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Dolmans MM, Petraglia F, Catherino WH, Donnez J. Pathogenesis of uterine fibroids: current understanding and future directions. Fertil Steril 2024; 122:6-11. [PMID: 38453042 DOI: 10.1016/j.fertnstert.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
Fibroids are benign uterine tumors characterized by the proliferation of uterine smooth muscle cells, embedded in an abundant extracellular matrix. Their prevalence is estimated to be >50% in women aged >45 years. Fibroids represent a considerable health burden. It is time to acquire a deeper mechanistic understanding of uterine fibroid-related etiology and pathogenesis, which may help pinpoint new strategies and an individualized approach. There is a need to gather prospective data and conduct studies to compare alternative approaches and assess long-term outcomes with respect to quality of life, recurrence of symptoms (bleeding and bulk symptoms), fertility, and even complications The goal of this review was to evaluate the widely accepted pathogenesis and identify risks factors and future directions for clinical and basic research into fibroids.
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Affiliation(s)
- Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Maternal-Infancy, Careggi University Hospital Florence, Florence, Italy; Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - William H Catherino
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jacques Donnez
- Université Catholique de Louvain, Brussels, Belgium; Society for Research into Infertility (SRI), Brussels, Belgium
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Broni EK, Echouffo-Tcheugui JB, Palatnik A, Graham EM, Turkson-Ocran RA, Commodore-Mensah Y, Ndumele CE, Michos ED. Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis. Am J Obstet Gynecol 2024:S0002-9378(24)00561-1. [PMID: 38703940 DOI: 10.1016/j.ajog.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Metabolic syndrome is linked to an increased risk of incident cardiovascular disease and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term cardiovascular disease risk. OBJECTIVE To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort. STUDY DESIGN We studied 3367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy, and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from examinations 2 (2002-2004) to 6 (2016-2018). RESULTS The mean age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy (hazard ratio, 1.32 [95% confidence interval, 1.01-1.73]) and hystero-oophorectomy (hazard ratio, 1.40 [95% confidence interval, 1.13-1.74]) were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy. CONCLUSION Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomies and the mechanisms underpinning these associations may be explored.
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Affiliation(s)
- Eric K Broni
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Anna Palatnik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Ernest M Graham
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD
| | - Ruth-Alma Turkson-Ocran
- General Medicine, Research; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
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Mitro SD, Wise LA, Waetjen LE, Lee C, Zaritsky E, Harlow SD, Solomon DH, Thurston RC, El Khoudary SR, Santoro N, Hedderson MM. Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife. JAMA Netw Open 2024; 7:e246832. [PMID: 38625699 PMCID: PMC11022113 DOI: 10.1001/jamanetworkopen.2024.6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/18/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. Objective To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. Design, Setting, and Participants The Study of Women's Health Across the Nation is a prospective, multisite cohort study in the US. Participants were followed-up from enrollment (1996-1997) through 13 semiannual visits (1998-2013). Participants had a menstrual period in the last 3 months, were not pregnant or lactating, were aged 42 to 52 years, were not using hormones, and had a uterus and at least 1 ovary. Participants with prior fibroid diagnoses were excluded. Data analysis was performed from November 2022 to February 2024. Exposures Blood pressure, anthropometry, biomarkers (cholesterol, triglycerides, and C-reactive protein), and self-reported antihypertensive treatment at baseline and follow-up visits were measured. Hypertension status (new-onset, preexisting, or never [reference]) and hypertension treatment (untreated, treated, or no hypertension [reference]) were categorized. Main Outcomes and Measures Participants reported fibroid diagnosis at each visit. Discrete-time survival models estimated hazard ratios (HRs) and 95% CIs for associations of time-varying hypertension status, antihypertensive treatment, anthropometry, and biomarkers with incident reported fibroid diagnoses. Results Among 2570 participants without a history of diagnosed fibroids (median [IQR] age at screening, 45 [43-48] years; 1079 [42.1%] college educated), 526 (20%) reported a new fibroid diagnosis during follow-up. Risk varied by category of hypertension treatment: compared with those with no hypertension, participants with untreated hypertension had a 19% greater risk of newly diagnosed fibroids (HR, 1.19; 95% CI, 0.91-1.57), whereas those with treated hypertension had a 20% lower risk (HR, 0.80; 95% CI, 0.56-1.15). Among eligible participants with hypertension, those taking antihypertensive treatment had a 37% lower risk of newly diagnosed fibroids (HR, 0.63; 95% CI, 0.38-1.05). Risk also varied by hypertension status: compared with never-hypertensive participants, participants with new-onset hypertension had 45% greater risk of newly diagnosed fibroids (HR, 1.45; 95% CI, 0.96-2.20). Anthropometric factors and blood biomarkers were not associated with fibroid risk. Conclusions and Relevance Participants with untreated and new-onset hypertension had increased risk of newly diagnosed fibroids, whereas those taking antihypertensive treatment had lower risk, suggesting that blood pressure control may provide new strategies for fibroid prevention.
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Affiliation(s)
- Susanna D. Mitro
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Davis
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Eve Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - Rebecca C. Thurston
- Department of Psychology and Psychiatry, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
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Cameron K, Borahay M, Hong X, Baker V, Vaught A, Wang X. Uterine fibroids and risk of hypertensive disorders of pregnancy - results from a racially diverse high-risk cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.05.24303830. [PMID: 38496516 PMCID: PMC10942496 DOI: 10.1101/2024.03.05.24303830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Study Question What is the impact of the presence of uterine fibroids on the risk of developing hypertensive disorders of pregnancy (HDP) in a predominantly urban, low-income, Black, and Hispanic population of women with ultrasound or clinically diagnosed uterine fibroids with rich phenotypic data to carefully control for potential confounders? Summary answers The odds of HDP were 39% higher in women with uterine fibroids compared to those without when controlled for age at delivery, race, prepregnancy BMI, education, parity, and smoking status; neither fibroid location or size modified this risk. What is known already Studies are conflicting regarding the impact of uterine fibroids on risk of HDP; limitations of prior studies include primarily Western European populations and lack of measurement of potential confounders. Study design size and duration A total of 7030 women from the Boston Birth Cohort (a racially diverse cohort recruited from 1998 to 2018) that had clinical and ultrasound data regarding uterine fibroid status were included in this analysis. Participants/materials setting and methods Four hundred eighty-nine women with uterine fibroids and 6541 women without were included. Hypertensive disorders of pregnancy were ascertained from medical records. Logistic regression was performed to assess the risk of HDP in women with and without uterine fibroids. Covariates adjusted for included age at delivery, race, pre-pregnancy BMI, education, parity, and smoking status during pregnancy. Sub-analyses were performed to assess the impact of specific fibroid location and overall fibroid volume burden. Main results and the role of chance The incidence of uterine fibroids in the cohort was 7% (N=489). Twelve percent of women without uterine fibroids and 17% of women with fibroids developed HDP; in multivariate analyses adjusted for the potential confounders above, the odds of HDP were 39% higher in women with uterine fibroids compared to those without (p=0.03). Women with a uterine fibroid diagnosis based on ICD code (n=297) versus asymptomatic incidental ultrasound diagnosis (n=192) had a significantly greater chance of developing HDP (20 vs 15%, p=0.006). There did not appear to be an association between number of fibroids or total fibroid volume and the risk of developing HDP. Limitations, reasons for caution: This study has a relatively small sample size. While post-hoc power calculation determined that there was adequate power to detect a 4.6% difference in the incidence of development of HDP between participants with uterine fibroids and those without, the sub-analyses based on fibroid size, location, and method of diagnosis were underpowered to determine a similar level of difference. Wider implications of the findings In a racially diverse cohort, presence of uterine fibroids was a significant risk factor for developing HDP, regardless of uterine fibroid size or location. This may have implications for additional monitoring and risk stratification in women with uterine fibroids. Study funding/competing interests KC supported by WRHR NIH NICHD Award # K12 HD103036, PI Andrew Satin, RD James Segars. The Boston Birth Cohort (the parent study) was supported in part by the National Institutes of Health (NIH) grants (2R01HD041702, R01HD098232, R01ES031272, R01ES031521, and U01 ES034983); and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) (UT7MC45949). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by any funding agencies. Trial registration number The BBC is registered under clinicaltrials.gov NCT03228875 .
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Nasab S, Gough EK, Nylander E, Borahay M, Segars J, Baker V, Wang X, Cameron K. Uterine Fibroids and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.05.24303824. [PMID: 38496589 PMCID: PMC10942514 DOI: 10.1101/2024.03.05.24303824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Capsule In this study the presence of uterine fibroids was significantly associated with an increased risk of development of hypertensive disorders of pregnancy even when accounting for age and BMI in meta-regression. This finding has potential implications for risk stratification and monitoring for hypertension during pregnancy in this population. Objective To examine the association between uterine fibroids and the development of hypertensive disorders in pregnancy. Data sources Cochrane, Embase, PubMed, MEDLINE, Scopus, and Web of Science databases were searched from inception through April 2023. Study Selection and Synthesis Cohort, case-control, or case series studies including uterine fibroid status and hypertensive disorders of pregnancy status were included. The comparison group was pregnant women without uterine fibroids. Inverse-variance weighted random effects models were used to pool RR and OR estimates separately. Age and BMI were explored as potential sources of heterogeneity using inverse-variance weighted meta-regression. Main Outcomes Hypertensive disorders of pregnancy (HDP) defined as gestational hypertension, pre-eclampsia, eclampsia, superimposed preeclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Results A total of 17 studies were included (Total N=1,374,395 participants, N=64,968 with uterine fibroids). Thirteen studies were retrospective cohorts and four were case-control studies. Women with uterine fibroids had a significantly higher risk of hypertensive disorders in pregnancy compared to women without uterine fibroids with RR 1.74 (95% CI 1.33-2.27, p<0.01), and OR 2.87 (95% CI 1.38-5.97, p<0.01), in cohort studies and case-control studies, respectively. In meta-regression analyses, age did not significantly change the positive association between uterine fibroids and hypertensive disorders in pregnancy. Conclusion Uterine fibroids were associated with an increased risk of hypertensive disorders of pregnancy when all available literature was synthesized, including when shared risk factors are examined in meta-regression analyses. Relevance If confirmed in future studies, investigations into the mechanisms of this association are needed as this finding potentially has implications for risk stratification and monitoring for hypertensive disorders of pregnancy in this population. Trial Registration PROSPERO, ID # 331528.
