Risk of acute ischemic heart disease in postmenopausal women depends on von Willebrand factor and fibrinogen concentrations, and blood group genotype.
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ABO Blood-Group System↗
Biomedical subjects
Y T van der Schouw
Publications and source records attributed to Y T van der Schouw.
Cardiovascular disease and cognitive performance in middle-aged and elderly men.
BACKGROUND: Decline of cognitive function with age may be due, in part, to atherosclerotic changes. The aim of the present study was to determine the relative contribution of cardiovascular disease (CVD) to cognitive functioning in middle-aged and elderly men. METHODS: In a cross-sectional study, cognitive tests were administered to 400 independently living men aged 40-80 years. Compound scores were calculated for memory function, processing capacity/speed, and executive function. The MMSE was used as a measure of global cognitive function. Carotid intima-media thickness, pulse wave velocity and ankle brachial blood pressure index were assessed as measures of sub-clinical CVD. The adjusted association of sub-clinical and prevalent CVD with neuropsychological test scores in the total group and in subgroups was assessed by linear regression analysis. RESULTS: Increased IMT was associated with lower scores on memory performance, and increased PWV was associated with lower scores on processing capacity and executive functioning. Compared with subjects with no CVD, both sub-clinical and prevalent cardiovascular diseases were related to a lower memory performance, beta's (95% CI) were -0.45 (-0.83, -0.07) and -0.45 (-0.84, 0.01), respectively. These associations were present in both middle-aged and elderly men. Furthermore, we observed that for subjects who had sub-clinical or prevalent cardiovascular disease the distribution of MMSE-scores was shifted toward lower values; the distributions were statistically different (p=0.003). CONCLUSIONS: The results of this study support a relation of sub-clinical CVD with cognitive functioning in middle-aged and elderly men. These results suggest that actions to prevent cognitive decline by preventing atherosclerosis should be taken before middle age.
Adult↗
HFE mutations and risk of coronary heart disease in middle-aged women.
BACKGROUND: Although heterozygosity for the C282Y mutation in the HFE gene has been associated with an increased risk of cardiovascular events, epidemiological studies remain inconclusive. The aim of the present study was to obtain further evidence as to whether HFE mutations are associated with risk of coronary heart disease (CHD) in middle-aged women. We used data of a cohort of 15 236 Dutch middle-aged women to investigate whether C282Y carriers and H63D carriers are at increased risk of coronary heart disease compared with non-carriers. MATERIALS AND METHODS: Women were included in the study between 1993 and 1997 and were followed until 1 January 2000 for cardiovascular events. HFE genotyping was performed on all 211 coronary heart disease cases and a randomly selected sample from the baseline cohort (n = 1526). A weighted Cox proportional hazards model was used to estimate crude, age-adjusted and multivariate adjusted hazard ratios for C282Y and H63D carriership in relation to coronary heart disease. RESULTS: Compared with non-carriers, those that carried the C282Y allele were not at increased risk for CHD (HR = 1.25, 95% CI = 0.74-2.09). Neither did we find an association between the H63D mutation and CHD risk (HR = 0.73, 95% CI = 0.43-1.24). CONCLUSIONS: Our results are in accordance with similar studies to date, for which we present a meta-analysis. HFE mutations appear not to affect the risk of coronary heart disease.
Aged↗
Arterial calcium on mammograms is not associated with inflammatory markers for heart disease risk.
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Aged↗
Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review.
BACKGROUND: Guidelines for lifestyle and dietary modification in patients with coronary artery disease (CAD) are mainly supported by evidence from general population studies. CAD patients, however, differ from the general population in age (older) and treatment with preventive drugs. This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients. METHODS AND RESULTS: A literature search was performed on the effect of lifestyle and dietary changes on mortality in CAD patients. Prospective cohort studies and randomized controlled trials of patients with established CAD were included if they reported all-causes mortality and had at least 6 months of follow-up. The effect estimates of smoking cessation (relative risk [RR], 0.64; 95% CI, 0.58 to 0.71), increased physical activity (RR, 0.76; 95% CI, 0.59 to 0.98), and moderate alcohol use (RR, 0.80; 95% CI, 0.78 to 0.83) were studied most extensively. For the 6 dietary goals, data were too limited to provide reliable effect size estimates. Combinations of dietary changes were associated with reduced mortality (RR, 0.56; 95% CI, 0.42 to 0.74). CONCLUSIONS: Available studies show convincingly the health benefits of lifestyle changes in CAD patients. Effect estimates of combined dietary changes look promising. Future studies should confirm these findings and assess the contribution of the individual dietary factors.
