medications. These are presented in this narrative review. Calcium supplementation could theoretically cause atheroma formation via calcium deposition, and in one study was found to be associated with myocardial infarction, but this has not been replicated. Vitamin D supplementation has been extensively investigated for cardiac benefit, but no consistent effect has been found. Despite findings in the early 21st century that menopausal hormone therapy was associated with coronary artery disease and venous thromboembolism (VTE), this therapy is now thought to be potentially safe (from a cardiac perspective) if started within the first 10 years of the menopause. Selective estrogen receptor modulators (SERMs) are associated with increased risk of VTE and may be related to fatal strokes (a subset of total strokes). Bisphosphonates could theoretically provide protection against atheroma. However, data from randomised trials and observational studies have neither robustly supported this nor consistently demonstrated the potential association with atrial fibrillation. Denosumab does not appear to be associated with cardiovascular disease and, although parathyroid hormone analogues are associated with palpitations and dizziness, no association with a defined cardiovascular pathology has been demonstrated. Finally, romosozumab has been shown to have a possible cardiovascular signal, and therefore post-market surveillance of this therapy will be vital.
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Ferreira MCM, Oliveira MVD, Paiva MSM, Lemke V, Mangione F, Oliveira GMMD. Closing the Gender Gap in Ischemic Heart Diseases and Myocardial Infarction. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Fan X, He S, Song H, Yin W, Zhang J, Peng Z, Yang K, Zhai X, Zhao L, Gong H, Ping Y, Jiao X, Zhang S, Yan C, Wang H, Li RK, Xie J. Human endometrium-derived stem cell improves cardiac function after myocardial ischemic injury by enhancing angiogenesis and myocardial metabolism. Stem Cell Res Ther 2021; 12:344. [PMID: 34112245 PMCID: PMC8193887 DOI: 10.1186/s13287-021-02423-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The human endometrium in premenopausal women is an active site of physiological angiogenesis, with regenerative cells present, suggesting that the endometrium contains adult angiogenic stem cells. In the context of cardiac repair after ischemic injury, angiogenesis is a crucial process to rescue cardiomyocytes. We therefore investigated whether human endometrium-derived stem cells (hEMSCs) can be used for cardiac repair after ischemic injury and their possible underlying mechanisms. METHODS Comparisons were made between hEMSCs successfully isolated from 22 premenopausal women and human bone marrow mesenchymal stem cells (hBMSCs) derived from 25 age-matched patients. Cell proliferation, migration, differentiation, and angiogenesis were evaluated through in vitro experiments, while the ability of hEMSCs to restore cardiac function was examined by in vivo cell transplantation into the infarcted nude rat hearts. RESULTS In vitro data showed that hEMSCs had greater proliferative and migratory capacities, whereas hBMSCs had better adipogenic differentiation ability. Human umbilical cord vein endothelial cells, treated with conditioned medium from hEMSCs, had significantly higher tube formation than that from hBMSCs or control medium, indicating greater angiogenic potentials for hEMSCs. In vivo, hEMSC transplantation preserved cardiac function, decreased infarct size, and improved tissue repair post-injury. Cardiac metabolism, assessed by 18F-FDG uptake, showed that 18F-FDG uptake at the infarction area was significantly higher in both hBMSC and hEMSC groups, compared to the PBS control group, with hEMSCs having the highest uptake, suggesting hEMSC treatment improves cardiomyocyte metabolism and survival after injury. Mechanistic assessment of the angiogenic potential for hEMSCS revealed that angiogenesis-related factors angiopoietin 2, Fms-like tyrosine kinase 1, and FGF9 were significantly upregulated in hEMSC-implanted infarcted hearts, compared to the PBS control group. CONCLUSION hEMSCs, compared to hBMSCs, have greater capacity to induce angiogenesis, and improved cardiac function after ischemic injury.
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Affiliation(s)
- Xuemei Fan
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China ,grid.263452.40000 0004 1798 4018Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Sheng He
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China ,grid.452461.00000 0004 1762 8478The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huifang Song
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Wenjuan Yin
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Jie Zhang
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Zexu Peng
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Kun Yang
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China ,grid.263452.40000 0004 1798 4018Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoyan Zhai
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Lingxia Zhao
- grid.263452.40000 0004 1798 4018Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Gong
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Yi Ping
- grid.452845.aThe Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiangying Jiao
- grid.263452.40000 0004 1798 4018The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Sanyuan Zhang
- grid.452461.00000 0004 1762 8478The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Changping Yan
- grid.452461.00000 0004 1762 8478The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongliang Wang
- grid.452461.00000 0004 1762 8478The First Hospital of Shanxi Medical University, Taiyuan, China ,grid.263452.40000 0004 1798 4018Key Laboratory of Molecular Imaging, Molecular Imaging Precision Medicine Collaborative Innovation Center, Shanxi Medical University, Taiyuan, China
| | - Ren-Ke Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Jun Xie
- The Laboratory of Stem Cell Regenerative Medicine Research, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Cell Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China.
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Rodrigues C, Odutayo A, Patel S, Agarwal A, da Costa BR, Lin E, Yeh RW, Jüni P, Goodman SG, Farkouh ME, Udell JA. Accuracy of Cardiovascular Trial Outcome Ascertainment and Treatment Effect Estimates from Routine Health Data: A Systematic Review and Meta-Analysis. CIRCULATION. CARDIOVASCULAR QUALITY AND OUTCOMES 2021; 14:e007903. [PMID: 33993728 DOI: 10.1161/circoutcomes.120.007903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Registry-based randomized controlled trials allow for outcome ascertainment using routine health data (RHD). While this method provides a potential solution to the rising cost and complexity of clinical trials, comparative analyses of outcome ascertainment by clinical end point committee (CEC) adjudication compared with RHD sources are sparse. Among cardiovascular trials, we set out to systematically compare the incidence of cardiovascular events and estimated randomized treatment effects ascertained from RHD versus traditional clinical evaluation and adjudication. METHODS We searched MEDLINE (1976 to August 2020) for studies where outcome ascertainment was performed by both RHD and CEC adjudication to compare the incidence of cardiovascular events and treatment effects. We derived ratios of hazard ratios to compare treatment effects from RHD and CEC adjudication. We pooled ratios of hazard ratios using an inverse variance random-effects meta-analysis. RESULTS Nine studies (1988-2020; 32 156 patients) involving 10 randomized control trials compared outcome ascertainment with RHD and CEC in patients with or at risk of cardiovascular disease. There was a high degree of agreement and interrater reliability between CEC and RHD outcome determination for all-cause mortality (agreement percentage: 98.4%-100% and κ: 0.95-1.0) and cardiovascular mortality (agreement percentage: 97.8%-99.9% and κ: 0.66-0.99). For myocardial infarction, the κ values ranged from 0.67-0.98, and for stroke the values ranged from 0.52-0.89. In contrast, the κ value for peripheral artery disease was low (κ: 0.27). There was little difference in the randomized treatment effect derived from CEC and RHD ascertainment of events based on the ratios of hazard ratio, with pooled ratios of hazard ratios ranging from 0.93 (95% CI, 0.63-1.39) for cardiovascular mortality to 1.27 (95% CI, 0.67-2.41) for stroke. CONCLUSIONS Clinical outcome ascertainment using retrospectively acquired RHD displayed high levels of agreement with CEC adjudication for identifying all-cause mortality and cardiovascular outcomes. Importantly, cardiovascular treatment effects in randomized control trials determined from RHD and CEC resulted in similar point estimates. Overall, our review supports the use of RHD as a potential alternative source for clinical outcome ascertainment in cardiovascular trials. Validation studies with prospectively planned linkage are warranted.