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Brewster LM, Perrotta ID, Jagernath Z, Taherzadeh Z, van Montfrans GA. Ultrastructural changes in resistance arterioles of normotensive and hypertensive premenopausal women with uterine fibroids. Ultrastruct Pathol 2023; 47:1-12. [PMID: 36780499 DOI: 10.1080/01913123.2023.2171168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023]
Abstract
The association between uterine smooth muscle fibroids and systemic arterial hypertension is poorly understood. Therefore, we explored possible concomitant myocyte pathology of systemic resistance-sized arterioles (200 to 400 μm), isolated from omental samples donated by 19 women (mean age 42 y; SE 1) undergoing fibroid surgery. Vessels of 17 women (8 hypertensives) were available for transmission electron microscopy. We found ultrastructural vessel wall abnormalities in all patients, albeit with greater severity in hypertensives. In the endothelium, this ranged from moderate mitochondrial and endoplasmic reticulum stress in normotensives, to necrosis and sloughing in hypertensives. Myocyte-like cells were observed to migrate across the internal elastic lamina, with isolated subendothelial myocytes in normotensives, and focal subendothelial multicellular aggregates or myo-intimal "cushions" in hypertensives. Medial myocytes of all patients showed abnormalities similar to fibroids, with dilated sarco-endoplasmic reticulum, elongated mitochondria, and myofilament loss involving focal areas or entire cells. To our knowledge, the first study on the ultrastructure of systemic resistance arterioles of women with fibroids indicates that severe abnormalities are present that likely affect blood pressure regulation. Whether these perturbations are induced by fibroids, or represent systemic pathology that affects myocytes of both uterine and vascular tissue warrants further exploration.
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Affiliation(s)
- L M Brewster
- CK Science Foundation, Amsterdam, the Netherlands
| | - I D Perrotta
- University of Calabria, Department of Biology, Ecology and Earth Sciences, Centre for Microscopy and Microanalysis, Cosenza, Italy
| | - Z Jagernath
- Department of Cardiology, Academic Hospital of the University of Paramaribo, Suriname
| | - Z Taherzadeh
- Targeted Drug Delivery Research Center and Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (formerly, Department of Biomedical Engineering and Physics, University Medical Centers Amsterdam, Amsterdam, the Netherlands)
| | - G A van Montfrans
- Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Amsterdam, the Netherlands
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Alashqar A, El Ouweini H, Gornet M, Yenokyan G, Borahay MA. Cardiometabolic profile of women with uterine leiomyoma: a cross-sectional study. Minerva Obstet Gynecol 2023; 75:27-38. [PMID: 35333033 DOI: 10.23736/s2724-606x.22.04952-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Emerging evidence suggests that cardiometabolic risk factors contribute to uterine leiomyoma development, but cardiometabolic profiles of women with the tumor remain poorly defined. This study aimed to determine the association of cardiometabolic comorbidities and cardiometabolic medication use with a leiomyoma diagnosis. METHODS In this cross-sectional study, aggregate-level data from 2013-2020 were collected using the SlicerDicer feature of Epic (Epic, Verona, WI, USA) electronic medical record system. Women ≥18 years with at least one visit or hospital encounter at the Johns Hopkins Health System (N.=679,981) were assigned as cases or controls according to leiomyoma status. Individual prevalence of each prespecified cardiometabolic comorbidity and relevant prescription medications was obtained. Prevalence Odds Ratios were used to assess the association of cardiometabolic comorbidities and medication use with uterine leiomyoma. RESULTS Women with uterine leiomyoma (N.=27,703) were more likely to be obese (2.56; 95% CI: 2.49-2.63), have metabolic syndrome (1.82; 95% CI: 1.51-2.19), essential hypertension (1.45; 95% CI: 1.42-1.49), diabetes mellitus (1.29; 95% CI: 1.24-1.33) and hyperlipidemia (1.23; 95% CI: 1.19-1.26). These associations were stronger among younger women and persisted after excluding those with a hysterectomy. Notably, statins were the only medications associated with a lower leiomyoma risk (0.81; 95% CI: 0.79-0.84). CONCLUSIONS Uterine leiomyoma is associated with a spectrum of cardiometabolic comorbidities and use of associated medications, constituting an unfavorable cardiometabolic profile in women with the tumor. If definitively correlated, prevention and early management of cardiometabolic risk factors may decrease uterine leiomyoma incidence, and screening women with uterine leiomyoma for cardiometabolic comorbidities may aid in cardiovascular disease prevention.
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Affiliation(s)
- Abdelrahman Alashqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.,Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | - Hala El Ouweini
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.,American University of Beirut, Beirut, Lebanon
| | - Megan Gornet
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Biostatistics Center, Baltimore, MD, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA -
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Sliz E, Tyrmi JS, Rahmioglu N, Zondervan KT, Becker CM, Uimari O, Kettunen J. Evidence of a causal effect of genetic tendency to gain muscle mass on uterine leiomyomata. Nat Commun 2023; 14:542. [PMID: 36726022 PMCID: PMC9892568 DOI: 10.1038/s41467-023-35974-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
Uterine leiomyomata (UL) are the most common tumours of the female genital tract and the primary cause of surgical removal of the uterus. Genetic factors contribute to UL susceptibility. To add understanding to the heritable genetic risk factors, we conduct a genome-wide association study (GWAS) of UL in up to 426,558 European women from FinnGen and a previous UL meta-GWAS. In addition to the 50 known UL loci, we identify 22 loci that have not been associated with UL in prior studies. UL-associated loci harbour genes enriched for development, growth, and cellular senescence. Of particular interest are the smooth muscle cell differentiation and proliferation-regulating genes functioning on the myocardin-cyclin dependent kinase inhibitor 1 A pathway. Our results further suggest that genetic predisposition to increased fat-free mass may be causally related to higher UL risk, underscoring the involvement of altered muscle tissue biology in UL pathophysiology. Overall, our findings add to the understanding of the genetic pathways underlying UL, which may aid in developing novel therapeutics.
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Affiliation(s)
- Eeva Sliz
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Biocenter Oulu, Oulu, Finland.
| | - Jaakko S Tyrmi
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, Oulu, Finland
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Krina T Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Christian M Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Johannes Kettunen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, Oulu, Finland
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Kim G, Jang G, Song J, Kim D, Lee S, Joo JWJ, Jang W. A transcriptome-wide association study of uterine fibroids to identify potential genetic markers and toxic chemicals. PLoS One 2022; 17:e0274879. [PMID: 36174000 PMCID: PMC9521910 DOI: 10.1371/journal.pone.0274879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Uterine fibroid is one of the most prevalent benign tumors in women, with high socioeconomic costs. Although genome-wide association studies (GWAS) have identified several loci associated with uterine fibroid risks, they could not successfully interpret the biological effects of genomic variants at the gene expression levels. To prioritize uterine fibroid susceptibility genes that are biologically interpretable, we conducted a transcriptome-wide association study (TWAS) by integrating GWAS data of uterine fibroid and expression quantitative loci data. We identified nine significant TWAS genes including two novel genes, RP11-282O18.3 and KBTBD7, which may be causal genes for uterine fibroid. We conducted functional enrichment network analyses using the TWAS results to investigate the biological pathways in which the overall TWAS genes were involved. The results demonstrated the immune system process to be a key pathway in uterine fibroid pathogenesis. Finally, we carried out chemical–gene interaction analyses using the TWAS results and the comparative toxicogenomics database to determine the potential risk chemicals for uterine fibroid. We identified five toxic chemicals that were significantly associated with uterine fibroid TWAS genes, suggesting that they may be implicated in the pathogenesis of uterine fibroid. In this study, we performed an integrative analysis covering the broad application of bioinformatics approaches. Our study may provide a deeper understanding of uterine fibroid etiologies and informative notifications about potential risk chemicals for uterine fibroid.
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Affiliation(s)
- Gayeon Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Gyuyeon Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jaeseung Song
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Daeun Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Sora Lee
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jong Wha J. Joo
- Department of Computer Science and Engineering, Dongguk University-Seoul, Seoul, South Korea
| | - Wonhee Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
- * E-mail:
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Kolstad EMM, Østergård S, Andersen G, Fuglsang K. Intravascular leiomyomatosis: a continuing diagnostic challenge. BMJ Case Rep 2022; 15:e249480. [PMID: 36104036 PMCID: PMC9476136 DOI: 10.1136/bcr-2022-249480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a woman in her 60s with intravascular leiomyomatosis. She suffered from numerous non-specific symptoms including weight loss, anaemia and sudden swelling of the left lower extremity. CT imaging showed the presence of an enlarged left ovary and a thrombus extending from the left ovarian venous plexus intruding into the right atrium of the heart. Cancer antigen 125 was 20 U/mL. Pelvic transvaginal ultrasound examination identified two normal ovaries and a mass adjacent to the left ovary. A second opinion on the CT scan was requested at a oncogynaecological multidisciplinary team meeting, where the radiologist of the team identified an intervascular leiomyomatosis. After further investigation, surgical treatment was planned and completed in collaboration with the departments of cardiothoracic and vascular surgery. The patient recovered fully.
