Maturitas

Editorial Board

2010-04-01

Reproductive hormone exposure timing and ischemic heart disease: Complicated answers to a simple question

2010-01-13

Premenopausal women have a relatively lower risk of ischemic heart disease (IHD) compared to age matched men and this gender gap narrows after menopause. The observation that the onset of IHD occurs 10 years later in women than it does in men is said to suggest that endogenous reproductive hormones play a protective role. Indeed, animal models and human epidemiological studies suggest that oophorectomy is a risk factor for accelerated IHD. In animal models, hormone therapy (HT) has anti-atherosclerotic effects after oophorectomy, HT in the form of oral contraceptives (OCs) prevents atherosclerosis in anovulatory cycling women, and large numbers of premenopausal women taking OCs have relative safety from an IHD standpoint . Further, observational epidemiological studies in humans have consistently demonstrated protective effects for IHD among HT users. Such studies are typically performed on relatively younger women where HT is prescribed for vasomotor symptoms during menopausal transition or shortly following menopause. In contrast, clinical trials in older, postmenopausal and often asymptomatic women have demonstrated no overall benefit and early adverse effects when randomized to a variety of forms of HT . These data discrepancies have called into question the validity of the reproductive hormone estrogen protection hypothesis, and raise the alternative possibility that HT efficacy may differ according to the timing of exposure. Stated as a simple question, is the effect of HT on the risk of IHD in relatively young pre- or early menopausal women with vasomotor symptoms, different than it is in older, fully menopausal women?

New therapeutic targets and agents for osteoporosis

Serge Rozenberg — 2010-02-01

In this issue of Maturitas, a review article by Gallagher and Sai, describes how major discoveries have modified our current understanding of the molecular biology of bone remodelling and the consequent development of new therapeutic agents for osteoporosis . The discovery of the RANKL (Receptor Activator of NF-Kappa B Ligand)/Osteoprotegerin signalling pathway in the osteoclast has provided insight into the mechanisms of osteoclastogenesis . Bone resorption-formation equilibrium is a complex system that includes several key players: OPG, a member of the TNF (tissue necrosis factor) receptor superfamily negatively regulates osteoclastogenesis by binding to RANKL. It inhibits osteoclast formation and action. Cathepsin K, a cysteine protease that is highly expressed in osteoclasts, plays an essential role in bone resorption, as a potent extracellular-degrading enzyme. Recent research has shown that several proteins are essential for osteoblast proliferation, differentiation and survival. Of particular importance is the Wingless-type and integrase 1(Wnt/β-Catenin pathway). These fundamental discoveries have led, in less than a decade, to the development of new, very powerful anti-resorbtive agents.

Molecular biology of bone remodeling: Implications for new therapeutic targets for osteoporosis

J. Chris Gallagher, A.J. Sai — 2010-01-11

Abstract: Osteoporosis is a major public health problem for adults over age 55 years costing billions of euros/dollars. Over the last 20 years anti-resorptive drugs were the treatment of choice for osteoporosis and most were derived from the bisphosphonate molecule.In the last 7 years remarkable advances in molecular biology and genetics have led to a detailed understanding of the bone remodeling cycle and as a result new therapeutic targets for treatment emerged.These new compounds have different modes of action depending on their role in the bone remodeling cycle. A major discovery was the important role of RANKL (receptor activator of nuclear factor kappa B ligand) secreted by osteoblasts and responsible for stimulating osteoclastic bone resorption. This led to development of a potent monoclonal antibody that blocks its action. This drug should be available soon as a new treatment for osteoporosis. Other molecular targets in resorption have been identified and several specific antagonists are potential treatments. However, a significant limiting factor for a new anti-resorptive drug is the cost of bringing it to the market because of the huge costs of a fracture trial.Although anti-resorptive agents have been the backbone of osteoporosis treatment they do not rebuild bone architecture and development of anabolic agents is needed. These are likely to evolve from an understanding of the LRP/Wnt signaling pathway. Already an antibody against sclerostin has shown promise in animal studies, and not to forget parathyroid hormone which was the first clinically useful anabolic treatment for osteoporosis.

