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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The combined progestogen/estrogen oral contraceptive is the most common form of contraception in the US. They contain 1 of 5 synthetic progestogens (derived from 19-nortestosterone) and 1 of 2 estrogens. 3 new progestin compounds are in use in Europe and Asia. They are norgestimate, desogestrel, and gestodene. Estrogen seems to cause vascular complications. Progestin may cause atherosclerosis. Desogestrel and gestodene were studied for 6 months. They have little effect on glucose and lipid metabolism. Triphasal ethinyl estradiol/levonorgestrel and ethinyl estradiol/norethindrone (Ortho Novum 7/7/7) were compared in a 12-month prospective clinical trial. There seems to be no consensus of a pattern of increased breast cancer associated with oral contraceptive use. The UK National Case Control Study Group analyzed women younger than 36 years at the time breast cancer was diagnosed. 91% of their cohort had used pills. A significant trend was found when risk was analyzed with duration of taking pills. Women who had taken the pill for 4 years had no increased risk of breast cancer. However, there was an increased relative risk of 1.7 (P0.001) for women who took pills for more than 8 years. Among women using the pill for 8 years, the relative risk was 2.6 (p0.0001). AMong women using pills with 50 ug. of estrogen, the trend to increased risk was (P0.10). The 1988 National Survey of adolescent males showed that 60% of men never married were active sexually. Among 17- to 19-year-old-men who live in metropolitan areas, condom use has more than doubled, compared with 1979. In 1988, a "new" copper-containing IUD was approved for use in the US by the Food and Drug Administration, the Copper T 380 A. Pregnancy rates are less with this than with older devices. IUDs may cause pelvic inflammatory disease with resulting tubal infertility. However, the risk was overstated earlier. Women who have only 1 sexual partner in their lifetime had no significant risk of tubal infertility. "lost" IUDs continue to be a problem.
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PMID:Contraception. 210 26

Female cynomolgus monkeys, a previously established model of carotid and coronary artery atherosclerosis, were used to study the relationships between potential risk factors and carotid artery atherosclerosis. Over a 24-month treatment period, one-third of the monkeys (n = 25) were given the oral contraceptive Ovral, one-third of the monkeys (n = 26) were given the oral contraceptive Demulen, and the remaining monkeys constituted a control group (n = 26). At necropsy, the atherosclerosis extent was measured in the left and right common carotid arteries and the left and right carotid bifurcations. Plasma lipid concentrations, regional adiposity, and social status were related to carotid artery atherosclerosis extent. The relationships between regional adiposity and social status and carotid artery atherosclerosis were accounted for, at least in part, by plasma lipid concentrations. Oral contraceptives had an adverse effect on plasma cholesterol concentrations and a protective effect against carotid artery atherosclerosis after adjusting for their effect on plasma lipids. The net result of these effects was little or no change in atherosclerosis extent in the carotid arteries due to oral contraceptive treatment.
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PMID:Carotid artery atherosclerosis in cholesterol-fed female cynomolgus monkeys. Effects of oral contraceptive treatment, social factors, and regional adiposity. 234 95

The effects on atherogenesis of stress, pregnancy, and oral contraceptive therapy were studied in a nonhuman primate model. The stress of social subordination was associated with ovarian dysfunction, unfavorable lipoprotein changes, and increased coronary artery atherosclerosis compared with nonstressed (socially dominant) or normal monkeys. Although pregnant animals exhibited lower high-density lipoprotein cholesterol concentrations, they had only one half as much diet-induced coronary artery atherosclerosis as their nonpregnant counterparts. Monkeys treated with an Ovral-like regimen also exhibited adverse lipoprotein changes. Nevertheless, prevalence and extent of coronary artery plaques decreased. We conclude that estrogen is an important factor in the animals' "female protection" against diet-induced atherosclerosis. We also suggest that the lowering of high-density lipoproteins by the progestin component of higher-dose contraceptives is not necessarily atherogenic if a sufficiently potent exogenous estrogen is administered concomitantly.
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PMID:From menarche to menopause: coronary artery atherosclerosis and protection in cynomolgus monkeys. 271 67

