- Email: [email protected]
MENOPAUSAL SYMPTOMS AND ECHOCARDIOGRAPHIC CHANGES IN HYPOTHYROSIS
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
S57
212
214
LEFT VENTRICULAR HYPERTROPHY - IMPACT OF MENOPAUSAL HORMONE THERAPY?
RALOXIFENE MODIFIES THE INSULIN SENSITIVITY OF POSTMENOPAUSAL WOMEN
M. Dören 1 , A. Obst 2 , C. Schwahn 3 , H. Völzke 3 , C.O. Schmidt 3 , M. Dörr 4, S.B. Felix 4 , S. Schwarz 1 . 1 Charité-Universitätsmedizin Berlin, Women’s Health, Berlin, Germany; 2 Ernst Moritz Arndt University of Greifswald, Dept. Internal Medicine B, Cardiology & Pulmonary Diseases, Greifswald, Germany; 3 Ernst Moritz Arndt University of Greifswald, Institute for Community Medicine, SHIP, Greifswald, Germany; 4 Ernst Moritz Arndt University of Greifswald, Dept. Internal Medicine B, Cardiology, Greifswald, Germany
F. Grover-Páez, A.B. Zavalza-Gómez, R. Anaya-Prado. Mexican Institute of Social Security, Menaopausal Search Division Unit, Guadalajara, Mexico
Objectives: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular diseases. Several studies, mostly based on small study samples, hypothesized that menopausal hormone therapy (MHT) may reduce the likelihood of LVH, although this has not been a consistent finding. We examined the cross-sectional and longitudinal association between MHT use and echogardiographically determined LVH in women ≥ 45 years. Methods: The current study consists of cross-sectional (975 women) and longitudinal analyses (361 women without LVH at baseline) using data from the Study of Health in Pomerania. Women were principally divided into ever and never users of MHT. Analyses were repeated with an alternative classification of MHT use (never, past, and current). Multivariable logistic regression models were adjusted for age, pulse pressure, use of antihypertensive medication, school education, smoking, and weight (including lengths of follow-up also in longitudinal analysis). Results: We observed no significant association between ever use of MHT and LVH in cross-sectional and longitudinal analyses. Analysis performed regarding never, past, and current MHT revealed, that current users of MHT had lower odds for LVH compared to never users, although this was not statistically significant in cross-sectional analyses. Comparable results for current MHT users were obtained at 5-year follow-up. Conclusions: We did not obtain a statistical significant association between MHT use and LVH in cross-sectional as well as in longitudinal analyses. Lower odds for LVH for MHT users might be explained by the “healthy-user bias”. Keywords: Menopausal hormone therapy, left ventricular hypertrophy, Study of Health in Pomerania.
213 MENOPAUSAL SYMPTOMS AND ECHOCARDIOGRAPHIC CHANGES IN HYPOTHYROSIS I. Filatova, K. Skvortsov. Saratov State Medical University, Internal Diseases, Saratov, Russian Federation Objectives: Assessement of early menopausal symptoms appearence in premenopause, in period of disordered menstrual cycle and their association with thyroid status. Methods: radioimmune assessment, modified menopausal index, echocardiography Results: In women (age 32-54 yo) we revealed significant association between levels of thyrotropic hormone (TTH, radioimmune assessment) and severity of climacteric syndrome (CS) assessed by means of modified menopausal index (MMI) (r=0,68, p<0,01). 48% of women (mean age 36,8±4,7 yo) had disordered menstrual cycle, light and moderate menopausal symptoms (12,8±1,9). 32% demonstrated early development of menopause (mean age 41,8±4.9 yo), CS expression was more significant (26,2±3,7). We revealed no statistically significant increase in wall myocardial thickness in absence of left ventricular hypertrophy. This finding correlated with TTH level (r=0,49, p<0,05). 17 patients (36%) have shown pericardial changes. These findings (pericardial infusion, systolic separation of pericardial leaves) also correlated with TTH level (r=0,44, p<0,05). Long-term follow-up (2 years) revealed absence of pericardial infusion, decrease of menopausal symptoms, menstrual cycle normalization due to medicational treatment (euthyroid state). Conclusions: Unsatisfactory compensation of hypothyrosis provokes early beginning of menopause, development of more severe CS in presence of myopericardial changes due to deficit of TTH. It is essential to assess and to correct (medicationally) thyroid function in premenopause. Keywords: premenopause, hypothyrosis, menopausal symptoms, pericardial infusion
