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Wong GRM, Lee EJA, Liaw QY, Rajaram H. The role of oestrogen therapy in reducing risk of Alzheimer's disease: systematic review. BJPsych Open 2023; 9:e194. [PMID: 37846476 PMCID: PMC10594166 DOI: 10.1192/bjo.2023.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Studies have shown a relationship between oestrogen and Alzheimer's disease. However, there is neither clear nor strong evidence on the use of oestrogen-only therapy in reducing the risk of Alzheimer's disease. AIMS To assess the effects of oestrogen-only therapy on reducing the risk of Alzheimer's disease. METHOD Inclusion criteria was determined with the PICO framework. Outcome was cognitive function measured by neuropsychological tests and strict protocols. Exclusion criteria included non-Alzheimer's dementia, progesterone-only therapy and pre-menopausal women. Searches were conducted in nine electronic healthcare databases, last searched in July 2022. Quality assessments conducted on randomised controlled trials (RCTs) were performed with the GRADE assessment, and cohort studies and case-control studies were assessed with the Newcastle-Ottawa Scale. Extracted data were used to analyse participants, interventions and outcomes. RESULTS Twenty-four studies satisfied the search criteria (four RCTs, nine cohort studies, 11 case-control studies). Fifteen studies showed positive associations for oestrogen-only therapy reducing the risk of Alzheimer's disease, and the remaining nine found no evidence of association. CONCLUSIONS Fifteen studies showed that oestrogen-only therapy effectively reduced the risk of Alzheimer's disease, whereas nine showed no correlation. Studies also investigated oestrogen-related variables such as length of oestrogen exposure, being an apolipoprotein E ε4 carrier and concomitant use of non-steroidal anti-inflammatory drugs, and their role in neuroprotection. This review was limited by the limited ranges of duration of oestrogen treatment and type of oestrogen-only therapy used. In conclusion, oestrogen-only therapy has potential for use in preventing Alzheimer's disease, although current evidence is inconclusive and requires further study.
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Kling JM, Dowling NM, Bimonte-Nelson H, Gleason CE, Kantarci K, Stonnington CM, Harman SM, Naftolin F, Pal L, Cedars M, Manson JE, James TT, Brinton EA, Miller VM. Associations between pituitary-ovarian hormones and cognition in recently menopausal women independent of type of hormone therapy. Maturitas 2023; 167:113-122. [PMID: 36395695 PMCID: PMC10077876 DOI: 10.1016/j.maturitas.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine associations of pituitary-ovarian hormone levels with cognition before and after different formulations of hormone therapy (HT) or placebo independent of treatment group. METHODS Recently menopausal, healthy women were randomized to 0.45 mg/day oral conjugated equine estrogens (o-CEE, n = 109), 50 μg/day transdermal 17β (tE2, n = 107) or placebo pills and patches (n = 146); women on active treatment received oral 200 mg/day micronized progesterone for 12 days per month. Levels of estrone, 17β-estradiol, follicle stimulating hormone, luteinizing hormone, androstenedione, and testosterone were determined prior to and after 48 months of study participation. Neuropsychological testing was administered at baseline, and months 18, 36 and 48. Latent growth curve models controlling for education level, age, APOE allele status, waist circumference, and treatment examined the trajectories of each cognitive domain after accounting for the effect of hormone levels at baseline and months 18, 36 and 48. A linear multivariate mixed model examined the effect of changes in hormone levels on changes in trajectories of complex attention tasks with varying degrees of difficulty. RESULTS All women were adherent to treatment at month 48. Higher baseline estrone levels were associated with poorer global cognition, auditory attention and working memory, visual attention, and executive function, but not working memory. Higher levels of baseline 17β-E2 were associated with poorer cognitive performance, with marginal significance at baseline in speeded language and mental flexibility (p = 0.013). Other hormone levels were not associated with cognition. Controlling for all treatments, hormone levels at baseline and at month 48 did not have any significant correlation with cognitive trajectories over time. SUMMARY In healthy, recently menopausal women, baseline estrone levels were inversely associated with selected cognitive factors independent of two types of HT or placebo during 4 years of follow-up. Baseline levels of the other pituitary-ovarian hormones studied were not associated with baseline cognition, nor were changes in any hormones associated with changes in cognition during the study. The marginal association between estradiol levels and cognitive factors warrants further investigation. CLINICALTRIALS GOV NUMBERS NCT00154180, NCT00623311.