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Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168716. [PMID: 34444464 PMCID: PMC8393224 DOI: 10.3390/ijerph18168716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.
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202
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Wang M, Kartsonaki C, Guo Y, Lv J, Gan W, Chen ZM, Li LM, Hu CG, Yang L, Yu M. Factors related to age at natural menopause in China: results from the China Kadoorie Biobank. Menopause 2021; 28:1130-1142. [PMID: 34342284 PMCID: PMC8462451 DOI: 10.1097/gme.0000000000001829] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the potentially modifiable factors affecting age at natural menopause (ANM) in Chinese women. METHODS We used cross-sectional data from the China Kadoorie Biobank study which that recruited 0.5 million (0.3 million women) Chinese adults aged 30 to 79 from 2004 to 2008. Multinomial logistic regression models were used to examine the relationships between ANM and various factors recorded at baseline. RESULTS Among 87,349 postmenopausal women, the mean ANM (SD) was 48.7 (4.3) years. Older age, being a housewife, earlier menarche, and passive smoking were associated with both premature menopause (PM, ie, ANM <40 years) and early menopause (EM, ie, ANM between 40 and 44 years). A higher odds for EM was observed in women who were widowed (odds ratio: 1.10, 95% confidence interval: 1.04-1.16), had spontaneous abortions (1.33 [1.05-1.69]), current regular smoking (1.19 [1.07-1.37]), and frequent spicy food intake (1.11 [1.05-1.08]). Higher socioeconomic status; later first birth; more live births and induced abortions; longer breastfeeding; tea drinking, as well as intakes of meat, fruits, dairy, and soybean products; and increased body mass index gain were inversely associated with PM and/or EM. In contrast, women who had more pregnancies, occasional alcohol drinking, higher levels of physical activity or body mass index, vitamin intake, and hypertension were more likely to have a later age at menopause (LM, ie, ANM ≥53 years). CONCLUSIONS This large epidemiological study found a wide range of sociodemographic, lifestyle, dietary, and reproductive factors related to PM, EM, and LM in Chinese women.
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Affiliation(s)
- Meng Wang
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Jun Lv
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Haidian District, Beijing, China
| | - Wei Gan
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen, China
| | - Zheng-Ming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Li-Ming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Haidian District, Beijing, China
| | - Chong-Gao Hu
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Min Yu
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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203
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Narvaez Linares NF, Poitras M, Burkauskas J, Nagaratnam K, Burr Z, Labelle PR, Plamondon H. Neuropsychological Sequelae of Coronary Heart Disease in Women: A Systematic Review. Neurosci Biobehav Rev 2021; 127:837-851. [PMID: 34062209 DOI: 10.1016/j.neubiorev.2021.05.026] [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: 11/02/2020] [Revised: 04/28/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022]
Abstract
Heart disease, such as coronary heart disease (CHD), is the leading cause of death among aging women. However, over the past years, the mortality rate has declined, resulting in an increased number of CHD survivors. In this context, research has uncovered relationships between cardiovascular disease (CVD) and the development of neurodegenerative diseases, suggesting that CHD can act as a precursor. Despite heart disease affecting both sexes, CVD research has significantly neglected women. Therefore, we conducted the first systematic review of neuropsychological sequelae of CHD in women to gain a clear portrait of the current knowledge of the association of CHD on women's neuropsychological status. We found that studies continue to include an insufficient number of women in their research. Our work also uncovered that there is variability in the definition of CHD by researchers (i.e., operationalization of the variable), which could explain inconsistencies across studies. Overall, we found evidence that supports the heart-brain disease hypothesis. To conclude, we provide several guidelines for future research involving the impact of CHD in women.
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Affiliation(s)
- N F Narvaez Linares
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
| | - M Poitras
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
| | - J Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, Palanga, LT-00135, Lithuania.
| | - K Nagaratnam
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada; Faculty of Health Sciences, 125 University Private, Ottawa, ON, K1N 6N5, Canada.
| | - Z Burr
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
| | - P R Labelle
- University of Ottawa Library, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
| | - H Plamondon
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
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Welten SJ, Onland-Moret NC, Boer JM, Verschuren WM, van der Schouw YT. Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke. Stroke 2021; 52:2583-2591. [PMID: 34078111 PMCID: PMC8312566 DOI: 10.1161/strokeaha.120.030558] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The few epidemiological studies that addressed the association between age at menopause and ischemic and hemorrhagic stroke risk in women had conflicting findings. We aimed to investigate whether age at (natural and surgical) menopause is a risk factor for total, ischemic, and hemorrhagic stroke in women. METHODS We analyzed data from 16 244 postmenopausal women, aged 26 to 70 years at recruitment who were enrolled in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort between 1993 and 1997. Participants were followed for the occurrence of stroke until January 1, 2011. At baseline, participants filled in questionnaires about health, reproductive history including age at menopause, diet, and lifestyle. Cox regression was used to investigate the association between age at menopause and stroke. All analyses were adjusted for age, smoking, systolic blood pressure, and body mass index. RESULTS Mean age of menopause was 46.4 (7.0) years. A total of 830 strokes (571 ischemic, 162 hemorrhagic, 97 unclassified) were identified. Earlier menopause was associated with an increased risk of total stroke. Compared with women who experienced menopause between 50 and 54 years old, women who underwent menopause before age 40 years had 1.48× higher risk (95% CI, 1.19-1.85) of total stroke. In continuous analyses, we observed a 2% lower total stroke risk for each year menopause was delayed (hazard ratio, 0.98 [95% CI, 0.97-0.99]). The risk between earlier menopause and stroke was confined to ischemic stroke, earlier menopause was not associated with hemorrhagic stroke. The association with age at menopause was stronger for natural menopause (hazard ratio <40 versus 50-54 years, 1.74 [95% CI, 1.12-2.70]) than for surgical menopause (hazard ratio <40 versus 50-54 years, 1.26 [95% CI, 0.84-1.89]). CONCLUSIONS The risk of total and ischemic stroke decreased with an increase in age at menopause. Whether this should have clinical consequences such as intensified risk factor control should be subject of further studies.
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Affiliation(s)
- Sabrina J.G.C. Welten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (S.J.G.C.W., N.C.O.-M., W.M.M.V., Y.T.v.d.S.)
- Department of General Practice, Amsterdam University Medical Center, Location VU, Amsterdam Public Health Research Institute, the Netherlands (S.J.G.C.W.)
| | - N. Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (S.J.G.C.W., N.C.O.-M., W.M.M.V., Y.T.v.d.S.)
| | - Jolanda M.A. Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands (J.M.A.B., W.M.M.V.)
| | - W.M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (S.J.G.C.W., N.C.O.-M., W.M.M.V., Y.T.v.d.S.)
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, the Netherlands (J.M.A.B., W.M.M.V.)
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (S.J.G.C.W., N.C.O.-M., W.M.M.V., Y.T.v.d.S.)
