Biomedical subjects

D Kritz-Silverstein

Publications and source records attributed to D Kritz-Silverstein.

At least 19 recordsLinked to original sources

PubMed2001

Cross-sectional and prospective study of exercise and depressed mood in the elderly : the Rancho Bernardo study.

This study examined cross-sectional and prospective associations of exercise with depressed mood in a community-based sample of older men and women (aged 50--89 years in 1984--1987) in southern California. Regular strenuous exercise and exercise > or =3 times per week were reported; depressed mood was assessed by using the Beck Depression Inventory (BDI). After exclusion of persons with categorical depression and those rating themselves largely or extremely physically limited during the previous month, data on 932 men and 1,097 women were available for cross-sectional analysis. Exercise and depressed mood were reassessed for 404 men and 540 women in 1992--1995; these data were the focus of prospective analyses. In 1984--1987, exercise rates were high (>80%), and average BDI scores were low. Cross-sectional analyses indicated that before and after adjustment for covariates, exercise was significantly associated with less depressed mood. However, prospective analyses of the 944 persons who attended both clinic visits indicated no association between baseline exercise and either follow-up BDI score (p > 0.10) or change in BDI score between baseline and follow-up (p > 0.10). Results confirm that exercisers have less depressed mood. However, exercise does not protect against future depressed mood for those not clinically depressed at baseline.

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PubMed2001

Cumulative duration of breast-feeding influences cortisol levels in postmenopausal women.

Cortisol levels dramatically increase during pregnancy, peak at birth, and subsequently decline. However, all previous studies examined women during pregnancy and early postpartum. None examined the long-term association of parity and lactation with cortisol levels. We examined the relation of reproductive history to cortisol levels in postmenopausal women. Subjects were 749 women, aged 50-89, who were not using estrogen in 1984-1987 when morning cortisol was measured. Parity was not significantly associated with cortisol. However, women who breast-fed for >12 months had significantly higher cortisol levels than women who breast-fed for shorter durations or not at all (p = 0.003). This association was stronger among women with three or more births. Duration of breast-feeding is a determinant of cortisol levels in postmenopausal women. Because both increased cortisol and increased duration of breast-feeding may play protective roles in certain autoimmune diseases, such as rheumatoid arthritis, we suggest that the beneficial effect of lactation on the course of these diseases may be mediated by cortisol.

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PubMed2001

Usual dietary isoflavone intake is associated with cardiovascular disease risk factors in postmenopausal women.

Intervention data suggest a cardioprotective role for supplemental isoflavones; however, few studies have examined the cardiovascular disease (CVD) benefit of usual dietary isoflavone intake. This cross-sectional study examined the association between usual dietary isoflavone intake and CVD risk factors, including lipids and lipoproteins, body mass index (BMI) and fat distribution, blood pressure, glucose and insulin. Subjects were postmenopausal women (n = 208) aged 45-74 y, who attended screening and baseline visits for a randomized, double-blind, placebo-controlled trial examining the effects of isoflavone use. At screening, total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were measured, and demographic, behavioral and menopausal characteristics were assessed. One month later, dietary intake over the past year was assessed with a standardized questionnaire. Anthropometric measurements and blood pressure were obtained, and a 75-g oral glucose tolerance test was administered. Isoflavone consumption did not vary by age, exercise, smoking, education or years postmenopausal. Women with high genistein intake had a significantly lower BMI (P-trend = 0.05), waist circumference (P-trend = 0.05) and fasting insulin (P-trend = 0.07) than those with no daily genistein consumption. In adjusted analyses, genistein, daidzein and total isoflavone intake were each positively associated with HDL cholesterol (P = 0.05) and inversely associated with postchallenge insulin (P = 0.05). These data suggest a protective role for dietary soy intake against CVD in postmenopausal women.

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PubMed2000

Vasomotor symptoms are not associated with reduced bone mass in postmenopausal women: the Rancho Bernardo Study.

