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Is Cardiac Diastolic Dysfunction a Part of Post-Menopausal Syndrome?
Maslov, PZ, Kim, JK, Argulian, E, Ahmadi, A, Narula, N, Singh, M, Bax, J, Narula, J
JACC. Heart failure. 2019;(3):192-203
Abstract
Post-menopausal women exhibit an exponential increase in the incidence of heart failure with preserved ejection fraction compared with men of the same age, which indicates a potential role of hormonal changes in subclinical and clinical diastolic dysfunction. This paper reviews the preclinical evidence that demonstrates the involvement of estrogen in many regulatory molecular pathways of cardiac diastolic function and the clinical data that investigates the effect of estrogen on diastolic function in post-menopausal women. Published reports show that estrogen deficiency influences both early diastolic relaxation via calcium homeostasis and the late diastolic compliance associated with cardiac hypertrophy and fibrosis. Because of the high risk of diastolic dysfunction and heart failure with preserved ejection fraction in post-menopausal women and the positive effects of estrogen on preserving cardiac function, further clinical studies are needed to clarify the role of endogenous estrogen or hormone replacement in mitigating the onset and progression of heart failure with preserved ejection fraction in women.
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Cortical Bone Material Strength Index and Bone Microarchitecture in Postmenopausal Women With Atypical Femoral Fractures.
Popp, KL, Caksa, S, Martinez-Betancourt, A, Yuan, A, Tsai, J, Yu, EW, Bouxsein, ML
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2019;(1):75-82
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Abstract
Atypical femoral fractures are rare fractures that occur in the subtrochanteric or diaphyseal region of the femur with minimal or no trauma. Though the association of atypical femoral fractures (AFFs) and bisphosphonate (BP) use is a growing concern in the management of osteoporosis, currently there is little knowledge about which patients may be at risk for an atypical femoral fracture. Given that these fractures initiate in the femoral cortex, we aimed to determine whether cortical bone tissue properties (bone material strength index; BMSi), as measured by in vivo impact microindentation, are altered in atypical fracture patients. We also aimed to identify factors associated with the BMSi measurements. We enrolled postmenopausal women with recent AFFs (n = 15) or hip fractures (Hip Fxs; n = 20), long-term (>5 years) BP users (n = 30), and treatment naïve controls (n = 88). We measured total hip and femoral neck BMD by DXA, cortical bone microstructure at the distal tibia by HR-pQCT, and BMSi at the midtibia by impact microindentation. BMSi values were similar in all groups, with no effects of long-term BP use or lower values in patients with AFFs or Hip Fxs, even after multivariable adjustment. BMSi measurements were independent of age, femoral BMD, duration of BP treatment, vitamin D level, and cortical bone microstructure, including cortical porosity and cortical tissue mineral density. In conclusion, impact microindentation values are not negatively affected by long-term BP use and do not appear to discriminate individuals who suffer AFFs. Thus, our results do not support clinical use of impact microindentation to identify those at risk for AFFs. This remains to be verified in larger studies. © 2018 American Society for Bone and Mineral Research.
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Effectiveness of Genistein Supplementation on Metabolic Factors and Antioxidant Status in Postmenopausal Women With Type 2 Diabetes Mellitus.
Braxas, H, Rafraf, M, Karimi Hasanabad, S, Asghari Jafarabadi, M
Canadian journal of diabetes. 2019;(7):490-497
Abstract
OBJECTIVES The risk of type 2 diabetes mellitus (T2DM) increases in women after menopause. Genistein is known to modulate metabolic pathways. The aim of this study was to investigate the effects of genistein supplementation on metabolic parameters, oxidative stress and obesity values in postmenopausal women with T2DM. METHODS This randomized, double-blind, placebo-controlled clinical trial was conducted on 54 postmenopausal women 47 to 69 years of age with T2DM. The genistein group (n=28) was given 2 genistein capsules daily for 12 weeks. Each capsule contained 54 mg genistein. The placebo group (n=26) received 2 placebo capsules daily for the same period. Fasting blood samples, anthropometric measurements, dietary intakes and physical activity levels of subjects were collected at baseline and at the end of the trial. Data were analyzed by independent t test, paired t test and analysis of covariance. RESULTS Genistein supplementation significantly reduced serum levels of fasting blood glucose (FBS), glycated hemoglobin (A1C), serum triglyceride (TG) and malondialdehyde (MDA) and increased total antioxidant capacity (TAC) compared with the placebo group at the end of the study (p<0.05 for all). Serum high-density lipoprotein cholesterol and quantitative insulin sensitivity check index significantly increased within the genistein group. Changes in anthropometric indexes and other variables were not significant in any of the groups. CONCLUSIONS Genistein administration improved FBS, A1C, serum TG, TAC and MDA in postmenopausal women with T2DM and may be useful in the control of metabolic status and oxidative stress in these subjects.