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Affiliation(s)
| | - Signe Østergård
- Gynecology and Obstetrics, Aarhus Universitetshospital Skejby, Aarhus, Denmark
| | | | - Katrine Fuglsang
- Gynecology and Obstetrics, Aarhus Universitetshospital Skejby, Aarhus, Denmark
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Harvey RE, Laughlin‐Tommaso SK, Stewart EA, Limberg JK, Curry TB, Joyner MJ, Barnes JN. The relationship between muscle sympathetic nerve activity and systemic hemodynamics is altered in women with uterine fibroids. Physiol Rep 2022; 10:e15445. [PMID: 36117415 PMCID: PMC9483612 DOI: 10.14814/phy2.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023] Open
Abstract
Women with uterine fibroids (UF), benign tumors of the myometrium, have a higher prevalence of hypertension than women without UF. The cause for this relationship is unclear. Muscle sympathetic nerve activity (MSNA) is a regulator of arterial blood pressure, and it is possible that variations in MSNA predispose women with UF to develop hypertension. The purpose of this study was to assess baseline blood pressure and MSNA and the relationships between MSNA and systemic hemodynamics in women with and without UF. We measured blood pressure (brachial intra-arterial line), MSNA (microneurography), and systemic hemodynamics (total peripheral resistance and cardiac output) at rest in 14 healthy, normotensive, premenopausal women with UF (42 ± 2 years old) and 9 healthy, normotensive, premenopausal women without UF (41 ± 2 years old). Baseline blood pressure and MSNA did not differ between groups (p > 0.05 for both). In women with UF, there was a positive correlation between MSNA and total peripheral resistance (r = 0.75, p = 0.02), as well as a negative correlation between MSNA and cardiac output (r = -0.73, p = 0.03). In contrast, these relationships were not seen in women without UF (p > 0.05 for both relationships). These data suggest that autonomic interactions with systemic hemodynamics, and thus blood pressure regulation, are different in healthy women with UF compared to healthy women without UF.
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Affiliation(s)
- Ronée E. Harvey
- Mayo Clinic College of Medicine and ScienceMayo ClinicRochesterMinnesotaUSA
- Department of AnesthesiologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - Jacqueline K. Limberg
- Department of AnesthesiologyMayo ClinicRochesterMinnesotaUSA
- Department of Nutrition and Exercise PhysiologyUniversity of MissouriColumbiaMissouriUSA
| | | | | | - Jill N. Barnes
- Department of AnesthesiologyMayo ClinicRochesterMinnesotaUSA
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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12
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Li B, Yuan Z, Zhang Y, Li F, Huang L, Yang Z, Liu H, Liu Z. Exploring the role of uterine fibroids in promotion of cardiovascular diseases by diabetes exposure: Findings from national health and nutrition examination survey 1999-2006. Front Cardiovasc Med 2022; 9:975920. [PMID: 36017104 PMCID: PMC9395617 DOI: 10.3389/fcvm.2022.975920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 12/11/2022] Open
Abstract
Objective The relationship between uterine fibroids (UF) and cardiovascular diseases (CVDs) in the diabetes population seemed to remain undetermined in previous studies. This study aims to explore the association between UF and CVDs by using the database from the National Health and Nutrition Examination Survey (NHANES). To further evaluate the connection between UF and CVDs we also tested the potential differences due to diabetes exposure. Materials and methods National Health and Nutrition Examination Survey data (1999–2006) were collected and used in this study. A total of 5,509 individuals were included and analyzed. The student’s t-test and the chi-squared test were used to explore the demographic characteristic between UF and non-UF groups. Logistic regression analysis was performed to determine the odds ratios of UF and covariates. Results Female participants were divided into UF (n = 694, 12.60%) and non-UF (n = 4,815, 87.40%) groups. The incidence of CVDs in UF patients (n = 245, 35.30%) were higher than non-UF individuals (n = 776, 16.12%) (p < 0.001). In addition, each subtype of CVDs were also different, which contains hypertension (33.29 vs. 15.31%, p < 0.001), heart failure (1.59 vs. 0.52%, p < 0.01), angina (2.59 vs. 0.62%, p < 0.001), heart attack (1.73 vs. 0.58%, p < 0.01) and coronary heart disease (1.44 vs. 0.54%, p < 0.01). The odds ratios of CVDs according to logistic regression were 2.840 (95% CI: 2.387–3.379) for UF patients (p < 0.001), while the odds ratios (ORs) were 1.438 (95% CI: 1.175–1.760) after taking account for the age, body mass index (BMI), diabetes, race, education, and annual family income (p < 0.001). In addition, secondary analysis indicated more adverse effects in by UF exposure on CVDs risk among non-diabetes individuals (OR = 1.389, 95% CI = 1.124–1.718, p < 0.01) than diabetes patients (p = 0.063). Conclusion Overall, UFs were positively associated with CVDs, and this effect seems blunted by diabetes exposure.
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Affiliation(s)
- Bin Li
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Zhen Yuan
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Yizhi Zhang
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Feng Li
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Lin Huang
- Pharmaceutical and Medical Technology College, Putian University, Putian, China
| | - Zhihui Yang
- Pharmaceutical and Medical Technology College, Putian University, Putian, China
| | - Haiyue Liu
- Xiamen Key Laboratory of Genetic Testing, Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Zuheng Liu
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.,Xiamen Key Laboratory of Cardiac Electrophysiology, Department of Cardiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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13
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Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocr Rev 2022; 43:678-719. [PMID: 34741454 PMCID: PMC9277653 DOI: 10.1210/endrev/bnab039] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/24/2022]
Abstract
Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive treatment option exists for hormone-dependent uterine fibroids, due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and the complexity of uterine fibroids can contribute to the progress of newer targeted therapies.
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Affiliation(s)
- Qiwei Yang
- Qiwei Yang, Ph.D. Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, M167, Billings, Chicago, IL 60637, USA.
| | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland
| | | | - Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Hoda Elkafas
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Pharmacology and Toxicology, Egyptian Drug Authority, formerly National Organization for Drug Control and Research, Cairo 35521, Egypt
| | - Thomas G Boyer
- Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229-3900, USA
| | - Ayman Al-Hendy
- Correspondence: Ayman Al-Hendy, MD, Ph.D. Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, N112, Peck Pavilion, Chicago, IL 60637. USA.
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14
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Wu X, Xiao C, Han Z, Zhang L, Zhao X, Hao Y, Xiao J, Gallagher CS, Kraft P, Morton CC, Li J, Jiang X. Investigating the shared genetic architecture of uterine leiomyoma and breast cancer: A genome-wide cross-trait analysis. Am J Hum Genet 2022; 109:1272-1285. [PMID: 35803233 PMCID: PMC9300879 DOI: 10.1016/j.ajhg.2022.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/25/2022] [Indexed: 01/09/2023] Open
Abstract
Little is known regarding the shared genetic architecture or causality underlying the phenotypic association observed for uterine leiomyoma (UL) and breast cancer (BC). Leveraging summary statistics from the hitherto largest genome-wide association study (GWAS) conducted in each trait, we investigated the genetic overlap and causal associations of UL with BC overall, as well as with its subtypes defined by the status of estrogen receptor (ER). We observed a positive genetic correlation between UL and BC overall (rg = 0.09, p = 6.00 × 10-3), which was consistent in ER+ subtype (rg = 0.06, p = 0.01) but not in ER- subtype (rg = 0.06, p = 0.08). Partitioning the whole genome into 1,703 independent regions, local genetic correlation was identified at 22q13.1 for UL with BC overall and with ER+ subtype. Significant genetic correlation was further discovered in 9 out of 14 functional categories, with the highest estimates observed in coding, H3K9ac, and repressed regions. Cross-trait meta-analysis identified 9 novel loci shared between UL and BC. Mendelian randomization demonstrated a significantly increased risk of BC overall (OR = 1.09, 95% CI = 1.01-1.18) and ER+ subtype (OR = 1.09, 95% CI = 1.01-1.17) for genetic liability to UL. No reverse causality was found. Our comprehensive genome-wide cross-trait analysis demonstrates a shared genetic basis, pleiotropic loci, as well as a putative causal relationship between UL and BC, highlighting an intrinsic link underlying these two complex female diseases.
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Affiliation(s)
- Xueyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chenghan Xiao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhitong Han
- Department of Life Sciences, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xunying Zhao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yu Hao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jinyu Xiao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - C Scott Gallagher
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Peter Kraft
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cynthia Casson Morton
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Manchester Centre for Audiology and Deafness, Manchester Academic Health Science Center, University of Manchester, Manchester M13 9PL, UK
| | - Jiayuan Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Xia Jiang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Program in Genetic Epidemiology and Statistical Genetics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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15
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Chen Y, Xiong N, Xiao J, Huang X, Chen R, Ye S, Tan X. Association of uterine fibroids with increased blood pressure: a cross-sectional study and meta-analysis. Hypertens Res 2022; 45:715-721. [PMID: 35169279 DOI: 10.1038/s41440-022-00856-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
Uterine fibroids (UFs) are the most common benign gynecological tumor and greatly affect reproductive health in women of reproductive age. Some studies have indicated an association between UFs and several cardiovascular disease (CVD) risk factors. To determine whether UFs are associated with increased blood pressure, we performed a cross-sectional study and meta-analysis. In the cross-sectional study, 8401 participants who underwent a physical examination at the First Affiliated Hospital of Shantou University Medical College from June 2011 to June 2013 were divided into a uterine fibroid group (1617 cases) and a control group (6784 cases) to assess the relationship between UFs and blood pressure. Then, we conducted a systematic review to confirm the results. The cross-sectional study showed that UFs were associated with an increased rate of elevated blood pressure [OR = 1.35, 95% confidence interval (CI): 1.016-1.792]. The meta-analysis revealed a significant association between UFs and the prevalence of hypertension [pooled OR = 1.44, 95% CI: 1.17-1.75, P = 0.0004; I2 = 68%]. Thus, UFs may be associated with the prevalence of hypertension. Women with uterine fibroids should be closely monitored for hypertension.