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
| | - N Maritza Dowling
- Department of Acute & Chronic Care, School of Nursing, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Heather Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ 85006, USA
| | - Carey E Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health and the Wisconsin Alzheimer's Disease Research Center, Madison VA GRECC, Madison, WI, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Marcelle Cedars
- Department of Obstetrics and Gynecology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Taryn T James
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Virginia M Miller
- Department of Surgery, Mayo Clinic, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, USA
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Pal L, Morgan K, Santoro NF, Manson JE, Taylor HS, Miller VM, Brinton EA, Lobo R, Neal-Perry G, Cedars MI, Harman SM, James TT, Gleason CE. Cardiometabolic measures and cognition in early menopause - Analysis of baseline data from a randomized controlled trial. Maturitas 2022; 162:58-65. [PMID: 35617770 PMCID: PMC10089771 DOI: 10.1016/j.maturitas.2022.04.004] [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: 11/22/2021] [Revised: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The relationships between cardiometabolic indices and cognition were examined in recently menopausal women. METHODS Cross-sectional analysis of baseline data from the KEEPS (Kronos Early Estrogen Prevention Study)-Cognitive ancillary study (n = 621). Cognitive performance was assessed by the Modified Mini Mental Status (3MS) score (primary outcome). Physical cardiometabolic indices included body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and blood pressure (BP). Biochemical cardiometabolic indices included serum levels of high sensitivity C-reactive protein (hs-CRP), total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-HDL (non-HDL-C), triglycerides (TG), fasting serum glucose (FSG), and insulin resistance (HOMA-IR). Socio-demographic variables included age, race/ethnicity, education, and lifestyle (physical activity, smoking). Central adiposity was defined as WC > 88 cm (>35 in) and WHR > 0.8. Separate stepwise multivariable analyses (GLM, ordinal logistic regression and logistic regression) assessed relationships between 3MS scores (as continuous, in tertiles and dichotomized at 90 respectively) with the measures of central adiposity (predictor variables); socio-demographic variables (age, time since menopause, race, educational status and lifestyle) and cardiometabolic variables (BP, lipids, FSG, HOMA-IR and hs-CRP) were examined as covariates. The final multivariable models included time since menopause, race, ethnicity, educational status, strenuous exercise, BMI ≥30 kg/m2, non-HDL-C and hs-CRP as covariates. Due to the high collinearity between the two indices of central adiposity, within each analytic strategy, separate models examined the respective associations of WC > 88 cm and WHR > 0.8 with 3MS score. RESULTS On adjusted analyses, indices of central adiposity were independent predictors of significantly lower 3MS scores (p < 0.05). Consistency in this relationship was observed across the three different multivariable regression analytic approaches (GLM, ordinal and logistic regression). CONCLUSIONS Among recently menopausal women, WC > 88 cm and WHR > 0.8 were associated with significantly lower cognitive function, as reflected by lower 3MS scores. The mechanisms that might explain the observed negative implications of central adiposity for cognitive function warrant further study.
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Affiliation(s)
- Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States.
