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Ben Shimol J. Perimenopause in women with rheumatologic diseases: a spotlight on an under-addressed transition. Climacteric 2024; 27:115-121. [PMID: 37990992 DOI: 10.1080/13697137.2023.2276201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Abundant research has been published describing the effects invoked during menopause across different organ systems. Changing levels of estrogen and progesterone result in bidirectional alterations of immune cell pathways. Overall, the net trend dampens immunoregulation and promotes inflammation. In paradigmatic rheumatologic diseases, the combined effect is far from predictable. While some features may abate during menopause, studies have shown a general increased frequency toward disease exacerbation. Similarly, while impossible to isolate the ramifications of menopause in women with fibromyalgia, a tendency toward enhanced symptoms is unquestionably apparent. Furthermore, the comorbidities accrued by increasing age and the consequences of long-term medication use may also confound this picture. Periodic rheumatologic visits are warranted, with clinical assessments directed toward a multi-disciplinary approach. Ultimately, while an arsenal of effective tools is available for caring for these women and their underlying conditions, more studies are needed to better clarify how the different stages surrounding perimenopause affect subpopulations with rheumatic diseases and fibromyalgia-related disorders so that clinical course can be predicted and addressed prior to the emergence of symptomatology.
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Affiliation(s)
- J Ben Shimol
- Department of Rheumatology, Barzilai University Medical Center, Ashqelon, Israel
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2
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Le Bourvellec M, Delpech N, Hervo J, Bosquet L, Enea C. Effect of exercise modalities on postexercise hypotension in pre- and postmenopausal women: a systematic review and meta-analysis. J Appl Physiol (1985) 2024; 136:864-876. [PMID: 38328822 DOI: 10.1152/japplphysiol.00684.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
Hormonal changes associated with menopause increase the risk of hypertension. Postexercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis [International Prospective Registered of Systematic Review (PROSPERO): CRD42023297557] was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE + RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic blood pressure (SBP) and diastolic blood pressure (DBP) for at least 30 min after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CIs) were calculated, and Q-test and Z-test were conducted to assess differences between moderators. Forty-one trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP: g = -0.69, 95% CI -0.87 to -0.51; DBP: g = -0.31, 95% CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering blood pressure (BP) in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.NEW & NOTEWORTHY This meta-analysis has demonstrated that a single bout of exercise induces postexercise hypotension (PEH) in women and that the hormonal shift occurring with menopause does not influence the magnitude of PEH. However, we have shown with moderate evidence that the effectiveness of exercise modalities differs between pre- and postmenopausal women. Resistance and combined exercises are the best modalities to induce PEH in premenopausal women, whereas resistance and aerobic exercises are more effective in postmenopausal women.
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Affiliation(s)
- Morgane Le Bourvellec
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Nathalie Delpech
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Jéromine Hervo
- Laboratoire de Traitement de l'information Médicale (LaTIM), UMR1101, Université Bretagne Occidentale, Brest, France
| | - Laurent Bosquet
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Carina Enea
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
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Alhawari H, Alzoubi O, Alshelleh S, Alfaris L, Abdulelah M, AlRyalat SA, Altarawneh S, Alzoubi M. Blood pressure difference between pre and post-menopausal women and age-matched men: A cross-sectional study at a tertiary center. J Clin Hypertens (Greenwich) 2024. [PMID: 38523574 DOI: 10.1111/jch.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
Hypertension is a prominent risk factor for cardiovascular and cerebrovascular diseases. Gender differences and menopausal status contribute to blood pressure changes across the lifespan which have not been completely characterized. Our study aims to explore the impact of multiple factors on blood pressure levels in previously healthy women and men. Factors of interest included gender, menopausal status, age, and body mass index. Healthy women and men were recruited through healthcare facility announcements. Detailed menopausal history was obtained from females. The authors measured each participant's systolic and diastolic blood pressure at our outpatient clinics twice on the same day, and two different days, one week apart, and the authors included the mean of the averaged two readings for each participant. The study sample consisted of 313 participants. Female gender was a significant predictor of lower systolic and diastolic blood pressure (p < .001), while age significantly correlated with higher systolic blood pressure readings (p = .004). Although systolic blood pressure levels were significantly higher in postmenopausal females (124 mmHg) compared to premenopausal females (116 mmHg), our multiple linear regression analysis revealed that postmenopausal status did not significantly predict changes in either systolic or diastolic blood pressure. Our study demonstrates significant associations between blood pressure levels and various factors such as gender and age. This could emphasize the intricate interplay of demographic and clinical factors in blood pressure variations among individuals, highlighting the importance of a holistic approach to diagnosing hypertension, which considers various individual factors, including gender and age.
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Affiliation(s)
- Hussein Alhawari
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Osama Alzoubi
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sameeha Alshelleh
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Leen Alfaris
- Departement of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Mohamad Abdulelah
- Departement of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - Saleh Altarawneh
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
| | - Mohammad Alzoubi
- Department of Internal Medicine, Faculty of medicine, the University of Jordan, Amman, Jordan
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4
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Blum A. Gender differences in vascular aging and in coronary artery disease pathophysiology. QJM 2023; 116:745-749. [PMID: 36821436 DOI: 10.1093/qjmed/hcad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/24/2023] Open
Abstract
Women have a clinical advantage over men in relation to atherosclerotic cardiovascular disease (CVD) (morbidity and mortality). This advantage disappears once women become older, and in their seventh decade, the risk to develop CVD equals men at that age. There have been several theories about this gender difference that were related to hormones, and the different morphology and physiology that characterize the cardiovascular system in women. In this review, the different mechanisms will be reviewed and discussed.
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Affiliation(s)
- A Blum
- Department of Medicine, Azrieli Faculty of Medicine, Tzafon Medical Center, Bar Ilan University, Lower Galilee 15208, Israel
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He Z, Wen X, Zhou L. Reproductive health factors in relation to risk of hypertension in postmenopausal women: Results from NHANES 2011-2014. Medicine (Baltimore) 2023; 102:e35218. [PMID: 37713823 PMCID: PMC10508507 DOI: 10.1097/md.0000000000035218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Few studies have systematically assessed the relationship between multiple reproductive factors and hypertension, and these limited studies paid more attention to age at menarche and menopause, abortion, or the number of live births, and yielded controversial results. This study aimed to explore the relationship between reproductive health factors and hypertension from 5 aspects: history of menstruation, pregnancy, delivery, gynecological surgery, and reproductive-related medication use. We analyzed data from the National Health and Nutrition Examination Survey 2011 to 2014. Data on reproductive factors were collected using a questionnaire survey. The associations between multiple reproductive factors and the risk of hypertension were assessed using multivariable logistic regression models. There were significant inverse associations between age at menopause (odds ratio [OR] = 0.984, 95% confidence interval [CI]: 0.971-0.998, P = .0234 per 1-year increase), age at first live birth (OR = 0.970, 95% CI: 0.944-0.998, P = .0346 per 1-year increase), age at last live birth (OR = 0.982, 95% CI: 0.964-0.999, P = .0488 per 1-year increase), and the risk of hypertension. In contrast, a positive association was found between the risk of hypertension and a history of gestational diabetes (OR = 1.693, 95% CI: 1.042-2.751, P = .0333), hysterectomy (OR = 1.398, 95% CI: 1.139-1.717, P = .0014), ovariectomy (OR = 1.374, 95% CI: 1.074-1.758, P = .0115), and birth control pill use (OR = 1.293, 95% CI: 1.035-1.616, P = .0236). Age at menopause but not menarche, is inversely associated with hypertension. A history of gestational diabetes, hysterectomy, ovariectomy, or birth control pills was associated with a higher risk of hypertension.
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Affiliation(s)
- Zehao He
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Xiaoxiao Wen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Long Zhou
- Institute of Cardiovascular Diseases & Department of Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Kar D, Roy S. Factors associated with the CVD risk factors and body fat pattern of postmenopausal Hindu caste and Lodha tribal populations living in India: An exploratory study. Womens Midlife Health 2023; 9:4. [PMID: 37095574 PMCID: PMC10127089 DOI: 10.1186/s40695-023-00087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Loss in ovarian function during mid-life results in adverse changes in the cardiovascular profile of women. The association between CVD risk factors and menopause differ cross-culturally since several modifiable factors play significant roles in explaining CVD mortality in addition to differences in endogenous estrogen. Very few of the studies from the Indian subcontinent have been concerned with the menopause-specific CVD risk factors, particularly among the tribal groups. Thus, we intended to study the variations in body fat pattern and CVD risk factors between Hindu caste and Lodha tribal postmenopausal women and how these risk factors were associated with differential socio-economic, reproductive and menstrual characteristics and lifestyle variables. The Lodha tribal populations is considered a Particularly Vulnerable Group (PVTG) in this country. METHODS This cross-sectional study was conducted among the Bengali Hindu caste and Lodha tribal populations of the State of West Bengal, India covering three districts namely Howrah, Jhargram and East Midnapure. A total of 197 postmenopausal participants were recruited for this study (urban caste 69, rural caste 65 and rural Lodha 63). Data on blood glucose and total cholesterol levels, blood pressure, muscle mass, body fat distribution and sociodemographic, reproductive and menstrual history and lifestyle variables were collected following standard protocols. Analysis of variance (ANOVA) was applied to compare blood glucose, total cholesterol and blood pressure levels and body fat measures across the three populations. Stepwise multiple linear regression analysis was performed to find out the factors associated with CVD risk factors. The data were analyzed with the Statistical Package for Social Science version 20.0(IBM corporation, 2011). RESULTS This cross-sectional comparison of women at midlife, though exploratory in nature showed significant differences in body fat pattern and CVD risk factors between caste and tribal groups owing to socioeconomic disparities and, differences in reproductive characteristics and lifestyle factors. CONCLUSION The caste and tribal populations differed significantly in body fat pattern and CVD risk factors and in the factors associated with CVD risk suggesting interplay between menopause and modifiable factors in explaining CVD risk factors during mid-life.