Male breast cancer: An update in diagnosis, treatment and molecular profiling

Susan Onami, Melanie Ozaki, Joanne E. Mortimer, Sumanta Kumar Pal — 2010-02-03

Abstract: Significant advances have been made in the diagnosis and treatment of female breast cancer, resulting in a decline in incidence and a global improvement in clinical outcome. The statistics for male breast cancer (MBC) stand in sharp contrast—over the past several decades, there has been a steady rise in the incidence of this disease, and clinical outcome has improved at a much slower pace. In the current review, the clinicopathologic features of MBC are described in detail. An emphasis is placed on molecular profiling of MBC, which may identify candidate biomarkers and putative targets for pharmacologic intervention. The current role of cytotoxic chemotherapy and endocrine therapy (including tamoxifen, aromatase inhibitors and GnRH analogues) is defined in the context of currently available studies. Furthermore, the potential role of targeted agents, including HER2-directed therapies, PARP inhibitors, and angiogenesis inhibitors, is delineated.

Ethnic differences in body composition and the associated metabolic profile: A comparative study between Asians and Caucasians

S.N. Wulan, K.R. Westerterp, G. Plasqui — 2009-12-25

Abstract: It is estimated that Asia will be the home of more than 100 million people with type 2 diabetes by the year of 2025. This region combines a high proportion of the world's population with rapidly rising diabetes prevalence rates. The increase in diabetes in Asia differs from that reported in other parts of the world: it has developed in a shorter time, in a younger age group, and in people with lower body-mass index (BMI).Studies reported that for the same BMI, Asians have a higher body fat percentage, a prominent abdominal obesity, a higher intramyocellular lipid and/or a higher liver fat content compared to Caucasians. These characteristics may contribute to a higher predisposition to insulin resistance at a lesser degree of obesity than Caucasians. The differences in body composition are more pronounced depending on the region. For the same BMI, among three major ethnic groups in Asia, Asian Indians have the highest body fat, followed by Malay and Chinese.Lower insulin sensitivity is already observed in Asian Indian adolescents with a higher body fat and abdominal obesity compared to Caucasian adolescents. In general, Asian adolescents share the same feature of body composition such as higher body subcutaneous fat, lower appendicular skeletal muscle and lower gynoid fat compared to Caucasian adolescents. This unfavourable body composition may predispose to the development of insulin resistance at later age. Genetics may play a role and the interaction with environmental factors (changes in lifestyle) could increase the risk of developing the metabolic syndrome.

Laparoscopic surgery for gynaecological cancers in obese women

Igor E. Martinek, Krishnayan Haldar, Roberto Tozzi — 2009-12-23

Abstract: The use of laparoscopic surgery in the management of gynaecological malignancies has been growing for over a decade. Concomitantly the incidence of obesity has been increasing worldwide. This review summarizes the available studies on minimal invasive surgery in obese women with gynaecological malignancies. We undertook a literature search to identify the differences between traditional open methods and the laparoscopic approach in terms of intra- and postoperative outcome and patient safety. Only eight relevant studies were identified. Six of these focused on endometrial cancer, one study included early stage cervical and ovarian cancers with other benign conditions, while another paper included cervical and endometrial pre-cancers and only a few malignant conditions.Obesity is generally known to increase the risk of intra- and postoperative complications. However, several studies show that obesity, formerly precluding keyhole surgery, seems now to be an indication for the laparoscopic approach. As compared to laparotomy, laparoscopic surgery has a good postoperative outcome, reduced estimated blood loss (EBL) and pain and in some series an increased lymph node count. Laparoscopy has been shown to be cost effective with a shorter hospital stay and return to normal activity. Survival is reported to be the same with both laparotomy and laparoscopy. The benefits of minimal invasive surgery in gynaecological surgery are starting to be found with robotic surgery.

Optimizing bone health in chronic kidney disease

Solenne Pelletier, Roland Chapurlat — 2010-01-05

Abstract: Phosphocalcic metabolism disorders often complicate chronic kidney disease (CKD) and worsen as kidney function declines, with a consequence on bone structural integrity. The risk of fracture exceeds that of the normal population in both patients with pre-dialysis CKD and end-stage renal disease (ESRD). The increasing incidence of CKD, the high mortality rate induced by hip fracture, the decreased quality of life and economic burden of fragility fracture make the renal bone disorders a major problem of public health around the world. Optimizing bone health in CKD patients should be a priority. Bone biopsy is invasive. Dual-energy X-ray absorptiometry, commonly used to screen individuals at risk of fragility fracture in the general population, is not adequate to assess advanced CKD because it does not discriminate fracture status in this population. New non-invasive three-dimensional high-resolution imaging techniques, distinguishing trabecular and cortical bone, appear to be promising in the assessment of bone strength and might improve bone fracture prediction in this population. Therapeutic intervention in the chronic kidney disease-mineral and bone disorders (CKD-MBD) should begin early in the course of CKD to maintain serum concentration of biological parameters involved in mineral metabolism in the normal recommended ranges, prevent the development of parathyroid hyperplasia, prevent extra-skeletal calcifications and preserve skeletal health.In this paper, we review studies of mineral and bone disorders in patients with CKD and ESRD, the utility of current techniques to assess bone health and the preventive and therapeutic strategies for managing CKD-MBD.

