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Rakisheva A, Sliwa K, Bauersachs J, Van Linthout S, Chopra VK, Bayes-Genis A, Fruzzetti F, Cannatà A, Deniau B, Mebazaa A, Savarese G, Ray R, Vitale C, Metra M, Rosano GMC. Multidisciplinary care of peripartum heart failure: A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26:742-753. [PMID: 38679896 DOI: 10.1002/ejhf.3246] [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: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
Heart failure is the most common cardiovascular complication during pregnancy and the postpartum period. It is associated with increased risk of maternal morbidity and mortality as well as potentially life-threatening foetal pathology. Management of heart failure in pregnancy requires expert knowledge of cardiovascular disease as well as obstetrics which underscores the importance of multidisciplinary cardio-obstetrics teams in order to optimize diagnosis, treatment and outcome. This includes counselling of women at risk before and during the course of pregnancy in order to strengthen the relationship between medical specialists and patients, as well as to allow patient-centred delivery of care and improve quality of life.
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Affiliation(s)
- Amina Rakisheva
- Department of Cardiology, City Cardiology Center, Almaty, Kazakhstan
- Qonaev City Hospital, Almaty, Kazakhstan
| | - Karen Sliwa
- Cape Heart Institute, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | | | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Franca Fruzzetti
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Antonio Cannatà
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Ray
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Cristiana Vitale
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Rowland SN, Heaney LM, Da Boit M, Bailey SJ. Trimethylamine N-Oxide Concentration and Blood Pressure in Young Healthy Men and Women: A Replicated Crossover Study. Metabolites 2023; 13:876. [PMID: 37512583 PMCID: PMC10383726 DOI: 10.3390/metabo13070876] [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: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Trimethylamine N-oxide (TMAO), a gut-derived metabolite and marker of gut dysbiosis, has been linked to hypertension. Blood pressure is proposed to be elevated in hormonal contraceptive users and males compared to age-matched eumenorrheic females, but the extent to which TMAO differs between these populations has yet to be investigated. Peripheral and central blood pressure were measured, with the latter determined via applanation tonometry, and plasma TMAO concentration was assessed using liquid chromatography-tandem mass spectrometry. The following variables were assessed on two occasions in each of the following conditions: the early follicular phase (EFP) and mid-luteal phase (MLP) in eumenorrheic women (n = 13), and the pill-free interval (INACTIVE) and pill consumption days (ACTIVE) in women using oral contraceptive pills (n = 12), and in men (n = 22). Briefly, 17-β-estradiol and progesterone concentrations were quantified via ELISA in all females. There were no differences in TMAO concentration between EFP (2.9 ± 1.7 μmol/L) and MLP (3.2 ± 1.1 μmol/L), between INACTIVE (3.3 ± 2.9 μmol/L) and ACTIVE (2.3 ± 1.1 μmol/L) days, or between men (3.0 ± 1.8 μmol/L), eumenorrheic women (3.0 ± 1.3 μmol/L) and contraceptive users (2.8 ± 1.4 μmol/L). Blood pressure was consistent across the menstrual cycle and pill days, but brachial systolic blood pressure was higher in males than females. There were no differences in brachial diastolic blood pressure or central blood pressure between the sexes. Repeated measures of TMAO, blood pressure, 17-β-estradiol and progesterone were consistent in all populations. These findings suggest that the link between TMAO and blood pressure is limited in healthy young adults.
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Affiliation(s)
- Samantha N Rowland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Liam M Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Mariasole Da Boit
- Health and Life Sciences, School of Allied Health Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
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Gravholt CH, Viuff M, Just J, Sandahl K, Brun S, van der Velden J, Andersen NH, Skakkebaek A. The Changing Face of Turner Syndrome. Endocr Rev 2023; 44:33-69. [PMID: 35695701 DOI: 10.1210/endrev/bnac016] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 01/20/2023]
Abstract
Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is considered a rare genetic condition and is associated with a wide range of clinical stigmata, such as short stature, ovarian dysgenesis, delayed puberty and infertility, congenital malformations, endocrine disorders, including a range of autoimmune conditions and type 2 diabetes, and neurocognitive deficits. Morbidity and mortality are clearly increased compared with the general population and the average age at diagnosis is quite delayed. During recent years it has become clear that a multidisciplinary approach is necessary toward the patient with TS. A number of clinical advances has been implemented, and these are reviewed. Our understanding of the genomic architecture of TS is advancing rapidly, and these latest developments are reviewed and discussed. Several candidate genes, genomic pathways and mechanisms, including an altered transcriptome and epigenome, are also presented.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Mette Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Kristian Sandahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Medical Centre, Amalia Children's Hospital, 6525 Nijmegen, the Netherlands
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Anne Skakkebaek
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus 8200 N, Denmark
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Kalenga CZ, Dumanski SM, Metcalfe A, Robert M, Nerenberg KA, MacRae JM, Premji Z, Ahmed SB. The effect of non-oral hormonal contraceptives on hypertension and blood pressure: A systematic review and meta-analysis. Physiol Rep 2022; 10:e15267. [PMID: 35510324 PMCID: PMC9069167 DOI: 10.14814/phy2.15267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023] Open
Abstract
Oral contraceptives (OC) are associated with increased risk of hypertension and elevated blood pressure (BP). Whether non-oral hormonal contraceptives have similar associations is unknown. We sought to investigate the effect of non-oral hormonal contraceptive (NOHC) use on the risk of hypertension and changes in BP, compared to non-hormonal contraceptive and OC use. We searched bibliographic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) until August 2020. Studies reporting risk of hypertension or changes in systolic and diastolic BP with NOHC use compared with either non-hormonal contraceptive or OC use. Abstract screening, full-text review, data extraction, and quality assessment were completed in duplicate. For studies reporting dichotomous outcomes, we reported results as relative risk with 95% confidence intervals (CI). A random-effects model was used to estimate pooled weighted mean difference and 95% CI of change in BP. Twenty-five studies were included. A lower incidence of hypertension was observed with injectable contraceptive use compared to non-hormonal contraceptive and OC use, although it was unclear if this was statistically significant. Compared to non-hormonal contraceptive use, injectable contraceptive use was associated with increased BP (SBP: 3.24 mmHg, 95%CI 2.49 to 3.98 mmHg; DBP: 3.15 mmHg, 95%CI 0.09 to 6.20 mmHg), the hormonal intra-uterine device use was associated with reduced BP (SBP: -4.50 mmHg, 95%CI -8.44 to -0.57 mmHg; DBP: -7.48 mmHg, 95% -14.90 to -0.05 mmHg), and the vaginal ring was associated with reduced diastolic BP (-3.90 mmHg, 95%CI -6.67 to -1.13 mmHg). Compared to OC use, the injectable contraceptive use was associated with increased diastolic BP (2.38 mmHg, 95%CI 0.39 to 4.38 mmHg). NOHC use is associated with changes in BP which differ by type and route of administration. Given the strong association between incremental increases in BP and cardiovascular risk, prospective studies are required.