Objective: To investigate the effects of raloxifene on insulin sensitivity in postmenopausal women. Design: This study involves a placebo-controlled, double-blind, randomized study including 64 postmenopausal women between 45 and 55 years. The subjects were all screened for insulin resistance with the homeostasis model assessment (IR-HOMA) and those patients in the lowest quartile (n=16) were assigned as insulin sensitive and those in the highest quartile as insulin resistant patients (n=16). The patients in both groups received 60 mg/d either raloxifene hydrochloride (n=8) or a placebo (n=8) for a period of 12 weeks. Insulin sensitivity and the serum lipid profile, as well as anthropometric measurements, were established before and after therapy. Results: Baseline measurements showed that the highest quartile was associated with a significantly higher weight, body mass index, waist and waist-to-hip ratio (p<0.05). Raloxifene treatment significantly reduced the IR-HOMA scores in insulin resistant patients when compared to placebo and those patients receiving raloxifene in the insulin sensitive group. Conclusions: Raloxifene reduces insulin resistance in insulin resistant postmenopausal women. Keywords: Raloxifene, insulin sensitive, postmenopausal women, homeostasis model assessment.
215 DIFFERENCES IN CARDIOVASCULAR RISK FACTORS BETWEEN POSTMENOPAUSAL CHINESE AND AUSTRALIAN WOMEN C. Haines. Chinese University of Hong Kong, O&G, Shatin, Hong Kong Objectives: In 2002, the standardized death rate from ischaemic heart disease became higher in Chinese than in Australian women. This study compared cardiovascular risk factors in the two populations. Methods: We compared risk factors using data provided by WHO as well as local data. Results: There was a clear disparity in the prevalence of cardiovascular risk factors between Chinese and Australian women. Australian women had a higher prevalence of obesity and hypercholesterolaemia, but Chinese women had a higher prevalence of hypertension and diabetes. In “healthy” postmenopausal Chinese women, 46% were either overweight or obese and 62.4% had either borderline or elevated concentrations of total cholesterol. Conclusions: These data suggest that the prevalence of all cardiovascular risk factors is rising in postmenopausal Chinese women. It can be anticipated that cardiovascular disease will soon be a far greater problem in this region than it is at the present time. We remain uncertain why there is such an imbalance in the distribution in cardiovascular risk factors between Chinese and Australian women. Keywords: Menopause, cardiovascular disease, obesity, hypertension, hyperlipidaemia.
216 PROINFLAMATORY AND ANTIINFLAMATORY CYTOKINES IN MENOPAUSAL WOMEN WITH ACUTE MYOCARDIAL INFARCTION (AMI) COMPARING WITH STABLE ANGINA PECTORIS I. Hudic 1 , L. Dizdarevic-Hudic 2, F. Radoncic 1 . 1 Clinic for Gynecology and Obstetrition, Tuzla, Bosnia and Herzegovina; 2 Clinic for Internal Medicine, Tuzla, Bosnia and Herzegovina Objectives: To analyze the pro-inflammatory and anti-inflammatory cytokine concentrations in menopausal patients with acute myocardial infarction (AMI) comparing to menopausal patients with stable angina pectoris and to investigate if interleukin 6 (IL-6) correlates with interleukin 10 (IL-10) in AMI. Methods: Prospective study was made on 20 patients with AMI and 10 patients with stable angina. The cytokine concentrations were measured from blood samples. In statistical analyses were used descriptive statistics, normality and correlation tests. Results: Median value of IL-6 in AMI was 17.8 pg/ml and in control group
S57
212
214
LEFT VENTRICULAR HYPERTROPHY - IMPACT OF MENOPAUSAL HORMONE THERAPY?