To further understand the pathophysiology of arterial diseases induced by oral contraceptives (OCs), a case report is presented of a young woman who died of extensive visceral artery thrombosis. The possible role of estrogens and progestogens and of cigarette smoking as the predisposing factors in this patient are discussed. A 26-year-old woman, who complained of progressive abdominal pain and whose past medical and surgical history was negative, was admitted to the general surgery service. She was the mother of 1 child and had had 2 previous spontaneous abortions. She had received ethinyl estradiol 35 mcg with norethindrone 500 mcg and 1000 mcg for 3 months, but because of a problem with breakthrough bleeding the medication was changed to mestranol 50 mcg with norethindrone 1000 mcg. She had been taking Ortho-Novum 1/50 for 2 1/2 years. She had smoked 25-35 cigarettes daily for about 10 years but denied use of alcohol or other drugs. She was not known to be diabetic, hypertensive, or dyslipidemic, and had no history of atherosclerosis in her family. For 7 months prior to her admission, the patient complained of abdominal pain, which progressively increased in intensity and duration, interrupted by periods of well-being. The patient reported 2 recent, isolated episodes of mild proctalgia but no tenesmus or melena. There had been no fever, but the patient had been anorexic for the past 2 weeks and reported losing 10 kg in the past month. She had no complaints apart from those related to the gastrointestinal system. At an emergency laparotomy, gangrenous acalculous cholecystitis and infarction of the terminal ileum were discovered. A cholecystectomy with resection of the terminal ileum and the right colon was performed. An end-to-end primary anastomosis was performed. On exploration of the superior mesenteric artery, a thrombus was discovered at its origin. As a transverse arteriotomy showed a good retrograde flow, a thrombectomy was performed. There appeared to be an unsatisfactory antegrade flow. The superior mesenteric artery then was transposed in an end-to-end fashion on the abdominal aorta. An immediate postoperative arteriogram showed thrombosis of the celiac axis at its origin. Revascularization failed to improve the condition of the intestine. The patient died. The intent of this case report is to emphasize that the association between smoking and oral contraceptives can cause cardiovascular disease in young women, and a failure to recognize this association can result in delayed diagnosis and worsen the prognosis.
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PMID:Intimal hyperplasia and thrombosis of the visceral arteries in a young woman: possible relation with oral contraceptives and smoking. 337 98

Eleven healthy young women (age range 20-28 years) were given three different oral contraceptives (OCs) in random order, each contraceptive for 3 months. Smoking, eating, drinking and habits of physical activity were similar throughout the study period. The combinations were: ethinyl-estradiol/noretisterone (EE/NET) 35 micrograms/0.5 mg, 35 micrograms/1 mg and 50 micrograms/1 mg. The 35/0.5 and the 50/1 EE/NET combinations led to significant weight increases of 2.4 and 1.7 kg, respectively. All EE/NET combinations produced LDL-TG increases, from a pretreatment value of 0.28 +/- 0.04 (SD) mmol/l to 0.34 +/- 0.07, 0.35 +/- 0.06 and 0.42 +/- 0.13 mmol/l (P less than 0.01 for all). LDL-cholesterol increased from 2.99 +/- 0.63 mmol/l to 3.35 +/- 0.62 (P less than 0.01) after 35/1 treatment and to 3.43 +/- 0.62 mmol/l (P less than 0.001) after 50/1 treatment. These two EE/NET combinations also caused significant reductions of HDL-cholesterol, in both cases from a pretreatment value of 1.75 +/- 0.16 mmol/l to 1.64 +/- 0.24 mmol/l (P less than 0.05). Since all values after EE/NET treatment remained well within normal ranges, these low-dose OCs probably have little effect on the development of atherosclerosis due to serum lipoprotein abnormalities. However, our findings suggest that OCs may interfere with the cholesterol ester/TG exchange between LDL and HDL.
Atherosclerosis 1982 Dec
PMID:Effects of ethinyl-estradiol/noretisterone combinations on serum lipoproteins. 715 2