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Affiliation(s)
- Cindy Z. Kalenga
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Sandra M. Dumanski
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Kidney Disease NetworkCalgaryAlbertaCanada
| | - Amy Metcalfe
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
| | - Magali Robert
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Kara A. Nerenberg
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Jennifer M. MacRae
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahra Premji
- University of VictoriaVictoriaBritish ColumbiaCanada
| | - Sofia B. Ahmed
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Kidney Disease NetworkCalgaryAlbertaCanada
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Jimoh OS, Abdul IF, Balogun OR, Biliaminu SA, Adeniran AS, Jimoh-Abdulghaffaar HO, Adesina KT, Ahmed A, Oladosu WO. Atherogenic and cardiovascular risks of women on combined oral contraceptives: A comparative study. Niger J Clin Pract 2021; 24:1759-1765. [PMID: 34889782 DOI: 10.4103/njcp.njcp_431_20] [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] [Indexed: 11/04/2022]
Abstract
Background Although combined oral contraceptive (COC) is commonly used in sub-Saharan Africa, data on its cardiovascular disease risk remains scanty. The study aimed to determine serial serum lipid profiles and cardiovascular disease risks among COC-users. Methods This is a prospective, comparative multicentered study conducted at four health facilities in Nigeria. Participants were new users of contraceptives; 120 each of women initiating COCs (group I) and those initiating other forms of nonhormonal contraceptives (group II) were recruited and monitored over a 6-month period. Serial lipid profile, blood pressure, and atherogenic risk for cardiovascular diseases were measured at recruitment (start) and scheduled follow-up clinic visits at 3 months and 6 months for all participants. Statistical analysis was performed with SPSS (version 21.0) and P value < 0.05 was considered significant. Results In all, 225 participants (111 COC-users, 114 nonCOC-users) that completed the study were aged 18 to 49 years. There was a statistically significant increase in the diastolic blood pressure (P = 0.001), Low Density Lipoprotein- Cholesterol (P = 0.038) and higher atherogenic risk (P = 0.001) among COC-users compared to nonCOC-users. The serial total serum cholesterol, triglyceride, High Density Lipoprotein, systolic blood pressure, and body mass index were higher among COC-users but were not statistically significant compared to nonCOC-users. Conclusion Alterations in lipid profile and increased short-term atherogenic risk for cardiovascular disease were reported among the COC-users in this study. Serial lipid profile and atherogenic risk assessment for cardiovascular diseases are recommended for monitoring of COC-users.
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Affiliation(s)
- O S Jimoh
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Nigeria
| | - I F Abdul
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O R Balogun
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - S A Biliaminu
- Department of Chemical Pathology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A S Adeniran
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - K T Adesina
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A Ahmed
- Department of Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Nigeria
| | - W O Oladosu
- Department of Chemical Pathology, Federal Medical Centre, Abeokuta, Nigeria
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6
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Olaniyi KS, Sabinari IW, Olatunji LA. Oral ethinylestradiol–levonorgestrel therapy counteracts fructose-induced renal metabolic impairment in female rats. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Peppa M, Pavlidis G, Mavroeidi I, Katogiannis K, Varoudi M, Thymis J, Kostelli G, Vlastos D, Plotas P, Bamias A, Parissis J, Ikonomidis I. Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome. J Hypertens 2021; 39:2051-2057. [PMID: 34102661 DOI: 10.1097/hjh.0000000000002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. METHODS Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. RESULTS Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). CONCLUSIONS HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.
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Affiliation(s)
- Melpomeni Peppa
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center
| | | | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center
| | | | | | | | | | | | | | - Aristotelis Bamias
- 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Barsky L, Shufelt C, Lauzon M, Johnson BD, Berga SL, Braunstein G, Bittner V, Shaw L, Reis S, Handberg E, Pepine CJ, Bairey Merz CN. Prior Oral Contraceptive Use and Longer Term Mortality Outcomes in Women with Suspected Ischemic Heart Disease. J Womens Health (Larchmt) 2021; 30:377-384. [PMID: 33481672 PMCID: PMC8098756 DOI: 10.1089/jwh.2020.8743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Previous Women's Ischemia Syndrome Evaluation (WISE) work demonstrated prior oral contraceptive (OC) use was associated with lower coronary artery disease (CAD) in women with suspected ischemia. The association of prior OC use with longer term all-cause and cardiovascular disease (CVD) mortality is unclear. Materials and Methods: WISE women undergoing coronary angiography for suspected ischemia (enrolled 1996-2001) with prior OC use history and 10-year follow-up data were analyzed. A blinded core laboratory assessed atherosclerotic CAD severity. Kaplan-Meier analyses evaluated prior OC use relative to all-cause and CVD mortality. Cox regression analyses adjusted for baseline differences. Mediation, interaction, and multicollinearity were analyzed. Results: Our 686 women had a mean age 62.5 ± 9.6 years, multiple cardiac risk factors, and 39% previously used OC. Prior OC users were younger, with less lipid-lowering medication use and lower atherosclerotic CAD severity scores (all p < 0.05). Prior OC use was associated with lower 10-year all-cause (p = 0.007) and CVD mortality (p = 0.019). After adjustment, this was no longer significant (p = 0.77 and p = 0.90, respectively). Atherosclerotic CAD severity score mediated one-third of the observed association. Prior OC use was associated with increased CVD mortality among women with very elevated menopausal systolic blood pressure (SBP). Conclusions: Unadjusted prior OC use was associated with lower longer-term all-cause and CVD mortality. One-third of this observed effect appears mediated by the atherosclerotic CAD severity score. Prior OC was adversely associated with CVD mortality in women with very elevated menopausal SBP. Additional investigation is needed to understand the potential benefits and harms of prior OC use. Clinical Trial Number: NCT00000554, or https://www.clinicaltrials.gov/ct2/show/NCT00000554.
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Affiliation(s)
- Lili Barsky
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Marie Lauzon
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - B. Delia Johnson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah L. Berga
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Glenn Braunstein
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leslee Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York, USA
| | - Steven Reis
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eileen Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carl J. Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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Florio KL, Kao M, Johnson T, Tuttle HA, White D, Nelson L, Patel N, Ramaeker D, Kendig S, Schmidt L, Grodzinsky A, Economy K. Contraception for the Cardiac Patient: a Cardiologist’s Primer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Purpose of review
Cardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for providers caring for women with heart disease.
Recent findings
Specific recommendation for the use of either non-hormonal or hormonal contraception requires knowledge of the types of contraceptive options available, cost, failure rates, and contraindications to use. Newer progestin-only options have become available and should be considered first-line therapy for women with cardiovascular disease.
Summary
The physiologic burden of pregnancy on the cardiovascular system can cause significant maternal morbidity and mortality for women with underlying CVD. These women should be offered safe and effective options for birth control, and both cardiology and obstetrical providers alike should possess fundamental knowledge of appropriate options.
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Baker SE, Limberg JK, Scruggs ZM, Curry TB, Nicholson WT, Barnes JN, Joyner MJ. Greater Influence of Aerobic Fitness on Autonomic Support of Blood Pressure in Young Women Than in Older Women. Hypertension 2020; 75:1497-1504. [PMID: 32336237 DOI: 10.1161/hypertensionaha.119.14042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aging increases autonomic support of blood pressure; however, the impact of aerobic fitness on autonomic support of blood pressure has not been addressed in women. As such, we hypothesized that aerobic fitness would be related to the change in blood pressure during ganglionic blockade such that women with greater aerobic fitness would have a blunted fall in blood pressure during ganglionic blockade due to increased vagal tone. Thirteen young premenopausal and 13 older postmenopausal women completed a screening visit where aerobic fitness (maximal oxygen consumption, VO2max) was measured. On a separate study day, participants were instrumented for assessment of muscle sympathetic nerve activity, heart rate (electrocardiography), and beat by beat blood pressure (arterial catheter and pressure transducer) and underwent pharmacological blockade of the autonomic ganglia using trimethaphan camyslate. Heart rate, blood pressure, and muscle sympathetic nerve activity were analyzed before and during ganglionic blockade. In young women, there was a significant relationship between aerobic fitness and the change in blood pressure during ganglionic blockade (r=0.761, P=0.003). In older women, there was no relationship between aerobic fitness and the change in blood pressure during ganglionic blockade (r=-0.106, P=0.73). Measures of heart rate variability were related to fitness in young women, but not older women (root mean square of successive differences between normal heartbeats, r=0.713, P=0.006 versus r=-0.172, P=0.575). Our data suggest that in young women, autonomic support of blood pressure is attenuated in those that are highly fit; however, this relationship is not significant in older women.