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Affiliation(s)
- Yequn Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
- Institute of Clinical Electrocardiology, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
- Institute of Cardiac Engineering, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
| | - Nianling Xiong
- Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Jiaxin Xiao
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiru Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Rongbing Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Shu Ye
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Xuerui Tan
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
- Institute of Clinical Electrocardiology, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
- Institute of Cardiac Engineering, The First Affiliated Hospital of Shantou University Medical College (SUMC), Shantou, China
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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16
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Emokpae M, Kareem F. Association between the concentrations of some toxic metals and the risk of uterine fibroids among Nigerian women. ENVIRONMENTAL DISEASE 2022. [DOI: 10.4103/ed.ed_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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17
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Ahmed N, El Aal NA, ELLakwa H, Hassanein S, Ammar H. Role of three-dimensional ultrasound and Doppler in differentiating leiomyoma and adenomyosis of uterus. MENOUFIA MEDICAL JOURNAL 2022; 35:762. [DOI: 10.4103/mmj.mmj_214_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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18
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Moresco A, Feltrer-Rambaud Y, Wolfman D, Agnew DW. Reproductive one health in primates. Am J Primatol 2021; 84:e23325. [PMID: 34516669 DOI: 10.1002/ajp.23325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/28/2021] [Accepted: 08/21/2021] [Indexed: 12/13/2022]
Abstract
One Health is a collaborative trans-disciplinary approach to health; integrating human, animal, and environmental health. The focus is often on infection disease transmission and disease risk mitigation. However, One Health also includes the multidisciplinary and comparative approach to disease investigation and health of humans, animals, and the environment. One key aspect of environmental/ecosystem health is conservation, the maintenance of healthy, actively reproducing wildlife populations. Reproduction and reproductive health are an integral part of the One Health approach: the comparative aspects of reproduction can inform conservation policies or breeding strategies (in situ and ex situ) in addition to physiology and disease. Differences in reproductive strategies affect the impact poaching and habitat disruption might have on a given population, as well as ex situ breeding programs and the management of zoo and sanctuary populations. Much is known about chimpanzees, macaques, and marmosets as these are common animal models, but there is much that remains unknown regarding reproduction in many other primates. Examining the similarities and differences between and within taxonomic groups allows reasonable extrapolation for decision-making when there are knowledge gaps. For example: (1) knowing that a species has very low reproductive rates adds urgency to conservation policy for that region or species; (2) identifying species with short or absent lactation anestrus allows ex situ institutions to better plan contraception options for specific individuals or prepare for the immediate next pregnancy; (3) recognizing that progestin contraceptives are effective contraceptives, but may be associated with endometrial hyperplasia in some species (in Lemuridae but not great apes) better guides empirical contraceptive choice; (4) recognizing the variable endometriosis prevalence across taxa improves preventive medicine programs. A summary of anatomical variation, endocrinology, contraception, pathology, and diagnostics is provided to illustrate these features and aid in routine physical and postmortem examinations as well as primate management.
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Affiliation(s)
- Anneke Moresco
- International Primate Health & Welfare Group, Madrid, Spain.,Reproductive Health Surveillance Program, Morrison, Colorado, USA
| | - Yedra Feltrer-Rambaud
- International Primate Health & Welfare Group, Madrid, Spain.,EAZA Reproductive Management Group, Chester, UK
| | - Darcy Wolfman
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, National Capital Region, Baltimore, Maryland, USA
| | - Dalen W Agnew
- Reproductive Health Surveillance Program, Morrison, Colorado, USA.,Michigan State University, Lansing, Michigan, USA
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19
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Wesselink AK, Rosenberg L, Wise LA, Jerrett M, Coogan PF. A prospective cohort study of ambient air pollution exposure and risk of uterine leiomyomata. Hum Reprod 2021; 36:2321-2330. [PMID: 33984861 DOI: 10.1093/humrep/deab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent are ambient concentrations of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) associated with risk of self-reported physician-diagnosed uterine leiomyomata (UL)? SUMMARY ANSWER In this large prospective cohort study of Black women, ambient concentrations of O3, but not PM2.5 or NO2, were associated with increased risk of UL. WHAT IS KNOWN ALREADY UL are benign tumors of the myometrium that are the leading cause of gynecologic inpatient care among reproductive-aged women. Black women are clinically diagnosed at two to three times the rate of white women and tend to exhibit earlier onset and more severe disease. Two epidemiologic studies have found positive associations between air pollution exposure and UL risk, but neither included large numbers of Black women. STUDY DESIGN, SIZE, DURATION We conducted a prospective cohort study of 21 998 premenopausal Black women residing in 56 US metropolitan areas from 1997 to 2011. PARTICIPANTS/MATERIAL, SETTING, METHODS Women reported incident UL diagnosis and method of confirmation (i.e. ultrasound, surgery) on biennial follow-up questionnaires. We modeled annual residential concentrations of PM2.5, NO2 and O3 throughout the study period. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for a one-interquartile range (IQR) increase in air pollutant concentrations, adjusting for confounders and co-pollutants. MAIN RESULTS AND THE ROLE OF CHANCE During 196 685 person-years of follow-up, 6238 participants (28.4%) reported physician-diagnosed UL confirmed by ultrasound or surgery. Although concentrations of PM2.5 and NO2 were not appreciably associated with UL (HRs for a one-IQR increase: 1.01 (95% CI: 0.93, 1.10) and 1.05 (95% CI: 0.95, 1.16), respectively), O3 concentrations were associated with increased UL risk (HR for a one-IQR increase: 1.19, 95% CI: 1.07, 1.32). The association was stronger among women age <35 years (HR: 1.26, 95% CI: 0.98, 1.62) and parous women (HR: 1.28, 95% CI: 1.11, 1.48). LIMITATIONS, REASONS FOR CAUTION Our measurement of air pollution is subject to misclassification, as monitoring data are not equally spatially distributed and we did not account for time-activity patterns. Our outcome measure was based on self-report of a physician diagnosis, likely resulting in under-ascertainment of UL. Although we controlled for several individual- and neighborhood-level confounding variables, residual confounding remains a possibility. WIDER IMPLICATIONS OF THE FINDINGS Inequitable burden of air pollution exposure has important implications for racial health disparities, and may be related to disparities in UL. Our results emphasize the need for additional research focused on environmental causes of UL. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the National Cancer Institute (U01-CAA164974) and the National Institute of Environmental Health Sciences (R01-ES019573). L.A.W. is a fibroid consultant for AbbVie, Inc. and accepts in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, FertilityFriend.com and Kindara.com for primary data collection in Pregnancy Study Online (PRESTO). M.J. declares consultancy fees from the Health Effects Institute (as a member of the review committee). The remaining authors declare they have no actual or potential competing financial interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles, CA, USA
| | - Patricia F Coogan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
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20
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Kirschen GW, AlAshqar A, Miyashita-Ishiwata M, Reschke L, El Sabeh M, Borahay MA. Vascular biology of uterine fibroids: connecting fibroids and vascular disorders. Reproduction 2021; 162:R1-R18. [PMID: 34034234 DOI: 10.1530/rep-21-0087] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
Fibroids are benign tumors caused by the proliferation of myometrial smooth muscle cells in the uterus that can lead to symptoms such as abdominal pain, constipation, urinary retention, and infertility. While traditionally thought of as a disease process intrinsic to the uterus, accumulating evidence suggests that fibroid growth may be linked with the systemic vasculature system, although cell-intrinsic factors are certainly of principal importance in their inception. Fibroids are associated with essential hypertension and preeclampsia, as well as atherosclerosis, for reasons that are becoming increasingly elucidated. Factors such as the renin-angiotensin-aldosterone system, estrogen, and endothelial dysfunction all likely play a role in fibroid pathogenesis. In this review, we lay out a framework for reconceptualizing fibroids as a systemic vascular disorder, and discuss how pharmaceutical agents and other interventions targeting the vasculature may aid in the novel treatment of fibroids.
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Affiliation(s)
- Gregory W Kirschen
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdelrahman AlAshqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | | | - Lauren Reschke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Malak El Sabeh
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
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21
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Orta OR, Terry KL, Missmer SA, Harris HR. Dairy and related nutrient intake and risk of uterine leiomyoma: a prospective cohort study. Hum Reprod 2021; 35:453-463. [PMID: 32086510 DOI: 10.1093/humrep/dez278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/26/2019] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is there an association between consumption of dairy foods and related nutrients and risk of uterine leiomyoma? SUMMARY ANSWER While dairy consumption was not consistently associated with uterine leiomyoma risk, intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. WHAT IS KNOWN ALREADY Two studies have examined the association between dairy intake and uterine leiomyoma risk with inconsistent results. Dairy foods have been inversely associated with inflammation and tumorigenesis, suggesting that vitamins and minerals concentrated in these dietary sources may influence uterine leiomyoma risk. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out using data collected from 81 590 premenopausal women from 1991 to 2009 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Diet was assessed with a validated food frequency questionnaire every 4 years. Cases were restricted to self-reported ultrasound or hysterectomy-confirmation uterine leiomyoma. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE Eight thousand one hundred and forty-two cases of ultrasound or hysterectomy-confirmed uterine leiomyoma were diagnosed over an 18-year period. When compared to participants who consumed two servings a week of total dairy foods, participants who consumed four or more servings had a borderline significant 8% reduced risk of uterine leiomyoma (HR = 0.92, 95% CI = 0.85, 1.00; ptrend = 0.19). When the association between specific dairy foods and uterine leiomyoma was examined, the relation between dairy-food intake and uterine leiomyoma appeared to be driven primarily by yogurt consumption (HR for 2+ servings/day = 0.76; 95% CI = 0.55, 1.04 compared to <=4 servings/week; ptrend = 0.03); however, there was a small number of cases in the 2+ servings/day group (n = 39). Of the nutrients examined, the association was strongest for calcium from foods (HR fifth quintile = 0.92, 95% CI = 0.86, 0.99; ptrend = 0.04). LIMITATIONS, REASONS FOR CAUTION Some cases of uterine leiomyoma were likely misclassified, particularly those that were asymptomatic. It is possible that dairy product constituents reduce uterine leiomyoma symptomology rather than development, giving the appearance of a protective effect on leiomyoma development: no data on uterine leiomyoma symptomology were available. We did not have vitamin and mineral concentrations from actual blood levels. Similarly, there is the potential for misclassification of participants based on predicted 25(OH)D, and changes in vitamin D supplementation over time may have impacted prediction models for 25(OH)D. Further, some error in the self-reporting of dietary intake is expected. Given our prospective design, it is likely that these misclassifications were non-differential with respect to the outcome, likely biasing estimates toward the null. WIDER IMPLICATIONS OF THE FINDINGS While no clear association between overall dairy consumption and uterine leiomyoma risk was observed, our findings suggest that intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by research grant HD081064 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Nurses' Health Study II is supported by the Public Health Service grant UM1 CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). There are no conflicts of interest to declare.
