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

Cardiovascular disease is the leading cause of death in women. In pooled analysis, observational studies have shown a 50% reduction in death and myocardial infarction among users of hormone replacement therapy (HRT) for the primary and secondary prevention of cardiovascular disease. The first randomized trial of HRT for secondary prevention of heart disease found no benefit to therapy (Heart and Estrogen/progestin Replacement Study ). Even after 6.8 years of follow-up, there was still no cardiovascular benefit from the use of HRT (HERS II). HRT was associated with a 50% increased risk of heart attacks within the first year as well as an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) (relative risk 2.89) and gallbladder disease (RR 1.38). The Estrogen Replacement and Atherosclerosis trial found no evidence that HRT slowed the progression of subclinical angiographic disease either. This was despite a favorable effect on high-density lipoprotein and low-density lipoprotein. The first randomized trial of HRT for the primary prevention of heart disease found no overall benefit (Women's Health Initiative). The combination of estrogen and progestin resulted in a 29% increase in heart attacks, 41% increase in stroke, a doubling of thrombotic events (DVT and PE), as well as a 26% increase in breast cancer. The risk for thrombotic events was greatest in the first year whereas the risk of breast cancer increased progressively with duration of therapy. HRT is no longer recommended for the primary or secondary prevention of cardiovascular disease or stroke. It may still be considered for short-term relief of menopausal symptoms in women without high-risk conditions, but alternatives exist.
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PMID:Hormone Replacement Therapy for Primary and Secondary Prevention of Heart Disease. 1268 16

Postmenopausal women in Western societies are conscious of breast cancer as a potential cause of death and ill health, which they wish to avoid with the advice of their doctors. Yet many factors that predispose women to the development of cancer will have been laid down before the menopause, in their genetic makeup or during their adolescent years. Even in middle age it is important to take account of the intrinsic level of risk, and to give women advice tailored to their own individual risk level. This results from their family history, previous diseases such as benign breast disease, and previous treatment for breast cancer or Hodgkin's disease. For those at the highest level of risk, strategies will include regular screening, prophylactic mastectomy, and the use of chemoprevention agents, such as tamoxifen. These women should avoid hormone replacement therapy (HRT) and control their menopausal symptoms and osteoporosis through the use of other agents now available - venlafaxine for menopausal symptoms and bisphosphonates for osteoporosis. Raloxifene is an agent under trial that may be valuable for breast cancer control as well as for osteoporosis. Women at standard population risk will require less robust preventive strategies, which will include screening and lifestyle modification. Their decisions regarding HRT should now be modified by recent evidence of associated risks. Recent studies show that tibolone causes less mammographic density and has a lower relative risk of breast cancer than combined estrogen/progestogen preparations. There is limited evidence that controlling obesity, participating in exercise and adopting a diet low in fats and high in fruit and vegetables will alter risk at this age. These precautions will, however, reduce the risk of other diseases common in this age group, such as hypertension, heart disease, stroke, and type 2 diabetes mellitus. Alcohol, even in small amounts, is a risk factor for breast cancer. Given the cardioprotective effect of moderate alcohol intake, advice on alcohol must reflect the individual relative risk of cardiovascular disease and breast cancer. Personal risk assessment is relevant for all women. Screening and a healthy lifestyle are worthwhile approaches for all, with the more aggressive approaches such as chemoprevention and prophylactic surgery reserved for those who have substantially elevated levels of risk. Once the menopause has passed, screening is probably the most effective evidence-based tool for breast cancer control by early diagnosis.
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PMID:Strategies for managing breast cancer risk after the menopause. 1533 Jun 77

Several plants and plant-derived pure compounds, designated as phytoestrogens, have been reported to cause estrogenic effects. They have been used for alleviation of menopausal symptoms, prevention of osteoporosis, heart disease and cancer. There is an increased interest in studying phytoestrogens such as isoflavones and lignans for their use as replacements for synthetic estrogens. In this study, the estrogenic activity of essential oils of eleven Pimpinella species and the compounds isolated from these species were evaluated using the yeast estrogen screen (YES) assay. The essential oils containing (E)-anethole as major compound showed estrogenic activity in the YES assay, except for the aerial parts without fruits of P. anisetum and P. flabellifolia. The percent maximal response produced by most anethole-containing oils was 30-50%. Fruits of P. isaurica and P. peucedanifolia were estrogenic in spite of the absence or trace amount of anethole, respectively. This study indicates that the estrogenic activity of Pimpinella oils is not solely due to the presence of anethole. Components other than anethole may be responsible for contributing towards the estrogenic activity. The essential oils from different species varied in their estrogenic potencies (relative potency from 8.3 x 10(-8) to 1.2 x 10(-6) compared to 17 beta-estradiol) and among the different plant parts, the fruit oils of most species were estrogenic followed by the aerial parts without fruits and the root oils and their EC50 values varied from 45 micrograms/mL to 650 micrograms/mL.
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PMID:Estrogenic activity of isolated compounds and essential oils of Pimpinella species from Turkey, evaluated using a recombinant yeast screen. 1536 61

Heart disease is the major health issue facing women in the United States today. Yet, less than 50% of women are aware cardiovascular disease is a health problem. Atherosclerosis begins in childhood and lipid streaks have been identified in girls ages 15-19 in the abdominal aorta and the right coronary artery. Risk factors for cardiovascular disease in women include smoking, diabetes, hypertension, lipid disorders, and menopause. Observational studies have reported a 30-50% reduction in cardiovascular events when estrogen was administered to younger women for menopausal symptoms, yet randomized trials in older patients have failed to show benefit with hormonal replacement therapy. Recent studies have reported preservation of lipid and vascular vasodilatation with low-dose conjugated equine estrogens (CEE) in women and an absence of inflammatory and clotting changes that were observed in high-dose CEE. Recommendations for reducing cardiovascular risk in postmenopausal women include smoking cessation, regular exercise, and weight control. Should hormone therapy be continued beyond management of menopausal symptoms and treatment for osteoporosis, a statin drug should be added to eliminate future cardiovascular complications. Future research will examine low-dose hormonal therapy, earlier administration after menopause, newer agents, and routes of estrogen administration.
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PMID:Hormones and coronary atherosclerosis in women. 1554 92

