Moderate Physical Activity May Decrease Heart Disease Risk in Perimenopausal Women

Unab I. Khan, M.B.,B.S., M.S.            Assistant Professor of Pediatrics and Family & Social Medicine Division of Adolescent Medicine The Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY 10467MedicalResearch.com Interview with:
Unab I. Khan, M.B.,B.S., M.S.  
Assistant Professor of Pediatrics and Family & Social Medicine
Division of Adolescent Medicine
The Children’s Hospital at Montefiore
The Pediatric Hospital for Albert Einstein College of Medicine
Bronx, NY 10467


MedicalResearch: What are the main findings of the study?

Dr. Khan: We wanted to find factors that lead to either an increase or decrease in risk of developing cardiovascular disease. We found that in middle aged overweight and obese women, who may not have any medical problems like diabetes, high blood pressure, high cholesterol, an increase in weight over time and the development of any of the conditions stated above, increased the risk of cardiovascular disease significantly.

On the other hand, even moderate physical activity decreased the risk of heart disease, even in the presence of the above stated conditions.
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Obstructive Sleep Apnea Associated with Hypertension in Perimenopausal Women

MedicalResearch.com Interview with:
Rodrigo Pinto Pedrosa, MD, PhD
Sleep and Heart Laboratory,
Pronto Socorro Cardiológico de Pernambuco
Pernambuclo, Brazil

MedicalResearch.com: What are the main findings of the study?

Dr. Pedrosa: Perimenopause is associated with increased cardiovascular risk. This study evaluated the association between obstructive sleep apnea (OSA) and arterial stiffness and hypertension in perimenopausal women. OSA (apnea-hypopnea index: ≥5 events/hour) and moderate/severe OSA (apnea-hypopnea index: ≥15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) of women, respectively.  Women with moderate/severe obstructive sleep apnea  had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake blood pressure,  nocturnal blood pressure,  diastolic blood pressure, as well as higher arterial stiffness (pulse wave velocity: 11.5 [10.1 to 12.3] vs 9.5 [8.6 to 10.8] m/s, p<0.001) than women without obstructive sleep apnea, respectively. Oxygen desaturation index during the night was independently associated with 24h arterial blood pressure and with arterial stiffness.
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Post Menopause: Exercise Reduced Blood Pressure, Atherosclerosis Marker

MedicalResearch.com Interview with:
Michael Nyberg Ph.D.
Post-doc  Human Physiology and Exercise Physiology
Integrated Physiology Group
Department of Nutrition, Exercise and Sports,
Faculty of Science, University of Copenhagen and

Jens Bangsbo, Dr. Sci., Ph.D.
Professor of Human Physiology and Exercise Physiology
Head of Integrated Physiology Group, Section of Human Physiology
Head of Copenhagen Centre of Team Sports and Health
Deputy Head of Department, research
Copenhagen Denmark

MedicalResearch.com: What are the main findings of the study?

Answer: The main findings of the study were that despite being of similar age, the postmenopausal displayed higher blood pressure and higher blood levels of an early marker of atherosclerosis than women that had not reached menopause. Furthermore, just 12 weeks of floorball training twice a week for one hour improved the women’s conditions and reduced their blood pressure significantly. In addition, there was positive development in levels of substances vital to blood vessel function, including a decrease in the early marker of atherosclerosis.

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Most Women Remain Sexually Active into theirs 50s, 60s and Beyond.

MedicalResearch.com Interview with:
Holly Thomas, MD
General Internal Medicine Fellow, Women’s Health and Clinical Research
University of Pittsburgh
Pittsburgh, PA 15213

MedicalResearch.com: What are the main findings of the study?

Dr. Thomas: We found that, despite popular perception, the majority of women (85%) who are sexually active at midlife will remain sexually active four years later. We also found that the majority of women score low on a measure of sexual function. However, low sexual function scores did not mean women stopped having sex. In fact, the score on the sexual function measure did not predict whether women maintained sexual activity. Finally, we found that importance of sex was a strong predictor of whether women remained sexually active. Women who felt sex was moderately to extremely important in their lives were 3 times more likely to maintain sexual activity.
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Menopause and Poor Sleep Quality

MedicalResearch.com Interview with:
Chih-Jen Chang, MD
Department of Family Medicine
National Cheng Kung University Hospital, Tainan, Taiwan

MedicalResearch.com: What are the main findings of the study?