Cause of Death↗
Endogenous sex hormone levels and cognitive function in aging men: is there an optimal level?
OBJECTIVE: To determine whether endogenous sex hormone levels are associated with cognitive functioning in men. METHODS: Cognitive performance was assessed in 400 independently living men between ages 40 and 80 in a population-based cross-sectional study. Compound scores were calculated for memory function, processing capacity/speed, and executive function. The Mini-Mental State Examination was used as a measure of global cognitive function. The adjusted association of testosterone (T) and estradiol (E2) (total, bioavailable) with neuropsychological test scores in the total group and in subgroups was assessed by linear and logistic regression analysis. RESULTS: Curvilinear associations were observed between T and memory performance and processing capacity/speed, suggesting optimal sex hormone levels. No association between E2 and cognitive functioning was found. After the population was subdivided into four age decades, a linear association of T with cognitive functioning in the oldest age category remained. No association was found in the other age decades. Lower bioavailable T levels were associated with lower scores on processing capacity/speed and executive function; beta (95% CI) values were 0.36 (0.07 to 0.66) and 0.17 (-0.01 to 0.35). Similar results were observed for total T. CONCLUSIONS: Higher testosterone (T) levels are associated with better cognitive performance in the oldest age category. Apparent curvilinear associations between T and certain cognitive functions in men suggest an optimal hormone level for particular cognitive tasks and are explained by linear associations in the oldest age category.
Adult↗
Alcohol and arterial wave reflections in middle aged and elderly men.
BACKGROUND: Augmentation index (AIx) is a measure of arterial wave reflection, providing information on the workload of the heart. and is a possible marker for cardiovascular disease risk. The relation of alcohol consumption with cardiovascular disease (CVD) risk is U-shaped with a protective effect of moderate alcohol consumption. The relation of alcohol consumption level with AIx has not been widely investigated, which prompted this study of the relation of alcohol consumption with AIx in a population-based cohort of men aged 40-80 years. METHODS: Three hundred and seventy-four men (mean age 60.5 years) participated in this cross-sectional study. Alcohol consumption and smoking habits were determined through a validated questionnaire. Fasting blood samples were drawn and analyzed for glucose and lipid levels and AIx was estimated by radial applanation tonometry using the SphygmoCor Device. The resultant data were analyzed using linear regression models. RESULTS: Age, height, heart rate, blood pressure, packyears, current smoking, presence of CVD and hypertension were independently related to AIx. The relation of alcohol consumption with AIx was U-shaped, with a significantly lower AIx in the group drinking 4-8 glasses/week (difference = -2.91%, 95% CI [-5.65; -0.18]) relative to those drinking 0-3 glasses/week. Additional adjustment for current smoking did not change this relationship, but adjustment for pulse wave velocity attenuated the relation. CONCLUSIONS: In a population-based cohort of men aged 40-80 years the relation of alcohol consumption level with AIx was U-shaped, further expanding the evidence for vascular protective effects of moderate alcohol intake.
Adult↗
Phytoestrogens and breast cancer risk. Review of the epidemiological evidence.
Phytoestrogens are natural plant substances. The three main classes are isoflavones, coumestans, and lignans. Phytoestrogens have anticarcinogenic potential, but they have also significant estrogenic properties. For an evaluation of the effect of phytoestrogens on breast cancer risk we reviewed the analytical epidemiological data. A total of 18 studies were included. Up to now, there are 13 studies that have assessed the direct relation between the individual dietary intake of soy products and the risk of breast cancer. Overall, results do not show protective effects, with the exception maybe for women who consume phytoestrogens at adolescence or at very high doses. Only four of these 13 studies are prospective, and none of them found statistically significant breast cancer reductions. Four studies assessed urinary isoflavones excretion in relation to breast cancer. Three of these are case control studies, where excretion was measured after breast cancer occurrence and thus seriously limiting causal interpretation of the results. The only prospective study with urinary measurements before breast cancer occurrence was done in a Dutch postmenopausal population and showed a non-significant breast cancer risk reduction for high excretion. Three studies measured enterolactone (lignan): two case control studies reported a preventive effect on breast cancer risk, but the only prospective study did not . In conclusion, few prospective studies (n = 5) were done to assess the effects of phytoestrogens on breast cancer risk. None of them found protective effects. However, these prospective studies did not focus on 'age at consumption', which seems to be important based on results from dietary case control studies done so far.
