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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

185 cases of pregnancy in cardiac patients followed since 1965 included 48 therapeutic abortions, 20% premature deliveries, 36 Caesarean sections, and 101 vaginal deliveries. Abortions, done by dilatation and curettage or hysterotomy, usually with tubal ligation, were performed in class III or IV cardiopathies (inoperable or relapses) and in those with decompensation in first trimester or in previous pregnancies. 10 women were operated by closed heart technique during pregnancy, usually mitral valvotomy procedures. Treatments during pregnancy included bed rest, hospitalization 2 weeks before term, low salt diet, diuretics, digitalis, calcium heparin, sedatives, and antibiotics. Prognosis depends on severity and nature of the cardiopathy, age, parity, obstetric history, and the patient's ability to follow instructions. Deliveries were originally done by Caesarean section if sterilization was planned, but recently tubal ligation is done within 2 months postpartum. 55% of the vaginal deliveries were by forceps under local anesthesia; 40% by natural chiildbirth. 4 neonates died, and 36 were premature or dysmature. Lactation was suppressed by ethinyl estradiol in almost all patients.
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PMID:[Cardiac disease and pregnancy. 2. Pregnancy in the cardiac patient. 185 cases studied at the Boucicaut maternity hospital]. 100 Sep 14

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

The forms of administration, mechanisms of action, side effects and complications, and other aspects of female hormonal contraception are set forth in this "lesson" for medical students. Female hormonal contraception has been in use for over 30 years and is used by more than 150 million women worldwide. Oral contraceptives suppress the preovulatory peak of follicle stimulating hormone and luteinizing hormone, preventing ovulation and follicular maturation. Progestins render the cervical mucus impermeable to sperm and modify the endometrium so that it will no longer support implantation. The synthetic estrogen ethinyl estradiol is used in most combined oral contraceptives (OCs). Among the numerous progestins in use are the newer desogestrel, gestodene, and norgestimate, which have fewer androgenic and metabolic effects than did the 1st generation. the different forms of administration of hormonal methods include combined OCs, oral preparations containing low doses of progestin continuously administered or high doses continuously or discontinuously administered. Intramuscular injection of progestins and the so-called "morning after" postcoital pills are less often prescribed. The combined preparations may be monophasic, biphasic, triphasic, or sequential. Sequential preparations should be avoided because of the hyperestrogenic climate they induce. The low-dose progestin preparations are indicated for women with contraindications to synthetic estrogen. They must be taken at the same time each day and have a relatively high rate of side effects, especially ovarian and breast cysts and irregular bleeding. High-dose progestin preparations have significant metabolic effects and are indicated primarily for patients with gynecological problems such as fibromas and endometriosis. Intramuscular injection of medroxyprogesterone acetate every 3 months is effective but has the same side effects as high-dose progestins. It is indicated primarily for patients unable to control their own behavior. The hormonal methods are all highly effective in preventing pregnancy when correctly administered. Side effects may be minor problems, such as nervousness and nausea, that are usually of short duration. the more serious side effects, including modifications of lipid or carbohydrate metabolism, hemostasis, blood pressure, or hepatic functioning and cardiovascular effects, have been reduced with the new lower dosed formulations. Absolute contraindications to hormonal contraception include undiagnosed vaginal bleeding or amenorrhea, history of thromboembolic or cerebral vascular accidents, severe cardiopathy or hypertension, hyperlipidemia, hepatopathy, hormonodependent cancer, pituitary tumors, porphyria, and severe mental problems. Relative contraindications impose the need for careful monitoring and follow-up. The practitioner should be aware of the possibility of interactions between OCs and certain other drugs.
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PMID:[Hormonal contraception]. 160 74

Changes in blood pressure were measured at three-monthly intervals over one year in a prospective study of 704 women using an oral contraceptive (OC) containing levonorgestrel 250 ug with ethinyl estradiol 50 ug and 703 women using an intrauterine device (IUD). The study was conducted in 11 centres in seven developing and three developed countries. Women using OC developed systolic blood pressures which were 3.6-5.0 mmHg higher than those using IUDs; their diastolic pressures became 1.9-2.7 mm higher. The OC-induced change was not affected by climate, age, a family history of hypertension, stroke or heart disease or by a history of hypertension in pregnancy. The life-table rate of hypertension (BP 140/90 or more) in the first year of OC treatment was 0.6 +/- 0.4 in the developing countries and 1.1 +/- 0.8 in the developed ones, per 100 woman-years of use. The vasopressor response to OC varied widely between centres but was not obviously related to the economic development of the country.
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PMID:The WHO multicentre trial of the vasopressor effects of combined oral contraceptives: 1. Comparisons with IUD. Task Force on Oral Contraceptives. WHO Special Programme of Research, Development and Research Training in Human Reproduction. 250 94

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

The effects of oral contraceptives and estrogen replacement drugs on blood lipids that affect cardiovascular disease (atherogenic effects) are reviewed by comparing their androgenicity and progestin potency. Although early oral contraceptives with high doses of estrogen were indicted for increasing risk of thromboembolic disorders and heart attacks, today's pills low in estrogen still bear the same risk for cardiovascular events. A brief explanation of the lipoproteins is presented, emphasizing the importance of High Density Lipoprotein (HDL) in protecting against heart disease and stroke. Menstruating women have naturally high HDL. The estrogen in oral contraceptives and postmenopausal estrogen replacements increases HDL as much as 30%, while decreasing LDL, the component carrying most of the cholesterol. It seems that the progestin in oral contraceptives will lower HDL, and studies show that this action is related to androgenicity and dose of the progestin. Progestins such as levonorgestrel and norgestrel are more androgenic, while norethynodrel, ethynodiol diacetate and norethindrone are less so. When used in combination with estrogens, progestins are less androgenic, but when used alone, the androgenic and atherogenic effects dominate. The lower the estrogen dose in the combination, say around 20-35 mcg ethinyl estradiol, the more atherogenic the progestin. These actions are confirmed theoretically by measurements of sex hormone binding globulin, a blood protein that reflects estrogen activity, as well as by epidemiologic studies in Sweden and Great Britain, where rates of heart attack and stroke in pill users remain as high as they were when pills contained high doses of estrogen.
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PMID:Low-dose oral contraceptives: progestin potency, androgenicity, and atherogenic potential. 353 47

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


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