Dr. Chang:  Postmenopausal women without vasomotor symptoms (hot flushes and night sweats) have poorer sleep quality than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor sleep quality independently of cardiometabolic factors and lifestyle.
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Osteoporosis: Improving Bone Mineral Density Postmenopause with Monoclonal Antibody Romosozumab

Michael McClung, MD Founding Director, Oregon Osteoporosis Center 5050 NE Hoyt Street, Suite 626 Portland, OR 97213MedicalResearch.com Interview with
Michael McClung, MD
Founding Director, Oregon Osteoporosis Center
5050 NE Hoyt Street, Suite 626
Portland, OR 97213


MedicalResearch.com: What are the main findings of the study?

Dr. McClung: In this Phase 2 trial, each of five romosozumab dose regimens significantly increased BMD compared with pooled placebo groups at the lumbar spine, total hip and femoral neck regions (all p<0.001). The largest increases were observed with the romosozumab 210 mg once-monthly dose, with mean increases, compared with baseline, of 11.3 percent at the lumbar spine, 4.1 percent at the total hip and 3.7 percent at the femoral neck.
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Sugar-Sweetened Beverages and Endometrial Cancer

Maki Inoue-Choi, PhD, MS, RD Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institute on Minority Health and Health Disparities, NIH Rockville, MD 20850MedicalResearch.com Interview with:
Maki Inoue-Choi, PhD, MS, RD
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Institute on Minority Health and Health Disparities, NIH
Rockville, MD 20850

MedicalResearch.com: What are the main findings of the study?

Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer.
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Menopause: Effects of Sex Hormones on Cognition and Mood

Dr. Victor W. Henderson MD Professor of Health Research and Policy and of Neurology and Neurological Sciences Stanford University, Stanford, CA 94305MedicalResearch.com Interview with:
Dr. Victor W. Henderson MD
Professor of Health Research and Policy and of Neurology and Neurological Sciences
Stanford University, Stanford, CA 94305


MedicalResearch.com: What are the main findings of the study?

Dr. Henderson: Estrogen or hormone therapy effects on some health outcomes differ by age, harmful at one age and beneficial at another.

This difference is sometimes referred to as the “critical window” or “timing” theory. It is controversial whether the so-called critical-window applies to memory or other cognitive skills.

In assessing the critical window hypothesis, we found that the relation between blood levels of estrogen and memory or reasoning skills is the same in younger postmenopausal women as in older postmenopausal women.  Essentially, there is no association at either age.
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Hot Flashes: Study of Local Anesthetic Nerve Block

MedicalResearch.com Interview with:
David Walega, MD Chief of the Division of Pain Medicine Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine.David Walega, MD
Chief of the Division of Pain Medicine
Northwestern Memorial Hospital and
Northwestern University Feinberg School of Medicine.

MedicalResearch.com: What are the main findings of the study?

Dr. Walega: Patients who underwent a single stellate ganglion injection with a local anesthetic had a 50% decrease in moderate -to- very severe hot flashes and this effect appeared to last thru the 6 month duration of the study; the placebo or “sham control” group had injections of saline and they did not demonstrate long-term improvements in hot flash symptoms

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Menopausal Hormone Therapy and Health Outcomes

JoAnn E. Manson, MD, DrPH Chief, Division of Preventive Medicine Brigham and Women's Hospital Professor of Medicine and the Michael and Lee Bell Professor of Women's Health Harvard Medical School 900 Commonwealth Avenue , 3rd fl Boston , Massachusetts   02215 MedicalResearch.com Interview with:
JoAnn E. Manson, MD, DrPH
Chief, Division of Preventive Medicine
Brigham and Women’s Hospital
Professor of Medicine and the
Michael and Lee Bell Professor of Women’s Health
Harvard Medical School
Boston , Massachusetts   02215

WHI investigators publish most comprehensive report to date on the two Hormone Therapy Trials and extend follow-up to 13 years: Results inform clinical decision making

Researchers from the Women’s Health Initiative (WHI) Hormone Therapy (HT) Trials provide new information from extended follow-up of postmenopausal women in the two HT trials (estrogen plus progestin and estrogen alone) and the most comprehensive look at the findings to date. The study, published October 2 in the Journal of the American Medical Association, presents information on a wide range of diseases and quality-of-life outcomes, comparisons of the two trials side-by-side, and a full breakdown of results by age and time since menopause onset. The WHI, which enrolled 27,347 women nation-wide in the two hormone therapy trials, is sponsored by the National Institutes of Health.

