The role of medications in successful aging.

Successful aging includes good health and low levels of disability. To that end, primary prevention is far better than managing subsequent organ damage. When medication is needed to prevent or manage disease, the preferred choice should be associated with the greatest benefits and fewest adverse effects. Cardiovascular diseases are the leading cause of morbidity and mortality in postmenopausal women worldwide. Considering disease-adjusted life years, other leading causes are chronic obstructive pulmonary disease, diabetes mellitus, dementias, hearing loss, cancers of the breast, lung and bowel, osteoporosis, fractures and falls, depression, osteoarthritis, refractive errors of the eye and non-diabetic chronic kidney disease. This review explores the global prevalence of these diseases in women aged 50 years and older, and medications commonly used for them, and contrasts the effects of menopausal hormone therapy (MHT) with others. When initiated early, there is good evidence for MHT benefit in all-cause mortality and primary prevention of cardiovascular disease, diabetes and osteoporosis; fair evidence for benefit in dementias, depression and osteoarthritis; limited evidence for benefit in chronic obstructive pulmonary disease, hearing loss, non-diabetic chronic kidney disease and colorectal cancer; null effects on lung cancer and refractive errors; and varied effects on breast cancer and stroke. Relative benefits and adverse effects of other medications warrant consideration.

Hormone replacement therapy - where are we now?

Hormone replacement therapy (HRT) was the standard of care for menopause management until 2002, when perceptions changed following release of the initial results from the Women's Health Initiative (WHI) trial. Fears of breast cancer and heart attacks engendered by that report were not supported by the data, especially for recently menopausal women. Clinically, HRT is usually initiated near menopause. The WHI tested something different - the effects of HRT started a decade or more after menopause. As it turned out, age at starting HRT is critical in determining benefit/risk. HRT use plummeted following the WHI in 2002 and has remained low, prompting strong interest in alternative treatments. None provide the range of benefits across multiple organ systems offered by estrogen. Most have concerning adverse effects in their own right. HRT can provide effective relief for a wide range of health conditions, potentially avoiding the need for multiple treatments for separate problems. Unfortunately, among many women and clinicians, the perception of HRT benefit/risk is distorted, and its use avoided, leading to unnecessary distress. Following the WHI, many clinicians have not received adequate training to feel comfortable prescribing HRT. When initiated within 10 years of menopause, HRT reduces all-cause mortality and risks of coronary disease, osteoporosis, and dementias.

Menopausal hormone therapy for primary prevention: why the USPSTF is wrong.

The US Preventive Services Task Force (USPSTF) Draft Recommendation statement on Menopausal Hormone Therapy: Primary Prevention for Chronic Diseases, released in May 2017, perpetuates a major disconnect between the primary population affected, women within roughly 10 years of menopause, and the data cited. Furthermore, major elements of the evidence relied upon have been misinterpreted or misstated, particularly in regard to coronary heart disease and breast cancer, for which there is no statistically significant evidence of harm. As currently drafted, the recommendations reiterate the USPSTF statements of 2012, 2005 and 2002, and will perpetuate egregious harm to the public health. In an attempt to avoid that outcome and to facilitate a return to rational discourse regarding menopausal hormone therapy, an ad hoc group of experts in menopausal health submitted this comprehensive response to the USPSTF.

The evidence base for HRT: what can we believe?

Prior to the unexpected early termination of the Women's Health Initiative (WHI) trial of continuous conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA), the prevailing view was that hormone replacement therapy (HRT) was a low-risk intervention with immediate value for symptom relief in recently menopausal women, and that it probably conferred long-term protection against the major chronic diseases that affect women after menopause. Rather than replicating prior studies, the WHI was designed to test whether the beneficial associations consistently seen in women starting HRT near menopause would be found in women well beyond menopause. Views of the benefits and risks of HRT changed dramatically in 2002 with the unexpected early termination of the CEE + MPA trial and the alarming initial WHI report. HRT use plummeted world-wide, driven by fear of breast cancer and skepticism about cardiovascular benefits. Stunningly, the contrasting findings of the WHI trial of CEE alone reported 2 years later - suggesting prevention of coronary heart disease in women who began HRT at age <60 years, and a reduction in breast cancer overall - were largely ignored. Key lessons from the WHI are that the effects of HRT on most organ systems vary by age and time since last physiologic exposure to hormones and that there are differences between regimens. In the years since the first WHI report, we have learned much about the characteristics of women who are likely to benefit from HRT. The range of HRT regimens has also increased. Not all women have indications for HRT, but for those who do and who initiate within 10 years of menopause, benefits are both short-term (vasomotor, dyspareunia), and long-term (bone health, coronary risk reduction). Critically, the 'facts' that most women and clinicians consider in making the decision to use, or not use, HRT are frequently wrong or incorrectly applied.

