Nicotine replacement therapy and cardiovascular disease

Smoking is a well-established and important risk factor for cardiovascular disease. Cessation of smoking clearly decreases the chances of a first or subsequent cardiovascular event. Nicotine replacement therapy (NRT) is a proven adJunctive therapy to increase the probability of quitting smoking. Anecdotal reports of adverse events in patients using NRT have led some to question its safety. Is nicotine, whether in tobacco products or in NRT, the cause of the cardiovascular consequences associated with tobacco use? Is using NRT to assist with smoking cessation safer than smoking? Should health care professionals avoid recommending NRT for patients with established cardiovascular disease? This article summarizes the mechanisms of harm associated with smoking and reviews the safety of NRT in both the general population and the population with cardiovascular disease. Recommendations for NRT use are offered.     

雌孕激素替代治疗对大鼠心血管功能的保护作用

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Libido, menopause, and estrogen replacement therapy

Patients may be embarrassed to communicate their concerns regarding a decrease in sexual desire to their physician, let alone request treatment. Drs Beard and Curtis recommend that patients be asked specific questions to elicit symptoms of sexual dysfunction. They outline a program of hormone replacement therapy for women who have sexual dysfunction secondary to genitourinary atrophy and for those whose loss of libido is secondary to declining levels of estrogen.     

Libido,menopause, and estrogen replacement therapy

Patients may be embarrassed to communicate their concerns regarding a decrease in sexual desire to their physician, let alone request treatment. Drs Beard and Curtis recommend that patients be asked specific questions to elicit symptoms of sexual dysfunction. They outline a program of hormone replacement therapy for women who have sexual dysfunction secondary to genitourinary atrophy and for those whose loss of libido is secondary to declining levels of estrogen.     

Sex hormone replacement therapy and modulation of vascular function in cardiovascular disease

Epidemiological and experimental studies suggest vascular protective effects of estrogen. Cardiovascular disease (CVD) is less common in premenopausal women than in men and postmenopausal women. Cytosolic/nuclear estrogen receptors (ERs) have been shown to mediate genomic effects that stimulate endothelial cell growth but inhibit vascular smooth muscle proliferation. However, the Heart and Estrogen/Progestin Replacement Study (HERS), HERS-II and Women’s Health Initiative clinical trials demonstrated that hormone replacement therapy (HRT) may not provide vascular benefits in postmenopausal women and may instead trigger adverse cardiovascular events. HRT may not provide vascular benefits because of the type of hormone used. Oral estrogens are biologically transformed by first-pass metabolism in the liver. By contrast, transdermal preparations avoid first pass metabolism. Also, natural estrogens and phytoestrogens may provide alternatives to synthetic estrogens. Furthermore, specific ER modulators could minimize the adverse effects of HRT, including breast cancer. HRT failure in CVD could also be related to changes in vascular ERs. Genetic polymorphism and postmenopausal decrease in vascular ERs or the downstream signaling mechanisms may reduce the effects of HRT. HRT in the late postmenopausal period may not be as effective as during menopausal transition. Additionally, while HRT may aggravate pre-existing CVD, it may thwart its development if used in a timely fashion. Lastly, the vascular effects of progesterone and testosterone, as well as modulators of their receptors, may modify the effects of estrogen and thereby provide alternative HRT strategies. Thus, the beneficial effects of HRT in postmenopausal CVD can be enhanced by customizing the HRT type, dose, route of administration and timing depending on the subject’s age and cardiovascular condition.     

The impact of renal replacement therapy on toddler time

The impact of renal replacement therapy on the day-to-day activity of 5 toddlers is presented. For those on hemodialysis, 50% of the waking hours involved activity related to management of the renal failure; the remainder was spent feeding or in normal (play) activity. Peritoneal dialysis demanded only 10% of waking hours for direct renal activity. The data are potentially useful in counseling families when discussing the impact of renal failure and its management on the toddler.     

