11 Per Cent American Men Have Concurrent Sexual Partners

A new US study has found that 11 per cent of American men have concurrent sexual partners, which is believed to contribute to the spread of HIV.

The study was carried out by researchers at the University of North Carolina (UNC) and is published online ahead of print in the American Journal of Public Health.

The researchers set out to determine the proportion and distribution of men with concurrent sexual partners, which is believed to significantly influence the speed of the spread of HIV/AIDS.

According to ABC news, lead author, Dr. Adaora Adimora, clinical associate professor of epidemiology at the School of Public Health in the University of North Carolina at Chapel Hill, said that:

“Concurrent partnerships are an important sexual network characteristic because of the way they connect people to each other.”

“These kinds of relationships can spread HIV through a population faster than the same number of monogamous relationships,” said Adimora.

Having overlapping sexual relationships contributes to what the researchers called the density of a person’s sexual network, which speeds up transmission in the overall population.

For instance, compare two scenarios: a man with HIV who has three concurrent sexual partners and a man with HIV who has three sexual partners one after another without them being concurrent. In the first scenario the man could pass the infection onto three people in the time the man in the second scenario has only passed it to one person.

Adimora and colleagues used data on 4,928 men taken from the 2002 National Survey of Family Growth conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC). From the dates of reported sexual partnerships they were able to work out the prevalence of concurrent sexual partnerships and relate it to demographic patterns linked to risk.

The results showed that 11 per cent of men had had concurrent sexual partners in the preceding 12 months, and compared to men who had not:
Concurrency was significantly linked to being unmarried (odds ratio 4.6), non-Hispanic black (odds ratio 2.6), or Hispanic (odds ratio 2.3).

Having spent a spell in prison during the preceding 12 months also increased the odds (odds ratio 2.1).

Men with concurrent sexual partners were more likely to report being intoxicated with drugs or alcohol during intercourse (odds ratio 2.1).

Men with concurrent sexual partners were also more likely to have had female sexual partners who were also in concurrent sexual relationships (odds ratio 6.1), and to have had sex with another man (odds ratio 1.9).

The researchers concluded that:

“The higher concurrency prevalence in various groups, dense sexual networks, and mixing between high-risk subpopulations and the general population may be important factors in the US epidemic of heterosexual HIV infection.”

Treating depression in the workplace pays off for workers and employers

Employers prepared to pick up the cost of providing treatment for depression amongst their workers could reap benefits in terms of improved productivity and greater job retention.
A study conducted by researchers at the National Institute of Mental Health found that those workers who participated in a program that included telephone outreach intervention had fewer symptoms, worked more hours and stayed in their job longer than participants the receiving usual care.

Depression is a costly business and places enormous burdens on society; experts believe depression costs the U.S. economy tens of billions of dollars each year in terms of loss of productivity alone.

Depression is among the most costly of all health problems for employers, and though there is ample evidence that there are effective treatments, many depressed workers are untreated or inadequately treated.

Even those employers who purchase corporate health benefits many often do not invest in enhanced depression screening-treatment programs because of the uncertainty of the value of such investments.

Dr. Philip S. Wang and his colleagues examined the impact of a depression outreach-treatment program on the outcomes of depression symptom relief, job retention, sickness absence, and increased work productivity.

Their two-part randomized controlled trial included 604 employees covered by a managed behavioral health plan who were identified in a 2-stage screening process as having significant depression; 304 employees were enrolled in the enhanced care program while 300 received the program’s usual care.

Those employees reluctant to enter treatment were offered structured cognitive behavioral psychotherapy exclusively via the telephone while you purchase viagra.

The telephonic outreach and care management program encouraged workers to enter outpatient treatment such as psychotherapy and/or antidepressant medication, monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to clinicians.

The researchers found that the severity of the depression was significantly lower in the intervention group than in the usual care group at 6 months and at 12 months, and that patients in the intervention group were more likely to recover.

It was also found that this group also worked significantly more hours and had a higher rate of job retention.

The researchers say the enhanced depression care of workers benefited the workers as well as the workplace outcomes, particularly in terms of recovered hiring, training, and salary costs.

They say many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers.

The study, the “Enhanced Depression Treatment and Work Outcomes,” is published in the current issue of the Journal of the American Medical Association (JAMA).