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Okhai H, Sabin CA, Haag K, Sherr L, Dhairyawan R, Burns F, Gilson R, Post F, Ross J, Mackie N, Sullivan A, Shepherd J, Tariq A, Jones R, Fox J, Rosenvinge M, Tariq S. Menopausal status, age and management among women living with HIV in the UK. HIV Med 2021; 22:834-842. [PMID: 34309177 DOI: 10.1111/hiv.13138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is currently little evidence exploring menopausal status, age at last menstrual period (LMP) and management of menopause among women living with HIV aged 45-60 years in England. METHODS Socio-demographic, lifestyle and clinical data were collected through a self-completed cross-sectional survey. Longitudinal CD4 count and viral load data were available from linkage to clinical records, if consent was provided. Women were categorised as pre-, peri- or post-menopausal. Factors associated with menopausal stage were examined using ordinal logistic regression adjusting for age. Age at LMP was estimated using Kaplan-Meier survival analysis. RESULTS The 847 women had a median age of 49 [interquartile range (IQR): 47-52] years. Most were of black ethnicity (81.3%), were born outside the UK (85.0%) and had completed secondary education (88.7%); 177 (20.4%), 373 (43.0%) and 297 (34.2%) were pre-, peri- or post-menopausal, respectively. After adjusting for age, associations of menopausal status with non-cohabiting relationship [adjusted odds ratio = 0.63 (95% confidence interval: 0.43-0.91)], baseline viral load ≥ 100 000 copies/mL [2.67 (1.20-5.94)] and unemployment [1.34 (0.97-1.84)] remained significant. Median (IQR) age at LMP was 54 (51-55) years in the group. In total, 27.9% (233/836) of women reported severe menopausal symptoms; 45.6% of those with somatic symptoms had heard of hormone replacement therapy and 8.7% had used it. Only 5.6% of women with urogenital symptoms had used topical oestrogen. CONCLUSIONS Our findings highlight the importance of educating both women and their healthcare providers about menopausal symptoms and management options.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | | | - Fiona Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Frank Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ann Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Anjum Tariq
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Rachael Jones
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shema Tariq
- Institute for Global Health, University College London, London, UK
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206
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Zhao W, Hou Y, Song X, Wang L, Zhang F, Zhang H, Yu H, Zhou Y. Estrogen Deficiency Induces Mitochondrial Damage Prior to Emergence of Cognitive Deficits in a Postmenopausal Mouse Model. Front Aging Neurosci 2021; 13:713819. [PMID: 34335235 PMCID: PMC8319728 DOI: 10.3389/fnagi.2021.713819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Estrogen deficiency contributes to the development of Alzheimer's disease (AD) in menopausal women. In the current study, we examined the impact of estrogen deficiency on mitochondrial function and cognition using a postmenopausal mouse model. Methods: Bilateral ovariectomy was conducted in adult females C57BL/6J. Cognitive function was examined using the Morris water maze (MWM) test at 2 weeks, 1, 2, and 3 months after ovariectomy. Neurodegeneration was assessed using an immunofluorescence assay of microtubule-associated protein 2 (MAP2) in the hippocampus and immunoblotting against postsynaptic density-95 (PSD95). Mitochondrial function in the hippocampus was assessed using immunoblotting for NDUFB8, SDHB, UQCRC2, MTCO1, and ATP5A1. Mitochondrial biogenesis was examined using immunoblotting for PGC-1α, NRF1, and mtTFA. Mitochondrion fission was assessed with immunoblotting for Drp1, whereas mitochondrion fusion was analyzed with immunoblotting for OPA1 and Mfn2. Mitophagy was examined with immunoblotting for PINK1 and LC3B. Mice receiving sham surgery were used as controls. Results: Ovariectomy resulted in significant learning and memory deficits in the MWM test at 3 months, but not at any earlier time points. At 2 weeks after ovariectomy, levels of Drp1 phosphorylated at Ser637 decreased in the hippocampus. At 1 month after ovariectomy, hippocampal levels of NDUFB8, SDHB, PGC-1α, mtTFA, OPA1, and Mfn2 were significantly reduced. At 2 months after ovariectomy, hippocampal levels of MAP2, PSD95, MTCO1, NRF1, and Pink1 were also reduced. At 3 months, levels of LC3B-II were reduced. Conclusions: The cognitive decline associated with estrogen deficiency is preceded by mitochondrial dysfunction, abnormal mitochondrial biogenesis, irregular mitochondrial dynamics, and decreased mitophagy. Thus, mitochondrial damage may contribute to cognitive impairment associated with estrogen deficiency.
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Affiliation(s)
- Wei Zhao
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yue Hou
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Xinxin Song
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Lei Wang
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Fangfang Zhang
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Hanting Zhang
- Departments of Neuroscience and Behavioral Medicine and Psychiatry, Rockefeller Neurosciences Institute, West Virginia University Health Sciences Center, Morgantown, WV, United States
| | - Haiyang Yu
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yanmeng Zhou
- Institute of Pharmacology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
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207
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Stevenson JC, Collins P, Hamoda H, Lambrinoudaki I, Maas AHEM, Maclaran K, Panay N. Cardiometabolic health in premature ovarian insufficiency. Climacteric 2021; 24:474-480. [PMID: 34169795 DOI: 10.1080/13697137.2021.1910232] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.
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Affiliation(s)
- J C Stevenson
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - P Collins
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - H Hamoda
- Department of Gynaecology, King's College Hospital, London, UK
| | - I Lambrinoudaki
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Maclaran
- Department of Gynaecology, Chelsea & Westminster Hospital, London, UK
| | - N Panay
- Department of Gynaecology, Queen Charlotte's and Chelsea & Westminster Hospitals, Imperial College London, London, UK
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208
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 546] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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209
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Dinh QN, Vinh A, Arumugam TV, Drummond GR, Sobey CG. G protein-coupled estrogen receptor 1: a novel target to treat cardiovascular disease in a sex-specific manner? Br J Pharmacol 2021; 178:3849-3863. [PMID: 33948934 DOI: 10.1111/bph.15521] [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] [Received: 01/20/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 12/19/2022] Open
Abstract
As an agonist of the classical nuclear receptors, estrogen receptor-α and -β (NR3A1/2), estrogen has been assumed to inhibit the development of cardiovascular disease in premenopausal women. Indeed, reduced levels of estrogen after menopause are believed to contribute to accelerated morbidity and mortality rates in women. However, estrogen replacement therapy has variable effects on cardiovascular risk in postmenopausal women, including increased serious adverse events. Interestingly, preclinical studies have shown that selective activation of the novel membrane-associated G protein-coupled estrogen receptor, GPER, can promote cardiovascular protection. These benefits are more evident in ovariectomised than intact females or in males. It is therefore possible that selective targeting of the GPER in postmenopausal women could provide cardiovascular protection with fewer adverse effects that are caused by conventional 'receptor non-specific' estrogen replacement therapy. This review describes new data regarding the merits of targeting GPER to treat cardiovascular disease with a focus on sex differences.
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Affiliation(s)
- Quynh Nhu Dinh
- Department of Physiology, Anatomy and Microbiology and Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Antony Vinh
- Department of Physiology, Anatomy and Microbiology and Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Thiruma V Arumugam
- Department of Physiology, Anatomy and Microbiology and Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology and Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Christopher G Sobey
- Department of Physiology, Anatomy and Microbiology and Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
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211
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Matsuo K, Mandelbaum RS, Matsuzaki S, Klar M, Roman LD, Wright JD. Ovarian conservation for young women with early-stage, low-grade endometrial cancer: a 2-step schema. Am J Obstet Gynecol 2021; 224:574-584. [PMID: 33412129 DOI: 10.1016/j.ajog.2020.12.1213] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low grade, and nearly 1 of every 8 low-grade endometrial cancer diagnoses occurs in women younger than 50 years with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing particularly among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative. In young women with endometrial cancer, consideration of ovarian conservation is especially relevant to avoid both the short-term and long-term sequelae of surgical menopause including menopausal symptoms, cardiovascular disease, metabolic disease, and osteoporosis. Although disadvantages of ovarian conservation include failure to remove ovarian micrometastasis (0.4%-0.8%), gross ovarian metastatic disease (4.2%), or synchronous ovarian cancer (3%-5%) at the time of surgery and the risk of future potential metachronous ovarian cancer (1.2%), ovarian conservation is not negatively associated with endometrial cancer-related or all-cause mortality in young women with early-stage, low-grade endometrial cancer. Despite this, utilization of ovarian conservation for young women with early-stage, low-grade endometrial cancer remains modest with only a gradual increase in uptake in the United States. We propose a framework and strategic approach to identify young women with early-stage, low-grade endometrial cancer who may be candidates for ovarian conservation. This evidence-based schema consists of a 2-step assessment at both the preoperative and intraoperative stages that can be universally integrated into practice.
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Affiliation(s)
- Ritu Thamman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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213
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Hägg S, Jylhävä J. Sex differences in biological aging with a focus on human studies. eLife 2021; 10:e63425. [PMID: 33982659 PMCID: PMC8118651 DOI: 10.7554/elife.63425] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
Aging is a complex biological process characterized by hallmark features accumulating over the life course, shaping the individual's aging trajectory and subsequent disease risks. There is substantial individual variability in the aging process between men and women. In general, women live longer than men, consistent with lower biological ages as assessed by molecular biomarkers, but there is a paradox. Women are frailer and have worse health at the end of life, while men still perform better in physical function examinations. Moreover, many age-related diseases show sex-specific patterns. In this review, we aim to summarize the current knowledge on sexual dimorphism in human studies, with support from animal research, on biological aging and illnesses. We also attempt to place it in the context of the theories of aging, as well as discuss the explanations for the sex differences, for example, the sex-chromosome linked mechanisms and hormonally driven differences.
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Affiliation(s)
- Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
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214
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Bimonte-Nelson HA, Bernaud VE, Koebele SV. Menopause, hormone therapy and cognition: maximizing translation from preclinical research. Climacteric 2021; 24:373-381. [PMID: 33977823 DOI: 10.1080/13697137.2021.1917538] [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
Menopause-associated and hormone-associated cognitive research has a rich history built from varied disciplines and species. This review discusses landmark rodent and human work addressing cognitive outcomes associated with varied experiences of menopause and hormone therapy. Critical variables in menopause and cognitive aging research are considered, including menopause etiology, background hormone milieu and parameters of exposure to estrogens and progestogens. Recent preclinical research has identified that menopause and ovarian hormone fluctuations across many neurobiological systems affect cognitive aging, mapping novel avenues for future research. Preclinical models provide insight into complex interdisciplinary relationships in a systematic and highly controlled fashion. We highlight that acknowledging the strengths and weaknesses for both preclinical and clinical research approaches is vital to accurate interpretation, optimal translation and the direction of future research. There is great value in collaboration and communication across preclinical and clinical realms, especially regarding reciprocal feedback of findings to advance preclinical models, improve experimental designs and enrich basic science translation to the clinic. In searching for biological mechanisms underlying the cognitive consequences of menopause and hormone therapies, it is noteworthy that clinical and preclinical scientists are grounded in the same fundamental goal of optimizing health outcomes for women across the lifespan.