A study of the prevalence of hyperlipidemia has been conducted among female telephone company employees using oral contraceptives (OCs) or estrogenic hormones. This paper relates hormone formulation and estrogen/progestin potency to striglyceride and cholesterol concentrations in total plasma and lipoprotein fractions and relative lipid composition. Changes in these lipid parameters are of interest because they may predict atherosclerosis risk. Results in 148 hormone users are compared with those in 306 nonhormone users. All data are adjusted for the effects of age, relative body weight, cigarette smoking, and alcohol intake. Triglyceride concentrations in whole plasma, very low density lipoprotein (VLDL), and high density lipoprotein (HDL) are elevated 1.5-2.5 fold with increasing estrogen potency. Low density lipoprotein (LDL) triglyceride concentration is elevated to a similar degree among OC users regardless of estrogen potency, but there is no significant effect of postmenopausal estrogen use on LDL triglyceride concentrations. The LDL cholesterol concentration shows an increasing trend with increasing estrogen potency in a random sample of OC-treated women, but is slightly lower than control in postmenopausal women treated with estrogen alone. The HDL cholesterol concentration in plasma is highest with hormones having the greatest estrogen potency and lowest with those having the greatest progestin potency. The VLDL cholesterol to triglyceride ratio adjusted for triglyceride concentration is significantly increased with the use of Ovral, a progestin-predominant contraceptive preparation. The LDL cholesterol to triglyceride ratio is reduced with the use of all OCs examined, except for Ovral, where the ratio is above average. The HDL cholesterol to triglyceride ratio is reduced for all combination OCs examined. The use of a sequential OC or postmenopausal estrogens is not associated with a significant alteration in the cholesterol to triglyceride ratio in any lipoprotein fraction. Knowledge of estrogen and progestin potency and kind of progestin are important in predicting the effect of OCs on plasma and lipoprotein lipids. On the basis of observed differences in lipoprotein lipid concentrations and relationships, the potential arteriosclerotic risk from sex hormones may vary among OC formulations.
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PMID:Oral contraceptive and postmenopausal estrogen effects on lipoprotein triglyceride and cholesterol in an adult female population: relationships to estrogen and progestin potency. 729 96

Premenopausal women, 1 control group (n=9) taking no medication or using no oral contraceptives (OCs) and 1 treated group (n=10) receiving OCs for contraception, were studied to determine any effects OCs have on mononuclear cell cholesteryl ester hydrolase (CEH) activity. 9 of the 10 medicated women were taking Ortho Novum 1/50 and the other person was receiving Norlestrin 1/50. Normally menstruating women (controls) showed a significant rise in CEH levels on Day 20 of the menstrual cycle (P .05). The enzyme activity in women on OCs was significantly lower than control women in 3 of 4 testing periods. In addition, plasma and mononuclear cell cholesterol and esters were measured along with plasma estrogen and progesterone levels. Although free cholesterol levels in normal cycling (control) women and in the OC group did not vary significantly during the menstrual cycle between the 2 groups, the women on OCs had significantly higher ester levels than the control women in 3 of the 4 test periods P .05-.005). When paired ratios of plasma cholesterol to esterified cholesterol were compared between control and OC groups, the ratio of free/esterified was significantly higher in the control group in 3 of 4 tests. In the mononuclear cells, on the other hand, the cholesterol/cholesteryl ester ratio was significantly lower in the control group during the 4 test periods. No association between levels of endogenous sex hormones (estradiol, progesterone) and CEH activity were found. CEH levels may be related to incidence of atherosclerosis, and women taking OCs may have increased chances of developing this disease.
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PMID:The effect of oral contraceptives on mononuclear cell cholesteryl ester hydrolase activity. 736 9

