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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Female reproductive hormones cause breast cancer. Long-term use of postmenopausal hormones increases the risk of breast cancer. The apparent survival advantage seen in women diagnosed with breast cancer while taking postmenopausal hormones may be due to the hormone-responsive nature of their tumors, diagnosis at an earlier stage, or other biases. Thus, the data indicating a survival advantage do not specify what the policies were on the use of hormones after diagnosis. Substantial evidence from studies of obesity confirms the association of higher estrogen levels with poorer prognosis. Tamoxifen (Nolvadex), acting as an antiestrogen in breast tissue, increases the likelihood of survival, as does oophorectomy in premenopausal women. Given these data, women diagnosed with breast cancer should use hormones sparingly. Alternatives to hormone therapy should be used for long-term prevention of heart disease and osteoporosis.
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PMID:Estrogen replacement therapy for breast cancer patients. 959 75

Contemporary interest in postmenopausal hormone therapy as a coronary preventive intervention in women derives from the increased prevalence of coronary disease in the postmenopausal years, the importance of estrogen status as a determinant of coronary risk for women, the less favorable outcomes of coronary events for women than for men, the biologically plausible mechanisms of estrogen benefit, and encouraging epidemiologic data suggesting that estrogen use may favorably affect coronary risk. Observational studies describe the greatest reduction in mortality risk with estrogen use in women at high risk for coronary disease or with documented coronary heart disease, with greater benefit currently accruing for those with angiographically severe rather than angiographically mild disease. Noncoronary risks of estrogen use warrant consideration; these include endometrial hyperplasia, breast cancer, and venous thromboembolism. Noncoronary benefits include a decrease in osteoporosis and osteoporotic fractures and in vasomotor symptoms of estrogen deficiency. Because about one of two U.S. women die from cardiovascular disease (heart disease and stroke), emphasis is warranted on available data, which suggest that the group of women likely to experience the greatest cardioprotection from hormone therapy are those with defined coronary disease or those at high risk for occurrence; the group of women least likely to benefit are those at increased risk for breast cancer.
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PMID:Postmenopausal hormone therapy. Is it useful for coronary prevention? 950 77

Mrs. S's case demonstrates the dilemmas that many women face at menopause regarding HRT. No clear answer to her question exists. Oncology nurses need to help women understand that taking HRT is a decision that is best made after carefully weighing the risks and benefits of therapy. Mrs. S needs to realize that she has some risk factors for heart disease, osteoporosis, breast cancer, and uterine cancer. Depending on her motivation, Mrs. S can modify some of the risk factors (e.g., reducing her weight and cholesterol). Smoking cessation also would reduce her risk for heart disease and, to a lesser extent, osteoporosis. Although her risk for developing breast cancer is higher than for a woman without a family history of breast cancer, she only has one relative who was older when she developed breast cancer. This risk factor in itself probably would not be enough to advise her against taking HRT. Additional testing may offer some clarification. If her breasts are difficult to examine or her mammograms are difficult to interpret, Mrs. S may feel that the risk of missing breast cancer early is too high to justify taking HRT. An abnormal endometrial biopsy also may make Mrs. S decide against taking HRT. BMD testing might help to better assess her risk for osteoporosis. If some bone loss has occurred before menopause, she may want to give more consideration to taking HRT or medications such as alendronate sodium to reduce her risk for an osteoporotic fracture. Women need to understand that, often, no best answer is available to the question of whether or not to take HRT. With every decision comes some consequences. An understanding of risk factors and ways to maximize cardiovascular, breast, endometrial, and bone health are important factors to consider when making an informed decision. Clearly, this is an area where oncology nurses can provide tremendous patient education and support to women making decisions about HRT.
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PMID:Case in point. Counseling about hormone replacement therapy. 959 44

