Estrogen and coronary heart disease in women

We review herein the evidence that estrogen is protective against the development of cardiovascular disease in women. To our knowledge, no studies in women have looked at endogenous estrogen levels as predictors of cardiovascular disease. Studies of surrogate measures of endogenous estrogen such as parity, age at menarche, and age at menopause have provided inconsistent results. Current use of oral contraceptives increases risk in older women who smoke cigarettes, but most studies of past use show no increased risk. Most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in risk of a coronary event in women using unopposed oral estrogen. These important observations need to be confirmed in a double-blind, randomized clinical trial, since the protection is biologically plausible and the magnitude of the benefit would be quite large if selection factors can be excluded.     

肥胖型多囊卵巢综合征与心血管疾病的研究现状

多囊卵巢综合征(PCOS)是一种好发于青春期和生育期的内分泌疾病,以雄激素过多和持续不排卵为主要特征,有35%~60%的患者合并有中心性肥胖。近年来很多研究表明,PCOS与心血管疾病有着密切联系,尤其是肥胖患者。肥胖通过加重胰岛素抵抗、血脂异常、高血压、血管功能的改变及低度慢性炎症等多方面因素促进心血管疾病的进展。现就肥胖型PCOS与心血管疾病的联系,肥胖加重心血管疾病的机制和治疗进行综述。     

新疆喀什伽师县农村维吾尔族妇女性行为调查研究

目的：探讨新疆喀什地区伽师县克孜勒博依乡维吾尔族妇女宫颈癌有关的性行为高危因素,为制定新疆农村妇女宫颈癌的性行为干预提供科学依据。方法2009年6-7月,对新疆喀什伽师县克孜勒博依乡1000例维吾尔族妇女采用访谈方式进行妇女性行为的问卷调查。结果伽师县克孜勒博依乡1000例农村维吾尔族妇女文化层次低、经济收入低;月经期及性卫生不良,早婚、早育、多婚、多育等较为普遍,15岁之前结婚者占25．8％,16～20岁结婚者占57．9％,20岁之前完成初次分娩者占74．4％,有41．9％的妇女至少离过1次婚,分娩4次以上者占37．9％;避孕方式以宫内节育器为主,使用宫内节育器避孕者占56．6％,仅有0．4％的妇女使用避孕套;100％的妇女配偶在6～8岁时进行过伊斯兰教的割礼（包皮切除术）,性生活后洗阴道的妇女占83．8％。结论农村维吾尔族妇女中宫颈癌性行为有关的高危因素普遍存在,这些因素可能是维吾尔族妇女宫颈癌发病率高的重要原因,在农村维吾尔族妇女中进行性行为干预极为迫切。     

Epidemiology of congenital rubella syndrome. The role of maternal parity.

Rubella vaccination policies are primarily directed at control of congenital rubella syndrome. In the United States, vaccination of children of both sexes, ages 1 theough 12 years, has been recommended. This policy depends on the hypothesis that children are the major source of infection for pregnant women. If true, then as maternal parity increases one would expect an increasing prevalence of rubella antibody or an increase in the frequence of rubella syndrome in babies. A serologic survey of 3,081 pregnant women has failed to show an increase in prevalence of rubella antibody with increasing parity. Case-control studies comparing groups of children with rubella syndrome to birth certificate and hospital control groups also have failed to show an excess of multiparae among the mothers of babies with rubella syndrome. Thus, these results do not support the hypothesis that children are the major source of infection for pregnant women.     

