Factors In Postmenopausal Women Research Articles

Ethnicity may be a risk modifier for knee osteoarthritis

Evaluation of: Wright NC, Kershner Riggs G, Lisse JR, Chen Z: Self-reported osteoarthritis, ethnicity, body mass index, and other associated risk factors in postmenopausal women – results from the Women’s Health Initiative. J. Am. Geriatr. Soc. 56(9), 1736–1743 (2008). Participants in the Women’s Health Initiative were examined for risk factors for physician-diagnosed osteoarthritis (OA), including ethnicity. This study compared 82,795 women without OA with 63,600 women with OA, including 85% white, 9.4% African–American, 3.3% Hispanic, 1.9% Asian and 0.5% American Indian women. Age and body mass index were the strongest risk factors for disease. The distribution of risk factors varied between ethnic groups, being lowest in non-Hispanic white women. Stratification according to ethnicity was performed and the data were examined for interaction. The odds of OA in the highest body mass index category were higher in African–American women (odds ratio [OR]: 3.31; 95% confidence interval [CI]: 2.79–3.91) and Am...

The impact of tibolone and hormone therapy on serum C-reactive protein, tumor necrosis factor-α and hepatocyte growth factor in postmenopausal women

Objective To investigate the effect of tibolone and hormone treatment on serum C-reactive protein, tumor necrosis factor-α and hepatocyte growth factor as independent markers of cardiovascular disease.Design Ninety-five normotensive and healthy postmenopausal women with no systemic or cardiac disease who attended the Marmara University Menopause Outpatient Clinic were included in this study. The women were assigned into three groups. The women who accepted hormone replacement therapy were randomized to two groups. Group 1 received 0.625 mg conjugated estrogen (CE) +2.5 mg medroxyprogesterone acetate (MPA)/day. Group 2 received 2.5 mg tibolone/day. Group 3 was the control group consisting of women who did not want hormone replacement therapy. Serum samples were measured for highly specific C-reactive protein, tumor necrosis factor and hepatocyte growth factor before the treatment and after 6 months of therapy. Values at the end of the 6th month and baseline were compared.Results The increase in C-reactive protein and the decrease in tumor necrosis factor-α levels demonstrated at the end of treatment were statistically significant, in both the hormone therapy and tibolone groups. However, the decrease in hepatocyte growth factor was significant only in the tibolone group.Conclusions The positive impact of both tibolone and hormone therapy on inflammatory markers appears to be protective against cardiovascular diseases. However, the clinical implications of these findings are yet to be evaluated in large clinical trials.

Dose-Response Relationship between Moderate-Intensity Exercise Duration and Coronary Heart Disease Risk Factors in Postmenopausal Women

This study was designed to investigate whether, in a dose-response manner, there would be greater health benefits in a group of postmenopausal women completing 45 minute- vs. 30 minutes of moderate intensity (50% maximal oxygen uptake reserve, VO2R) exercise 5 days . wk(-1). Apparently healthy but sedentary postmenopausal women (n = 33) were randomized to a nonexercise control group, a 30-minute exercise duration group, or a 45-minute exercise duration group. Exercise training was performed 5 days . wk(-1) for 12 weeks at 50% VO2R. Participants were instructed to not change their usual diet throughout the study. Twenty-six women completed the study. After 12 weeks, VO2max increased significantly (p < 0.05) in both 30-minute (0.20 +/- 0.21 L . min(-1)) and 45-minute (0.41 +/- 0.10 L . min(-1)) groups. Repeated measures ANOVA identified a significant interaction between exercise duration and VO2max values (F = 4.72, p < 0.05), indicating that VO2max responded differently to 30-minute and 45-minute exercise durations. Trend analysis showed that body mass, body composition, waist circumference, and high-density lipoprotein cholesterol (HDL-C) changed favorably (p < 0.05) across control, 30-minute, and 45-minute groups. Although most health organizations agree that 150 min . wk(-1) of physical activity will reduce the risk of all-cause and cardiovascular mortality, few randomized, controlled studies have examined whether completing more physical activity than the recommended amount will yield additional benefits. Findings from the present study suggest that there is a dose-response relationship between exercise duration and numerous health outcomes in postmenopausal women, including cardiorespiratory fitness, body mass, body composition, waist circumference, and HDL-C.