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Affiliation(s)
- Craig Rodrigues
- Women's College Research Institute, Toronto, Canada (C.R., S.P., E.L., J.A.U.).,School of Medicine, Queen's University, Kingston, Canada (C.R.)
| | - Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada
| | - Sagar Patel
- Women's College Research Institute, Toronto, Canada (C.R., S.P., E.L., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada
| | - Arnav Agarwal
- Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada
| | - Bruno Roza da Costa
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Institute of Health Policy, Management, and Evaluation (B.R.d.C., P.J., J.A.U.), University of Toronto, Toronto, Canada.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland (B.R.d.C.)
| | - Ethan Lin
- Women's College Research Institute, Toronto, Canada (C.R., S.P., E.L., J.A.U.).,Faculty of Medicine, University of Ottawa, Canada (E.L.)
| | - Robert W Yeh
- Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation (B.R.d.C., P.J., J.A.U.), University of Toronto, Toronto, Canada
| | - Shaun G Goodman
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada
| | - Michael E Farkouh
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (M.E.F., J.A.U.)
| | - Jacob A Udell
- Women's College Research Institute, Toronto, Canada (C.R., S.P., E.L., J.A.U.).,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada (A.O., B.R.d.C., P.J., S.G.G., M.E.F., J.A.U.).,Department of Medicine, Faculty of Medicine (A.O., S.P., A.A., P.J., S.G.G., M.E.F., J.A.U.), University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation (B.R.d.C., P.J., J.A.U.), University of Toronto, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (M.E.F., J.A.U.).,ICES, Toronto, Canada (J.A.U.).,Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada (J.A.U.)
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73
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Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2021; 41:1328-1336. [PMID: 31876924 DOI: 10.1093/eurheartj/ehz898] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Judy Luu
- Division of Cardiology, Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg MB R3A, Manitoba, Canada
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Centre for Preclinical Research and Technology, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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74
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Langer RD. The role of medications in successful aging. Climacteric 2021; 24:505-512. [PMID: 33977831 DOI: 10.1080/13697137.2021.1911991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Successful aging includes good health and low levels of disability. To that end, primary prevention is far better than managing subsequent organ damage. When medication is needed to prevent or manage disease, the preferred choice should be associated with the greatest benefits and fewest adverse effects. Cardiovascular diseases are the leading cause of morbidity and mortality in postmenopausal women worldwide. Considering disease-adjusted life years, other leading causes are chronic obstructive pulmonary disease, diabetes mellitus, dementias, hearing loss, cancers of the breast, lung and bowel, osteoporosis, fractures and falls, depression, osteoarthritis, refractive errors of the eye and non-diabetic chronic kidney disease. This review explores the global prevalence of these diseases in women aged 50 years and older, and medications commonly used for them, and contrasts the effects of menopausal hormone therapy (MHT) with others. When initiated early, there is good evidence for MHT benefit in all-cause mortality and primary prevention of cardiovascular disease, diabetes and osteoporosis; fair evidence for benefit in dementias, depression and osteoarthritis; limited evidence for benefit in chronic obstructive pulmonary disease, hearing loss, non-diabetic chronic kidney disease and colorectal cancer; null effects on lung cancer and refractive errors; and varied effects on breast cancer and stroke. Relative benefits and adverse effects of other medications warrant consideration.
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Affiliation(s)
- R D Langer
- Jackson Hole Center for Preventive Medicine, Jackson, WY, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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75
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Servadei F, Anemona L, Cardellini M, Scimeca M, Montanaro M, Rovella V, Di Daniele F, Giacobbi E, Legramante IM, Noce A, Bonfiglio R, Borboni P, Di Daniele N, Ippoliti A, Federici M, Mauriello A. The risk of carotid plaque instability in patients with metabolic syndrome is higher in women with hypertriglyceridemia. Cardiovasc Diabetol 2021; 20:98. [PMID: 33957931 PMCID: PMC8103747 DOI: 10.1186/s12933-021-01277-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Metabolic syndrome certainly favors growth of carotid plaque; however, it is uncertain if it determines plaque destabilization. Furthermore, it is likely that only some components of metabolic syndrome are associated with increased risk of plaque destabilization. Therefore, we evaluated the effect of different elements of metabolic syndrome, individually and in association, on carotid plaques destabilization. Methods A total of 186 carotid endarterectomies from symptomatic and asymptomatic patients were histologically analysed and correlated with major cardiovascular risk factors. Results Metabolic syndrome, regardless of the cluster of its components, is not associated with a significant increase in risk of plaque destabilization, rather with the presence of stable plaques. The incidence of unstable plaques in patients with metabolic syndrome is quite low (43.9 %), when compared with that seen in the presence of some risk factors, but significantly increases in the subgroup of female patients with hypertriglyceridemia, showing an odds ratio of 3.01 (95% CI, 0.25–36.30). Conclusions Our data may help to identify patients with real increased risk of acute cerebrovascular diseases thus supporting the hypothesis that the control of hypertriglyceridemia should be a key point on prevention of carotid atherosclerotic plaque destabilization, especially in post-menopausal female patients.
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Affiliation(s)
- Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Manuel Scimeca
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy.,San Raffaele University, Via di Val Cannuta 247, 00166, Rome, Italy.,Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131, Rome, Italy
| | - Manuela Montanaro
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Valentina Rovella
- UOC of Internal Medicine, Center of Hypertension, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Daniele
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | | | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rita Bonfiglio
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy.,Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, MI, 20122, Milano, Italy
| | - Patrizia Borboni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy. .,Tor Vergata Oncoscience Research (TOR), University of Rome "Tor Vergata", Rome, Italy.