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Affiliation(s)
- Sarah E Baker
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (S.E.B., Z.M.S., T.B.C., W.R.N., M.J.J.)
| | - Jacqueline K Limberg
- Department of Nutrition & Exercise Physiology, University of Missouri, Columbia (J.K.L.)
| | - Zachariah M Scruggs
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (S.E.B., Z.M.S., T.B.C., W.R.N., M.J.J.)
| | - Timothy B Curry
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (S.E.B., Z.M.S., T.B.C., W.R.N., M.J.J.)
| | - Wayne T Nicholson
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (S.E.B., Z.M.S., T.B.C., W.R.N., M.J.J.)
| | - Jill N Barnes
- Department of Kinesiology, University of Wisconsin, Madison (J.N.B.)
| | - Michael J Joyner
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (S.E.B., Z.M.S., T.B.C., W.R.N., M.J.J.)
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Abstract
Untoward side effects of pharmaceuticals can result in considerable morbidity and expense to the health care system. There is likely a sizable fraction of the hypertensive population with disease either induced or exacerbated by polypharmacy. The elevation of blood pressure in drug-induced hypertension occurs through a variety of mechanisms, most notably, sodium and fluid retention, activation of the renin-angiotensin-aldosterone system, alteration of vascular tone, or a combination of these pathways. Recognition of common medications causing drug-induced hypertension is important to effectively control blood pressure. The epidemiology, pathophysiology, and management of these agents are discussed.
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Affiliation(s)
- Matthew C Foy
- Division of Nephrology, Louisiana State University Health Science Center, 5246 Brittany Dr, Baton Rouge, LA 70808, USA
| | - Joban Vaishnav
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Christopher John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 416, Baltimore, MD 21287, USA.
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Olaniyi KS, Olatunji LA. Oral ethinylestradiol–levonorgestrel normalizes fructose-induced hepatic lipid accumulation and glycogen depletion in female rats. Can J Physiol Pharmacol 2019; 97:1042-1052. [DOI: 10.1139/cjpp-2019-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The present study investigated the effects of oral ethinylestradiol–levonorgestrel (EEL) on hepatic lipid and glycogen contents during high fructose (HF) intake, and determined whether pyruvate dehydrogenase kinase-4 (PDK-4) and glucose-6-phosphate dehydrogenase (G6PD) activity were involved in HF and (or) EEL-induced hepatic dysmetabolism. Female Wistar rats weighing 140–160 g were divided into groups. The control, EEL, HF, and EEL+HF groups received water (vehicle, p.o.), 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel (p.o.), fructose (10% w/v), and EEL plus HF, respectively, on a daily basis for 8 weeks. Results revealed that treatment with EEL or HF led to insulin resistance, hyperinsulinemia, increased hepatic uric acid production and triglyceride content, reduced glycogen content, and reduced production of plasma or hepatic glutathione- and G6PD-dependent antioxidants. HF but not EEL also increased fasting glucose and hepatic PDK-4. Nonetheless, these alterations were attenuated by EEL in HF-treated rats. Our results demonstrate that hepatic lipid accumulation and glycogen depletion induced by HF is accompanied by increased PDK-4 and defective G6PD activity. The findings also suggest that EEL would attenuate hepatic lipid accumulation and glycogen depletion by suppression of PDK-4 and enhancement of a G6PD-dependent antioxidant barrier.
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Affiliation(s)
- Kehinde Samuel Olaniyi
- HOPE Cardiometabolic Research Team & Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Lawrence Aderemi Olatunji
- HOPE Cardiometabolic Research Team & Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
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13
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Fardoun M, Dehaini H, Shaito A, Mesmar J, El-Yazbi A, Badran A, Beydoun E, Eid AH. The hypertensive potential of estrogen: An untold story. Vascul Pharmacol 2019; 124:106600. [PMID: 31629918 DOI: 10.1016/j.vph.2019.106600] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease (CVD) is the major cause of morbidity and mortality worldwide. The implication of estrogen in this disease has been extensively studied. While the vast majority of published research argue for a cardioprotective role of estrogen in vascular inflammation such as in atherosclerosis, the role of estrogen in hypertension remains far from being resolved. The vasorelaxant effect of estrogen has already been well-established. However, emerging evidence supports a vasoconstrictive potential of this hormone. It has been proposed that the microenvironment dictates the effect of estrogen-induced type 1 nitric oxide synthase-1 (nNOS) on vasotone. Indeed, depending on nNOS product, nitric oxide or superoxide, estrogen can induce vasodilation or vasoconstriction, respectively. In this review, we discuss the evidence supporting the vasorelaxant effects of estrogen, and the molecular players involved. Furthermore, we shed light on recent reports revealing a vasoconstrictive role of estrogen, and speculate on the underlying signaling pathways. In addition, we identify certain factors that can account for the discrepant estrogenic effects. This review emphasizes a yin-yang role of estrogen in regulating blood pressure.
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Affiliation(s)
- Manal Fardoun
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Hassan Dehaini
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - Abdallah Shaito
- Department of Biological and Chemical Sciences, Faculty of Arts and Sciences, Lebanese International University, 1105 Beirut, Lebanon
| | - Joelle Mesmar
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Ahmed El-Yazbi
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon; Department of Pharmacology and Toxicology, Alexandria University, Alexandria, Egypt
| | - Adnan Badran
- Department of Nutrition, University of Petra, Amman, Jordan
| | - Elias Beydoun
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Ali H Eid
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon; Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar.
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Villa P, Amar ID, Shachor M, Cipolla C, Ingravalle F, Scambia G. Cardiovascular Risk/Benefit Profile of MHT. ACTA ACUST UNITED AC 2019; 55:medicina55090571. [PMID: 31500138 PMCID: PMC6780586 DOI: 10.3390/medicina55090571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Data emerging from the Women’s Health Initiative (WHI) study point toward an association between menopausal hormone therapy (MHT) and cardiovascular (CV) risk. However, post hoc subgroup analyses stratifying participants according to their age and time since menopause, have opened the way to a better understanding of the relationship between estrogen and CV risk. The aim of this review was to revise the current literature and evaluate the CV risk or benefit following administration of MHT considering several factors such as MHT timing, dose, route of administration, and formulation. Materials and Methods: An electronic databases search of MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, congress abstracts, and Grey literature (Google Scholar; British Library) was performed, with the date range from each database’s inception until June 2019. All the studies evaluating MHT and cardiovascular risk, including thromboembolism or stroke, were selected. Results: Timing of MHT initiation was shown to be a critical factor in CV risk assessment. In concordance with the “timing hypothesis”, healthy symptomatic women who initiated MHT when aged younger than 60 years, or who were within 10 years of menopause onset, have demonstrated a reduction in both coronary heart disease (CHD) risk and all-cause mortality. In particular, MHT therapy was associated with improvement of subclinical signs of atherosclerosis. Venous thromboembolism (VTE) risk is reduced when low doses of oral estrogen are used. Moreover, transdermal hormonal application significantly reduces CV risk compared with oral administration. MHT impact on the CV system is influenced by either factors inherent to the specific regimen, or factors inherent to the specific patient. Hence, individualization of care is necessary. Conclusion: CV risk calculation should be considered by clinicians in order to exclude patients with high CV risk, in whom MHT is contraindicated. Assessing risks and benefits in a patient-centered approach according to individual’s features, health status, and personal preferences is important in order to realize a safe and effective treatment.