RALOXIFENE MODIFIES THE INSULIN SENSITIVITY OF POSTMENOPAUSAL WOMEN
M. Dören 1 , A. Obst 2 , C. Schwahn 3 , H. Völzke 3 , C.O. Schmidt 3 , M. Dörr 4, S.B. Felix 4 , S. Schwarz 1 . 1 Charité-Universitätsmedizin Berlin, Women’s Health, Berlin, Germany; 2 Ernst Moritz Arndt University of Greifswald, Dept. Internal Medicine B, Cardiology & Pulmonary Diseases, Greifswald, Germany; 3 Ernst Moritz Arndt University of Greifswald, Institute for Community Medicine, SHIP, Greifswald, Germany; 4 Ernst Moritz Arndt University of Greifswald, Dept. Internal Medicine B, Cardiology, Greifswald, Germany
F. Grover-Páez, A.B. Zavalza-Gómez, R. Anaya-Prado. Mexican Institute of Social Security, Menaopausal Search Division Unit, Guadalajara, Mexico
Objectives: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular diseases. Several studies, mostly based on small study samples, hypothesized that menopausal hormone therapy (MHT) may reduce the likelihood of LVH, although this has not been a consistent finding. We examined the cross-sectional and longitudinal association between MHT use and echogardiographically determined LVH in women ≥ 45 years. Methods: The current study consists of cross-sectional (975 women) and longitudinal analyses (361 women without LVH at baseline) using data from the Study of Health in Pomerania. Women were principally divided into ever and never users of MHT. Analyses were repeated with an alternative classification of MHT use (never, past, and current). Multivariable logistic regression models were adjusted for age, pulse pressure, use of antihypertensive medication, school education, smoking, and weight (including lengths of follow-up also in longitudinal analysis). Results: We observed no significant association between ever use of MHT and LVH in cross-sectional and longitudinal analyses. Analysis performed regarding never, past, and current MHT revealed, that current users of MHT had lower odds for LVH compared to never users, although this was not statistically significant in cross-sectional analyses. Comparable results for current MHT users were obtained at 5-year follow-up. Conclusions: We did not obtain a statistical significant association between MHT use and LVH in cross-sectional as well as in longitudinal analyses. Lower odds for LVH for MHT users might be explained by the “healthy-user bias”. Keywords: Menopausal hormone therapy, left ventricular hypertrophy, Study of Health in Pomerania.
213 MENOPAUSAL SYMPTOMS AND ECHOCARDIOGRAPHIC CHANGES IN HYPOTHYROSIS I. Filatova, K. Skvortsov. Saratov State Medical University, Internal Diseases, Saratov, Russian Federation Objectives: Assessement of early menopausal symptoms appearence in premenopause, in period of disordered menstrual cycle and their association with thyroid status. Methods: radioimmune assessment, modified menopausal index, echocardiography Results: In women (age 32-54 yo) we revealed significant association between levels of thyrotropic hormone (TTH, radioimmune assessment) and severity of climacteric syndrome (CS) assessed by means of modified menopausal index (MMI) (r=0,68, p<0,01). 48% of women (mean age 36,8±4,7 yo) had disordered menstrual cycle, light and moderate menopausal symptoms (12,8±1,9). 32% demonstrated early development of menopause (mean age 41,8±4.9 yo), CS expression was more significant (26,2±3,7). We revealed no statistically significant increase in wall myocardial thickness in absence of left ventricular hypertrophy. This finding correlated with TTH level (r=0,49, p<0,05). 17 patients (36%) have shown pericardial changes. These findings (pericardial infusion, systolic separation of pericardial leaves) also correlated with TTH level (r=0,44, p<0,05). Long-term follow-up (2 years) revealed absence of pericardial infusion, decrease of menopausal symptoms, menstrual cycle normalization due to medicational treatment (euthyroid state). Conclusions: Unsatisfactory compensation of hypothyrosis provokes early beginning of menopause, development of more severe CS in presence of myopericardial changes due to deficit of TTH. It is essential to assess and to correct (medicationally) thyroid function in premenopause. Keywords: premenopause, hypothyrosis, menopausal symptoms, pericardial infusion