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76
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Prabakaran S, Schwartz A, Lundberg G. Cardiovascular risk in menopausal women and our evolving understanding of menopausal hormone therapy: risks, benefits, and current guidelines for use. Ther Adv Endocrinol Metab 2021; 12:20420188211013917. [PMID: 34104397 PMCID: PMC8111523 DOI: 10.1177/20420188211013917] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
Women are at increased risk for cardiovascular disease (CVD) compared with men. While traditional risk factors for CVD seem to disproportionately affect women and contribute to this disparity, increased prevalence of CVD at midlife calls into question the contribution of menopause. Given the potential role that declining hormone levels play in this transition, menopause hormone therapies (MHT) have been proposed as a strategy for risk factor reduction. Unfortunately, trials have not consistently shown cardiovascular benefit with use, and several describe significant risks. Notably, the timing of hormone administration seems to play a role in its relative risks and benefits. At present, MHT is not recommended for primary or secondary prevention of CVD. For women who may benefit from the associated vasomotor, genitourinary, and/or bone health properties of MHT, CVD risks should be taken into account prior to administration. Further research is needed to assess routes, dosing, and formulations of MHT in order to elucidate appropriate timing for administration. Here, we aim to review both traditional and sex-specific risk factors contributing to increased CVD risk in women with a focus on menopause, understand cardiovascular effects of MHT through a review of several landmark clinical trials, summarize guidelines for appropriate MHT use, and discuss a comprehensive strategy for reducing CV risk in women.
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Affiliation(s)
| | | | - Gina Lundberg
- Department of Medicine, Emory University, 137 Johnson Ferry Rd, Suite 1200, Marietta, GA 30068, USA
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77
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Kim CS, Yea K, Morrell CN, Jeong Y, Lowenstein CJ. Estrogen activates endothelial exocytosis. Biochem Biophys Res Commun 2021; 558:29-35. [PMID: 33895548 DOI: 10.1016/j.bbrc.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 01/22/2023]
Abstract
Estrogen therapy is used to treat patients with post-menopausal symptoms, such as hot flashes and dyspareunia. Estrogen therapy also decreases the risk of fractures from osteoporosis in post-menopausal women. However, estrogen increases the risk of venous thromboembolic events, such as pulmonary embolism, but the pathways through which estrogen increase the risk of thromboembolism is unknown. Here, we show that estrogen elicits endothelial exocytosis, the key step in vascular thrombosis and inflammation. Exogenous 17β-estradiol (E2) stimulated endothelial exocytosis of Weibel-Palade bodies (WPBs), releasing von Willebrand factor (vWF) and interleukin-8 (IL-8). Conversely, the estrogen antagonist ICI-182,780 interfered with E2-induced endothelial exocytosis. The ERα agonist propyl pyrazole triol (PPT) but not the ERβ agonist diarylpropionitrile (DPN) induced vWF release, while ERα silencing counteracted vWF release by E2, suggesting that ERα mediates this effect. Exocytosis triggered by E2 occurred rapidly within 15 min and was not inhibited by either actinomycin D or cycloheximide. On the contrary, it was inhibited by the pre-treatment of U0126 or SB203580, an ERK or a p38 inhibitor, respectively, suggesting that E2-induced endothelial exocytosis is non-genomically mediated by the MAP kinase pathway. Finally, E2 treatment enhanced platelet adhesion to endothelial cells ex vivo, which was interfered with the pre-treatment of ICI-182,780 or U0126. Taken together, our data show that estrogen activates endothelial exocytosis non-genomically through the ERα-MAP kinase pathway. Our data suggest that adverse cardiovascular effects such as vascular inflammation and thrombosis should be considered in patients before menopausal hormone treatment.
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Affiliation(s)
| | - Kyungmoo Yea
- Department of New Biology, DGIST, Daegu, 42988, South Korea
| | - Craig N Morrell
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, 14642, USA
| | - Youngtae Jeong
- Department of New Biology, DGIST, Daegu, 42988, South Korea.
| | - Charles J Lowenstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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78
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MacDonald CJ, El Fatouhi D, Madika AL, Fagherazzi G, Kurth T, Severi G, Boutron-Ruault MC. Association of Migraine With Incident Hypertension After Menopause: A Longitudinal Cohort Study. Neurology 2021; 97:e34-e41. [PMID: 33883242 DOI: 10.1212/wnl.0000000000011986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Migraine has been identified as a potential risk factor for hypertension in prospective studies. In women, migraine prevalence decreases after menopause, but no studies have determined whether migraine is associated with hypertension after menopause. This study sought to determine whether history of migraine was associated with an increased risk of hypertension among menopausal women. METHODS We assessed associations between migraine and hypertension in a longitudinal cohort study of 56,202 menopausal women participating in the French E3N cohort, with follow-up beginning in 1993. We included women who did not have hypertension or cardiovascular disease at the time of menopause. Migraine was classified as ever or never at each questionnaire cycle. Cox proportional hazards models were used to investigate relations between migraine and hypertension, controlling for potential confounding. A secondary analysis with baseline in 2011 considered aura status, grouping participants reporting migraine as migraine with aura, migraine without aura, or unknown migraine type. RESULTS During 826,419 person-years, 12,501 cases of incident hypertension were identified, including 3,100 among women with migraine and 9,401 among women without migraine. Migraine was associated with an increased risk of hypertension in menopausal women (hazard ratio [HR]migraine 1.29 [95% confidence interval 1.24, 1.35]) and was consistent in post hoc sensitivity analyses, such as when controlling for common migraine medications. Associations between migraine and hypertension were similar whether or not women reported aura (HRmigraine aura 1.54 [1.04, 2.30], HRmigraine no aura 1.32 [0.87, 2.02], p heterogeneity 0.60). Associations were slightly stronger among ever users of menopausal hormone therapy (HRmigraine 1.34 [1.27, 1.41]) than among never users (HRmigraine 1.19 [1.11, 1.28]). CONCLUSIONS Migraine was associated with an increased risk of hypertension among menopausal women. In secondary analysis, we did not observe a significant difference between migraine with aura and migraine without aura.