Source : www.news-medical.net

Older American Women Better Informed About Cholesterol Than Younger Women, But Gaps Remain In Knowledge And Screening

Older adult American women are better informed about cholesterol and more likely to monitor it than younger adult women, but gaps remain in cholesterol knowledge and efforts to screen for it adequately, according to results of a national survey released today by the Society for Women’s Health Research, a Washington, D.C., based advocacy organization.

More than seventy percent of women 55 and older said they have had their cholesterol tested within the past year, but almost 20 percent said they have never had their cholesterol tested, have not had it tested in the last four years, or don’t know if they’ve ever had it tested.

The American Heart Association and the National Heart, Lung, and Blood Institute recommend that everyone 20 and older should have their cholesterol measured at least once every five years.

“High cholesterol is a major risk factor for heart disease and cholesterol levels naturally rise as you age, so it is important for aging women to make sure their cholesterol score is in an acceptable range,” said Jo Parrish, vice president of communications for the Society for Women’s Health Research, a Washington, D.C., based non-profit advocacy organization.

Four in 10 (41.2 percent) women 55 and older were “very surprised” or “somewhat surprised” to learn that cholesterol levels naturally increase with age. Nearly one-third (31.1 percent) were “very surprised” or “somewhat surprised” that you can still have high cholesterol levels even if you exercise regularly and maintain a healthy diet.

A person’s total cholesterol number is made up of low density lipoproteins (LDL), high density lipoproteins (HDL) and triglycerides, another fatty substance found in the blood. A desirable level of total cholesterol is less than 200.

“Lowering your LDL level is the major goal for women and men, but there is also evidence that HDL and triglyceride levels are more important for women’s heart health than men’s,” Parrish said. “That’s why it is important for women to know about the components that make up total cholesterol and to know if their numbers are optimal.”

LDL, known as the “bad” cholesterol, deposits on the inside of your vessels to make plaques. Elevated levels of LDL increase your risk of heart disease and stroke. An optimal level of LDL is less than 100. HDL is called the “good” cholesterol because a high HDL level decreases your risk of cardiovascular disease. For women, an HDL less than 50 is considered a risk factor for cardiovascular disease.

More than half of women 55 and older surveyed did not know or incorrectly guessed the optimal levels for HDL and LDL cholesterol. Similar numbers did not know that HDL is the “good” cholesterol. Eighty percent, however, did know that less than 200 is considered a healthy range for total cholesterol. By contrast, only 63.7 percent of adult women under 45 knew that.

Heart disease typically strikes women after menopause and 10 years later in life than it strikes men.

“A healthy diet and lifestyle throughout life reduces your risk of heart disease,” Parrish said, “but as we get older and approach retirement age it is important to more closely monitor our risk factors. Fortunately, Medicare eligible patients have access to cholesterol screening through their preventive benefits package.

“Women have under utilized their Medicare preventive benefits in the past, so we want to encourage them to take advantage of these important health care services that are available to them free through Medicare.”

To help women learn more about cholesterol screening and Medicare preventive services, the Society for Women’s Health Research has posted on its Web site, http://www.womenshealthresearch.org, a non-branded brochure for consumers called “Medicare’s Preventive Care Services … To Manage Cholesterol and Your Heart Health.” The Society’s site also provides additional links to information on Medicare and heart health during September, which is National Cholesterol Awareness Month.

The nationally representative telephone survey of 524 adult U.S. women was conducted by GfK Custom Research North America, June 29-July 1, on behalf of the Society for Women’s Health Research. Support for the survey was provided by Dezenhall Resources. The non-branded brochure on cholesterol screening and Medicare preventive services was developed by Abbott Laboratories.

The Society for Women’s Health Research is the nation’s only non-profit organization whose mission is to improve the health of all women through research, education and advocacy. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the need for more information about conditions affecting women exclusively, predominately, or differently than men. The Society advocates increased funding for research on women’s health; encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease; promotes the inclusion of women in medical research studies; and informs women, providers, policy makers and media about contemporary women’s health issues. Visit the Society’s Web site at http://www.womenshealthresearch.org for more information.