Objective: To investigate the effects of raloxifene on insulin sensitivity in postmenopausal women. Design: This study involves a placebo-controlled, double-blind, randomized study including 64 postmenopausal women between 45 and 55 years. The subjects were all screened for insulin resistance with the homeostasis model assessment (IR-HOMA) and those patients in the lowest quartile (n=16) were assigned as insulin sensitive and those in the highest quartile as insulin resistant patients (n=16). The patients in both groups received 60 mg/d either raloxifene hydrochloride (n=8) or a placebo (n=8) for a period of 12 weeks. Insulin sensitivity and the serum lipid profile, as well as anthropometric measurements, were established before and after therapy. Results: Baseline measurements showed that the highest quartile was associated with a significantly higher weight, body mass index, waist and waist-to-hip ratio (p<0.05). Raloxifene treatment significantly reduced the IR-HOMA scores in insulin resistant patients when compared to placebo and those patients receiving raloxifene in the insulin sensitive group. Conclusions: Raloxifene reduces insulin resistance in insulin resistant postmenopausal women. Keywords: Raloxifene, insulin sensitive, postmenopausal women, homeostasis model assessment.
215 DIFFERENCES IN CARDIOVASCULAR RISK FACTORS BETWEEN POSTMENOPAUSAL CHINESE AND AUSTRALIAN WOMEN C. Haines. Chinese University of Hong Kong, O&G, Shatin, Hong Kong Objectives: In 2002, the standardized death rate from ischaemic heart disease became higher in Chinese than in Australian women. This study compared cardiovascular risk factors in the two populations. Methods: We compared risk factors using data provided by WHO as well as local data. Results: There was a clear disparity in the prevalence of cardiovascular risk factors between Chinese and Australian women. Australian women had a higher prevalence of obesity and hypercholesterolaemia, but Chinese women had a higher prevalence of hypertension and diabetes. In “healthy” postmenopausal Chinese women, 46% were either overweight or obese and 62.4% had either borderline or elevated concentrations of total cholesterol. Conclusions: These data suggest that the prevalence of all cardiovascular risk factors is rising in postmenopausal Chinese women. It can be anticipated that cardiovascular disease will soon be a far greater problem in this region than it is at the present time. We remain uncertain why there is such an imbalance in the distribution in cardiovascular risk factors between Chinese and Australian women. Keywords: Menopause, cardiovascular disease, obesity, hypertension, hyperlipidaemia.
216 PROINFLAMATORY AND ANTIINFLAMATORY CYTOKINES IN MENOPAUSAL WOMEN WITH ACUTE MYOCARDIAL INFARCTION (AMI) COMPARING WITH STABLE ANGINA PECTORIS I. Hudic 1 , L. Dizdarevic-Hudic 2, F. Radoncic 1 . 1 Clinic for Gynecology and Obstetrition, Tuzla, Bosnia and Herzegovina; 2 Clinic for Internal Medicine, Tuzla, Bosnia and Herzegovina Objectives: To analyze the pro-inflammatory and anti-inflammatory cytokine concentrations in menopausal patients with acute myocardial infarction (AMI) comparing to menopausal patients with stable angina pectoris and to investigate if interleukin 6 (IL-6) correlates with interleukin 10 (IL-10) in AMI. Methods: Prospective study was made on 20 patients with AMI and 10 patients with stable angina. The cytokine concentrations were measured from blood samples. In statistical analyses were used descriptive statistics, normality and correlation tests. Results: Median value of IL-6 in AMI was 17.8 pg/ml and in control group