Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of postmenopausal estrogens primarily to prevent heart disease should be reserved for women at high risk by virtue of an unfavorable low-density lipoprotein: high-density lipoprotein (LDL:HDL) ratio or the presence of manifest disease. Unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce the risk of cardiovascular disease. There is no reason to give progestins to a woman without a uterus. The management of a woman with an intact uterus is less well defined, given the unknowns about progestin's long-term effects on lipids or the heart.
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PMID:Estrogen and estrogen-progestogen replacement: therapy and cardiovascular diseases. 825 94

The routine prescription of hormone replacement therapy for elderly women to prevent heart disease is not indicated. Until better data are available, the use of estrogens primarily to prevent heart disease probably should be reserved for women at high risk by virtue of their LDL/HDL ratio or the presence of manifest coronary heart disease. There is no reason to give progestins to the woman without a uterus; unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce risk. The management of a woman with an intact uterus is more problematic given the unknowns about progestin's long-term effects on lipids or the heart and the unwillingness of many elderly women to resume regular (or irregular) bleeding. There are, however, many proven benefits of hormone replacement therapy, including the prevention of osteoporosis and urogenital atrophy. Decisions about when it is too late to start estrogen, or when it is time to stop it, will need to be made on a case-by-case basis.
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PMID:Estrogens, lipids, and heart disease. 844 40

Mucometrocolpos is the distention of the uterus and vagina caused by obstruction to the drainage of genital secretions. Although most cases of mucometrocolpos are sporadic, it may be part of an autosomal recessive condition, known as McKusick-Kaufman syndrome (MKS), including postaxial polydactyly and congenital heart disease as main findings. The diagnosis may be difficult when the presence of additional findings creates an overlap with other syndromes. We report on a female infant with mucometrocolpos, postaxial polydactyly, congenital heart disease, short limbs, short ribs, and chest constriction. The clinicopathological findings are described and discussed in the context of the phenotypic spectrums of MKS and mucometrocolpos concomitant with Ellis van Creveld syndrome.
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PMID:Diagnostic problems in a case with mucometrocolpos, polydactyly, congenital heart disease, and skeletal dysplasia. 898 98

Estrogen is a key regulatory hormone, which in addition to its role in reproduction, affects a number of physiological systems, including the skeleton and cardiovascular system. The important role of estrogen in various tissues is perhaps most evident in postmenopausal women who, in addition to menopausal symptoms, experience increases in osteoporosis and coronary heart disease as their estrogen levels decline. Estrogen replacement, while effective against osteoporosis and heart disease, produces a number of side effects associated with the breast and uterus which limits compliance. Selective estrogen receptor modulators (SERMs), such as raloxifene and tamoxifen, produce beneficial estrogen-like effects on bone and lipid metabolism, while antagonizing estrogen in reproductive tissue. SERMs can be distinguished from each other in reproductive tissue, particularly the uterus, by their activity profile. For example, while triphenylethylenes like tamoxifen behave as partial agonists, raloxifene (a benzothiophene) behaves as a complete antagonist in the uterus. The SERM profile is distinct from that of full estrogens (ie. 17beta-estradiol or 17alpha-dihydroequilenin) which behave as estrogen agonists in all tissues and pure estrogen antagonists (i.e. ICI-164,384) which exhibit only an estrogen antagonist profile in a battery of tissue types. The precise mechanism by which SERMs produce this tissue-selective pharmacology remains a question. It is clear, however, that for raloxifene, both the estrogen agonist effects on bone and cholesterol metabolism as well as the estrogen antagonist effects in uterine and mammary tissue involve high affinity interaction with the estrogen receptor. The estrogen antagonist activity is mediated via classical pharmacological competition for estrogen receptor binding. The estrogen agonist activity, in bone for example, appears to involve novel post-receptor pathways and non-classical estrogen response element(s) which are activated by SERMs. These novel response elements may represent natural pathways which respond to estrogen metabolites in vivo.
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PMID:Selective estrogen receptor modulators: an alternative to hormone replacement therapy. 942 Dec 6