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Affiliation(s)
- Debasmita Kar
- Department of Anthropolgy, University of Calcutta, 35 Ballygunge Circular Road, 700019 Ballygunge, Kolkata, India
| | - Subho Roy
- Department of Anthropolgy, University of Calcutta, 35 Ballygunge Circular Road, 700019 Ballygunge, Kolkata, India
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Mustafa A. Association between hysterectomy and hypertension among Indian middle-aged and older women: a cross-sectional study. BMJ Open 2023; 13:e070830. [PMID: 37080618 PMCID: PMC10124308 DOI: 10.1136/bmjopen-2022-070830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To examine the association between hysterectomy and hypertension among middle-aged and older women in India, as well as to determine if the association differs across different age groups. DESIGN A cross-sectional exploratory study. SETTING AND PARTICIPANTS Nationally representative population-based data of the Longitudinal Ageing Study in India (2017-2018) were used in this study. The sample included 32 460 women aged 45 years and above. OUTCOME MEASURES Self-reported hypertension was the outcome variable. The variable was a binary variable, with 1 representing hypertensive and 0 representing not hypertensive. METHODS Entropy balance method, along with logistic regression analysis, was used to meet the objectives. RESULTS 31.3% of the women with hysterectomy and 42.5% of the women without hysterectomy were hypertensive. A perfect covariate balance was achieved between the treatment and control groups using the entropy balance method. Women with hysterectomy had 36% (OR 1.36; 95% CI 1.26 to 1.48) higher odds of hypertension than women without hysterectomy. The OR was 1.23 (95% CI 1.03 to 1.47) for the age group 45-49, whereas, for the age group 80+, it was 1.87 (95% CI 1.18 to 2.97), showing that the magnitude of the association between hysterectomy and hypertension varied with age. CONCLUSION The findings of this study suggest that hysterectomy and hypertension have a significant association in middle-aged as well as older women in India.
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Affiliation(s)
- Akif Mustafa
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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9
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Canfora F, Calabria E, Pecoraro G, Leuci S, Coppola N, Mazzaccara C, Spirito F, Aria M, D'Aniello L, Mignogna MD, Adamo D. Prevalence of hypertension and correlation with mental health in women with burning mouth syndrome: A case-control study. Front Cardiovasc Med 2023; 9:969148. [PMID: 36741839 PMCID: PMC9894887 DOI: 10.3389/fcvm.2022.969148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023] Open
Abstract
Background The relationship between hypertension (HTN) and chronic pain is still a matter of debate, and its prevalence in patients with burning mouth syndrome (BMS) has never been evaluated. This study aimed to assess the prevalence of HTN in women with BMS and to evaluate its relationship with potential predictors such as risk factors for cardiovascular diseases, pain, and mental health status analyzing differences with healthy women. Methods In total, 250 women with BMS (WBMS) were prospectively recruited and compared with an equal number of healthy women (HW) matched for age. Education, body mass index, smoke and alcohol consumption, intensity and quality of pain, and psychological profile were further investigated to identify the potential predictors of HTN. Specifically, pain assessment [the Numeric Rating Scale (NRS) and Short-Form McGill Pain Questionnaire (SF-MPQ)] and psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS)] was carried out for the participants. Results HTN was found in 128 (51.2%) WBMS and 76 (30.4%) HW (p < 0.001**). The scores of the NRS, SF-MPQ, HAM-D, HAM-A, and PSQI were statistically significantly higher in the WBMS than in the HW (p < 0.001**). A strongly linear correlation between HTN and employment status, systemic diseases, and education level (p < 0.001**) was found in WBMS, while a strong correlation between HTN and employment status, hypercholesterolemia, systemic diseases, and drug consumption was found in HW (p < 0.001**). No statistically significant correlation was found between HTN and pain, anxiety, depression, and sleep disturbances. Conclusion These results suggest that WBMS showed a higher prevalence of HTN compared with controls. Unemployed WBMS with lower education and other systemic comorbidities are at an increased risk of developing HTN. HTN is associated with alteration in the vascular structure and function of the brain, and these processes accelerate brain aging, which contributes to a reduction in intracortical connectivity, thus affecting the modulatory system of control of pain in patients with BMS, independently of their mental health assessment. Predictors that may underlie this association remain unclear, taking into account the differences found in HW, and should be further elucidated.
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Affiliation(s)
- Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy,*Correspondence: Elena Calabria ✉
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Stefania Leuci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University of Naples Federico II, Naples, Italy
| | - Luca D'Aniello
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Liang X, Chou OHI, Cheung CL, Cheung BMY. Is hypertension associated with arthritis? The United States national health and nutrition examination survey 1999-2018. Ann Med 2022; 54:1767-1775. [PMID: 35786117 PMCID: PMC9258429 DOI: 10.1080/07853890.2022.2089911] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Hypertension and arthritis are two common diseases in the general population, with multiple common risk factors. This study aimed to assess the association between hypertension (HTN) and arthritis. PATIENTS AND METHODS This cohort study included 48,372 eligible non-pregnant participants aged ≥ 20 years who had valid data on hypertension and arthritis from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. The association between hypertension and arthritis was studied by logistic regression, adjusting for demographics, socioeconomic factors, excess sodium intake, physical activity, ever smoking, diabetes status and body mass index (BMI). RESULTS Among the participants, 48.0% (95% CI: 47.2-48.9) had hypertension and 24.5% (95% CI: 23.8-25.3) had self-reported arthritis. Hypertension was associated with arthritis [OR = 2.90, (95% CI: 2.74-3.07), p < 0.01], which remained significant [OR = 1.27, (95% CI:1.18-1.37), p < 0.01] after adjustments. Stratified by the types of arthritis, the association remained significant in rheumatoid arthritis (RA) [OR = 1.25, (95% CI: 1.11-1.41), p < 0.01] and osteoarthritis (OA) [OR = 1.32, (95% CI: 1.16-1.50); p < 0.01]. There was no clear association between hypertension and OA in participants aged 60 years old and above [OR = 1.08, (95% CI: 0.92-1.26); p = 0.37]. CONCLUSIONS In this large nationally representative survey over 20 years, arthritis, including both RA and OA, was strongly associated with hypertension. Our study demonstrates a need for hypertension screening and blood control among patients with arthritis.Key MessagesArthritis was associated with hypertension.Both rheumatoid arthritis and osteoarthritis are strongly associated with hypertension.There is an urgency for hypertension screening and blood control among patients with arthritis.
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Affiliation(s)
- Xiaopeng Liang
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Oscar Hou In Chou
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Ching Lung Cheung
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Hong Kong, China
| | - Bernard M Y Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.,Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Hong Kong, China
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11
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Hu Z, Chen L, Wang X, Zhang L, Chen Z, Zheng C, Cao X, Song Y, Zhou H, Tian Y, Cai J, Huang Y, Gu R, Tian Y, Shao L, Wang Z. Reproductive lifespan in association with risk of hypertension among Chinese postmenopausal women: Results from a large representative nationwide population. Front Cardiovasc Med 2022; 9:898608. [PMID: 36003912 PMCID: PMC9393301 DOI: 10.3389/fcvm.2022.898608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe association between reproductive lifespan and risk of hypertension among postmenopausal women is unclear.MethodsA total of 94,141 postmenopausal women with a mean age of 64.8 years from the China Hypertension Survey were enrolled at baseline from 2012 to 2015. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Blood pressure and physical examination of the participants were performed by trained medical staff. Logistic regression was used to estimate the odds ratios for hypertension by years of reproductive lifespan.ResultsThe average years of reproductive lifespan in Chinese women was 34.0 years. Women who were longer in reproductive lifespan were more likely to have older age at recruitment, higher body mass index, larger waist circumference, lower mean systolic blood pressure, and higher mean diastolic blood pressure (p < 0.05). After adjustments, odds ratios (95% confidence interval) for hypertension were 1.035 (0.988–1.085), 1.007 (0.966–1.048), 1.000 (reference), 0.932 (0.899–0.967), and 0.953 (0.909–0.997) for those with reproductive lifespan at ≤ 28, 29–31, 32–34 (reference), 35–37, and ≥ 38 years, respectively, with a significantly inverse association was seen in those with reproductive lifespan at 35–37 and ≥ 38 years. The overall risk of hypertension declined with the increase in reproductive lifespan, and the risk of hypertension was reduced by 1.1% for every 1-year increase in the reproductive lifespan (odds ratio, 0.989; 95% confidence interval, 0985–0.994) per year. The negative association between reproductive lifespan and hypertension was evident among age at recruitment groups, body mass index categories, and education levels, with the strongest association among women aged ≥ 70 years. Positive associations between reproductive lifespan and risk of hypertension were evident among women aged < 60 years, and this association was stronger among current alcohol drinkers.ConclusionBased on the large nationally representative sample, Chinese postmenopausal women with a shorter reproductive lifespan have a higher risk of hypertension.
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Affiliation(s)
- Zhen Hu
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Chen
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Linfeng Zhang
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo Chen
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Congyi Zheng
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Cao
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxin Song
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Haoqi Zhou
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yixin Tian
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiayin Cai
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yilin Huang
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runqing Gu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Tian
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Shao
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zengwu Wang
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Zengwu Wang,
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Mehta PK, Gaignard S, Schwartz A, Manson JE. Traditional and Emerging Sex-Specific Risk Factors for Cardiovascular Disease in Women. Rev Cardiovasc Med 2022; 23:288. [PMID: 39076638 PMCID: PMC11266960 DOI: 10.31083/j.rcm2308288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 07/31/2024] Open
Abstract
Cardiovascular disease (CVD) remains a major health threat in women. While traditional CVD risk factors such as hypertension, hyperlipidemia, diabetes, and smoking have been recognized for over 50 years, optimal control of these risk factors remains a major challenge. Unique sex-specific risk factors such as adverse pregnancy outcomes, premature menopause and low estrogen states, and chronic autoimmune inflammatory disorders also contribute to increased CVD risk in women. In addition, psychological risk factors such as stress, depression, and social determinants of health may have a disproportionately adverse impact in women. An improved understanding of traditional and emerging sex-specific CVD risk factors and management of modifiable factors is critical for clinicians who provide care for women. Early recognition and treatment of risk factors may alter the trajectory of adverse CVD events. A multi-disciplinary approach with team-based care involving multiple specialists and improved, targeted educational efforts are needed to reduce CVD risk factors and its adverse consequences in women.
