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Peer Reviewed

Title: Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study.
Author: Battaglia C; Mancini F; Fabbri R; Persico N; Busacchi P; Facchinetti F; Venturoli S
Source: Fertility and Sterility. 2009 Jul 8;
Abstract: OBJECTIVE: To compare the effects of a pill containing drospirenone with those of a combined contraceptive vaginal ring on the lipid and carbohydrate metabolism and on the surrogate markers of arterial function. SETTING: Bologna University School of Medicine. PATIENT(S): Thirty-seven women with polycystic ovary syndrome (PCOS) were randomly submitted to drospirenone + ethinylestradiol (group I; n = 19) or combined contraceptive vaginal ring (group II; n = 18) therapy. The duration of the study was 6 months. INTERVENTION(S): The effect of treatments was assessed after 6 months of therapy. MAIN OUTCOME MEASURE(S): Utero-ovarian ultrasound analysis and color Doppler evaluation of uterine and stromal ovarian arteries. In addition, analysis of brachial artery flow-mediated vasodilatation and 24-hour ambulatory blood pressure monitoring were performed. Fasting blood samples were drawn for testing biochemical and hormonal parameters and nitrites/nitrates. RESULT(S): Both treatments improved hirsutism, hyperandrogenemia, and ultrasound and color Doppler ovarian parameters. Both drospirenone + ethinylestradiol or contraceptive vaginal ring induced a slight but significant increase of diurnal and 24-hour blood pressure. Although both therapies worsened the lipid profile, the oral pill administration was associated with a more evident increase of circulating triglycerides. The 6-month treatment with the vaginal ring significantly improved the area under the curve for glucose, insulin, and C-peptide, whereas the drospirenone + ethinylestradiol pill induced an increase in the insulinogenic index and homeostatic model assessment estimate for insulin resistance values. CONCLUSION(S): Vaginal hormonal contraception appears to be preferable to oral ethinylestradiol + drospirenone administration in hyperinsulinemic patients with PCOS.
Language: English
Keywords:
ITALY | RESEARCH REPORT | PROSPECTIVE STUDIES | COMPARATIVE STUDIES | CLIENTS | OVARIAN CYSTS | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | LOW-DOSE PROGESTINS | VAGINAL RING | CARDIOVASCULAR EFFECTS | CARBOHYDRATE METABOLIC EFFECTS | LIPID METABOLIC EFFECTS | BLOOD PRESSURE | ULTRASONICS | Developed Countries | Europe, Southern | Europe | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Physiology | Biology | Metabolic Effects | Lipids | Hemic System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342128

Peer Reviewed

Title: Safety of Contraceptive Method Use Among Women With Systemic Lupus Erythematosus: A Systematic Review.
Author: Culwell KR; Curtis KM; Del Carmen Cravioto M
Source: Obstetrics and Gynecology. 2009 Aug;114(2, Part 1):341-353.
Abstract: OBJECTIVE:: To evaluate the evidence on the safety of contraceptive method use among women with systemic lupus erythematosus (SLE). DATA SOURCES:: We searched the PubMed, MEDLINE, and LILACS databases for peer-reviewed articles published from database inception through January 2009, concerning the safety of contraceptive use among women with SLE. METHODS OF STUDY SELECTION:: We included studies that examined health outcomes among women using a contraceptive method after the diagnosis of SLE. The quality of each individual piece of evidence was assessed using the U.S. Preventive Services Task Force grading system. TABULATION, INTEGRATION, AND RESULTS:: Our search yielded 275 articles. A total of 14 articles that reported on 13 studies met our inclusion criteria. Available evidence, including two good-quality randomized controlled trials, indicates that use of combined oral contraceptives does not lead to increased flares of disease or worsening disease activity in women with inactive or stable active SLE. No increase in disease activity with use of progestogen-only contraceptives was noted in four studies. Limited evidence indicates a possible increased risk of thrombosis in women with positive antiphospholipid antibodies and history of oral contraceptive use. Limited evidence indicates that the use of the copper intrauterine device is not associated with worsening disease activity or infection in women with SLE. CONCLUSION:: Available evidence indicates that many women with SLE can be considered good candidates for most contraceptive methods, including hormonal contraceptives. The benefits of contraception for many women with SLE likely outweigh the risks of unintended pregnancy in this population. Women with positive antiphospholipid antibodies are not good candidates for combined hormonal contraception given their elevated baseline risk of thrombosis.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | CLIENTS | WOMEN | SYSTEMIC LUPUS ERYTHEMATOSUS | CONTRACEPTIVE METHODS | CONTRACEPTIVE SAFETY | RISK FACTORS | ANTIBODIES | CARDIOVASCULAR EFFECTS | THROMBOSIS | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Diseases | Contraception | Family Planning | Safety | Public Health | Health | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Thromboembolism | Embolism | Vascular Diseases
Document Number: 342215

Peer Reviewed

Title: Effects of oral contraception with ethinylestradiol and drospirenone on oxidative stress in women 18-35 years old.
Author: De Groote D; d'Hauterive SP; Pintiaux A; Balteau B; Gerday C; Claesen J; Foidart JM
Source: Contraception. 2009 Aug;80(2):187-93.
Abstract: BACKGROUND: Oral contraceptives (OCs) with estrogens and progestins may affect oxidative stress (OS) status. STUDY DESIGN: A group of 32 women using oral contraceptives (OCU) containing 0.03 mg ethinylestradiol and 3 mg drospirenone have been compared to a matched control group of 30 noncontraception users (NCU). Blood levels of antioxidants, trace elements and markers of lipid peroxidation were assessed by biochemical methods. A microarray analysis of whole blood mRNA levels of 200 genes involved in OS-dependant pathway was also performed. RESULTS: Levels of zinc, vitamin E and antibodies to oxidized low-density lipoproteins (LDLs) were not significantly different between the two groups. On the other hand, significant increases in the mean levels of lipid peroxides (+176%, p<.001), oxidized LDLs (+145%, p<.002), copper (+103%, p<.001), Cu/Zn ratio (+100%, p<.001) and a significant decrease in the mean level of beta-carotene (-41%, p<.01) were observed in the OCU compared to NCU. There was a highly significant positive correlation between the lipid peroxide levels and the copper-to-zinc ratio. From the 200 genes tested by microarray, one coding for HSP70 was significantly up-regulated (log(2) fold change=+ 0.45, p<.02) and one coding for inducible nitric oxide synthase significantly down-regulated (log(2) fold change=-0.24, p<.05) in the OCU compared to the NCU. CONCLUSIONS: The recently introduced combination of ethinylestradiol and drospirenone induced the heightening of lipid peroxidation correlated with high levels of copper, a situation that could be associated with increased cardiovascular risk.
Language: English
Keywords:
BELGIUM | RESEARCH REPORT | CONTROL GROUPS | WOMEN | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | LOW-DOSE PROGESTINS | ORAL CONTRACEPTIVES, SIDE EFFECTS | METABOLIC EFFECTS | CARDIOVASCULAR EFFECTS | SERUM COPPER LEVEL | Europe, Western | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Contraceptive Safety | Safety | Public Health | Health | Physiology | Biology | Hemic System
Document Number: 342303