Controversies concerning the use of phytoestrogens in menopause management: Bioavailability and metabolism

Patricia de Cremoux, Pascale This, Guy Leclercq, Yves Jacquot — 2010-01-05

Abstract: It has been proposed that the use of phytoestrogens (PE) in menopausal therapy could be beneficial to woman health, particularly with respect to hot flushes. Indeed, PE may compensate the lack of endogenous 17β-estradiol occurring during menopause. However, therapeutic benefits remain questionable, as highlighted by recent publications. Indeed, data are often subjected to controversy since a number of exogenous and endogenous factors influencing the responsiveness of patients are not sufficiently taken into account. In the present paper, we will discuss the role of bioavailability and metabolism in the instability of individual response to PE.

New drug treatments for urinary incontinence

Dudley Robinson, Linda Cardozo — 2010-01-04

Abstract: Urinary incontinence remains a common and distressing condition affecting many women and is known to have a significant effect on quality of life (QoL). Whilst conservative and behavioural therapy are important in the management of women with both stress incontinence and overactive bladder (OAB) ultimately many may benefit from pharmacological therapy. Antimuscarinic drugs are the commonly used agents in the treatment of OAB although often compliance and persistence are affected by adverse effects. Consequently many newer agents remain under investigation. In addition duloxetine has recently been introduced for the management of women with stress incontinence and may offer an alternative to surgery in selected cases.The aim of this review is to provide an overview of the current and new developments in the management of women with urinary incontinence as well as reviewing the role of oestrogen therapy in relation to lower urinary tract dysfunction.

Bone mineral density and prediction of non-osteoporotic disease

Florence Tremollieres, Claude Ribot — 2010-01-05

Abstract: It is widely recognized that bone mineral density (BMD) is one of the best predictors of osteoporotic fractures. Sex hormone status clearly affects bone either directly or indirectly and a longer estrogen exposure appears to be a major determinant of postmenopausal BMD. Accordingly, several studies have led to the hypothesis that BMD might represent a marker of the accumulated lifetime exposure of estrogen and therefore be used as a predictor factor of the risk of other postmenopausal conditions such as breast cancer or cardiovascular diseases (CVD).With regard to the risk of breast cancer, there is evidence that different surrogate markers of lifetime exposure to estrogen are associated with an increased risk for breast cancer. Most of these markers are the opposite of those for the risk of fracture. Furthermore, several studies have also reported that women with higher BMD have an increased risk of breast cancer compared to women with lower BMD. On the other hand, postmenopausal women with osteoporosis are at increased risk for acute cardiovascular events and mortality independently of age and cardiovascular risk factors. BMD has been shown to inversely correlate with surrogate markers of CVD including aortic calcifications and atherosclerosis. The underlying mechanisms of such a relationship are not fully understood. Several plausible molecular links are serum lipids, pro-inflammatory cytokines or the RANK/RANK ligand/osteoprotegerin system. Interestingly, all of these factors are modulated by estrogens. It could thus be hypothesized that the intensity of postmenopausal estrogen deficiency could be also the common pathogenic factor between atherosclerosis and osteoporosis.

Parkinson's disease in women: A call for improved clinical studies and for comparative effectiveness research

J.M. Pavon, H.E. Whitson, M.S. Okun — 2010-01-11

Abstract: The incidence and prevalence of Parkinson's disease (PD) is expected to rise precipitously over the next several decades, as will the associated healthcare related costs. The epidemiology and disease manifestations of PD may differ when comparing women to men. Women are for example less likely to acquire PD, and in several studies have demonstrated a delayed onset of motor symptoms. Women, however, are more likely to experience PD-related complications that may lead to disability (e.g. depression and medication-associated dyskinesia). Further, there are purported differences in the treatment and treatment outcomes in PD men compared to women. Whether estrogen, other hormonal activity, or whether multiple factors underpin these findings remains unknown. Also unknown is whether estrogen itself may represent a therapeutic option for symptomatic PD treatment. This review summarizes what is known about gender differences in epidemiology, clinical features, treatment outcomes (medical and surgical/deep brain stimulation), and social impact among all available PD studies. We offer expert opinion regarding the shortcomings of the current evidence, and we propose a detailed list of studies that will help to clarify important gender related PD questions. Our hope is that this review will spark comparative effectiveness research into improving care and outcomes in women with PD.