| | - Kelly Morgan
- SSM Health Dean Medical Group, Madison, WI, United States
| | - Nanette F Santoro
- Department of Obstetrics, Gynecology, University of Colorado, Denver, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, United States
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, United States
| | | | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, United States
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, United States
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, United States
| | - S Mitchell Harman
- Kronos Longevity Research Institute and the Phoenix Veterans Administration Health Care System, Phoenix, AZ, United States
| | - Taryn T James
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison Geriatric Research Education and Clinical Center (GRECC), United States
| | - Carey E Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison Geriatric Research Education and Clinical Center (GRECC), United States
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Zeydan B, Lowe VJ, Tosakulwong N, Lesnick TG, Senjem ML, Jack CR, Fields JA, James TT, Gleason CE, Dowling NM, Miller VM, Kantarci K. Sleep quality and cortical amyloid-β deposition in postmenopausal women of the Kronos early estrogen prevention study. Neuroreport 2021; 32:326-331. [PMID: 33470769 PMCID: PMC7878341 DOI: 10.1097/wnr.0000000000001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Hormone therapy improves sleep in menopausal women and recent data suggest that transdermal 17β-estradiol may reduce the accumulation of cortical amyloid-β. However, how menopausal hormone therapies modify the associations of amyloid-β accumulation with sleep quality is not known. In this study, associations of sleep quality with cortical amyloid-β deposition and cognitive function were assessed in a subset of women who had participated in the Kronos early estrogen prevention study. It was a randomized, placebo-controlled trial in which recently menopausal women (age, 42-58; 5-36 months past menopause) were randomized to (1) oral conjugated equine estrogen (n = 19); (2) transdermal 17β-estradiol (tE2, n = 21); (3) placebo pills and patch (n = 32) for 4 years. Global sleep quality score was calculated using Pittsburgh sleep quality index, cortical amyloid-β deposition was measured with Pittsburgh compound-B positron emission tomography standard uptake value ratio and cognitive function was assessed in four cognitive domains 3 years after completion of trial treatments. Lower global sleep quality score (i.e., better sleep quality) correlated with lower cortical Pittsburgh compound-B standard uptake value ratio only in the tE2 group (r = 0.45, P = 0.047). Better global sleep quality also correlated with higher visual attention and executive function scores in the tE2 group (r = -0.54, P = 0.02) and in the oral conjugated equine estrogen group (r = -0.65, P = 0.005). Menopausal hormone therapies may influence the effects of sleep on cognitive function, specifically, visual attention and executive function. There also appears to be a complex relationship between sleep, menopausal hormone therapies, cortical amyloid-β accumulation and cognitive function, and tE2 formulation may modify the relationship between sleep and amyloid-β accumulation.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic Rochester MN
- Department of Neurology, Mayo Clinic Rochester MN
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic Rochester MN
| | | | | | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic Rochester MN
- Department of Information Technology, Mayo Clinic Rochester MN
| | | | | | - Taryn T. James
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI
| | - N. Maritza Dowling
- Department of Acute & Chronic Care, School of Nursing, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Virginia M. Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester MN
- Department of Surgery, Mayo Clinic Rochester MN
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Miller VM, Naftolin F, Asthana S, Black DM, Brinton EA, Budoff MJ, Cedars MI, Dowling NM, Gleason CE, Hodis HN, Jayachandran M, Kantarci K, Lobo RA, Manson JE, Pal L, Santoro NF, Taylor HS, Harman SM. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Menopause 2019; 26:1071-1084. [PMID: 31453973 PMCID: PMC6738629 DOI: 10.1097/gme.0000000000001326] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Kronos Early Estrogen Prevention Study (KEEPS) was designed to address gaps in understanding the effects of timely menopausal hormone treatments (HT) on cardiovascular health and other effects of menopause after the premature termination of the Women's Health Initiative. METHOD The KEEPS was a randomized, double-blinded, placebo-controlled trial to test the hypothesis that initiation of HT (oral conjugated equine estrogens [o-CEE] or transdermal 17β-estradiol [t-E2]) in healthy, recently postmenopausal women (n = 727) would slow the progression of atherosclerosis as measured by changes in carotid artery intima-media thickness (CIMT). RESULTS After 4 years, neither HT affected the rate of increase in CIMT. There was a trend for reduced accumulation of coronary artery calcium with o-CEE. There were no severe adverse effects, including venous thrombosis. Several ancillary studies demonstrated a positive effect on mood with o-CEE, and reduced hot flashes, improved sleep, and maintenance of bone mineral density with both treatments. Sexual function improved with t-E2. There were no significant effects of either treatment on cognition, breast pain, or skin wrinkling. Variants of genes associated with estrogen metabolism influenced the age of menopause and variability in effects of the HT on CIMT. Platelet activation associated with the development of white matter hyperintensities in the brain. CONCLUSIONS KEEPS and its ancillary studies have supported the value and safety of the use of HT in recently postmenopausal women and provide a perspective for future research to optimize HT and health of postmenopausal women. The KEEPS continuation study continues to pursue these issues.