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Affiliation(s)
- H A Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ, USA.,Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - V E Bernaud
- Department of Psychology, Arizona State University, Tempe, AZ, USA.,Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - S V Koebele
- Department of Psychology, Arizona State University, Tempe, AZ, USA.,Arizona Alzheimer's Consortium, Phoenix, AZ, USA
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215
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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology. Biomolecules 2021; 11:biom11050708. [PMID: 34068722 PMCID: PMC8151888 DOI: 10.3390/biom11050708] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.
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216
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Hickey M, Moss KM, Mishra GD, Krejany EO, Domchek SM, Wark JD, Trainer A, Wild RA. What Happens After Menopause? (WHAM): A prospective controlled study of cardiovascular and metabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy. Gynecol Oncol 2021; 162:88-96. [PMID: 33972087 DOI: 10.1016/j.ygyno.2021.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To prospectively measure cardiometabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared to a similar age comparison group, and the effects of Hormone Therapy (HT) on cardiometabolic risk. METHODS Prospective observational study of 95 premenopausal women planning RRBSO and 99 comparisons who retained their ovaries. At baseline and 12 months, blood pressure (BP), Body Mass Index (BMI), waist and hip circumference, fasting total, HDL and LDL cholesterol, triglycerides, high-sensitivity C-reactive protein, glucose and insulin were measured and HOMA-IR was calculated. Chi-square tests, t-tests and adjusted logistic regression models were used to compare groups. RESULTS Baseline cardiometabolic phenotypes were similar between groups but more RRBSO participants were overweight/obese with higher waist/hip ratios. By 12 months, BP and cardiometabolic phenotypes were largely unchanged. Paired t-tests showed statistically significant increases in BMI (p = 0.037) and weight (p = 0.042) and larger increases in waist circumference (p < 0.001) and waist-hip ratio (p = 0.009) after RRBSO vs comparisons. However, these were not significant when adjusted for baseline values. After RRBSO 60% initiated Hormone Therapy (HT). Paired t-tests demonstrated that non-HT users had a significantly greater mean increase in waist circumference of 4.3 cm (95% CI 2.0-6.5) compared to 1.3 cm in HT users (95% CI -0.2-2.7, p < 0.001), which remained significant when adjusted for baseline values (p = 0.02). At 12 months, mean waist circumference was 2.94 cm greater in non-HT users compared to HT users. CONCLUSIONS Cardiometabolic risk markers are largely unchanged 12 months after RRBSO. Hormone Therapy after RRBSO may prevent against an increase in waist circumference.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Efrosinia O Krejany
- Gynaecology Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, USA
| | - John D Wark
- Bone and Mineral Medicine, Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Trainer
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Robert A Wild
- Departments of Obstetrics and Gynecology, Biostatistics and Epidemiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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217
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Associations of long-term exposure to environmental noise and outdoor light at night with age at natural menopause in a US women cohort. Environ Epidemiol 2021; 5:e154. [PMID: 34131615 PMCID: PMC8196097 DOI: 10.1097/ee9.0000000000000154] [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: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
Previous studies have suggested noise, especially at night time, and light at night (LAN) could cause neuroendocrine disturbance and circadian disruption, which may lead to ovarian follicle atresia and earlier onset of menopause. However, no study to date has directly investigated the associations of exposure to these factors and menopausal age. Methods Premenopausal women from the Nurses' Health Study II (NHS II) were followed from age 40 through 2015. Median daytime and nighttime anthropogenic noise and outdoor LAN exposure were measured from a geospatial prediction model and satellite images, respectively, at residential addresses throughout the follow-up. Time-varying Cox proportional hazard models were used to calculate the hazard ratios and 95% confidence intervals, adjusting for individual lifestyle, reproductive history, and neighborhood socioeconomic factors. Possible effect modification by region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract population density and median income was examined. Results A total of 63,380 of 105,326 women self-reported natural menopause during 1,043,298 person-years of follow-up. No associations were found for noise (both daytime and nighttime) and outdoor LAN exposure with age at natural menopause (hazard ratios = 0.99-1.00) in the fully adjusted models. Sensitivity analyses showed similar null associations. No meaningful effect modification was found for region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract socioeconomic measures in stratified analyses. Conclusion No associations were found between environmental noise and outdoor LAN exposure in mid-adulthood and menopausal age in this cohort of US women.
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218
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Lumme JE, Savukoski SM, Suvanto ETJ, Pesonen PRO, Auvinen JP, Sebert S, Hyppönen E, Järvelin MR, Puukka KS, Herzig KH, Oura P, Ojaniemi M, Niinimäki M. Early-onset climacterium is not associated with impaired vitamin D status: a population-based study. Menopause 2021; 28:899-908. [PMID: 33950031 DOI: 10.1097/gme.0000000000001781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate vitamin D status in women with the onset of the climacteric phase by age 46 as both early menopause and inadequate vitamin D status may increase the risk of adverse health outcomes. METHODS A cross-sectional study included 2,544, 46-year-old women from a birth cohort. Women were divided into the following two groups according to their menstrual history and follicle-stimulating hormone (FSH) concentration: 1) climacteric (FSH ≥25 IU/L and amenorrhea ≥4 mo, n = 351) and 2) preclimacteric women (FSH <25 IU/L and having regular/irregular menstrual cycles, n = 2,193). Serum 25-hydroxyvitamin D (25(OH)D) concentrations were compared between the groups. A linear regression model was performed to investigate which factors are associated with 25(OH)D status. RESULTS Mean serum 25(OH)D concentrations were higher in climacteric compared with preclimacteric women (68.1 ± 19.8 nmol/L vs 65.2 ± 19.3 nmol/L, P = 0.01). However, in the linear regression model, climacteric status was not associated with 25(OH)D status (multivariable adjusted mean difference 4.5 nmol/L, 95% confidence interval -1.4 to 10.4, P = 0.137). A total of 76 of the climacteric women were using systemic estrogen hormone therapy (HT). In a subanalysis, including only climacteric women, the use of HT was associated with higher 25(OH)D status (multivariable adjusted mean difference 5.9 nmol/L, 95% confidence interval 1.3-10.5, P = 0.013). CONCLUSIONS The onset of the climacteric phase by age 46 was not associated with inadequate 25(OH)D concentrations, whereas HT use was associated with higher 25(OH)D status in women with early-onset climacterium.
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Affiliation(s)
- Johanna E Lumme
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Susanna M Savukoski
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eila T J Suvanto
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula R O Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha P Auvinen
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Oulunkaari Health Center, Ii, Finland
| | - Sylvain Sebert
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
| | - Elina Hyppönen
- Australian Centre for Precision Health, University of South Australia, Cancer Research Institute, Adelaide, Australia
- Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marjo-Riitta Järvelin
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London Kingston Lane, Uxbridge, Middlesex, UK
| | - Katri S Puukka
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- NordLab Oulu, Oulu University Hospital, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Karl-Heinz Herzig
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Institute of Biomedicine, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Petteri Oura
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Marja Ojaniemi
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Maarit Niinimäki
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Ryu KJ, Yi KW, Kim YJ, Shin JH, Hur JY, Kim T, Seo JB, Lee KS, Park H. Machine Learning Approaches to Identify Factors Associated with Women's Vasomotor Symptoms Using General Hospital Data. J Korean Med Sci 2021; 36:e122. [PMID: 33942581 PMCID: PMC8093602 DOI: 10.3346/jkms.2021.36.e122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. METHODS Data on 3,298 women, aged 40-80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. RESULTS In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. CONCLUSION Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.
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Affiliation(s)
- Ki Jin Ryu
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Kyong Wook Yi
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Yong Jin Kim
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jun Young Hur
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Tak Kim
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jong Bae Seo
- Department of Biosciences, Mokpo National University, Muan, Korea
- Department of Biomedicine, Health & Life Convergence Science, Mokpo National University, Muan, Korea
| | - Kwang Sig Lee
- AI Center, Korea University College of Medicine, Seoul, Korea.
| | - Hyuntae Park
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea.