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The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial.
Eatemadnia, A, Ansari, S, Abedi, P, Najar, S
Complementary therapies in medicine. 2019;:109-113
Abstract
OBJECTIVES Hypericum perforatum (St John's wort) is an herbal plant that has antidepressant activity and contains ingredients such as flavonols derivatives, bioflavonoids, proanthocyanidins, xanthones, phloroglucinol, and naphthodianthrones. This study was aimed to test the effect of Hypericum perforatum on hot flashes, menopausal symptoms, and depression in postmenopausal women. DESIGN & SETTING This randomized controlled study was conducted on 80 postmenopausal women aged 45-60 in Izeh, Iran. INTERVENTION Two groups received 270-330 μg of H. perforatum (n = 40) or placebo (n = 40) tablets three times a day for two months. MAIN OUTCOMES Data were collected using a socio-demographic questionnaire, the modified Kupperman index before the intervention and 2, 4, 6 and 8 weeks after intervention. The Hamilton Depression Rating Scale was used to gather data before the intervention and in the 8th week of intervention. The data were analyzed using an independent t-test, chi-square test, and repeated measure test. RESULTS Seventy women completed the study and five women from each group withdrew the study. The frequency and intensity of hot flashes and the score of Kupperman scale significantly decreased in the H. perforatum group compared to the control group (p < 0.001). In addition, the intensity of depression significantly decreased in the H. perforatum group compared to the control group. At the end of the study, 80% of women in the intervention group did not have depression compared to only 5.7% in the control group (p < 0.001). CONCLUSION Treatment with Hypericum perforatum is an efficient way of reducing hot flashes, menopausal symptoms, and depression in postmenopausal women.
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Arriba por la Vida Estudio (AVE): Study protocol for a standing intervention targeting postmenopausal Latinas.
Takemoto, M, Schechtman, M, Villa, N, Talavera, G, Sears, DD, Natarajan, L, Owen, N, Rosenberg, DE, Dunstan, D, Allison, M, et al
Contemporary clinical trials. 2019;:66-72
Abstract
BACKGROUND Postmenopausal Latinas are a growing population group in the US who are at high risk for cardiovascular disease. Epidemiological studies have shown that excessive sitting is related to cardiovascular disease risk. Older women sit for prolonged periods and most individuals do not meet physical activity guidelines. Reducing sitting through increased standing may improve cardiovascular risk. More research is needed on how to intervene to increase standing in older Latinas. OBJECTIVE To describe the protocol for a randomized controlled trial to increase standing in postmenopausal Latinas: the Arriba por la Vida Estudio (AVE). DESIGN/METHODS Postmenopausal Latinas will be randomized to one of two study arms: an increase standing intervention or a heart healthy attention-comparison condition. A total of 250 overweight postmenopausal Latinas will be recruited and followed for 12weeks. AVE is based on various models of behavior change including strategies such as self-monitoring, goal setting, and habit formation. Participants will receive three in-personhealth-counseling sessions (including one in-home visit) and five follow-up telephone calls using motivational interviewing techniques. Those in the attention-comparison condition will receive an equal number of contacts as the standing intervention with topics focused on healthy aging. The primary outcome is objectively-measured sitting time over three months measured via thigh-worn inclinometers and secondary outcomes include blood pressure, physical functioning and glucoregulatory and lipid biomarkers. CONCLUSIONS The findings from this study will provide valuable information about effective approaches to increase standing time in postmenopausal Latinas and its impact on cardiovascular disease risk. TRIAL REGISTRATION This study is registered at clincialtrials.gov Identifier: NCT02905929.
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An Association Between Large Optic Nerve Cupping and Cognitive Function.