Society for Women’s Health Research (SWHR)
1025 Connecticut Ave. NW, Ste. 701
Washington, DC 20036
United States

Source : www.medicalnewstoday.com

Symptomatic Testosterone Deficiency Relatively Rare In Men

A new study reveals that relatively few men, only 5.6 percent of the male population, actually suffer from low testosterone accompanied by clinical symptoms. That percentage, however, rises substantially with age.

Low testosterone levels are typically defined as less than 300 ng/dL (nanograms per deciliter) of total testosterone and less than 5 ng/dL of free testosterone. Free testosterone is the amount of the hormone unbound to other proteins and is “free” to work inside the body. “Low levels of testosterone impact many aspects of male physiology,” said Andre B. Araujo, Ph.D., a research scientist at the New England Research Institutes in Watertown, Mass., and lead author of the study. “This is particularly significant because the ongoing aging of the U.S. male population is likely to cause the number of men suffering from androgen deficiency to increase appreciably.”

Consistent with a recently issued Clinical Practice Guideline from the Endocrine Society, symptomatic androgen deficiency in the study by Araujo and colleagues is defined as low total and free testosterone plus the presence of low libido, erectile dysfunction, osteoporosis or facture, or two or more of the following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance.

For this study, the researchers analyzed data on 1,475 randomly selected men enrolled in the Boston Area Community Health (BACH) Survey. The survey tracked subjects between the ages of 30 79 and compiled complete data on factors such as testosterone, symptoms of hormone deficiency, and medications that may impact sex hormone levels. Among all men in the study (mean age 47.3 plus-or-minus 12.5 years), approximately 24 percent had low total testosterone and 11 percent had low levels of free testosterone. Interestingly, while low testosterone levels were associated with symptoms, many men with low testosterone levels were asymptomatic (e.g., among men aged 50 years and older 47.6 percent were asymptomatic).

“Since these men would not likely come to clinical attention,” said Araujo, “it may be important to determine whether there are clinical risks to missing these asymptomatic men with low testosterone levels.” Overall, only 5.6 percent of men in the study had symptomatic androgen deficiency. For those men in the upper range of ages in the study (70 years or older), however, the percentage increased to 18.4 percent.

The researchers predicted that by the year 2025 there may be as many as 6.5 million American men 30-79 years of age with symptomatic androgen deficiency, an increase of 38 percent from year 2000 population estimates.

“This study did not assess whether men with symptomatic androgen deficiency are good candidates for testosterone therapy,” said Araujo. “Well designed randomized placebo controlled trials would be needed to address the risks and benefits of testosterone therapy.”

The BACH Survey was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (Grant DK 56842). Analyses for the current study were supported through an unrestricted educational grant from GlaxoSmithKline.

A rapid release version of this paper has been published on-line and will appear in the November 2007 issue of the Journal of Clinical Endocrinology & Metabolism, a publication of The Endocrine Society.

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology.

Source : www.medicalnewstoday.com

Studying The Effects Of Negative Emotion On Memory

Do you remember exactly where you were when you learned of the Sept. 11 terrorist attacks? Your answer is probably yes, and researchers are beginning to understand why we remember events that carry negative emotional weight.

In Current Directions in Psychological Science, a journal of the Association for Psychological Science, Boston College psychologist, Elizabeth Kensinger and colleagues, explain when emotion is likely to reduce our memory inconsistencies.

Her research shows that whether an event is pleasurable or aversive seems to be a critical determinant of the accuracy with which the event is remembered, with negative events being remembered in greater detail than positive ones.

For example, after seeing a man on a street holding a gun, people remember the gun vividly, but they forget the details of the street. Functional Magnetic Resonance Imaging (fMRI), studies have shown increased cellular activity in emotion-processing regions at the time that a negative event is experienced.

The more activity in the orbitofrontal cortex and the amygdala, two emotion-processing regions of the brain, the more likely an individual is to remember details intrinsically linked to the emotional aspect of the event, such as the exact appearance of the gun.

Kensinger argues that recognizing the effects of negative emotion on memory for detail may, at some point, save our lives by guiding our actions and allowing us to plan for similar future occurrences. “These benefits make sense within an evolutionary framework,” writes Kensinger. “It is logical that attention would be focused on potentially threatening information.”

This line of research has far-reaching implications in understanding autobiographical memory and assessing the validity of eyewitness testimony. Kensinger also believes that this research may end insight into the symptoms of posttraumatic stress disorder.