Estrogens exhibit potent anti-atherogenic effects through mechanisms which may involve direct effects on the artery. The existence of the classical estrogen receptor (ERalpha) in vascular tissues has been established. Recently a new estrogen receptor (ERbeta) has been discovered which represents a distinct gene product with homology to the classical ERalpha. The purpose of the present study was to determine if ERbeta mRNA is expressed in vascular tissues of female and male primates. Oligonucleotide primers were developed for the specific RT-PCR amplification of ERalpha or ERbeta mRNA. RT-PCR products of the appropriate size for ERalpha and for ERbeta were observed after amplification of RNA isolated from coronary arteries of both male and female cynomolgus monkeys. Similar results were obtained from cultured aortic smooth muscle cells and from monkey reproductive tissues such as ovary and uterus. The relative expression of ERbeta to ERalpha mRNA was greatest in ovary, on the same order of magnitude in monkey vascular tissues and uterus, while the human breast cancer cell line MCF-7 exhibited a very low level of ERbeta relative to ERalpha. Sequence analysis of isolated RT-PCR products showed >95% similarity between the monkey and the published human sequences for both ERalpha and ERbeta. These findings suggest that estrogen may influence vascular gene expression not only through classical ERalpha but also through the newly described ERbeta. These findings also demonstrate the potential for targeting of these receptors in males for prevention or treatment of heart disease.
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PMID:Coronary artery and cultured aortic smooth muscle cells express mRNA for both the classical estrogen receptor and the newly described estrogen receptor beta. 960 13

We sought to determine the strength of the evidence suggesting that estrogen and postmenopausal replacement hormones play a role in the development of breast cancer. We reviewed the existing English language literature in MEDLINE on hormones and breast cancer, including reports on cell proliferation and endogenous hormone levels, as well as epidemiologic studies of the relationship between the use of postmenopausal hormones and the risk of breast cancer in women. A factor that increases the probability that cancer will develop in an individual has been defined as a cancer cause. The Hill criteria for demonstrating a link between environmental factors and disease were used to review the evidence for a causal relationship between female hormones and breast cancer. We found evidence of a causal relationship between these hormones and breast cancer, based on the following criteria: consistency, dose-response pattern, biologic plausibility, temporality, strength of association, and coherence. The magnitude of the increase in breast cancer risk per year of hormone use is comparable to that associated with delaying menopause by a year. The positive relationship between endogenous hormone levels in postmenopausal women and risk of breast cancer supports a biologic mechanism for the relationship between use of hormones and increased risk of this disease. The finding that the increase in risk of breast cancer associated with increasing duration of hormone use does not vary substantially across studies offers further evidence for a causal relationship. We conclude that existing evidence supports a causal relationship between use of estrogens and progestins, levels of endogenous estrogens, and breast cancer incidence in postmenopausal women. Hormones may act to promote the late stages of carcinogenesis among postmenopausal women and to facilitate the proliferation of malignant cells. Strategies that do not cause breast cancer are urgently needed for the relief of menopausal symptoms and the long-term prevention of osteoporosis and heart disease.
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PMID:Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer. 962 69

It is well established that adjuvant radiotherapy (RT) reduces loco-regional recurrences in breast cancer. The effect on overall survival, on the other hand, is a much-debated issue. Some old trials with a long follow-up as well as the first report on the overview of the randomized RT trials initiated before 1975 showed a reduced survival among irradiated patients compared with the surgical controls. In the update of the overview this proved to be due to cardiac deaths. In two more recent studies, adjuvant RT in the postmastectomy setting improved the survival of node-positive premenopausal patients who were also treated with chemotherapy. In one of these trials it was indicated that cardiac mortality was not increased. There are few data concerning the cardiac side effects of RT after conservative surgery. Some studies suggest that radiation-induced heart disease may be a potential problem also among these patients. Therefore, the search for both the causes of radiation-induced heart disease and preventive measures is crucial issues in breast cancer radiation oncology.
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PMID:Radiation-induced ischemic heart disease in breast cancer--a review. 967 94