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Affiliation(s)
- Conor James MacDonald
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
| | - Douae El Fatouhi
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
| | - Anne-Laure Madika
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
| | - Guy Fagherazzi
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
| | - Tobias Kurth
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
| | - Gianluca Severi
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy.
| | - Marie-Christine Boutron-Ruault
- From Center for Research in Epidemiology and Population Health (CESP) (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018; Université Paris-Saclay (C.J.M., D.E.F., A.-L.M., G.S., M.-C.B.-R.), Université Paris-Sud, Villejuif; EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (A.-L.M.), Université de Lille, CHU Lille, France; Deep Digital Phenotyping Research Unit, Department of Population Health (G.F.), Luxembourg Institute of Health, Strassen; Institute of Public Health Charité-Universitätsmedizin Berlin (T.K.), Germany; and Department of Statistics, Computer Science and Applications (DISIA) (G.S.), University of Florence, Italy
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79
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Mehta J, Kling JM, Manson JE. Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Front Endocrinol (Lausanne) 2021; 12:564781. [PMID: 33841322 PMCID: PMC8034540 DOI: 10.3389/fendo.2021.564781] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment's risks and benefits. Since the Women's Health Initiative (WHI) trial results in 2002, including post-intervention analysis and cumulative 18-year follow up, it has become clear that the risks of HT are low for healthy women less than age 60 or within ten years from menopause. For those who are experiencing bothersome vasomotor symptoms, the benefits are likely to outweigh the risks in view of HT's efficacy for symptom management. HT also has a role in preventing osteoporosis in appropriate candidates for treatment. A comprehensive overview of the types, routes, and formulations of currently available HT, as well as HT's benefits and risks by outcomes of interest are provided to facilitate clinical decision making.
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Affiliation(s)
- Jaya Mehta
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Juliana M. Kling
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
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80
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Newman C, Tannock LR, Goldberg I. Response to Letter to the Editor: "Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2021; 106:e1926-e1927. [PMID: 33484130 DOI: 10.1210/clinem/dgaa970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Connie Newman
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa R Tannock
- Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Ira Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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81
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Davis SR, Stuckey BGA, Magraith KS, Baber RJ. Letter to the Editor: "Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2021; 106:e1917-e1918. [PMID: 33484146 DOI: 10.1210/clinem/dgaa968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Nedlands, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Karen S Magraith
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rodney J Baber
- Menopause and Menstrual Disorders Clinic, The Royal North Shore Hospital, Sydney
- Faculty of Medicine and Health, The University of Sydney NSW, St. Leonards, Australia
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82
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Maas AHEM, Rosano G, Cifkova R, Chieffo A, van Dijken D, Hamoda H, Kunadian V, Laan E, Lambrinoudaki I, Maclaran K, Panay N, Stevenson JC, van Trotsenburg M, Collins P. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur Heart J 2021; 42:967-984. [PMID: 33495787 PMCID: PMC7947184 DOI: 10.1093/eurheartj/ehaa1044] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).
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Affiliation(s)
- Angela H E M Maas
- Department of Cardiology, Director Women’s Cardiac Health Program, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525GA Nijmegen, The Netherlands
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic
- Department of Internal Cardiovascular Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Olgettina Street, 60 - 20132 Milan (Milan), Italy
| | - Dorenda van Dijken
- Department of Obstetrics and Gynaecology, OLVG location West, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
| | - Haitham Hamoda
- Department Gynaecology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, M4:146 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | - Ellen Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, 30 Panepistimiou Str., 10679 Athens, Greece
| | - Kate Maclaran
- Department Gynaecology, Chelsea and Westminster Hospital, NHS Foundation Trust, 69 Fulham Road London SW10 9NH, UK
| | - Nick Panay
- Department of Gynaecology, Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College, Du Cane Road, London W12 0HS, UK
| | - John C Stevenson
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Mick van Trotsenburg
- Bureau Gender PRO Vienna and Department of Obstetrics and Gynaecology, University Hospital St. Poelten-Lilienfeld, Probst Führer Straße 4 · 3100 St. Pölten, Austria
| | - Peter Collins
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Nie L, Wei D, Liu P, Zhang L, Fan K, Song Y, Wang M, Wang L, Xu Q, Wang J, Liu X, Li L, Mao Z, Huang H, Wang C, Huo W. C-Reactive Protein Mediates the Effect of Serum Progesterone on Obesity for Men and Postmenopausal Women in Henan Rural Cohort Study. J Inflamm Res 2021; 14:633-644. [PMID: 33692633 PMCID: PMC7939495 DOI: 10.2147/jir.s293882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Studies of progesterone with obesity have been lacking, and no prior studies have investigated progesterone and C-reactive protein in rural natural populations. This study aimed to investigate the association of serum progesterone with obesity based on anthropometric parameters in Henan Rural Cohort, then further to explore the potential role of C-reactive protein in this association. Patients and Methods A total of 4687 participants (2474 men and 2213 postmenopausal women) from the Henan Rural Cohort study were included. Logistic regression analysis, linear regression analysis, and restricted cubic splines were performed to estimate the relationships between progesterone, C-reactive protein, obesity, and obesity-related parameters. Mediation analysis was carried out to assess the intermediary role of C-reactive protein played in the association between progesterone and obesity. Results After controlling for confounders, the odds ratios of obesity no matter how obesity was defined was associated with progesterone (P trend <0.05). Moreover, progesterone was related to obesity-related parameters. Also, C-reactive protein increased with the elevation of progesterone, and C-reactive protein was associated with obesity no matter how obesity was defined (P trend <0.001). Mediation analysis indicated that hsCRP had the mediating effects on the obesity, and the proportion of the effects were 15.35% and full mediating effect (defined by body mass index), 15.46% and 12.24% (defined by waist circumference), 19.14% and 12.12% (defined by waist-to-hip ratio), 23.81% and 15.09% (defined by waist-to-height ratio) for men and postmenopausal women, relatively. Conclusion In the Chinese rural men and postmenopausal women population, progesterone and C-reactive protein are related to obesity. We firstly found C-reactive protein partly mediates the effect of progesterone on obesity, indicating that systemic inflammation played a critical role in the association.
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Affiliation(s)
- Luting Nie
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Pengling Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Keliang Fan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yu Song
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Mian Wang
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qingqing Xu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Juan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hui Huang
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Wenqian Huo
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Tolchin B, Conwit R, Epstein L, Russell J. Author Response: AAN Position Statement: Ethical Issues in Clinical Research in Neurology. Neurology 2021; 96:409. [PMID: 38124246 DOI: 10.1212/wnl.0000000000011475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Horie K, Nanashima N, Maeda H, Tomisawa T, Oey I. Blackcurrant ( Ribes nigrum L.) Extract Exerts Potential Vasculoprotective Effects in Ovariectomized Rats, Including Prevention of Elastin Degradation and Pathological Vascular Remodeling. Nutrients 2021; 13:nu13020560. [PMID: 33567796 PMCID: PMC7915542 DOI: 10.3390/nu13020560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Estrogen exerts cardioprotective effects in menopausal women. Phytoestrogens are plant-derived substances exhibiting estrogenic activity that could beneficially affect vascular health. We previously demonstrated that blackcurrant (Ribes nigrum L.) extract (BCE) treatment exerted beneficial effects on vascular health via phytoestrogenic activity in ovariectomized (OVX) rats, which are widely used as menopausal animal models. Here, we examined whether BCE treatment reduced elastin degradation and prevented pathological vascular remodeling in OVX rats fed a regular diet (OVX Control) or a 3% BCE-supplemented diet (OVX BCE), compared with sham surgery rats fed a regular diet (Sham) for 3 months. The results indicated a lower staining intensity of elastic fibers, greater elastin fragmentation, and higher α-smooth muscle actin protein expression in OVX Control rats than in OVX BCE and Sham rats. Pathological vascular remodeling was only observed in OVX Control rats. Additionally, we investigated matrix metalloproteinase (MMP)-12 mRNA expression levels to elucidate the mechanism underlying elastin degradation, revealing significantly upregulated MMP-12 mRNA expression in OVX Control rats compared with that in Sham and OVX BCE rats. Together, we identify BCE as exerting a vascular protective effect through reduced MMP-12 expression and vascular smooth muscle cell proliferation. To our knowledge, this is the first report indicating that BCE might protect against elastin degradation and pathological vascular remodeling during menopause.