Is grand multiparity an independent predictor of pregnancy risk? A retrospective observational study

OBJECTIVE: To determine whether high maternal parity has any effect on pregnancy outcome independent of other maternal characteristics. DESIGN AND SETTING: Retrospective observational study using the database of a referral obstetric unit in a 280-bed regional hospital in far north Queensland. PARTICIPANTS: All 15 908 women who had singleton births between 1992 and 2001, comprising 653 women with grand multiparity (>or= 5 previous births at gestation >or= 20 weeks) and 15 255 women with lower parity. MAIN OUTCOME MEASURES: Spontaneous vaginal birth, postpartum haemorrhage (estimated blood loss > 500 mL), placental retention requiring manual removal, blood transfusion associated with the birth, and perinatal death. RESULTS: Women with grand multiparity were significantly older than those with lower parity, more likely to be Indigenous, not to have had antenatal care, to have smoked during pregnancy and to have had one or more previous caesarean sections. On univariate analysis, women with grand multiparity were more likely to have a postpartum haemorrhage (9.2% v 5.3%) and blood transfusion (2.8% v 1.5%). However, multivariate logistic regression analysis of women who began labour (ie, did not have an elective caesarean section) showed that grand multiparity was not significantly associated with postpartum haemorrhage or blood transfusion when other maternal characteristics were included in the model (regression coefficients [95% CI], 1.36 [0.99-1.87] and 1.09 [0.59-2.02], respectively). However, they remained more likely to have a spontaneous vaginal birth (regression coefficient [95% CI], 2.10 [1.56-2.74]). CONCLUSIONS: Women with grand multiparity do not have an increased likelihood of poor pregnancy outcomes. Birth-suite protocols which dictate extra interventions as routine during labour in these women should be revised.     

A follow-up study of women with a history of severe preeclampsia: relationship between metabolic syndrome and preeclampsia

Background  Women with a history of preeclampsia have twice the risk of cardiovascular diseases, and there is a graded relationship between the severity of preeclampsia and the risk of cardiac disease. Moreover, metabolic scores are associated with developing preeclampsia. However, since there are no diagnostic criteria for metabolic syndrome during pregnancy and pregnant women undergo metabolic changes, it is difficult to elucidate the relationship between preeclampsia and metabolic syndrome. We carried out a cross-sectional study to investigate the relationship between metabolic syndrome and preeclampsia among women with a history of severe preeclampsia shortly after an indexed pregnancy.

Methods  We recruited 62 women with a history of severe preeclampsia 1 to 3 years after an indexed pregnancy. Blood pressure and body compositional indices were recorded. Fasting blood samples were tested for glucose, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, triglycerides, and insulin. A questionnaire was used to collect demographic data including pre-pregnancy weight and family history of diseases associated with cardiovascular diseases. Criteria for metabolic syndrome were defined by the National Cholesterol Education Program, Adult Treatment Panel III 2001 (NCEP III) and International Diabetes Federation 2005 (IDF). Data were analyzed by the α² test and multivariate Logistic regression.

Results  According to NCEP III and IDF standards, 17 (27%) and 24 (39%) women, respectively, were identified as having metabolic syndrome. Being overweight pre-pregnancy and currently overweight were risk factors, and currently overweight was an independent risk factor. A combination of blood pressure and waist circumference was predictive of metabolic syndrome with a sensitivity of 91.67% and specificity of 94.74%.

Conclusions  An unfavorable metabolic constitution in women may lead to metabolic syndrome, preeclampsia, and long-term cardiovascular disease. In women with severe preeclampsia, therapeutic interventions should include weight-control shortly after pregnancy, especially among women who were previously overweight.

     

Physicians' attitudes to four common problems: hypertension, atrial fibrillation, transient ischaemic attacks, and angina pectoris

A questionnaire was completed by 341 senior physicians on their attitudes to four common cardiovascular problems. Their replies showed that uncertainty about the end point for diastolic blood pressure still prevails and that their approach to the management of hypertension of differing severity in men and women of varying ages stems more from personal belief than from the results of clinical trials. Unless patients with atrial fibrillation also had mitral valve disease anticoagulation was not thought to be necessary, thereby making it ethically possible to carry out a trial of anticoagulants in stroke prevention on patients with atrial fibrillation but no valvular disease. The physicians' suggestions for very active management in transient ischaemic attacks extended beyond the evidence available to them, whereas their approach to the use of coronary arteriography closely reflected the results of clinical trials. These findings may indicate that recent cardiovascular trials that have provided definitive results have had more impact than earlier inadequate studies.     

Patients' response to tubal division.