Vajaranant, TS, Hallak, J, Espeland, MA, Pasquale, LR, Klein, BE, Meuer, SM, Rapp, SR, Haan, MN, Maki, PM
American journal of ophthalmology. 2019;:40-47
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Abstract
PURPOSE To determine if a larger cup-to-disc ratio is associated with poor cognitive function in postmenopausal women without glaucoma or ocular hypertension. METHODS We used data from the Women's Health Initiative (WHI) hormone trial, originally designed to test effects of hormone therapy (HT) on various health outcomes. Large cup-to-disc ratio was defined as greater than 0.6 in either eye based on stereoscopic optic nerve photographs. Global cognitive function was assessed annually by Modified Mini-Mental State Examination (3MSE) in the WHI Memory Study. Exclusions were no information on optic nerve grading; no 3MSE scores at the time of the eye examination, ocular hypertension (intraocular pressure >23 mm Hg, Goldmann applanation tonometry), or glaucoma medication use. A generalized linear model for log-transformed 3MSE scores was used for determining the association between large cup-to-disc ratio and 3MSE scores, adjusting for age, race, diabetes, body mass index, cardiovascular disease, smoking, HT randomization, education, and diabetic retinopathy. RESULTS Analyses included 1636 women (mean age ± standard deviation, 69.57 ± 3.64 years; 90.39% white). Of those, 122 women had large cup-to-disc ratio. The mean 3MSE scores in women with vs without large cup-to-disc ratio were 95.4 ± 6 vs 96.6 ± 5. In the adjusted model, women with large cup-to-disc ratio had statistically significantly lower 3MSE scores, compared with those without large cup-to-disc ratio, yielding the predicted mean difference in 3MSE scores of 0.75 with a standard error of 0.05 units (P = .04). CONCLUSIONS Postmenopausal women who had large cup-to-disc ratio without glaucoma or ocular hypertension exhibited lower global cognitive function. Further investigation is warranted. NOTE Publication of this article is sponsored by the American Ophthalmological Society.
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Eating behaviors and weight loss outcomes in a 12-month randomized trial of diet and/or exercise intervention in postmenopausal women.
Mason, C, de Dieu Tapsoba, J, Duggan, C, Wang, CY, Alfano, CM, McTiernan, A
The international journal of behavioral nutrition and physical activity. 2019;(1):113
Abstract
BACKGROUND Certain eating behaviors are common among women with obesity. Whether these behaviors influence outcomes in weight loss programs, and whether such programs affect eating behaviors, is unclear. METHODS Our aim was to examine the effect of baseline eating behaviors on intervention adherence and weight among postmenopausal women with overweight or obesity, and to assess intervention effects on eating behaviors. Four hundred and 39 women (BMI ≥25 kg/m2) were randomized to 12 months of: i) dietary weight loss with a 10% weight loss goal ('diet'; n = 118); ii) moderate-to-vigorous intensity aerobic exercise for 225 mins/week ('exercise'; n = 117); iii) combined dietary weight loss and exercise ('diet + exercise'; n = 117); or iv) no-lifestyle change control (n = 87). At baseline and 12 months, restrained eating, uncontrolled eating, emotional eating and binge eating were measured by questionnaire; weight and body composition were assessed. The mean change in eating behavior scores and weight between baseline and 12 months in the diet, exercise, and diet + exercise arms were each compared to controls using the generalized estimating equation (GEE) modification of linear regression adjusted for age, baseline BMI, and race/ethnicity. RESULTS Baseline restrained eating was positively associated with change in total calories and calories from fat during the dietary intervention but not with other measures of adherence. Higher baseline restrained eating was associated with greater 12-month reductions in weight, waist circumference, body fat and lean mass. Women randomized to dietary intervention had significant reductions in binge eating (- 23.7%, p = 0.005 vs. control), uncontrolled eating (- 24.3%, p < 0.001 vs. control), and emotional eating (- 31.7%, p < 0.001 vs. control) scores, and a significant increase in restrained eating (+ 60.6%, p < 0.001 vs. control); women randomized to diet + exercise reported less uncontrolled eating (- 26.0%, p < 0.001 vs. control) and emotional eating (- 22.0%, p = 0.004 vs. control), and increased restrained eating (+ 41.4%, p < 0.001 vs. control). Women randomized to exercise alone had no significant change in eating behavior scores compared to controls. CONCLUSIONS A dietary weight loss intervention helped women modify eating behaviors. Future research should investigate optimal behavioral weight loss interventions for women with both disordered eating and obesity. TRIAL REGISTRATION NCT00470119 (https://clinicaltrials.gov). Retrospectively registered May 7, 2007.
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Lipid profile differences during menopause: a review with meta-analysis.
Ambikairajah, A, Walsh, E, Cherbuin, N
Menopause (New York, N.Y.). 2019;(11):1327-1333
Abstract
OBJECTIVES The aim of the study was to determine lipid profile differences between premenopausal and postmenopausal women. METHODS The present review used a meta-analytic approach. Sixty-six studies were included, which provided a total sample of 114,655 women consisting of 68,394 that were premenopausal and 46,261 that were postmenopausal. RESULTS The main findings were that (1) lipoproteins were significantly higher in postmenopausal women compared to premenopausal women including triglycerides (0.27 mmol/L, 95% confidence interval, 0.22-0.31), total cholesterol (0.58, 0.50-0.65), low-density lipoprotein (0.45, 0.38-0.53), and total cholesterol to high-density lipoprotein levels (0.39, 0.16-0.62); (2) there was no difference in high-density lipoprotein levels between premenopausal and postmenopausal women (0.02, -0.00-0.04); and (3) the differences in lipid levels was partly attributable to the mean age difference between premenopausal and postmenopausal women. CONCLUSIONS These findings are important as they provide precise estimates of lipid differences in women around menopause. Furthermore the results suggest that the unfavorable lipid profile that develops in postmenopausal women puts them at higher risk of cardiovascular disease such as heart disease and stroke if appropriate lifestyle/pharmacological interventions are not implemented.