The cardiovascular safety aspects of calcium supplementations: where does the truth lie? A personal perspective.

Clinical guidelines may change with time, as more information from topline studies emerges. Calcium plus vitamin D supplementation became routine decades ago, especially in the older population, based on the assumption that it may promote bone health and prevent fractures, and perhaps induce additional favorable health outcomes. During the past years, an ongoing debate defies this paradigm, mainly because of a potential cardiovascular risk on the one hand, and uncertainty in regard to the extent of the beneficial bone effects on the other hand. The following article summarizes the main recent developments, trying to put some order into the controversial information and opinions which have been published in the medical literature. We conclude that the best current evidence supports a primary strategy of obtaining recommended intakes of calcium and vitamin D from dietary sources. But, since most western diets are inadequate in that regard, and since there is no clear evidence of harm from modest supplementation (up to 1000 mg of elemental calcium and 400 IU of vitamin D3), supplementation is appropriate when dietary intake is inadequate.

Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events.

BACKGROUND: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS. DESIGN: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events. METHODS: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS + ABI, were fitted for the primary outcome of major coronary events. RESULTS: In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS + ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p = 0.050) and 9.6% (95% CI 6.1 to 16.4%, p < 0.001), respectively. Restricting the FRS + ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p < 0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p = 0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p = 0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p = 0.483) in women. CONCLUSIONS: An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

Have we come full circle - or moved forward? The Women's Health Initiative 10 years on.

In mid-summer 2002, the announcement that the Women's Health Initiative (WHI) trial of combination hormone therapy (HRT) had stopped jolted the field of women's health. It set off a cascade that first stunned, then meaningfully changed the future for millions of women, their partners, and tens of thousands of clinicians and scientists. With 10 years' hindsight, we can begin to put the lessons learned from the WHI HRT trials into perspective. These trials were primarily designed to test whether women considerably past menopause, and mostly asymptomatic, experienced treatment benefits from HRT expected from studies of generally symptomatic women who started near menopause. The definitive answer was 'no'. Unfortunately, the findings were generalized to all postmenopausal women regardless of age. Data accumulated from the WHI and other studies over the past decade have shown that, in women with symptoms or other indications, initiating HRT near menopause - the classic pattern of use - will probably provide a favorable benefit : risk ratio. Spurred by the WHI, many hypotheses and some insights about potential mechanisms for HRT effects on diverse organ systems have emerged, along with new perspectives on regimens, compounds, and routes of administration. This overview provides an historical perspective on the WHI design and the evolution of its message; summarizes current perspectives and insights contributed by eminent colleagues; reviews the state of the art; and looks to the future. We have come full circle in some ways, with mounting evidence supporting benefit for HRT started near menopause and with hard lessons learned about pathophysiology, publicity and interpreting data. Now we move on.

In an animal model nephrogenic systemic fibrosis cannot be induced by intraperitoneal injection of high-dose gadolinium based contrast agents.