Source : www.medicalnewstoday.com

Obesity Spreads Among Friends And Family

A new American study shows that obesity spreads among friends and family with close social ties, even when they don’t live near each other. The research is the first to explore the impact of social networks on the spread of obesity, and will help to develop new clinical and public health initiatives.

The research was funded by the US National Institute on Aging (NIA), part of the National Institutes of Health (NIH) and is published in the current online edition of the New England Journal of Medicine (NEJM).

One third of adult Americans, that is 66 million men and women, are obese, which significantly increases their risk of developing serious health problems such as type 2 diabetes, heart disease and stroke.

“We need to learn as much as we can about contributing factors. This study describes social network influences that might be an important part of that equation,” said Richard J. Hodes, Director of the NIA.

The researchers who conducted the study were Drs Nicholas Christakis of the Harvard Medical School, and James Fowler of the University of California in San Diego. They said that a sedentary lifestyle and eating more high calorie food are important reasons why obesity has risen steeply, but they suggest that the attitudes, behaviours and acceptance of obesity among family and friends in a person’s social network also play a strong role.

For their research, Christakis and Fowler used data from the Framingham Heart Study (FHS). The FHS is administered by the National Heart, Lung and Blood Institute, (NHLBI), also part of the NIH, and comprises a large scale, long term project that is now taking data from grandchildren of the original cohort enrolled in the 1940s.

Christakis and Fowler examined weight, height and other data from over 5,000 FHS participants at seven dates between 1971 and 2003. At the start of the study their ages ranged between 21 and 70, with an average of 38. They called these key participants “egos”.

They also looked at the data relating to the parents, spouses, siblings, children and close friends of the key participants, to find out whether obesity spreads from person to person in social networks. These were called “alters”.

The total number of people they explored, egos and alters together, formed a large social network of over 12,000 individuals.

Christakis said that:

“We were able to reconstruct a large network of individuals who had been repeatedly weighed over time as part of the Framingham Heart Study, and we could see that as one person gained weight, those around him or her gained weight.”

“We didn’t find that people who were overweight simply flocked together. Rather, we found what seemed to be a spread of obesity and that the likelihood of a person becoming obese depended on the nature of the relationship,” explained Christakis.

The findings showed that:
The chance of a key participant becoming obese went up by 57 per cent if he or she had a close friend who became obese.
If he or she had a same sex friend who became obese, this figure went up to 71 per cent.
But no such increase in a person’s chance of becoming obese was found in opposite sex friendships.
Perception of friendship was also important: when both the key participant and his or her friend said their friendship was close, the key participant’s chance of becoming obese was 171 per cent if the friend became obese.
They were not likely to become obese however if only the friend claimed the friendship was close.
Among pairs of brothers and sisters, one becoming obese increased the chance of the other one becoming obese by 40 per cent.
This chance was higher among same sex siblings as opposed to opposite sex siblings.
Among married couples, the chance of a husband or wife becoming obese if the spouse became obese was increased by 37 per cent.
The spread of obesity in a social network was not dependent on geographic distance.
Social distance, the degree of separation between two people in the network, had greater influence than geographic distance.
A geographic neighbour becoming obese did not increase a key participant’s chance of becoming obese.
Smoking behaviour did not affect the spread of obesity from person to person.
Christakis said:

“We identified distinct clusters of obese people within social networks, and the clusters spread about three people deep.”

“People who were only one degree removed from each other socially, such as siblings or close friends, influenced one another twice as much as people who were two degrees removed from each other,” he added.

The study concluded that:

“Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.”

“The rising rate of obesity threatens to reverse the decline in disability in the older population, with major implications for the health care system,” said Dr Richard Suzman, Director of the NIA’s Behavioral and Social Research Program.

“This seminal study breaks important new ground in showing how social networks may amplify other factors and help account for the dramatic increase in obesity across the population,” he said.

Source : www.medicalnewstoday.com

Weight Loss Drug Accomplia Dangerous For People On Anti Depressants Says European Watchdog

The European Medicines Agency (EMEA) says the weight loss drug Accomplia, which has also been shown to help smokers quit, should not be used by patients who are severely depressed or taking anti-depressants as it heightens the risk of suicide among this group.