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Affiliation(s)
- Virginia M. Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Fredrick Naftolin
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Sanjay Asthana
- Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine and Public Health and the Geriatric Research, Madison, WI
| | - Dennis M. Black
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | | | - Matthew J. Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance, CA
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - N. Maritza Dowling
- Departments of Acute and Chronic Care, Epidemiology and Biostatistics, George Washington University School of Nursing and Milken Institute School of Public Health, Washington, DC
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health and the William S. Middleton Memorial VA, Geriatric Research, Education and Clinical Center, Madison, WI
| | - Howard N. Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA
| | - Muthuvel Jayachandran
- Department of Physiology and Biomedical Engineering, Division of Nephrology and Hypertension, Division of Hematology Research, Mayo Clinic, Rochester, MN
| | | | - Rogerio A. Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Nanette F. Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Hugh S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Peters R, Booth A, Rockwood K, Peters J, D’Este C, Anstey KJ. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ Open 2019; 9:e022846. [PMID: 30782689 PMCID: PMC6352772 DOI: 10.1136/bmjopen-2018-022846] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. DESIGN A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. DATA SOURCES Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. ELIGIBILITY CRITERIA For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. RESULTS Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. CONCLUSIONS The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others. PROSPERO REGISTRATION NUMBER 42016052914.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Jean Peters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine D’Este
- Australian National University (ANU), Canberra, Australian Capital Territory, Australia
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Kantarci K, Tosakulwong N, Lesnick TG, Zuk SM, Lowe VJ, Fields JA, Gunter JL, Senjem ML, Settell ML, Gleason CE, Shuster LT, Bailey KR, Dowling NM, Asthana S, Jack CR, Rocca WA, Miller VM. Brain structure and cognition 3 years after the end of an early menopausal hormone therapy trial. Neurology 2018; 90:e1404-e1412. [PMID: 29661902 PMCID: PMC5902783 DOI: 10.1212/wnl.0000000000005325] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The effects of 2 frequently used formulations of menopausal hormone therapy (mHT) on brain structure and cognition were investigated 3 years after the end of a randomized, placebo-controlled trial in recently menopausal women with good cardiovascular health. METHODS Participants (aged 42-56 years; 5-36 months past menopause) were randomized to one of the following: 0.45 mg/d oral conjugated equine estrogen (oCEE); 50 μg/d transdermal 17β-estradiol (tE2); or placebo pills and patch for 4 years. Oral progesterone (200 mg/d) was given to mHT groups for 12 days each month. MRIs were performed at baseline, at the end of 4 years of mHT, and 3 years after the end of mHT (n = 75). A subset of participants also underwent Pittsburgh compound B-PET (n = 68). RESULTS Ventricular volumes increased more in the oCEE group compared to placebo during the 4 years of mHT, but the increase in ventricular volumes was not different from placebo 3 years after the discontinuation of mHT. Increase in white matter hyperintensity volume was similar in the oCEE and tE2 groups, but it was statistically significantly greater than placebo only in the oCEE group. The longitudinal decline in dorsolateral prefrontal cortex volumes was less in the tE2 group compared to placebo, which correlated with lower cortical Pittsburgh compound B uptake. Rates of global cognitive change in mHT groups were not different from placebo. CONCLUSIONS The effects of oCEE on global brain structure during mHT subside after oCEE discontinuation but white matter hyperintensities continue to increase. The relative preservation of dorsolateral prefrontal cortical volume in the tE2 group over 7 years indicates that mHT may have long-term effects on the brain. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the rates of change in global brain volumes and cognitive function in recently menopausal women receiving mHT (tE2 or oCEE) were not significantly different from women receiving placebo, as measured 3 years after exposure to mHT.