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Affiliation(s)
- Kayo Horie
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8564, Japan;
- Correspondence: ; Tel.: +81-172-39-5527
| | - Naoki Nanashima
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8564, Japan;
| | - Hayato Maeda
- Faculty of Agriculture and Life Science, Hirosaki University, Hirosaki 036-8561, Japan;
| | - Toshiko Tomisawa
- Department of Nursing Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8564, Japan;
| | - Indrawati Oey
- Department of Food Science, University of Otago, Dunedin 9054, New Zealand;
- Riddet Institute, Palmerston North 4442, New Zealand
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86
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Park CY, Lim JY, Kim WH, Kim SY, Park HY. Evaluation of menopausal hormone therapy use in Korea (2002-2013): A nationwide cohort study. Maturitas 2021; 146:57-62. [PMID: 33722365 DOI: 10.1016/j.maturitas.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study aimed to evaluate the degree of menopausal hormonal therapy (MHT) use and the related trends, as well as the characteristics of Korean women who used MHT by type of hormone therapy. METHODS Women aged ≥40 years were selected using data from the Korea National Insurance Service-National Sample Cohort 2002-2013 database. MHT entailed either estrogen therapy or estrogen plus progestogen therapy, as categorized by the Anatomical Therapeutic Chemical system. The prevalence of MHT use was calculated as the number of women with prescriptions annually and the level of hormone consumption was calculated using the defined daily dose (DDD). RESULTS The proportion of MHT users among women aged ≥40 years was 7.8 % in 2002, which decreased to 6.3 % in 2013. The overall MHT consumption level in 2002 was 27.5 DDDs/1000 inhabitants/day. There was a sharp decline in the first few years after 2002 and this value decreased to 12.5 DID in 2013; however, the decrease had lessened from 2006 to 2013 and differed by HT type, administration route, age, and income level. During the 11-year follow-up, over 70 % of women were prescribed MHT for less than 1 year, while only 11.8 % had a prescription for 3 years or more, and women who started treatment at age 45-59 years showed longer treatment duration. CONCLUSIONS Since 2002, MHT use among Korean women, especially overall MHT consumption, has declined remarkably. Regarding the pattern of use among women who took hormone preparations during 2002-2013, MHT was used around menopause, over the short term only, and at low dose.
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Affiliation(s)
- Chan Young Park
- Division of Epidemiology and Health Index, Center for Genome Science, Korea National Institute of Health, Cheongju-city, Republic of Korea; Division of Cardiovascular Diseases, Center for Biomedical Science, Korea National Institute of Health, Cheongju-city, Republic of Korea.
| | - Joong-Yeon Lim
- Division of Cardiovascular Diseases, Center for Biomedical Science, Korea National Institute of Health, Cheongju-city, Republic of Korea.
| | - Won-Ho Kim
- Division of Cardiovascular Diseases, Center for Biomedical Science, Korea National Institute of Health, Cheongju-city, Republic of Korea.
| | - So Young Kim
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
| | - Hyun-Young Park
- Division of Epidemiology and Health Index, Center for Genome Science, Korea National Institute of Health, Cheongju-city, Republic of Korea.
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Goldschmidt-Clermont PJ, Volinsky FG, LaRosa SP, Gilbert JR, Periçak-Vance MA. Time for Well-Powered Controlled Prospective Studies to Test a Causal Role for Herpes Viruses in Alzheimer's Disease Using Antiherpetic Drugs. J Gerontol A Biol Sci Med Sci 2021; 75:1058-1060. [PMID: 31175818 DOI: 10.1093/gerona/glz150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Twenty-six phase III studies on Alzheimer's disease are ongoing or have been completed in 2018. Most of these studies are targeting amyloid-beta, its production, polymerization, and/or multiple interactions. None of the amyloid-beta studies seem to affect positively the clinical outcome of patients with Alzheimer's disease thus far, no matter the advancement of disease. It is time to consider other hypotheses for the pathogenesis of Alzheimer's disease, including the potential role of human herpes viruses (HHV), and especially HHV1 (herpes simplex virus type 1), HHV3 (varicella zoster virus), HHV6A, and HHV7. With this perspective, we review the scientific evidence and make the case for appropriately powered, prospective, randomized, and controlled studies using an anti-HHV drug, to establish a causal role for HHV in Alzheimer's disease.
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Affiliation(s)
- Pascal J Goldschmidt-Clermont
- ALZADY International LLC, Miami, Florida.,Leonard M. Miller School of Medicine, University of Miami, Florida.,Epiphany Biosciences Inc., San Francisco, California
| | | | | | - John R Gilbert
- Leonard M. Miller School of Medicine, University of Miami, Florida.,The John P. Hussman Institute for Human Genomics, Florida.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Florida
| | - Margaret A Periçak-Vance
- Leonard M. Miller School of Medicine, University of Miami, Florida.,The John P. Hussman Institute for Human Genomics, Florida.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Florida
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88
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Yi XY, Wang ZH, Wang Y. Genistein for glycolipid metabolism in postmenopausal women: a meta-analysis. Climacteric 2021; 24:267-274. [PMID: 33410719 DOI: 10.1080/13697137.2020.1859473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of genistein on glycolipid metabolism in postmenopausal women. METHODS Electronic databases were searched and relevant reports were hand-screened. We included only randomized controlled trials of isolated genistein for glycolipid metabolism. The primary outcome for lipid metabolism included a changed value of low-density lipoprotein cholesterol (LDL-C), and for glucose metabolism was a changed value of homeostasis model assessment for insulin resistance (HOMA-IR). Secondary outcomes included a changed value of total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), fasting blood insulin (INS), and body mass index (BMI). RESULTS Ten trials with 11 articles were included. The level of LDL-C was not decreased in the genistein group compared with the placebo group (standardized mean difference [SMD] = -0.58; 95% confidence interval [CI] - 1.19, 0.02; p = 0.06). No statistical significance was found in subgroup analyses. HOMA-IR was obviously improved in the genistein group with SMD of -0.51 (95% CI -0.88, -0.14; p = 0.006). In subgroup analyses, HOMA-IR was improved more in women with BMI <30 kg/m2 and without metabolic disorders (p < 0.0001). For secondary outcomes, there were significant differences in total cholesterol, HDL-C, FBG, and INS, but not triglyceride or BMI. CONCLUSIONS Genistein was effective in ameliorating glycolipid metabolism by increasing HDL-C levels and decreasing total cholesterol levels and improving insulin sensitivity.