Does daily vitamin D 800IU and calcium 1000mg supplementation decrease the risk of falling in ambulatory women aged 65–71 years? A 3-year randomized population-based trial (OSTPRE-FPS)

2009-12-31

Abstract: Objective: The hypothesis was that the calcium and vitamin D supplementation prevents falls at the population level.Study design: The OSTPRE-FPS was a randomized population-based open-trial with 3-year follow-up. The supplementation group (n=1566) received daily cholecalciferol 800IU+calcium carbonate 1000mg, while the control group (n=1573) received no supplementation or placebo. A randomly selected subsample of 593 subjects underwent a detailed measurement program including serum 25(OH)D measurements.Main outcome measure: The occurrence of falls was the primary outcome of the study. The participants in the subsample were telephoned at 4 months intervals and the rest of the trial population was interviewed by phone once a year.Results: In the entire trial population (ETP), there were 812 women with 1832 falls in the intervention group and 833 women with 1944 falls in the control group (risk ratio was 0.98, 95% CI 0.92–1.05, P=0.160). The supplementation was not associated with single or multiple falls in the ETP. However, in the subsample, multiple fall incidence decreased by 30% (odds ratio (OR) 0.70, 95% CI 0.50–0.97, P=0.034) in the supplementation group. Further, the supplementation decreased the incidence of multiple falls requiring medical attention (OR 0.72, 95% CI 0.53–0.97, P=0.031) in the ETP. The mean compliance in the entire trial population was 78% and in the subsample 79%.Discussion: Overall, the primary analysis showed no association between calcium and vitamin D supplementation and risk of falls. However, the results of a post hoc analysis suggested that there was a decreased risk of multiple falls requiring medical attention: this finding requires confirmation.

Evaluation of a natural health product decision aid: A tool for middle aged women considering menopausal symptom relief

Prudy Menard, Dawn Stacey, France Légare, Kirsten Woodend — 2009-12-21

Abstract: Objective: To evaluate the effectiveness of a self-administered decision aid for menopausal women facing decisions about natural health products.Study design: This pre-/post-test study included peri- or post-menopausal women, aged 45–64 considering the use of a natural health product for management of menopausal symptoms. They were recruited from a Women's Health Center.Outcome measures: The primary outcome was decisional conflict and secondary outcomes included knowledge, strength of values, and decision preference.Results: Of 24 women, the typical participant was 50–64 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 24% (p<0.001) and knowledge improved from 76% to 87% (p=0.001). Of the 24 women, 10 were unsure of their choice at baseline and 3-post use of the decision aid (p=0.015). There was a trend for women preferring natural health products (n=12) to be more likely to rate the non-chemical aspect as important and the cost of the natural health product as less important; women who preferred not to take natural health products (n=3) rated the non-chemical aspect as less important and the costs as more important.Conclusions: The natural health product decision aid improved the quality of decisions by enhancing knowledge and reducing decisional conflict. As well, women were more likely to make a choice that was consistent with their values.

A prospective cohort study of menstrual symptoms and morbidity over 15 years following laparoscopic Filshie clip sterilisation

I.Z. MacKenzie, Wendy Thompson, Fenella Roseman, Eileen Turner, John Guillebaud — 2010-01-18

Abstract: Objective: To observe the incidence of menstrual symptoms and relevant surgery after sterilisation.Study design: 1101 women sterilised with Filshie clips between 1983 and 2002 were assessed prospectively comparing menstrual symptomatology documented immediately before surgery and 5–14 years later by questionnaire.Main outcome measures: Prevalence of menstrual dysfunction and subsequent surgery related to pre-operative menstrual symptoms and contraception.Results: After excluding 232 (24%) of the 968 eligible women sent questionnaires whose address had changed, 573 of the remaining 735 women (78%) completed the questionnaire, 223 5–6 years after sterilisation, 175 after 7–9 years and 175 after 10–15 years; the respondents were demographically representative of the total population. Heavy periods increased from 9% before to 35% (P<0.0001) after sterilisation, painful periods from 2% to 21% (P<0.0001) and 6% had undergone hysterectomy or endometrial ablation. These findings were not influenced by the pre-sterilisation method of contraception but were inversely related to advancing age (P<0.0002). The lowest rates of menstrual symptoms were reported 10–15 years after sterilisation.Conclusion: Menstrual symptoms increased following Filshie clip sterilisation irrespective of pre-sterilisation symptoms and contraception. Whatever the causative mechanism, the progestogen-loaded intrauterine system (IUS), with similar efficacy but with improved menstrual symptoms, should be considered before sterilisation.