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220
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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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221
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Christensen MW, Kesmodel US, Christensen K, Kirkegaard K, Ingerslev HJ. Early ovarian ageing: is a low number of oocytes harvested in young women associated with an earlier and increased risk of age-related diseases? Hum Reprod 2021; 35:2375-2390. [PMID: 32949236 DOI: 10.1093/humrep/deaa188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do young women with early ovarian ageing (EOA), defined as unexplained, and repeatedly few oocytes harvested in ART have an increased risk of age-related events? SUMMARY ANSWER At follow-up, women with idiopathic EOA had an increased risk of age-related events compared to women with normal ovarian ageing (NOA). WHAT IS KNOWN ALREADY Early and premature menopause is associated with an increased risk of cardiovascular diseases (CVDs), osteoporosis and death. In young women, repeated harvest of few oocytes in well-stimulated ART cycles is a likely predictor of advanced menopausal age and may thus serve as an early marker of accelerated general ageing. STUDY DESIGN, SIZE, DURATION A register-based national, historical cohort study. Young women (≤37 years) having their first ART treatment in a public or private fertility clinic during the period 1995-2014 were divided into two groups depending on ovarian reserve status: EOA (n = 1222) and NOA (n = 16 385). Several national registers were applied to assess morbidity and mortality. PARTICIPANTS/MATERIALS, SETTING, METHODS EOA was defined as ≤5 oocytes harvested in a minimum of two FSH-stimulated cycles and NOA as ≥8 oocytes in at least one cycle. Cases with known causes influencing the ovarian reserve (endometriosis, ovarian surgery, polycystic ovary syndrome, chemotherapy etc.) were excluded. To investigate for early signs of ageing, primary outcome was an overall risk of ageing-related events, defined as a diagnosis of either CVD, osteoporosis, type 2 diabetes, cancer, cataract, Alzheimer's or Parkinson's disease, by death of any-cause as well as a Charlson comorbidity index score of ≥1 or by registration of early retirement benefit. Cox regression models were used to assess the risk of these events. Exposure status was defined 1 year after the first ART cycle to assure reliable classification, and time-to-event was measured from that time point. MAIN RESULTS AND THE ROLE OF CHANCE Median follow-up time from baseline to first event was 4.9 years (10/90 percentile 0.7/11.8) and 6.4 years (1.1/13.3) in the EOA and NOA group, respectively. Women with EOA had an increased risk of ageing-related events when compared to women with a normal oocyte yield (adjusted hazard ratio 1.24, 95% CI 1.08 to 1.43). Stratifying on categories, the EOA group had a significantly increased risk for CVD (1.44, 1.19 to 1.75) and osteoporosis (2.45, 1.59 to 3.90). Charlson comorbidity index (1.15, 0.93 to 1.41) and early retirement benefit (1.21, 0.80 to 1.83) was also increased, although not reaching statistical significance. LIMITATIONS, REASONS FOR CAUTION Cycles never reaching oocyte aspiration were left out of account in the inclusion process and we may therefore have missed women with the most severe forms of EOA. We had no information on the total doses of gonadotrophin administered in each cycle. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate that oocyte yield may serve as marker of later accelerated ageing when, unexpectedly, repeatedly few oocytes are harvested in young women. Counselling on life-style factors as a prophylactic effort against cardiovascular and other age-related diseases may be essential for this group of women. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this study. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M W Christensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - U S Kesmodel
- Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - K Christensen
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - K Kirkegaard
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | - H J Ingerslev
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Metabolic profile of women with premature ovarian insufficiency compared with that of age-matched healthy controls. Maturitas 2021; 148:33-39. [PMID: 34024349 DOI: 10.1016/j.maturitas.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE . To compare the metabolic profile of women with spontaneous premature ovarian insufficiency (POI) with that of age-matched healthy controls. STUDY DESIGN . A cross-sectional case-control study was conducted using 1:1 matching by age. Women below the age of 40 with spontaneous POI who did not receive any medication (n = 303) and age-matched healthy women (n = 303) were included in this study. MAIN OUTCOME MEASURES . Metabolic profiles, including serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), glucose, uric acid, urea and creatinine, were compared between women with POI and controls. For women with POI, factors associated with the metabolic profile were analyzed. RESULTS . Women with POI were more likely to exhibit increased serum levels of TG (β, 0.155; 95% CI, 0.086, 0.223) and glucose (0.067; 0.052, 0.083), decreased levels of HDL-C (-0.087; -0.123, -0.051), LDL-C (-0.047; -0.091, -0.003) and uric acid (-0.053; -0.090, -0.015), and impaired kidney function (urea [0.070; 0.033, 0.107]; creatinine [0.277; 0.256, 0.299]; eGFR [-0.234; -0.252, -0.216]) compared with controls after adjusting for age and BMI. BMI, parity, gravidity, FSH and E2 levels were independent factors associated with the metabolic profile of women with POI. CONCLUSION . Women with POI exhibited abnormalities in lipid metabolism, glucose metabolism, and a decrease in kidney function. In women with POI, early detection and lifelong management of metabolic abnormalities are needed.
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Hyvärinen M, Karvanen J, Aukee P, Tammelin TH, Sipilä S, Kujala UM, Kovanen V, Rantalainen T, Laakkonen EK. Predicting the age at natural menopause in middle-aged women. Menopause 2021; 28:792-799. [PMID: 33857956 PMCID: PMC8284377 DOI: 10.1097/gme.0000000000001774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To predict the age at natural menopause (ANM). METHODS Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ± SD) between the predicted and observed ANM. RESULTS Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ± 0.49 and 0.62 ± 0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ± 1.02). CONCLUSIONS In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians' decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women.
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Affiliation(s)
- Matti Hyvärinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Karvanen
- Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland
| | - Pauliina Aukee
- Department of Obstetrics and Gynecology, Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuija H. Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M. Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Vuokko Kovanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Rantalainen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K. Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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224
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Qi T, Huang Y, Li S, Ying Q, Jiang Z, Ma L, Li C, Chen P, Xu W, Lan Y, Chu K, Xu L, Lou J, Yu W, Zhou J. Associations of age at natural menopause and occupations in Chinese female workers: A cross-sectional study. ENVIRONMENTAL RESEARCH 2021; 195:110776. [PMID: 33516685 DOI: 10.1016/j.envres.2021.110776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
AIMS To investigate the impact of occupation types on age at natural menopause. METHODS This is a nation-wide cross-sectional study based on 17,948 female workers aged over 40, who come from different industries or organizations. A face-to-face standardized questionnaire was conducted in all participants with the help of occupational hygienists. Occupational titles were coded according to the International Standard Classification of Occupations (2008) (ISCO08). Cox regression model was used to assess the association between each independent occupation and menopausal timing. Models were adjusted for marriage, education, average annual family income, parity, cigarette smoking, alcohol consumption. RESULTS Higher risks of earlier age at natural menopause was found among legislators and senior officials (ISCO Minor group:111, HR = 2.328, P < 0.001), among other health associated professionals (ISCO Minor group: 325, HR = 1.477, P = 0.003), the workers involved in mining and mineral processing (ISCO Minor group: 811, HR = 1.515, P = 0.048) and metal processing and finishing (ISCO Minor group: 812, HR = 1.722, P < 0.001). Reduced risks of earlier age at natural menopause, including: finance professionals (ISCO Minor group: 241, HR = 0.751, P = 0.021), manufacturing and construction supervisors (ISCO Minor group: 312, HR = 0.477, P = 0.002), administrative and specialized secretaries (ISCO Minor group: 334, HR = 0.788, P = 0.045), cleaners and helpers (ISCO Minor group: 911, HR = 0.633, P = 0.01). CONCLUSIONS This is the first study to address the influence of occupation types on reproductive aging, showing some specific occupations could be associated with age at natural menopause. Further investigations are necessary to clarify whether it is chance finding or a true association.
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Affiliation(s)
- Tongyun Qi
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Yizhou Huang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Saisai Li
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Qian Ying
- Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Zhaoqiang Jiang
- Institute of Occupational Disease, Zhejiang Academy of Medical Sciences, Hangzhou, 310013, People's Republic of China
| | - Linjuan Ma
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Chunming Li
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Peiqiong Chen
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Wenxian Xu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Yibing Lan
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Ketan Chu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China
| | - Ling Xu
- Zhejiang Maternal and Child Care and Reproductive Health Center, Hangzhou, 310012, People's Republic of China
| | - Jianlin Lou
- Institute of Occupational Disease, Zhejiang Academy of Medical Sciences, Hangzhou, 310013, People's Republic of China.
| | - Wenlan Yu
- National Institute of Occupational Health and Poison Control, Chinese Center of Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People's Republic of China.