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Affiliation(s)
- Puja K. Mehta
- Emory Women’s Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Scott Gaignard
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA 30322, USA
| | - Arielle Schwartz
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA 30322, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
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Ghaddar F, Zeidan RK, Salameh P, Tatari S, Achkouty G, Maupas-Schwalm F. Risk Factors for Coronary Heart Disease Among Lebanese Women: A Case–Control Study. Vasc Health Risk Manag 2022; 18:297-311. [PMID: 35464735 PMCID: PMC9021001 DOI: 10.2147/vhrm.s350108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Women are increasingly concerned by coronary heart disease (CHD), with peculiarities of their own, particularly concerning risk factors. The aim of the study was to assess the risk factors for CHD in Lebanese women over forty. Patients and Methods A case–control study was carried out in 6 hospitals in Beirut and Mount-Lebanon, from December 2018 to December 2019 including 1500 patients (1200 controls and 300 cases). Women were stratified into pre- and post-menopausal groups. Personal and medical data were collected from hospital records and during an interview where validated questionnaires were used. Binary logistic regressions were performed to investigate potential predictors of CHD in the 2 groups. Results In post-menopausal women, dyslipidemia (adjusted odds ratio [aOR], 3.018; 95% confidence interval, 2.102–4.332), hypertension (aOR: 2.449, [1.386–4.327]), a family history of CHD (aOR: 2.724, [1.949–3.808]), cigarette smoking (aOR: 2.317, [1.574–3.410]) and common non-rheumatic joint pain (aOR: 1.457, [1.053–2.016]) were strongly associated with CHD. Conversely, living in Mount Lebanon seemed protective, compared to Beirut (aOR: 0.589, [0.406–0.854]), as well as having a moderate monthly income (aOR: 0.450, [0.220–0.923]), adhering to a Mediterranean diet (aOR: 0.965, [0.936–0.994]), and practicing physical activity [PA] (aOR: 0.396, [0.206–0.759] and 0.725, [0.529–0.992], respectively for high and moderate vs low PA). In pre-menopausal women, dyslipidemia (aOR: 6.938, [1.835–26.224]), hypertension (aOR: 6.195, [1.318–29.119]), family histories of dyslipidemia (aOR: 6.143, [1.560–24.191]) and CHD (aOR: 4.739, [1.336–16.805]) reached statistical significance. Conclusion The identification of factors associated with CHD in women, some of which are frequent and trivialized in post-menopause, underlines the need to put in place specific and dedicated CHD prevention strategies in women.
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Affiliation(s)
- Fatima Ghaddar
- Doctoral School of Biology Health and Biotechnologies, Toulouse University, Toulouse, France
- Correspondence: Fatima Ghaddar, Doctoral school of Biology Health and Biotechnologies, Toulouse University, Toulouse, France, Tel +32 470 53 71 52, Email
| | - Rouba K Zeidan
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Public Health II, Lebanese University, Mount-Lebanon, Lebanon
- INSPECT-LB, National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon
- CERIPH, Center for Research in Public Health, Faculty of Public Health, Lebanese University, Mount-Lebanon, Lebanon
| | - Pascale Salameh
- INSPECT-LB, National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon
- Department of Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Souzan Tatari
- Cardiology department, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Guy Achkouty
- Cardiology Department, Mount Lebanon University Hospital, Mount-Lebanon, Lebanon
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Wickham KA, Nørregaard LB, Oxfeldt M, Cheung SS, Gliemann L, Hansen M, Hellsten Y. Short-Term Supplementation With Fermented Red Clover Extract Reduces Vascular Inflammation in Early Post-menopausal Women. Front Cardiovasc Med 2022; 9:826959. [PMID: 35224058 PMCID: PMC8866445 DOI: 10.3389/fcvm.2022.826959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The decline in estrogen at menopause poses a critical challenge to cardiovascular and metabolic health. Recently, a growing interest in the role of phytoestrogens, with a particular focus on isoflavones, has emerged as they can bind to estrogen receptors and may mimic the roles of endogenous estrogen. Fermented red clover extract (RC) contains isoflavones with superior bioavailability compared to non-fermented isoflavones, however little is known regarding the impact of isoflavones on cardiovascular and metabolic health. We assessed markers of vascular health in plasma and skeletal muscle samples obtained from healthy but sedentary early post-menopausal women (n = 10; 54 ± 4 years) following 2 weeks of twice daily treatment with placebo (PLA) or RC (60 mg isoflavones per day). The two interventions were administered using a randomized, double-blind, crossover design with a two-week washout period. Plasma samples were utilized for assessment of markers of vascular inflammation. There was a statistically significant reduction (~5.4%) in vascular cell adhesion molecule 1 (VCAM-1) following 2 weeks of RC supplementation compared to PLA (p = 0.03). In contrast, there was no effect of RC supplementation compared to PLA on skeletal muscle estrogen receptor content and enzymes related to vascular function, and angiogenesis. Supplementation with RC reduces vascular inflammation in early post-menopausal women and future studies should address the long-term impact of daily supplementation with RC after menopause.
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Affiliation(s)
- Kate A. Wickham
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Environmental Ergonomics Lab, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Line B. Nørregaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Oxfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Stephen S. Cheung
- Environmental Ergonomics Lab, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette Hansen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Ylva Hellsten
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Sex Differences in Spironolactone and the Active Metabolite Canrenone Concentrations and Adherence. Biomedicines 2022; 10:biomedicines10010137. [PMID: 35052816 PMCID: PMC8773364 DOI: 10.3390/biomedicines10010137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 12/07/2022] Open
Abstract
We aim to investigate sex differences in blood concentrations of spironolactone and the active metabolite canrenone in resistant hypertension patients. Furthermore, sex differences in adherence for spironolactone and other antihypertensive drugs (AHDs) were studied. The patients in this post hoc study had all participated in a single-blind randomized controlled trial called RHYME-RCT (Dutch Trial Register, NL6736). Concentrations in blood of several AHDs were assessed in RHYME-RCT to investigate adherence to treatment. This allowed for a comparison of drug exposure to spironolactone and canrenone between males and females. In linear regression models, no statistically significant sex differences (N = 35) in spironolactone (B =−10.23, SE = 7.92, p = 0.206) or canrenone (B = 1.24, SE = 10.96, p = 0.911) concentrations after adjustment for dose and time between sampling and intake were found. Furthermore, no statistically significant differences in non-adherence to spironolactone were found between sexes (N = 54, male 15% vs. female 38%, p = 0.100), but non-adherence to spironolactone was associated with non-adherence to other AHDs (p ≤ 0.001). Spironolactone and canrenone concentrations were not different between males and females with resistant hypertension. Although not statistically significant, females were twice as likely to be non-adherent to spironolactone compared to males, and thereby also more likely to be non-adherent to other AHDs.
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Mishra SR, Waller M, Chung HF, Mishra GD. Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: findings from a 20-year prospective study. Maturitas 2022; 159:52-61. [DOI: 10.1016/j.maturitas.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
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Mishra SR, Waller M, Chung HF, Mishra GD. Epidemiological studies of the association between reproductive lifespan characteristics and risk of Type 2 diabetes and hypertension: A systematic review. Maturitas 2021; 155:14-23. [PMID: 34876245 DOI: 10.1016/j.maturitas.2021.09.009] [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: 02/07/2021] [Revised: 08/16/2021] [Accepted: 09/19/2021] [Indexed: 12/23/2022]
Abstract
Some reproductive factors are found to be associated with metabolic outcomes in women; however, little is known about reproductive lifespan characteristics and the mutual effect of age at menarche and age at menopause on cardiovascular risk. This systematic review evaluated reproductive lifespan characteristics and describes the mutual effect of age at menarche and age at menopause on the risk of type 2 diabetes (T2DM) and hypertension at midlife. PubMed, EMBASE, and Web of Science were screened for studies published up to September 1, 2020. The individual effect estimates were reviewed and synthesized without meta-analysis due to methodological and clinical or conceptual diversity in reported studies. Of the 3033 identified studies, 20 were included in the final synthesis: 6 reported reproductive life span; 12 reported age at menarche, and 7 reported age at menopause. Synthesis of two cohorts, with a median follow-up of 9-11 years, showed that a shorter reproductive lifespan was positively associated with T2DM, yielding 6-15% higher risk of T2DM for a one-year decrease in reproductive lifespan. A few studies also demonstrated that women who experienced early menarche (four of six studies) and early menopause (two of five studies) were positively associated with risk of T2DM. The association between reproductive lifespan and hypertension was unclear due to the limited availability of studies. Our findings suggest that a shorter reproductive lifespan is associated with T2DM risk in postmenopausal women, especially those with early menarche and early menopause. Large cohort studies are needed to assess the association between reproductive lifespan and incident hypertension in midlife.
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Affiliation(s)
- Shiva R Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia.
| | - Michael Waller
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Hsin-Fang Chung
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Gita D Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
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Effects of heavy metals on hypertension during menopause: a Korean community-based cross-sectional study. ACTA ACUST UNITED AC 2021; 28:1400-1409. [PMID: 34581292 DOI: 10.1097/gme.0000000000001865] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the associations between serum cadmium, lead, and mercury and hypertension in pre- and postmenopausal women. METHODS Serum heavy metal (cadmium, lead, and mercury) levels were analyzed in 7,226 randomly selected women who participated in Korean National Health and Nutrition Examination Surveys from 2009 to 2017. Odds ratios (ORs) for hypertension were calculated for log2-transformed serum heavy metal levels, median tertile levels of serum cadmium, mercury, and lead, and for interactions between heavy metal levels and tertiles, after covariate adjustment. RESULTS A doubling of serum cadmium was associated with hypertension in premenopausal (OR 2.47; 95% CI, 1.01-6.10, P = 0.049) and postmenopausal women (OR 1.70; 95% CI, 1.02-2.84, P = 0.043), and significant trends were observed for cadmium tertiles (P < 0.01). In premenopausal women, a two-fold increase in serum mercury increased the OR of hypertension by 3.08 (95% CI, 1.12-8.43, P = 0.029), and significant trends were also observed for serum mercury tertiles (P < 0.01). Interactions between serum cadmium, lead, and mercury levels in pre- and postmenopausal women were found to impact the prevalence of hypertension. CONCLUSION Given increasing exposure to heavy metals in Korea, further prospective study is needed to identify associations between heavy metal exposures, both separately and in combination, with the prevalence of cardiovascular disease risk factors in well-characterized cohorts of different populations and to determine means of preventing heavy metal exposure.