Accomplia is made by the French pharmaceutical giant sanofi-aventis; the generic name of the drug is rimonabant. It has been authorized in the European Union since June 2006, to be used in combination with diet and exercise to help obese and overweight patients lose weight. It was not approved as a smoking cessation agent. Clinical trials showed that it could help patients lose 10 per cent of their body weight.

A warning was issued when it was approved by the EMEA informing doctors not to prescribe it to patients on anti-depressants because of risk of psychiatric side effects, and depression in particular. Information accompanying the drug indicated that doctors should not prescribe it to patients with uncontrolled serious psychiatric conditions such as major depression.

This latest warning is an upgrade, issued by the EMEA’s Committee for Medicinal Products for Human Use (CHMP) following one year of monitoring the drug since its approval. The CHMP asked the manufacturer to submit all the information it had on the psychiatric side effects of the drug.

The CHMP panel met last week to review the information on Accomplia’s side effects and concluded that the benefits of the drug still outweighed the risks, but not in patients with ongoing major depression or who are taking anti-depressants. As well as updating the psychiatric side effect information, they also recommended that the warning be upgraded to say that Accomplia should be stopped if the patient develops depression.

A letter is being sent to all doctors telling them about the new warning and suggesting that patients and the people who care for them should be advised of the risk of depression from taking Accomplia.

Last month, the US Food and Drug Administration (FDA) Advisory Committee for Endocrine and Metabolic Drugs (EMDAC) said that sanofi-aventis had failed to show that Accomplia (rimonabant) was safe and voted against recommending the anti-obesity treatment for use in the United States. According to a report in Britain’s Daily Mail, two of the patients in a trial reviewed by the FDA committed suicide and one was suicidal. One of the patients in the trial had also tried to kill his daughter.

Sanofi-aventis withdrew their application for FDA approval of Accomplia and said it would submit a new one in due course.

The body that controls drugs in the UK, the Medicines and Healthcare products Regulatory Agency, up to the end of last month, has received 318 reports of patients being affected by side effects from taking Accomplia. The drug has been on sale in the UK since July 2006. Since then more than 40,000 Britons have used it.

The CHMP recommendation now goes to the European Commission for a final decision.

Accomplia is used by patients who are obese with a body mass index (BMI) greater than or equal to 30 kg per meter squared as part of a program that includes exercise and diet. It is also used by patients who are overweight (BMI of 27 or more) who have other risk factors such as type 2 diabetes or high levels of blood fat.

The active ingredient in Accomplia (rimonabant) is a cannabinoid receptor antagonist. This blocks the cannabinoid type 1 (CB1) receptor in the brain which helps to control food intake. Blocking the receptor makes it easier for patients to stop over-eating. CB1 receptors are also found in fat cells in the body

Source : www.medicalnewstoday.com

Medical marijuana

SAN FRANCISCO (Ivanhoe Broadcast News) — For more than 4,000 years, it was used medicinally. Then, in 1942, medical marijuana was banned in the United States. But that’s not the end of the story. Today, patients with illnesses like cancer, AIDS and multiple sclerosis say it relieves pain and reduces nausea from their meds — and is the only thing that gets them through.

Brian Klein takes three pills twice a day for HIV. He’s also recovering from hepatitis C.

“It was pretty devastating getting both at the same time,” Brian says.

Hepatitis C meds are known for their severe side effects like nausea. Brian tried lots of treatments to relieve it, but only one worked — marijuana.

“Within a few minutes I could go eat. Whereas, before using it, I couldn’t even keep down water. So it was an amazing, dramatic difference,” Brian says.

A study on hepatitis C patients showed smoking marijuana made them three-times more likely to get rid of the virus because it got them through treatment.

“If there’s a patient for whom that medicine doesn’t work, and they do get benefit from marijuana, then that could really be the difference between life and death,” says Donald Abrams, M.D., an oncologist and HIV researcher from the University of California, San Francisco. “When we talk about the side effects, if you will, of marijuana compared to many, many prescription drugs that doctors prescribe on a daily basis, it’s really quite safe.”

Although medical marijuana is allowed in 12 states, the federal government has declared it “is not medicine” and “not safe.” Opponents say much more research is needed and that it’s linked to a higher risk of cancer, heart attack and brain damage.

