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Drugs classified as calcium channel blockers (CHBs) are now among the most frequently prescribed drugs for the treatment of cardiovascular disease. Although the currently available CCBs have major differences in their structural and cardiovascular effects, they share the common property of blocking the transmembrane flow calcium ions through voltage gated L-type channels. These drugs have been approved for the treatment of hypertensive heart disease: they reduce left ventricular hypertrophy and improve its sequelae, such as ventricular dysrhythmias, impaired filling and contractility, and myocardial ischemia. Long-acting CCBs have been shown to reduce mortality and morbidity in elderly patients with systolic hypertension, appear to be extremely useful in patients with cyclosporin-induced hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine. Long-acting dihydropyridine have been shown to be effective and safe in the treatment classic angina pectoris and vasospastic angina, supraventricular arrhythmias, particularly reentrant AV-nodal tachycardia, others to be beneficial in patients with congestive heart failure, and all of them have potential for decreasing atherogenesis.
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PMID:[Calcium channel blockers in the treatment of cardiovascular disease]. 1157 40

Adolescents reporting persistent chronic illness at ages 16, 22, and 32 years (n = 296, limiting in daily life n = 52, non-limiting n = 244) were compared with those without any chronic illness (n = 401) in their life situation, psychosocial well-being and health habits at age 32 years. The data were drawn from a follow-up survey of a Finnish urban age cohort from age 16 until age 32 years. The group of persistent chronic illnesses included allergies (n = 249, 84%), non-allergic skin conditions (n = 10), migraine (n = 29), diabetes mellitus (n = 5), and others (n = 9). Results indicated that adults with persistent chronic illness limiting their daily life reported more depression and lower self-esteem than those with non-limiting chronic illness or healthy controls. Daily smoking was more common among females with any chronic illness than among healthy controls. No significant differences were found between adults with any persistent chronic illness (mainly non-severe allergic conditions) and healthy controls in psychosocial well-being. More attention in health care should be paid to psychological well-being in persons with limiting chronic illness. The study also raises the question how to improve health habit counselling within health care among females with chronic illness.
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PMID:Long-term psychosocial effects of persistent chronic illness. A follow-up study of Finnish adolescents aged 16 to 32 years. 1203 49

Given the rapidly increasing number of women above 50 it is of pivotal importance to consider health issues related to gonadal hormone deficiency. The possibility of alleviating such symptoms by hormone replacement therapy (HRT) should be recognized by all physicians, not merely by gynaecologists. But which women should be given what therapy, and for how long? Due to the increased risk of endometrial cancer and bleeding problems when using oestrogen monotherapy, only women who have undergone hysterectomy could use this regimen unless treatment is aimed at amelioration of urogenital symptomatology only. In this case a vaginal administration of low-dose oestrogens is possible as such doses do not induce endometrial proliferation. In all other cases a combination of an oestrogen and a progestogen must be used. There are several options for doing so. During the early phase of the climacteric period when irregular and/or heavy vaginal bleeds are part of the symptomatology a cyclical therapy will often combat these problems. As women pass into the menopause a sequential regimen is often preferred until 1-3 years have elapsed since menopause. With advancing time since menopause women become more and more reluctant to experience monthly bleeds. In such cases a continuous combined regimen may be offered even though it cannot guarantee a bleed-free remedy.Non-oral, particularly transdermal, therapy is an alternative in women with co-existing morbidity such as migraine, diabetes, malfunction of the gastrointestinal tract and liver disease. Oral therapy is preferred particularly in women with elevated plasma levels of LDL-cholesterol, lipoprotein(a) or homocysteine. Oral therapy induces liver protein synthesis. This could be an advantage in cases with low plasma levels of sex hormone-binding globulin (SHBG) as low levels of SHBG may promote androgenic stigmata such as hirsutism and a lowering of the voice. However, in cases with too low an androgen influence the use of a non-oral therapy may counteract symtoms such as low libido.Tibolone could be used for the prevention (and treatment?) of osteoporosis but it will also mitigate the typical climacteric symptoms. Raloxifene is a fairly new type of drug which is classified as a selective oestrogen receptor modulator (SERM). It will reduce vertebral fractures to the same extent as bisphosphonates, albeit the increase in bone density is less. Raloxifene has no effect on climacteric symptoms. Its greatest benefit is a clear reduction of breast cancer in women, which is in contrast to HRT/ERT.There are insufficent data on tibolone and the incidence of breast cancer. Experimental data, however, are intriguing in suggesting less impact on the breast than conventional HRT/ERT.
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PMID:The role of ERT/HRT. 1209 68