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Affiliation(s)
- Paola Villa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia oncologica, 00168 Roma, Italy.
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Inbal Dona Amar
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Maayan Shachor
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Clelia Cipolla
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia oncologica, 00168 Roma, Italy.
| | - Fabio Ingravalle
- Department of Biomedicine and Prevention, University of Tor Vergata, 00133 Rome, Italy.
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia oncologica, 00168 Roma, Italy.
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
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15
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Beck KR, Thompson GR, Odermatt A. Drug-induced endocrine blood pressure elevation. Pharmacol Res 2019; 154:104311. [PMID: 31212012 DOI: 10.1016/j.phrs.2019.104311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022]
Abstract
Patients with uncontrolled hypertension are at risk for cardiovascular complications. The majority of them suffers from unidentified forms of hypertension and a fraction has so-called secondary hypertension with an identifiable cause. The patient's medications, its use of certain herbal supplements and over-the-counter agents represent potential causal factors for secondary hypertension that are often overlooked. The current review focuses on drugs that are likely to elevate blood pressure by affecting the human endocrine system at the level of steroid synthesis or metabolism, mineralocorticoid receptor activity, or by affecting the catecholaminergic system. Drugs with known adverse effects but where benefits outweigh their risks, drug candidates and market withdrawals are reviewed. Finally, potential therapeutic strategies are discussed.
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Affiliation(s)
- Katharina R Beck
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and the Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Davis, California, USA
| | - Alex Odermatt
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
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16
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Baker SE, Limberg JK, Dillon GA, Curry TB, Joyner MJ, Nicholson WT. Aging Alters the Relative Contributions of the Sympathetic and Parasympathetic Nervous System to Blood Pressure Control in Women. Hypertension 2019; 72:1236-1242. [PMID: 30354803 DOI: 10.1161/hypertensionaha.118.11550] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Autonomic support of blood pressure increases with age in humans. Large differences exist in the dose of trimethaphan (TMP) required for ganglionic blockade in young and older women. We asked whether differences in the dose of TMP required to achieve ganglionic blockade are because of differences in the relative contributions of the sympathetic and parasympathetic nervous system in control of blood pressure with age. Muscle sympathetic nerve activity (microneurography, peroneal nerve), heart rate (HR), and blood pressure were recorded before and during incremental doses of TMP camsylate until ganglionic blockade was achieved (absence of muscle sympathetic nerve activity and <5-bpm increase in HR during a valsalva maneuver; final TMP dose, 1-7 mg/min). HR variability was analyzed from the ECG waveform (WinCPRS). The dose of TMP required to achieve ganglionic blockade is positively related to basal HR variability, where women with high HR variability require a higher dose of TMP to achieve ganglionic blockade. In contrast, baseline muscle sympathetic nerve activity is inversely related with the dose of TMP required to achieve ganglionic blockade, such that women with high basal muscle sympathetic nerve activity required a lower dose of TMP. As such, the change in HR with ganglionic blockade was positively related, and the change in mean arterial pressure was inversely related, with the dose of TMP required to achieve ganglionic blockade. These data suggest loss of parasympathetic tone and increased sympathetic tone with aging contribute to the increase in blood pressure with age in women and dictate the dose of TMP that is necessary to achieve ganglionic blockade.
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Affiliation(s)
- Sarah E Baker
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | | | | | - Timothy B Curry
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Michael J Joyner
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN
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17
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Dresseno LP, Lehnen AM, Teló G, Silveira A, Markoski MM, Machado UF, Schaan BD. Impact of flaxseed and soy nuts as dietary supplements on lipid profile, insulin sensitivity, and GLUT4 expression in ovariectomized rats. Appl Physiol Nutr Metab 2018; 43:1282-1287. [PMID: 29806984 DOI: 10.1139/apnm-2018-0137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We assessed the effects of a diet with flaxseed or soy nuts versus estradiol on the lipid profile, insulin sensitivity, and glucose transporter type 4 (GLUT4) expression in ovariectomized female rats. Forty-four female Wistar rats (90 days old) underwent ovariectomy and were divided into 4 groups: C (standard diet), E (standard diet + subcutaneous 17β-estradiol pellets), L (standard diet + flaxseed + subcutaneous placebo pellets), and S (standard diet + soy nuts + subcutaneous placebo pellets). Customized diets and the insertion of pellets were started 21 days after ovariectomy and were continued for another 21 days. We measured body mass, insulin tolerance, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and GLUT4 (in cardiac and adipose tissues). We found a lower body mass and a lower Lee index in group E and a trend toward improved insulin sensitivity in group S (p = 0.066). Groups L and S showed a better lipid profile when compared with group C. Microsomal GLUT4 increased in group L (in cardiac and adipose tissues), and plasma membrane GLUT4 increased in groups E, L, and S (in both tissues). We conclude that flaxseed and soy nuts as dietary supplements improve lipid profile and increase GLUT4 expression.
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Affiliation(s)
- Luciana P Dresseno
- a Endocrine Division, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350. CEP 90035-003 - Porto Alegre, RS, Brazil
- b Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, Brazil
| | - Alexandre M Lehnen
- b Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, Brazil
| | - Gabriela Teló
- d Endocrine Division, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre 90620-001, Brazil
| | - Ariel Silveira
- b Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, Brazil
| | - Melissa M Markoski
- b Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, Brazil
| | - Ubiratan F Machado
- c Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-900, Brazil
| | - Beatriz D Schaan
- d Endocrine Division, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre 90620-001, Brazil
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18
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Olaniyi KS, Olatunji LA. Oral ethinylestradiol-levonorgestrel attenuates cardiac glycogen and triglyceride accumulation in high fructose female rats by suppressing pyruvate dehydrogenase kinase-4. Naunyn Schmiedebergs Arch Pharmacol 2018; 392:89-101. [PMID: 30276420 DOI: 10.1007/s00210-018-1568-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022]
Abstract
Fructose (FRU) intake has increased dramatically in recent decades with a corresponding increased incidence of insulin resistance (IR), particularly in young adults. The use of oral ethinylestradiol-levonorgestrel (EEL) formulation is also common among young women worldwide. The present study aimed at determining the effect of EEL on high fructose-induced cardiac triglyceride (TG) and glycogen accumulation. The study also investigated the possible involvement of pyruvate dehydrogenase kinase-4 (PDK-4) in EEL and/or high fructose metabolic effects on the heart. Ten-week-old female Wistar rats were allotted into four groups. The control, EEL, FRU, and EEL + FRU rats received distilled water (vehicle, p.o.), 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel (p.o.), 10% fructose (w/v), and 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel and 10% fructose, respectively, daily for 8 weeks. Data showed that EEL or high fructose caused IR' impaired glucose tolerance' hyperlipidemia' increased plasma lactate, lactate dehydrogenase, PDK-4, uric acid, xanthine oxidase (XO), adenosine deaminase (ADA), malondialdehyde (MDA), cardiac uric acid, TG, TG/HDL- cholesterol, glycogen synthesis, MDA, and visceral fat content and reduced glutathione. High fructose also resulted in impaired pancreatic β-cell function, hyperglycemia, and increased cardiac PDK-4, lactate synthesis, and mass. Nonetheless, these alterations were ameliorated in EEL plus high fructose rats. This study demonstrates that high fructose-induced myocardial TG and glycogen accumulation is attributable to increased PDK-4. Besides, EEL could be a useful pharmacological utility for protection against cardiac dysmetabolism by inhibiting PDK-4.