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225
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Bellinge JW, Lee SC, Schultz CJ. Use of cardiovascular imaging in risk restratification of the diabetic patient. Curr Opin Endocrinol Diabetes Obes 2021; 28:122-133. [PMID: 33394721 DOI: 10.1097/med.0000000000000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Diabetes mellitus is no longer considered a cardiovascular disease (CVD) risk equivalent, but the optimal methods of risk stratification are a matter of debate. The coronary calcium score (CCS) is a measure of the burden of atherosclerosis and is widely used for CVD risk stratification in the general population. We review recently published data to describe the role of the CCS in people with diabetes mellitus. RECENT FINDINGS People with diabetes mellitus have 10-year event rates for CVD and CVD mortality that are considered high, at a much lower level of CCS than the general population. Different categories of CCS are pertinent to men and women with diabetes mellitus. CCS may be particularly useful in clinical settings when CVD risk is known to be increased but difficult to quantify, for example peri-menopausal women, young persons with diabetes, type 1 diabetic individuals and others. With modern techniques, the radiation dose of a CSS has fallen to levels wherein screening and surveillance could be considered. SUMMARY The CCS is able to quantify CVD risk in people with diabetes mellitus when there is clinical uncertainty and identifies those with very high event rates. Future research should aim to identify effective risk reduction strategies in this important group.
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Affiliation(s)
- Jamie W Bellinge
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sing Ching Lee
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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226
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Brennan A, Hickey M. Management of Early Menopause/Premature Ovarian Insufficiency in Women with or at High Risk of Breast Cancer. Semin Reprod Med 2021; 38:309-314. [PMID: 33791998 DOI: 10.1055/s-0041-1726467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The global incidence of breast cancer is increasing, as is the efficacy of treatments. Consequently, increasing survival rates reinforce the importance of survivorship issues, including posttreatment menopausal symptoms, sexual function, and mental health and well-being. Breast cancer patients can experience a range of menopausal symptoms associated with their treatment. Most commonly women may experience vasomotor symptoms, including hot flushes and night sweats. Particularly for women on maintenance tamoxifen therapy, up to 80% will experience hot flushes, with almost one-third of these women reporting severe symptoms. Breast cancer patients may also experience genitourinary symptoms of menopause, which may include vaginal dryness and irritation, dyspareunia, and dysuria. Hormonal therapy has long been established as the most effective treatment for vasomotor symptoms. However, the hormonal nature of breast malignancies renders systemic hormone therapies unsuitable for these patients, posing a unique treatment challenge, which may result in clinicians not feeling confident to manage them. Consequently, this review outlines pharmacological and nonpharmacological options for women with bothersome menopausal symptoms after breast cancer treatment and provides practical, evidence-based guidance for clinicians.
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Affiliation(s)
| | - Martha Hickey
- Royal Women's Hospital, Parkville, Victoria Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
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227
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Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6636856. [PMID: 33816624 PMCID: PMC7987413 DOI: 10.1155/2021/6636856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Aims The aim of this meta-analysis was to comprehensively evaluate the association of early age at natural menopause with the risk for all-cause and cardiovascular mortality. Methods Literature retrieval was done on August 4, 2020. Article selection and data extraction were completed independently and in duplicate. Early age at natural menopause was grouped into premature menopause (<40 years), early menopause (40-44 years), and relatively early menopause (45-49 years). Effect-size estimates are summarized as hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results Sixteen articles involving 321,233 women were meta-analyzed. Overall analyses revealed a statistically significant association of early age at natural menopause with all-cause mortality risk (HRadjusted = 1.08, 95% CI: 1.03 to 1.14, P = 0.002; RRadjusted = 1.05, 95% CI 1.01 to 1.08, P = 0.005), but not with cardiovascular mortality risk. In dose-response analyses, the association with all-cause mortality was significant for premature menopause with (HRadjusted = 1.10; 95% CI: 1.01 to 1.21; P = 0.034) and without (RRadjusted = 1.34; 95% CI: 1.08 to 1.66; P = 0.007) considering follow-up intervals. As for cardiovascular mortality, marginal significance was noted for premature menopause after considering follow-up intervals (HR = 1.09; 95% CI: 1.00-1.19; P = 0.045). Subgroup analyses indicated that gender, country, and follow-up periods were possible causes of heterogeneity. There was an overall low probability of publication bias. Conclusions Our findings indicate that premature menopause is a promising independent risk factor for both all-cause and cardiovascular mortality.
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228
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Nikolis A, Frank K, Guryanov R, Gombolevskiy V, Morozov S, Makhmud K, Chernina V, Gotkin RH, Green JB, Cotofana S. Differences in Temporal Volume between Males and Females and the Influence of Age and BMI: A Cross-Sectional CT-Imaging Study. Facial Plast Surg 2021; 37:632-638. [PMID: 33684952 DOI: 10.1055/s-0041-1725201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The temple has been identified as one of the most compelling facial regions in which to seek aesthetic improvement-both locally and in the entire face-when injecting soft tissue fillers. OBJECTIVE The objective of this study is to identify influences of age, gender, and body mass index (BMI) on temporal parameters to better understand clinical observations and to identify optimal treatment strategies for treating temporal hollowing. METHODS The sample consisted of 28 male and 30 female individuals with a median age of 53 (34) years and a median BMI of 27.00 (6.94) kg/m2. The surface area of temporal skin, the surface area of temporal bones, and the temporal soft tissue volume were measured utilizing postprocessed computed tomography (CT) images via the Hausdorff minimal distance algorithm. Differences between the investigated participants related to age, BMI, and gender were calculated. RESULTS Median skin surface area was greater in males compared with females 5,100.5 (708) mm2 versus 4,208.5 (893) mm2 (p < 0.001) as was the median bone surface area 5,329 (690) mm2 versus 4,477 (888) mm2 (p < 0.001). Males had on average 11.04 mL greater temporal soft tissue volume compared with age and BMI-matched females with p < 0.001. Comparing the volume between premenopausal versus postmenopausal females, the median temporal soft tissue volume was 46.63 mL (11.94) versus 40.32 mL (5.69) (p = 0.014). CONCLUSION The results of this cross-sectional CT imaging study confirmed previous clinical and anatomical observations and added numerical evidence to those observations for a better clinical integration of the data.
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Affiliation(s)
- Andreas Nikolis
- Division of Plastic Surgery, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Robert Guryanov
- Department of Plastic Surgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Victor Gombolevskiy
- Moscow Health Care Department, Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | - Sergey Morozov
- Moscow Health Care Department, Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | - Kamal Makhmud
- Private Practice, Medlaz Clinic, Moscow, Russian Federation
| | - Valeria Chernina
- Moscow Health Care Department, Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Jeremy Blair Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, Florida
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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229
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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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230
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Giersch GEW, Charkoudian N, Pereira T, Edgell H, Freeberg KA, Craighead DH, Neill M, Allison EY, Zapcic AK, Smith KJ, Bock JM, Casey DP, Shenouda N, Ranadive SM, Tremblay JC, Williams AM, Simpson LL, Meah VL, Ruediger SL, Bailey TG, Pereira HM, Lei TH, Perry B, Mündel T, Freemas JA, Worley ML, Baranauskas MN, Carter SJ, Johnson BD, Schlader ZJ, Bates LC, Stoner L, Zieff G, Poles J, Adams N, Meyer ML, Hanson ED, Greenlund IM, Bigalke JA, Carter JR, Kerr ZY, Stanford K, Pomeroy A, Boggess K, de Souza HLR, Meireles A, Arriel RA, Leite LHR, Marocolo M, Chapman CL, Atencio JK, Kaiser BW, Comrada LN, Halliwill JR, Minson CT, Williams JS, Dunford EC, MacDonald MJ, Santisteban KJ, Larson EA, Reed E, Needham KW, Gibson BM, Gillen J, Barbosa TC, Cardoso LLY, Gliemann L, Tamariz-Ellemann A, Hellsten Y, DuBos LE, Babcock MC, Moreau KL, Wickham KA, Vagula M, Moir ME, Klassen SA, Rodrigues A. Commentaries on Point:Counterpoint: Investigators should/should not control for menstrual cycle phase when performing studies of vascular control. J Appl Physiol (1985) 2021; 129:1122-1135. [PMID: 33197376 DOI: 10.1152/japplphysiol.00809.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts,Oak Ridge Institute for Science and Education, Oak Ridge, Tennnessee
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute for Environmental Medicine, Natick, Massachusetts
| | - T Pereira
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - H Edgell
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Matthew Neill
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Elric Y Allison
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Andrea K Zapcic
- Department of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kurt J Smith
- Integrative Physiology Lab, Department of Kinesiology and Nutrition, University of Chicago, Chicago, Illinois
| | - Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa,Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland, College Park, Maryland
| | - Joshua C Tremblay
- Centre for Heart, Lung and Vascular Health, University of British Columbia–Okanagan, Kelowna, British Columbia, Canada
| | - Alexandra M Williams
- Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Lydia L Simpson
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stefanie L Ruediger
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia