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Affiliation(s)
- Kejal Kantarci
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC.
| | - Nirubol Tosakulwong
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Timothy G Lesnick
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Samantha M Zuk
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Val J Lowe
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Julie A Fields
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Jeffrey L Gunter
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Matthew L Senjem
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Megan L Settell
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Carey E Gleason
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Lynne T Shuster
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Kent R Bailey
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - N Maritza Dowling
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Sanjay Asthana
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Clifford R Jack
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Walter A Rocca
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
| | - Virginia M Miller
- From the Departments of Radiology (K.K., S.M.Z., V.J.L., J.L.G., M.L. Senjem, M.L. Settell, C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Psychology and Psychiatry (J.A.F.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI; and Department of Biostatistics (N.M.D.), George Washington University, Washington, DC
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8
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Kantarci K, Lowe VJ, Lesnick TG, Tosakulwong N, Bailey KR, Fields JA, Shuster LT, Zuk SM, Senjem ML, Mielke MM, Gleason C, Jack CR, Rocca WA, Miller VM. Early Postmenopausal Transdermal 17β-Estradiol Therapy and Amyloid-β Deposition. J Alzheimers Dis 2018; 53:547-56. [PMID: 27163830 PMCID: PMC4955514 DOI: 10.3233/jad-160258] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: It remains controversial whether hormone therapy in recently postmenopausal women modifies the risk of Alzheimer’s disease (AD). Objective: To investigate the effects of hormone therapy on amyloid-β deposition in recently postmenopausal women. Methods: Participants within 5–36 months past menopause in the Kronos Early Estrogen Prevention Study, a randomized, double blinded placebo-controlled clinical trial, were randomized to: 1) 0.45 mg/day oral conjugated equine estrogens (CEE); 2) 50μg/day transdermal 17β-estradiol; or 3) placebo pills and patch for four years. Oral progesterone (200 mg/day) was given to active treatment groups for 12 days each month. 11C Pittsburgh compound B (PiB) PET imaging was performed in 68 of the 118 participants at Mayo Clinic approximately seven years post randomization and three years after stopping randomized treatment. PiB Standard unit value ratio (SUVR) was calculated. Results: Women (age = 52–65) randomized to transdermal 17β-estradiol (n = 21) had lower PiB SUVR compared to placebo (n = 30) after adjusting for age [odds ratio (95% CI) = 0.31(0.11–0.83)]. In the APOEɛ4 carriers, transdermal 17β-estradiol treated women (n = 10) had lower PiB SUVR compared to either placebo (n = 5) [odds ratio (95% CI) = 0.04(0.004–0.44)], or the oral CEE treated group (n = 3) [odds ratio (95% CI) = 0.01(0.0006–0.23)] after adjusting for age. Hormone therapy was not associated with PiB SUVR in the APOEɛ4 non-carriers. Conclusion: In this pilot study, transdermal 17β-estradiol therapy in recently postmenopausal women was associated with a reduced amyloid-β deposition, particularly in APOEɛ4 carriers. This finding may have important implications for the prevention of AD in postmenopausal women, and needs to be confirmed in a larger sample.
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Affiliation(s)
- Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Lynne T Shuster
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samantha M Zuk
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Carey Gleason
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center (GRECC) William S. Middleton Memorial, Veterans' Hospital, Madison, WI, USA
| | | | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Departments of Surgery, Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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9
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Marchi RD, Dell’Agnolo CM, Lopes TCR, Gravena AAF, Demitto MDO, Brischiliari SCR, Borghesan DHP, Carvalho MDDB, Pelloso SM. Prevalence of metabolic syndrome in pre- and postmenopausal women. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:160-166. [PMID: 28225859 PMCID: PMC10118865 DOI: 10.1590/2359-3997000000253] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. MATERIALS AND METHODS A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel III - NCEP-ATP III-2005. RESULTS MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. CONCLUSION MS was more prevalent among postmenopausal women than among premenopausal women.
