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

The concensus conclusions reached at a concensus development conference on Estrogen Use and Postmenopausal Women in September 1979 are based on 3 position papers prepared for the conference, the response of the panel, and the general discussion by the audience, followed by the panel and other conference participants. The evidence for the efficacy of estrogens in treating specific conditions associated with menopause was reviewed 1st. It was accepted that estrogens are more effective than placebo in decreasing the frequency and severity of vasomotor symptoms. Estrogens are effective in overcoming the atrophy of the vaginal epithelium and the associated symptoms. Present evidence does not justify the use of estrogens to treat primary psychological problems. The validity of 3 randomized trials indicating that exogenous estrogens can retard bone loss if given around the time of menopause was acknowledged. There is no convincing evidence that estrogens in customary doses increase the risk of thromboembolic phenomena, stroke, or heart disease in women who have undergone natural menopause. Evidence was also reviewed concerning adverse effects associated with post-menopausal estrogen use. In the absence of exogenous estrogens, the incidence of endometrial cancer is about 1/1000 postmenopausal women per year. This rate increases severalfold beginning after about 2-4 years of use of 0.625 or 1.25 mg of conjugated estrogens daily. Cystic hyperplasia of the endometrium, regarded as a premalignant condition, has been associated with unopposed estrogen, whether endogenous or exogenous.
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PMID:Estrogen use and postmenopausal women: a National Institutes of Health Consensus Development Conference. 4 37

Estrogen replacement therapy (ERT) is suggested for women with symptomatic estrogen deficiency, but patients with breast cancer are advised against ERT because of concerns that ERT may precipitate cancer recurrence. The attitudes of women with breast cancer regarding ERT is critical in the design of appropriate strategies for the management of their menopause. A randomly selected group of 224 women with breast cancer responded to an anonymous survey that addressed the presence of menopause, antecedent therapies, symptoms related to estrogen deficiency, concerns about osteoporosis or heart disease, attitude about ERT, and perception about ERT-related cancer risk. Among women who completed the survey, 77% were postmenopausal and 81% had had multimodality therapy. Of menopausal women, 27% believed they needed some treatment for menopause and 8% had taken ERT since cancer diagnosis. Most women were afraid that ERT may precipitate cancer recurrence (78%) but they also were concerned about the menopause-related risk of osteoporosis (70%) and heart disease (72%). Overall, 44% of menopausal women were willing to consider ERT under medical supervision. Those treated with surgery alone were distinct in that 71% would consider ERT (p < 0.04). Premenopausal women were more concerned about osteoporosis (82% vs. 66% for postmenopausal), heart disease (92% vs. 73%), and the possibility that ERT may precipitate cancer recurrence (98% vs. 73%). Yet, at the same time, they were more willing to consider ERT under medical supervision (59% vs. 40% for menopausal). The present study underscores that women with breast cancer are very aware and concerned about the adverse health consequences of estrogen deficiency and would consider ERT under medical supervision.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Estrogen replacement therapy in women with breast cancer: a survey of patient attitudes. 147 53

Coronary heart disease, a major cause of morbidity and death, is the leading cause of death in older women, with an incidence that approaches that in men of comparable age. Estrogen favorably alters lipid metabolism and should therefore diminish the risk for coronary heart disease in estrogen users. Epidemiologic data from case-control and prospective cohort studies have suggested that estrogen use may confer protection from cardiovascular disease and decrease all-cause mortality rates in postmenopausal women. Because the age-adjusted mortality rate due to heart disease among American women is approximately four times the combined mortality rate due to endometrial and breast cancers, even modest changes in the risk of fatal heart disease after estrogen use would dramatically impact the overall risk-benefit equation.
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PMID:Estrogen replacement and cardiovascular disease: serum lipids and blood pressure effects. 269 Jun 37