Doppler ultrasound examination is an easy and non-invasive examination technique to image the anatomical and functional situation of cervical vessels. An increasing number of ENT-specialists has been using Doppler sonography in the diagnosis of cochlear and vestibular disorders. We analysed the frequency of pathological Doppler examination results of 150 patients with vertigo, hearing loss and tinnitus. Especially patients with vertigo bear a greater risk for stenosis of the extracranial arteries (28%) compared to an asymptomatical population (1%). Patients with hearing loss and tinnitus showed a different degree of artery disorders (23% of the patients with hearing loss; 18% of the patients with tinnitus). Patients bearing no risk for atherosclerosis showed in 13% (vertigo) and 8% (hearing loss and tinnitus) stenosis of the cervical arteries. Thus we found by Doppler ultrasound examination more stenoses in patients with cochlear or vestibular symptoms than in an asymptomatical population. The early attribution of stenosis to a malfunction of the inner ear helps to avoid invasive examinations of cervical vessels. In addition to this, imminent cerebral ischaemia can be revealed at an early stage.
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PMID:[Incidence of Doppler ultrasound detectable stenoses of cervical arteries in patients with cochlear-vestibular symptoms]. 826 28

Steroids diffuse through polysiloxone at a constant rate, and steroids placed in the vagina rapidly pass through the vaginal epithelium into the circulation. Combining these principles led to the development of contraceptive vaginal rings (CVR) consisting of various progestins, with and without oestrogen, placed in flexible polysiloxone, doughnut-shaped devices. As occurs with oral contraceptives, the CVRs containing progestin plus oestrogen are left in the vagina for 3 weeks and removed for 1 week to allow withdrawal bleeding, while CVRs releasing a small dose of progestins without oestrogen are left in the vagina continuously for several months. Large-scale, clinical trials were performed with a low dose levonorgestrel-releasing-only CVR by the WHO. At 1 year, continuation rates were about 50 per 100 women with 17.2 per 100 discontinuing for menstrual problems and 4.5 for pregnancy. Two sizes of a CVR containing levonorgestrel and oestradiol were studied in a multinational trial organized by the Population Council. At the end of 1 year, about half the women were continuing with the method, one-quarter had discontinued because of bleeding problems, and pregnancy rates were between 1 and 2 per 100 women. The CVR was well accepted by women and their partners, but because of lowered HDL-cholesterol levels and accelerated atherosclerosis in female monkeys, further development of this formulation was discontinued. Recently, phase II clinical trials with CVRs containing combinations of NET-acetate plus ethinyloestradiol and 3-ketodesogestrel plus ethinyloestradiol have been undertaken. These CVRs provide good bleeding control, inhibit ovulation consistently and do not have an adverse effect on serum lipids. Phase III trials with these two types of CVRs will be initiated shortly.
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PMID:Vaginal contraceptive rings. 848 60

Tinnitus is a frequent symptom but a tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. The symptom "pulsating noise in the ear" may be due to various cause but most frequently, by glomus tumors, intracranial hypertension and atherosclerosis of the carotid arteries. Pulsatile tinnitus can often present a serious diagnostic problem. The diagnostic evaluation includes physical examination, audiologic assessment and imaging techniques (ultrasonic examination of cervical vessels, high-resolution computed tomography of the temporal bones, nuclear magnetic resonance, angiography of the carotid arteries and magnetic resonance angiography). Evaluation should be individualized but must include a thorough ENT work up. The evaluation of the patient includes otomicroscopy, palpation and auscultation of ears and cervical region and the head positioning test. The cause of pulsatile tinnitus may be even identified on otoscopic examination. Further investigations by other specialities (neurology, internal medicine, ophthalmology) may become necessary. Life-threatening causes such as arteriovenous shunts or carotid artery stenosis must be ruled out. Nevertheless, in several cases it will not be possible to determine the etiology of tinnitus. Finally, therapeutic options which occasionally can include surgical techniques or interventional radiology are discussed.
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PMID:[Pulsating tinnitus]. 1070 57


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