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10
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Kantarci K, Tosakulwong N, Lesnick TG, Zuk SM, Gunter JL, Gleason CE, Wharton W, Dowling NM, Vemuri P, Senjem ML, Shuster LT, Bailey KR, Rocca WA, Jack CR, Asthana S, Miller VM. Effects of hormone therapy on brain structure: A randomized controlled trial. Neurology 2016; 87:887-96. [PMID: 27473135 PMCID: PMC5035155 DOI: 10.1212/wnl.0000000000002970] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To investigate the effects of hormone therapy on brain structure in a randomized, double-blinded, placebo-controlled trial in recently postmenopausal women. Methods: Participants (aged 42–56 years, within 5–36 months past menopause) in the Kronos Early Estrogen Prevention Study were randomized to (1) 0.45 mg/d oral conjugated equine estrogens (CEE), (2) 50 μg/d transdermal 17β-estradiol, or (3) placebo pills and patch for 48 months. Oral progesterone (200 mg/d) was given to active treatment groups for 12 days each month. MRI and cognitive testing were performed in a subset of participants at baseline, and at 18, 36, and 48 months of randomization (n = 95). Changes in whole brain, ventricular, and white matter hyperintensity volumes, and in global cognitive function, were measured. Results: Higher rates of ventricular expansion were observed in both the CEE and the 17β-estradiol groups compared to placebo; however, the difference was significant only in the CEE group (p = 0.01). Rates of ventricular expansion correlated with rates of decrease in brain volume (r = −0.58; p ≤ 0.001) and with rates of increase in white matter hyperintensity volume (r = 0.27; p = 0.01) after adjusting for age. The changes were not different between the CEE and 17β-estradiol groups for any of the MRI measures. The change in global cognitive function was not different across the groups. Conclusions: Ventricular volumes increased to a greater extent in recently menopausal women who received CEE compared to placebo but without changes in cognitive performance. Because the sample size was small and the follow-up limited to 4 years, the findings should be interpreted with caution and need confirmation. Classification of evidence: This study provides Class I evidence that brain ventricular volume increased to a greater extent in recently menopausal women who received oral CEE compared to placebo.
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Affiliation(s)
- Kejal Kantarci
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison.
| | - Nirubol Tosakulwong
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Timothy G Lesnick
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Samantha M Zuk
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Jeffrey L Gunter
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Carey E Gleason
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Whitney Wharton
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - N Maritza Dowling
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Prashanthi Vemuri
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Matthew L Senjem
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Lynne T Shuster
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Kent R Bailey
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Walter A Rocca
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Clifford R Jack
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Sanjay Asthana
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Virginia M Miller
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
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11
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Harvey RE, Coffman KE, Miller VM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. ACTA ACUST UNITED AC 2015; 11:239-257. [PMID: 25776297 DOI: 10.2217/whe.14.64] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the era of individualized medicine, gaps in knowledge remain about sex-specific risk factors, diagnostic and treatment options that might reduce mortality from cardiovascular disease (CVD) and improve outcomes for both women and men. In this review, contributions of biological mechanisms involving the sex chromosomes and the sex hormones on the cardiovascular system will be discussed in relationship to the female-specific risk factors for CVD: hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms. Additionally, sex-specific factors to consider in the differential diagnosis and treatment of four prevalent CVDs (hypertension, stroke, coronary artery disease and congestive heart failure) will be reviewed with emphasis on areas where additional research is needed.
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Affiliation(s)
- Ronée E Harvey
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Kirsten E Coffman
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Virginia M Miller
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.,Department of Surgery, Medical Sciences, 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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Gleason CE, Dowling NM, Wharton W, Manson JE, Miller VM, Atwood CS, Brinton EA, Cedars MI, Lobo RA, Merriam GR, Neal-Perry G, Santoro NF, Taylor HS, Black DM, Budoff MJ, Hodis HN, Naftolin F, Harman SM, Asthana S. Effects of Hormone Therapy on Cognition and Mood in Recently Postmenopausal Women: Findings from the Randomized, Controlled KEEPS-Cognitive and Affective Study. PLoS Med 2015; 12:e1001833; discussion e1001833. [PMID: 26035291 PMCID: PMC4452757 DOI: 10.1371/journal.pmed.1001833] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 04/22/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Menopausal hormone therapy (MHT) reportedly increases the risk of cognitive decline in women over age 65 y. It