Heart disease, breast cancer, and hormone therapy were top clinical concerns in women's health in 1997. One of the major reports on heart disease confirmed that women are no different from men in terms of early infarct-related artery patency rates, reocclusion after thrombolytic therapy, and ventricular functional response to injury/reperfusion; nevertheless, women have 3 times the mortality of men in the first 30 days after an acute myocardial infarction. Research brought only modest gains in the understanding of breast cancer etiology in 1997, but engendered major debate on whether women younger than 50 years should have mammograms every 1 to 2 years. A National Institutes of Health consensus conference said no, but the National Cancer Institute's National Cancer Advisory Board said yes. Evidence of estrogen benefits and risks mounted: One report added to the data suggesting that estrogen may retard age-related memory loss, while another study reported that the risk of breast cancer significantly increased with long-term use of estrogens. The interest in selective estrogen receptor modulators (SERMs), also called "designer estrogens," grew. Efforts to develop pharmacologic treatment for obesity suffered a setback in 1997 when a team reported that 1 in 3 patients who used d-fenfluramine developed abnormal valvular thickening, with the most severe cases needing valve replacement. One of the most promising events in colorectal cancer, the third most common cancer in women, was the set of screening guidelines issued by the Agency for Health Care Policy and Research. The year ended with major ethical debates about multiple gestation and cloning.
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PMID:Perspective on women's health: editors' 1997-1998 year in review. 973 99

Heart disease, lung cancer, and HIV infection are among the diseases previously thought to be primarily men's health problems that have been documented in recent years to be serious health problems for women. Researchers have reported that women with heart disease have poorer outcomes and receive less intensive therapy than men. Clinicians and consumers are just beginning to realize that cardiac disease is the #1 cause of death in women -- outpacing breast cancer. In the breast cancer arena, the impact of such genetic links as BRCA1 and BRCA2 is still unclear, as is the issue of screening mammograms for women under the age of 50. Other top issues in women's health include efforts to ban "drive through" deliveries and early postmastectomy discharge, calculation of the high price of prematurity, changes in Pap screening techniques, and continuing efforts to understand the effects of estrogen. This editorial examines the key issues and trends in women's health reported and debated in 1996.
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PMID:Examining Women's Health: 1996-1997. 974 86

Our objective was to determine if physician beliefs about the benefits and risks of hormone replacement therapy (HRT) differ by physician gender or specialty in a managed care setting. In a cross-sectional survey of providers in a health maintenance organization in North Carolina, 105 gynecologists, internists, and family physicians and physician assistants were surveyed, and 74 providers completed and returned the survey (70.5% response rate). Providers' beliefs about the benefits and risks of HRT differed by specialty and gender of physician. Gynecologists are significantly less concerned about the potential risks of HRT on breast cancer (p = 0.004) and thromboembolic events (p = 0.005) compared with family physicians and internists. Female providers across the three specialty categories were significantly different from their male colleagues in their beliefs about the benefits of HRT with regard to the reduction in risk of heart disease (79% versus 64%, p = 0.001), osteoporosis (83% versus 75%, p = 0.045), and Alzheimer's disease (45% versus 26%, p = 0.026). There was a trend toward female physicians being more convinced about the risks of breast cancer than their male colleagues (p = 0.08). Our results suggest that providers in a managed care setting vary in their beliefs about the benefits and risks of HRT, and this may affect provider-patient discussions about HRT.
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PMID:Differences in providers' beliefs about benefits and risks of hormone replacement therapy in managed care. 978 14

After the age of about 35, the natural cycle becomes less predictable. Oestrogen levels fluctuate, leading to some anovulatory cycles. Sometimes periods stop suddenly but more often become erratic and less frequent for a year or two before the final period (menopause). About 75% of women experience symptoms at the time of the menopause, which typically lasts 1-3 years and occurs at around the age of 50. Long-term effects of the menopause are a rapid decline in bone density and greater risk of heart disease. Useful life-style adjustments for menopausal women are to eat calcium-rich foods, stop smoking, restrict alcohol intake and exercise regularly, especially weight-bearing exercise such as walking, dancing or sports. Hormone replacement therapy (HRT) is effective in reducing menopausal symptoms and appears to reduce the long-term risks of osteoporosis and heart disease. Women may start taking HRT before periods cease if they have troublesome symptoms during the pre- and peri-menopausal stage. Women who have had a hysterectomy may use oestrogen on its own. Women who have a uterus need a combination of oestrogen and progestogen. Current evidence suggests that to take HRT for up to 5-8 years incurs no additional risk of breast cancer, although to take it for longer than 10 years seems to increase the risk slightly.
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PMID:The menopause: preparing women for what to expect. 981 54


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