Sex hormone replacement therapy and modulation of vascular function in cardiovascular disease

Epidemiological and experimental studies suggest vascular protective effects of estrogen. Cardiovascular disease (CVD) is less common in premenopausal women than in men and postmenopausal women. Cytosolic/nuclear estrogen receptors (ERs) have been shown to mediate genomic effects that stimulate endothelial cell growth but inhibit vascular smooth muscle proliferation. However, the Heart and Estrogen/Progestin Replacement Study (HERS), HERS-II and Women's Health Initiative clinical trials demonstrated that hormone replacement therapy (HRT) may not provide vascular benefits in postmenopausal women and may instead trigger adverse cardiovascular events. HRT may not provide vascular benefits because of the type of hormone used. Oral estrogens are biologically transformed by first-pass metabolism in the liver. By contrast, transdermal preparations avoid first pass metabolism. Also, natural estrogens and phytoestrogens may provide alternatives to synthetic estrogens. Furthermore, specific ER modulators could minimize the adverse effects of HRT, including breast cancer. HRT failure in CVD could also be related to changes in vascular ERs. Genetic polymorphism and postmenopausal decrease in vascular ERs or the downstream signaling mechanisms may reduce the effects of HRT. HRT in the late postmenopausal period may not be as effective as during menopausal transition. Additionally, while HRT may aggravate pre-existing CVD, it may thwart its development if used in a timely fashion. Lastly, the vascular effects of progesterone and testosterone, as well as modulators of their receptors, may modify the effects of estrogen and thereby provide alternative HRT strategies. Thus, the beneficial effects of HRT in postmenopausal CVD can be enhanced by customizing the HRT type, dose, route of administration and timing depending on the subject's age and cardiovascular condition.     

Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers

Vitamin D is very important for overall health and wellbeing. A major source of vitamin D comes from exposure to sunlight. Measurement of 25-hydroxyvitamin D in the blood and not 1,25-dihydroxyvitamin D is used to determine vitamin D status. A blood level of 25-hydroxyvitamin D of at least 20 ng/mL is considered to be vitamin D sufficient. Vitamin D deficiency increases the risk of many common cancers, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and type I diabetes.     

The impact of blood coagulability on atherosclerosis and cardiovascular disease

Summary. Although the link between blood coagulation and atherogenesis has been long postulated, only recently, and through the extensive work on transgenic mice, crossbred on an atherogenic background, has the direction of this interaction become visible. In general, hypercoagulability in mice tends to increase atherosclerosis, whereas hypocoagulability reduces the atherosclerotic burden, depending on the mouse model used. The information on a direct relationship between coagulation and atherosclerosis in humans, however, is not that clear. Almost all coagulation proteins, including tissue factor, are found in atherosclerotic lesions in humans. In addition to producing local fibrin, a matrix for cell growth, serine proteases such as thrombin may be very important in cell signaling processes, acting through the activation of protease‐activated receptors (PARs). Activation of PARs on vascular cells drives many complex processes involved in the development and progression of atherosclerosis, including inflammation, angiogenesis, and cell proliferation. Although current imaging techniques do not allow for a detailed analysis of atherosclerotic lesion phenotype, hypercoagulability, defined either by gene defects of coagulation proteins or elevated levels of circulating markers of activated coagulation, has been linked to atherosclerosis‐related ischemic arterial disease. New, high‐resolution imaging techniques and sensitive markers of activated coagulation are needed in order to study a causal contribution of hypercoagulability to the pathophysiology of atherosclerosis. Novel selective inhibitors of coagulation enzymes potentially have vascular effects, including inhibition of atherogenesis through attenuation of inflammatory pathways. Therefore, we propose that studying the long‐term vascular side effects of this novel class of oral anticoagulants should become a clinical research priority.     

The impact of coffee consumption on blood pressure,cardiovascular disease and diabetes mellitus

Introduction: Coffee is the most widely consumed beverage, next to water. However, there has been a long-standing controversy regarding its safety on blood pressure (BP) and cardiovascular disease (CVD) and intuitively, physicians dissuaded their patients from coffee drinking.

Areas covered: This controversy was, primarily, based on older prospective studies or case reports, which showed a positive association of coffee drinking with the incidence of hypertension and CVD. In contrast to these reports, recent, well controlled, studies have demonstrated either a neutral or beneficial effect of moderate coffee consumption (3–4 cups/day), on BP, CVD, heart failure (HF), cardiac arrhythmias, or diabetes mellitus (DM). For the preparation of this special report, an English language focused search of the Medline database was conducted between 2010 and 2016 on studies with data on effect on the coffee consumption in patients with high BP, CVD, HF, cardiac arrhythmias or DM. Of the 94 abstracts reviewed, 34 pertinent papers were selected, and the findings from these papers together with collateral literature will be discussed in this special report.

Expert commentary: Based on the evidence from these studies, coffee consumption in moderation, is safe and is beneficial in both healthy persons as well as patients with high BP, CVD, HF, cardiac arrhythmias or DM. Therefore, coffee restriction is not warranted for these patients, although some caution should be exercised.     