| | - Tom G Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre of Research on Exercise, Physical Activity and Health, The University of Queensland, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Tze-Huan Lei
- College of Physical Education, Hubei Normal University, Huangshi, China,Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Blake Perry
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Toby Mündel
- School of Sport Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Jessica A Freemas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Morgan L Worley
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Marissa N Baranauskas
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Stephen J Carter
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Blair D Johnson
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zachary J Schlader
- H.H. Morris Human Performance Laboratories, Dept. of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Lauren C Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jillian Poles
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nathan Adams
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ian M Greenlund
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jeremy A Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana,Department of Psychology, Montana State University, Bozeman, Montana
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Stanford
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex Pomeroy
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kim Boggess
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hiago L R de Souza
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson Meireles
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Rhai A Arriel
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Laura H R Leite
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Jessica K Atencio
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brendan W Kaiser
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Lindan N Comrada
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - John R Halliwill
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | | | - Jennifer S Williams
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emily C Dunford
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Maureen J MacDonald
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Emily A Larson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Emma Reed
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Karen W Needham
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Brandon M Gibson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Jenna Gillen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Thales C Barbosa
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Licy L Yanes Cardoso
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Lyndsey E DuBos
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew C Babcock
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kerrie L Moreau
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, Colorado
| | - Kate A Wickham
- Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | | | - M Erin Moir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | | | - Alex Rodrigues
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Li Y, Zhao D, Wang M, Sun JY, Liu J, Qi Y, Hao YC, Deng QJ, Liu J, Liu J, Liu M. Combined effect of menopause and cardiovascular risk factors on death and cardiovascular disease: a cohort study. BMC Cardiovasc Disord 2021; 21:109. [PMID: 33622241 PMCID: PMC7903751 DOI: 10.1186/s12872-021-01919-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Observational studies suggest that early menopause is associated with increased risk of death and cardiovascular disease (CVD); however, the results of these studies have been inconsistently. We aimed to assess the association of menopause with death and CVD and whether this association was modified by cardiovascular risk factors. METHODS The study population was women age 35-64 years living in two communities of Beijing who were enrolled in the Chinese Multi-provincial Cohort Study in 1992. Participants were followed until first cardiovascular event, death, or the end of follow-up (2018). Self-reported age at menopause was recorded. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of death and CVD after adjusting for baseline covariates of age, family history of CVD, and white blood cell count, as well as time-varying covariates of menopause, use of oral estrogen, and conventional risk factors. Additionally, we assessed the combined effect of age at menopause and risk factors on the primary endpoint. RESULTS Of 2104 eligible women, 124 died and 196 had a first CVD event (33 fatal CVD and 163 non-fatal CVD). Compared with women who experienced menopause at age 50-51 years, the risk of death was higher in women with menopause at age 45-49 years (HR 1.99, 95% CI 1.24-3.21; P = 0.005), and the risk of ischemic stroke was higher in women with menopause at age < 45 years (HR 2.16, 95% CI 1.04-4.51; P = 0.04) and at age 45-49 years (HR 2.05, 95% CI 1.15-3.63; P = 0.01). Women who had menopause before age 50 years and at least one elevated risk factor at baseline had a higher risk of death (HR 11.10, 95% CI 1.51-81.41; P = 0.02), CVD (HR 3.98, 95% CI 1.58-10.01; P = 0.003), ischemic CVD (HR 4.53, 95% CI 1.63-12.62; P = 0.004), coronary heart disease (HR 8.63, 95% CI 1.15-64.50; P = 0.04), and stroke (HR 2.92, 95% CI 1.03-8.29; P = 0.04) than those with menopause at age 50-51 years and optimal levels of all risk factors. CONCLUSIONS Earlier menopause may predict death and ischemic stroke. Furthermore, there is a combined effect of earlier menopause and elevated risk factors on death and CVD.
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Affiliation(s)
- Yan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jia-Yi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Chen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qiu-Ju Deng
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Kahn LG, Harley KG, Siegel EL, Zhu Y, Factor-Litvak P, Porucznik CA, Klein-Fedyshin M, Hipwell AE. Persistent organic pollutants and couple fecundability: a systematic review. Hum Reprod Update 2021; 27:339-366. [PMID: 33147335 PMCID: PMC7903116 DOI: 10.1093/humupd/dmaa037] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite increasing regulation, exposure to persistent organic pollutants (POPs) remains a serious public health concern due to their accumulation in the environment and ability to biomagnify up the food chain. POPs are associated with endocrine-disrupting effects including adverse reproductive outcomes that could affect fecundability, i.e. the capacity to conceive a pregnancy, quantified as time to pregnancy (TTP). OBJECTIVE AND RATIONALE Results of epidemiologic studies that examine the impact of various chemical classes of POPs on TTP have not been synthesised. We undertook a systematic review to summarise the strength of evidence for associations of four common groups of POPs with couple fecundability and to identify gaps and limitations in the literature in order to inform policy decisions and future research. SEARCH METHODS We performed an electronic search of literature published between 1 January 2007 and 6 August 2019 in MEDLINE, EMBASE.com, Global Health, DART/TOXLINE and POPLINE. We included empirical research papers that examined human exposure to organochlorine (OC) pesticides, brominated flame retardants, polychlorinated organic compounds and/or per- and polyfluoroalkyl substances (PFAS) and considered TTP or fecundability as an outcome. Standardised forms for screening, data extraction and study quality were developed using DistillerSR software, and all reviews were completed in duplicate. We used the Newcastle-Ottawa Scale to assess risk of bias and devised additional quality metrics based on specific methodological features of fecundability studies. OUTCOMES The search returned 4573 articles, and 28 papers from 19 different studies met inclusion criteria. Among them, four studies measured TTP prospectively, three had data on participants' prenatal exposure, three examined associations in both male and female partners and one focused exclusively on males. Analyses varied widely in terms of exposure characterisation, precluding a meta-analytic approach. Evidence was strongest for adverse associations of female exposure to polychlorinated biphenyls with TTP, with some additional support for associations of female exposure to polybrominated diphenyl ethers and PFAS with longer TTP. Our review provided little or no support for associations between female exposure to OC pesticides or male exposure to any of the POP groups and TTP. WIDER IMPLICATIONS Evidence suggests that female exposure to at least some POPs may reduce fecundability. Although many of these chemicals are no longer in production, they are still detectable in human biosamples because of their persistence in the environment. Replacement chemicals that are being introduced as older ones are restricted may have similar reproductive consequences. Future studies should examine these newer POPs, assess interactions between POPs and other chemical and non-chemical exposures, investigate how POPs are distributed in and metabolised by the human body and focus on populations that may be disproportionately exposed.
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Affiliation(s)
- Linda G Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016 USA
| | - Kim G Harley
- Center for Environmental Research and Children’s Health, University of California Berkeley, Berkley, CA 94720, USA
| | - Eva L Siegel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Christina A Porucznik
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
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233
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Lersten I, Clain E, Santoro N. Use of Hormone Therapy in Women with Early Menopause and Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:302-308. [PMID: 33540459 DOI: 10.1055/s-0040-1721719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Women with early menopause or primary ovarian insufficiency (POI) experience a menopausal state a decade or more earlier than their peers. The health consequences for POI are vast and varied with detrimental effects seen on neurological, psychological, bone, and cardiovascular systems. The risk profile of POI patients requires special attention, as they differ from a typical menopausal population. This review will explore the health risks associated with POI and examine the various treatment options and also the risks associated with hormone therapy. Given the risks and benefits, POI patients should be strongly encouraged to start hormone therapy until the median age of menopause.
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Affiliation(s)
- Ivy Lersten
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Clain
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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234
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Stewart EA, Missmer SA, Rocca WA. Moving Beyond Reflexive and Prophylactic Gynecologic Surgery. Mayo Clin Proc 2021; 96:291-294. [PMID: 33549251 PMCID: PMC8088594 DOI: 10.1016/j.mayocp.2020.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN.