The association of menopause-related vasomotor symptoms with later bone mineral density (BMD) at axial and appendicular sites was examined in community-dwelling older women. Subjects were 894 postmenopausal women from the Rancho Bernardo Study who had BMD measured in 1988-1991 and responded to a 1989 mailed survey that included questions about menopause symptoms. Mean age was 73 years (SE +/- 9.5, range 47-97), and mean age at menopause was 47 years (SD +/- 6.8, range 21-62). Vasomotor symptoms were recalled by two thirds (68%) and night sweats by 36% of all women, with no significant differences in symptom frequency by age or type of menopause. Postmenopausal estrogen (PME) had been used by 644 women (72%) for an average duration of 12.3 (+/-11) years. Among women who reported current estrogen use with a duration >3 years, those who experienced vasomotor symptoms had significantly higher BMD at the lumbar spine (p = 0.01), femoral neck (p = 0.05) and midshaft radius (p = 0.05) compared with women who did not experience symptoms. Vasomotor symptoms were not associated with BMD among past or never PME users or among women who reported current PME use for 3 or fewer years. Analyses stratified by age, type of menopause, or when PME use began showed similar results. Women who reported night sweats also had no difference in BMD compared with women without night sweats. In conclusion, vasomotor symptoms are not a marker for low BMD years after menopause in women with access to healthcare. Vasomotor symptoms significantly increased the likelihood of continued use of PME, which was in turn associated with higher BMD levels.

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PubMed2000

Prevalence and clustering of menopausal symptoms in older women by hysterectomy and oophorectomy status.

This study examines the association of hysterectomy and oophorectomy with the prevalence and clustering of menopausal symptoms in a large population-based sample of older women. Subjects were 1121 women aged 50-89 from the Rancho Bernardo Study. Information on menopause, hysterectomy, oophorectomy, estrogen use, and other covariates was obtained in 1984-1987. A 1989 mailed survey obtained information on menopausal symptoms. In this sample, 22.1% reported hysterectomy with bilateral oophorectomy, and 25.3% reported hysterectomy with ovarian conservation. Mean time since hysterectomy was 26 (+/-12) years. Overall, 37% reported current estrogen use, and 40% reported past use. The duration of estrogen use was longer for women who had a hysterectomy (p < 0.001). Age-adjusted comparisons indicated that more women who had a hysterectomy, with or without bilateral oophorectomy, reported greater energy after menopause (p = 0.003 and p = 0.001, respectively), and more women with bilateral oophorectomy reported greater interest in sex (p = 0.007) and that life was getting better (p = 0.012) than women with natural menopause. Principal components factor analysis of the symptom data for all women yielded four factors: psychological, vasomotor, positive feelings, and self-image. Analyses performed within each group of women yielded similar factors and loadings. Adjusted comparisons of factor scores indicated that positive feelings were significantly higher in women who had a hysterectomy, with or without bilateral oophorectomy (p < 0.01) than in women with natural menopause. This difference was limited to current estrogen users. Vasomotor symptoms, psychological symptoms, and negative self-image did not differ by hysterectomy or oophorectomy status before or after stratification for estrogen use (p > 0.10). This study found after a hysterectomy, women are more likely to recall positive feelings about their menopause than women with natural menopause. Relief from symptoms leading to hysterectomy and use of replacement estrogen may be partly responsible. Results do not support the thesis that surgical menopause is associated with a sustained increased prevalence of vasomotor, psychological, or other symptoms.

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PubMed2000

Higher basal cortisol predicts verbal memory loss in postmenopausal women: Rancho Bernardo Study.