Breast cancer is the most common cancer in the United States comprising 30% of all cancers. There is strong evidence indicating that cumulative estrogen, and possibly progesterone, exposure of breast epithelial cells causes this cancer. After age 40 the sharp increase of cancer rate slows considerably. In industrialized countries the rate is 6 times higher than in Asia or Africa, however, ethnicity does not seem to be a major factor, as shown by studies on Japanese migrants to the U.S. Early menarche, before age 12, increases the risk fourfold, and higher levels of estrogen and progesterone found in daughters of breast cancer victims. Strenuous physical activity could delay menarche to 15.4 years of age, thus lowering the risk. Menopause lowers the risk, too, as does a shorter active menstruation history. Increased parity also decreases the risk, late first full-term pregnancy does the opposite. In parous women prolactin levels are lower, and sex hormone-binding globulin (SHBG) levels are higher. In older age weight gain also becomes a contributory factor. Estrogen plays a strong role in the genesis of breast cancer, and estradiol levels were 30% higher in cancer patients. Urinary estrogen levels were 36% higher in North American teenagers than in Asians. Fat intake and reserpine use can increase prolactin levels, however, its role is only putative, as is the role of progesterone. Increasing duration of use of oral contraceptives also raises the risk depending on age at first use and duration. Estrogen replacement therapy is similarly implicated, although a combination estrogen- progesterone therapy was beneficial. Furthermore, the benefits of estrogen to prevent osteoporosis and heart disease also have to be balanced against its carcinogenic potential.
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PMID:Endogenous and exogenous endocrine factors. 269 90

This third paper from the Persantine Aspirin Trial examines the data to identify risk factors for stroke in persons with a history of carotid territory transient ischemic attacks (TIAs) Fifteen centers in the United States and Canada participated, and 890 subjects were admitted and randomly allocated to either aspirin plus placebo or aspirin plus dipyridamole (Persantine). Persons with the following characteristics were in greater jeopardy for stroke, retinal infarction, or death: older age, history of heart disease, history of peripheral vascular disease, and persisting neurologic deficit from a recent event. Elevated diastolic blood pressure, diabetes, use of estrogen, and smoking were not found to be risk factors. Elevated systolic blood pressure was a risk factor primarily in subjects with a history of heart disease. Estrogen use may actually have had a protective effect for women. This cannot be considered as a report of the natural history of TIA patients; it does identify risk factors in a specific cohort of subjects under treatment.
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PMID:Persantine aspirin trial in cerebral ischemia--Part III: Risk factors for stroke. The American-Canadian Co-Operative Study Group. 286 49

A women spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Many epidemiologic studies have examined the long-term effect of postmenopausal estrogen deprivation and of ERT. Since the 1970s, we have evaluated the risks and benefits of ERT in one population of older women in the California retirement community of Leisure World. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures by about 50%. The effect is greatest in longterm users, but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users have retained more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40%. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. One of the most feared aspects of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The risks and benefits of estrogen replacement therapy: Leisure World. 758 89

Hot flashes are the most frequent somatic complaint of women going through the menopause. Although the exact pathophysiology of the hot flash remains unknown, it appears to be related to an alteration in the set point of the hypothalamic thermoregulatory center. With the withdrawal of estrogen, some event parallel to the release of GnRH (and subsequent release of LH) causes a decrease in the set point of the thermoregulatory center. The hot flash, with its characteristic sweating and vasodilation, represents the attempt to decrease the body core temperature and restore equilibrium. Estrogen therapy reliably treats hot flashes in the majority of women in addition to its proven beneficial effect on heart disease and osteoporosis. It is rare that health care providers can so reliably and safely positively impact on a patient's symptoms and overall health.
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PMID:The hot flash: pathophysiology and treatment. 760 59