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Age at Natural Menopause and Blood Pressure Traits: Mendelian Randomization Study. J Clin Med 2021; 10:jcm10194299. [PMID: 34640315 PMCID: PMC8509463 DOI: 10.3390/jcm10194299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023] Open
Abstract
Observational studies suggest that early onset of menopause is associated with increased risk of hypertension. Whether this association is causal or due to residual confounding and/or reverse causation remains undetermined. We aimed to evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure traits in Caucasian women. A cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from the CoLaus and Rotterdam studies. Regression models were built with observational data to study the associations of ANM with systolic and diastolic blood pressure (SBP/DBP) and hypertension. One-sample MR analysis was performed by calculating a genetic risk score of 54 ANM-related variants, previously identified in a genome-wide association study (GWAS) on ANM. In the two-sample MR analysis we used the estimates from the ANM-GWAS and association estimates from 168,575 women of the UK Biobank to evaluate ANM-related variants and their causal association with SBP and DBP. Pooled analysis from both cohorts showed that a one-year delay in menopause onset was associated with 2% (95% CI 0; 4) increased odds of having hypertension, and that early menopause was associated with lower DBP (β = −1.31, 95% CI −2.43; −0.18). While one-sample MR did not show a causal association between ANM and blood pressure traits, the two-sample MR showed a positive causal association of ANM with SBP; the last was driven by genes related to DNA damage repair. The present study does not support the hypothesis that early onset of menopause is associated with higher blood pressure. Our results suggest different ANM-related genetic pathways could differently impact blood pressure.
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Shah J, Chandanani S, Reddy J, Kirubamani H, Boruah AM, Jain A, Mane S, Biniwale P, Mathur P, Ridhorkar A, Natarajan S, Tiwari B. Evaluation of the Efficacy and Safety of Rheum rhaponticum Root Extract (ERr 731) for Menopausal Symptoms in Perimenopausal Indian Women: An Interim Analysis. J Midlife Health 2021; 12:108-115. [PMID: 34526744 PMCID: PMC8409715 DOI: 10.4103/jmh.jmh_86_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Hormonal therapy for menopause has been found to be the most efficacious treatment, but it may be associated with adverse effects in some of the women. Rheum rhaponticum root extract (”ERr 731”), which is available worldwide, is a natural, reliable, effective, and well-tolerated remedy for women in perimenopausal women with menopausal symptoms (MSs), but there is no Indian study demonstrating its efficacy, safety, and tolerability till date. Objective: This study aimed to evaluate the efficacy and safety of ERr 731 in alleviating MSs in perimenopausal Indian women. Patients and Methods: In this open-labeled prospective study, 129 perimenopausal women were treated with tablet containing 4 mg of Rr dried root extract once daily for 12 weeks. The Menopause Rating Scale (MRS) II score, endometrial thickness (ET), blood pressure, glycemic status, lipid profile, and high-sensitivity C-reactive protein (hs-CRP) level were periodically assessed and compared. Results: A significant reduction (67% by 12th week) in the mean MRS II score was observed from baseline till the end of 12 weeks (18.1; 95% confidence interval [CI]: 17.0–19.2; P < 0.001). A monotonic reduction in the mean total MRS II score over time was found (1.51 units/week; 95% CI: 1.42–1.60 units/week; P < 0.001) noticeable. There was a reduction in the mean ET from baseline till the end of 12 weeks, although the change was not significant. There were significant reductions in the mean fasting (6.3 mg/dl; 95% CI: 1.7–11.0 mg/dl; P = 0.008) and postprandial (6.3 mg/dl; 95% CI: 1.0–11.7; P = 0.021) blood glucose levels and glycated hemoglobin level (0.30%; 95% CI: 0.085–0.520; P = 0.007) at 12 weeks. No significant changes were noted in terms of blood pressure, lipid profile, and hs-CRP level. The drug was found to be safe. Conclusion: ERr 731 was well tolerated and was found to be efficacious and safe in alleviating MSs in Indian perimenopausal women.
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Affiliation(s)
- Jignesh Shah
- Department of Obstetrics and Gynecology, Dr. Shah Maternity and Nursing Home, Ahmedabad, India
| | - Sonia Chandanani
- Department of Obstetrics and Gynecology, Bombay Maternity and Surgical Hospital, Surat, Gujarat, India
| | - Jayanthi Reddy
- Department of Obstetrics and Gynecology, JJ Hospital, Hyderabad, Telangana, India
| | - Hepzibah Kirubamani
- Department of Obstetrics and Gynecology, St. Thomas Hospital, Chennai, India
| | - Arun Madhab Boruah
- Department of Obstetrics and Gynecology, Sampreeti Hospital, Sivasagar, Assam, India
| | - Anju Jain
- Department of Obstetrics and Gynecology, Jain Hospital, Varanasi, Uttar Pradesh, India
| | - Sheela Mane
- Department of Obstetrics and Gynecology, Anugraha Nursing Home, Bengaluru, Karnataka, India
| | | | | | - Anuradha Ridhorkar
- Department of Obstetrics and Gynecology, Ridhorkar Hospital, Nagpur, Maharashtra, India
| | - Suma Natarajan
- Ganga Women and Child Center, Coimbatore, Tamil Nadu, India
| | - Brajbala Tiwari
- Department of Obstetrics and Gynecology, Life Care Hospital, Indore, Madhya Pradesh, India
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Wong A, Chen SQ, Halvorson BD, Frisbee JC. Microvessel Density: Integrating Sex-Based Differences and Elevated Cardiovascular Risks in Metabolic Syndrome. J Vasc Res 2021; 59:1-15. [PMID: 34535606 DOI: 10.1159/000518787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Metabolic syndrome (MetS) is a complex pathological state consisting of metabolic risk factors such as hypertension, insulin resistance, and obesity. The interconnectivity of cellular pathways within various biological systems suggests that each individual component of MetS may share common pathological sources. Additionally, MetS is closely associated with vasculopathy, including a reduction in microvessel density (MVD) (rarefaction) and elevated risk for various cardiovascular diseases. Microvascular impairments may contribute to perfusion-demand mismatch, where local metabolic needs are insufficiently met due to the lack of nutrient and oxygen supply, thus creating pathological positive-feedback loops and furthering the progression of disease. Sexual dimorphism is evident in these underlying cellular mechanisms, which places males and females at different levels of risk for cardiovascular disease and acute ischemic events. Estrogen exhibits protective effects on the endothelium of pre-menopausal women, while androgens may be antagonistic to cardiovascular health. This review examines MetS and its influences on MVD, as well as sex differences relating to the components of MetS and cardiovascular risk profiles. Finally, translational relevance and interventions are discussed in the context of these sex-based differences.
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Affiliation(s)
- Angelina Wong
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Shu Qing Chen
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Brayden D Halvorson
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Jefferson C Frisbee
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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22
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Noninvasively measured radial pressure wave analysis provides insight into cardiovascular changes during pregnancy and menopause. Taiwan J Obstet Gynecol 2021; 60:888-893. [PMID: 34507667 DOI: 10.1016/j.tjog.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Pregnancy and menopause are significant life events associated with major changes in female hormone levels and changes in cardiovascular health. The role of estrogen in influencing cardiovascular risk is an ongoing research topic. Many studies have provided evidence that radial pressure wave characteristics are an important indicator to consistently and independently predict cardiovascular events. The aim of this study was to investigate if radial pressure wave analysis provided statistical insights into the physiological variations due to pregnancy and menopause. Furthermore, the study investigated how these variations could serve as an indicator for cardiovascular risks. As the radial pulse measurement is non-invasive and speedy, it may be helpful in evaluating cardiovascular changes and risk during these transitions. MATERIALS AND METHOD A total of 702 randomly selected female subjects (90 pregnant and 97 post-menopausal), aged 20-59, enrolled in the study. The visit measured the subject's hemodynamic parameters including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and radial pressure waves. SBP and DBP were evaluated by an automatic blood pressure monitor. Radial pressure wave data were continuously recorded for 12-s using a TD01C pulse measuring instrument. Spectrum analysis of the radial pressure wave was performed to evaluate the first five harmonic components (C1-C5). RESULTS A comparison of pregnant women to non-pregnant women showed C3 and C5 were lower. Heart rate C2 and C4 were higher in pregnant women. A comparison of women pre-menopausal and post-menopausal showed no significant difference in SBP or DBP. Menopause significantly changed the C1 and C4 radial pressure wave harmonics. An increase in C1 and a decrease in C4 were observed. CONCLUSION AND DISCUSSION This study provided further clinical evidence to support the hemodynamic model that describes the cardiovascular changes and risks related to the harmonic components of the pulse spectrum. Beyond blood pressure, the effects of menopause on the radial pressure wave, especially on hemodynamic index C4, independent of age and BMI, may explain increased post-menopausal cardiovascular risk. This and past studies collectively suggest that radial pressure wave components may be an indicator of a female body's ability to supply oxygen and nutrients. Harmonic analysis of the radial pressure wave may provide additional insights into the underlying mechanism of the cardiovascular changes over the lifespan of a woman.