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Affiliation(s)
- O R Orta
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - K L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, Massachusetts, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, Michigan, USA
| | - H R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Fischer NM, Nieuwenhuis TO, Singh B, Yenokyan G, Segars JH. Angiotensin-Converting Enzyme Inhibitors Reduce Uterine Fibroid Incidence in Hypertensive Women. J Clin Endocrinol Metab 2021; 106:e650-e659. [PMID: 33035320 PMCID: PMC7823233 DOI: 10.1210/clinem/dgaa718] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 01/16/2023]
Abstract
CONTEXT In vitro and in vivo evidence has supported the role of angiotensin II blockade in reducing leiomyoma cell proliferation and growth. However, no population-based study to date has investigated this potential association. OBJECTIVE This work aims to determine whether prior angiotensin-converting enzyme inhibitor (ACEi) use is associated with a reduced odds of leiomyoma development. DESIGN A nested case-control study was conducted. SETTING The population was assembled from the Truven Health MarketScan Research Database, which includes private health insurance claims from January 1, 2012 to December 31, 2017. PATIENTS OR OTHER PARTICIPANTS We included (n = 353 917) women age 18 to 65 with hypertension. Cases (n = 13 108) with a leiomyoma diagnosis were matched to controls (n = 340 808) with no such diagnosis at a 1:26 ratio by age and region of origin within the United States. INTERVENTION Prior ACEi use was determined from outpatient drug claims. MAIN OUTCOME MEASURE Leiomyoma development was indicated by a first-time diagnosis code. RESULTS Women on an ACEi experienced a 31.8% reduced odds of developing clinically recognized leiomyoma compared to nonusers (odds ratio [OR] 0.68; 95% CI, 0.65-0.72). This association was significant for each age group: 30 to 39 years (OR 0.86; 95% CI, 0.74-0.99), 40 to 49 years (OR 0.71; 95% CI, 0.66-0.76), 50 to 59 years (OR 0.63; 95% CI, 0.58-0.69), and 60 to 65 years (OR 0.58; 95% CI, 0.50-0.69). Of the ACEis, lisinopril (OR 0.67; 95% CI, 0.64-0.71), quinapril (OR 0.62; 95% CI, 0.41-0.92), and ramipril (OR 0.35; 95% CI, 0.23-0.50) demonstrated a significant association with reduced leiomyoma incidence. CONCLUSIONS ACEi use was associated with a reduced odds of developing clinically recognized leiomyoma in adult hypertensive women.
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Affiliation(s)
- Nicole M Fischer
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women’s Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Bhuchitra Singh
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women’s Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gayane Yenokyan
- Biostatistics Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - James H Segars
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women’s Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
OBJECTIVE It is unclear whether uterine fibroids are associated with the occurrence of hypertensive disorders of pregnancy (HDP). Thus, this study aimed to evaluate the association between uterine fibroids and HDP in a prospective cohort. METHODS Overall, 2404 pregnant women who received antenatal care were enrolled in a prospective cohort in China between 2014 and 2016; 2277 women met the inclusion criteria of this study. The clinical characteristics of participants were assessed via questionnaires and physical examinations at baseline (before the 20th week of gestation), 21st-27th, 28th-34th, and 35th-39th gestational weeks. Ultrasound examination was performed before the 20th week of pregnancy to determine the presence of uterine fibroids. Linear mixed-effect and Cox proportional hazard regression models were used to analyze the association of uterine fibroids with blood pressure and HDP. RESULTS Of 2277 pregnant women, 242 (10.6%) had uterine fibroids, and 45 (2.0%) subsequently developed HDP. The incidence of HDP in women with and without uterine fibroids was 5% (n = 12) and 1.6% (n = 33), respectively. The longitudinal SBPs and DBPs were significantly higher in women with uterine fibroids than in those without. The multivariable Cox model showed that the presence of uterine fibroids was associated with increased HDP risk (adjusted hazard radio: 2.95, 95% confidence interval: 1.35-6.44). CONCLUSION Uterine fibroids in early pregnancy were associated with an increased HDP risk. Blood pressure of women with uterine fibroids should be closely monitored, and HDP preventive measures are crucial.
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Chung HF, Ferreira I, Mishra GD. The association between menstrual symptoms and hypertension among young women: A prospective longitudinal study. Maturitas 2020; 143:17-24. [PMID: 33308624 DOI: 10.1016/j.maturitas.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate whether menstrual symptoms are associated with increased risk of hypertension among young women, and whether the relationship is bi-directional. STUDY DESIGN We included 7729 women participating in the Australian Longitudinal Study on Women's Health, aged 22-27 years in 2000 and who were followed up every 3 years until 2015. Premenstrual syndrome, painful (dysmenorrhoea), heavy (menorrhagia), and irregular menstrual periods over the previous 12 months were self-reported and recorded as 'never', 'rarely', 'sometimes', or 'often'. Questions regarding physician-diagnosed hypertension were asked, specifically for other than during pregnancy (defined as chronic hypertension) and during pregnancy (hypertensive disorder in pregnancy, HDP). Longitudinal data were analysed with generalised estimating equation time-lagged models to estimate relative risks (RRs) and 95 % confidence intervals (CI), adjusted for time-varying covariates. MIAN OUTCOME MEASURES Chronic hypertension, HDP, and menstrual disorders. RESULTS Over 15 years of follow-up, 757 women (9.8 %) reported having been diagnosed with chronic hypertension. Among 4473 parous women, 483 (10.8 %) reported a diagnosis of HDP. Women who often experienced heavy periods had an increased risk of incident chronic hypertension (RR 1.53, 1.13-2.09), compared with those who had not experienced heavy periods. We also found that women with chronic hypertension had an increased risk of incident heavy (RR 1.23, 1.02-1.50) and irregular periods (RR 1.42, 1.17-1.72). However, there was no apparent association between any menstrual symptoms and subsequent risk of HDP. CONCLUSIONS The association between heavy periods (menorrhagia) and chronic hypertension may be bi-directional in young women. Chronic hypertension may also be associated with subsequent risk of irregular periods.
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Affiliation(s)
- Hsin-Fang Chung
- School of Public Health, The University of Queensland, Queensland, Australia.
| | - Isabel Ferreira
- Illawarra Health and Medical Research Institute & School of Medicine, University of Wollongong, New South Wales, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Queensland, Australia
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Harris HR, Eliassen AH, Doody DR, Terry KL, Missmer SA. Dietary fat intake, erythrocyte fatty acids, and risk of uterine fibroids. Fertil Steril 2020; 114:837-847. [PMID: 32680614 DOI: 10.1016/j.fertnstert.2020.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prospectively evaluate the association between dietary fat intake and risk of uterine fibroids; and to evaluate the association between erythrocyte membrane fatty acid (FA) levels and fibroid risk. DESIGN Prospective cohort study. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence interval (CI). In a subset of participants 34 individual FAs were measured and logistic regression analysis was used to estimate odds ratios (ORs) and 95% CI for the association between FA tertiles and fibroids. SETTING Not applicable. PATIENT(S) Premenopausal US women (81,590) in the Nurses' Health Study II, aged 25-42 years at enrollment in 1989 for whom diet was assessed by a food frequency questionnaire. A total of 553 participants with erythrocyte FA measurements. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Cases of fibroids were defined on the basis of self-reported ultrasound or hysterectomy confirmation. RESULT(S) A total of 8,142 cases of ultrasound-confirmed or hysterectomy-confirmed were diagnosed during an 18-year period (1991-2009). No associations were observed between intake of any dietary fats and fibroids in the multivariable models. However, when erythrocyte FAs were examined, an inverse association was observed between total n-3 polyunsaturated FAs and likelihood of fibroids (OR for third versus first tertile, 0.41; 95% CI 0.19-0.89). In addition, total trans FAs were associated with more odds of fibroids (OR for third tertile, 3.33; 95% CI 1.50-7.38). CONCLUSION(S) Our findings provide preliminary suggestions that n-3 polyunsaturated FAs and trans FAs may play a role in fibroid etiology; however, these results should be confirmed in future studies.