BACKGROUND: In animals, higher endogenous or exogenous corticosteroids cause neuronal dysfunction, damage, and loss, especially in the hippocampus. In humans, high cortisol levels have been linked to memory impairment. OBJECTIVE: To prospectively examine the relation between morning basal cortisol level and change in cognitive performance during an average follow-up of 2 years. DESIGN: Longitudinal cohort. SETTING: Geographic community in southern California. MEASUREMENTS: Between 1984 and 1987, blood for basal morning cortisol was obtained along with pertinent medical, behavioral, and physical covariates from 749 post-menopausal women, mean age 72 years, who were not taking corticosteroids or postmenopausal hormones. Cognitive function was assessed in 502 women in the period from 1988 to 1991 and repeated in 136 women in the period from 1991 to 1993. RESULTS: In both age- and multiply adjusted linear regression models, higher baseline cortisol was a significant predictor of worsened category fluency. No other cognitive domain tested was related to cortisol. CONCLUSIONS: These results support the hypothesis that subtle dysregulation of cortisol axis is related to memory loss. Interventions that block this pathway may provide new therapeutic options to prevent cognitive decline.

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PubMed2000

Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study.

This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in community-dwelling postmenopausal women who were not using estrogen replacement therapy. Six hundred and eighty-four women, aged 50-89 yr, were surveyed for hysterectomy and oophorectomy status and had plasma obtained between 1984-1987. Of these, 438 (67%) had not undergone hysterectomy or oophorectomy (intact), 123 (18%) reported hysterectomy with bilateral oophorectomy, and 123 (18%) reported hysterectomy with conservation of 1 or both ovaries. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% (P < 0.001) in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with ovarian conservation. Androstenedione levels were about 10% lower in hysterectomized women with or without ovarian conservation compared to those in intact women (P = 0.039). Total estradiol levels tended to be lower (P = 0.095) in bilaterally oophorectomized women. Levels of bioavailable estradiol, estrone, and SHBG did not differ by hysterectomy and oophorectomy status. Among intact women, total, but not bioavailable, testosterone levels increased with age (P = 0.015), reaching premenopausal levels for the 70-79 decade with relatively stable levels thereafter. Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr age range. Androstenedione levels decreased 27% and SHBG levels increased 30% (P < 0.001) with age in intact, but not oophorectomized, women. Levels of other hormones did not vary with age. Stratification by years since menopause or surgery yielded similar results. These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women. The clinical consequences of lower testosterone levels years after oophorectomy are unknown. Reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed.

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PubMed1999

The association of behavior and lifestyle factors with menstrual symptoms.

The present study examines the association of obesity, cigarette smoking, alcohol consumption, and exercise with the prevalence of menstrual cycle disorders among 2912 women aboard U.S. Navy ships. Self-administered surveys obtained information on weight, height, cigarette smoking, alcohol consumption, and exercise. Participants also indicated whether they experienced cramps or pain during their period requiring medication or time off work, bleeding between periods, excessive frequency of periods, heavy periods, periods lasting for longer than a week, scanty menstrual flow, and irregular periods during the past 90 days. Women ranged in age from 18 to 49 years, with an average of 26 years. After adjustment for age, race, and pay grade, current cigarette smoking was associated with increased risk of all menstrual symptoms and cycle disorders. As compared with nonsmokers, current smokers were at increased risk of cramps or pain requiring medication or time off work (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.03, 1.25), bleeding between periods (OR = 1.22, CI = 1.09, 1.38), excessive frequency of periods (OR = 1.33, CI = 1.17, 1.51), heavy periods (OR = 1.17, CI = 1.06, 1.29), periods lasting longer than a week (OR = 1.31, CI = 1.16, 1.48), scanty flow (OR = 1.13, CI = 1.01, 1.29), and irregular periods (OR = 1.14, CI = 1.05, 1.24). Obesity, exercise, and alcohol consumption did not show consistent associations with menstrual symptoms or cycle disorders. Logistic regression models that included age, race, pay grade, and all behavioral and lifestyle variables indicated only cigarette smoking was associated with an increased risk of bleeding between periods (OR = 1.33, CI = 1.05, 1.68), excessive frequency of periods (OR = 1.38, CI = 1.21, 1.58), periods lasting longer than a week (OR = 1.45, CI = 1.13, 1.84), and irregular periods (OR = 1.25, CI = 1.05, 1.47). Although the lifestyle factors are all potentially modifiable, results suggest that only interventions targeted at smoking cessation might be useful in reducing the prevalence of menstrual symptoms, cycle disorders, and time lost from work.