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Affiliation(s)
- Kehinde Samuel Olaniyi
- HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240001, Nigeria
| | - Lawrence Aderemi Olatunji
- HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240001, Nigeria.
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19
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Graugaard-Jensen C, Hvistendahl GM, Frøkiær J, Bie P, Djurhuus JC. Oral Contraceptives and Renal Water Handling: A diurnal study in young women. Physiol Rep 2018; 5:5/23/e13547. [PMID: 29233909 PMCID: PMC5727291 DOI: 10.14814/phy2.13547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022] Open
Abstract
To test the hypothesis that use of oral contraceptives (OC) changes diurnal variation in fluid balance mechanisms including blood pressure, secretion of vasopressin and oxytocin, and renal water and electrolyte excretion. Fifteen naturally cycling (NC) women in mid‐follicular phase and 11 long‐term OC users were included in a 24‐h standardized inpatient study for measurements of vasopressin, oxytocin, sodium, and osmolality in plasma as well as urinary excretion of electrolytes, aquaporin‐2, and prostaglandin E2. Blood pressure and heart rate were monitored noninvasively. Plasma vasopressin showed circadian rhythm (P = 0.02) and were similar in both groups (P = 0.18) including nighttime increases (P < 0.001). There was no circadian rhythm in plasma oxytocin within (P = 0.84) or between groups (P = 0.22). OC users had significantly lower plasma osmolality (Δosm: 3.05 ± 0.29 mosm/kg, P = 0.04) and lower plasma sodium (ΔNa+: 0.91 ± 0.09 mmol/l, P = 0.05). The two groups showed similar nighttime decreases in diuresis (1.08 ± 0.04 mL/(kg·h), P < 0.001) and increases in urine osmolality (109 ± 9 mosm/kg, P = 0.02), but similar rates of excretion of Aquaporin‐2, prostaglandin E2 and sodium. Nighttime decreases in mean arterial pressure of approximately 13% were significant in both groups (P < 0.001), but 24‐h average mean arterial pressure was significantly higher in OC users than in controls (+4.7 ± 0.4 mmHg, P = 0.02). Packed cell volumes were similar between groups (P = 0.54). OC does not change the diurnal patterns of renal fluid excretion, but resets the osmoreceptors for vasopressin release and leads to a significant increase in arterial blood pressure.
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Affiliation(s)
| | | | - Jørgen Frøkiær
- Department of Clinical Physiology and Nuclear Medicine, University Hospital of Aarhus, Aarhus N, Denmark
| | - Peter Bie
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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20
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21
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Changes in hormonal and metabolic parameters in transgender subjects on cross-sex hormone therapy: A cohort study. Maturitas 2018; 107:92-96. [DOI: 10.1016/j.maturitas.2017.10.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/25/2017] [Accepted: 10/13/2017] [Indexed: 11/20/2022]
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22
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Contribution of stress and sex hormones to memory encoding. Psychoneuroendocrinology 2017; 82:51-58. [PMID: 28501551 DOI: 10.1016/j.psyneuen.2017.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/03/2017] [Accepted: 05/01/2017] [Indexed: 01/31/2023]
Abstract
Distinct stages of the menstrual cycle and the intake of oral contraceptives (OC) affect sex hormone levels, stress responses, and memory processes critically involved in the pathogenesis of mental disorders. To characterize the interaction of sex and stress hormones on memory encoding, 30 men, 30 women in the early follicular phase of the menstrual cycle (FO), 30 women in the luteal phase (LU), and 30 OC women were exposed to either a stress (socially evaluated cold-pressor test) or a control condition prior to memory encoding and immediate recall of neutral, positive, and negative words. On the next day, delayed free and cued recall was tested. Sex hormone levels verified distinct estradiol, progesterone, and testosterone levels between groups. Stress increased blood pressure, cortisol concentrations, and ratings of stress appraisal in all four groups as well as cued recall performance of negative words in men. Stress exposure in OC women led to a blunted cortisol response and rather enhanced cued recall of neutral words. Thus, pre-encoding stress facilitated emotional cued recall performance in men only, but not women with different sex hormone statuses pointing to the pivotal role of circulating sex hormones in modulation of learning and memory processes.
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23
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Subramanian M, MohanKumar SMJ, Balasubramanian P, Northcott CA, Garver H, Fink GD, MohanKumar PS. Chronic exposure to low doses of estradiol-17ß increases blood pressure in young female rats: A possible role for central Endothelin-1. Sci Rep 2017; 7:139. [PMID: 28273940 PMCID: PMC5428019 DOI: 10.1038/s41598-017-00213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/14/2017] [Indexed: 02/04/2023] Open
Abstract
Previously, we demonstrated that chronic exposure to low levels of estradiol-17β (E2) increases mean arterial pressure (MAP) in young female Sprague-Dawley (SD) rats, however, the underlying mechanisms are unclear. Since endothelin-1 (ET-1) is implicated in blood pressure (BP) regulation, we hypothesized that E2’s effects on MAP are mediated through central ET-1. To test this, young female SD rats were either sham implanted or implanted s.c. with slow-release E2 pellets (20 ng/day for 90 days). BP was monitored by telemetry. After 75 days of E2 exposure, ETA antagonist or vehicle was administered i.c.v. After 90 days of E2 exposure, rats were sacrificed, and the paraventricular nucleus (PVN) and rostral ventrolateral medulla (RVLM) were microdissected for gene expression and protein analysis of ET-1 and its receptors. E2 exposure increased MAP after pellet implantation. Gene expression of ET-1 and ETA but not ETB receptors were upregulated in the PVN and RVLM of E2 treated animals. Further, the protein levels of ETA receptor were also increased in the PVN of E2 treated animals. However, i.c.v. infusion of the ETA antagonist did not completely block the increase in blood pressure. Our results suggest that increases in central ET-1 activity could possibly play a role in chronic E2-induced increase in BP but further studies are needed to completely understand the contribution of ET-1 in this phenomenon.
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Affiliation(s)
- Madhan Subramanian
- Department of Pathobiology & Diagnostic Investigation, Michigan State University, East Lansing, MI, 48824, USA
| | - Sheba M J MohanKumar
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia, Athens, GA, 30602, USA.,Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - Priya Balasubramanian
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - Carrie A Northcott
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - Hannah Garver
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - Gregory D Fink
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, 48824, USA
| | - P S MohanKumar
- Department of Pathobiology & Diagnostic Investigation, Michigan State University, East Lansing, MI, 48824, USA. .,Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia, Athens, GA, 30602, USA.