Of the 187 women who underwent laparoscopic tubal division at the Massachusetts General Hospital between September 1969 and June 1973, one hundred thirty-nine were interviewed in a follow-up study. The mean age was 33.9 years; the mean gravidity was 5.0 and mean parity 3.8. Most women were married, with religious affiliations reflecting those of the general hospital population, and most underwent tubal division because they felt they had had enough children. The majority (85.6%) were satisfied with their decision and reported similar or improved mental and physical health and sexual activity. Almost all (93.5%) said that they would make the same choice again, and more than half (54.7%) would have liked to have had this operation earlier. Those ambivalent or regretful about their decision could not be readily identified by any preoperative characteristics such as age, parity, and marital status.     

某单位不同年龄段三年间心血管危险因素变化趋势分析

目的：分析某单位职工近3年间无干预状态下不同年龄段心血管危险因素的变化趋势。方法：回顾性分析某单位职工近3年的体检结果,统计学分析不同年龄段高血压、血脂异常及血糖升高等主要心血管危险因素的变化趋势。结果：在25~55岁年龄组（A组）中,男性血脂异常、高血压患病率明显逐年递增趋势,2009年高于2007年（P〈0.01）,男性血脂异常、高血压及体重超重患病率明显高于女性（P〈0.01）;女性血脂异常患病率明显逐年递增趋势,血糖升高、高血压及体重超重无明显变化;而在56~70岁年龄组（B组）中,血脂异常、血糖升高、高血压、超重患病率无逐年递增趋势,相反女性血脂异常患病率明显高于男性,男性血糖升高高于女性,高血压及体重超重患病率无性别差异;B组中高血压、血脂异常、血糖升高明显高于A组。结论：在无干预状态下,该单位职工不同年龄段及不同性别心血管危险因素变化趋势不同,55岁以下年龄组,特别是男性,不良生活方式无改善是导致危险因素患病率上升的原因;56岁以上年龄组中,女性职工更应注意心血管病的二级预防。     

臀位妊娠分娩方式的选择

①目的　分析臀位妊娠影响母儿结局的因素及初产妇是否可以选择阴道分娩。②方法　对我院单胎臀住妊娠369例孕产妇的资料进行整理分析,比较初产妇及经产妇的分娩方式。单因素及多因素分析影响单胎臀位妊娠的母儿结局的因素。③结果　初产妇组143／256(55.9％),经产妇组78／113(69％)选择阴道分娩,两组产妇分娩方式的选择上有显著性差异,但这两组产妇的围生儿结局相似,母亲结局相似(P>0.05)。多因素分析提示,足月妊娠及剖宫产对臀位妊娠的新生儿有利;婴儿结局与产次无关。但多产和剖宫产对母亲来说则是不利因素。④结论　初产妇选择阴道分娩的条件和经产妇相似。臀位妊娠分娩方式的选择应全面考虑围生儿及母亲因素,结合产妇及家属的意愿来决定。     

选择性雌激素受体调节剂——雷洛昔芬

长期以来,人们注意到性别差异以及两性之间在激素水平的差异,是形成两性之间心血管疾病不同发生率、不同疾病进展乃至不同预后转归的原因。鉴于此,对绝经后女性采用雌激素替代疗法在一定程度上降低了绝经后女性心血管疾病的发生率,并对实际病例也产生一定的治疗作用。但雌激素本身广泛的作用以及由此所引起的高乳腺癌和高子宫内膜癌发生率严重限制了雌激素替代疗法的应用。现代药物研发注重保留雌激素的心血管保护作用,同时去除其不良的刺激组织增生作用,开发了选择性雌激素受体调节剂,并将其应用于雌激素替代疗法,以发挥其对绝经后女性的心血管保护作用。     

Hormone replacement therapies in women at risk of cardiovascular disease and osteoporosis in South Australia in 1997.

