Emerging risk factors and assessment of organ damage in postmenopausal hypertensive women.

The numerous risk factors for acute cerebrocardiovascular events present in postmenopausal women have attracted a multidisciplinary approach. In hypertensive patients and postmenopausal intensive alike, the need for stratification of risk based on blood pressure, association of other risk factors and organ damage is becoming more and more evident. This study investigated some emerging factors, such as endothelial dysfunction, adhesion molecules and elevated homocysteine levels that may be markers of organ damage. It also examined the current importance of carotid US intima-media thickness assessment, cardiac US imaging and 24 hour ambulatory blood pressure monitoring (ABPM) in detecting organ damage. The study results indicated that the conventional stratification of cerebrocardiovascular risk in these patients is changing. The new approach in postmenopausal hypertensives tends to assess the presence of other emerging factors. Furthermore, assessment of organ damage is crucial for determining disease development and outcome that may be positively influenced by suitable pharmacological treatment.

[Portal flow, nutritional status, and circulation effects of parathormone]. / Flusso portale, stato nutrizionale ed effetti circolatori del paratormone.

Circulatory effects of parathyroid hormone (PTH) were reported in experimental animal models, also in liver portal system. We devised to study non invasively relationship between plasmatic iPTH and portal blood flow rate in humans. The study was done in a group of healthy post-menopausal women aged 52.0 +/- 5.2 years (range 47-65), not treated with hormone therapy, with different body mass index. Women were studied by echocolor-doppler and by clinical and biochemical assays of common laboratory test and of iPTH, insulin and prolactin (RIA). A positive correlation between iPTH and mean portal flow rate was observed in the overall group. Women with BMI < 25 showed a more marked correlation between these two parameters, not observed in women with BMI > 25, with slight-moderate overweight. In this last group an inverse correlation between blood pressure and iPTH was observed. From these preliminary results, as previously observed in chronic disease, relationship among iPTH, regional flows and nutritional state can be operating also in physiological conditions.

[Quality of life in menopause. Experimental research]. / Qualità di vita nella menopausa. Una ricerca sperimentale.

Psychophysiological relationship in menopausal women was explored by the comparison of stress level and resistance to stress and related symptoms: socio-economic and cultural variables and willingness to participate into a specific therapeutic program were taken into account. One hundred women, aged 44-59 years (54.2 +/- 5.64), that consecutively were referred to an out-patient menopausal Clinic, were studied by a questionnaire that evaluates quality of life (qol) derived and adapted from the Sickness Impact Profile and the Functional Living Test; moreover the test MSP (psychological stress measurement), translated from the original and adapted to Italy, was used. Psychological complaints of women examined are minimal: adaptation tests are substantially normal, and stress index measurements are even lower in comparison with a gender and age matched population group. Our results suggest that after a short period of psychological tension at the onset of climaterium, women acquire a positive, stable status, well different from stereotypes and prejudices around psychological disturbance associated with menopause. Minimal relevance of perceived disturbance seems the reason that limits the women's need and request for a specific therapy. Menopausal depression seems more related to life changes than to hormonal alterations. Reduced physical fitness, increased risk of parental death, difficulty to cope with new roles, apart the care of adult sons or daughters. A critical point is socio-economic level and the possibility to maintain a satisfying work. Contextual conditions, and specially degree of instruction, type of role change inside the family and number of sons, appears the most evident and relevant variables that mediate psychophysical conditions and perceived quality of life.

Response of biochemical markers of bone turnover to estrogen treatment in post-menopausal women: evidence against an early anabolic effect on bone formation.

Bone loss following menopause can be prevented or reduced by estrogen replacement therapy (ERT). The primary action of estrogen on bone is generally considered to be antiresorptive, but some evidence would also suggest a stimulatory effect on bone formation. The aim of this study was to assess the effect of ERT on biochemical markers of bone resorption (urinary pyridinoline and deoxypyridinoline), and of bone formation (bone-specific alkaline phosphatase--B-ALP, and the C-terminal propeptide of type I collagen--CICP) in a group of 25 postmenopausal women with no evidence of osteoporosis. Since the suggested anabolic effect of estrogen seems to take place in the early period of ERT, we measured the response of markers immediately before and after the start of treatment (30, 60, 120 and 180 days). The markers of bone resorption started to decrease at 30 days and remained low thereafter. We also observed a similar decrease in serum levels of B-ALP and CICP, reflecting a reduction of bone formation rate. Our data would indicate that ERT at the given dose does not have early anabolic effects on bone, in addition to its recognized suppressive effect on bone resorption.