Patients seeking alternatives to hormone replacement are increasingly using non-prescription phytoestrogen supplements. The potential of these herbal remedies to prevent bone loss, heart disease, menopausal symptoms or breast cancer has been a focus of attention in scientific and lay literature. It is important to understand the effects of phytoestrogens, particularly whether excess exposure can promote hyperplasia or neoplasia of breast tissue. We report the case of a man diagnosed with breast cancer whose history was notable for extensive use of supplemental phytoestrogens and the absence of family history of breast cancer or BRCA1/BRCA2 mutation. In conclusion, breast tissue effects of phytoestrogens remain unclear. The increasing popularity and availability of phytoestrogen dietary supplements necessitates additional research in order to counsel patients regarding their safety and efficacy.
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PMID:Phytoestrogen supplementation: a case report of male breast cancer. 1554 40

There are no new data in the Women's Health Initiative. The Collaborative Study of Hormone Factors in breast cancer showed a non-significant increased risk after 5 years. HERS showed an increased risk of cardiovascular disease in HT users with previous heart disease. The Cache County study indicated that estrogen therapy initiated after age 60 increased the incidence of Alzheimer's disease. The daily progestogen in the HT users decreased the estrogen receptors in the coronary arteries and minimized the beneficial direct effect of estrogen. It also decreased progesterone receptors in the endometrium, thus making it less endometrial-protective. The WHI was contrary to previous studies of estrogen therapy because women with specific menopausal symptoms were excluded, were older, had never used estrogen and had long-term estrogen deficiency. It takes healthy tissue to allow an effective response to estrogen and maintenance of health. Maximal benefit of HT may require early onset of treatment, near the time of menopause. However, it is never too late to arrest the progression of osteoporosis and decrease the risk of fracture.
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PMID:The women's health initiative reports in perspective: facts or fallacies? 1566 45

Because of major advances in diagnostic and surgical methods, females with congenital heart disease (CHD) now survive into and beyond their reproductive years. Management of pregnancy in this patient population is well described, but gynecologic management such as menstruation, contraception and menopause have received scanty attention. Accordingly, the gynecologic health issues confronting these patients are described. Menstrual patterns in acyanotic females with CHD are similar to the general population, but cyanotic females have menstrual irregularities including amenorrhea, which implies anovulation and an increased risk of uterine carcinoma. Anticoagulants predispose to heavy vaginal bleeding and corpus luteum rupture. Contraceptives must be selected according to individual patient profiles. Hormone replacement therapy is warranted for relief of menopausal symptoms as in the general population and should be relatively safe because estrogen dose is low.
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PMID:Gynecological health of females with congenital heart disease. 1570 68

Menopause is a transitional time for women. This gives practitioners an opportunity to focus on recommending healthy life-style changes. Hormone replacement therapy (HRT) has been the mainstay of therapy for menopausal symptoms. With recent research findings, women and their physicians are seeking alternatives that do not carry the risks associated with HRT. Exercise has been shown to help some women with symptoms of hot flashes, as have relaxation techniques and deep breathing. Dietary changes to incorporate whole foods and soy are thought by some to help with menopausal symptoms, and are recommended because of a positive impact on heart disease and obesity; soy isoflavones may also help with menopausal symptoms. Botanicals such as black cohosh and red clover have been shown in some studies to decrease severity and frequency of hot flashes. We recommend that HRT be prescribed when other measures have failed to adequately control symptoms. Bioidentical hormones are preferred in our practice.
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PMID:Integrative therapies for menopause. 1581 59

Estrogen, with or without a progestin, is effective for the treatment of menopausal symptoms. Larger doses of estrogen/progestin have been used than required for the amelioration of menopausal symptoms. Both positive and negative outcomes of hormone therapy are reported in postmenopausal women. The positive aspects have been those associated with a reduction in menopausal symptoms such as hot flashes, and improvement in vulvovaginal atrophy with maintenance of bone mineral density. The problems have included an increased risk of venous thrombosis and breast cancer. The anticipation is that as the dose of oral estrogen and progestins is lowered, the benefits can be maintained and the side effects reduced. Recent clinical trials have found that lower doses of estrogen and/or progestin reduce or improve menopausal symptoms and maintain bone mineral density. The impact of lower doses of hormones on heart disease, and venous thromboembolism and stroke remain to be determined in future studies.
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PMID:Lower doses of oral estrogen and progestogens as treatment for postmenopausal women. 1585 5

HRT should not be used for the prevention or treatment of chronic disease (eg, heart disease, osteoporosis, dementia). HRT is effective in alleviating moderate to severe menopausal symptoms. Clinicians must be aware of the risks and benefits of HRT and discuss them thoroughly with their patients. As new forms and lower doses of hormones become available, additional studies will be needed to compare therapeutic strategies adequately. Studies of younger perimenopausal and menopausal women are needed. Whatever regimen is chosen, the lowest allowable estrogen dose to relieve symptoms for the shortest time is recommended. Alternatives to hormonal therapy are being examined and some may be considered. Table 1 provides an evidence-based summary of current recommendations.
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PMID:Hormone replacement therapy. 1716 76


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