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Affiliation(s)
- X-Y Yi
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Z-H Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Y Wang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin, China
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89
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Abstract
Hormone replacement therapy (HRT) was the standard of care for menopause management until 2002, when perceptions changed following release of the initial results from the Women's Health Initiative (WHI) trial. Fears of breast cancer and heart attacks engendered by that report were not supported by the data, especially for recently menopausal women. Clinically, HRT is usually initiated near menopause. The WHI tested something different - the effects of HRT started a decade or more after menopause. As it turned out, age at starting HRT is critical in determining benefit/risk. HRT use plummeted following the WHI in 2002 and has remained low, prompting strong interest in alternative treatments. None provide the range of benefits across multiple organ systems offered by estrogen. Most have concerning adverse effects in their own right. HRT can provide effective relief for a wide range of health conditions, potentially avoiding the need for multiple treatments for separate problems. Unfortunately, among many women and clinicians, the perception of HRT benefit/risk is distorted, and its use avoided, leading to unnecessary distress. Following the WHI, many clinicians have not received adequate training to feel comfortable prescribing HRT. When initiated within 10 years of menopause, HRT reduces all-cause mortality and risks of coronary disease, osteoporosis, and dementias.
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Affiliation(s)
- R D Langer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - H N Hodis
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - R A Lobo
- Department of Obstetrics and Gynecology, Colombia University Irving Medical Center, New York, NY, USA
| | - M A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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Roshi, Tandon VR, Mahajan A, Sharma S, Khajuria V. Comparative Efficacy and Safety of Clonazepam versus Nortrptilline on Menopausal Symptom among Forty Plus Women: A Prospective, Open-Label Randomized Study. J Midlife Health 2021; 11:120-125. [PMID: 33384533 PMCID: PMC7718939 DOI: 10.4103/jmh.jmh_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/04/2022] Open
Abstract
Aims and Objectives The aim of this study is to compare the effect of clonazepam and nortryptiline on menopausal symptoms in above 40 years women. Materials and Methods A prospective, randomized, open-label comparative study was conducted in a tertiary care teaching hospital for 1 year. Patients were randomized into two groups. Both the groups had 60 patients, out of which Group A had 39 menopausal patients and Group B had 31 menopausal patients, respectively. Group 1 received tablet clonazepam 0.5 mg bed time orally daily. Group 2 received tablet nortryptiline 25 mg bed time orally daily. The primary efficacy end points were effect on menopausal symptoms evaluated by at 0, 4, and 8 weeks. Results Mean age since menopause was 45 ± 4.06 years, and the mean number of years since menopause was 9.18 ± 7.59 years clonazepam and nortryptiline recorded statistically comparable effect with numerical superiority of nortryptiline both at 4 and 8 weeks on mean Menopausal Symptom Score, thereby indicating that both the drugs may have directly/indirectly improved the mean menopausal symptoms equally. Improvement in the clonazepam group was numerically and statistically more than nortryptiline group at 4 and 8 weeks on mean Vasomotor Symptom Score with P < 0.01 in clonazepam group and P < 0.05 in nortryptiline group both at 4 and 8 weeks. Both the drugs showed comparable results on psychosocial symptom score both at 4 and 8 weeks with numerical superiority in nortryptiline group. Clonazepam group showed more improvement on mean physical score than nortryptiline group numerically and statistically. Both the drugs showed comparable results on mean sexual symptom score at 4 weeks, but nortryptiline proved to be statistically better at 8 weeks P < 0.01 versus P < 0.05 in clonazepam group. Conclusion Clonazepam and nortryptiline recorded statistically comparable effect at 4 and 8 weeks on mean menopausal symptom. Both the drugs were equally safe and did not recorded any serious Adverse Drug Reaction (ADRs).
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Affiliation(s)
- Roshi
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
| | - Vishal R Tandon
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
| | - Annil Mahajan
- Department of Medicine and, Jammu, Jammu and Kashmir, India
| | - Sudhaa Sharma
- Department of Gynae and Obst, GMC, Jammu, Jammu and Kashmir, India
| | - Vijay Khajuria
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
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Aranda G, Halperin I, Gomez-Gil E, Hanzu FA, Seguí N, Guillamon A, Mora M. Cardiovascular Risk Associated With Gender Affirming Hormone Therapy in Transgender Population. Front Endocrinol (Lausanne) 2021; 12:718200. [PMID: 34659112 PMCID: PMC8515285 DOI: 10.3389/fendo.2021.718200] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Transgender men and women represent about 0.6 -1.1%% of the general population. Gender affirming hormone therapy (GAHT) helps ameliorate gender dysphoria and promote well-being. However, these treatments' cardiovascular (CV) effects are difficult to evaluate due to the limited number of extensive longitudinal studies focused on CV outcomes in this population. Furthermore, these studies are mainly observational and difficult to interpret due to a variety of hormone regimens and observation periods, together with possible bias by confounding factors (comorbidities, estrogen types, smoking, alcohol abuse, HIV infection). In addition, the introduction of GAHT at increasingly earlier ages, even before the full development of the secondary sexual characteristics, could lead to long-term changes in CV risk compared to current data. This review examines the impact of GAHT in the transgender population on CV outcomes and surrogate markers of CV health. Furthermore, we review available data on changes in DNA methylation or RNA transcription induced by GAHT that may translate into changes in metabolic parameters that could increase CV risk.