Title: Epidemiology of non-alcoholic fatty liver disease in China.
Author: Fan JG; Farrell GC
Source: Journal of Hepatology. 2009 Jan;50(1):204-10.
Abstract: Fatty liver (steatosis) is highly prevalent in China and is more often linked to obesity than to alcoholism. Among more affluent regions of China, the community prevalence of non-alcoholic fatty liver disease (NAFLD) is approximately 15%. With the increasing pandemic of obesity, the prevalence of NAFLD has approximately doubled in the past decade. The risk factors resemble those in other ethnic populations, but it is important to note that ethnic-specific definitions of central obesity, obesity and metabolic syndrome are more useful in assessment of Chinese people. The full range of histological manifestations of NAFLD has been demonstrated in Chinese patients, but to date hepatic severity is generally mild. In contrast to chronic hepatitis C, steatosis is less common in patients with chronic hepatitis B; it is associated with metabolic, and not viral factors and does not appear to affect disease severity. Although long-term outcomes of NAFLD in Chinese populations remain unclear, it may be a predictor of metabolic disorders, diabetes and cardiovascular disease. Public health interventions are therefore indicated to halt or reverse the national trend of obesity in China so as to improve liver as well as metabolic health.
Language: English
Keywords:
CHINA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | ETHNIC GROUPS | PREVALENCE | HEPATIC EFFECTS | OBESITY | RISK FACTORS | CULTURE | LIPID METABOLIC EFFECTS | HEPATITIS | METABOLIC EFFECTS | LONGTERM EFFECTS | DIABETES | CARDIOVASCULAR EFFECTS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Measurement | Physiology | Biology | Body Weight | Sociocultural Factors | Lipids | Viral Diseases | Diseases | Time Factors | Population Dynamics
Document Number: 330390

Title: Use of combined oral contraceptives alters metabolic determinants and genetic regulation of C-reactive protein. The Cardiovascular Risk in Young Finns Study.
Author: Haarala A; Eklund C; Pessi T; Lehtimaki T; Huupponen R; Jula A; Viikari J; Raitakari O; Hurme M
Source: Scandinavian Journal of Clinical and Laboratory Investigation. 2009;69(2):168-74.
Abstract: BACKGROUND: Use of combined oral contraceptives (COCs) is known to increase concentrations of C-reactive protein (CRP), an important predictor of cardiovascular disease. The inflammatory nature of the disease is well acknowledged. The aim of this study was to find out whether the metabolic, lifestyle and genetic determinants of CRP differ between women who use COCs and those who do not use any hormonal contraceptives (non-users). MATERIAL AND METHODS: A total of 1,257 women (24-39 years) participated in the ongoing Cardiovascular Risk in Young Finns Study, a population based cross-sectional follow-up study. Use of hormonal contraceptives was determined by questionnaire. Plasma CRP and other cardiovascular risk factors were measured; five CRP gene polymorphisms were genotyped (-717A>G, -286C>T>A, +1059G>C, +1444C>T and +1846G>A) and CRP haplotypes were constructed. RESULTS: Multivariate regression analysis revealed that BMI and leptin were the main determinants of CRP in non-users, whereas in COC users the main determinants were BMI, leptin and triglycerides. The median CRP and triglyceride values were significantly higher in COC users than in non-users. The correlations between triglyceride and CRP were tested separately in different COC users in accordance with progestagen content and dosage, the analysis revealing significant association only in women using a high dosage of progestagen or cyproterone. The haplotypes of CRP gene had no significant association with CRP concentration in COC users, while independent effects on CRP were found in non-users. CONCLUSION: Our study suggests that use of COCs alters the metabolic determinants and genetic regulation of CRP.
Language: English
Keywords:
FINLAND | RESEARCH REPORT | WOMEN | YOUTH | CONTRACEPTIVE AGENTS, PROGESTIN | BODY WEIGHT | CARDIOVASCULAR EFFECTS | METABOLIC EFFECTS | Developed Countries | Europe, Northern | Europe | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Physiology | Biology
Document Number: 341244

Title: Long-term oral contraceptive treatment, metabolic syndrome and measures of cardiovascular risk in pre-menopausal women: National Health and Nutrition Examination Survey 1999-2004.
Author: Hurwitz BE; Henry N; Goldberg RB
Source: Gynecological Endocrinology. 2009 Jun 2;:1-9.
Abstract: Aim. Differences in subclinical cardiometabolic measures were examined as a function of oral contraceptive pills (OCP) treatment duration to compare never-treated women with four OCP-treatment groups (<1, 1-5, 5-10 and >10 years). Methods. The NHANES (1999-2004) database was used to evaluate 2089 healthy, pre-menopausal women, aged 18-55 years, with or without OCP history, no other hormonal treatment or history of systemic conditions. Outcome measures included body mass, central obesity, blood pressure, glycemia, insulinemia, lipid profile and inflammation. Analyses evaluated differences in prevalence of Metabolic Syndrome (MetS), constituent MetS and other clinical risk criteria, as well as outcome magnitudes. Analyses controlled for demographic and health-related variables, and study-eligible conditions. Results. Relative to other groups, women with >10 years OCP-use, and to some extent those with 5-10 years treatment, displayed no differences in prevalence of MetS and most risk criteria. Further analysis showed that, relative to women treated for <5 years, those with more prolonged OCP treatment displayed lower body mass and fasting glycemia with higher HDL-c levels, but more elevated LDL-c and total cholesterol. Conclusions. The findings of both beneficial and detrimental subclinical cardiometabolic differences with more long-term OCP-treatment reinforces the need to monitor changes in these factors within the context of the treated patient's risk-benefit profile. However, because the magnitude of these differences was small, relative to normative ranges, it may be concluded that OCPs, as used in recent decades, are unlikely to markedly affect cardiometabolic risk.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | MENOPAUSE | CARDIOVASCULAR EFFECTS | ORAL CONTRACEPTIVES | RISK FACTORS | Developed Countries | North America | Americas | Demographic Factors | Population | Reproduction | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Health
Document Number: 341563