Identifying Abdominal Aortic Aneurysm Risk Factors in Postmenopausal Women

Evaluation of: Lederle FA, Larson JC, Margolis KL et al.: Abdominal aortic aneurysm events in the Women's Health Initiative: cohort study. Br. Med. J. 337, A1724 (2008). A linked cohort study of 161,808 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative was conducted during which participants were followed for the incidence of abdominal aortic aneurysm repair or rupture. This study evaluated the association between potential risk factors and subsequent abdominal aortic aneurysm events in women. A total of 467 women reported a diagnosis of abdominal aortic aneurysm before entering the study or during participation, with 184 aneurysm-related events identified. Abdominal aortic aneurysm events were strongly associated with age and smoking and negatively associated with diabetes and baseline use of postmenopausal hormone supplementation. Previous studies investigating abdominal aortic aneurysm have focused primarily on men, with little reliable information available on women. This study contributes a large female cohort to provide better insight into gender-specific abdominal aortic aneurysm risks and disease associations.

The Differential Effect of the Phytoestrogen Genistein on Cardiovascular Risk Factors in Postmenopausal Women: Relationship with the Metabolic Status

The wide family of the phytoestrogens has become an alternative to the classical hormonal therapy in menopause; nevertheless, some findings are still conflicting. To examine the effect of genistein administration on metabolic parameters and vascular reactivity considering the basal endocrine status of the patients. A randomized placebo controlled study was conducted at a university hospital. Fifty postmenopausal women participated. Thirty subjects (group A) were randomized to receive 54 mg/d genistein while 20 subjects (group B) were treated with the placebo for 24 wk. In group A, we distinguish two subgroups: 14 normoinsulinemic and 12 hyperinsulinemic patients. Anthropometric measures, hormonal and lipid assays, oral glucose tolerance test with glycemic, insulin, and C-peptide evaluation, indexes of insulin sensitivity and endothelial function, and euglycemic-hyperinsulinemic clamps were performed. The insulin basal values significantly decreased in group A, whereas the homeostasis model index of insulin sensitivity and the fasting glucose levels significantly improved compared with placebo group. The genistein administration decreased fasting glucose and area under the curve glucose levels in the normoinsulinemic patients after treatment. In the hyperinsulinemic patients, a significant reduction in fasting insulin, fasting C-peptide, and area under the curve insulin levels as well as an increase in fractional hepatic insulin extraction was shown. In these patients, high-density lipoprotein cholesterol levels were significantly improved. The endothelium-dependent and -independent dilatation improved in the treated group. Normoinsulinemic patients showed both a significantly enhanced flow-mediated and nitrate-mediated dilatation, whereas no significant changes were found in the hyperinsulinemic group. The glycoinsulinemic metabolism and the endothelial function were significantly influenced by genistein. In particular, normoinsulinemic patients showed an improvement in glycemic and vascular reactivity indexes. Conversely, an improvement in the insulin sensitivity indexes was noted in hyperinsulinemic patients.

Type 2 Diabetes Mellitus and Risk of Stress, Urge and Mixed Urinary Incontinence

To improve the understanding of the etiological relation between type 2 diabetes and urinary incontinence, we examined associations between diabetes and urinary incontinence type in 71,650 women 37 to 79 years old in the Nurses' Health Study and the Nurses' Health Study II. From 1976 to 2000 in the Nurses' Health Study and 1989 to 2001 in the Nurses' Health Study II participants reported diagnoses of type 2 diabetes. Women with incident urinary incontinence at least weekly were identified from 2000 to 2002 in the Nurses' Health Study and 2001 to 2003 in the Nurses' Health Study II. We pooled data from the 2 cohorts, and estimated odds ratios and 95% confidence intervals using multivariable logistic regression adjusting for age, parity, body mass index, smoking, hysterectomy, functional limitations, menopausal status, postmenopausal hormone use, incontinence promoting medications and study cohort. The incidence of at least weekly urinary incontinence was 5.3% (3,612 of 67,984) among women without type 2 diabetes and 8.7% (318 of 3,666) among women with diabetes. Overall the multivariable adjusted odds of incident urinary incontinence were increased 20% (OR 1.2, 95% CI 1.0-1.3, p = 0.01) among women with vs without type 2 diabetes. This increase appeared largely explained by significantly greater odds of urge urinary incontinence (OR 1.4, 95% CI 1.0-1.9, p = 0.03). There was no apparent association between diabetes and stress (p = 0.3) or mixed (p = 0.6) urinary incontinence, although confidence intervals were somewhat wide. Our findings suggest that type 2 diabetes may especially influence urge urinary incontinence. Further research is needed to confirm this finding and identify pathways linking these conditions.