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Affiliation(s)
- Gloria Aranda
- Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi I Sunyer- Hospital Clinic, Barcelona, Spain
| | - Irene Halperin
- Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi I Sunyer- Hospital Clinic, Barcelona, Spain
- Endocrinology Department, Hospital Clinic, Barcelona, Spain
| | | | - Felicia A. Hanzu
- Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi I Sunyer- Hospital Clinic, Barcelona, Spain
- Endocrinology Department, Hospital Clinic, Barcelona, Spain
| | - Núria Seguí
- Endocrinology Department, Hospital Clinic, Barcelona, Spain
| | - Antonio Guillamon
- Departamento de Psicobiologia, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Mireia Mora
- Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi I Sunyer- Hospital Clinic, Barcelona, Spain
- Endocrinology Department, Hospital Clinic, Barcelona, Spain
- *Correspondence: Mireia Mora,
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Kövesdi E, Szabó-Meleg E, Abrahám IM. The Role of Estradiol in Traumatic Brain Injury: Mechanism and Treatment Potential. Int J Mol Sci 2020; 22:E11. [PMID: 33374952 PMCID: PMC7792596 DOI: 10.3390/ijms22010011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Patients surviving traumatic brain injury (TBI) face numerous neurological and neuropsychological problems significantly affecting their quality of life. Extensive studies over the past decades have investigated pharmacological treatment options in different animal models, targeting various pathological consequences of TBI. Sex and gender are known to influence the outcome of TBI in animal models and in patients, respectively. Apart from its well-known effects on reproduction, 17β-estradiol (E2) has a neuroprotective role in brain injury. Hence, in this review, we focus on the effect of E2 in TBI in humans and animals. First, we discuss the clinical classification and pathomechanism of TBI, the research in animal models, and the neuroprotective role of E2. Based on the results of animal studies and clinical trials, we discuss possible E2 targets from early to late events in the pathomechanism of TBI, including neuroinflammation and possible disturbances of the endocrine system. Finally, the potential relevance of selective estrogenic compounds in the treatment of TBI will be discussed.
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Affiliation(s)
- Erzsébet Kövesdi
- Molecular Neuroendocrinology Research Group, Institute of Physiology, Medical School, Center for Neuroscience, Szentágothai Research Center, University of Pécs, H-7624 Pecs, Hungary;
| | - Edina Szabó-Meleg
- Department of Biophysics, Medical School, University of Pécs, H-7624 Pecs, Hungary;
| | - István M. Abrahám
- Molecular Neuroendocrinology Research Group, Institute of Physiology, Medical School, Center for Neuroscience, Szentágothai Research Center, University of Pécs, H-7624 Pecs, Hungary;
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93
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Hormonersatztherapie und vaskuläres Risiko. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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94
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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95
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Newman CB, Blaha MJ, Boord JB, Cariou B, Chait A, Fein HG, Ginsberg HN, Goldberg IJ, Murad MH, Subramanian S, Tannock LR. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2020; 105:5909161. [PMID: 32951056 DOI: 10.1210/clinem/dgaa674] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride-induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces ASCVD risk. CONCLUSION This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases.
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Affiliation(s)
- Connie B Newman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Jeffrey B Boord
- Department of Administration and Parkview Physicians Group Endocrinology Section, Parkview Health System, Fort Wayne, Indiana
| | - Bertrand Cariou
- Department of Endocrinology, L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Alan Chait
- Department of Medicine, University of Washington, Seattle, Washington
| | - Henry G Fein
- Department of Medicine, Division of Endocrinology, Sinai Hospital, Baltimore, Maryland
| | - Henry N Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ira J Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
| | | | - Lisa R Tannock
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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96
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Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, Brandi ML, Cano A, Collins P, Cooper C, Genazzani AR, Hillard T, Kanis JA, Kaufman JM, Lambrinoudaki I, Laslop A, McCloskey E, Palacios S, Prieto-Alhambra D, Reginster JY, Rizzoli R, Rosano G, Trémollieres F, Harvey NC. Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? Osteoporos Int 2020; 31:2271-2286. [PMID: 32642851 PMCID: PMC7661391 DOI: 10.1007/s00198-020-05497-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
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Affiliation(s)
- S Rozenberg
- Department of Obstetrics and Gynecology CHU St Pierre, Université Libre de Bruxelles, Vrije Universiteit, Brussels, Belgium
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - M Aubertin-Leheudre
- Department of Physical Activity Sciences, Faculty of Sciences, Université du Québec à Montréal, CRIUGM, Montreal, Québec, Canada
| | - M-L Brandi
- Department of Biochemical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
- Unit of Bone and Mineral Diseases, University Hospital of Florence, Florence, Italy
| | - A Cano
- Department of Obstetrics and Gynecology, University of Valencia and INCLIVA Health Research Institute, Valencia, Spain
| | - P Collins
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, Royal Brompton Campus, Sydney Street, London, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Hillard
- Department of Obstetrics & Gynaecology, Poole Hospital NHS Trust, Poole, UK
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - J-M Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - I Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Laslop
- Scientific Office, Federal Office for Safety in Health Care, Vienna, Austria
| | - E McCloskey
- Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - S Palacios
- Director of Palacios Institute of Women's Health, Madrid, Spain
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liege, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - F Trémollieres
- Menopause Center, Hôpital Paule de Viguier, University Hospital of Toulouse and INSERM U1048-I2MC-Equipe 9, Toulouse, France
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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97
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El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e506-e532. [PMID: 33251828 DOI: 10.1161/cir.0000000000000912] [Citation(s) in RCA: 369] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.
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98
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Lee HY, Cho KM, Kim MK, Lee M, Kim H, Choi CY, Kim KK, Park JS, Kim HH, Bae YS. Sphingosylphosphorylcholine blocks ovariectomy-induced bone loss by suppressing Ca 2+ /calmodulin-mediated osteoclast differentiation. J Cell Mol Med 2020; 25:473-483. [PMID: 33230972 PMCID: PMC7810965 DOI: 10.1111/jcmm.16101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/29/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022] Open
Abstract
Osteoporosis is a disease in which bone mineral density decreases due to abnormal activity of osteoclasts, and is commonly found in post‐menopausal women who have decreased levels of female hormones. Sphingosylphosphorylcholine (SPC) is an important biological lipid that can be converted to sphingosine‐1‐phosphate (S1P) by autotaxin. S1P is known to be involved in osteoclast activation by stimulating osteoblasts, but bone regulation by SPC is not well understood. In this study, we found that SPC strongly inhibits RANKL‐induced osteoclast differentiation. SPC‐induced inhibitory effects on osteoclast differentiation were not affected by several antagonists of S1P receptors or pertussis toxin, suggesting cell surface receptor independency. However, SPC inhibited RANKL‐induced calcineurin activation and subsequent NFATc1 activity, leading to decrease of the expression of Trap and Ctsk. Moreover, we found that bone loss in an experimental osteoporosis mouse model was recovered by SPC injection. SPC also blocked ovariectomy‐induced body weight increase and Nfatc1 gene expression in mice. We also found that SPC inhibits RANKL‐induced osteoclast differentiation in human macrophages. Since currently available treatments for osteoporosis, such as administration of female hormones or hormone receptor modulators, show serious side effects, SPC has potential as a new agent for osteoporosis treatment.