AIM AND OBJECTIVE: Nephrogenic systemic fibrosis (NSF) has been reported in humans to be most likely induced by gadolinium based contrast agents (GBCA), namely by gadodiamide, gadopentetate dimeglumine, and gadoversetamide, rarely by other GBCA. The pathogenesis of NSF remains unclear; different hypotheses are under discussion. The objective of the study is to assess if in the animal model human-like NSF changes can be induced by high-dose, intraperitoneal GBCA injections over four weeks. MATERIALS AND METHODS: After approval by the institutional animal ethics committee, six rats each were randomly assigned to groups, and treated with seven different GBCA. Intraperitoneal (IP) injections - proven in the animal model to be effective - were chosen to prolong the animals' exposure to the respective GBCA. GBCA doses of previous intravenous (IV) animal studies were applied. After five weeks all rats were sacrificed. Sham controls were treated with IP saline injections, employing the same regimen. RESULTS: No findings comparable with human NSF were observed in all animals after IP treatment with all seven GBCA at daily doses of 2.5 and 5.0 mmol/kg body weight (BW). No histopathological abnormalities of all examined organs were noted. Weight loss was stated in weeks three and four with GBCA injections at doses of 5.0 mmol/kg BW, but rats regained weight after cessation of GBCA treatment. CONCLUSIONS: NSF-comparable pathological findings could not be induced by high dose intraperitoneal injection of seven GBCA.

On the need to clarify and disseminate contemporary knowledge of hormone therapy initiated near menopause.

The dramatic change in opinion on postmenopausal hormone therapy (HT) following initial reports from the Women's Health Initiative (WHI) came about as the 'baby boom' generation of women created the largest population of newly menopausal women in history. That trial of conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) focused on outcomes in women starting HT a decade or more after menopause. Yet clinical practice has focused on initiation near menopause. Recent findings in the limited numbers of younger menopausal women in the WHI CEE + MPA trial, and findings in the CEE-only trial, suggest that age at initiating HT strongly influences outcomes, and that benefits greatly exceed risk for most women who start within 10 years of menopause. Findings in other cohorts support this view. Benefits are both short (vasomotor, dyspareunia) and long term (bone health, possible coronary risk reduction). Not all postmenopausal women have indications for HT, but, even if the fraction is one-third, the numbers affected are staggering. Low-dose and non-oral regimens, and other compounds, were introduced in the wake of the WHI. Emerging evidence suggests that these may further reduce risk in some population subgroups. The demonizing of HT may already have caused a burden of chronic disease that could have been mitigated or delayed. It is time for action to re-establish appropriate clinical context based on this emerging evidence, to reverse the inappropriate broad generalization of the WHI findings to younger menopausal women, and to support outcomes studies of current regimens in younger menopausal women.

In vitro assessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions.

Discography is a controversial diagnostic procedure involving the injection of radiographic contrast medium (RCM) into the intervertebral disc. Iatrogenic bacterial discitis is a rare but serious complication. The intervention has been increasingly performed in our patients here in the United Arab Emirates. Prophylactic intravenous antibiotic administration can reduce post-interventional discitis; however, this may favour the development of bacterial resistance. Direct intradiscal injection of an antibiotic together with the RCM is a potential alternative. To date, there has been only one study on the efficacy of antibiotics added to an RCM. Equally, there are only limited data regarding the potential direct effect of RCM on bacterial growth. The purpose of this study was to determine whether the efficacy of antibiotics is affected when RCM are added. In an in vitro study, the effect of non-ionic RCM on the growth of five laboratory bacterial strains, alone and in combination with three broad-spectrum antimicrobials, was tested. Bacterial growth was assessed in the absence and the presence of RCM, antibiotics and their combinations. All three RCM alone demonstrated some inhibition of bacterial growth at high concentrations. In the presence of the RCM, all three antibiotics retained their inhibitory effect on bacterial growth. In conclusion, our in vitro experiments did not reveal any changes in the antimicrobial efficacy of the three antibiotics in the presence of the three tested RCM. Subsequent clinical trials will need to assess whether intradiscal antibiotic administration may be a suitable substitute for, or a supplement to, prophylactic systemic antibiotics before discography.

Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.