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24
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Baker SE, Limberg JK, Ranadive SM, Joyner MJ. Neurovascular control of blood pressure is influenced by aging, sex, and sex hormones. Am J Physiol Regul Integr Comp Physiol 2016; 311:R1271-R1275. [PMID: 27856414 DOI: 10.1152/ajpregu.00288.2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/01/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022]
Abstract
In this review, we highlight that the relationship between muscle sympathetic nerve activity (MSNA) and mean arterial pressure is complex, differs by sex, and changes with age. In young men there is an inverse relationship between MSNA and cardiac output where high MSNA is compensated for by low cardiac output. This inverse relationship is not seen in older men. In young women sympathetic vasoconstriction is offset by β-adrenoreceptor mediated vasodilation, limiting the ability of young women to maintain blood pressure in response to orthostatic stress. However, β-mediated dilation in women is attenuated with age, leading to unopposed α-adrenergic vasoconstriction and a rise in the direct transduction of MSNA into increases in blood pressure. We propose that these changes with age and menopausal status are major contributing factors in the increased prevalence of hypertension in older women. In addition to aging, we highlight that changes in sex hormones in young women (across the menstrual cycle, with oral contraceptive use, or with pregnancy) influence MSNA and the transduction of MSNA into increases in blood pressure. It is likely that the β-adrenergic receptors and/or changes in baroreflex sensitivity play a large role in these sex differences and changes with alterations in sex hormones.
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Affiliation(s)
- Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
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25
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Gottfridsson C, Panfilov S, Ebrahimi A, Gigger E, Pollard C, Henderson S, Ambery P, Raichlen JS. Drug-induced blood pressure increase - recommendations for assessment in clinical and non-clinical studies. Expert Opin Drug Saf 2016; 16:215-225. [PMID: 27830951 DOI: 10.1080/14740338.2017.1259615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Changes in blood pressure (BP) are now proactively examined throughout the drug development process as an integral aspect of safety monitoring. This is because hypertension is a very strong risk factor for cardiovascular events and drug-induced increases in BP have attracted increased regulatory attention. However, there is currently no guidance from regulatory agencies on the minimum BP data required for submissions, and there are no specific criteria for what constitutes a safety signal for increased BP in non clinical studies. Areas covered: Evaluation of BP increases through the drug discovery and development process. Expert opinion: Research into the effects of drugs should begin before clinical development is initiated and continue throughout the clinical trial program. Non clinical studies should inform a benefit-risk analysis that will aid decision-making of whether to enter the drug into Phase I development. The degree of acceptable risk will vary according to the therapy area, treatment indication and intended population for the new drug, and the approach to BP assessment and risk mitigation should be tailored accordingly. However, BP monitoring should always be included in clinical trials, and data collected from multiple studies, to convincingly prove or refute a suspicion of BP effects.
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Affiliation(s)
- Christer Gottfridsson
- a Patient Safety , Global Medicines Development, AstraZeneca R&D , Gothenburg , Sweden
| | - Seva Panfilov
- b CVMD Global Medicines Development , AstraZeneca R&D , Gothenburg , Sweden
| | - Ahmad Ebrahimi
- c ECG Centre, Global Medicines Development , AstraZeneca R&D , Gothenburg , Sweden
| | - Emery Gigger
- d Regulatory Policy, Global Medicines Development , AstraZeneca R&D , Gaithersburg , MD , USA
| | - Chris Pollard
- e Drug Safety & Metabolism , AstraZeneca R&D , Cambridge , UK
| | | | - Philip Ambery
- g Clinical CVMD, Biologics, MedImmune , Cambridge , UK
| | - Joel S Raichlen
- h CVMD Global Medicines Development , AstraZeneca R&D , Gaithersburg , MD , USA
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Abstract
Hypertension continues to be the most common cardiovascular disorder in the USA and worldwide. While generally considered a disorder of aging individuals, hypertension is more prevalent in athletes and the active population than is generally appreciated. The timely detection, diagnosis, and appropriate treatment of hypertension in athletes must focus on both adequately managing the disorder and ensuring safe participation in sport while not compromising exercise capacity. This publication focuses on appropriately diagnosing hypertension, treating hypertension in the athletic population, and suggesting follow-up and participation guidelines for athletes.
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Affiliation(s)
- Kevin T Schleich
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - M Kyle Smoot
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael E Ernst
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA. .,Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA.
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Wenger NK, Ferdinand KC, Bairey Merz CN, Walsh MN, Gulati M, Pepine CJ. Women, Hypertension, and the Systolic Blood Pressure Intervention Trial. Am J Med 2016; 129:1030-6. [PMID: 27427323 DOI: 10.1016/j.amjmed.2016.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Abstract
Hypertension accounts for approximately 1 in 5 deaths in American women and is the major contributor to many comorbid conditions. Although blood pressure lowering reduces cardiovascular disease outcomes, considerable uncertainty remains on best management in women. Specifically, female blood pressure treatment goals have not been established, particularly among older and African American and Hispanic women, for whom hypertension prevalence, related adverse outcomes, and poor control rates are high. The Systolic Blood Pressure Intervention Trial (SPRINT) planned to clarify optimal blood pressure management in both sexes. Although confirming that a lower blood pressure goal is generally better, because female enrollment and event rates were low and follow-up shortened, outcomes differences in women were not statistically significant. Thus optimal blood pressure goals for women have not been established with the highest evidence. This review addresses SPRINT's significance and key remaining knowledge gaps in optimal blood pressure management to improve women's health.
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Affiliation(s)
- Nanette K Wenger
- Department of Cardiology, Emory University School of Medicine Atlanta, Ga
| | - Keith C Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, La
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, Calif
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona-Phoenix
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville.
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Limberg JK, Peltonen GL, Johansson RE, Harrell JW, Kellawan JM, Eldridge MW, Sebranek JJ, Walker BJ, Schrage WG. Greater Beta-Adrenergic Receptor Mediated Vasodilation in Women Using Oral Contraceptives. Front Physiol 2016; 7:215. [PMID: 27375493 PMCID: PMC4896959 DOI: 10.3389/fphys.2016.00215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background: β-adrenergic receptors play an important role in mitigating the pressor effects of sympathetic nervous system activity in young women. Based on recent data showing oral contraceptive use in women abolishes the relationship between muscle sympathetic nervous system activity and blood pressure, we hypothesized forearm blood flow responses to a β-adrenergic receptor agonist would be greater in young women currently using oral contraceptives (OC+, n = 13) when compared to those not using oral contraceptives (OC–, n = 10). Methods: Women (18–35 years) were studied during the early follicular phase of the menstrual cycle (days 1–5) or placebo phase of oral contraceptive use. Forearm blood flow (FBF, Doppler ultrasound) and mean arterial blood pressure (MAP, brachial arterial catheter) were measured at baseline and during graded brachial artery infusion of the β-adrenergic receptor agonist, Isoproterenol (ISO), as well as Acetylcholine (ACH, endothelium-dependent vasodilation) and Nitroprusside (NTP, endothelium-independent vasodilation). Forearm vascular conductance was calculated (FVC = FBF/MAP, ml/min/100 mmHg) and the rise in FVC from baseline during infusion quantified vasodilation (ΔFVC = FVCinfusion − FVCbaseline). Results: ISO increased FVC in both groups (p < 0.01) and ISO-mediated ΔFVC was greater in OC+ compared to OC– (Main effect of group, p = 0.02). Expressing data as FVC and FBF resulted in similar conclusions. FVC responses to both ACH and NTP were also greater in OC+ compared to OC–. Conclusions: These data are the first to demonstrate greater β-adrenergic receptor-mediated vasodilation in the forearm of women currently using oral contraceptives (placebo phase) when compared to those not using oral contraceptives (early follicular phase), and suggest oral contraceptive use influences neurovascular control.