“Our main goal was to provide as much information as possible from the WHI hormone therapy trials to help women and their clinicians make the most informed decisions about hormone therapy use. The WHI findings, presented in detail by age group and time since menopause onset, help to guide clinical decision making,”, said JoAnn Manson, MD, DrPH, first author of the report and Chief of Preventive Medicine at Brigham and Women’s Hospital. Manson is one of the Principal Investigators of the WHI and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School .

 

Key findings of the report are that hormone therapy has a complex pattern of health risks and benefits and that younger women tend to have a more favorable risk-to-benefit profile than older women. The researchers also found that combination estrogen plus progestin (in women with an intact uterus) had more risks than estrogen alone (used in women with hysterectomy), primarily due to an increased risk of breast cancer with the former but not the latter. Both forms of hormone therapy increased the risk of stroke, blood clots in the legs, gallstones, and urinary incontinence, while benefits included decreased risk of hip fractures, other fractures, diabetes, and hot flashes/night sweats. Estrogen plus progestin increased dementia (in women >65 years), but neither treatment affected cognition in younger women. For estrogen alone, younger women (ages 50-59) had more favorable results for all-cause mortality, heart attacks, and colorectal cancer, and their overall risk-to-benefit profile on estrogen alone was more favorable than for older women.  Effects on quality-of-life outcomes with HT were mixed, with improvement in sleep and joint pain but increases in breast tendernes.

After stopping hormone therapy, most risks and benefits of hormone therapy dissipated. However, over the 13-yr cumulative follow-up period, breast cancer risk remained slightly elevated for estrogen plus progestin but became significantly reduced for estrogen alone. For estrogen plus progestin, a significant reduction in uterine (endometrial) cancer emerged during follow up and the risk of hip fracture remained significantly (but modestly) reduced. For both forms of hormone therapy, there was no significant increase or decrease in the rate of total cancer (all types combined), cancer mortality, cardiovascular mortality, or all-cause mortality in the overall study population.

 

The researchers conclude that the findings from the two WHI trials do not support use of hormone therapy for prevention of chronic disease, but treatment is appropriate for symptom management in some women. The absolute risks of adverse events in younger women are lower than in older women, menopausal symptoms are more common in younger age groups, and the quality-of-life benefits are likely to outweigh the risks for many women who seek treatment for symptoms during the menopause transition.  “Short-term use of hormone therapy to manage moderate-to-severe hot flashes or other symptoms in early menopause remains appropriate,  A clear distinction between the use of hormone therapy for symptom management in women with indications for treatment and its use for the purpose of chronic disease prevention is essential,” added Manson.  “Although studies of other hormone therapy formulations , doses, and routes of delivery are needed to find treatments with fewer risks, these medications are now among the best studied treatments in medical history. Clinicians can share information from the WHI trials with their patients and help them make more informed choices.”

Citation:

Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials. JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278040.

Yoga and Effect on Menopause Symptoms

MedicalResearch.com Interview with:
Katherine Newton, PhD
Senior Investigator at Group Health Research Institute in Seattle

MedicalResearch.com: What are the main findings of the study?

Answer: We found that when women took a 12-week yoga class and practiced yoga at home, they had significantly less insomnia than did women who did not. This was the only statistically significant finding in this MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network randomized controlled trial. We also found that being in the yoga class did not decrease the number of hot flashes or night sweats. Yoga  was linked to better sleep quality and less depression—but  these effects were not statistically significant. In separate papers, published slightly earlier, our MsFLASH group reported that a non-yoga exercise program seemed linked to slightly improved sleep and less insomnia and depression—but these effects were not statistically significant. And an omega-3 (fish oil) supplement was not linked to any improvement in hot flashes, night sweats, sleep, or mood.