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PubMed1999

Gender differences in cognitive function with age: the Rancho Bernardo study.

BACKGROUND: Estrogen deficiency has been proposed as a cause of memory loss in postmenopausal women. If true, men should have less memory loss with age than women. The present study is designed to examine the postulated effect of estrogen on memory by studying the effect of gender on the age-related decline in cognitive function. METHODS: Cross-sectional study of 800 women and 551 men aged 65 to 95 years, members of the community-based Rancho Bernardo Study (begun in 1972 and 1974) who completed the Beck Depression Inventory in 1984-1987 and 12 standardized tests of cognitive function in 1988-1991. All participants were white, middle to upper-middle class, relatively well educated, and ambulatory. At all visits, use of estrogen therapy was ascertained and validated. RESULTS: Test performance worsened with age in both sexes, with similar patterns in men compared with women who were current, past, or never users of estrogen. Between-gender comparisons of the slope for age on each cognitive function test after adjustment for education, depressed mood, and estrogen use (in women) indicated that men had a significantly steeper decrement with age than women on the Buschke total recall and long-term memory tests (P <. 001), on the immediate and delayed recall tasks of the visual reproduction tests (P < .01 and .05, respectively), and on category fluency (P < .05). Similar results were obtained when gender comparisons included only women who had never used estrogen. CONCLUSION: These weak or absent gender differences in decline in cognitive function with age do not support the thesis that estrogen deficiency is associated with a decline in cognitive function in postmenopausal women.

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PubMed1999

Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study.

A cross-sectional population-based study examined the association between endogenous sex hormones and depressed mood in community-dwelling older men. Participants included 856 men, ages 50-89 yr, who attended a clinic visit between 1984-87. Total and bioavailable testosterone, total and bioavailable estradiol, and dihydrotestosterone levels were measured by radioimmunoassay in an endocrinology research laboratory. Depressed mood was assessed with the Beck Depression Inventory (BDI). Levels of bioavailable testosterone and bioavailable estradiol decreased with age, but total testosterone, dihydrotestosterone, and total estradiol did not. BDI scores increased with age. Low bioavailable testosterone levels and high BDI scores were associated with weight loss and lack of physical activity, but not with cigarette smoking or alcohol intake. By linear regression or quartile analysis the BDI score was significantly and inversely associated with bioavailable testosterone (both Ps = 0.007), independent of age, weight change, and physical activity; similar associations were seen for dihydrotestosterone (P = 0.048 and P = 0.09, respectively). Bioavailable testosterone levels were 17% lower for the 25 men with categorically defined depression than levels observed in all other men (P = 0.01). Neither total nor bioavailable estradiol was associated with depressed mood. These results suggest that testosterone treatment might improve depressed mood in older men who have low levels of bioavailable testosterone. A clinical trial is necessary to test this hypothesis.

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PubMed1998

Prospective association of smoking and alcohol use with cognitive function in an elderly cohort.

Cross-sectional studies of the associations of alcohol and tobacco use with cognitive function do not take into account behavior change after memory loss or differential survival. This prospective study examines the association of cigarette smoking and alcohol consumption at baseline with risk of poor cognitive function 13-18 years later. Between 1973 and 1975, 1469 relatively well-educated, noninstitutionalized men and women from Rancho Bernardo, California, answered standardized questions about smoking and alcohol consumption. Between 1988 and 1991, 511 of these men and women completed five standardized cognitive function tests. At baseline, 20.4% of the men and 23.0% of the women were cigarette smokers. Smoking was associated with increased mortality in men but not in women. In surviving male participants, cognitive function test scores did not significantly differ by baseline smoking status. Among female participants, smoking was associated with categorically defined poorer function on two of five tests. At baseline, 16% of the men and 29% of the women were nondrinkers. Drinking more than two drinks per day was associated with decreased mortality in both sexes. Among women, increasing consumption of alcohol predicted a significant decline in the long-term recall and savings scores of the visual reproduction test. Moderate drinking, approximately two drinks per day, predicted categorically defined poor performance on the Buschke long-term recall task in women. Alcohol consumption was not associated with cognitive function in men. Overall, the observed associations were weak, and no clear pattern was observed. Although there were some gender differences in observed associations and a survivor effect cannot be excluded, data from these healthy, educated, noninstitutionalized people offer no compelling evidence that social drinking or cigarette smoking causes or prevents impaired cognitive function in old age. The large number of comparisons and inconsistent results suggest that the few statistically significant findings may be spurious. Additional long-term prospective studies are needed to determine the generalizability of these findings to individuals in less healthy or less well-educated cohorts.