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Affiliation(s)
- Ha Young Lee
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea
| | - Kwang Min Cho
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea
| | - Min Kyung Kim
- Department of Cell and Developmental Biology, BK21 Program and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Mingyu Lee
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hun Kim
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Cheol Yong Choi
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea
| | - Kyeong Kyu Kim
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Hee Kim
- Department of Cell and Developmental Biology, BK21 Program and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Yoe-Sik Bae
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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99
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Phungphong S, Kijtawornrat A, Wattanapermpool J, Bupha-Intr T. Improvement in cardiac function of ovariectomized rats by antioxidant tempol. Free Radic Biol Med 2020; 160:239-245. [PMID: 32763410 DOI: 10.1016/j.freeradbiomed.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 12/13/2022]
Abstract
A rise in heart disease incidence in women after menopause has led to investigations into the role of female sex hormones on cardiac function. Although various adverse changes in cardiac contractile function following loss of female sex hormones have been reported, a clear mechanism of action has never been characterized. In order to examine whether an elevation in oxidative stress is a major cause of cardiac contractile dysfunction after female sex hormone deprivation, cardiac functions of ovariectomized rats with and without supplementation of superoxide scavenger tempol were compared to those of sham-operated controls. Chronic deprivation of female sex hormones reduced total oxidative capacity and increased plasma carbonyl protein content. Tempol supplementation of ovariectomized rats significantly ameliorated plasma oxidative stress status. Echocardiography demonstrated a significant decrease in left ventricular ejection fraction in ovariectomized rats, which was completely prevented by tempol supplementation. Decreased myocardial contractility occurs with reduced maximum myofilament force of contraction and amplitude of transient intracellular Ca2+ concentration, both phenomena completely attenuated by tempol supplementation. However, tempol only partially prevented shift of heart myosin heavy chain from dominant α-to β-isoform of ovariectomized rats. Immunoblot analysis of protein carbonylation indicated that tempol supplementation significantly reduced the level of cardiac myofibrillar proteins oxidation increased in ovariectomized rat heart. Taken together, the results indicate changes of cardiac contractile machinery following loss of female sex hormones were, in part, due to an increase in oxidative stress, and antioxidant supplementation could be considered another potential prevention measure in postmenopausal women.
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Affiliation(s)
- Sukanya Phungphong
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Tepmanas Bupha-Intr
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand.
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100
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Honigberg MC, Zekavat SM, Niroula A, Griffin GK, Bick AG, Pirruccello JP, Nakao T, Whitsel EA, Farland LV, Laurie C, Kooperberg C, Manson JE, Gabriel S, Libby P, Reiner AP, Ebert BL, Natarajan P. Premature Menopause, Clonal Hematopoiesis, and Coronary Artery Disease in Postmenopausal Women. Circulation 2020; 143:410-423. [PMID: 33161765 DOI: 10.1161/circulationaha.120.051775] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Premature menopause is an independent risk factor for cardiovascular disease in women, but mechanisms underlying this association remain unclear. Clonal hematopoiesis of indeterminate potential (CHIP), the age-related expansion of hematopoietic cells with leukemogenic mutations without detectable malignancy, is associated with accelerated atherosclerosis. Whether premature menopause is associated with CHIP is unknown. METHODS We included postmenopausal women from the UK Biobank (n=11 495) aged 40 to 70 years with whole exome sequences and from the Women's Health Initiative (n=8111) aged 50 to 79 years with whole genome sequences. Premature menopause was defined as natural or surgical menopause occurring before age 40 years. Co-primary outcomes were the presence of any CHIP and CHIP with variant allele frequency >0.1. Logistic regression tested the association of premature menopause with CHIP, adjusted for age, race, the first 10 principal components of ancestry, smoking, diabetes, and hormone therapy use. Secondary analyses considered natural versus surgical premature menopause and gene-specific CHIP subtypes. Multivariable-adjusted Cox models tested the association between CHIP and incident coronary artery disease. RESULTS The sample included 19 606 women, including 418 (2.1%) with natural premature menopause and 887 (4.5%) with surgical premature menopause. Across cohorts, CHIP prevalence in postmenopausal women with versus without a history of premature menopause was 8.8% versus 5.5% (P<0.001), respectively. After multivariable adjustment, premature menopause was independently associated with CHIP (all CHIP: odds ratio, 1.36 [95% 1.10-1.68]; P=0.004; CHIP with variant allele frequency >0.1: odds ratio, 1.40 [95% CI, 1.10-1.79]; P=0.007). Associations were larger for natural premature menopause (all CHIP: odds ratio, 1.73 [95% CI, 1.23-2.44]; P=0.001; CHIP with variant allele frequency >0.1: odds ratio, 1.91 [95% CI, 1.30-2.80]; P<0.001) but smaller and nonsignificant for surgical premature menopause. In gene-specific analyses, only DNMT3A CHIP was significantly associated with premature menopause. Among postmenopausal middle-aged women, CHIP was independently associated with incident coronary artery disease (hazard ratio associated with all CHIP: 1.36 [95% CI, 1.07-1.73]; P=0.012; hazard ratio associated with CHIP with variant allele frequency >0.1: 1.48 [95% CI, 1.13-1.94]; P=0.005). CONCLUSIONS Premature menopause, especially natural premature menopause, is independently associated with CHIP among postmenopausal women. Natural premature menopause may serve as a risk signal for predilection to develop CHIP and CHIP-associated cardiovascular disease.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., J.P.P., T.N., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.)
| | - Seyedeh M Zekavat
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Yale University School of Medicine, New Haven, CT (S.M.Z.)
| | - Abhishek Niroula
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (A.N., T.N., B.L.E.)
| | - Gabriel K Griffin
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Department of Pathology (G.K.G., T.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander G Bick
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN (A.G.B.)
| | - James P Pirruccello
- Cardiology Division (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., J.P.P., T.N., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.)
| | - Tetsushi Nakao
- Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., J.P.P., T.N., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (A.N., T.N., B.L.E.).,Department of Pathology (G.K.G., T.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eric A Whitsel
- Gillings School of Global Public Health and School of Medicine, University of Chapel Hill, NC (E.A.W.)
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (L.V.F.)
| | - Cecelia Laurie
- Department of Biostatistics, University of Washington, Seattle (C.L.)
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., A.P.R.)
| | - JoAnn E Manson
- Division of Preventive Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Stacey Gabriel
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.)
| | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (P.L.)
| | - Alexander P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., A.P.R.)
| | - Benjamin L Ebert
- Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (A.N., T.N., B.L.E.)
| | | | - Pradeep Natarajan
- Cardiology Division (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., J.P.P., T.N., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.)
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