Peer Reviewed

Title: The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement.
Author: Kilic S; Yuksel B; Doganay M; Bardakci H; Akinsu F; Uzunlar O; Mollamahutoglu L
Source: Contraception. 2009 Aug;80(2):152-7.
Abstract: BACKGROUND: This study was conducted to evaluate the effect of levonorgestrel-releasing intrauterine devices (LNG-IUDs) on menorrhagia in patients receiving anticoagulant therapy after cardiac valve replacement. STUDY DESIGN: Forty women with menorrhagia who underwent cardiac valve replacement and were taking anticoagulant medication were enrolled in the study. The women were randomly divided into two groups: LNG-IUDs were inserted into 20 women in Group 1 over the first 3 days of menstrual bleeding, while the women in Group 2 were followed without any intervention. The activated partial thromboplastin time, prothrombin time, international normalized ratio, hematocrit level, hemoglobin level, ferritin level and pictorial bleeding assessments for the quantity of menstrual bleeding were recorded. RESULTS: Three months after insertion of LNG-IUDs, the women in Group 1 had a significant decrease in blood loss and higher hemoglobin, hematocrit and ferritin values. No difference was detected for these parameters in the control group at the third and sixth months of the study. Coagulation parameters did not differ between the two groups. CONCLUSION: LNG-IUDs can be considered as an effective non-surgical treatment for menorrhagia in women receiving anticoagulant therapy after cardiac valve replacement.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | CARDIOVASCULAR EFFECTS | POSTOPERATIVE PROCEDURES | DRUGS | BLOOD COAGULATION EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Physiology | Biology | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hematological Effects | Hemic System
Document Number: 342392

10.

Title: [Effect of combined hormonal contraceptives on the vascular endothelium und new cardiovascular risk parameters] Effekt hormonaler Kontrazeptiva auf das Endothel und neue kardiovaskulare
Author: Merki-Feld GS
Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):89-92.
Abstract: Epidemiological studies indicate an increased cardiovascular risk in users of combined oral contraceptives (COC) but not progestagen-only preparations. A specially high risk was observed in women older than 35 years with additional cardiovascular risk factors like smoking or hypertension. The mechanisms underlying arterial occlusion can not be explained by hormonal effects on the vascular tonus, nor by effects on newer risk parameters like homocysteine or transforming growth factor-beta. However, CRP increases during oral and transdermal COC use, an effect which can not be observed during use of a progestagen-only implant. Studies concerning the effect of COC on the vasotonus, nitric oxide, homocysteine and CRP usually include young healthy women with intact endothelial function. Females with nicotinabusus, hypertension and hypercholesterolemia have a damaged endothelium. The effect of hormonal treatment on the endothelium in these women might include decreased ability to release the strong vasodilator nitric oxid and as a consequence of that impaired vasodilation.
Language: German
Keywords:
RESEARCH REPORT | EPIDEMIOLOGY | ORAL CONTRACEPTIVES, COMBINED | CARDIOVASCULAR EFFECTS | HYPERTENSION | TREATMENT | RISK FACTORS | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Vascular Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 329574

11.

Title: [Contraception in women with special problems] Kontrazeption bei Problemfallen.
Author: Mueck A; Neulen J; Thaler C; Birkhauser M; Braendle W
Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):117-28.
Abstract: Thromboembolic, cardiovascular and cerebrovascular events are age-dependent. They are extremely rare in young women. In contrast to the progestogen-only pills, oral contraceptives (OC) increase the risk of venous thrombosis. However, decisive ist the genetic predisposition. In healthy non-smokers of less than 35 years of age, the risk to suffer from a myocardial infarction or a cerebrovascular accident is not increased by OC. Risk factors play a major role in the etiology of cardiovascular dieases. A detailed personal and family history is therefore mandatory before OC are prescribed. Very rarely, blood pressure is increased by OC. Although the incidence of such an increase is very low, blood pressure has to be measured regularly in pill users. Inspite of a current opinion, weight increase is rare in OC users. It depends mainly on the individual predisposition. An increased water retention can be reduced by a combined OC containing a progestagen with an antimineralocorticoid activity. Changes in insulin and blood sugar induced by low-dose OC are minimal so that they have no clinical relevance. OC do not increase the incidence of diabetes. Adrenal and thyroid function are not influenced by OC, there is no increased incidence of prolactinomas. Asthma is no contraindication against OC. If there is a cycle-dependent aggravation of the disease, OC might be beneficial. OC have no side-effects on the eye or the ear. In women suffering from lupus erythematodes having no renal participation, no increased antiphospholipid-antibodies and showing a stable or inactve disease, low-dose OC might be used.
Language: German
Keywords:
RESEARCH REPORT | RISK FACTORS | ORAL CONTRACEPTIVES | CARDIOVASCULAR EFFECTS | HEART DISEASES | CONTRACEPTIVE AGENTS, PROGESTIN | PROGESTERONE | CONTRACEPTIVE SAFETY | Biology | Contraceptive Methods | Contraception | Family Planning | Physiology | Diseases | Contraceptive Agents, Female | Contraceptive Agents | Progestational Hormones | Hormones | Endocrine System | Safety | Public Health | Health
Document Number: 329570

12.