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Walter A Rocca
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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235
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van der Meulen M, Zamanipoor Najafabadi AH, Lobatto DJ, van den Hout WB, Andela CD, Zandbergen IM, Pereira AM, van Furth WR, Vliet Vlieland TPM, Biermasz NR. Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants. Pituitary 2021; 24:79-95. [PMID: 33025546 PMCID: PMC7864816 DOI: 10.1007/s11102-020-01089-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Prolactinomas are the most prevalent functioning pituitary adenomas. They affect gonadal function as well as health-related quality of life (HRQoL). This study aimed to report healthcare utilization and costs, including their determinants, for prolactinoma patients. METHODS Cross-sectional study of 116 adult prolactinoma patients in chronic care in a Dutch tertiary referral center. Patients completed four validated questionnaires, assessing healthcare utilization and costs over the previous 12 months (Medical Consumption Questionnaire), disease bother and needs (Leiden Bother and Needs Questionnaire Pituitary), HRQoL (Short Form-36), and self-reported health status (EuroQol 5D). Regression analyses were used to assess associations between disease-related characteristics and healthcare utilization and costs. RESULTS Mean age was 52.0 years (SD 13.7) and median follow-up was 15.0 years (IQR 7.6-26.1). Patients visited the endocrinologist (86.2%), general practitioner (37.9%), and ophthalmologist (25.0%) most frequently. Psychological care was used by 12.9% of patients and 5% were admitted to hospital. Mean annual healthcare costs were €1928 (SD 3319), mainly for pituitary-specific medication (37.6% of total costs), hospitalization (19.4%) and specialist care (16.1%). Determinants for higher healthcare utilization and costs were greater disease bother and needs for support, lower HRQoL, elevated prolactin, and longer disease duration, while tumor size, hypopituitarism and adrenal insufficiency were not significantly associated with healthcare utilization and costs. CONCLUSION Healthcare utilization and costs of prolactinoma patients are related to patient-reported HRQoL, bother by disease and needs for support. Therefore, addressing patients' HRQoL and needs is a way forward to improve efficiency of care and patients' health status.
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Affiliation(s)
- Merel van der Meulen
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden, The Hague, The Netherlands
| | - Daniel J Lobatto
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making & Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelie D Andela
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M Zandbergen
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden, The Hague, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
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236
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Schipper I, Louwers YV. Premature and Early Menopause in Relation to Cardiovascular Disease. Semin Reprod Med 2021; 38:270-276. [PMID: 33511582 DOI: 10.1055/s-0040-1722318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Postmenopausal women have an increased risk for cardiovascular diseases. It has been postulated that the loss of ovarian function and subsequent deficiency of endogenous estrogens after menopause contributes to this elevated risk of cardiovascular disease in postmenopausal women. Compared with woman entering menopause at the mean age of 51 years, in women with early menopause or premature ovarian insufficiency the risk for cardiovascular disease is even greater. These women lack the cardioprotective effect of endogenous estrogens for many more years than do women entering natural menopause. The majority of data assessing the risk of cardiovascular disease in relation to age at menopause and specifically premature menopause are derived from large epidemiological cohort studies. In addition, observations in women undergoing bilateral oophorectomy at an early age provide convincing evidence regarding association between early menopause or POI and the development of cardiovascular events and mortality. Moreover, genetic variants associated with earlier age at menopause have also been found to increase the risk of cardiovascular events in women. It has been substantiated that hormone replacement therapy (HRT) decreases the risk for ischemic heart disease and eliminates the increased cardiovascular disease mortality. It is therefore crucial to start HRT as soon as possible, particularly in women with premature ovarian insufficiency.
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Affiliation(s)
- Izaäk Schipper
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
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237
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Peters SAE, Woodward M. Oestradiol and the risk of myocardial infarction in women: a cohort study of UK Biobank participants. Int J Epidemiol 2021; 50:1241-1249. [PMID: 33734370 DOI: 10.1093/ije/dyaa284] [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: 01/30/2020] [Accepted: 12/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is commonly assumed that high oestradiol levels in women are cardioprotective. We assessed the association between oestradiol and the risk of incident myocardial infarction (MI) in women. METHODS We used data from 263 295 female UK Biobank participants [mean age 56.2; standard deviation (SD) 8.0 years] without previous cardiovascular disease (CVD). Associations of oestradiol with age and other cardiovascular risk factors were assessed. Cox proportional hazards models estimated crude, ag- and multiple-adjusted hazard ratios (HR) for MI associated with oestradiol levels. RESULTS After a mean follow-up of 9 years, 2206 incident cases of MI had been recorded, including 230 events among the 57 204 women (mean age 48) with detectable oestradiol levels. In the unadjusted analyses, a unit higher in log-transformed oestradiol was associated with an HR [95% confidence interval (CI) for MI of 0.73 (0.58; 0.92)]. After adjusting for age, this HR became 0.94 (0.75; 1.17), and after further adjusting for classical CVD risk factors, it was 1.05 (0.83; 1.31. Results were similar in subgroup analyses defined by age, menopausal status, socioeconomic status, contraceptive pill use and the use of hormone replacement therapy. The multivariable-adjusted HR for the 171 431 women (mean age 59) with undetectable levels of oestradiol, compared with those with detectable levels, was 0.97 (0.92; 1.02). CONCLUSIONS Higher levels of oestradiol were not associated with a decreased risk of MI. The presumed cardioprotective effects of oestradiol seem to be largely confounded by age and further confounded by other cardiovascular risk factors.
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Affiliation(s)
- Sanne A E Peters
- George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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238
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Differing effects of estrogen deficiency on the contractile function of atrial and ventricular myocardium. Biochem Biophys Res Commun 2021; 541:30-35. [PMID: 33461065 DOI: 10.1016/j.bbrc.2020.12.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
Estrogen deficiency has a significant influence on the excitation-contraction coupling in the ventricular myocardium but its impact on the atrial contractile function has not been studied. We have compared the effects of estrogen deficiency on the contractility and cytosolic Ca2+ transient of single cardiomyocytes isolated from the left atrium (LA) and the left ventricle (LV) of rats subjected to ovariectomy (OVX) or sham surgery (Sham). The characteristics of actin-myosin interaction were studied in an in vitro motility assay. We found that OVX decreased the contractility of LV single cardiomyocytes but increased that of LA myocytes. The disturbance of ventricular mechanical function may be explained by the acceleration of Ca2+ transient and reduced Ca2+ sensitivity of the actin-myosin interaction. The augmentation of LA contractility may be explained by accelerated cross-bridge kinetics and increased end-diastolic sarcomere length, which may lead to elevated tension in atrial cells due to the Frank-Starling mechanism.
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239
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Giri R, Vincent AJ. Prevalence and Risk Factors of Premature Ovarian Insufficiency/Early Menopause. Semin Reprod Med 2021; 38:237-246. [PMID: 33434933 DOI: 10.1055/s-0040-1722317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Premature ovarian insufficiency (POI) and early menopause, defined as loss of ovarian activity prior to 40 years or menopause between the ages of 40 and 45 years, respectively, is associated with significant adverse health impacts. Recent data indicate that the prevalence of POI and early menopause is greater than was previously thought, affecting more than 10% of women. Biopsychosocial risk factors including genetic, autoimmune, reproductive, lifestyle, early-life, social/environmental, and iatrogenic have been associated with POI/early menopause or earlier age at menopause. However, establishing a causal role and the underlying mechanisms remains elusive. Understanding and clarification of these risk factors will facilitate prevention and risk minimization strategies to optimize women's health.
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Affiliation(s)
- Rinky Giri
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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240
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Price MA, Alvarado BE, Rosendaal NT, Câmara SM, Pirkle CM, Velez MP. Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging. Menopause 2021; 28:484-490. [PMID: 33399323 PMCID: PMC8284368 DOI: 10.1097/gme.0000000000001729] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In women, the risk of cardiovascular disease (CVD) is higher in the postmenopausal period. The effect that menopausal type, natural versus surgical, or the age at natural menopause has on CVD needs further investigation. To this end, we assessed the association between menopausal type and timing and the 10-year office-based Framingham Risk Score (FRS) in women from the Canadian Longitudinal Study on Aging. METHODS We included women aged 45 to 85 years from the Canadian Longitudinal Study on Aging Comprehensive cohort of seven Canadian provinces who were menopausal at the time of recruitment and had no prior CVD. Poisson regressions were used to evaluate the association between menopausal characteristics and the FRS. Natural menopause was defined as the cessation of menstrual periods for at least 1 year in women with no history of hysterectomy. Surgical menopause was defined as hysterectomy with or without oophorectomy prior to natural menopause. As main covariates, we examined age, education, province of residency, and hormone therapy. RESULTS A total of 10,090 women (8,200 natural menopausal and 1,890 surgical menopausal) were eligible for the study. In the multivariable model, surgical menopause was associated with a higher mean FRS compared with natural menopause (CVD risk 12.4% vs 10.8%, P < 0.001). Compared with women with age at natural menopause from 50 to 54 years (CVD risk 10.2%), natural menopause before age 40, 40 to 44, or 45 to 49 had a higher CVD risk (12.2%, 11.4%, and 10.6%, respectively, P < 0.001). CONCLUSIONS Our study supports an association between menopausal type and timing on CVD risk prediction and highlights the need to be judicious about surgical menopause. Preventative interventions for CVD should be considered in surgical menopausal women and women with an age at natural menopause less than 45 years.