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Binkley HM, Phillips KL, Wise SL. Menopausal Women: Recognition, Exercise Benefits, Considerations, and Programming Needs. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schreuder MM, Mirabito Colafella KM, Boersma E, Brugts JJ, Roeters van Lennep JE, Versmissen J. The effect of age on blood pressure response by 4-week treatment perindopril: A pooled sex-specific analysis of the EUROPA, PROGRESS, and ADVANCE trials. Clin Transl Sci 2021; 14:2193-2199. [PMID: 34080302 PMCID: PMC8604217 DOI: 10.1111/cts.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
Previous studies showed that postmenopausal women are more likely to have poorly controlled hypertension than men of the same age. Whether this is caused by inadequate treatment or poor response to antihypertensive agents remains unknown. The aim of this study is to analyze treatment response to the most potent renin angiotensin aldosterone system (RAAS) inhibitor perindopril in different age categories in women and men. Individual patient data were used from the combined European Trial on Reduction of Cardiac Events With Perindopril (EUROPA), Perindopril Protection Against Recurrent Stroke Study (PROGRESS), and Action in Diabetes and Vascular disease: Preterax and Diamicron‐MR Controlled Evaluation (ADVANCE) trials, which include patients with vascular disease (n = 29,463). We studied the relative and absolute changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) during a 4‐week run‐in phase in which all patients were treated with the perindopril‐based treatment in different age categories. In total, 8366 women and 21,097 men were included in the analysis. Women greater than 65 years of age showed a significantly smaller blood pressure reduction after perindopril treatment (2.8 mmHg [95% confidence interval {CI} = 0.1–5.5] less reduction compared to women ≤45 years, p = 0.039). In men, the SBP reduction after perindopril in patients greater than 55–65 and greater than 65 years was lower compared to the age category less than or equal to 45 years (adjusted mean difference >55–65: 2.8 mmHg [95% CI = 1.8–3.7], p < 0.001, >65: 3.7 mmHg [95% CI = 2.7–4.7], p < 0.001). A trend of less blood pressure reduction was seen with ageing in both men and women (p < 0.001). To conclude, we observed that in both women and men the perindopril leads to less SBP reduction with increasing age, whereas the DBP reduction increases with age. More research is needed to determine whether it would be beneficial to use age‐adjusted perindopril dosages.
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Affiliation(s)
- Michelle M Schreuder
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Jorie Versmissen
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Department of Hospital Pharmacy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115646. [PMID: 34070454 PMCID: PMC8197532 DOI: 10.3390/ijerph18115646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.
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Association of the Risk of Osteoarthritis and Hypertension in the Korean Adult Population Aged 40-59 in Pre- and Postmenopausal Women: Using Korea National Health and Nutrition Examination Survey 2012-2016 Data. Int J Hypertens 2021; 2021:8065838. [PMID: 33708440 PMCID: PMC7929687 DOI: 10.1155/2021/8065838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Previous studies reported the relation of osteoarthritis (OA) and hypertension (HTN) mostly in postmenopausal women. This study aimed to identify the association between OA and HTN in pre- and postmenopausal women. Methods We used data of 4,627 middle-aged (40–59 years) women from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2012 to 2016. Chi-square and t-test compared the characteristics of the participants. Binomial logistic regression was used to identify an association between OA and HTN under controlling covariates such as age, tobacco smoking, alcohol consumption, and obesity. Results There were 1,859 participants with non-OA and menopause, 104 with OA and nonmenopause, and 375 with OA and menopause, respectively. The number of women with OA and HTN was 129. OA was significantly associated with HTN diagnosis in postmenopausal women under controlling covariates (odds ratio: 1.408, 95% CI: 1.092–1.815, p=0.008). However, this relationship was weakened in premenopausal women (odds ratio: 1.651, 95% CI: 0.950–2.869, p=0.075). Conclusion In conclusion, women with HTN showed a distinct association with OA than the normotensives, and this relationship was more apparent among postmenopausal women. Further research is needed for a preventive approach.
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Bobescu E, Bălan A, Moga MA, Teodorescu A, Mitrică M, Dima L. Are There Any Beneficial Effects of Spirulina Supplementation for Metabolic Syndrome Components in Postmenopausal Women? Mar Drugs 2020; 18:md18120651. [PMID: 33348926 PMCID: PMC7767256 DOI: 10.3390/md18120651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Abstract
Spirulina is a phytosynthetic filamentous cyanobacterium with microscopic dimensions, which naturally grows in the highly-salted alkaline lakes of Africa, Mexico, America, and Asia. Several bioactive peptides extracted from Spirulina were demonstrated to possess antimicrobial, antiviral, antitumor, immunomodulatory, antiallergic and antihypertensive properties. It has been reported that the consumption of Spirulina could prevent or manage metabolic syndrome components. In women, metabolic disorders are more prevalent during menopause. Postmenopausal women present higher waist circumference, increased blood pressure, hypertriglyceridemia, hyperglycemia, and decreased HDL-cholesterol values, leading to an increased risk of cardiovascular events. Therefore, in order to prevent cardiovascular diseases, it is essential to manage the components of the metabolic syndrome during the postmenopausal period. As recent reports indicated the efficiency of Spirulina supplementation in the management of the metabolic syndrome components, our study aims to review all the clinical trials conducted on this topic. Our main objective is to have a better understanding of whether and how this cyanobacterium could manage the abnormalities included in the metabolic syndrome and if it could be used as a therapeutic approach in postmenopausal women with this condition. We selected relevant articles from PubMed, Google Scholar and CrossRef databases, and a total number of 20 studies met our criteria. All included clinical trials indicated that Spirulina has positive effects in managing metabolic syndrome components. Spirulina is a valuable cyanobacterium that can be used as a food supplement for the management of metabolic syndrome, and it is able to reduce the risk of cardiovascular events. The optimal dose and period of administration remain a debated subject, and future investigations are required. Considering the beneficial effects reported against each component of the metabolic syndrome, Spirulina could also be effective in the postmenopausal period, when this syndrome is the most prevalent, but there is a strong need for human clinical trials in order to sustain this observation.
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Affiliation(s)
- Elena Bobescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania; (E.B.); (M.A.M.); (M.M.)
| | - Andreea Bălan
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania; (E.B.); (M.A.M.); (M.M.)
- Correspondence: ; Tel.: +40-769-901-194
| | - Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania; (E.B.); (M.A.M.); (M.M.)
| | - Andreea Teodorescu
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, University Transilvania Brasov, 500019 Brasov, Romania; (A.T.); (L.D.)
| | - Maria Mitrică
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania; (E.B.); (M.A.M.); (M.M.)
| | - Lorena Dima
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, University Transilvania Brasov, 500019 Brasov, Romania; (A.T.); (L.D.)
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Anastasaki M, Papadakis S, Linardakis M, Anyfantakis D, Symvoulakis EK, Lionis C. Burden of metabolic syndrome among primary care patients in Crete, Greece: A descriptive study. Eur J Gen Pract 2020; 26:166-174. [PMID: 33320035 PMCID: PMC7744156 DOI: 10.1080/13814788.2020.1851676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Metabolic Syndrome (MetS) is a clustering of abdominal obesity, hypertriglyceridaemia, low HDL cholesterol, hyperglycaemia and hypertension. Early identification of MetS is important for preventing cardiovascular disease (CVD). MetS has not been systematically explored in Greek primary care. OBJECTIVES To examine MetS frequency among primary care patients 40 years of age or older in Crete. METHODS A descriptive study was conducted (July-December 2015). General practitioners, randomly selected from regional physician listings, recruited consecutive patients, 40 years of age or older, visiting their practice. Chart audits were completed for eligible patients using medical records, including demographics and cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus). MetS was defined using the revised NCEP ATP III criteria. Frequencies with 95% confidence intervals were calculated. Gender differences were explored using Chi-square and Mann-Whitney tests. RESULTS Our sample consisted of 815 patients (55.7% female; mean age 65.2 years; range 40-98 years) from 44 GP practices. Overall, 73.6% (95% CI 70.4, 76.6) were identified with MetS, with a higher proportion of males (75.6%; 95% CI 71.0, 79.8) than females (72.0%; 95% CI 67.8, 76.0). Among the total sample, relatively high rates of hypertension (males: 64.5%; 95% CI 59.9, 70.0 and females: 61.1%; 95% CI 56.8, 65.8), dyslipidaemia (males: 69.3%; 95% CI 64.3, 74.1 and females: 63.5%; 95% CI 59.3, 68.0), diabetes mellitus (males: 46.9%; 95% CI 42.2, 52.4 and females: 36.5%; 95% CI 32.5, 41.6) and coronary heart disease (males: 21.2%; 95% CI 17.0, 25.2 and females: 6.2%; 95% CI 4.2, 8.6) were documented. CONCLUSION MetS and CVD risk factors were encountered at high frequencies in the studied population of primary care patients in Crete.
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Affiliation(s)
- Marilena Anastasaki
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
| | - Sophia Papadakis
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
| | - Manolis Linardakis
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
| | - Dimitrios Anyfantakis
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
| | - Christos Lionis
- Faculty of Medicine, Clinic of Social and Family Medicine, University of Crete, Crete, Heraklion, Greece
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Waheed N, Elias-Smale S, Malas W, Maas AH, Sedlak TL, Tremmel J, Mehta PK. Sex differences in non-obstructive coronary artery disease. Cardiovasc Res 2020; 116:829-840. [PMID: 31958135 DOI: 10.1093/cvr/cvaa001] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/03/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Ischaemic heart disease is a leading cause of morbidity and mortality in both women and men. Compared with men, symptomatic women who are suspected of having myocardial ischaemia are more likely to have no obstructive coronary artery disease (CAD) on coronary angiography. Coronary vasomotor disorders and coronary microvascular dysfunction (CMD) have been increasingly recognized as important contributors to angina and adverse outcomes in patients with no obstructive CAD. CMD from functional and structural abnormalities in the microvasculature is associated with adverse cardiac events and mortality in both sexes. Women may be particularly susceptible to vasomotor disorders and CMD due to unique factors such as inflammation, mental stress, autonomic, and neuroendocrine dysfunction, which predispose to endothelial dysfunction and CMD. CMD can be detected with coronary reactivity testing and non-invasive imaging modalities; however, it remains underdiagnosed. This review focuses on sex differences in presentation, pathophysiologic risk factors, diagnostic testing, and prognosis of CMD.