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Affiliation(s)
| | | | | | - John W Harrell
- Department of Kinesiology, University of Wisconsin Madison, WI, USA
| | | | - Marlowe W Eldridge
- Department of Kinesiology, University of WisconsinMadison, WI, USA; Department of Pediatrics, University of WisconsinMadison, WI, USA
| | - Joshua J Sebranek
- Department of Anesthesiology, University of Wisconsin Madison, WI, USA
| | - Benjamin J Walker
- Department of Anesthesiology, University of Wisconsin Madison, WI, USA
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Harvey RE, Coffman KE, Miller VM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. ACTA ACUST UNITED AC 2015; 11:239-257. [PMID: 25776297 DOI: 10.2217/whe.14.64] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the era of individualized medicine, gaps in knowledge remain about sex-specific risk factors, diagnostic and treatment options that might reduce mortality from cardiovascular disease (CVD) and improve outcomes for both women and men. In this review, contributions of biological mechanisms involving the sex chromosomes and the sex hormones on the cardiovascular system will be discussed in relationship to the female-specific risk factors for CVD: hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms. Additionally, sex-specific factors to consider in the differential diagnosis and treatment of four prevalent CVDs (hypertension, stroke, coronary artery disease and congestive heart failure) will be reviewed with emphasis on areas where additional research is needed.
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Affiliation(s)
- Ronée E Harvey
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Kirsten E Coffman
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Virginia M Miller
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.,Department of Surgery, Medical Sciences, 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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30
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Harvey RE, Hart EC, Charkoudian N, Curry TB, Carter JR, Fu Q, Minson CT, Joyner MJ, Barnes JN. Oral Contraceptive Use, Muscle Sympathetic Nerve Activity, and Systemic Hemodynamics in Young Women. Hypertension 2015; 66:590-7. [PMID: 26101348 PMCID: PMC4537364 DOI: 10.1161/hypertensionaha.115.05179] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/28/2015] [Indexed: 01/21/2023]
Abstract
Endogenous female sex hormones influence muscle sympathetic nerve activity (MSNA), a regulator of arterial blood pressure and important factor in hypertension development. Although ≈80% of American women report using hormonal contraceptives sometime during their life, the influence of combined oral contraceptives (OCs) on MSNA and systemic hemodynamics remains equivocal. The goal of this study was to determine whether women taking OCs have altered MSNA and hemodynamics (cardiac output and total peripheral resistance) at rest during the placebo phase of OC use compared with women with natural menstrual cycles during the early follicular phase. We retrospectively analyzed data from studies in which healthy, premenopausal women (aged 18-35 years) participated. We collected MSNA values at rest and hemodynamic measurements in women taking OCs (n=53; 25±4 years) and women with natural menstrual cycles (n=74; 25±4 years). Blood pressure was higher in women taking OCs versus those with natural menstrual cycles (mean arterial pressure, 89±1 versus 85±1 mm Hg, respectively; P=0.01), although MSNA was similar in both groups (MSNA burst incidence, 16±1 versus 18±1 bursts/100 heartbeats, respectively; P=0.19). In a subset of women in which detailed hemodynamic data were available, those taking OCs (n=33) had similar cardiac output (4.9±0.2 versus 4.7±0.2 L/min, respectively; P=0.47) and total peripheral resistance (19.2±0.8 versus 20.0±0.9 U, respectively; P=0.51) as women with natural menstrual cycles (n=22). In conclusion, women taking OCs have higher resting blood pressure and similar MSNA and hemodynamics during the placebo phase of OC use when compared with naturally menstruating women in the early follicular phase.
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Affiliation(s)
- Ronee E Harvey
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.).
| | - Emma C Hart
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Nisha Charkoudian
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Timothy B Curry
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Jason R Carter
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Qi Fu
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Christopher T Minson
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Michael J Joyner
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
| | - Jill N Barnes
- From the Department of Anesthesiology, Mayo Clinic, Rochester, MN (R.E.H., T.B.C., M.J.J., J.N.B.); School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (E.C.H.); Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA (N.C.); Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton (J.R.C.); Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center (Q.F.); and Department of Human Physiology, University of Oregon, Eugene (C.T.M.)
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31
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Joyner MJ, Wallin BG, Charkoudian N. Sex differences and blood pressure regulation in humans. Exp Physiol 2015; 101:349-55. [DOI: 10.1113/ep085146] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Affiliation(s)
| | - B. Gunnar Wallin
- Institute of Neuroscience and Physiology; The Sahlgren Academy at Gothenburg University; Göteborg Sweden
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division; US Army Research Institute of Environmental Medicine; Natick MA USA
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Akintomide H, Panicker S. Nomegestrol acetate/17-beta estradiol: a review of efficacy, safety, and patient acceptability. Open Access J Contracept 2015; 6:77-86. [PMID: 29386925 PMCID: PMC5683186 DOI: 10.2147/oajc.s61942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Nomegestrol acetate (NOMAC) 2.5 mg with 17-beta estradiol (E2) 1.5 mg is a new combined oral contraceptive (COC) formulation and is the first monophasic E2 pill to be marketed, having been licensed for use in Europe in 2011. It is available to be taken daily in a regimen of 24 active pills followed by four placebo pills. NOMAC is a highly selective 19-nor progestogen derivative with specific binding to progesterone receptors, anti-estrogenic activity and no androgenic, mineralocorticoid nor glucocorticoid effects. E2 is an estrogen that is identical to endogenous estrogen. While it has been in use for only a short period of time, current evidence suggests that NOMAC/E2 is just as effective, safe, and acceptable as existing COC preparations. Two large Phase III trials conducted in the Americas and across Europe, Australia, and Asia showed lower cumulative pregnancy rates in the NOMAC/E2 groups compared to the drospirenone (DRSP) 3 mg in combination with ethinyl estradiol (EE) 30 µg (DRSP/EE) groups but this difference was not statistically significant. NOMAC/E2 exhibits a good safety profile and has less effects on cardiovascular risk, hemostatic, metabolic, and endocrine factors in comparison to COCs containing EE in combination with levonorgestrel (LNG) or DRSP. NOMAC/E2 has also been found to cause less breast cell proliferation when compared to E2 alone and has some anti-proliferative effect on human breast cancer cells. NOMAC/E2 is considered acceptable as its compliance, continuation rates, and bleeding patterns were similar to COCs containing DRSP/EE and LNG 150 µg combined with EE 30 µg or LNG 100 µg combined with EE 20 µg (LNG/EE). However, discontinuation was found to be slightly higher in the NOMAC/E2 groups in the two large Phase III trials comparing NOMAC/E2 use with DRSP/EE. As the scientific literature has limited information on NOMAC/E2, further experience with NOMAC/E2 is required.
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Affiliation(s)
- Hannat Akintomide
- Sexual and Reproductive Health, Central and North West London NHS Trust, Margaret Pyke Centre, London, UK
| | - Sabeena Panicker
- Sexual and Reproductive Health, Central and North West London NHS Trust, Margaret Pyke Centre, London, UK
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33
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Kassel LE, Odum LE. Our own worst enemy: pharmacologic mechanisms of hypertension. Adv Chronic Kidney Dis 2015; 22:245-52. [PMID: 25908474 DOI: 10.1053/j.ackd.2014.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/02/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022]
Abstract
Drug-induced hypertension is often an unrecognized cause of resistant or secondary hypertension. It is defined as hypertension resulting from the unintended effect of a drug or from a drug's antagonistic effect on antihypertensive medications. The main mechanisms of drug-induced hypertension, when categorized broadly, include volume retention and sympathomimetic effects. These mechanisms along with management strategies will be further discussed in this article.