Estrogen use is associated with protection from cardiovascular disease in postmenopausal women. This benefit appears to be magnified among women with pre-existing heart disease. The possible bias of intrinsically better health in women using estrogen has not been ruled out in observational studies. Therefore, two double-blind randomized clinical trials are underway in postmenopausal women. One in women with coronary disease is known as HERS (Heart Estrogen-progestin Replacement Study) and another in predominantly healthy women is the WHI (Women's Health Initiative). Several mechanisms of estrogen mediated protection from cardiovascular disease have been identified including increased HDL, lower LDL, lower VLDL-cholesterol/triglyceride ratio, increased clearance of intermediate density lipoprotein (IDL) and LDL via an upregulated LDL receptor, diminished penetration and degradation of LDL in the arterial wall, an inhibition of LDL oxidation by various estrogens and a reversal of inappropriate acetylcholine (EDRF)-mediated vasoconstriction in arteriosclerotic vessels. The predominating mechanism is not known, but estrogen replacement therapy is both likely to be beneficial to female health, pending randomized trials, as well as a tool to understand mechanisms of prevention of coronary artery disease.
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PMID:Effects of estrogens on lipoprotein metabolism and cardiovascular disease in women. 785 90

The anticonvulsive and antihypertensive values of magnesium (Mg) in eclampsia, and its antiarrhythmic applications in a variety of cardiac diseases, have caused Mg to be considered only for parenteral administration by many physicians. In contrast, nutritionists have long recognized Mg as an essential nutrient, because severe deficiencies elicit neuromuscular manifestations similar to those justifying its use in eclampsia. More recently, this element has been used to favorably influence latent tetany with and without thrombotic complications, to delay preterm birth, to influence premenstrual syndrome, and to ameliorate migraine headaches. Most of these disorders exclusively or largely afflict women. The lesions of arteries and heart caused by experimental Mg deficiency have been well documented and may contribute to human cardiovascular disease. Estrogen's enhancement of Mg utilization and uptake by soft tissues and bone may explain resistance of young women to heart disease and osteoporosis, as well as increased prevalence of these diseases when estrogen secretion ceases. However, estrogen-induced shifts of Mg can be deleterious when estrogen levels are high and Mg intake is suboptimal. The resultant lowering of blood Mg can increase the Ca/Mg ratio, thus favoring coagulation. With Ca supplementation in the face of commonly low Mg intake, risk of thrombosis increases.
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PMID:Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. 840 7

In the United States, cardiovascular disease represents the leading cause of death among women. A majority of the deaths are due to coronary disease. In addition, the incidence of heart attacks increases with age. Among those who are 65 years of age or older, the estimated heart attack rate is 374,000 per year for women, compared with 440,000 per year for men. In the past three decades, a number of observational studies have suggested that estrogen therapy can reduce the risk of coronary disease in postmenopausal women. This protective effect appears to be much greater in women who have existing coronary disease. These observational data point to the potential usefulness of estrogen therapy in preventing cardiovascular death among women. Although large, well-controlled, clinical trials are needed to confirm the benefit of estrogen therapy, several important findings strongly support the cardioprotective effect of estrogen therapy. For example, in monkeys estrogen prevents the accumulation of low-density lipoprotein (LDL) cholesterol (a known risk factor for heart disease) in coronary arteries, and estrogen has also been shown to increase high-density lipoprotein (HDL) cholesterol (a known cardioprotective factor). Estrogen also possesses a vasodilating property, which can improve cardiac performance in ischemic heart disease. In addition, recent studies have demonstrated that estrogens (especially equilin) exhibit a high antioxidant effect, which may also be related to cardioprotectivity. Although estrogen therapy has been observed to decrease the risk of coronary disease, long-term estrogen therapy has also been found to increase the risk of uterine carcinoma; the addition of progesterone to estrogen therapy may lessen this undesirable risk, however. On the other hand the addition of progesterone to estrogen therapy may decrease estrogen's beneficial effect on HDL cholesterol. What should be the present position on estrogen therapy in postmenopausal women? What is the best dosage regimen? Should it be used alone or in combination with a progesterone? These important issues are discussed, as are several current clinical trials addressing the issue of estrogen therapy in postmenopausal women.
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PMID:Benefit/risk of estrogen therapy in cardiovascular disease: current knowledge and future challenges. 853 Jul 12


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