Title: Cardiac manifestations of HIV infection: an African perspective.
Author: Ntsekhe M; Mayosi BM
Source: Nature Clinical Practice. Cardiovascular Medicine. 2009 Feb;6(2):120-7.
Abstract: The pericardium, myocardium, coronary arteries and pulmonary arteries are the main targets for cardiac disease in people who are infected with HIV. Geography and access to highly active anti-retroviral therapy (HAART) have a major influence on which of these targets is affected. In sub-Saharan Africa, where tuberculosis is endemic and access to HAART is limited, the dominant forms of HIV-associated heart disease are pericardial tuberculosis and cardiomyopathy. However, in industrialized countries, where tuberculosis is rare and HAART is widely available, coronary artery disease is the main cause of death and disability in these patients. Observational data suggest that HAART, by preserving immune function, reduces the incidence of myopericardial disease and pulmonary hypertension. The result has been that, although optimal strategies to reduce vascular disease in this population continue to be sought and debated in industrialized nations, the focus of prevention and treatment strategies for HIV-related heart disease in developing countries has been to support the active campaigns to get universal access to HAART in the first place. Herein, we review the cardiac manifestations of HIV in sub-Saharan Africa.
Language: English
Keywords:
AFRICA | SUMMARY REPORT | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | CARDIOVASCULAR EFFECTS | HEART DISEASES | HIV INFECTIONS | HYPERTENSION | Developing Countries | Viral Diseases | Diseases | Infections | Physiology | Biology | Vascular Diseases
Document Number: 330530

13.
Title: [Options of hormonal contraceptives and substitution in female diabetic patients] Moznosti hormonalni antikoncepce a substituce u diabeticek.
Author: Sadlonova J
Source: Vnitrni Lekarstvi. 2009 Apr;55(4):375-83.
Abstract: The pregnancy planning is extremely important for women with diabetes mellitus and therefore, reliable contraceptives are indispensable for such women. Generally, female diabetic patients can use the same forms of contraceptives as healthy women, however, in their case many specific circumstances must be considered, which are addressed in the first part of the overview. In particular, the selection of hormonal contraceptives for type I female diabetic patients with late complications and type II female diabetic patients is problematic as in this area very few studies are available. The other part of the overview is dedicated to hormonal substitution therapy. The author discusses its metabolic effects and possible administration to female diabetic patients. Menopause and diabetes mellitus are associated with a high risk of cardiovascular complications. Both pharmacologic and non-pharmacologic control of risk factors may reduce the risk of the disease. However, a definite recommendation of hormonal substitution therapy is not possible; both the benefits and risks for a particular female patient need to be considered.
Language: Czech
Keywords:
RESEARCH REPORT | CLIENTS | WOMEN | DIABETES | PREGNANCY | FAMILY PLANNING | CONTRACEPTIVE USAGE | CARDIOVASCULAR EFFECTS | RISK FACTORS | MENOPAUSE | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Diseases | Reproduction | Contraception | Physiology | Biology | Health
Document Number: 341198

14.

Title: Contraceptive hormone use and cardiovascular disease.
Author: Shufelt CL; Bairey Merz CN
Source: Journal of the American College of Cardiology. 2009 Jan 20;53(3):221-31.
Abstract: Contraceptive hormones, most commonly prescribed as oral contraceptives (OCs), are a widely utilized method to prevent ovulation, implantation, and, therefore, pregnancy. The Women's Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting a review of the safety, efficacy, and side effects of other forms of hormone therapy. A variety of basic science, animal, and human data suggests that contraceptive hormones have antiatheromatous effects; however, relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion, and arrhythmogenesis. Newer generation OC formulations in use indicate no increased myocardial infarction risk for current users, but a persistent increased risk of venous thromboembolism. There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the nonoral routes (transdermal and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy, and other vascular diseases, including migraines, prior to use. Existing data are mixed with regard to possible protection from OCs for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | HORMONES | ORAL CONTRACEPTIVES | HORMONE REPLACEMENT THERAPY | CARDIOVASCULAR EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | RISK BEHAVIOR | RISK FACTORS | SCREENING | Developed Countries | North America | Americas | Demographic Factors | Population | Endocrine System | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Behavior | Examinations and Diagnoses
Document Number: 329606

15.

Title: Metabolic and cardiovascular impact of oral contraceptives in polycystic ovary syndrome.
Author: Soares GM; Vieira CS; de Paula Martins W; Dos Reis RM; de Sa MF; Ferriani RA
Source: International Journal of Clinical Practice. 2009 Jan;63(1):160-9.
Abstract: Chronic anovulation, polycystic ovarian morphology and hyperandrogenism are the diagnostic criteria for polycystic ovary syndrome (PCOS). Metabolic disturbances are more common in PCOS women who are prone to develop metabolic syndrome and to present higher levels of some cardiovascular disease risk marker. Oral contraceptives are widely used in PCOS, but conflicting data have been reported regarding their impact on carbohydrate and lipid metabolism on PCOS women. This paper presents a critical evaluation of combined oral contraceptives (COCs) metabolic effect - carbohydrate metabolism and insulin sensitivity, lipid metabolism, haemostasis, body weight, arterial pressure and cardiovascular impact - on PCOS women. Because of the paucity of data on the impact of COCs on cardiovascular and metabolic parameters in PCOS patients, most of there commendations are based on studies involving ovulatory women. The use of low-dose COCs is preferable in PCOS, especially among patients with glucose intolerance, insulin resistance and uncomplicated diabetes mellitus. Although reported as a side effect of COCs, marked weight gain has not been confirmed among users. However, when arterial hypertension or elevated risk for thromboembolism is present, progestogen-only hormonal contraceptives should be used instead of COCs. Regarding dyslipidaemia, COCs reduce low-density lipoprotein and total cholesterol and elevate high-density lipoprotein and triglycerides, and therefore are not recommended for women with high triglycerides levels. The choice of a COC, which alleviates the PCOS-induced hyperandrogenism without significant negative impact on cardiovascular risk, is one of the greatest challenges faced by gynaecologists nowadays.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | OVARIAN CYSTS | CARDIOVASCULAR EFFECTS | ORAL CONTRACEPTIVES, COMBINED | BODY WEIGHT | CARBOHYDRATE METABOLIC EFFECTS | ORAL CONTRACEPTIVES, SIDE EFFECTS | LIPID METABOLIC EFFECTS | CONTRACEPTIVE SAFETY | BLOOD PRESSURE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Economic Development | Economic Factors | Diseases | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Metabolic Effects | Safety | Public Health | Health | Lipids | Hemic System
Document Number: 341138

16.