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Affiliation(s)
- Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David R Doody
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kathryn L Terry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
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Uterine Fibroids, Race, Ethnicity, and Cardiovascular Outcomes. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lin CY, Wang CM, Chen ML, Hwang BF. The effects of exposure to air pollution on the development of uterine fibroids. Int J Hyg Environ Health 2019; 222:549-555. [DOI: 10.1016/j.ijheh.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/25/2022]
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Li W, Hong B, Li Q, Li Z, Bi K. An integrated serum and urinary metabonomic research of Rhizoma Curcumae-Rhizoma Sparganii drug pair in hysteromyoma rats based on UPLC-Q-TOF-MS analysis. JOURNAL OF ETHNOPHARMACOLOGY 2019; 231:374-385. [PMID: 30476536 DOI: 10.1016/j.jep.2018.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rhizoma Curcumae and Rhizoma Sparganii (RCRS), a celebrated traditional Chinese medicine drug pair, has been used to treat hysteromyoma (HY). AIM OF THE STUDY We aimed to identify the endogenous biomarkers of RCRS against HY. MATERIALS AND METHODS HY rat model was established by injecting intramuscularly estradiol benzoate and progesterone injection from inner thigh in sequence. Body weight, uterus morphological indexes, immunohistochemistry (IHC) and hematoxylin and eosin (HE) staining experiments were used to evaluate the efficacy of RCRS (The rats were treated with RCRS extract, which was made by soxhlet reflux method. The rats were administrated intragastrically with 2 mL of RCRS extract). UPLC-Q-TOF-MS based metabonomics was adopted to analyze the serum and urine biomarkers from HY rats before and after RCRS treatment. Principle component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) were utilized to identify differences of metabolic profiles in rats among the four groups. RESULTS 16 potential biomarkers from serum and 18 potential biomarkers from urine in both positive and negative mass spectrometry detection modes were identified, primarily related to Linoleic acid metabolism and Glyoxylate and dicarboxylate metabolism. RCRS drug pair has therapeutic effects on rats with HY via the regulation of multiple metabolic pathways. CONCLUSIONS This study provides a useful method to get insight into the integrated metabonomic mechanism of RCRS drug pair on HY rats.
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Affiliation(s)
- Wenjing Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning Province 110016, PR China; School of Pharmacy, Qiqihar Medical University, Qiqihar, Heilongjiang Province 161006, PR China
| | - Bo Hong
- School of Pharmacy, Qiqihar Medical University, Qiqihar, Heilongjiang Province 161006, PR China
| | - Qing Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning Province 110016, PR China
| | - Zuojing Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning Province 110016, PR China
| | - Kaishun Bi
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning Province 110016, PR China.
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Laughlin-Tommaso SK, Fuchs EL, Wellons MF, Lewis CE, Calderon-Margalit R, Stewart EA, Schreiner PJ. Uterine Fibroids and the Risk of Cardiovascular Disease in the Coronary Artery Risk Development in Young Adult Women's Study. J Womens Health (Larchmt) 2019; 28:46-52. [PMID: 30412447 PMCID: PMC6343187 DOI: 10.1089/jwh.2018.7122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine fibroids, the most common reproductive tract tumor in women, have been associated with hypertension and atherosclerotic cardiovascular disease (CVD). Prior studies of fibroids and CVD have examined the subset of women with symptomatic fibroids who undergo hysterectomy, itself a risk factor for CVD. We aimed to study the risk of subclinical CVD, as determined by coronary artery calcification (CAC), carotid intima media thickness (CIMT), and left ventricular (LV) mass, in women with ultrasound-diagnosed uterine fibroids. MATERIALS AND METHODS Participants were 972 women from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort recruited in 1985-1986. CARDIA screened black and white women aged 35-49 years by ultrasound for fibroids at 16 years of follow-up (2002-2004). Demographics and CVD risk factors were collected in 2000-2001 at 15 years of follow-up (baseline for this analysis). Women were tested at years 15, 20, and 25 for CAC, at year 20 for CIMT, and at year 25 for echocardiographic LV mass. Multivariable logistic regression was used to estimate the odds of CAC, CIMT, and LV mass. RESULTS Fifty-two percent of women had fibroids (61.7% in black, 38.3% in white women). Most CVD risk factors were more common in women with fibroids. Adjusted odds of subclinical CVD, such as elevated CIMT and elevated LV mass, were not different for women with fibroids compared with those without (CIMT odds ratio [OR] = 1.03; confidence interval [95% CI] 0.7-1.5 and LV mass OR = 1.14; 95% CI 0.77-1.68), when adjusted for confounders. CONCLUSIONS Although women with fibroids had more CVD risk factors, presence of fibroids was not associated with subclinical CVD.
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Affiliation(s)
- Shannon K. Laughlin-Tommaso
- Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erika L. Fuchs
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Melissa F. Wellons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Elizabeth A. Stewart
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Pamela J. Schreiner
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
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Risk of Hyperlipidemia in Women with Hysterectomy-A Retrospective Cohort Study in Taiwan. Sci Rep 2018; 8:12956. [PMID: 30154502 PMCID: PMC6113310 DOI: 10.1038/s41598-018-31347-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022] Open
Abstract
Hysterectomy has been associated with metabolic change and cardiovascular risk for women after removing the uterus, but inconclusive. This large retrospective cohort study evaluated the hyperlipidemia risk for women with a hysterectomy and/or oophorectomy. From claims data of one million people in the National Health Insurance (NHI) database of Taiwan, we established a cohort consisting of 5887 women newly received a surgery of hysterectomy from 2000-2013, 563 women had a hysterectomy and a oophorectomy, and 556 women had a oophorectomy. From the claims data, 28024 women without any of the surgeries were identified to form the comparison cohort, frequency matched by birth year and surgery year of the women with hysterectomy. By the end of 2013, the incidence of hyperlipidemia was 1.3 times greater in women with a hysterectomy than in comparison women (3.43 vs. 2.65 per 100 person-years), with an adjusted hazard ratio (aHR) of 1.27 (95% CI = 1.19-1.35) for hysterectomy women after controlling for age, oophorectomy, hormone therapy and comorbidities. The incidence of hyperlipidemia increased to 4.93 per 100 person-years in women with both a hysterectomy and an oophorectomy. The relative risk of hyperlipidemia was higher for young women than the elderly women with the surgery. Women with comorbidity of obesity, hypertension or diabetes had a higher incidence of hyperlipidemia. In conclusion, the risk of developing hyperlipidemia could be elevated for women who had a hysterectomy and/or an oophorectomy. Women with hysterectomy should routinely monitor their metabolic status, particularly for young women and those with comorbidity of metabolic symptoms.
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Ding DC, Tsai IJ, Hsu CY, Wang JH, Lin SZ, Sung FC. Risk of hypertension after hysterectomy: a population-based study. BJOG 2018; 125:1717-1724. [PMID: 29953717 DOI: 10.1111/1471-0528.15389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Affiliation(s)
- D-C Ding
- Department of Obstetrics and Gynaecology; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
- Institute of Medical Sciences; Tzu Chi University; Hualien Taiwan
| | - I-J Tsai
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - CY Hsu
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
| | - J-H Wang
- Department of Research; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - S-Z Lin
- Department of Neurosurgery; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - F-C Sung
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Department of Health Services Administration; China Medical University; Taichung Taiwan
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Yasui T, Hayashi K, Okano H, Kamio M, Mizunuma H, Kubota T, Lee JS, Suzuki S. Uterine leiomyomata: a retrospective study of correlations with hypertension and diabetes mellitus from the Japan Nurses’ Health Study. J OBSTET GYNAECOL 2018; 38:1128-1134. [DOI: 10.1080/01443615.2018.1451987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kunihiko Hayashi
- Department of Basic Medical Sciences, School of Health Sciences, Gunma University, Maebashi, Japan
| | | | - Masayo Kamio
- Department of Basic Medical Sciences, School of Health Sciences, Gunma University, Maebashi, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | | | - Jung-Su Lee
- Department of Health Promotion Science, School of Public Health, University of Tokyo, Tokyo, Japan
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Haan YC, Diemer FS, Van Der Woude L, Van Montfrans GA, Oehlers GP, Brewster LM. The risk of hypertension and cardiovascular disease in women with uterine fibroids. J Clin Hypertens (Greenwich) 2018; 20:718-726. [PMID: 29569360 DOI: 10.1111/jch.13253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/28/2017] [Accepted: 01/01/2018] [Indexed: 11/28/2022]
Abstract
Women with fibroids have a notably high hypertension risk. However, adjusted data regarding other cardiovascular disease (CVD) risk factors are scarce. In this cross-sectional study, CVD risk factors, hemodynamic parameters, and asymptomatic organ damage were analyzed between women with uterine fibroids and controls in a multi-ethnic population. In total, 104 women with self-reported fibroids and 624 controls were included. Women with fibroids had significantly higher odds to have hypertension (OR 3.4; 95% CI 2.2-5.2), diabetes (1.7; 1.0-2.9), and hypercholesterolemia (1.8; 1.1-3.2). After adjustment for confounders, only the odds ratio for hypertension was significant (1.8; 1.1-3.1). Asymptomatic organ damage occurred significantly more often in women with fibroids (66.7%; 95% CI 55.8%-77.6% vs 42.9%; 38.0-47.8 in controls), especially in the younger age group (respectively 48.5%; 31.1%-65.9% vs 22.1%; 17.0-27.2). In this study, women with fibroids had a remarkably high hypertension risk compared to controls, with more asymptomatic organ damage, in particular young women.