小剂量雌激素在跌重性闭经患者排卵功能恢复中的作用

目的:探讨生理剂量雌激素替代治疗跌重性闭经后排卵恢复的影响因素及促性腺激素水平的变化。方法:收集2008年7月—2014年6月在复旦大学附属妇产科医院接受雌激素替代治疗的36例跌重性闭经患者的临床资料。分析其闭经前体质指数(body mass index,BMI)、基础BMI(发生闭经时)、促黄体生成素(LH)和促黄体生成素释放激素(LHRH)激发试验数据;雌激素治疗每个周期结束的临床检查资料以及治疗后每隔6个月的LHRH激发试验数据。测量患者基础体温和血清孕酮了解排卵情况。结果:36例患者中,20例恢复正常排卵,平均治疗时间为(24.1±13.6)个月;16例未恢复排卵,接受雌激素替代治疗的时间为(6.65±3.36)个月。患者恢复正常排卵的时间与闭经前BMI(P<0.01)和基础BMI(P=0.04)负相关。闭经前BMI每增加1kg/m~2,治疗时间缩短3.6个月;基础BMI每增加1kg/m~2,排卵恢复时间缩短3.1个月。20例恢复排卵患者中,17例患者BMI平均增加(1.92±2.11)kg/m~2,2例未变,1例下降0.4kg/m~2;排卵未恢复患者的BMI未改变。恢复正常排卵患者的LH水平显著增加[(5.6±1.6)mIU/mL vs(1.2±0.4)mIU/mL,P=0.005;LHRH激发试验中释放水平曲线下面积(AUC)增加(44.6±10.1 vs 17.1±6.3,P=0.027)。结论:跌重性闭经患者可通过补充生理量雌激素恢复排卵。LH分泌水平及其对LHRH的反应恢复是患者跌重性闭经排卵功能重建的重要机制。闭经前BMI或基础BMI越低,患者需要雌激素替代治疗的时间更长。     

雌激素替代疗法对去卵巢大鼠呼吸的影响

目的观察雌二醇对去卵巢大鼠呼吸的影响。方法 3 0只雌性成年SD大鼠随机分为去卵巢组 (A组 )、雌二醇组 (B组 )和假手术组 (C组 ) ,双侧卵巢切除术后 10天起 ,A组大鼠皮下注射 17 β雌二醇 (2 0 μg/kg/d) ,B组和C组大鼠仅注射生理盐水 ,连续用药 6周后 ,通过检测血清雌二醇水平和引导膈神经放电 ,评定雌激素对大鼠呼吸的影响。结果A组大鼠血清雌二醇浓度明显低于B组和C组 (P <0 .0 1) ,B组与C组之间无显著性差异 ;A组大鼠的膈神经放电频率和积分幅度低于B组和C组 (P <0 .0 5 ) ,B组与C组之间无显著性差异。结论雌二醇对去卵巢大鼠的呼吸有兴奋作用     

Estrogen replacement therapy for the prevention of osteoporosis

Estrogen replacement therapy is the most effective single means of preventing and treating osteoporosis. The most common objection by patients, the resumption of menses if the uterus is present, may be eliminated by providing estrogen and progestin continuously. An additional concern, endometrial carcinoma, appears to be largely alleviated by coadministration of progestin. Evidence indicates that concomitant progestin administration actually reduces the incidence of endometrial carcinoma to less than that in untreated women. An incidental but potentially more important benefit is protection against coronary artery disease. Optimal management includes initiation of estrogen therapy shortly after menopause, long-term continuation and calcium supplementation.     

植物雌激素对绝经后骨质疏松的影响

植物雌激素是一类具弱雌激素样的生物活性物质,能与雌激素受体结合,广泛存在于动物或人类摄取的各种植物中,它们对于激素相关疾病有广泛作用,特别是对骨质疏松的作用,近几年来引起人们的广泛关注。     

Carcinoma of the breast and hormone replacement therapy for osteoporosis

The benefits of hormone replacement therapy for postmenopausal women, especially in the prevention and treatment of osteoporosis, are well known. It is still not clear whether oestrogen replacement therapy can be given safely to women with breast cancer. The incidence and survival of breast cancer is rising in the UK and increasing numbers of young women with breast cancer treated systemically experience an early menopause and are at prolonged risk of osteoporosis. This review discusses the risk/benefit analysis of oestrogen replacement therapy for breast cancer patients, and alternative therapies: SERMs, phyto-oestrogens and bisphosphonates. A schedule for monitoring osteoporosis for breast cancer patients with a therapeutic early menopause is suggested.