Title: The Transnational study of oral contraceptive cardiovascular safety: history and science.
Author: Suissa S
Source: Journal of Clinical Epidemiology. 2009;62:588-593.
Abstract: This study, in which Kuhl et al. reported elevated ethinyl estradiol (EE) levels in women receiving the gestodene/EE combination oral contraceptives (OCs) compared with desogestrel-containing combination OCs, by its implication that such differences could be associated with increased cardiovascular risks, had attracted much publicity and created great concern in Germany. The working group found sufficient methodological deficiencies in the Kuhl study to question the validity of its findings of significant differences in effects between the various OCs. Besides a large number of studies mostly irrelevant to the issue of cardiovascular risk, Schering had conducted a large postmarketing phase IV study in over 100,000 women. Joe Fleiss, who was the primary reviewer of that report, presented the shortest review I had ever witnessed: he raised the thick report in the air and simply tossed it on the floor. It was clear to all that the data were simply unreliable and unusable to address this safety concern. The working group thus recommended that the only way to address the safety issue regarding gestodene was to conduct epidemiological studies on the safety of all newer low-dose OCs and saw it as an international priority, particularly in view of the number of newer OCs that had been brought to market and the scarcity of recent published studies. Schering agreed in principle to fund such research, and Walter coordinated the writing of protocols for a research program that included three studies. The Trinational study, a field case-control study conducted in three European countries was the only one retained. The Value Added Medical Products (VAMP), the predecessor of the General Practice Research Database (GPRD), historical cohort study was rejected for political (no data on German women) and scientific reasons, such as the absence of important confounder data and insufficient OC history. The Saskatchewan study was rejected because gestodene was not available in Saskatchewan, and other low-dose COCs, by themselves, were not relevant to the sponsors. (excerpt)
Language: English
Keywords:
EUROPE, WESTERN | CONFERENCES AND CONGRESSES | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CROSS-CULTURAL COMPARISONS | WOMEN | CONTRACEPTIVE SAFETY | ORAL CONTRACEPTIVES | CARDIOVASCULAR EFFECTS | GESTODENE | ORAL CONTRACEPTIVES, COMBINED | DESOGESTREL | ORAL CONTRACEPTIVES, LOW-DOSE | LOW-DOSE PROGESTINS | NORTH AMERICA, NORTHERN | Europe | Developed Countries | Research Methodology | Comparative Studies | Studies | Demographic Factors | Population | Safety | Public Health | Health | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Americas
Document Number: 331005

17.

Title: ST elevation myocardial infarction in a teenager: case report and review of the literature.
Author: Vivo RP; Krim SR
Source: Southern Medical Journal. 2009 May;102(5):523-6.
Abstract: In the presence or absence of atherosclerosis, young adults can experience a myocardial infarction. Notably, young patients are at increased risk to be misdiagnosed since they do not frequently have traditional coronary risk factors. We describe a 19-year-old woman with chest pain and ST elevation on electrocardiogram who was initially suspected to have pericarditis. History revealed hormonal contraception and marked elevation of troponins, which later led to the diagnosis of myocardial infarction. Angiography displayed an occlusion of the right coronary artery that resolved with anticoagulation treatment. She recovered uneventfully. Differential diagnoses of ST elevation and various causes of acute coronary syndromes among young patients are reviewed.
Language: English
Keywords:
UNITED STATES OF AMERICA | CASE STUDIES | CLIENTS | WOMEN | ORAL CONTRACEPTIVES, COMBINED | CARDIOVASCULAR EFFECTS | SIGNS AND SYMPTOMS | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Diseases
Document Number: 341205

18.

Peer Reviewed

Title: Depot-medroxyprogesterone acetate: An update.
Author: Bakry S; Merhi ZO; Scalise TJ; Mahmoud MS; Fadiel A
Source: Archives of Gynecology and Obstetrics. 2008 Jul;278(1):1-12.
Abstract: Depo-Provera is a contraceptive approved by the US Food and Drug Administration (FDA) since 1992 and used worldwide by more than 90 million women. Despite the fact that progestins are endogenous hormones that are secreted by the body, its excess might lead to detrimental health eVects. Whether progestins as contraceptives are friends or foes is a questionable matter. In this manuscript, we drive the attention to both usage and side eVects Depo-Provera. Depot-medroxyprogesterone acetate (DMPA) is a highly eVective, convenient non-daily hormonal contraceptive option that has been available worldwide for many years. The experience with DMPA provides a large body of long-term data regarding the efficacy and safety of this contraceptive method; this long-term experience has established that the use of DMPA does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture; however, patients are often more concerned about the relatively immediateeVects of contraceptives such as potential changes in menstrual cycle, body weight, and mood disturbances. Concerns about such issues may lead to reluctance to initiate therapy or premature discontinuation. Counseling and understanding of women's concerns and experiences using Depo-Provera is important and could help health care providers redesign counseling strategies to improve contraceptive continuation and improve patient adherence. (author's)
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | DEPO-PROVERA | CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CARDIOVASCULAR EFFECTS | OSTEOPOROSIS | GYNECOLOGIC DISEASES | BODY WEIGHT | CONTRACEPTIVE SAFETY | Medroxyprogesterone Acetate | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Physiology | Biology | Skeletal Effects | Genital Effects, Female | Genitalia, Female | Genitalia | Urogenital System | Safety | Public Health | Health
Document Number: 327011

19.

Peer Reviewed

Title: Cardiovascular disease and global health equity: Lessons from tuberculosis control then and now.
Author: Bukhman G; Kidder A
Source: American Journal of Public Health. 2008 Jan;98(1):44-54.
Abstract: Early 20th-century cardiovascular voluntary organizations in the United States drew strength from the well-established antituberculosis movement. By mid-century, heart disease among the young and tuberculosis had declined in this country. The international fight against tuberculosis has gathered force since the 1990s. Meanwhile, support for international cardiovascular interventions has lagged behind. We trace the divergent path of the international cardiovascular movement and suggest ways in which it could once again learn from the trials and achievements of tuberculosis control.
Language: English
Keywords:
GLOBAL | UNITED STATES OF AMERICA | HISTORICAL REVIEW | CRITIQUE | CARDIOVASCULAR EFFECTS | TUBERCULOSIS | PREVENTION AND CONTROL | INEQUALITIES | CAMPAIGNS | PUBLIC HEALTH | Developed Countries | North America | Americas | Physiology | Biology | Infections | Diseases | Socioeconomic Factors | Economic Factors | Communication Programs | Communication | Health
Document Number: 325760

20.