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Affiliation(s)
- Nida Waheed
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Suzette Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Waddah Malas
- Emory Women's Heart Center, Division of Cardiology, Department of Medicine, Emory University, 1462 Clifton Rd, Suite 505, Atlanta, GA 30329, USA
| | - Angela H Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tara L Sedlak
- Leslie Diamond Women's Heart Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Tremmel
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Puja K Mehta
- Emory Women's Heart Center, Division of Cardiology, Department of Medicine, Emory University, 1462 Clifton Rd, Suite 505, Atlanta, GA 30329, USA
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Socio-economic and reproductive concomitants of abdominal adiposity and hypertension: A study on Bengali-speaking Hindu women of Habra, North 24 Parganas, West Bengal, India. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Obesity and hypertension have become a global epidemic among the women, especially as they experience additional stressful events compared to men. The epidemiology of these two metabolic disorders is regulated by various biological, socio-economic, reproductive and lifestyle factors related to women. However, inconsistency in the nature and magnitude of the effects of these traits indicates exploring the areas where little emphasis has been given. In this context, the present study attempted to determine the effect of socio-economic and reproductive traits on hypertension and abdominal adiposity among women living in the North 24 Parganas district of West Bengal, India. Data on socio-demographic and reproductive traits were collected from 319 adult women from both rural and urban sectors of Habra block I. Anthropometric measurements and Blood pressure levels were measured following standard protocols. Results highlighted that the prevalence of obese individuals and hypertensive individuals were 73.4 and 50.5 per cent respectively. Women with low income (OR=0.51) were at lower risk and post-menopausal women (OR=1.71) were at higher risk of developing abdominal adiposity. The risk of developing hypertension increased with higher educational attainment (OR=2.43). Post-menopausal women (OR=0.46) and shifting workers (OR=0.40) were at lower risk of developing hypertension. The risk also decreased with increased age (OR=0.96). Present study revealed that menopause is a significant event to predict abdominal adiposity and hypertension among Bengali-speaking Hindu women.
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Anagnostis P, Paschou SA, Katsiki N, Krikidis D, Lambrinoudaki I, Goulis DG. Menopausal Hormone Therapy and Cardiovascular Risk: Where are we Now? Curr Vasc Pharmacol 2020; 17:564-572. [PMID: 29984659 DOI: 10.2174/1570161116666180709095348] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/05/2018] [Accepted: 06/15/2018] [Indexed: 12/15/2022]
Abstract
Transition to menopause is associated with an increase in cardiovascular disease (CVD) risk, mainly attributed to lipid and glucose metabolism dysregulation, as well as to body fat redistribution, leading to abdominal obesity. Indeed, epidemiological evidence suggests that both early menopause (EM, defined as age at menopause <45 years) and premature ovarian insufficiency (POI, defined as age at menopause <40 years) are associated with 1.5-2-fold increase in CVD risk. Menopausal hormone therapy (MHT) exerts a favorable effect on CVD risk factors (with subtle differences regarding oestrogen dose, route of administration, monotherapy or combination with progestogen and type of progestogen). Concerning CVD morbidity and mortality, most studies have shown a beneficial effect of MHT in women at early menopausal age (<10 years since the final menstrual period) or younger than 60 years. MHT is strongly recommended in women with EM and POI, as these women, if left untreated, are at risk of CVD, osteoporosis, dementia, depression and premature death. MHT has also a favorable benefit/ risk profile in perimenopausal and early postmenopausal women, provided that the patient is not at a high CVD risk (as assessed by 10-year calculation tools). Transdermal oestrogens have a lower risk of thrombosis compared with oral regimens. Concerning progestogens, natural progesterone and dydrogesterone have a neutral effect on CVD risk factors. In any case, the decision for MHT should be individualized, tailored according to the symptoms, patient preference and the risk of CVD, thrombotic episodes and breast cancer.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Katsiki
- 2nd Propedeutic Department of Internal Medicine, "Hippokration General Hospital", Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Krikidis
- 2nd Cardiology Department, "Hippokration General Hospital", Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Serum 25-hydroxyvitamin D and hypertension in premenopausal and postmenopausal women: National Health and Nutrition Examination Surveys 2007-2010. Public Health Nutr 2020; 23:1236-1246. [PMID: 31948509 DOI: 10.1017/s1368980019003665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A recent meta-analysis suggested that the association between vitamin D and risk of hypertension was markedly stronger in women aged <55 years in observational data, while the association became null in women aged ≥55 years. We therefore hypothesized that this difference in associations might potentially be caused by the change in oestrogen around menopause. Our objective was to investigate associations between vitamin D status and hypertension risk and to evaluate those associations as they may differ according to menopausal status. DESIGN A cross-sectional population survey conducted by the US Centers for Disease Control and Prevention, National Center for Health Statistics. SETTING The National Health and Nutrition Examination Surveys (NHANES) 2007-2010 formed the setting for the present study. PARTICIPANTS We analysed data from 2098 premenopausal women and 2298 postmenopausal women. RESULTS After adjustment for sociodemographic, behavioural and dietary factors, higher concentrations both of serum total 25-hydroxyvitamin D (25(OH)D) and serum 25-hydroxycholecalciferol (25(OH)D3) revealed significant dose-dependent trends with lower risk of hypertension (Ptrend = 0·005 and 0·014, respectively) in premenopausal women. In those women, 25(OH)D ≥ 50 nmol/l (sufficient; in contrast to deficient, vitamin D < 30 nmol/l) appeared to have a protective effect against hypertension (OR = 0·64, 95 % CI 0·39, 1·02 for total 25(OH)D and OR = 0·60, 95 % CI 0·36, 1·00 for 25(OH)D3). Neither association with hypertension was observed in postmenopausal women. CONCLUSIONS Serum 25(OH)D concentrations were associated with lower risk of hypertension in premenopausal women, but not in postmenopausal women.
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Yoon H, Lee JH, Gi MY, Cha JA, Moon AE, Seong JM. Relationship Between Metabolic Syndrome and Beta-Cell Function in Nondiabetic Korean Premenopausal and Postmenopausal Women: 2015 Korean National Health and Nutrition Examination Survey. Metab Syndr Relat Disord 2019; 18:39-46. [PMID: 31589549 DOI: 10.1089/met.2019.0087] [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: 11/12/2022] Open
Abstract
Background: This study was conducted to assess the relationship between metabolic syndrome (MetS) and beta-cell function in nondiabetic Korean women. Methods: This study included 2,507 women (premenopausal women, 1,359; postmenopausal women, 1,148) who were aged ≥20 and used 2015 Korean National Health and Nutrition Examination Survey (KNHANES) data. Results: Key study results were as follows: first, in both premenopausal and postmenopausal women, after adjusting for related variables [except body mass index (BMI)], MetS (P < 0.001) and metabolic syndrome score (MSS; P < 0.001) were positively associated with the homeostasis model assessment of beta-cell function (HOMA-B) levels. Second, in premenopausal women, when further adjusted for BMI, MetS (P = 0.002) and MSS (P < 0.001) were also positively associated with HOMA-B levels. However, in postmenopausal women, when further adjusting for BMI, the associations of MetS (P = 0.322) or MSS (P = 0.855) and HOMA-B levels were no longer significant. Conclusions: Metabolic syndrome was positively associated with beta-cell function in nondiabetic Korean premenopausal women, but not in Korean postmenopausal women.
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Affiliation(s)
- Hyun Yoon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea
| | - Jun Ho Lee
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, Gwangju, South Korea
| | - Ju Ae Cha
- Department of Nursing, Chunnam Techno University, Gokseong-gun, South Korea
| | - Ae Eun Moon
- Department of Dental Hygiene, Honam University, Gwangju, South Korea
| | - Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si, South Korea
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Anagnostis P, Goulis DG. Menopause and its Cardiometabolic Consequences: Current Perspectives. Curr Vasc Pharmacol 2019; 17:543-545. [DOI: 10.2174/1570161117999190228123237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Chonbuk National University, Jeonju, Korea
| | - Youngran Yang
- School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Chonbuk National University, Jeonju, Korea
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Cho SMJ, Lee H, Pyun WB, Kim HC. Differential Control Rate of Systolic and Diastolic Blood Pressure among Korean Adults with Hypertension: the Sixth Korean National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI). Korean Circ J 2019; 49:1035-1048. [PMID: 31190479 PMCID: PMC6813160 DOI: 10.4070/kcj.2019.0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/27/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives Discrepancy in blood pressure (BP) control rate may be owed to different risk factors associated with elevated systolic and diastolic BP (SBP and DBP). Methods In a nationally representative survey of Korean population with BP measurements, a total of 5,100 participants with hypertension was included in the analyses. Three separate types of control rates were calculated: SBP, DBP, and (combined) S&DBP among all participants with hypertension and participants with treated hypertension, separately. Control rates were compared across sex and age groups. Multivariable logistic regression was used to identify demographic factors associated with SBP, DBP, and S&DBP control rates, separately. Results In total, SBP, DBP, and S&DBP control rates were 63.0%, 63.7%, and 42.5% among all hypertension patients, and 77.5%, 87.4%, and 71.6% among treated hypertension patients. Men aged 40–49 years with hypertension and 30–39 years treated for hypertension had the highest SBP control rate (74.6% and 96.2%), which decreased by older age. Inversely, DBP control rate progressively increased with older age. SBP control rate among women with hypertension was the highest in 40–49 years (67.0%) but without linear trend by age group. Interestingly, both combined and DBP control rates were noticeably low among women aged 50–59 years. Women with body mass index ≥25 were at higher odds of having controlled SBP. Lower DBP control rate was observed in men with lower education level, higher household income, and heavy drinkers. Conclusions Separate examination of control rates demonstrated different sex- and age-differential trends, which would have been overlooked in combined control rates.
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Affiliation(s)
- So Mi Jemma Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.