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Affiliation(s)
- Madison A. Price
- Undergraduate Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Beatriz E. Alvarado
- Department of Public Health Sciences, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Nicole T.A. Rosendaal
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Saionara M.A. Câmara
- Faculty of Health Sciences of Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Catherine M. Pirkle
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI
| | - Maria P. Velez
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
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Onset of the climacteric phase by the mid-forties associated with impaired insulin sensitivity: a birth cohort study. ACTA ACUST UNITED AC 2021; 28:70-79. [DOI: 10.1097/gme.0000000000001658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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242
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The Impact of Premature Menopause on Future Risk of Cardiovascular Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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243
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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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244
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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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245
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Association of menopause with risk of carotid artery atherosclerosis. Maturitas 2020; 143:171-177. [PMID: 33308625 DOI: 10.1016/j.maturitas.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Observational studies suggest that the risk of cardiovascular disease increases during menopause; however, the menopause-related risk of subclinical atherosclerosis is unclear. The aim of the current study is to evaluate menopause and the risk of subclinical carotid atherosclerosis through a retrospective analysis of data from a population-based prospective cohort study. STUDY DESIGN The study sample comprised 879 women in the Beijing community enrolled in the Chinese Multi-provincial Cohort Study at baseline study in 1992 and followed up to at least one carotid ultrasound examination at three on-site follow-up surveys. Age at menopause was categorized as <40 years (premature menopause), 40-44 years (early menopause), 45-49 years (relatively early menopause), 50-51 years (reference), and >51 years (relatively late menopause). Menopause staging at baseline was categorized as: reproductive, menopausal transition/perimenopause, early postmenopause, and late postmenopause. Menopause as a time-varying covariate was calculated using waiting time to menopause and menopause status at the last follow-up (2012). MAIN OUTCOME MEASURES The main outcome measures included carotid plaque and intima-media thickening. Gray's test was performed to assess the equality of cumulative incidence functions between age groups at menopause and between menopause stages. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with menopause. RESULTS Of the 879 women included (mean [SD] age at baseline, 48.6 [8.1] years), 573 (65.2%) developed carotid plaques and 430 (48.9%) developed intima-media thickening during follow-up. Menopause was significantly associated with risk of developing carotid plaques (HR 1.93, 95% CI 1.05-3.54; P = 0.03) after adjustment for age at baseline, age at menopause, use of oral estrogen due to menopause, and traditional cardiovascular risk factors at baseline. No significant association was found between age at menopause and risk of carotid atherosclerosis. CONCLUSION Menopausal women, irrespective of age at menopause, had an increased risk of carotid plaque.
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246
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Panay N, Anderson RA, Nappi RE, Vincent AJ, Vujovic S, Webber L, Wolfman W. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric 2020; 23:426-446. [PMID: 32896176 DOI: 10.1080/13697137.2020.1804547] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.
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Affiliation(s)
- N Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, Imperial College, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A J Vincent
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
| | - S Vujovic
- Faculty of Medicine, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - L Webber
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - W Wolfman
- Department of Obstetrics and Gynaecology, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Manfrini O, Cenko E, Bugiardini R. Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap. Curr Atheroscler Rep 2020; 22:65. [PMID: 32880760 DOI: 10.1007/s11883-020-00882-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event. RECENT FINDINGS Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient's body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction.
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Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy.
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248
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Update on Women's Heart Disease. J Womens Health (Larchmt) 2020; 29:1028-1031. [DOI: 10.1089/jwh.2020.8486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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249
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Zhu D, Chung HF, Dobson AJ, Pandeya N, Brunner EJ, Kuh D, Greenwood DC, Hardy R, Cade JE, Giles GG, Bruinsma F, Demakakos P, Simonsen MK, Sandin S, Weiderpass E, Mishra GD. Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Hum Reprod 2020; 35:1933-1943. [PMID: 32563191 PMCID: PMC8453420 DOI: 10.1093/humrep/deaa124] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION How does the risk of cardiovascular disease (CVD) vary with type and age of menopause? SUMMARY ANSWER Earlier surgical menopause (e.g. <45 years) poses additional increased risk of incident CVD events, compared to women with natural menopause at the same age, and HRT use reduced the risk of CVD in women with early surgical menopause. WHAT IS KNOWN ALREADY Earlier age at menopause has been linked to an increased risk of CVD mortality and all-cause mortality, but the extent that this risk of CVD varies by type of menopause and the role of postmenopausal HRT use in reducing this risk is unclear. STUDY DESIGN, SIZE, DURATION Pooled individual-level data of 203 767 postmenopausal women from 10 observational studies that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) consortium were included in the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Postmenopausal women who had reported menopause (type and age of menopause) and information on non-fatal CVD events were included. Type of menopause (natural menopause and surgical menopause) and age at menopause (categorised as <35, 35-39, 40-44, 45-49, 50-54 and ≥55 years) were exposures of interest. Natural menopause was defined as absence of menstruation over a period of 12 months (no hysterectomy and/or oophorectomy) and surgical menopause as removal of both ovaries. The study outcome was the first non-fatal CVD (defined as either incident coronary heart disease (CHD) or stroke) event ascertained from hospital medical records or self-reported. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CI for non-fatal CVD events associated with natural menopause and surgical menopause. MAIN RESULTS AND THE ROLE OF CHANCE Compared with natural menopause, surgical menopause was associated with over 20% higher risk of CVD (HR 1.22, 95% CI 1.16-1.28). After the stratified analysis by age at menopause, a graded relationship for incident CVD was observed with lower age at menopause in both types of natural and surgical menopause. There was also a significant interaction between type of menopause and age at menopause (P < 0.001). Compared with natural menopause at 50-54 years, women with surgical menopause before 35 (2.55, 2.22-2.94) and 35-39 years (1.91, 1.71-2.14) had higher risk of CVD than those with natural menopause (1.59, 1.23-2.05 and 1.51, 1.33-1.72, respectively). Women who experienced surgical menopause at earlier age (<50 years) and took HRT had lower risk of incident CHD than those who were not users of HRT. LIMITATIONS, REASONS FOR CAUTION Self-reported data on type and age of menopause, no information on indication for the surgery (e.g. endometriosis and fibroids) and the exclusion of fatal CVD events may bias our results. WIDER IMPLICATIONS OF THE FINDINGS In clinical practice, women who experienced natural menopause or had surgical menopause at an earlier age need close monitoring and engagement for preventive health measures and early diagnosis of CVD. Our findings also suggested that timing of menopause should be considered as an important factor in risk assessment of CVD for women. The findings on CVD lend some support to the position that elective bilateral oophorectomy (surgical menopause) at hysterectomy for benign diseases should be discouraged based on an increased risk of CVD. STUDY FUNDING/COMPETING INTEREST(S) InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). GDM is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). There are no competing interests.
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Affiliation(s)
- Dongshan Zhu
- The University of Queensland, Epidemiology and Biostatistics Division, School of Public Health, Brisbane, Queensland, Australia
| | - Hsin-Fang Chung
- The University of Queensland, Epidemiology and Biostatistics Division, School of Public Health, Brisbane, Queensland, Australia
| | - Annette J Dobson
- The University of Queensland, Epidemiology and Biostatistics Division, School of Public Health, Brisbane, Queensland, Australia
| | - Nirmala Pandeya
- The University of Queensland, Epidemiology and Biostatistics Division, School of Public Health, Brisbane, Queensland, Australia
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Darren C Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organisation, Lyon, France
| | - Gita D Mishra
- The University of Queensland, Epidemiology and Biostatistics Division, School of Public Health, Brisbane, Queensland, Australia
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El Khoudary SR. Age at menopause onset and risk of cardiovascular disease around the world. Maturitas 2020; 141:33-38. [PMID: 33036700 DOI: 10.1016/j.maturitas.2020.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/05/2023]
Abstract
Earlier menopause onset has been linked to a greater risk of cardiovascular disease. Both menopause onset and cardiovascular disease risk vary by geographical region, race/ethnicity and socioeconomic status. As such, it is plausible to hypothesize that these factors may influence the association of menopause onset and cardiovascular disease risk. Taking a global approach, this narrative review focuses on how geographic, racial/ethnic and socioeconomic factors might influence menopause onset, mainly natural menopause, and possibly its association with cardiovascular disease risk. The contribution of genetic factors to menopause onset variation is also summarized. A clear gap in the literature has been identified. Several meta-analyses have assessed the question of whether menopause onset is related to cardiovascular disease risk by combining large populations of diverse racial/ethnic backgrounds and socioeconomic status across wide geographical regions. None of these analyses adequately assessed how these factors might modify the association of menopause onset and cardiovascular disease risk. Testing such a question requires the study of a large group of women of diverse racial/ethnic backgrounds across different geographical locations with good documentation of their socioeconomic status, clinical and environmental factors. The increasing evidence supporting age at menopause onset as a marker of overall health calls for worldwide efforts to implement a standardized approach to define age at menopause in both the clinical and the research fields.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard St., Suite 600, Pittsburgh, PA 15260, USA.
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