4-Butyrolactone↗
Treatment with hormone replacement therapy lowers remnant lipoprotein particles in healthy postmenopausal women: results from a randomized trial.
BACKGROUND: Recent evidence indicates that remnant lipoprotein particles (RLPs) may play a role in atherosclerosis. Remnant lipoprotein particles have been suggested to be the most atherogenic particles among the triglyceride-rich lipoproteins. In particular, these triglyceride-rich particles were identified as an independent risk factor for cardiovascular diseases (CVD) in women. Postmenopausal hormone replacement therapy (HRT) beneficially affects lipid profile, although total triglyceride levels often increase. Evidence on the effects of HRT on RLPs is limited. We determined whether 3 months' treatment of postmenopausal women with Tibolone or conjugated oestrogens combined with medroxyprogesterone acetate (CEE + MPA) affects RLP-cholesterol (RLP-C). MATERIALS AND METHODS: One hundred and five healthy postmenopausal women were randomized to either 2.5 mg of Tibolone, 0.625 mg of CEE + 2.5 mg of MPA or placebo. At baseline and after 3 months the lipid profile was determined. For assessment of RLP-C we used an immunoseparation-based method. RESULTS: Treatment with CEE + MPA significantly reduced RLP-C (-0.03 mmol L-1, P-value = 0.01) and appeared to increase triglycerides (0.15 mmol L-1, P-value = 0.20) compared with placebo. Tibolone did not significantly change RLP-C (-0.01 mmol L-1, P-value = 0.35) and significantly decreased triglycerides (-0.35 mmol L-1, P-value = 0.004). CONCLUSIONS: Treatment of postmenopausal women with conjugated oestrogens and medroxyprogesterone acetate reduced RLP-C, without a reduction in total triglycerides, whereas Tibolone did affect triglyceride levels, but not RLP-C. These observations may be relevant for explaining the effect of HRT on cardiovascular risk in healthy postmenopausal women.
Aged↗
Soy product consumption in 10 European countries: the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
OBJECTIVE: The aim of this study was to describe the variation of soy product intake in 10 European countries by using a standardised reference dietary method. A subsidiary aim was to characterise the pattern of soy consumption among a sub-group of participants with a habitual health-conscious lifestyle (HHL), i.e. non-meat eaters who are fish eaters, vegetarians and vegans. DESIGN: A 24-hour dietary recall interview (24-HDR) was conducted among a sample (5-12%) of all cohorts in the European Prospective Investigation into Cancer and Nutrition (EPIC). Study participants totalled 35 955 after exclusion of subjects younger than 35 or older than 74 years of age. Soy products were subdivided into seven sub-groups by similarity. Distribution of consumption and crude and adjusted means of intake were computed per soy product group across countries. Intake of soy products was also investigated among participants with an HHL. RESULTS: In total, 195 men and 486 women reported consuming soy products in the 24-HDR interview. Although soy product intake was generally low across all countries, the highest intake level was observed in the UK, due to over-sampling of a large number of participants with an HHL. The most frequently consumed soy foods were dairy substitutes in the UK and France and beans and sprouts among mid-European countries. For both genders, the sub-group of soy dairy substitutes was consumed in the highest quantities (1.2 g day-1 for men; 1.9 g day-1 for women). Participants with an HHL differed substantially from others with regard to demographic, anthropometric and nutritional factors. They consumed higher quantities of almost all soy product groups. CONCLUSIONS: Consumption of soy products is low in centres in Western Europe. Soy dairy substitutes are most frequently consumed. Participants with an HHL form a distinct sub-group with higher consumptions of fruit, vegetables, legumes, cereals and soy products compared with the other participants.
Adult↗
Phytoestrogens and breast cancer risk: review of the epidemiological evidence.
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Animals↗
HRT and heart disease: Dr Jekyll or Mrs Hyde?
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Confounding Factors, Epidemiologic↗
Methylenetetrahydrofolate reductase 677 C/T genotype and cardiovascular disease mortality in postmenopausal women.