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

The Heart and Estrogen/progestin Replacement Study (HERS) is a randomized, double-blind, placebo-controlled trial designed to test the efficacy and safety of estrogen plus progestin therapy for prevention of recurrent coronary heart disease (CHD) events in women. The participants are postmenopausal women with a uterus and with CHD as evidenced by prior myocardial infarction, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, or other mechanical revascularization or at least 50% occlusion of a major coronary artery. Between February 1993 and September 1994, 20 HERS centers recruited and randomized 2763 women. Participants ranged in age from 44 to 79 years, with a mean age of 66.7 (SD 6.7) years. Most participants were white (89%), married (57%), and had completed high school or some college (80%). As expected, the prevalence of coronary risk factors was high: 62% were past or current smokers, 59% had hypertension, 90% had serum LDL-cholesterol of 100 mg/dL or higher, and 23% had diabetes. Each woman was randomly assigned to receive one tablet containing 0.625 mg conjugated estrogens plus 2.5 mg medroxyprogesterone acetate daily or an identical placebo. Participants will be evaluated every 4 months for an average of 4.2 years for the occurrence of CHD events (CHD death and nonfatal myocardial infarction). We will also assess other major CHD endpoints, including revascularization and hospitalization for unstable angina. The primary analysis will compare the rate of CHD events in women assigned to active treatment with the rate in those assigned to placebo. The trial was designed to have power greater than 90% to detect a 35% reduction in the incidence of CHD events, assuming a 50% lag in effect for 2 years and a 5% annual event rate in the placebo group. The design, analysis, and conduct of the study are controlled by the Steering Committee of Principal Investigators and coordinated at the University of California, San Francisco. HERS is the largest trial of any intervention to reduce the risk of recurrent CHD events in women with heart disease and is the first controlled trial to seek evidence of the efficacy and safety of postmenopausal hormone therapy to prevent recurrent CHD events.
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PMID:Heart and Estrogen/progestin Replacement Study (HERS): design, methods, and baseline characteristics. 968 9

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

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and therapeutic role of raloxifene hydrochloride are reviewed. Raloxifene is a selective estrogen-receptor modulator (SERM) that has been approved for use in the prevention and treatment of osteoporosis in postmenopausal women. A SERM interacts with estrogen receptors, functioning as an agonist in some tissues and an antagonist in other tissues. Because of their unique pharmacologic properties, these agents can achieve the desired effects of estrogen without the possible stimulatory effects on the breasts or uterus. Raloxifene is rapidly absorbed from the gastrointestinal tract and undergoes extensive first-pass glucuronidation. Approximately 60% of a dose is absorbed; however, absolute bioavailability is only 2%. The volume of distribution is 2348 L/kg for a single oral dose of 30-150 mg, and the elimination half-life averages 32.5 hours. In clinical trials in postmenopausal women, raloxifene had an estrogen-like effect on bone turnover and increased bone mineral density. It reduced the risk of fractures in women with osteoporosis. Raloxifene also seemed to reduce the risk of breast cancer and positively influenced blood lipid markers of cardiovascular disease. Raloxifene is generally well tolerated; the most common adverse effects are hot flashes and leg cramps. A serious adverse effect is venous thromboembolism. The recommended dosage is 60 mg/day orally without regard to meals. Ultimately, it will be information on cardiovascular or breast cancer benefits that will determine the future role of raloxifene. Raloxifene is an alternative to traditional hormone replacement therapy for the prevention and treatment of osteoporosis in selected postmenopausal women. More study is needed to verify possible benefits related to heart disease and breast cancer.
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PMID:Raloxifene hydrochloride. 1100 95

Hydrometrocolpos is cHaracterized by a vaginal obstruction with cystic dilatation of uterus and vagina caused by accumulation of cervical and endometrial mucus. It could be in association with other malformations, such as postaxial polydactyly, anal atresia, esophageal atresia, renal agenesis, genital anomalies, cardiopathy or autosomal recessive disorder. The appropriate prenatal detection with the help of prenatal ultrasonography differential diagnosis and early treatment and prevention of complications.
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PMID:[Hydrometrocolpos: prenatal diagnosis. A case report]. 1214 62

An obstetric handbook was created in comic strip form in cooperation with the Ministry of Health in the region of Segou, Mali, for training of traditional midwives living far from community health centers. The drawings illustrate pregnancies at risk that the midwife should be able to identify in order to advise women to stay near the health facility before onset of labor. Drawings indicate pregnancies that are at risk because of the following: small stature, limping as a result of polio or sciatic paralysis, high parity, prior cesarean delivery, heart disease, overly large uterus, or prior stillbirth. Serious complications requiring referral to a health service are also illustrated and include severe anemia, genital bleeding, and signs of toxemia and edema. The midwife should accompany the woman during transport.
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PMID:[Obstetrical handbook in comic strip form]. 1229 24


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