For Brian, it was a short-term fix. He’s free of the hepatitis-C virus and has the energy to do simple things like read and exercise.

“This was relieving my nausea, and it worked. And I didn’t need it for anything more or less,” he says.

Dr. Abrams says patients with heart conditions or those who become paranoid, hyper or anxious from marijuana may want to steer clear.

Source : www.ivanhoe.com

Goltz syndrome gene found

Researchers funded in part by the National Institutes of Health have identified the gene that accounts for most cases of Goltz syndrome, a rare skin disorder that can also affect bone and eye development.
The cases appear to result from a defect in the gene known as PORCN, which contains the information needed to make a protein, referred to by researchers as porcupine. The Porcupine protein, which was first identified in fruit flies, was named for the pattern of spikes projecting from skin cells of the larval fly’s body, bearing a resemblance to the quills of a porcupine.

The researchers believe mutations in the PORCN gene cause at least 75 percent of Goltz syndrome cases.

“Identifying a genetic mutation for Goltz syndrome is a critical first step in understanding and eventually treating the condition,” said Duane Alexander, director of the National Institute of Child Health and Human Development, the NIH institute that provided funding for the Mental Retardation and Developmental Disabilities Research Center at Baylor College of Medicine, where the study was conducted.

The study was lead jointly by Xiaoling Wang, Department of Obstetrics and Gynecology at Baylor College of Medicine, and V. Reid Sutton, Department of Molecular and Human Genetics at Baylor College of Medicine.

The findings were published online in Nature Genetics .

Goltz syndrome, also called focal dermal hypoplasia, causes a distinctive red rash and thinning of the skin, which allows fat from the tissue below to protrude and form small yellowish-white lumps.

The disorder often causes brittle hair and nails, and deformities in the hands, such as extra, missing, or deformed fingers. Individuals with Goltz syndrome can also have missing or underdeveloped eyes. In addition, the disorder can affect the stomach, intestines, heart, lungs, and kidneys, said Dr. Ignatia B. Van den Veyver, associate professor at Baylor College of Medicine’s Departments of Obstetrics and Gynecology and of Molecular and Human Genetics and the senior author of the paper. Mental retardation is seen in about fifteen percent of patients with Goltz syndrome.

Because 90 percent of Goltz syndrome cases are seen in females, the disorder was believed to be caused by a gene on the X chromosome. After analyzing the genes of two girls with Goltz syndrome, the researchers found that both patients were missing a portion of the X chromosome where seven genes are located. Of the missing seven, the researchers learned that Goltz syndrome resulted from an absence of the PORCN gene, said Dr. Van den Veyver.

The PORCN gene is active in the embryo and fetus, creating proteins important in the development of the skin, skeleton, and eyes – all affected in the disorder.

Researchers then did genetic analyses of 15 girls with Goltz syndrome and found that the PORCN gene was affected in 10 of them.

Although the PORCN gene has been studied in mice and fruit flies, very little is known about the gene’s function in humans, said Dr. Van den Veyver. The mouse and Drosophila porcupine proteins are known to be important for the secretion of Wnt proteins from the cells that produce them. Wnt proteins are involved in early development. They interact with other proteins within the cell to begin the complex chain of events leading to the development and differentiation of organ systems in early life.

This discovery may lead to greater understanding of the function of Wnt proteins in humans, said Dr. Van den Veyver.

By identifying the genetic defect which causes Goltz syndrome, it may be possible to understand more of the processes critical for skin, eye and bone development, she said.

“The findings are important because they offer insight into a developmental disorder that was previously little understood,” said Ljubisa Vitkovic, M.D., of NICHD’s Mental Retardation and Developmental Disabilities Branch. “But they also illustrate how a mutation in the human counterpart of a protein known to regulate development in flies and mice can affect the skin and other human organs.”

Source : www.news-medical.net

Estrogen Therapy In Younger Postmenopausal Women Linked To Less Plaque In Arteries

New results from a substudy of the Women’s Health Initiative (WHI) Estrogen-Alone Trial show that younger postmenopausal women who take estrogen-alone hormone therapy have significantly less buildup of calcium plaque in their arteries compared to their peers who did not take hormone therapy. Coronary artery calcium is considered a marker for future risk of coronary artery disease.