OBJECTIVE: To describe changes in use of hormone replacement therapy (HRT) in an Australian population and to determine HRT use in women at risk of cardiovascular disease and osteoporotic fracture. DESIGN: Data were derived from the 1997 South Australian Health Omnibus Survey (a representative population survey) and compared with data from 1991, 1993 and 1995 Omnibus Surveys. SETTING: South Australia, 1997. PARTICIPANTS: 1049 women aged 40 years and over from a random selection of 4400 households. RESULTS: Among women aged 55-64 years (and thus likely to be postmenopausal), 60% had used HRT (ever use). Nearly two-thirds of these women used it currently. In this age group, mean length of HRT use had increased to 70 months (median, 60 months). Rates of HRT use had not changed significantly between 1991 and 1997 in women under 55 years, but had increased significantly in women aged 55 years or over (P < or = 0.01). Among women currently using HRT, 5.4% had used testosterone therapy, while 4% used unregistered products purported to contain hormones. Rates of ever use of HRT in women with zero, one, two, or three or more cardiovascular risk factors were 33%, 37%, and 45%, respectively. Among women with a diagnosis of osteoporosis, 52% had used HRT, with a mean length of use of 86 months (median, 60 months). CONCLUSION: HRT use is increasing in older-age groups. Longer-term therapy with potential for primary prevention is now occurring, but half of those with osteoporosis and more than half of those with risk factors for cardiovascular disease have not used HRT.     

Postpartum thyroid dysfunction in Mid Glamorgan

A high prevalence of postpartum thyroid dysfunction has been reported in several countries, but there have been no systematic studies of its prevalence in Britain. Among a group of 901 consecutive, unselected pregnant women thyroid autoantibodies were detected in 117 (13%) at booking. The clinical course of postpartum thyroid dysfunction, factors associated with its development, and its likely prevalence were defined in 100 of these women with thyroid antibodies and 120 women with no such antibodies who were matched for age. None of the women had a history of autoimmune thyroid disease. Normal reference ranges for thyroid function during pregnancy and post partum were established in the 120 women negative for thyroid antibodies. On the basis of these observations postpartum thyroid dysfunction was observed in 49 (22%) of the 220 women studied, and the prevalence in the total group of 901 women was estimated to be 16.7%. Thyroid dysfunction, mainly occurring in the first six months post partum, was usually transient and included both destruction induced hyperthyroidism and hypothyroidism. The development of the syndrome was significantly related to smoking more than 20 cigarettes a day and the presence of thyroid microsomal autoantibodies at booking. Of the 16 women with a family history of thyroid disease in whom thyroid microsomal autoantibody activity was detectable at booking, 11 developed thyroid dysfunction. Age, parity, presence of goitre at presentation, duration of breast feeding, and the sex and birth weight of the infant were not associated with the development of postpartum thyroid dysfunction. The mood changes experienced by women post partum may in part be associated with altered thyroid function during this time.     

Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease--a case-control study

A case-control study of gall stone disease in women in relation to use of contraceptives, reproductive history, and concentrations of endogenous hormones was undertaken. The study population comprised 200 hospital patients with newly diagnosed gall stone disease, 182 individually matched controls selected from the community, and 234 controls who were patients in hospital. Use of oral contraceptives was associated with an increased risk of developing gall stones among young subjects but a decreased risk among older subjects. The risk of developing gall stone disease increased in association with increasing parity, particularly among younger women. The risk fell with increasing age at first pregnancy, independent of parity. Mean urinary excretion over 24 hours of oestrone, but not of pregnanediol, was significantly (p less than 0.05) greater for postmenopausal patients than controls. The age dependence of the relative risk associated with exposure to oral contraceptives and pregnancy suggests that there are subpopulations of women susceptible to early formation of gall stones after exposure to either oral contraceptives or pregnancy.     

Placenta praevia and sex ratio at birth

The ratio of male to female sex among infants born to 391 women with and 114 079 without placenta praevia was analysed by parity. In the women without placenta praevia the sex ratio decreased significantly with increasing parity, whereas in the women with placenta praevia it increased. Overall, the sex ratio was increased among the women with placenta praevia, particularly multiparas. An increase in the sex ratio at birth is associated with insemination early or late in the menstrual cycle, which may result in delayed development and implantation of the blastocyst; this may be a predisposing factor in placenta praevia.     