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Treatment to External Labia and Vaginal Canal With CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women.
Samuels, JB, Garcia, MA
Aesthetic surgery journal. 2019;(1):83-93
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Abstract
BACKGROUND Increasingly, women have sought alternatives to traditional options (lubricants, estrogen products, and hormone replacement therapy) for unwelcome vaginal changes of menopause. OBJECTIVES This study evaluated whether a series of three monthly fractional CO2 laser treatments significantly improves and maintains vaginal health indices of elasticity, fluid volume, pH level, epithelial integrity, and moisture. Self-reported symptoms of vaginal atrophy were also measured. Biopsy samples after a series of three treatments were evaluated for histological changes to vaginal canal tissue. METHODS Forty postmenopausal women were treated extravaginally and internally with a fractional CO2 laser. Objective measurements of vaginal health index, as well as subjective measurements of symptoms of vulvovaginal atrophy (VVA), urinary incontinence, and sexual function were reported at baseline. Follow-up evaluations were at one, three, six, and 12 months after the third treatment. RESULTS Vaginal health index improved significantly after the first treatment and was maintained with mean improvement of 9.6 ± 3.3 (P < 0.001) and 9.5 ± 3.3 (P < 0.001) at the 6- and 12-month follow ups, respectively. Vaginal symptoms of dryness, itching, and dyspareunia improved significantly (P < 0.05) at all evaluations. Histological findings showed increased collagen and elastin staining, as well as a thicker epithelium with an increased number of cell layers and a better degree of surface maturation. CONCLUSIONS Fractional CO2 laser treatments were well tolerated and were associated with improvement in vaginal health and amelioration of symptoms of VVA. Histological changes in the epithelium and lamina propria, caused by fractional CO2 laser treatments, correlated with clinical restoration of vaginal hydration and pH to premenopausal levels.
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The effect of a randomized 12-week soy drink intervention on everyday mood in postmenopausal women.
Simpson, EEA, Furlong, ON, Parr, HJ, Hodge, SJ, Slevin, MM, McSorley, EM, McCormack, JM, McConville, C, Magee, PJ
Menopause (New York, N.Y.). 2019;(8):867-873
Abstract
OBJECTIVE Dietary soy may improve menopausal symptoms, and subsequently mediate mood. This novel study examines various doses of dietary soy drink on everyday mood stability and variability in postmenopausal women. METHODS Community-dwelling women (n = 101), within 7 years postmenopause, consumed daily either a low (10 mg, n = 35), medium (35 mg, n = 37), or high (60 mg, n = 29) dose of isoflavones, for 12 weeks. Menopausal symptoms and repeated measures of everyday mood (positive [PA] and negative [NA] affect) (assessed at four time points per day for 4 consecutive days, using The Positive and Negative Affect Schedule) were completed at baseline and follow-up. RESULTS The dietary soy intervention had no effect on everyday mood stability (for PA [F{2,70} = 0.95, P = 0.390] and NA [F{2,70} = 0.72, P = 0.489]) or variability (for PA [F{2,70} = 0.21, P = 0.807] and for NA [F{2,70} = 0.15, P = 0.864]), or on menopausal symptoms (for vasomotor [F{2,89} = 2.83, P = 0.064], psychological [F{2,88} = 0.63, P = 0.535], somatic [F{2,89} = 0.32, P = 0.729], and total menopausal symptoms [F{2,86} = 0.79, P = 0.458]). There were between-group differences with the medium dose reporting higher PA (low, mean 24.2, SD 6; and medium, mean 29.7, SD 6) and the low dose reporting higher NA (P = 0. 048) (low, mean 11.6, SD 2; and high, mean 10.6, SD 1) in mood scores. Psychological (baseline M = 18 and follow-up M = 16.5) and vasomotor (baseline M = 4.2 and follow-up M = 3.6) scores declined from baseline to follow-up for the overall sample. CONCLUSIONS Soy isoflavones had no effect on mood at any of the doses tested. Future research should focus on the menopause transition from peri to postmenopause as there may be a window of vulnerability, with fluctuating hormones and increased symptoms which may affect mood.