Self‐Reported Osteoarthritis, Ethnicity, Body Mass Index, and Other Associated Risk Factors in Postmenopausal Women—Results from the Women's Health Initiative

The objective of this analysis was to assess risk factors for self-reported osteoarthritis (OA) in an ethnically diverse cohort of women. The participants were postmenopausal women aged 50 to 79 (n=146,494) participating in the clinical trial and observational study of the Women's Health Initiative (WHI). Baseline OA and risk factors were collected from WHI questionnaires. Logistic regression was used to find the association between the risk factors and OA. Risk factor distribution and ethnicity interaction terms were used to assess ethnic differences in OA risk. Forty-four percent of the participants reported OA. Older age (odds ratio (OR)(70-79 vs 50-59)=2.69, 95% confidence interval (CI)=2.60-2.78) and higher body mass index (BMI) (OR(BMI>or=40.0 vs <24.9)=2.80, 95% CI=2.63-2.99) were found to be the strongest risk factors associated with self-reported OA. The prevalence of obesity (BMI>or=30.0) was 57.9% in African Americans, 51.0% in American Indians, 41.9% in Hispanic whites, and 32.9% in non-Hispanic whites. The prevalence of other major OA risk factors was higher in African-American, American-Indian, and Hispanic white women than in non-Hispanic white women. Non-Hispanic white women who were in the extreme obese category (BMI>or=40.0 kg/m(2)) had a 2.80 times (95% CI=2.63, 2.99) greater odds of self-reported OA. The odds were even higher in American-Indian (OR=4.22, 95% CI=1.82, 9.77) and African-American (OR=3.31, 95% CI=2.79, 3.91) women, indicating a significant interactive effect of BMI and ethnicity on odds of OA. In conclusion, OA is a highly prevalent condition in postmenopausal women, and there are differential effects according to ethnicity.

Prevalence of risk factors for referring post-menopausal women for bone densitometry. The INSTANT study

Background Measurement of bone density by densitometry is an appropriate public health strategy for prevention of osteoporotic fractures in at-risk individuals, and physicians are encouraged to screen for these risk factors in post-menopausal women. Objective To determine the frequency of risk factors for osteoporosis in a representative sample of the French general population in order to estimate the number of women eligible for bone densitometry. Methods A cross-sectional epidemiological survey of osteoporosis in 2081 post-menopausal women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on personal or family history of vertebral fracture or limb fracture, endocrine disorders, corticosteroid use, and early menopause. Body mass index was determined during the interview by measuring height and weight. Results A total of 1041 women interviewed (51.8%) reported at least one risk factor for osteoporosis and would thus be eligible for densitometry. The most frequently reported risk factor was vertebral fracture or collapse (20.8%), followed by endocrine disorders (10.5%) and long-term corticosteroid treatment (10.5%). The prevalence of vertebral and limb fracture increased with age. Multiple risk factors were reported by 381 women and the proportion of women presenting multiple risk factors increased with age. Conclusions Extrapolated to the general population, over five million women in France would be eligible for densitometry. Since only a small proportion of these currently receive a diagnosis of osteoporosis, a considerable number of women could thus potentially benefit from more widespread use of densitometry.

Case-control study of height, weight and BMI and breast cancer risk in Nigerian women

1506 Background: Studies in affluent Western countries have shown that weight was protective against breast cancer in premenopausal women but was a risk factor in postmenopausal women. However, dif...