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Postmenopausal Women: Impact Brisk Walking

MedicalResearch.com Interview with:
Pascale Mauriège, PhD, Division of Kinesiology
PEPS, Room 2148, Laval University, Québec, Canada G1K 7P4

MedicalResearch.com: What are the main findings of the study?
Answer:

1)    The impact of a 4-month brisk walking program (3 sessions/week of 45-min walking at 60% of heart rate reserve) on postmenopausal moderately obese (BMI=29-35 kg/m2) women’s perceived health, and more particularly the perceived ideal weight and stress level.

2)    The existence of a relationship between improvements in perceived ideal weight and fat mass reduction in the walking group.

3)    The lack of non respondents to our novel self-administered Short Perceived Health Questionnaire (SPHQ) that was completed within 2-3 min by all participant.

4)    The good reproductibility for five of six items of the SHPQ, and the validation of three questions against generic tools.
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Should the Ovaries be Removed at Time of Hysterectomy for Benign Disease?

MedicalResearch.com Interview with:

Catherine A. Matthews, MD
Associate Professor and Division Chief
Urogynecology and Reconstructive Pelvic Surgery
University of North Carolina, Chapel Hill

MedicalResearch.com: What are the main findings of the study?

Dr. Matthews: Women under 50 should try and preserve their ovaries at the time of hysterectomy for benign disease; however, women over 50 should consider elective ovarian removal as a way to reduce ovarian cancer. There is no adverse impact on cardiovascular, bone or sexual health in women over 50 who elect ovarian removal.
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Adipocyte Fatty Acid storage factors enhance subcutaneous fat storage in postmenopausal women

MedicalResearch.com Interview with
 Dr. Sylvia Santosa, PhD Department of Exercise Science Concordia University Department of Exercise Science Montreal, Quebec, Canada H4B 1R6Dr. Sylvia Santosa, PhD
Department of Exercise Science
Concordia University
Department of Exercise Science
Montreal, Quebec, Canada H4B 1R6

MedicalResearch.com: What are the main findings of the study?

Dr. Santosa: Our results show that postmenopausal women burn less fat making more available to be stored.  Our results also suggest that greater fat storage in postmenopausal women are likely to be attributed to changes in the pathways our fat cells use to store fat.  We found that some of the proteins that help our fat cells store fat were more active and this greater activity corresponded with the amount of fat stored from our circulation.
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Estrogen Effects on Metabolism & Weight Gain in Women Studied

It’s no secret that women often gain weight as they get older. The sex hormone estrogen has an important, if underappreciated, role to play in those burgeoning waistlines.

Now, researchers reporting in the October Cell Metabolism, a Cell Press publication, have traced those hormonal effects on metabolism to different parts of the brain. The findings may lead to the development of highly selective hormone replacement therapies that could be used to combat obesity or infertility in women without the risks for heart disease and breast cancer, the researchers say.

“When women approach menopause, they gain weight in fat and their energy expenditure goes down,” says Deborah Clegg of the University of Texas Southwestern Medical Center. Estrogen levels decline and women grow increasingly susceptible to obesity and metabolic syndrome.

Estrogen acts on receptors found throughout the body, in fat, on ovaries and in muscle. But when it comes to the hormone’s influence on metabolism, Clegg suspected receptors in the brain.

Others had traced the effects of estrogen on energy balance specifically to estrogen receptor-α (ERα). When her team deleted those receptors from the entire brains of mice, “we got very, very fat mice,” Clegg said. The animals consumed more calories and burned less.

The researchers showed female mice lacking ERα in one part of the brain (the hypothalamic steroidogenic factor-1 or SF1 neurons) gained weight without eating any more. Loss of ERα from another brain area (the hypothalamic pro-opiomelanocortin or POMC neurons) had the opposite effect: animals ate more without gaining weight. Loss of ERα receptors in those same neurons also led to various problems in ovulation and fertility.

The findings suggest that drugs developed to specifically target estrogen receptors in the brain might offer a useful alternative to hormone replacement therapies that hit receptors throughout the body. The researchers say they would like to continue to isolate other estrogen-related effects and symptoms, for instance, on hot flashes and cognition.

“The more we know about estrogen’s sites of action, the more likely it is we could develop designer hormone replacement therapies targeting tissue X, Y or Z,” Clegg said.