Sociodemographic and clinical factors associated with HRT use in women attending menopause clinics in Italy.

OBJECTIVE: The aim of this analysis is to find any association between the use of hormone replacement therapy (HRT) and sociodemographic and clinical factors among women attending 54 menopause clinics in Italy. METHODS: The analysis includes data relating to 17,851 women who attended one of 54 menopause clinics in Italy for general gynecological evaluations and counselling between 1995 and 1997. The characteristics of women reporting ever HRT use were compared with those of never users. The odds ratios (ORs) of HRT use were computed in relation to selected reference categories, together with their 95% confidence intervals (CIs). RESULTS: Of the 17,851 women interviewed, 8539 reported ever HRT use. The mean age of the never and ever HRT users was 52.8 years and 53.7 years, respectively. Higher education was associated with an increased frequency of HRT use: in comparison with women reporting no or primary-/middle-school education, the OR of HRT use of women reporting a high-school diploma or university degree was 1.3 (95% CI 1.1-1.6). HRT use tended to be less frequently reported with increasing body mass index (BMI): in comparison with women whose BMI was < 23.4 kg/m2, the OR of HRT use in those with a BMI of 23.4-26.1 kg/m2 and > or = 26.2 kg/m2 was 0.8 (95% CI 0.8-0.9) and 0.6 (95% CI 0.5-0.7), respectively. Among the postmenopausal women, those who had undergone surgical menopause had an OR of HRT use of 1.3 (95% CI 1.2-1.4). A history of breast cancer was associated with a lower frequency of HRT use (OR 0.3, 95% CI 0.2-0.4). Likewise, a history of thromboembolic disease (OR 0.5, 95% CI 0.4-0.7) or myocardial infarction (OR 0.7, 95% CI 0.6-0.9) was associated with a lower frequency of HRT use. CONCLUSIONS: In our study population, the variable most closely related to HRT use was education/social class, thus underlining the impact of information campaigns on HRT and women's health. Among the medical determinants, our analysis indicates that a history of myocardial infarction, thromboembolic disease or breast cancer is associated with less frequent use of HRT.

Blood pressure variations assessed by continuous 24-hour monitoring in menopausal and climacteric women.

Changes in the metabolic hormonal balance during the climacteric and menopause, especially surgically induced menopause, increase the risk of acute cerebrocardiovascular complications. This major risk may be linked to changes in blood pressure. In this study we performed twenty-four ambulatory blood pressure monitoring in climacteric (C), menopausal (PM), and surgically induced menopausal women (SM) to determine mean diurnal and nocturnal systodiastolic levels and percentage peaks, as variations in the pressure profile may be linked to organ damage. Our results showed that the entire series presented mainly diastolic increments (mDBP: HPM = 104.4 +/- 5.1; HSM = 106.3 +/- 2.9; HC = 100.2 +/- 3.1), and that this rise was greater in surgically induced menopausal women. In addition, these subjects presented the highest diastolic and systolic pressure peaks (HSM 37/42 versus HPM 35/36 and HC 29/31) also during the night (nocturnal peak: HSM 15/19 versus HPM 10/12 and HC 5/15). Non dippers seem more exposed to cerebrocardiovascular disease. Our results revealed that climacteric patients affected by arterial hypertension (mSBP = 162.2 +/- 4.1; mDBP = 100.2 +/- 3.1; 24 h systolic peak % = 24, diastolic peak % = 24) during the climacteric presented the same levels as observed in conclaimed menopause (mSBP 165.2 +/- 5.5; mDBP = 104.2 +/- 5.1; 24 h systolic peak % = 28, diastolic peak % = 29). Therefore, 24 h blood pressure monitoring is able to show that the pressure changes in hypertensive climacteric and menopausal women and could detect women who are at a greater risk of organ damage.