Dose-response Relationship Between Moderate-intensity Exercise Duration And Coronary Heart Disease Risk Factors In Postmenopausal Women

PURPOSE: This study was designed to investigate whether there would be greater health benefits in a group of postmenopausal women completing 45-min vs. 30-min of moderate intensity exercise, 5 days/wk. METHODS: Apparently healthy, but sedentary postmenopausal women (N = 33) were randomized to a nonexercise control group, a 30-min exercise group, or a 45-min exercise group. Exercise training was performed 5 days/wk for 12 wks at 50% VO2R. Participants were instructed to not change their usual diet throughout the study. RESULTS: Twenty-six women completed the study. Baseline and 12-week values (mean ± SD) for all physical and physiological characteristics are presented in the table. After 12wk, VO2max increased significantly (p < 0.05) in both 30-min (0.20 ± 0.21 L·min-1) and 45-min (0.41 ± 0.10 L·min-1) groups. Repeated measures ANOVA identified a significant interaction between exercise duration and VO2max values (F = 4.72, p < 0.05) indicating that VO2max responded differently to 30-min and 45-min exercise durations. Trend analysis showed that body mass, body composition, waist circumference, and high-density lipoprotein (HDL) cholesterol changed favorably (p < 0.05) across control, 30-min, and 45-min groups. CONCLUSION: Although most health organizations agree that 150 min/wk of physical activity will reduce the risk of all-cause and cardiovascular mortality, few randomized, controlled studies have examined whether completing more physical activity than the recommended amount will yield additional benefits. Findings from the present study suggest that in a dose response manner, increased exercise duration contributes to greater modifications in the coronary heart disease risk profile of postmenopausal women.

Abdominal Aortic Calcification Detected on Lateral Spine Images From a Bone Densitometer Predicts Incident Myocardial Infarction or Stroke in Older Women

Among a cohort of elderly women, abdominal aortic calcification scored on baseline lateral spine densitometric images intended for vertebral fracture assessment was associated with subsequent myocardial infarction or stroke over a median 4-yr period, independent of clinical cardiovascular disease risk factors. Cardiovascular disease (CVD) risk among older women is not adequately captured by traditional CVD risk factors. Lateral spine images obtained on bone densitometers for vertebral fracture assessment (VFA) can detect abdominal aortic calcification (AAC), an important marker of subclinical CVD. Our objective was to estimate the association between AAC scored on VFA images and subsequent myocardial infarction (MI) or stroke in elderly women. Among participants in a randomized controlled trial (women; age > 75 yr) of clodronate versus placebo, those who sustained an MI or stroke during the median 4-yr follow-up study period were selected as cases (n = 408), and 408 controls were randomly selected from the remainder of the parent study population. Baseline VFA images were scored for AAC with a previously validated 24-point scale and a newer, simpler 8-point scale. The OR of incident MI or stroke for those in the middle and top tertiles, respectively, compared with the bottom tertile of AAC score were 1.14 (95% CI, 0.79-1.66) and 1.74 (95% CI, 1.19-2.56) for the 24-point scale and 1.42 (95% CI, 0.98-2.05) and 1.77 (95% CI, 1.22-2.55) for the 8-point scale, adjusted for age, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, blood pressure, smoking, renal function, health status, and baseline diagnoses of diabetes mellitus, hypertension, angina, and prior stroke. AAC scored on VFA images is independently associated with incident MI or stroke. Because bone densitometry is indicated for all women > or = 65 yr of age, VFA imaging offers an opportunity to capture this CVD risk factor in postmenopausal women undergoing bone densitometry at very little additional cost.

Prognostic Role of Flow-Mediated Dilation and Cardiac Risk Factors in Post-Menopausal Women

The aim of this study was to examine the association between brachial artery flow-mediated dilation (FMD) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women, with adjustment for the presence of the major cardiovascular risk factors. Conventional major cardiovascular risk factors (cigarette smoking, hypercholesterolemia, hypertension, and diabetes) fail to explain nearly 50% of cardiovascular events. Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention. Evaluation of endothelial function, utilizing the noninvasive measurement of the brachial artery FMD, may serve as a screening tool to individualize high-risk patients. We conducted a prospective study on 2,264 post-menopausal women, age 54 +/- 6 years. The length of the follow-up was 45 +/- 13 months (range 6 to 65 months). During observation, 90 major events were recorded. Risk-adjusted relative risk values resulted 1.0, 1.33 (95% confidence interval [CI] 1.09 to 4.09), and 4.42 (95% CI 2.97 to 8.01) for women in the higher, intermediate, and lower tertile of FMD, respectively (p < 0.0001 for trend). The event rate for women in the lower tertile (FMD <or=4.5%) was greater than the combined event rate noted in the other 2 tertiles (women in the lower tertile accounted for 51 events [56.6% of total events]). When added to age and other conventional cardiovascular risk factors (smoking habits, presence of hypercholesterolemia, history of diabetes, hypertension), FMD contributed significantly to the model predicting cardiovascular events (likelihood ratio chi-square change: 10.22; p < 0.0001). In post-menopausal women, the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events.