Methylenetetrahydrofolate reductase (MTHFR) is involved in the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate. A 677 C/T single nucleotide polymorphism localized in the MTHFR gene is associated with both thermolability and reduced activity of the enzyme and is associated with increased homocysteine levels. The authors investigated the relation between the MTHFR 677 C/T polymorphism and risk of cardiovascular disease mortality in a cohort study of 12,239 women initially aged 52--67 years with a maximum follow-up time of 18 years (1976--1995; 153,732 woman-years of follow-up). The cardiovascular disease mortality rate was highest among women with the MTHFR 677 CC wild-type genotype and lowest among MTHFR 677 TT homozygotes. In comparison with women with the 677 CC wild-type genotype, age-adjusted rate ratios were 0.7 (95% confidence interval: 0.5, 0.9) for 677 CT heterozygotes and 0.6 (95% confidence interval: 0.4, 1.0) for 677 TT homozygotes. The possibility that this relation is a chance finding must be considered, because the relation is weak and of borderline significance. However, it provides an important argument against the view that increased levels of homocysteine directly raise cardiovascular disease risk.
Age Distribution↗
Hormone replacement therapy and endothelial function. Results of a randomized controlled trial in healthy postmenopausal women.
OBJECTIVE: To compare the effects of 3 months treatment with tibolone (a single entity synthetic steroid hormone with estrogenic, progestanic and androgenic activities), or continuous combined conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA), with placebo, on endothelial function. DESIGN: A single center, randomized, double-blind, placebo-controlled study. SETTING: Research center as part of the University Medical Center Utrecht. SUBJECTS: One hundred and five healthy postmenopausal women, sampled from the general population. INTERVENTIONS: Three months treatment with tibolone or CEE+MPA or placebo. MAIN OUTCOME MEASURE: At baseline and after 3 months, endothelial function was assessed non-invasively by measuring percent lumen diameter change in the brachial artery after reactive hyperemia and sublingual nitroglycerine spray. RESULTS: Results are presented as mean differences between treatment groups of endothelium dependent flow mediated dilatation (fmd) and endothelium independent nitroglycerine induced dilatation with 95% confidence intervals (95% CI). After treatment, there was a significant difference in mean fmd between the CEE+MPA group and the placebo group of 2.5% (95% CI: 0.3-4.6) while the tibolone group and the placebo group did not differ significantly (0.6%; 95% CI: 1.6-2.8). Nitroglycerine induced dilatation did not differ significantly between the groups. CONCLUSIONS: Hormone replacement therapy with CEE+MPA for 3 months increases endothelium dependent fmd of the brachial artery in healthy postmenopausal women. Tibolone did not alter fmd. The clinical significance of this improvement in fmd for cardiovascular disease risk needs to be established.
Aged↗
Prevalence of cerebral palsy in The Netherlands (1977-1988).
Children with cerebral palsy (CP) and their families often make strong demands on diagnostic, therapeutic, technical and social facilities. Prevalence estimates are needed to improve treatment and services. As recent Dutch data are not available, the present study aimed to assess the population prevalence of CP in the Netherlands. A representative Dutch area with 1.2 million inhabitants of which 172,000 were born between 1977 and 1988 was studied. To ascertain the children with CP from these birth years, medical practices (such as rehabilitation centres, paediatric and child neurological departments) were consecutively asked to contact their (supposed) CP cases. Next, a parents' organisation and finally regional news media assisted in the ascertainment. In total, 170 'supposed' CP cases underwent an expert examination. Of these 170, 127 children proved to be definite CP-cases, yielding a 'crude' average prevalence of 0.74 per 1,000 inhabitants (95% CI: 0.61-0.87). Under-ascertainment was recognised and quantified. Accordingly, the population prevalence of CP over the birth year period 1977-1988 was calculated as 1.51 per 1,000 inhabitants (average over the 12 birth years). The calculated CP prevalence rose significantly over time: from 0.77 (1977-1979) to 2.44 (1986-1988). This trend is in accordance with other studies.
Adolescent↗
Prospect-EPIC Utrecht: study design and characteristics of the cohort population. European Prospective Investigation into Cancer and Nutrition.