Risk factors related to the presence and severity of hot flushes in mid-aged Ecuadorian women

2009-12-09

Abstract: Background: Several studies drawn from the Ecuadorian population have previously reported that more than half of mid-aged women present hot flushes, which can impair their quality of life. However up-to-date risk factors for their presence and severity have not been assessed.Objective: To assess hot flush frequency and intensity and related risk factors among middle-aged Ecuadorian women.Methods: In this cross-sectional study, 1154 healthy women aged 40–59 years, visiting healthcare centers of eight main cities of Ecuador with more than 100,000 inhabitants, were assessed with the first item of the Menopause Rating Scale (MRS) and a questionnaire containing female and partner socio-demographic data.Results: Mean age of the entire sample was 48.8±5.6 years (median 48), a 48.7% had 12 or less years of schooling, 52.8% were postmenopausal, 43.6% lived at high altitude, 56.8% were married and 10% were on hormonal therapy (HT). Hot flushes accounted for 56% (n=646) of the whole sample, of which 29.1% and 9.1% were respectively graded as severe and very severe. Logistic regression determined that female sedentarism (OR: 2.42, CI 95% [1.63–3.59]), accessing a free healthcare system (OR: 1.96, CI 95% [1.30–2.96]), living at high altitude (OR: 1.82, CI 95% [1.14–2.90]) and having a partner abusing alcohol (OR: 1.92, CI 95% [1.09–3.35]) were significant risk factors related to the presence of hot flushes. The regression model also determined that among women with hot flushes (n=646), sedentarism (OR: 1.73, CI 95% [1.14–2.62]) and having a partner with erectile dysfunction (OR: 2.57, CI 95% [1.44–4.59]) were significant risk factors related to severe/very severe hot flushes whereas married status (OR: 0.53, CI 95% [0.32–0.86]), living at high altitude (OR: 0.46, CI 95% [0.26–0.78]) and partner healthiness (OR: 0.59, CI 95% [0.36–0.95]) were not.Conclusion: To the best of our knowledge this is the first and largest study assessing hot flushes in a mid-aged Ecuadorian population. We found that the presence and severity were not significantly related to age and hormonal status yet to other individual female/male characteristics and the demography of the studied population.

Treatment of menopausal hot flashes with 5-hydroxytryptophan

Robert R. Freedman — 2009-12-11

Abstract: Objective: Much recent research has focused on nonhormonal treatments for menopausal hot flashes. The purpose of the present study was to determine the effects of 5-hydroxytroptophan (5-HTP), the immediate precursor of serotonin, upon menopausal hot flashes. Selective, serotonergic, reuptake inhibitors (SSRIs), which increase the amount of serotonin in the synaptic gap, have shown some promise in the amelioration of hot flashes.Methods: We administered 5-HTP or placebo, in double-blind fashion, to 24 postmenopausal women reporting frequent hot flashes. Treatment outcome was measured using a miniature, electronic, hot flash recorder.Results: No significant effects of 150mg/day 5-HTP upon hot flash frequency were found. The 5-HTP group had 23.8±5.7 (SD) hot flashes/24h prior to treatment and 18.5±9.6 at the end of treatment. The placebo group had 18.5±9.6 before treatment and 22.6±12.4 at treatment completion.Conclusions: At the dose given, 5-HTP does not significantly ameliorate frequency of menopausal hot flashes, as measured objectively with an electronic recorder. Given the small size, this study must be considered preliminary in nature.

Comparative analysis of the uterine and mammary gland effects of progesterone and medroxyprogesterone acetate

Christiane Otto, Iris Fuchs, Richardus Vonk, Karl-Heinrich Fritzemeier — 2009-12-16