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PubMed1998

Prior oral contraceptive use is associated with higher blood pressure in older women.

Studies of young, premenopausal women suggest that changes in coronary risk factors do not persist after discontinuation of oral contraceptive use. However, little is known about longterm effects of past oral contraceptive use in older, postmenopausal women, who typically have a more atherogenic profile. This study examines the relation of past oral contraceptive use (including duration) to heart disease risk factors in postmenopausal women. Subjects were 517 women aged 50-69 from the Rancho Bernardo Study who attended follow-up clinic visits. Past oral contraceptive use was reported by 24.2% and two thirds had used oral contraceptives < or = 5 years. After adjustment for covariates, the only significant difference was that past users had higher diastolic blood pressures than never users (p < 0.01). Among older women, the diastolic blood pressure of past users was 3.9 mm Hg higher than that of never users (p < 0.01). Women who used oral contraceptives for < or = 5 years had diastolic blood pressures 3.6 mm Hg higher than those of never users (p < 0.01). No differences were found among younger women or those who used oral contraceptives > or = 6 years. Past oral contraceptive users may be at increased risk for heart disease because of a small but significant elevation in diastolic blood pressure that persists many years after discontinuing oral contraceptive use.

Age Factors↗

PubMed1998

Type A behavior pattern, heart disease risk factors, and estrogen replacement therapy in postmenopausal women: the Rancho Bernardo Study.

Cardiovascular disease is the leading cause of death among older American women. Estrogen replacement therapy (ERT) appears to reduce the risk of heart disease. For nearly five decades, the Type A behavior pattern (TABP) has been implicated in the cardiac morbidity and mortality of both men and women, but no studies have examined the use of replacement estrogen or whether its association with heart disease risk factors is different in Type A versus Type B women. We examined the effects of ERT and TABP on heart disease risk factors in a large population-based sample. Subjects were 1070 postmenopausal women, aged 50-89 years, who had been participants in the Rancho Bernardo Study. At a clinic visit made during 1984-1987, TABP was assessed with the Bortner Rating Scale, and heart disease risk factors (total cholesterol, high-density and low-density lipoprotein (HDL and LDL), triglycerides, fasting and postchallenge insulin and glucose, and blood pressure) were measured. Based on a median split (median = 154.0) of scores on the Bortner Rating Scale, 52% of these women were classified as Type A. Type A women were significantly younger than Rating women (mean = 68.4 versus 71.0 years, respectively). After adjustment for age, significantly more Type A than Type B women were on ERT (35% versus 24.7%, p = 0.001). Analyses stratified by TABP indicated that within the Type A group, current users of ERT had higher levels of HDL cholesterol (p) = 0.001) and lower levels of LDL cholesterol (p < 0.01), fasting plasma glucose (p < 0.001), and fasting insulin (p < 0.01). Among Type B women, current users of ERT had higher levels of HDL cholesterol (p = 0.07) and triglycerides (p < 0.01), lower levels of LDL cholesterol (p < 0.01), and lower systolic blood pressure (p < 0.05) but no significant differences in either fasting or postchallenge levels of either plasma glucose or serum insulin (each p < 0.01). Results of this study suggest that ERT may be associated with significant differences in the heart disease risk factor profile in Type A versus Type B women, and these differences may favor Type A women.