The side effects of oral contraceptives are summarized for the woman who wishes to use this form of contraception but is afraid. Mode of action is briefly summarized, emphasizing that the hormones found in "the pill" are the same as those occurring naturally in the body. The side effects are divided into the "nuisance" side effects of nausea, abdominal discomfort, changes in body weight, premenstrual symptoms, bleeding between periods, cramps, changes in sexual desire, and depression. These are similar to symptoms of early pregnancy and seldom last more than 3 months. Extensive studies have shown that a woman usually becomes pregnant quickly after stopping the pill. Extensive studies carried out for as long as 20 years have found no association with cancer. However, patients who already have cancer are not put on the pill as this may make the condition worse. If use is delayed until 6 weeks postpartum, lactation will not be affected. In Malaysia pills are not prescribed to women who suffer from blood clots, inflammation of the veins, liver disorders, diabetes, epilepsy, fibroids of the uterus, migraine, or other conditions which could be adversely affected by oral contraceptives. This is to assure the woman's safety. Studies in Great Britain found that a woman's chances of death during pregnancy are 17 times greater than her chances of dying from a condition resulting from oral contraception, and that risk of death during pregnancy increases with each pregnancy beyond 5.
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PMID:All you want to know about the pill. 1223 97

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73

The relative rarity of stroke in oral contraceptive (OC) users, estimated at 14/100,000 women per year, does not mean that the risk is not significant; it is 4 to 9 times as high for OC users as for controls. 86 well-documented cases of stroke in OC users treated at a neurologic clinic in Paris between 1974 and 1984 are analyzed. There were 5 groups of patients: 1) 66 cases of cerebrovascular accidents, 64 of which were ischemic 2) 6 cases of intracranial venous thrombosis 3) 6 cases of benign and reversible intracranial hypertension or cerebral pseudotumor without demonstrated venous thrombosis 4) 5 cases of vascular complications in the retina or optic nerve, and 5) a miscellaneous group of 5 cases. The patients were aged from 16-49 years and the mean age was 30.5 years. The duration of use of OCs varied from a few days to 15 years, with an average of 39 months. 42 to 56% had family histories of cerebrovascular problems and 40 to 50% had personal or familial histories of migraine. Among 79 OC users with strokes, 41% used moderate dosed and 59% used microdose pills. No patients used microdose progestin only pills. There were 2 peak age groups of patients, those 25-29 and 38-42 years old. Young women aged 25-29 had intracranial venous thrombosis, intracranial hypertension or pseudotumor, and acute ischemia of the optic nerve. The average age of the 64 patients with ischemic cerebral vascular accidents was 31 years. Of the 30 infarcts, 1/3 left significant sequelae and 3 were fatal. There were 21 transitory ischemic accidents and 13 prolonged reversible ischemic accidents usually without sequelae. There were warning signals in 52% of infarct cases. 45% of patients with cerebrovascular accidents had family histories of cerebrovascular accidents or cardiac infarct and 40 to 50% had personal or family histories of migraine. Fewer than 25% had hyperlipidemia, 20% smoked, and 8% had diabetes or a problem of glycoregulation. Coagulation changes were found in 6 of 64 patients, but 22 of 26 had immune complexes and anti-ethinyl estradiol or antiprogesterone antibodies. Among the 6 cases of intracranial venous thrombolic accidents there were 2 deaths and 2 cases of very serious sequelae. The average age of these patients was about 27. The role of OCs is difficult to confirm because there are too few cases for statistical analysis. Antihormone antibodies were found in 3 such cases studied, but coagulation problems were not observed. Patients in the study who had laboratoratory or angiographic evidence of atheromatous disorders mostly were in the older peak age groups. The younger patients with cerebral ischemic accidents were largely without atheromatous lesions, but were very likely to have antiestrogen or antiprogesterone antibodies.
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PMID:[Stroke and combined oral contraceptives]. 1228 Feb

Earlier and more frequent sexual activity and the significant risk of pregnancy have increased the need for contraception among young adolescent girls. The problem for the physician is to choose a contraceptive method which will not affect future fertility or the psychological and biological maturity of adolescents. Condoms, diaphragms, and spermicides are quite effective if used correctly; they have no deleterious side effects, and they provide protection against sexually transmitted diseases. They appear to be well-adapted to the sporadic sexual activity of adolescents. The efficacy of combined oral contraceptives (OCs) is also high. Side effects depend on the synthetic estrogen component and are dose dependent. Absolute contraindications to OC use in women of any age include thromboembolic disease, cerebral vascular accidents, severe cardiac or hepatic disorders, breast or genital cancer, pregnancy, undiagnosed genital bleeding, and pituitary adenoma. Relative contraindications include hypertension, diabetes, hyperlipidemia, obesity, history of hepatitis, migraines, epilepsy, asthma, renal insufficiency, cystic breast disease, and mammary fibroadenomas. Combined OCs do not seem to interfere with subsequent maturation of the hypothalamopituitary axis. The frequency of ovulatory cycles in adolescents who have discontinued pill use is the same as that in adolescents who have never used pills. However, estrogens accelerate the process of maturation in the bones, so combined OCs should never be prescribed for girls who have not terminated their growth. Minidose OCs containing 30-45 mcg of ethinyl estradiol aggravate the relative hyperestrogenism of adolescents and are associated with menstrual problems, functional ovarian cysts, and breast problems. They should only be prescribed for adolescents with regular sexual activity, no less than 3 years following menarche, with regular ovulatory menstrual cycles and no history of breast disorders. Otherwise, a standard-dose combined pill with 50 mcg EE should be selected. Continuous dose progestin minipills depend on peripheral effects such as modifications in the cervical mucus for their contraceptive effects. They are associated with frequent menstrual problems, functional ovarian cysts, and extrauterine pregnancies. They may be indicated for adolescents with regular sexual activity but with contraindications to combined OCs. Trimonthly injections of medroxyprogesterone acetate have major effects on endocrine metabolism and should be used only for adolescents with severe mental problems. IUD efficacy is high but they may be less well tolerated by adolescents than by older women and the risk of infection may be heightened. They should only be used for adolescents with absolute contraindications to use of hormonal contraceptives who have no history of genital infections.
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PMID:[Choosing contraception for adolescents]. 1228 May 85