Abstract: Objectives: In combined hormone replacement therapy (HRT) progestins are used to inhibit estradiol-activated uterine epithelial cell proliferation. In comparison to estradiol-only therapy, combined HRT leads to enhanced proliferation of mammary epithelial cells. In a quantitative mouse model, we assessed the balance between uterine and undesired mammary gland effects for two progestins that are widely used in HRT, progesterone and medroxyprogesterone acetate.Study design: Mice were ovariectomized and after 14 days they were treated subcutaneously with either vehicle, estradiol (100ng) or estradiol plus increasing doses of progesterone or medroxyprogesterone acetate for three weeks.Main outcome measures: Measures for progestogenic mammary gland activity were stimulation of side-branching and stimulation of epithelial cell proliferation. Progestogenic activity in the uterus was assessed by measuring inhibition of estradiol-activated uterine epithelial cell proliferation. ED50 and ID50 values for the distinct readouts were obtained and dissociation factors for uterine versus mammary gland activity were calculated.Results: MPA demonstrated uterine activity and mitogenic activity in the mammary gland at the same doses. In contrast, progesterone showed uterine activity at doses lower than those leading to significant stimulation of epithelial cell proliferation in the mammary gland.Conclusions: Progestins do not behave the same. Use of the natural hormone progesterone, but not MPA, in combined hormone therapy might offer a safety window between uterine effects and undesired proliferative activity in the mammary gland.

Effect of physical training on age-related reduction of GH secretion during exercise in normally cycling women

2010-01-19

Abstract: Objective: To evaluate whether prolonged physical activity (25km/week running for 8 years) modifies GH decline.Design: The GH response to maximal exercise on bicycle-ergometer was tested in younger (26–30 years) and older (42–46 years) healthy women. Each age group included 2 subgroups of 10 sedentary and 10 runners, which were compared. The workload was increased at 3min intervals from time 0 until exhaustion. Subjects with a low maximal capacity (as established in a preliminary test) pedalled for 3–4min against no workload at the beginning of the test, so that exercises lasted about 15min in all individuals.Results: At exhaustion, heart rate and systolic pressure were significantly higher in sedentary than in trained subjects, whereas , blood glucose and plasma lactate levels were similar in all groups. Exercise induced similar GH responses in younger sedentary and exercise-trained subjects and in older exercise-trained subjects, with mean peak levels 7.5 times higher than baseline. In contrast, in older sedentary women peak GH level was only 4.4 times higher than baseline and was significantly lower than in the other groups.Conclusion: These data suggest that in women prolonged physical training exerts protective effects against age-dependent decline in GH secretion.

Bone turnover markers and bone mineral density in hypertensive postmenopausal women on treatment

2010-01-25

Abstract: Objective: To evaluate bone mineral density (BMD) and bone metabolism in hypertensive postmenopausal women, and to differentiate the effect of thiazides from that of other antihypertensive agents.Subjects and methods: A community-based population of 636 postmenopausal women, 293 with hypertension (160 receiving thiazides, and 133 receiving other antihypertensive treatments), and 343 control women, were evaluated. Serum levels of aminoterminal propeptide of type I collagen (P1NP), C-terminal telopeptide of type I collagen (β-CTX), 25-hydroxivitamin D, and intact parathyroid hormone were measured by electrochemiluminiscence. BMD was determined by DXA, and heel quantitative ultrasound measurements (QUS) with a gel-coupled device.Results: BMD expressed as Z-score was higher in both groups of hypertensive women at all locations. Expressed as g/cm2, it was also higher in patients on thiazides at femoral neck and lumbar spine. Only in the latter site, differences remained significant after adjusting for potential confounding variables, including BMI. Bone turnover markers were lower in both groups of hypertensive women, although the difference was greater in those on thiazides. After adjusting for potential confounders, differences remained significant only in the thiazide group.Conclusions: Our results add evidence to the idea that thiazides are beneficial to prevent bone loss.

Menopause, increased iron stores and cholesterol

Luca Mascitelli, Francesca Pezzetta, Mark R. Goldstein — 2010-01-25

Agrinier et al. found that postmenopausal women had significantly higher age-adjusted levels of total and LDL cholesterol. Consequently, they speculated that the increase in coronary heart disease (CHD) risk during the sixth decade could be explained by an effect of estrogen deprivation on lipid profile occurring in the peri-menopause period. However, mounting evidence makes it unlikely that the difference in heart disease incidence between menstruating and menopausal women is caused by different cholesterol levels .

Causal mechanism for atherosclerosis or coronary heart disease in women: A constellation of components

2010-02-11

“[…] No specific event, condition, or characteristic is sufficient by itself to produce disease”, those are the words of Rothman in a chapter called basic concept to explain causation and causal inference in epidemiology , reminding us that causal mechanism for any effect must consist of a constellation of components that act in concert. Explaining the occurrence of coronary heart disease (CHD) or atherosclerosis does not make an exception to this premise, including in women. As a response to Mascitelli et al. (Maturitas 2010;65(4):403), we would like to add a few arguments on the causal mechanism for atherosclerosis or CHD in women.