Natural history and risk factors for bone loss in postmenopausal Caucasian women: a 15-year follow-up population-based study

In this 15-year follow-up study, we found that the estimated rate of bone loss at the femoral neck (FN) for women aged 45-68 was linear at a rate of 1.67% per year, but quadratic for lumbar spine (LS) at a rate of 3.12% initially, and slowing down with age. We also confirmed the protective role of HRT, increasing weight, and lean mass in long-term bone loss. The objective was to describe the natural history of bone loss and explore the role of environmental factors in postmenopausal women over a 15-year period. Bone mineral density (BMD) at the FN and the LS were measured in postmenopausal women from the Chingford Study. Height, weight, HRT status, and calcium/vitamin D supplement were assessed at each visit. Osteoarthritis of hip and spine was assessed by X-ray at baseline and at year 8. A total of 955 postmenopausal women with an average age of 54.7 at baseline were included. Both FN and LS BMD decreased significantly with age (p<0.0001). The decline was larger in the LS (-3.12% per year), which showed a quadratic relationship, than in the FN (-1.67% per year) with a linear relationship. The rate of bone loss was reduced by one third annually for the FN and LS respectively in current HRT users. Change in weight was positively associated with both DeltaFN and DeltaLS BMD (beta=0.16% and 0.09% change in DeltaFN and DeltaLS BMD per kilogramme change in weight respectively, p<0.0001 for both sites). Spine OA and progression were positively associated with DeltaLS BMD (beta=1.22% change in DeltaLS BMD per grade in spine OA and 0.45% change in DeltaLS BMD for patients who progressed, p<0.0001 for spine OA and p=0.002 for spine OA progression). Spine OA (beta=0.54% change in DeltaFN BMD per grade, p<0.0001), but not progression, and hip OA were positively associated with DeltaFN BMD. Furthermore, both age and body weight at baseline were positively associated with both DeltaFN and DeltaLS BMD (beta=0.02-0.04% change in DeltaFN and DeltaLS BMD per year increase in age at baseline and 0.004-0.007% change in DeltaFN and DeltaLS BMD per kilogramme increase in weight at baseline, all p<0.0001). This large population-based longitudinal study demonstrated that the decline of BMD over 15 years is linear with age for the FN, but quadratic for the LS. The study confirmed the protective role of HRT, increased weight and lean mass in long-term bone loss.

Influence of the Reproductive Factor and Life Style Factor in Postmenopausal Women's Bone Mineral Density

Purpose: This study was to identify the influencing factors in postmenopausal women's bone mineral density (BMD). Method: The sample for the study was 107 postmenopausal women who took the BMD test. For BMD measurement, lumbar spine BMD(L2-5) was measured by Dual-energy X-ray absorptiometry(DEXA). Data was collected by questionnaires on the selected variables such as reproductive factors and life style factors. Result: In reproductive factors, parity shows significant differences with BMD (F=4.16, p=.02). In life style factors, diet (F=3.01, p=.05) and exercise (F=7.39, p=.00) show significant differences with BMD. Excercise, diet and parity accounted for 42.0% of the influencing factors in Postmenopausal Women's Bone Mineral Density. Conclusion: The influencing factors in postmenopausal women's bone mineral density were excercise, diet and parity. In this paper, it is suggested that the influence of reproductive and life style factors in postmenopausal women's BMD should be studied by long term and needs repeated research. This study can be used as foundation material for nursing education program development for osteoporosis prevention and improvement.

VO2 peak Relates to Endothelial Function Independently of Other Cardiovascular Disease Risk Factors in Postmenopausal Women