Peer Reviewed

Title: Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome.
Author: Cheung LP; Lam PM; Lok IH; Haines CJ; So WY
Source: Human Reproduction. 2008;23(6):1431-1438.
Abstract: Women with polycystic ovary syndrome (PCOS) frequently exhibit central obesity, glucose intolerance, atherogenic dyslipidaemia and hypertension which are characteristic features of the metabolic syndrome (MetS). A total of 295 premenopausal Chinese women with PCOS diagnosed by the Rotterdam criteria (mean age: 30.2 plus or minus 6.4 years) and 98 control subjects without PCOS were evaluated for prevalence of MetS and cardiovascular risk factors, including dyslipidaemia and dysglycaemia. Using the 2005 modified Adult Treatment Panel III criteria, MetS (presence of three or more risk factors) was found in 24.9% of PCOS women compared to 3.1% of controls. The prevalence of MetS in PCOS women increased from 16.7% at under 30 years of age to 53.3% at over 40 years. MetS was also more prevalent in overweight and obese (41.3%) than normal-weight PCOS women (0.9%). However, multivariate regression analysis showed that women with PCOS had a 5-fold increase in risk of MetS (odds ratio 4.90; 95% confidence interval: 1.35-17.84) compared with women without PCOS even after controlling for age and BMI, suggesting PCOS alone is an independent risk factor for MetS. There is high prevalence of MetS in Hong Kong Chinese women with PCOS despite their relatively young age. Recognition of these cardiometabolic risk factors requires a high level of awareness in conjunction with early and regular screening. (author's)
Language: English
Keywords:
HONG KONG | RESEARCH REPORT | WOMEN | MENSTRUAL CYCLE | EXAMINATIONS AND DIAGNOSES | OVARIAN CYSTS | PREVALENCE | OBESITY | AGE FACTORS | RISK FACTORS | CARDIOVASCULAR EFFECTS | METABOLIC EFFECTS | Asia, Eastern | Asia | Developed Countries | Demographic Factors | Population | Menstruation | Reproduction | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Measurement | Research Methodology | Body Weight | Physiology | Biology | Population Characteristics
Document Number: 326851

21.

Peer Reviewed

Title: Nicotine in breast milk influences heart rate variability in the infant.
Author: Dahlstrom A; Ebersjo C; Lundell B
Source: Acta Paediatrica. 2008;:[5] p.
Abstract: The aim was to study the effects of postnatal exposure to nicotine on the regulation of heart rate and blood pressure in infants. Thirty-eight mother-infant pairs were studied. Twenty nonsmoking and 18 smoking (2-20 cigarettes per day) mothers were included. All infants were healthy, exclusively breastfed and their postnatal age was 6 weeks. During a home visit infant's urine and mothers' milk were sampled and concentrations of nicotine and cotinine were analyzed. Infants' electrocardiogram (ECG) were recorded, sleep state documented and blood pressure during sleep was measured. Heart rate variability (HRV) was calculated with spectral analysis of R-R intervals. The smoking mothers exposed their infants to nicotine in milk with a median nicotine concentration of 47 (8-192) microg/L. Analysis of infants' urine showed that the nonsmoking group had 0.8 (0-5.2) and the smoke group 60 (17-139) microg cotinine/L (p less than 0.01). The frequency domain low-to-high frequency (LF/HF) ratio, was correlatedto milk nicotine concentrations in the milk sample, from smoking mothers. HRV decreased, with increasing milk nicotine, ingested by the boys (r = -0.74, p = 0.02) but not the girls (r = -0.13, p = 0.76). The differences of mean arterial pressure between sleep states in the infants, were significantly lower in the smoke group 5.8(6.8) compared to the nonsmoke group 11.5(7.2) mmHg (p = 0.03). Postnatal exposure to nicotine influences autonomic cardiovascular control in infants. (author's)
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | INFANT | MOTHERS | BREASTFEEDING, EXCLUSIVE | TOBACCO USE | EXAMINATIONS AND DIAGNOSES | BLOOD PRESSURE | MOTHER-TO-CHILD TRANSMISSION | EXPOSURE | CARDIOVASCULAR EFFECTS | Europe, Northern | Europe | Developed Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Breastfeeding | Infant Nutrition | Nutrition | Health | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Hemic System | Physiology | Biology | Transmission | Infections | Diseases | Risk Factors
Document Number: 327168

22.

Peer Reviewed

Title: The effect of ethinyl estradiol -- cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome.
Author: Gul OB; Somunkiran A; Yucel O; Demirci F; Ozdemir I
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):25-30.
Abstract: Women with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol-cyproterone acetate (EE-CA) on serum Hcy levels in women with PCOS. A total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35 microg/2 mg) for 3 months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3-5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle. Three months of EE-CA therapy significantly decreased the Hcy levels from 55.97 +or- 16.04 to 54.03 +or- 16.15 (P = 0.01). A significant correlation was observed between the Hcy and total and free testosterone levels (r = 0.44, P = 0.015 and r = 0.46, P = 0.001 respectively). Although the decrease in Hcy levels with EE-CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | WOMEN | OVARIAN CYSTS | CARDIOVASCULAR EFFECTS | RISK FACTORS | ORAL CONTRACEPTIVES | ETHINYL ESTRADIOL | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Diseases | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 322612

23.

Title: Cardiovascular effects of medroxyprogesterone acetate and progesterone: a case of mistaken identity?
Author: Hermsmeyer RK; Thompson TL; Pohost GM; Kaski JC
Source: Nature Clinical Practice. Cardiovascular Medicine. 2008 Jul;5(7):387-95.
Abstract: Heart disease presentation can differ between the sexes because nonobstructive coronary disease and angina unrelated to exercise are considerably more prevalent in women than in men. When the outcomes of large, randomized, controlled trials failed to demonstrate cardiac risk protection, many women and their physicians abandoned hormone replacement therapy as primary or secondary prevention for cardiovascular disease. We are concerned that the apparent blanket condemnation of steroids has not sufficiently distinguished between the cardiovascular actions of estrogen, progesterone and the synthetic progestin medroxyprogesterone acetate. The actions of active metabolites of progestins are not well understood and in some cases have not been explored. We intend to present what is known and what is not known about progesterone per se versus medroxyprogesterone acetate, particularly with regard to cardiovascular effects. This Review considers the mounting evidence that progesterone improves cardiovascular function and proposes its mechanism of action-restoration of a threshold level of progesterone as preventive of microvascular cardiac ischemia-and compares oral and transdermal routes of administration. We hope to stimulate research to determine whether progesterone, with or without estrogen, has a role in reducing cardiovascular risk and treating cardiovascular disease including myocardial ischemia in postmenopausal women.
Language: English
Keywords:
UNITED STATES OF AMERICA | SUMMARY REPORT | WOMEN | HEART DISEASES | SEX FACTORS | PROGESTERONE | CONTRACEPTIVE AGENTS, PROGESTIN | CARDIOVASCULAR EFFECTS | Developed Countries | North America | Americas | Demographic Factors | Population | Diseases | Population Characteristics | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning
Document Number: 328471

24.