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Affiliation(s)
- Yentl C Haan
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederieke S Diemer
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Lisa Van Der Woude
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Gert A Van Montfrans
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Glenn P Oehlers
- Department of Cardiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Lizzy M Brewster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Public Health, Anton de Kom University of Suriname, Paramaribo, Suriname
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Erbay AR, Ede H, Zengin K, Erkoc MF, Tanık S, Albayrak S, Yetkin E. Association of Prostatic Volume and Carotid Intima-media Thickness in Patients With Benign Prostatic Hyperplasia. Urology 2018; 113:166-170. [DOI: 10.1016/j.urology.2017.11.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
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Appiah D, Schreiner PJ, Nwabuo CC, Wellons MF, Lewis CE, Lima JA. The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Menopause 2017; 24:1269-1276. [PMID: 28697037 PMCID: PMC5659880 DOI: 10.1097/gme.0000000000000919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition. METHODS We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points. RESULTS During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e' ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. CONCLUSION In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Chike C. Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Melissa F. Wellons
- Division of Diabetes, Endocrinology, and Metabolism, School of Medicine, Vanderbilt University, Nashville, TN
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joao A. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Hellwege JN, Torstenson ES, Russell SB, Edwards TL, Velez Edwards DR. Evidence of selection as a cause for racial disparities in fibroproliferative disease. PLoS One 2017; 12:e0182791. [PMID: 28792542 PMCID: PMC5549739 DOI: 10.1371/journal.pone.0182791] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/25/2017] [Indexed: 01/05/2023] Open
Abstract
Fibroproliferative diseases are common complex traits featuring scarring and overgrowth of connective tissue which vary widely in presentation because they affect many organ systems. Most fibroproliferative diseases are more prevalent in African-derived populations than in European populations, leading to pronounced health disparities. It is hypothesized that the increased prevalence of these diseases in African-derived populations is due to selection for pro-fibrotic alleles that are protective against helminth infections. We constructed a genetic risk score (GRS) of fibroproliferative disease risk-increasing alleles using 147 linkage disequilibrium-pruned variants identified through genome-wide association studies of seven fibroproliferative diseases with large African-European prevalence disparities. A comparison of the fibroproliferative disease GRS between 1000 Genomes Phase 3 populations detected a higher mean GRS in AFR (mean = 148 risk alleles) than EUR (mean = 136 risk alleles; T-test p-value = 1.75x10-123). To test whether differences in GRS burden are systematic and may be due to selection, we employed the quantitative trait loci (QTL) sign test. The QTL sign test result indicates that population differences in risk-increasing allele burdens at these fibroproliferative disease variants are systematic and support a model featuring selective pressure (p-value = 0.011). These observations were replicated in an independent sample and were more statistically significant (T-test p-value = 7.26x10-237, sign test p-value = 0.015). This evidence supports the role of selective pressure acting to increase frequency of fibroproliferative alleles in populations of African relative to European ancestry populations.
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Affiliation(s)
- Jacklyn N. Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Eric S. Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Shirley B. Russell
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail: (TLE); (DRVE)
| | - Digna R. Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail: (TLE); (DRVE)
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Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124:1501-1512. [DOI: 10.1111/1471-0528.14640] [Citation(s) in RCA: 462] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
Affiliation(s)
- EA Stewart
- Division of Reproductive Endocrinology and Infertility; Departments of Obstetrics and Gynecology and Surgery; Mayo Clinic; Rochester MN USA
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Mahalingaiah S, Sun F, Cheng JJ, Chow ET, Lunetta KL, Murabito JM. Cardiovascular risk factors among women with self-reported infertility. FERTILITY RESEARCH AND PRACTICE 2017; 3:7. [PMID: 28620545 PMCID: PMC5424365 DOI: 10.1186/s40738-017-0034-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/27/2017] [Indexed: 12/31/2022]
Abstract
Background Amongst women with certain types of ovulatory disorder infertility, the studies are conflicting whether there is an increased risk of long-term cardiovascular disease risk. This paper evaluates the associations of several CVD risk factors among Framingham women with self-reported infertility. Methods Women who completed the Framingham Heart Study Third Generation and Omni Cohort 2 Exam 2 (2008–2011), and reported on past history of infertility and current cardiovascular disease status were included in this cross-sectional study. Directly measured CVD risk factors were: resting blood pressure, fasting lipid levels, fasting blood glucose, waist circumference, and body mass index (BMI). Multivariable models adjusted for age, smoking, physical activity, and cohort. Generalized estimating equations adjusted for family correlations. We performed sensitivity analyses to determine whether the association between infertility and CVD risk factors is modified by menopausal status and menstrual cycle length. Results Comparing women who self-reported infertility to those who did not, there was an average increase in BMI (β = 1.03 kg/m2, 95% CI: 0.18, 1.89), waist circumference (β = 3.08 in., 95% CI: 1.06, 5.09), triglycerides (β = 4.47 mg/dl, 95% CI:−1.54, 10.49), and a decrease in HDL cholesterol (β = −1.60 mg/dl, 95% CI: −3.76, 0.56). We estimated that infertile premenopausal women have an increased odds of obesity (BMI ≥ 30 kg/m2) (OR = 1.56, 95% CI: 1.11, 4.49) and diabetes (OR = 1.96, 95% CI: 0.86, 4.49). Conclusions BMI and waist circumference were the most strongly correlated CVD risk factors amongst women reporting a history of infertility.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118 USA.,Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118 USA
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Crossstown Center, 801 Albany St, Boston, MA 02118 USA
| | - J Jojo Cheng
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118 USA
| | - Erika T Chow
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118 USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Crossstown Center, 801 Albany St, Boston, MA 02118 USA
| | - Joanne M Murabito
- Framingham Heart Study, Massachusetts. Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA USA
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Akbas M, Mihmanli V, Bulut B, Temel Yuksel I, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J OBSTET GYNAECOL 2016; 37:141-145. [DOI: 10.1080/01443615.2016.1229272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Murat Akbas
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Veli Mihmanli
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Berk Bulut
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ilkbal Temel Yuksel
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Gulsen Karahisar
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Demirayak
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Abstract
Uterine leiomyomata (UL) have a substantial impact on women's health, but relatively few studies have identified opportunities for primary prevention of these neoplasms. Most established risk factors are not modifiable, including premenopausal age, African ancestry, age at menarche, and childbearing history. The main challenge in studying UL is that a large proportion of tumors are asymptomatic. Herein, we review the epidemiology of UL from published studies to date. We highlight the advantages of ultrasound screening studies and the ways in which their innovative methods have helped clarify the etiology of disease. We conclude with a discussion of promising new hypotheses.
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Uimari O, Auvinen J, Jokelainen J, Puukka K, Ruokonen A, Järvelin MR, Piltonen T, Keinänen-Kiukaanniemi S, Zondervan K, Järvelä I, Ryynänen M, Martikainen H. Uterine fibroids and cardiovascular risk. Hum Reprod 2016; 31:2689-2703. [PMID: 27733532 DOI: 10.1093/humrep/dew249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/13/2016] [Accepted: 08/23/2016] [Indexed: 01/19/2023] Open
Abstract
STUDY QUESTION Are uterine fibroids associated with increased cardiovascular risk? SUMMARY ANSWER This study reports an association between increased serum lipids and metabolic syndrome with an increased risk of uterine fibroids. WHAT IS KNOWN ALREADY Recent studies suggest similarities in biological disease mechanisms and risk factors for fibroids and atherosclerosis: obesity, hypertension and abnormal serum lipids. These findings are awaiting confirmation that a population-based follow-up study could offer with extensive health examination data collection linked with a national hospital discharge register. STUDY DESIGN, SIZE, DURATION The Northern Finland Birth Cohort (NFBC1966) is a population-based long-term follow-up study including all children with estimated date of delivery in 1966 in the Northern Finland area. The data were collected from national registries, postal questionnaires and clinical health examinations. The study population for this study comprised all females included in the NFBC1966 that underwent an extensive clinical health examination at age 46 years (n = 3635). PARTICIPANTS/MATERIALS, SETTING, METHODS All females included in the NFBC1966 who were alive and traceable (n = 5118) were invited for the 46-year follow-up study; 3268 (63.9%) responded, returned the postal questionnaire and attended the clinical examination. Uterine fibroid cases were identified through the national hospital discharge register that has data on disease diagnoses based on WHO ICD-codes. Uterine fibroid codes, ICD-9: 218 and ICD-10: D25 were used for case identification. Self-reported fibroid cases were identified through the postal questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE A total of 729 fibroid cases were identified, including 293 based on hospital discharge registries. With adjustment for BMI, parity, education and current use of exogenous hormones the risk of prevalent fibroids rose significantly for every 1 mmol/l increase in LDL (OR = 1.13, 95% CI: 1.02-1.26 for all cases) and triglycerides (OR = 1.27, 95% CI: 1.09-1.49 for all cases). Metabolic syndrome associated with hospital discharge-based fibroid diagnosis (OR = 1.48, 95% CI: 1.09-2.01). Additionally every 1 unit increase in waist-hip ratio associated with fibroids (OR = 1.32, 95% CI: 1.10-1.57). LIMITATIONS, REASONS FOR CAUTION The case ascertainment may present some limitations. There was likely an under-identification of cases and misclassification of some cases as controls; this would have diluted the effects of reported associations. The data analysed were cross-sectional and therefore cause and effect for the associations observed cannot be distinguished. WIDER IMPLICATIONS OF THE FINDINGS Increased serum lipids and metabolic syndrome are associated with increased risk of uterine fibroids. Along with central obesity these findings add to an increased risk for cardiovascular disease among women with fibroids. These observations may suggest that there are shared predisposing factors underlying both uterine fibroids and adverse metabolic and cardiac disease risk, or that metabolic factors have a role in biological mechanisms underlying fibroid development. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Academy of Finland, University Hospital Oulu, University of Oulu, Finland, Northern Finland Health Care Foundation, Duodecim Foundation, ERDF European Regional Development Fund-Well-being and health: Research in the Northern Finland Birth Cohort 1966. The authors declare no conflict of interest.