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PubMed1998

The association of non-insulin-dependent diabetes mellitus and cognitive function in an older cohort.

OBJECTIVE: In this study, we examined the association of non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) with cognitive function in a population-based sample of older individuals. RESEARCH DESIGN AND METHODS: Subjects were 1509 healthy, community-dwelling men and women aged 55 years and older who were participants in the Rancho Bernardo Study and attended clinic visits in 1984-87 and in 1988-91. An oral glucose tolerance test was administered during the 1984-87 visits. Based on World Health Organization criteria, participants were classified into those with NIDDM, IGT, or normal glucose tolerance. During the 1988-91 clinic visits, 12 tests of cognitive function were administered. RESULTS: Of the participants, 14.3% of the men and 9.9% of the women had NIDDM, and 21.0% of the men and 28.0% of the women had IGT. Multiple regression analysis was used to compare the cognitive function of individuals with NIDDM and IGT with individuals with normal glucose tolerance after adjustment for age, education, obesity, depression, blood pressure, and current estrogen use. In men, there were no statistically significant differences in any of the 12 cognitive function tests by glucose tolerance category. Compared with those with normal glucose tolerance, women with IGT had lower scores on almost every cognitive function test, whereas women with NIDDM had higher scores, but none of these differences were statistically significant after adjustment for multiple comparisons. Furthermore, observed differences by NIDDM or IGT status were small and accounted for < or = 0.6% of the explained variance in cognitive function. CONCLUSIONS: This study shows no strong or consistent association between IGT or mild diabetes with cognitive function in community-dwelling older adults.

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PubMed1998

Birth weight, adult weight, and girth as predictors of the metabolic syndrome in postmenopausal women: the Rancho Bernardo Study.

OBJECTIVE: Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia. These disorders tend to cluster in a condition known as the metabolic syndrome (syndrome X). Only two studies have reported an association of birth weight to the metabolic syndrome. The present study is distinguished as the only study to focus on postmenopausal women. RESEARCH DESIGN AND METHODS: Subjects were 303 community-dwelling, postmenopausal Caucasian women aged 50-84 years. Metabolic and anthropometric variables were measured at a clinic visit; birth weight was assessed by self-report on a mailed questionnaire. RESULTS: The metabolic syndrome, defined as the simultaneous presence of hypertension, dyslipidemia, and abnormal glucose tolerance, was present in 7.9% of these women. Compared with women in the highest birth weight tertile (8.1-13.0 lb, mean 9.4 lb), those in the lowest birth weight tertile (2.5-6.8 lb, mean 5.5 lb) exhibited an increased prevalence (12.0 vs. 4.3%, P < 0.05) and 2.41 times the risk (95% CI 1.06-5.51) of developing the metabolic syndrome. Women with a heavy birth weight had an increased risk of adult obesity. Nevertheless, women in the lowest birth weight tertile who became adults in the highest tertile of BMI (>25.2 kg/m2) or waist circumference (>80.7 cm) had the highest prevalence of the metabolic syndrome (approximately 30%). CONCLUSIONS: Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal women.

Adult↗

PubMed1997

The Postmenopausal Estrogen/Progestin Interventions Study: primary outcomes in adherent women.