is unknown whether similar risks exist for recently postmenopausal women, and whether MHT affects mood in younger women. The ancillary Cognitive and Affective Study (KEEPS-Cog) of the Kronos Early Estrogen Prevention Study (KEEPS) examined the effects of up to 4 y of MHT on cognition and mood in recently postmenopausal women. METHODS AND FINDINGS KEEPS, a randomized, double-blinded, placebo-controlled clinical trial, was conducted at nine US academic centers. Of the 727 women enrolled in KEEPS, 693 (95.3%) participated in the ancillary KEEPS-Cog, with 220 women randomized to receive 4 y of 0.45 mg/d oral conjugated equine estrogens (o-CEE) plus 200 mg/d micronized progesterone (m-P) for the first 12 d of each month, 211 women randomized to receive 50 μg/d transdermal estradiol (t-E2) plus 200 mg/d m-P for the first 12 d of each month, and 262 women randomized to receive placebo pills and patches. Primary outcomes included the Modified Mini-Mental State examination; four cognitive factors: verbal learning/memory, auditory attention/working memory, visual attention/executive function, and speeded language/mental flexibility; and a mood measure, the Profile of Mood States (POMS). MHT effects were analyzed using linear mixed-effects (LME) models, which make full use of all available data from each participant, including those with missing data. Data from those with and without full data were compared to assess for potential biases resulting from missing observations. For statistically significant results, we calculated effect sizes (ESs) to evaluate the magnitude of changes. On average, participants were 52.6 y old, and 1.4 y past their last menstrual period. By month 48, 169 (24.4%) and 158 (22.8%) of the 693 women who consented for ancillary KEEPS-Cog were lost to follow-up for cognitive assessment (3MS and cognitive factors) and mood evaluations (POMS), respectively. However, because LME models make full use all available data, including data from women with missing data, 95.5% of participants were included in the final analysis (n = 662 in cognitive analyses, and n = 661 in mood analyses). To be included in analyses, women must have provided baseline data, and data from at least one post-baseline visit. The mean length of follow-up was 2.85 y (standard deviation [SD] = 0.49) for cognitive outcomes and 2.76 (SD = 0.57) for mood outcomes. No treatment-related benefits were found on cognitive outcomes. For mood, model estimates indicated that women treated with o-CEE showed improvements in depression and anxiety symptoms over the 48 mo of treatment, compared to women on placebo. The model estimate for the depression subscale was -5.36 × 10(-2) (95% CI, -8.27 × 10(-2) to -2.44 × 10(-2); ES = 0.49, p < 0.001) and for the anxiety subscale was -3.01 × 10(-2) (95% CI, -5.09 × 10(-2) to -9.34 × 10(-3); ES = 0.26, p < 0.001). Mood outcomes for women randomized to t-E2 were similar to those for women on placebo. Importantly, the KEEPS-Cog results cannot be extrapolated to treatment longer than 4 y. CONCLUSIONS The KEEPS-Cog findings suggest that for recently postmenopausal women, MHT did not alter cognition as hypothesized. However, beneficial mood effects with small to medium ESs were noted with 4 y of o-CEE, but not with 4 y of t-E2. The generalizability of these findings is limited to recently postmenopausal women with low cardiovascular risk profiles. TRIAL REGISTRATION ClinicalTrials.gov NCT00154180 and NCT00623311.
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Affiliation(s)
- Carey E. Gleason
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin, United States of America
- * E-mail:
| | - N. Maritza Dowling
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin, United States of America
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Whitney Wharton
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Emory Alzheimer’s Disease Research Center, Atlanta, Georgia, United States of America
| | - JoAnn E. Manson
- Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Virginia M. Miller
- Departments of Surgery and Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Craig S. Atwood
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin, United States of America
| | - Eliot A. Brinton
- Utah Foundation for Biomedical Research, Salt Lake City, Utah, United States of America
| | - Marcelle I. Cedars
- Obstetrics & Gynecology, University of California at San Francisco, San Francisco, California, United States of America
| | - Rogerio A. Lobo
- Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | - George R. Merriam
- VA Puget Sound Health Care System, Tacoma, Washington, United States of America
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Tacoma, Washington, United States of America
| | - Genevieve Neal-Perry
- Neuroscience and Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Nanette F. Santoro
- Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Hugh S. Taylor
- Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Dennis M. Black
- Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Matthew J. Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California, United States of America
| | - Howard N. Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, California, United States of America
| | - Frederick Naftolin
- Obstetrics & Gynecology, New York University School of Medicine, New York, New York, United States of America
| | - S. Mitchell Harman
- Kronos Longevity Research Institute, Phoenix, Arizona, United States of America
- Division of Endocrinology, Phoenix VA Medical Center, Phoenix, Arizona, United States of America
| | - Sanjay Asthana
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America
- Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin, United States of America
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