Title: IL-23 and IL-17 in tuberculosis.
Author: Khader SA; Cooper AM
Source: Cytokine. 2008 Feb;41(2):79-83.
Abstract: Tuberculosis is a chronic disease requiring the constant expression of cellular immunity to limit bacterial growth. The constant expression of immunity also results in chronic inflammation, which requires regulation. While IFN-gamma-producing CD4+ T helper cells (Th1) are required for control of bacterial growth they also initiate and maintain a mononuclear inflammatory response. Other T cell subsets are induced by Mycobacterium tuberculosis (Mtb) infection including those able to produce IL-17 (Th17). IL-17 is a potent inflammatory cytokine capable of inducing chemokine expression and recruitment of cells to parenchymal tissue. Both the IL-17 and the Th17 response to Mtb are largely dependent upon IL-23. Although both Th17 and Th1 cells are induced following primary infection with Mtb, the protective response is significantly altered in the absence of Th1 cells but not in the absence of Th17. In contrast, in vaccinated animals the absence of memory Th17 cells results in loss of both the accelerated memory Th1 response and protection. Th1 and Th17 responses cross-regulate each other during mycobacterial infection and this may be important for immunopathologic consequences not only in tuberculosis but also other mycobacterial infections.
Language: English
Keywords:
UNITED STATES OF AMERICA | LITERATURE REVIEW | CLIENTS | TUBERCULOSIS | BACTERIAL AND FUNGAL DISEASES | IMMUNITY, CELLULAR | VACCINATION | CARDIOVASCULAR EFFECTS | INFECTIONS | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Diseases | Immunity | Immune System | Physiology | Biology | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health
Document Number: 325743

25.

Title: Tubercular myocarditis presenting with ventricular tachycardia.
Author: Khurana R; Shalhoub J; Verma A; Assomull R; Prasad SK; Kooner JS; Sethi A
Source: Nature Clinical Practice. Cardiovascular Medicine. 2008 Mar;5(3):169-74.
Abstract: BACKGROUND: A previously fit and healthy 30-year-old man reported experiencing palpitations accompanied by nausea, sweating and presyncope. These symptoms were found to be associated with episodes of nonsustained ventricular tachycardia. He was a nonsmoker, did not drink excessively, denied illicit drug use and had no family history of structural cardiac disease or sudden death. INVESTIGATIONS: Electrocardiography, laboratory tests, electrophysiological studies, echocardiography, coronary angiography, chest radiography, cardiac MRI (with late gadolinium enhancement), chest CT, lymph-node biopsy, Ziehl Nielsen staining, blood and sputum cultures and heaf testing. DIAGNOSIS: Tubercular myocarditis. MANAGEMENT: Antituberculous chemotherapy supported by antiarrhythmic and steroid pharmacotherapy and cardioverter-defibrillator implantation. Repeated imaging was performed to monitor disease progression.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | MEN | SIGNS AND SYMPTOMS | CARDIOVASCULAR EFFECTS | EXAMINATIONS AND DIAGNOSES | TUBERCULOSIS | MYOCARDIAL INFARCTION | DRUGS | ADMINISTRATION AND DOSAGE | MANAGEMENT | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Heart Diseases | Treatment | Organization and Administration
Document Number: 325744

26.

Peer Reviewed

Title: Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: Long term follow-up of Hyderabad nutrition trial.
Author: Kinra S; Sarma KV; Ghafoorunissa; Mendu VV; Ravikumar R
Source: BMJ. British Medical Journal. 2008;337(251):a605.
Abstract: The objective of this study was to determine whether integration of nutritional supplementation with other public health programmes in early life reduces the risk of cardiovascular disease in undernourished populations. Its design used approximately 15 years' follow-up of participants born within an earlier controlled, community trial of nutritional supplementation integrated with other public health programmes. 1165 adolescents aged 13-18 year participated in 29 villages (15 intervention, 14 control) near Hyderabad city, south India. Balanced protein-calorie supplementation (2.51 MJ, 20 g protein) was offered daily to pregnant women and preschool children aged under 6 years, coupled with integrated delivery of vertical public health programmes. The main outcome measures were height, adiposity, blood pressures, lipids, insulin resistance (homoeostasis model assessment (HOMA) score), and arterial stiffness (augmentation index). The participants from the intervention villages were 14 mm (95% confidence interval 4 to 23; P=0.007) taller than controls but had similar body composition. The participants from the intervention villages had more favourable measures of insulin resistance and arterial stiffness: 20% (3% to 39%; P=0.02) lower HOMA score and 3.3% (1% to 5.7%; P=0.008) lower augmentation index. No strong evidence existed for differences in blood pressures and serum lipids. In this undernourished population, integrated delivery of supplemental nutrition with other public health programmes in pregnancy and early childhood was associated with a more favourable profile of cardiovascular disease risk factors in adolescence. This pragmatic study provides the most robust evidence to date on this important hypothesis for which classic trials are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular disease in low income and middle income countries. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS | PREGNANT WOMEN | CHILDREN | FOOD SUPPLEMENTATION | NUTRITION | NUTRITION PROGRAMS | INTEGRATED PROGRAMS | DELIVERY OF HEALTH CARE | CARDIOVASCULAR EFFECTS | DISEASE PREVENTION | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Primary Health Care | Health Services | Health | Programs | Organization and Administration | Physiology | Biology | Prevention and Control | Diseases
Document Number: 328113

27.