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Affiliation(s)
- Outi Uimari
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland .,PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Endometriosis CaRe Centre, Nuffield Department of Obstetrics and Gyneacology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Katri Puukka
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, PO Box 5000, 90014 Oulu, Finland
| | - Aimo Ruokonen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, PO Box 5000, 90014 Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Krina Zondervan
- Endometriosis CaRe Centre, Nuffield Department of Obstetrics and Gyneacology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Ilkka Järvelä
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Markku Ryynänen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Hannu Martikainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
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Cardiovascular risk factors and diseases in women undergoing hysterectomy with ovarian conservation. Menopause 2016; 23:121-8. [PMID: 26173076 DOI: 10.1097/gme.0000000000000506] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to determine the association of preexisting cardiovascular risk factors and cardiovascular diseases with hysterectomy with bilateral ovarian conservation using a case-central design. METHODS Using the Rochester Epidemiology Project records-linkage system, we identified all Olmsted County, MN women who underwent hysterectomy with ovarian conservation between January 1, 1965 and December 31, 2002 (cases). Each case was age-matched (± 1 y) with a randomly selected woman who resided in the county and did not undergo hysterectomy or oophorectomy before the index date (date of hysterectomy in her matched case). Using electronic codes, we identified cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, obesity, metabolic syndrome, and polycystic ovary syndrome) and cardiovascular diseases (coronary artery disease, congestive heart failure, myocardial infarction, and stroke) that occurred before the index date. Analyses were stratified by age at hysterectomy and indication for surgical operation. RESULTS During the study period, 3,816 women underwent hysterectomy with ovarian conservation for a benign indication. Preexisting hyperlipidemia, obesity, and metabolic syndrome were significantly more frequent in cases than in controls in univariable analyses. In multivariable analyses, obesity remained significantly associated overall, for nearly all age groups, and across all indications. Stroke was significantly more frequent in cases than in controls among women younger than 36 years. Congestive heart failure and stroke were significantly less common in cases than in controls among women older than 50 years. CONCLUSIONS Hysterectomy with ovarian conservation is associated with cardiovascular risk factors, particularly obesity. Obesity may contribute to underlying gynecologic conditions leading to hysterectomy; however, surgical selection may also play a role.
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Chavarro JE, Rich-Edwards JW, Gaskins AJ, Farland LV, Terry KL, Zhang C, Missmer SA. Contributions of the Nurses' Health Studies to Reproductive Health Research. Am J Public Health 2016; 106:1669-76. [PMID: 27459445 DOI: 10.2105/ajph.2016.303350] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To review the Nurses' Health Study's (NHS's) contribution to identifying risk factors and long-term health consequences of reproductive events. METHODS We performed a narrative review of the NHS I, NHS II, NHS3, and Growing Up Today Study (GUTS) publications between 1976 and 2016. RESULTS Collection of detailed reproductive history to identify breast cancer risk factors allowed the NHS to document an association between menstrual irregularities, a proxy for polycystic ovary syndrome (PCOS), and increased risk of diabetes and cardiovascular disease. The NHS II found that infertility associated with ovulation problems and gestational diabetes are largely preventable through diet and lifestyle modification. It also identified developmental and nutritional risk factors for pregnancy loss, endometriosis, and uterine leiomyomata. As women in NHS II age, it has become possible to address questions regarding long-term health consequences of pregnancy complications and benign gynecologic conditions on chronic disease risk. Furthermore, the NHS3 and GUTS are allowing new lines of research into human fertility, PCOS, and transgenerational effects of environmental exposures. CONCLUSIONS The multigenerational resources of the NHSs and GUTS, including linkages of related individuals across cohorts, can improve women's health from preconception through late adulthood and onto the next generation.
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Affiliation(s)
- Jorge E Chavarro
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Janet W Rich-Edwards
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Audrey J Gaskins
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Leslie V Farland
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Kathryn L Terry
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Cuilin Zhang
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Stacey A Missmer
- Jorge E. Chavarro, Janet W. Rich-Edwards, Audrey J. Gaskins, Leslie V. Farland, Kathryn L. Terry, and Stacey A. Missmer are with the Harvard T. H. Chan School of Public Health, and Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Cuilin Zhang is with the Epidemiology Branch, Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
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Sarkodie BD, Botwe BO, Adjei DN, Ofori E. Factors associated with uterine fibroid in Ghanaian women undergoing pelvic scans with suspected uterine fibroid. FERTILITY RESEARCH AND PRACTICE 2016; 2:9. [PMID: 28620536 PMCID: PMC5424414 DOI: 10.1186/s40738-016-0022-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/15/2016] [Indexed: 11/10/2022]
Abstract
Background Uterine fibroids are the most common benign tumours affecting premenopausal women and are often associated with considerable hospitalization and morbidity. Literature shows virtually no study concerning the quantification of the main factors associated with uterine fibroids in Ghanaian women. The purpose of this study was to assess the main factors associated with uterine fibroid among Ghanaian women presenting for ultrasound. Method A prospective cross-sectional study design was employed in this study. A total of two hundred and forty-four (244) women were consecutively evaluated from November 2011 to February 2012 using a 2–5 MHz curvilinear probe of Philips HD3 ultrasound machines at three centres in Accra using a trans-abdominal pelvic approach. Data was analysed with (SPSS) version 20.0 for windows, 2010; Chicago. The Pearson’s Chi-square test was used to determine associations between selected demographic and gynaecological characteristics and uterine fibroid appearance. All tests were two-tailed and p-value of less than 0.05 was interpreted as significant. Results The range, mean and standard deviation (SD) of the patients’ age were 14–54 years, 31.89 years and ± 7.92 respectively. Factors that associated significantly with uterine fibroid in Ghanaian women included obesity (X2 = 17.3, p-value = 0.001), participant’s age range (X2 = 47.4, p-value = 0.001), parity (X2 = −10.169, p-value = 0.001), and age at last delivery (X2 = 34.579, p-value = 0.001). Conclusion Uterine fibroid was mainly associated with women of older age group of the reproductive age than the younger age categories and also associated more with women with without children compared to those with more children. Moreover, it associated more with obese patients and patient with late age at last delivery.
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Affiliation(s)
| | - Benard Ohene Botwe
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - David Nana Adjei
- Department of Medical Laboratory Sciences, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Eric Ofori
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
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The Role of Complementary and Alternative Medicine for the Management of Fibroids and Associated Symptomatology. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:110-118. [PMID: 27217981 PMCID: PMC4859848 DOI: 10.1007/s13669-016-0156-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article discusses the role of complementary and alternative medicine (CAM) in the management of fibroids and associated symptomatology. Since there is such a paucity of direct research related to fibroids, conditions that are implicated in the causation of uterine fibroids and symptomatology that CAM treatments may or have been shown to make a difference are also considered.
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Abstract
Uterine fibroids are the most common type of benign gynecologic mass, and are present in up to 80 percent of women. Research exploring risk factors for fibroids presents conflicting or inconclusive findings. Symptoms for up to 50 percent of women experiencing fibroids include heavy menstrual bleeding, pelvic pressure or pain and gastrointestinal and genitourinary changes. Diagnosis is made by history and symptoms, physical examination and imaging. Several treatment options are available, and are based on symptoms, preferences and reproductive plans. Given the high prevalence of fibroids and the potential for women's health implications, it is essential that clinicians are aware of the latest evidence regarding fibroids to provide the highest quality of care for women whose health is affected by this condition.
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Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of Uterine Myomas: A Review. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:424-35. [PMID: 26985330 PMCID: PMC4793163 DOI: 10.22074/ijfs.2015.4599] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/16/2014] [Indexed: 11/09/2022]
Abstract
Myomas are the most common benign tumors of the genital organs in women of
childbearing age, causing significant morbidity and impairing their quality of life.
In our investigation, we have reviewed the epidemiological data related to the development of myomas in order to homogenize the current data. Therefore, a MEDLINE
and PubMed search, for the years 1990-2013, was conducted using a combination
of keywords, such as "myoma," "leiomyoma," "fibroids," "myomectomy," "lifestyle," "cigarette," "alcohol," "vitamins," "diet," and "hysterectomy". Randomized
controlled studies were selected based upon the authors’ estimation. Peer-reviewed
articles examining myomas were sorted by their relevance and included in this research. Additional articles were also identified from the references of the retrieved
papers and included according to authors’ estimation. Many epidemiologic factors are linked to the development of myomas; however,
many are not yet fully understood. These factors include age, race, heritage, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine and alcohol consumption, smoking, physical activity and stress), environmental and other influences,
such as hypertension and infection. Some of the epidemiological data is conflicting.
Thus, more research is needed to understand all the risk factors that contribute to
myoma formation and how they exactly influence their onset and growth.
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Affiliation(s)
- Radmila Sparic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Mirkovic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy; International Translational Medicine and Biomodelling Research Group Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia
| | - Andrea Tinelli
- International Translational Medicine and Biomodelling Research Group Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia; Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital, Lecce, Italy
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Gumber S, Stovall MI, Owens DC, Davis JN, Crane MM. Pathology in Practice. Uterine leiomyoma precipitated by hypertrophic cardiomyopathy in a chimpanzee. J Am Vet Med Assoc 2015; 247:615-7. [PMID: 26331419 DOI: 10.2460/javma.247.6.615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vitamin D and uterine leiomyoma among a sample of US women: Findings from NHANES, 2001-2006. Reprod Toxicol 2015; 57:81-6. [PMID: 26047529 DOI: 10.1016/j.reprotox.2015.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/05/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022]
Abstract
Scientific understanding of the etiology of uterine leiomyomata (UL) remains incomplete, but recent investigations have suggested an association between low Vitamin D and UL risk. In this study, we conducted a cross-sectional analysis of Vitamin D exposure, measured using serum levels of 25(OH)D (a Vitamin D metabolite), and self-reported UL diagnosis among 3590 women aged 20-54 in the National Health and Nutrition Examination Survey (NHANES 2001-2006). Multivariate logistic regression models comparing each quartile of 25(OH)D to the lowest quartile indicated no relationship between 25(OH)D and odds of UL in the whole population (Ptrend=0.37), or in sensitivity analyses. However, a probabilistic analysis correcting outcome misclassification indicated that insufficient 25(OH)D was associated with UL in white (Odds ratio (OR) median estimate: 2.17; 2.5, 97.5 percentiles: (1.26, 23.47)), but not black women (OR median estimate: 1.70; 2.5, 97.5 percentiles: (0.89, 3.51)), suggesting misclassification may have driven some of the null findings.
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Topçu HO, İskender CT, Timur H, Kaymak O, Memur T, Danışman N. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int J Gynaecol Obstet 2015; 130:244-6. [DOI: 10.1016/j.ijgo.2015.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/10/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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