Following the menopause, endothelial function is reported to deteriorate independently of changes in other cardiovascular disease (CVD) risk factors and its decline is an independent predictor for the development of CVD. Whether greater cardio-respiratory fitness (CRF) is related to improved endothelial function in postmenopausal women is unclear. PURPOSE This investigation aimed to examine the interrelationships between CRF (VO2 peak), CVD risk factors and endothelial function in 77 apparently healthy postmenopausal women (age 57.2 ± 3.6yr). METHODS: VO2 peak was assessed via a Bruce treadmill test, and body composition via skinfold analysis and measurement of waist and hip circumferences, BMI and body mass. A fasting venous blood sample was analysed for total cholesterol, high (HDL-C) and low density lipoproteins, triglycerides, glucose, insulin, glycosylated haemoglobin (HbA1c) and high sensitivity C-reactive protein (hsCRP). Flow mediated dilation (FMD) during reactive hyperaemia was recorded as an index of endothelial function. Relationships between variables were assessed using Pearson's correlation. Women were grouped into tertiles of CRF (low: 20.3 ± 1.1; medium: 25.3 ± 2.3; high: 33.2 ± 2.0 ml·kg·min-1), and group differences in CVD risk variables were assessed using ANOVA. The groups did not differ in age or years postmenopause (P > 0.05). RESULTS FMD was significantly correlated with VO2 peak (r = 0.31, P<0.01), and [hsCRP] (r = −0.25, P<0.05). The relationship between FMD and VO2 peak remained following normalization for [hsCRP] (P < 0.05). FMD also significantly differed between CRF groups (low: 3.5 ± 2.5; medium: 4.3 ± 2.7; high: 6.4 ±1.7 %), as did [HDL], [hsCRP] and all body composition variables (P < 0.05). The significant increase in FMD with greater CRF remained when [HDL], [hsCRP] or any body composition variable was included as a covariate (P < 0.05). CONCLUSION In postmenopausal women, endothelial function is significantly and positively related to CRF and this relationship is independent of differences in other key CVD risk factors. This work was Supported by a grant from Heart Research UK (2508/06/08)

Relationships between circulating hormone levels, mammographic percent density and breast cancer risk factors in postmenopausal women

Endogenous hormones and insulin-like growth factors (IGF) play a central role in breast cancer development. Mammographic density, an important breast cancer risk factor, has been associated with these biomarkers in premenopausal women. The aim of this study was to assess the relationships between circulating hormones, clinical features related to breast cancer risk and mammographic density in postmenopausal women. The study included 226 postmenopausal women participating in a clinical prevention trial. We performed baseline measurements of mammographic percent density and circulating levels of estradiol, sex-hormone binding globulin (SHBG), follicle stimulating hormone (FSH), prolactin, C-terminal cross-link telopeptide, IGF-I, and IGF binding protein-3. Median age and time since last menses were 52 years and 15 months, respectively. Median body mass index was 24.1 kg/m(2). After adjusting for age and body mass index, estradiol was the only biomarker significantly correlated with mammographic density (r = 0.17; P = 0.04). Women with normal body mass index had higher mammographic density (P < 0.001), higher SHBG (P < 0.0001), higher FSH (P = 0.002) and lower estradiol levels (P = 0.01) than those who were overweight. Women who had previous biopsies for benign breast disease had a higher mammographic density (P = 0.006). In these recently postmenopausal women, mammographic percent density is directly associated with circulating estradiol levels. Our results provide further support to the role of circulating hormones in breast cancer risk.

Effects of Isoflavone Dietary Supplementation on Cardiovascular Risk Factors in Type 2 Diabetes

A diet supplemented with soy protein and isoflavones has been shown to reduce cardiovascular risk factors in postmenopausal women with type 2 diabetes. However, it remains unclear which component is responsible for these effects. Our aim was to determine whether the addition of isoflavones alone modifies cardiovascular disease risk markers in this group of patients. Cardiovascular disease (CVD) is the leading cause of mortality in women in developed countries (1), and women with diabetes are four times more likely to die from CVD than men (2). Among other factors, postmenopausal estrogen depletion, greater insulin resistance, and dyslipidemia (3,4) may contribute to high risk of accelerated CVD. Modification of lifestyle is important to reduce CVD risk factors and delay progression of type 2 diabetes–associated complications. In particular, the addition of oral supplements, such as soy products, as part of a healthy diet has attracted recent interest because of their beneficial effects on lipid profiles (5–10). However, scant information is available on the effects of soy in individuals with type 2 diabetes (11–13), who are at higher risk due to hyperlipidemia, lower HDL levels, and abnormalities in LDL/lipoprotein composition (14). It also remains unclear whether a beneficial effect can be attributed to the soy protein or isoflavones. …

Severity of cardiovascular disease in postmenopausal women: associations with common estrogen receptor α polymorphic variants