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The Acute Effects of Mat Pilates on Hemodynamic and Salivary Nitrite Responses After Exercise in Postmenopausal Women. J Aging Phys Act 2019; 27:371-377. [DOI: 10.1123/japa.2018-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW Despite enhanced screening and therapeutic management, hypertension remains the most prevalent chronic disease in the United States and the leading cause of heart disease, chronic kidney disease, and stroke in both men and women. It is widely accepted that hypertension is a pro-inflammatory disease and that the immune system plays a vital role in mediating hypertensive outcomes and end organ damage. Despite known discrepancies in the risk of hypertension development between men and women, preclinical models of immune-mediated hypertension were historically developed solely in male animals, leading to a lack of sex-specific clinical practice guidelines or therapeutic targets. RECENT FINDINGS Following the NIH policy on the consideration of sex as a biological variable in 2015, significant advancements have been made into sex-specific disease mechanisms in inflammation and hypertension. This review article serves to critically evaluate recent advancements in the field of sex-specific immune-mediated hypertension.
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Affiliation(s)
- Megan A Sylvester
- Department of Physiology, College of Medicine, University of Arizona, 1656 E. Mabel St/Rm 417, P.O. Box 245218, Tucson, AZ, 85724-5218, USA
| | - Heddwen L Brooks
- Department of Physiology, College of Medicine, University of Arizona, 1656 E. Mabel St/Rm 417, P.O. Box 245218, Tucson, AZ, 85724-5218, USA. .,Sarver Heart Center, University of Arizona, Tucson, AZ, USA.
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Pollow DP, Uhlorn JA, Sylvester MA, Romero-Aleshire MJ, Uhrlaub JL, Lindsey ML, Nikolich-Zugich J, Brooks HL. Menopause and FOXP3 + Treg cell depletion eliminate female protection against T cell-mediated angiotensin II hypertension. Am J Physiol Heart Circ Physiol 2019; 317:H415-H423. [PMID: 31099612 DOI: 10.1152/ajpheart.00792.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although it is known that the prevalence and severity of hypertension increases in women after menopause, the contribution of T cells to this process has not been explored. Although the immune system is both necessary and required for the development of angiotensin II (ANG II) hypertension in men, we have demonstrated that premenopausal women are protected from T cell-mediated hypertension. The goal of the current study was to test the hypotheses that 1) female protection against T cell-mediated ANG II hypertension is eliminated following progression into menopause and 2) T regulatory cells (Tregs) provide premenopausal protection against ANG II-induced hypertension. Menopause was induced in Rag-1-/- mice (via 4-vinylcyclohexene diepoxide), and all mice received a 14-day ANG II infusion. Donor CD3+ T cells were adoptively transferred 3 wk before ANG II infusion. In the absence of T cells, systolic blood pressure responses to ANG II were similar to those seen in premenopausal mice (Δ12 mmHg). After adoptive transfer of T cells, ANG II significantly increased systolic blood pressure in postmenopausal females (Δ28 mmHg). A significant increase in F4/80 positive renal macrophages, an increase in renal inflammatory gene expression, along with a reduction in renal expression of mannose receptor C-type 1, a marker for M2 macrophages, accompanied the increase in systolic blood pressure (SBP). Flow cytometric analysis identified that Tregs were significantly decreased in the spleen and kidneys of Rag-1-/- menopausal mice versus premenopausal females, following ANG II infusion. In a validation study, an anti-CD25 antibody was used to deplete Tregs in premenopausal mice, which induced a significant increase in SBP. These results demonstrate that premenopausal protection against T cell-mediated ANG II hypertension is eliminated once females enter menopause, suggesting that a change in hormonal status upregulates macrophage-induced proinflammatory and T cell-dependent responses. Furthermore, we are the first to report that the presence of Tregs are required to suppress ANG II hypertension in premenopausal females.NEW & NOTEWORTHY Whether progression into menopause eliminated female protection against T cell-mediated hypertension was examined. Menopausal mice without T cells remained protected against angiotensin II (ANG II) hypertension; however, in the presence of T cells, blood pressure responses to ANG II increased significantly in menopause. Underlying mechanisms examined were anti-inflammatory protection provided by T regulatory cells in premenopausal females and renal inflammatory processes involving macrophage infiltration and cytokine activation.
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Affiliation(s)
- Dennis P Pollow
- Department of Physiology, University of Arizona, Tucson, Arizona
| | - Joshua A Uhlorn
- Department of Physiology, University of Arizona, Tucson, Arizona
| | | | | | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona, Tucson, Arizona.,University of Arizona Center on Aging, University of Arizona, Tucson, Arizona
| | - Merry L Lindsey
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi.,Research Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi
| | - Janko Nikolich-Zugich
- Department of Immunobiology, University of Arizona, Tucson, Arizona.,University of Arizona Center on Aging, University of Arizona, Tucson, Arizona
| | - Heddwen L Brooks
- Department of Physiology, University of Arizona, Tucson, Arizona.,University of Arizona Center on Aging, University of Arizona, Tucson, Arizona.,Department of Pharmacology, University of Arizona, Tucson, Arizona.,Sarver Heart Center, University of Arizona, Tucson, Arizona
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El-Refaye GE, Younis HA. The effect of 12 weeks of resistive exercises versus aerobic exercises in overweight hypertensive postmenopausal women. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_19_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Women's Quality of Life in Menopause with a Focus on Hypertension. J Obstet Gynaecol India 2018; 69:279-283. [PMID: 31178645 DOI: 10.1007/s13224-018-1172-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Abstract
Background One-third of each woman's life is naturally during her menopause. This study was conducted to determine the factors related to the quality of life in postmenopausal women. Materials and Methods This cross-sectional study was carried out using cluster sampling method on 218 postmenopausal women aged 40-60 years old in Kermanshah in 2014. The data were collected through interview and with the standard questionnaire of Menopausal Quality (MENQOL) of Life and analyzed using SPSS software version 19. Results The mean age of menopause was 50.03 ± 4.48 years. Mean scores of quality of life and four domains, vasomotor, psychosocial, physical and sexual were 3.15±0.970, 3.71 ± 1.81, 3.32±0.959, 2.91 ± 1.06, 3.74 ±1.59, respectively. Conclusion Chronic conditions such as hypertension in postmenopausal women can lead to lower quality of life. Therefore, provision of coherent support programs for controlling chronic diseases requires serious intervention from health care providers.
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Lee E. Influencing Factors on Health-Related Quality of Life in Middle-Aged Adults With Hypertension. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article aims to examine the influencing factors on health-related quality of life (HRQOL) in middle-aged adults with hypertension. HRQOL was assessed using EQ-5D from 263 middle-aged adults (40-60 years) with hypertension who participated in the 6th Korean National Health and Nutrition Examination Survey (2014). There were statistically significant differences in health-related quality of life according to income, education, subjective health status, experience of discomfort, activity limitation, stress, and aerobic physical activity. Factors influencing on health-related quality of life in middle-aged adults with hypertension were subjective health status, experience of discomfort, activity limitation, depression, and stress, which explained about 50% of total variance. These factors should be included in the nursing intervention, and psychological aspects such as depression should be emphasized.
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Ab Wahab SZ, Nik Hussain NH, Zakaria R, Abdul Kadir A, Mohamed N, Tohit NM, Norhayati MN, Hassan II. Long-term effects of honey on cardiovascular parameters and anthropometric measurements of postmenopausal women. Complement Ther Med 2018; 41:154-160. [PMID: 30477832 DOI: 10.1016/j.ctim.2018.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/24/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the long-term effects of Tualang Honey versus Honey Cocktail (mixture of honey, bee bread, and royal jelly) on cardiovascular markers and anthropometric measurements of postmenopausal women. METHODS We conducted a randomised, double blinded, two-armed parallel study comparing 20 g/day of Tualang Honey versus 20 g/day Honey Cocktail among postmenopausal women aged 45-65 years. The cardiovascular parameters and anthropometrics measurements were assessed at baseline, 6 months, and 12 months of the intervention. RESULTS 100 subjects were successfully randomised into the groups. There was a significant decrease in the diastolic blood pressure from 77.92 mmHg at baseline to 73.45 mmHg at 12 months (F-statistic = 2.55, p-value = 0.047) in the Tualang Honey group compared to Honey Cocktail. There was also a significant decrease in the fasting blood sugar from 6.11 mmol/L at baseline to 5.71 mmol/L at 12 months (F-statistic = 4.03, p-value = 0.021) in the Tualang Honey group compared to the Honey Cocktail group. The body mass index remained unchanged at 27 kg/m2 (F-statistic = 1.60, p-value = 0.010) throughout 12 months of the intervention in the Honey Cocktail group. CONCLUSION Subjects who received Honey Cocktail showed remarkable effects on body mass index. However, Tualang Honey supplementation showed superior effect in lowering diastolic blood pressure and fasting blood sugar compared to Honey Cocktail. Further studies are required to ascertain the underlying mechanism(s) of Tualang Honey and Honey Cocktail on each observed parameter.