Results of the WHI Coronary Artery Calcium Study are published in the June 21, 2007, issue of the New England Journal of Medicine. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

“These new results offer some reassurance to younger women who have had a hysterectomy and who would like to use hormone therapy on a short-term basis to ease menopausal symptoms,” noted Elizabeth G. Nabel, M.D., NHLBI director. “We must emphasize, however, that these findings do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease.”

The new findings are from an ancillary study of 1064 women who were 50-59 years of age at the start of the WHI hormone therapy clinical trial. Participants were randomly assigned to either 0.625 milligrams per day of conjugated equine estrogens (Premarin™) or placebo (inactive pill). Participants took assigned medication for an average of nearly seven and one-half years. After slightly more than one year after treatment ended, researchers used computed tomography (CT scan) to measure the level of calcium plaque in the women’s coronary arteries. Those who had taken estrogen were 30 to 40 percent less likely to have measurable levels of coronary artery calcium compared to those on placebo.

“Although our findings lend support to the theory that estrogen may slow early stages of plaque build-up in the coronary arteries, estrogen has complex effects and other known risks,” said JoAnn Manson, M.D., chief of Preventive Medicine at Harvard’s Brigham and Women’s Hospital and lead author of the paper. “The results are consistent with our earlier findings that younger women treated with estrogen had a trend toward fewer heart attacks but, for an individual woman, it remains uncertain whether the benefits of estrogen would outweigh the risks. For this reason, estrogen should not be used for the express purpose of preventing cardiovascular disease, but it may be appropriate for the short-term treatment of moderate-to-severe hot flashes or night sweats among recently menopausal women.”

In February 2006, WHI researchers reported that among the women in the estrogen-alone trial who were 50-59 years of age at study entry, women in the estrogen group had a non-significant trend towards lower rates of heart attacks compared to the placebo group, and significantly fewer women in the estrogen group required procedures to re-open clogged arteries. There was no suggestion of cardiovascular benefit in women who were 60 years or older.

“Heart attacks are uncommon among younger women, and the more relevant question is about long-term benefit as women grow older,” noted Jacques Rossouw, M.D., chief of the NHLBI Women’s Health Initiative Branch. “Conducting a clinical trial that would start any form of hormone therapy on postmenopausal women at a younger age and follow them for decades – when they would be more likely to have heart attacks – is not feasible.

“We cannot assume that any possible short-term, cardiovascular benefit from hormone therapy to postmenopausal women in their fifties would extend into older ages if they were to continue using hormones,” Rossouw cautioned. “We already know that starting hormone therapy in older women increases their risk of heart disease. And long-term hormone therapy has other risks such as strokes and blood clots, and, with the use of combination therapy, breast cancer.”

The WHI is a major, 15-year research program designed to address the most frequent causes of death, disability, and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis. The principal findings from the WHI hormone therapy trials, which studied 27,347 postmenopausal women on estrogen-alone or estrogen plus progestin, found that the overall risks of hormone therapy outweigh the benefits. Both of these trials were stopped early because of increased health risks and failure to prevent heart disease, a key question of the studies. Even though the risks for coronary heart disease were less pronounced in the estrogen alone trial than in the estrogen-plus-progestin trial, both therapies increased the risk of stroke and of blood clots.

Overall, the estrogen-alone study involved 40 clinical centers and 10,739 generally healthy postmenopausal women ages 50-79 who did not have a uterus. The clinical trial was stopped in February 2004 after approximately 7 years of follow up because of increased risk of stroke and no reduction in risk of coronary heart disease. The study also found an increased risk of blood clots.

The estrogen-plus-progestin study (conducted in postmenopausal women with a uterus) was stopped in 2002 due to an increase in breast cancer. Like estrogen-alone, combination hormone therapy was also found to increase the risk of stroke and blood clots regardless of the women’s age or time since menopause. Combination therapy was also found to increase the risk of heart disease in the first few years.

All women who wish to lower their risk of heart disease should make healthy lifestyle choices, such as following a diet low in sodium, saturated fat, transfat and cholesterol; maintaining a healthy weight; engaging in regular physical activity; and not smoking. In addition, they should work with their healthcare provider to identify and manage other known risk factors such as high blood pressure, high blood cholesterol, and diabetes.

Source : www.medicalnewstoday.com