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35
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The effect of oral Contraceptive pills and the natural menstrual cYCLe on arterial stiffness and hemodynamICs (CYCLIC). J Hypertens 2014; 32:100-7. [DOI: 10.1097/hjh.0000000000000012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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36
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Casey MJ, Salzman TA. Therapeutic, prophylactic, untoward, and contraceptive effects of combined oral contraceptives: catholic teaching, natural law, and the principle of double effect when deciding to prescribe and use. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:20-34. [PMID: 24978407 DOI: 10.1080/15265161.2014.919364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Combined oral contraceptives (COC) have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching.
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Lee JY, Ku SY, Kim SH, Hwang SS, Lee HW, Park SM. Oral contraceptive use and measurable cardiovascular risk factors in Korean women aged 20-50 years: the Fourth Korean National Health and Nutrition Examination Survey 2007-2009 (KNHANES IV). Gynecol Endocrinol 2013; 29:707-11. [PMID: 23772783 DOI: 10.3109/09513590.2013.797393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effects of oral contraceptives (OCs) on cardiovascular risk factors according to the duration of use. METHODS This is a cross-sectional study using data from the Fourth Korean National Health and Nutrition Examination Survey of reproductive-age women. Subjects were classified into three groups based on OC use: non-users, short-term users (0-12 months) and long-term users (>12 months). Measurable cardiovascular risk factors, defined by 2009 consensus criteria, were included as metabolic syndrome components. RESULTS Of the 2225 women surveyed, 1924 (86.5%) were non-users of OCs, 186 (8.4%) were short-term users and 115 (5.2%) were long-term users. The use of OCs for longer durations was not associated with increased levels of blood pressure or fasting glucose, or larger waist circumference. After adjusting the covariates, long-term OC use was associated significantly with elevated triglycerides (TG, >150 mg/dL) compared with non-users (odds ratio, 2.16; 95% confidence interval, 1.18-3.97). In addition, the use of OCs for longer durations was associated negatively with the risk of low high-density lipoprotein cholesterol (<50 mg/dL) (p for trend = 0.038). CONCLUSION These results suggest that the long-term use of OCs is associated with elevated TG. With the exception of lipid profile, it may be concluded that OCs are unlikely to affect cardiometabolic risk.
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Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Mortensen KH, Andersen NH, Gravholt CH. Cardiovascular phenotype in Turner syndrome--integrating cardiology, genetics, and endocrinology. Endocr Rev 2012; 33:677-714. [PMID: 22707402 DOI: 10.1210/er.2011-1059] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is emerging as a cardinal trait of Turner syndrome, being responsible for half of the 3-fold excess mortality. Turner syndrome has been proposed as an independent risk marker for cardiovascular disease that manifests as congenital heart disease, aortic dilation and dissection, valvular heart disease, hypertension, thromboembolism, myocardial infarction, and stroke. Risk stratification is unfortunately not straightforward because risk markers derived from the general population inadequately identify the subset of females with Turner syndrome who will suffer events. A high prevalence of endocrine disorders adds to the complexity, exacerbating cardiovascular prognosis. Mounting knowledge about the prevalence and interplay of cardiovascular and endocrine disease in Turner syndrome is paralleled by improved understanding of the genetics of the X-chromosome in both normal health and disease. At present in Turner syndrome, this is most advanced for the SHOX gene, which partly explains the growth deficit. This review provides an up-to-date condensation of current state-of-the-art knowledge in Turner syndrome, the main focus being cardiovascular morbidity and mortality. The aim is to provide insight into pathogenesis of Turner syndrome with perspectives to advances in the understanding of genetics of the X-chromosome. The review also incorporates important endocrine features, in order to comprehensively explain the cardiovascular phenotype and to highlight how raised attention to endocrinology and genetics is important in the identification and modification of cardiovascular risk.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
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Ferdinand KC, Nasser SA. Improved Understanding and Innovative Approaches for an Aging Dilemma: Resistant Hypertension in Women with Existing Vascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol 2012; 119:1143-50. [PMID: 22617578 PMCID: PMC3631421 DOI: 10.1097/aog.0b013e318257217a] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate whether continuous oral contraceptive pills (OCPs) will result in more pain relief in primary dysmenorrhea patients than cyclic OCPs, which induce withdrawal bleeding with associated pain and symptoms. METHODS We conducted a double-blind, randomized, controlled trial comparing continuous to a cyclic 21-7 OCP regimen (gestodene 0.075 mg and ethinyl estradiol 20 microgram) for 6 months in 38 primary dysmenorrhea patients. The primary outcome was the difference in subjective perception of pain as measured by the visual analog scale over a period of 6 months. RESULTS Twenty-nine patients completed the study. In both groups, pain reduction measured by visual analog scale declined over time and was significant at 6 months compared with baseline, with no difference between groups. Continuous regimen was superior to cyclic regimen after 1 month (mean difference -27.3, 95% confidence interval [CI] -40.5 to -14.2; P<.001) and 3 months (mean difference -17.8, 95% CI -33.4 to -2.1; P=.03) of treatment. Secondary outcomes noted no difference between groups in terms of menstrual distress as measured by the Moos Menstrual Distress Questionnaire. After 6 months, there was an increase in weight and a decrease in systolic blood pressure in the continuous group compared with the cyclic group. CONCLUSION Both regimens of OCPs are effective in the treatment of primary dysmenorrhea. Continuous OCPs outperform cyclic OCPs in the short term, but this difference is lost after 6 months. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00517556. LEVEL OF EVIDENCE I.
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Middlekauff HR, Park J, Gornbein JA. Lack of effect of ovarian cycle and oral contraceptives on baroreceptor and nonbaroreceptor control of sympathetic nerve activity in healthy women. Am J Physiol Heart Circ Physiol 2012; 302:H2560-6. [PMID: 22542619 DOI: 10.1152/ajpheart.00579.2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endogenous and exogenous female hormones regulate sympathetic nerve activity (SNA) in animal models, but their impact in humans is controversial. The purpose of this study is to investigate the effects of the ovarian cycle and oral contraceptive pills (OCPs) on SNA. We hypothesized that the effects of endogenous hormones were baroreflex (BR)-mediated and that these cyclical changes in BR control were blunted by OCPs. Furthermore, we hypothesized that the nocturnal fall in blood pressure (BP) ("dipping"), which is sympathetically mediated, also varied with the ovarian cycle. In 23 healthy females (13 OCP users, 10 age-matched, no OCPs), SNA was recorded (microneurography) at rest, during BR activation/deactivation, and cold pressor test (CPT) during low and high hormonal phases. Furthermore, 24-h BP monitoring was performed during low and high hormonal phases. SNA was lower during the low vs. high hormone phase in non-OCP users (17.3 ± 2.4 vs. 25.4 ± 3.2 bursts/min, P < 0.001) but was not different between phases in OCP users [15.5 ± 1.7 vs. 16.6 ± 2.0 bursts/min, P = not significant (NS)]. BR control of SNA was not different during the hormone phases in either group [SNA (total activity/min) mean slope %change from baseline, no OCP users, low vs. high hormone phase 35.4 ± 6.2 vs. 29.6 ± 3.4%, P = NS and OCP users, low vs. high hormone phase 35.7 ± 3.9 vs. 33.5 ± 3.5%, P = NS]. SNA activation during CPT was not impacted by hormonal phase or OCP use. Finally, nondipping was not different between OCP users and nonusers, although there was a trend for nondipping to occur more frequently in the OCP users. SNA varies during the ovarian cycle in women in the absence of OCPs. This modulation cannot be attributed to cyclical changes in the BR sensitivity.
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Affiliation(s)
- Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California 90095, USA
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