The European Prospective Investigation into Cancer and Nutrition (EPIC), which has been established in order to investigate the relations between nutrition and cancer, was initiated in 1990 and involves 10 European countries with heterogeneous dietary patterns and differing cancer incidence rates. This manuscript presents the design, recruitment and baseline characteristics of the Prospect-EPIC cohort co-ordinated in Utrecht, The Netherlands. The cohort is based on volunteers recruited among women participating in a regional breast cancer screening program. It comprises of 17,357 subjects aged 50-69 years at enrolment from Utrecht and vicinity, who have consented to participate in the study and its follow-up. Each participant filled out a general questionnaire and a food frequency questionnaire. Participants were also physically examined and have donated a blood sample. Participation rate was 34.5%. Blood samples were donated by most participants (97.5%) and detailed informed consents were obtained from 87.4% of participants. Mean age at enrolment was 57 years. Anthropometric, lifestyle and morbidity characteristics of the cohort population did not differ largely from those of similar study populations in The Netherlands. Based on the Prospect-EPIC population, we intend to conduct prospective total cohort, nested case-control or case-cohort studies, in order to investigate relations between consumption of certain food groups or nutrients and chronic diseases, including hormone dependant cancers such as breast, colon, endometrial and ovary cancers.
Aged↗
Oral contraceptive use in relation to age at menopause in the DOM cohort.
BACKGROUND: We investigated the hypothesis that long-term use of oral contraceptives (OCs), in particular high-dose OCs, could postpone age at menopause. METHODS: Data was used from 8701 women who participated in a breast cancer screening programme in Utrecht (DOM-3 cohort), and who did not use hormone replacement therapy (HRT) or OCs in the 4 years prior to their last menses. Data on OC-use, menopausal status, age at menopause, year of birth, parity, smoking behaviour, socio-economic status, body mass index and age at menarche was available. Use of high-dose OCs has been defined in this study as OC-use before 1972. The data was analysed by means of linear regression and Cox's proportional hazards analysis. Women still menstruating, women with surgical menopause and women lost to follow-up were censored at their last known date of menstruation. Endpoint was the natural menopause (n = 4589). RESULTS: The use of high-dose OCs advanced the onset of menopause by approximately 1.2 months for every year of OC-use compared with no OC-use. High-dose OC-use for > or = 3 years, adjusted for confounding variables, increased the risk of earlier menopause compared with no OC-use (adjusted hazard ratio 1.12; 95% CI 1.03--1.21). The use of lower dose OCs did not increase the risk of earlier menopause (adjusted hazard ratio 1.00; 95% CI 0.91--1.09). CONCLUSIONS: These results are inconsistent with the hypothesis that long-term use of OCs could postpone the onset of menopause by inhibiting follicle depletion. Possible explanations are discussed.
Age Factors↗
Intake of dietary phytoestrogens is low in postmenopausal women in the United States: the Framingham study(1-4).
Many plants that are consumed contain phytoestrogens. Only a few published studies have examined the dietary intake of phytoestrogens in the general Western population. The potentially positive health effects of phytoestrogens might be of relevance to postmenopausal women. The aim of the present study was to estimate the intake of dietary isoflavones, coumestans and lignans by healthy Western postmenopausal women. For this purpose, we studied 964 postmenopausal, Caucasian women who participated in the Framingham Offspring Study and completed the Willett food-frequency questionnaire (FFQ). By searching the medical and agricultural literature and contacting experts, we identified food sources of phytoestrogens. The concentrations of the different isoflavones, coumestrol and lignans in each food in the FFQ were scored in seven categories and multiplied by the serving size of the food and the frequency of its consumption. The estimated daily median intake of the isoflavone daidzein was 39 microg (24-57 microg); of genistein, 70 microg (28-120 microg); of formononetin, 31 microg (13-44 microg); and of biochanin A, 6 microg (2-11 microg). Median total intake of isoflavones was 154 microg (99-235 microg). The main sources of isoflavones were beans and peas. The estimated daily intake of coumestans was 0.6 microg (0.2-1.7 microg), with broccoli as the main source. The estimated daily median intake of matairesinol was 19 microg (12-28 microg) and of secoisolariciresinol 560 microg (399-778 microg). The median total intake of lignans was 578 microg (416-796 microg). The main source of the lignans was fruits. The daily dietary intake of phytoestrogens in healthy postmenopausal Caucasian women in the United States is <1 mg.
Diet↗