Decline in mortality from coronary heart disease in Finland from 1969 to 1979

The trends in mortality from coronary heart disease in the 1970s and the differences in trends between counties within Finland were calculated from official mortality statistics among the population aged 35 to 64 years. During this period coronary mortality declined by a mean of 1.1% for men and 2.3% for women annually in the whole of Finland. A community based cardiovascular control programme was started in 1972 in North Karelia, a county in the east of Finland. The decline in coronary mortality in this county between 1969 and 1979 was 24% in men and 51% in women. The decline in the rest of Finland over the same period was 12% in men and 24% in women. The decline in North Karelia was greater than that in other counties of Finland for both men and women and that difference exceeded random variation, with over 95% likelihood for both sexes. Even with adjustment for rates before 1974 with cross-county multiple regression analyses the difference persisted. Although further studies are needed, the changes in coronary mortality in North Karelia suggest that the preventive programme has been effective.     

动态血压监测评价高血压病靶器官损害的进展

动态血压监测（ABPM）诸指标与高血压病病人心、脑、肾损害有较好的相关性，可作其预测因子和研究工具。大量研究证明：24h平均动态血压，日间血压无均值，夜间血压均值与心血管并发症的相关性较偶测血压为优；夜间血压降低减弱或消失的高血压病人与较高的心血管意外发生率相关；血压变异性与心血管损坏的严重性相关，而不依赖于血压水平；血压负荷是比血压水平更为精确的心血管危险预测指标；ABPM在预测高血压无症状脑血管损害方面较诊室随测血压为优；微量清蛋白尿是原发性高血压早期肾脏结构和功能改变的标志，尿清蛋白分泌率与24h收缩压和舒张压及24h日间，夜间平均血压显著相关。     

Association between diaphragm use and urinary tract infection

We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.     

Hormonal factors and melanoma in women

The effect of exogenous hormones and reproductive factors on the risk of melanoma in women was investigated in a case-control study. Data from 91 women, aged from 15 to 81 years, and 91 matched controls were analysed in relation to use of oral contraceptives (OC), parity, age at the birth of the first child, and calculated length of ovulatory life. When potential confounding factors (including pigmentary characteristics and the lifetime exposure to sunlight were taken into account, there was no increase in risk of melanoma in relation to OC use, parity, or age at the birth of the first child. An unexplained association between melanoma and ovulatory life of greater length than 20 years was observed. The general findings of this study suggest that neither hormonal nor reproductive factors increase the risk of melanoma in women.     

Reproductive performance among patients with tubal ectopic pregnancy

Researchers studied 68 cases of tubal ectopic pregnancy that occurred at the university hospital in Benin city, Nigeria from February 1973- January 1976. Medical records existed for only 53 cases. The ratio of ectopic pregnancy to deliveries stood at 1:58 (incidence: 1.7%). Excluding maternity cases, these 68 cases represented 6.5% of all gynecological and adult female admissions. 1 of 40 abdominal surgeries performed at this hospital was due to a tubal ectopic pregnancy. Therefore it represents a significant condition in Nigeria. 90% of the women were 40 years old. 68% of the cases already had between 2-5 children. Average parity stood at 2.6. Only 9.4% of the women were nulliparous. Spontaneous abortions occurred in 26.48% of the women. Further, the investigators observed that the lower the parity the higher the incidence of spontaneous abortion. For example, the abortion rate for women with no children and those with 1 stood at 100% and 73.9% respectively while for women with 5 and 5 children it stood at 11.76% and 10.8% respectively. 58% of the cases had experienced a previous pelvic infection. Since there was an association between a high abortion rate and tubal ectopic pregnancy, the researchers also pointed out a possible common etiological factor causing both spontaneous abortions and tubal ectopic pregnancies. therefore a woman who may be likely to experience an early spontaneous abortion may be just as likely to have a tubal ectopic pregnancy and vice versa. Health practitioners should consider any pregnant woman who has had a tubal pregnancy to be at risk of a spontaneous abortion or early labor.