Impaired estrogen action is a risk factor for coronary artery disease (CAD). Associations of CAD with estrogen receptor alpha (ER alpha) polymorphisms, which may influence sensitivity to estrogen, have been reported for men; the data concerning women are not conclusive. We investigated the association of common ER alpha polymorphisms with the severity of CAD and with metabolic and reproductive factors in postmenopausal women undergoing coronary angiography. ER alpha polymorphisms at positions c.454-397 T>C (PvuII) and c.454-351 A>G (XbaI) were studied in 157 women (age 45-88 years). The severity of CAD was assessed by the number of arteries with >50% stenosis in the angiography. There was a significant association between the TT, TC, and CC genotypes (PvuII) and the severity of CAD (P=0.008); similar results were obtained for the XbaI polymorphism (P=0.021). These associations were independent of other risk factors for CAD. Women homozygous for the C allele had significantly higher triglyceride and insulin levels; they belonged more frequently to the group with a low number of births (n</=1; P=0.014, Fisher's exact). Common ER alpha polymorphisms may influence the severity of CAD in women undergoing coronary angiography, reflecting lifetime exposure to estrogen. Similar associations have been reported for men with CAD. These polymorphisms should probably be taken into account when associations with estrogenic actions are examined.

Effects of soy isoflavones and phytate on homocysteine, C-reactive protein, and iron status in postmenopausal women

Soy protein or its components may protect against the atherosclerotic cardiovascular disease (CVD) risk factors total homocysteine (tHcy), C-reactive protein (CRP), and excess body iron, which generally increase with menopause. The primary objective of this study was to determine the independent effect of the soy protein components isoflavones and phytate on CVD risk factors in postmenopausal women. The secondary objective was to identify factors [blood lipids, oxidative stress indexes, serum ferritin, plasma folate, plasma vitamin B-12, and body mass index (BMI)] contributing to tHcy and CRP concentrations. In a double-blind, 6-wk study, 55 postmenopausal women aged 47-72 y were randomly assigned to 1 of 4 soy protein (40 g/d) isolate treatments: native phytate and native isoflavone (n = 14), native phytate and low isoflavone (n = 13), low phytate and native isoflavone (n = 14), or low phytate and low isoflavone (n = 14). We measured iron indexes, tHcy, CRP, and BMI. Soy protein with native phytate significantly reduced tHcy (P = 0.017), transferrin saturation (P = 0.027), and ferritin (P = 0.029), whereas soy protein with native isoflavones had no effect on any variables. At baseline, BMI was highly correlated with tHcy (r = 0.39, P = 0.003) and CRP (r = 0.55, P < 0.0001), whereas HDL cholesterol was correlated with CRP (r = -0.30, P = 0.02). Multiple regression analysis showed that LDL cholesterol and BMI contributed significantly (R2= 19.9%, P = 0.003) to the overall variance in tHcy. Consuming phytate-rich foods and maintaining a healthy weight may reduce atherosclerotic CVD risk factors in postmenopausal women.

Risk factors for breast cancer in older women: the relative contribution of bone mineral density and other established risk factors

To determine the contribution of bone mineral density (BMD) to breast cancer risk relative to other established breast cancer risk factors in postmenopausal women with osteoporosis. Data for this analysis comprised those collected from women randomized to placebo in the MORE and CORE trials (N = 2,576). Risk factors measured at baseline included age, family history of breast cancer, estradiol level, body mass index, prior hormone therapy, BMD and vertebral fracture status. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Over a total of 13,698 woman-years of follow-up, 65 incident breast cancers occurred. In univariate analyses, older age and family history of breast cancer were the strongest predictors of breast cancer risk, associated with a 2.4- and 2.6-fold increase in breast cancer incidence. A higher estradiol level was associated with a 1.9-fold increase in breast cancer incidence. The association between femoral neck BMD and breast cancer incidence was only significant after adjustment for age (P = 0.03). The final multivariable model included age, family history, estradiol, BMD, and the BMD-estradiol interaction since the effect of BMD on breast cancer varied by estradiol level (interaction P-value, 0.04); in those with a lower estradiol level, a higher BMD was associated with a 2.6-fold increased in breast cancer. Overall, BMD is a relatively weak predictor of breast cancer risk in these postmenopausal women with osteoporosis, after taking into consideration age, family history and endogenous estradiol level.