Title: [Update on the progestin-only contraception] Mise au point sur la contraception progestative.
Author: Madelenat P; Koskas M
Source: Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 2008 Nov;37(7):637-60.
Abstract: Despite the lack of complete data concerning their effects, the use of progestin-only contraception is increasing in France (particularly the intra-uterine device, the subdermal implantation, and microprogestins). These prescriptions include a broad range of molecules and administration of doses. In some cases, prescriptions of progestogens are made out of the marketing authorisation indications (especially for macroprogestins). For all of these reasons, an Expert Advisory Board has been set up in order to answer the 35 questions addressed by an Expert Organization Board. The choice of these questions was based on controversial or nonconsensual points usually encountered in everyday clinical practice. When possible, answers given were strongly supported by data issued from medical literature. In situations where clinical studies were lacking, the Expert Advisory Board answered in the most consensual way. All answers given by the Expert Advisory Board were subsequently submitted to the Expert Assessment Board before the latest validation of this document. The progestogen only contraception has different levels of action (local and/or central) which may vary from one drug to another. Its prescription is granted satisfactory efficacy (the macroprogestins' efficacy has never been evaluated) but requires a strict pill-taking routine (especially for the microprogestin contraception). It has never been demonstrated that the use of progestogen is associated with an increased risk of breast cancer. Nevertheless, analysis of breast cancer and progestogen studies should be carried out carefully. Even though the effects, often misunderstood, of the different progestogens on mineral bone density are likely to vary according to the molecules, in particular due to the plasma estradiol level, there is no direct argument for considering the progestin only contraception as a fracture risk factor. As for the venous thromboembolism risk, progestogens are not considered to be risk factors. The progestogen only contraception is advised in the following cases: bad tolerance of exogenous oestrogens; in order to counteract an endogenous hyperoestrogenosis; metabolic or cardiovascular contraindications to estroprogestin; hormonal fluctuations generating premenstrual dysphoria or catamenial headaches. Lastly, the progestin-only contraception should be used as a prime contraception in some particular situations (breast feeding, adenomyosis...).
Language: French
Keywords:
FRANCE | RESEARCH REPORT | QUESTIONNAIRES | PRESCRIPTIONS | CONTRACEPTIVE AGENTS, PROGESTIN | THROMBOSIS | CARDIOVASCULAR EFFECTS | RISK FACTORS | Europe, Western | Europe | Developed Countries | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Thromboembolism | Embolism | Vascular Diseases | Diseases | Physiology | Biology
Document Number: 329622

29.
Peer Reviewed

Title: Prevalence of dyslipidemia and dysglycaemia in HIV infected patients.
Author: Manuthu EM; Lule GN; Karari E
Source: East African Medical Journal. 2008 Jan;85(1):10-17.
Abstract: Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS morbidity and mortality; however long-term metabolic consequences including dysglycaemia and dyslipidemia have raised concern regarding accelerated cardiovascular disease risk. Objective: To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-infected patients. Design: Cross-sectional comparative group study. Setting: Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility. Subjects: Consecutive HIV- positive adult patients. Main outcome measures: Dyslipidemia: presence of raised total or LDL cholesterol or low HDL cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, out of 342 screened patients, 295 were recruited and 58% were females. One hundred and thirty four (45%) were on HAART, 82% of whom were on stavudine, lamivudine and either nevirapine or efavirenz. Overall prevalence of dyslipidemia was 63.1% and dysglycaemia was 20.7%. High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917). HDL levels were low in 14.6% and 51.3% among HAART and HAART naive patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 C1 0.688-2.037). Among patients on HAART compared to HAART naive patients, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.221, respectively. Conclusions: HIV-infected patients demonstrated a high prevalence of dyslipidemia. HAART use was associated with high levels of total, and LDL cholesterol and high triglyceride levels, an established athrogenic lipid profile. However, HAART was not associated with low HDL cholesterol and had no significant effect on dysglycaemia.
Language: English
Keywords:
KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | CASE CONTROL STUDIES | PERSONS LIVING WITH HIV/AIDS | CARDIOVASCULAR EFFECTS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | SIDE EFFECTS | CHOLESTEROL | DIABETES | PREVALENCE | GLUCOSE METABOLISM EFFECTS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Physiology | Biology | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Lipids | Measurement | Carbohydrate Metabolic Effects | Metabolic Effects
Document Number: 326585

30.

Title: Effects of the progestagen-only contraceptive implant Implanon on cardiovascular risk factors.
Author: Merki-Feld GS; Imthurn B; Seifert B
Source: Clinical Endocrinology. 2008 Mar;68(3):355-360.
Abstract: Epidemiological studies on the cardiovascular risk of progestagen-only contraceptives are rare. With the present study we aimed to investigate the effect of the low-dose etonogestrel-releasing contraceptive implant Implanon on cardiovascular risk factors, including markers of inflammation. The design was a longitudinal study. The setting was a family planning centre of a University Hospital. The subjects were thirty-six healthy, nonsmoking women with regular cycles (n = 18 controls without hormonal contraception; n = 18 cases requesting the insertion of Implanon). Blood samples for the determination of C-reactive protein (CRP), nitric oxide (NO), sex hormones and plasma lipids were taken in the early follicular phase of the cycle in both groups. A second sample was taken 12 weeks after Implanon insertion or in the controls during the early follicular phase of cycle 4. Implanon treatment caused a 36% decrease in CRP (P less than 0.06) and a significant decrease in high density lipoprotein (HDL) (P less than 0.007), low density lipoprotein (LDL) (P less than 0.001), cholesterol (P less than 0.001), testosterone (P less than 0.05) and SHBG (P less than 0.002). Levels of NO, oestradiol and progesterone were not affected in either group. The cholesterol/HDL ratio did not change in Implanon carriers. There was a significant correlation between the cardiovascular risk factors CRP, cholesterol/HDL ratio and NO. The progestagen-only implant Implanon does not exert a negative effect on the cardiovascular risk factors CRP, cholesterol/HDL ratio and NO. These results suggest that the use of a progestagen-only contraception does not increase cardiovascular risk factors in healthy young women. (author's)
Language: English
Keywords:
SWITZERLAND | RESEARCH REPORT | LONGITUDINAL STUDIES | CASE CONTROL STUDIES | WOMEN | CONTRACEPTIVE IMPLANTS | LOW-DOSE PROGESTINS | CARDIOVASCULAR EFFECTS | RISK FACTORS | Europe, Central | Europe | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Physiology | Biology
Document Number: 325384


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