Health care and family planning providers who counsel women with medical disorders about contraception must weight the method's possible health risks against the risks of an unintended pregnancy. If pregnancy would pose a severe health risk or the couple desires no more children, sterilization should be considered. Barrier methods have the advantage of not complicating underlying medical conditions, but may not prevent pregnancy if used improperly. Hormonal contraception has the potential to exacerbate some diseases and can interact with other medications. On the other hand, low-dose combined oral contraceptives offer, in some instances, noncontraceptive beneficial effects. Specific medical conditions discussed in this report include cardiovascular diseases, diabetes, convulsive disorders, migraine, tuberculosis, liver disease, malignant diseases, anemia, sickle-cell disease, psychiatric conditions, and human immunodeficiency virus infection.
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PMID:IMAP statement on contraception for women with medical disorders. 1228 32

The author describes a range of contraceptive methods, and their side effects, which may be acceptable for new parents. The methods are the oral contraceptive pill, Norplant, Depo-Provera, and intrauterine devices (IUD). Natural methods and permanent contraception are options described in insets. The author notes that differences in the effectiveness rates among available types of oral contraceptive pills are small enough not to merit consideration when deciding which kind of pill may be appropriate. Combination birth control pills are taken daily at the same time for 21 out of 28 days. Combination pills are not recommended for women with a history of hypertension or other cardiovascular diseases, thrombophlebitis, migraine headaches, diabetes, active gallbladder disease, or mononucleosis. Any hormonal method may be particularly risky for smokers over age 35. The mini-pill, containing a smaller amount of progesterone and no estrogen, is taken every day and is also on a 28-day cycle. Containing no estrogen, the mini-pill is often recommended for women who are nursing, who are over age 35, or who suffer from hypertension or migraines. Both adverse and positive side effects may be experienced from use. Norplant is the brand name of a contraceptive system which releases progesterone from under the skin of a woman's upper arm over the course of a five-year period. The system has a theoretical effectiveness rate of more than 99%, although the duration of effectiveness may be less than five years in overweight women. The most common side effect is irregular bleeding, and removal is often a longer and more difficult procedure than insertion. The most commonly used injectable hormonal contraceptive is Depo-Provera, a progesterone solution which works for up to three months. The majority of users experience some side effects. Finally, IUDs are highly effective and need to be replaced only every 1-10 years depending upon how they are made. Women typically experience discomfort during IUD insertion, and they should not be used by women under age 20 years, who have never had children, or who have ever had a pelvic infection.
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PMID:Birth control for new parents. 1229 Aug 91

Many physicians will not provide oral contraceptives (OCs) to women with a history of migraine due to concerns about increasing the risk of a cerebrovascular accident. The World Health Organization's revised medical eligibility criteria indicate that only women with serious migraine that includes focal neurologic symptoms should be cautioned against OC use. This article reviews the research evidence on headache, migraine, and OCs. The recent literature suggests that healthy, nonsmoking women using low-dose OCs (35 mcg of estrogen or less) have no increased risk of stroke. Although the presence of diabetes, hypertension, and/or migraine appears to be associated with an increased risk of cerebral thromboembolism, the use of OCs does not synergistically add to the risk. It is important, however, for physicians to differentiate between tension headaches, migraines with aura (classic migraine), and migraines without aura (common migraine). Women with classic migraine should avoid OCs if an alternative method of contraception can be used. Common migraine is not a contraindication to OC use, although the frequency and severity of headaches during OC use should be monitored. OC discontinuation should be discontinued, at least temporarily, if previously existing migraine suddenly worsens, headaches that are qualitatively different than the type usually experienced by the patient occur, headaches wake a patient from sleep, or double vision or loss of vision occur.
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PMID:Headache, migraine and oral contraceptives. 1229 64


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