OBJECTIVE: To assess the efficacy of unopposed estrogen, and three estrogen/progestin regimens on selected heart disease risk factors among adherent women and to contrast those results with efficacy among all women in the PEPI study. DESIGN: A 3-year, multicenter, randomized, double-blinded, placebo-controlled clinical trial. PARTICIPANTS: A total of 847 healthy postmenopausal women aged 45 to 64 years of age with no known contraindication to hormone therapy, who attended their 36 month clinical visit. INTERVENTION: Participants were randomized in equal numbers to one of the following treatments: (1) placebo; (2) conjugated equine estrogen (CEE) 0.625 mg daily; (3) CEE 0.625 daily plus medroxyprogesterone acetate (MPA) 10 mg, days 1-12; (4) CEE 0.625 daily plus MPA 2.5 mg daily; or (5) CEE 0.625 daily plus micronized progesterone (MP) 200 mg, days 1-12. ANALYSIS: Analyses are based on adherent women, where adherence is defined as taking at least 80% of pills at each 6-month visit. RESULTS: Adherence rates were high in all groups except women with a uterus assigned to unopposed CEE. The difference in HDL-C levels resulting from the CEE vs. CEE+MP was approximately three times larger than in the intent-to-treat analyses, reaching statistical significance (P < 0.05). In each active treatment, LDL-C decreased 10-15%. Triglycerides increased 15-20% in each opposed CEE arm and over 25% in the CEE only arm; this difference was not statistically significant. Fibrinogen increased by 7% among placebo adherers, but decreased or remained fairly stable among the active arm adherers. Systolic blood pressure increased 3-5% in all treatment arms. Women adherent to the CEE+MPA arms had twice the increase of 2 h glucose levels as women adherent to CEE only, or CEE+MP (8-9% vs. 3-4%). Two-hour insulin levels decreased 3-12% for all arms. The patterns of change for fibrinogen, SBP, 2 h glucose and insulin were similar to those from the intent-to-treat analyses. CONCLUSIONS: In analyses limited to adherent women, all active treatments, compared to placebo, continued to have similar and favorable effects on LDL-cholesterol and fibrinogen and no significant effects on blood pressure or insulin levels. Given the overall high adherence rates in PEPI, the results are similar to the intent-to-treat analyses, as expected. Only the trend of HDL-C to have a larger increase in the CEE only arm (in the intent-to-treat analyses) gained statistical significance in analyses restricted to adherers.

Blood Glucose↗

PubMed1997

Effect of postmenopausal hormone therapy on body weight and waist and hip girths. Postmenopausal Estrogen-Progestin Interventions Study Investigators.

Reports from cross-sectional comparisons, nonrandomized prospective studies, and relatively small clinical trials indicate that postmenopausal hormone therapy may slightly decrease the amount of weight typically gained by women during the decade following menopause. Despite this, widespread belief remains that hormone therapy may cause weight gain. We use data from the Postmenopausal Estrogen/Progestin Interventions trial to characterize the impact of postmenopausal hormone therapy on weight and fat distribution and to examine the consistency of this impact among subgroups of women defined by lifestyle, clinical, and demographic factors. The Postmenopausal Estrogen/Progestin Interventions trial was a 3-yr, placebo-controlled, randomized clinical trial of 875 women assessing the effects on cardiovascular risk factors of four hormone regimens: oral conjugated equine estrogen (CEE) therapy (0.625 mg daily alone), CEE in combination with medroxyprogesterone acetate (2.5 mg daily), CEE in combination with medroxyprogesterone acetate (10 mg daily on days 1-12), and CEE in combination with micronized progesterone (200 mg daily on days 1-12). Women randomly assigned to CEE with or without a progestational agent averaged 1.0 kg less weight gain at the end of 3 yr (P = 0.006) than those assigned to placebo. Assignment to CEE was also associated with averages of 1.2 cm less increase in waist girth (P = 0.01) and 0.3 cm less increase in hip (P = 0.07) girth. In regression models that included weight change as a covariate, none of these differences reached statistical significance. There were no significant differences in weight or girth changes among any of the four active hormone regimens. After accounting for the effects of assignment to active hormone therapy and baseline weight, older age (P 0.008) and higher physical activity level at baseline (P = 0.002) were also independently predictive of less weight gain. The impact of hormone therapy on weight gain was similar among subgroups, except for those defined by baseline smoking status (P = 0.04) and physical activity level at home (P = 0.02). Factors that were independently associated with smaller increases in girths were: for waist, greater overall activity (P = 0.005) and Hispanic ethnicity (P = 0.02); and for hip, work activity (P = 0.003) and greater alcohol consumption (P = 0.03). None of these factors significantly affected the observed overall relationships between estrogen and changes in girth.

Animals↗

PubMed1997

Hysterectomy, oophorectomy, and heart disease risk factors in older women.

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.

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