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Affiliation(s)
- Siti Zubaidah Ab Wahab
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia; Department of Pharmacology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Nik Hazlina Nik Hussain
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Rahimah Zakaria
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Norazlina Mohamed
- Department of Pharmacology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Intan Idiana Hassan
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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Hildreth KL, Ozemek C, Kohrt WM, Blatchford PJ, Moreau KL. Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life. Menopause 2018; 25:1011-1019. [PMID: 29634636 PMCID: PMC6103796 DOI: 10.1097/gme.0000000000001112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages. METHODS Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses. RESULTS Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = -0.27 to -0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = -0.08, -0.03, P = 0.35). CONCLUSIONS Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
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Affiliation(s)
- Kerry L. Hildreth
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
| | - Cemal Ozemek
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago
| | - Wendy M. Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
| | - Patrick J. Blatchford
- Colorado Biostatistical Consortium, Colorado School of Public Health, University of Colorado Denver
| | - Kerrie L. Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
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Ding DC, Tsai IJ, Hsu CY, Wang JH, Lin SZ, Sung FC. Risk of hypertension after hysterectomy: a population-based study. BJOG 2018; 125:1717-1724. [PMID: 29953717 DOI: 10.1111/1471-0528.15389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Affiliation(s)
- D-C Ding
- Department of Obstetrics and Gynaecology; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
- Institute of Medical Sciences; Tzu Chi University; Hualien Taiwan
| | - I-J Tsai
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - CY Hsu
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
| | - J-H Wang
- Department of Research; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - S-Z Lin
- Department of Neurosurgery; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - F-C Sung
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Department of Health Services Administration; China Medical University; Taichung Taiwan
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Kishan A, Marakur N, Moodithaya S, Mirajkar AM. Electrodermal response to auditory stimuli in relation to menopausal transition period. J Basic Clin Physiol Pharmacol 2018; 29:123-129. [PMID: 29500922 DOI: 10.1515/jbcpp-2017-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/22/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Menopause-associated estrogen deficiency results in climacteric symptoms like vasomotor, psychological and sleep disturbances that cause a decline in the quality of life. Electrodermal activity (EDA), a psychophysiological measure, reflects sympathetic activity, which provides information associated with individual's emotions, phobias, arousal, cognition and stress. The study compared electrodermal response to auditory stimuli between postmenopausal and perimenopausal women with and without symptoms and also correlated the association of scores of the menopausal transition symptoms with indices of EDA. METHODS Seventy-five women volunteers in the age group of 45-60 years, 25 in each group who were postmenopausal, perimenopausal with symptoms and perimenopausal without symptoms, were recruited. Indices of EDA such as latency, amplitude, rise time and half recovery time for auditory stimuli were quantified using standard techniques. Symptoms of menopausal transition were assessed using Women Health Questionnaire. RESULTS Analysis using one-way analysis of covariance after controlling for variables showed that mean skin conductance level of EDA was significantly higher among perimenopausal women with symptoms compared with perimenopausal women without symptoms and postmenopausal women. Perimenopausal women with symptoms had significantly lower latency of response when compared with other groups. Analysis using Pearson correlation test showed that latency of EDA had significant positive correlation and amplitude had significant negative correlation with menopausal transition symptom scores. CONCLUSIONS Perimenopausal women with symptoms exhibited increased sympathetic sudomotor activity when compared with perimenopausal women without symptoms and postmenopausal women as measured by EDA. Further, select measures of EDA exhibited significant association with the symptoms of menopausal transition.
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Affiliation(s)
- Ashwini Kishan
- Department of Physiology, K.S. Hegde Medical Academy, Deralakatte, India
| | - Nikitha Marakur
- Department of Physiology, K.S. Hegde Medical Academy, Deralakatte, India
| | - Shailaja Moodithaya
- Department of Physiology, K.S. Hegde Medical Academy, Deralakatte-575018, India, Phone: 9845516116
| | - Amrit M Mirajkar
- Department of Physiology, K.S. Hegde Medical Academy, Deralakatte, India
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Seo BN, Park JE, Kim YE, Kang KW, Seol IC, Choi SM. Effects of acupuncture in postmenopausal women with prehypertension or stage 1 hypertension: study protocol for a prospective, comparative, interventional cohort study. Integr Med Res 2018; 7:95-102. [PMID: 29629296 PMCID: PMC5883999 DOI: 10.1016/j.imr.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Hypertension is a major cause of cardiovascular disease and associated mortality, and postmenopausal women are at a high risk of hypertension. We aim to investigate the hypotensive effect and safety of acupuncture, focusing on postmenopausal women with prehypertension and stage 1 hypertension. In addition, we aim to investigate whether the effect of acupuncture treatment differed, depending on Sasang Constitution and cold-heat pattern. Methods This study is designed as an intervention cohort study. Two hundred postmenopausal women aged <65 years with prehypertension or stage 1 hypertension living in Daejeon city in Korea will be recruited, and randomly assigned to either an acupuncture or no-treatment control group. The intervention will consist of four sessions; one session will include acupuncture performed 10 times for 4 weeks. There will be a 20-week observation period after each session, and the total study duration will be 96 weeks. Acupuncture will be applied at the bilateral Fengchi (GB20), Quchi (LI11), Zusanli (ST36), and Sameumgyo (SP6) acupoints. The effect of acupuncture will be evaluated by comparing the change in systolic and diastolic blood pressure between the acupuncture and control groups every 4 weeks until the end of the study. Discussion To evaluate the success of blood pressure management, long-term observation is required, but no long-term studies have been conducted to evaluate the effect of acupuncture on blood pressure in postmenopausal women. To our knowledge, this study will be the first long-term study to investigate this issue for more than 6-8 weeks.
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Affiliation(s)
- Bok-Nam Seo
- Department of Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Ji-Eun Park
- Department of Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Young-Eun Kim
- Department of Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Kyung-Won Kang
- Hoseo University Institutional Review Board, Daejeon, Korea
| | - In-Chan Seol
- Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Korea
| | - Sun-Mi Choi
- KM Standards Center, Korea Institute of Oriental Medicine, Daejeon, Korea
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Rindner L, Strömme G, Nordeman L, Wigren M, Hange D, Gunnarsson R, Rembeck G. Prevalence of somatic and urogenital symptoms as well as psychological health in women aged 45 to 55 attending primary health care: a cross-sectional study. BMC WOMENS HEALTH 2017; 17:128. [PMID: 29221473 PMCID: PMC5723029 DOI: 10.1186/s12905-017-0480-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Women's physical and mental ill-health such as stress-related symptoms, depression, pain, hypertension and urogenital health shows a marked increase around the ages 45-55 years. These women are an important group for Primary Health Care (PHC) due to their prevalent symptoms and illnesses. The aim of this study was to estimate the prevalence of somatic, psychological and urogenital symptoms in women aged 45-55 attending PHC and evaluate factors associated with severe symptoms. METHODS One hundred and thirty-one women were recruited from PHC in southwestern Sweden. Data were obtained from two self-reported questionnaires, the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS Exhaustion, depressive mood, muscle and joint problems, sleep and sexual problems were the most prevalent reported symptoms. Half of the women reported heart discomfort. Depression and increasing age were correlated to more severe symptoms. CONCLUSION We recommend that cardiovascular risk factors, musculoskeletal symptoms, sexual problems, sleeping problems and mental health should be actively asked for when women aged 45 to 55 attend PHC. We propose that preventive counselling of women in PHC before the age 45 should be evaluated in future studies.
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Affiliation(s)
- Lena Rindner
- Närhälsan, Skene Health Care Center, Varbergsvägen 80, SE-511 81, Skene, Sweden. .,Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden. .,Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Gunilla Strömme
- Närhälsan Svenljunga Antenatal Clinic, Svenljunga, Sweden.,Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden
| | - Lena Nordeman
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden.,Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience, Physiology, Gothenburg, Sweden
| | - Margareta Wigren
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden
| | - Dominique Hange
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden.,Närhälsan, Svenljunga Health Care Center, Svenljunga, Sweden.,Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ronny Gunnarsson
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden.,Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,General Practice and Rural Medicine, Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Gun Rembeck
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden.,Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Närhälsan Borås Adolescent Health Centre, Kvarngatan 4, 50336, Borås, Sweden
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Obesity in menopause - our negligence or an unfortunate inevitability? MENOPAUSE REVIEW 2017; 16:61-65. [PMID: 28721132 PMCID: PMC5509974 DOI: 10.5114/pm.2017.68594] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022]
Abstract
Numerous concerns about menopause exist among women, and fear of an increase in body weight is one of the most important of them. This paper presents an overview of current knowledge concerning the etiology of obesity related to menopause and about the mechanisms of its development, with particular regard to the hormonal changes that occur during this period of life. The role of estrogens in the regulation of energy balance and the effect of sex hormones on metabolism of adipose tissue and other organs are presented. The consequence of the sharp decline in the secretion of estrogens with subsequent relative hyperandrogenemia is briefly discussed. The main intention of this review is to clarify what is inevitable and what perhaps results from negligence and unhealthy lifestyles. In the last part of the paper the possibilities of counteracting the progress of adverse changes in body composition, by promoting beneficial lifestyle modifications and the use of hormonal substitution treatment, in cases where it is reasonable and possible, are described.
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Rindner L, Strömme G, Nordeman L, Hange D, Gunnarsson R, Rembeck G. Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting-a randomized controlled trial. Maturitas 2017; 98:14-19. [PMID: 28274323 DOI: 10.1016/j.maturitas.2017.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/12/2016] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Women's physical and mental ill-health shows a marked increase during menopause, which usually occurs between 45 and 55 years of age. Mental illness and somatic symptoms are common causes of long-term sick leave. Women suffer from a lack of knowledge about the menopause transition and its associated symptoms. The aim of the study was to investigate whether group education for women in primary health care (PHC) about the menopause transition can improve their physical and mental ill-health. STUDY DESIGN This randomized controlled study was conducted in PHC and aimed to evaluate a group education programme for women aged 45-55 years, around the menopause transition. A total of 131 women were randomized to group education or no intervention. The group intervention included two education sessions with topics related to menopause. They answered two questionnaires at baseline and at four-month follow-up: the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). MAIN OUTCOME MEASURE Change in MRS and MADRS scores over the four months. RESULTS The intervention group experienced a slight reduction in symptoms while the control group mostly experienced the opposite. CONCLUSION This study showed that it was feasible to implement group education on menopause for women aged 45-55 years. THE CLINICAL TRIAL REGISTRATION NUMBER NTC02852811.
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Affiliation(s)
- Lena Rindner
- Närhälsan, Skene Health Care Center, Skene, Närhälsan, Research and Development, Primary Health Care Region Västra Götaland, The Research and Development Center Södra Älvsborg, Sweden; Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden; Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden.
| | | | - Lena Nordeman
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology Department of Health and Rehabilitation, Unit of Physiotherapy, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden; Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden; Närhälsan, Svenljunga Health Care Center, Department of Public Health and Community Medicine/Primary Health, Gothenburg University, Sweden
| | - Ronny Gunnarsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden; Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden; Associate Professor in General Practice and Rural Medicine, Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia
| | - Gun Rembeck
- Research and Development Center Södra Älvsborg, Närhälsan, Research and Development, Primary Health Care Region, Västra Götaland, Sweden; Närhälsan Borås Youth Centre, Region Västra Götaland, Sweden, Borås, Sweden
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