CONTEXT: Prediction models to identify healthy individuals at high risk of cardiovascular disease have limited accuracy. A low ankle brachial index (ABI) is an indicator of atherosclerosis and has the potential to improve prediction. OBJECTIVE: To determine if the ABI provides information on the risk of cardiovascular events and mortality independently of the Framingham risk score (FRS) and can improve risk prediction. DATA SOURCES: Relevant studies were identified. A search of MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) was conducted using common text words for the term ankle brachial index combined with text words and Medical Subject Headings to capture prospective cohort designs. Review of reference lists and conference proceedings, and correspondence with experts was conducted to identify additional published and unpublished studies. STUDY SELECTION: Studies were included if participants were derived from a general population, ABI was measured at baseline, and individuals were followed up to detect total and cardiovascular mortality. DATA EXTRACTION: Prespecified data on individuals in each selected study were extracted into a combined data set and an individual participant data meta-analysis was conducted on individuals who had no previous history of coronary heart disease. RESULTS: Sixteen population cohort studies fulfilling the inclusion criteria were included. During 480,325 person-years of follow-up of 24,955 men and 23,339 women, the risk of death by ABI had a reverse J-shaped distribution with a normal (low risk) ABI of 1.11 to 1.40. The 10-year cardiovascular mortality in men with a low ABI (< or = 0.90) was 18.7% (95% confidence interval [CI], 13.3%-24.1%) and with normal ABI (1.11-1.40) was 4.4% (95% CI, 3.2%-5.7%) (hazard ratio [HR], 4.2; 95% CI, 3.3-5.4). Corresponding mortalities in women were 12.6% (95% CI, 6.2%-19.0%) and 4.1% (95% CI, 2.2%-6.1%) (HR, 3.5; 95% CI, 2.4-5.1). The HRs remained elevated after adjusting for FRS (2.9 [95% CI, 2.3-3.7] for men vs 3.0 [95% CI, 2.0-4.4] for women). A low ABI (< or = 0.90) was associated with approximately twice the 10-year total mortality, cardiovascular mortality, and major coronary event rate compared with the overall rate in each FRS category. Inclusion of the ABI in cardiovascular risk stratification using the FRS would result in reclassification of the risk category and modification of treatment recommendations in approximately 19% of men and 36% of women. CONCLUSION: Measurement of the ABI may improve the accuracy of cardiovascular risk prediction beyond the FRS.

Elevated blood pressure in primary care varies in relation to circadian and seasonal changes.

Blood pressure (BP) is known to vary by time of day and day of year. Studies differ substantially on the magnitude of the effect and there is doubt whether variation is clinically meaningful. We used more than 2 million BP measurements obtained between 1996 and 2004 from Geisinger Clinic primary care patients. General estimating equations were used to determine the effect of time of day and month of year on the probability of identifying BP values above four diagnostic cutoff points (SBP > or =120 mm Hg, SBP > or =140 mm Hg, DBP > or =80 mm Hg, DBP > or =90 mm Hg). Time of day and month of year were significantly associated with the odds of measuring elevated BP, regardless of definition. The odds ratio (OR) for SBP > or =120 mm Hg in the evening (1900 hours) versus midday (1200 hours) was 1.32 (P < 0.001). The OR for SBP > or =120 mm Hg in winter to summer months was 1.24 (P < 0.001). Similar results were found for each age/gender group. These data indicate that in clinical practice, measurement of an elevated BP may vary by 40% depending on the time of day and month of year. The magnitude of the variability in BP measurement attributable to the combined effect of these temporal factors is clinically significant. Anticipation of changes in BP attributable to temporal factors may improve accuracy of diagnosis and precision of therapy.

Comparison of two imaging protocols for acute stroke: unenhanced cranial CT versus a multimodality cranial CT protocol with perfusion imaging.

The aim of the study was to validate a multimodality cranial computed tomography (CCT) protocol for patients with acute stroke in the United Arab Emirates as a basic imaging procedure for a stroke unit. Therefore, a comparative study was conducted between two groups: retrospective, historical group 1 with early unenhanced CCT and prospective group 2 undergoing a multimodality CCT protocol. Follow-up unenhanced CCT>48 h served as gold standard in both groups. Group 1: Early unenhanced CCT of 50 patients were evaluated retrospectively, using Alberta Stroke Program Early CT Score, and compared with the definite infarction on follow-up CCT. Group 2: 50 patients underwent multimodality CCT (unenhanced CCT, perfusion studies: cerebral blood flow, cerebral blood volume, mean transit time and CT angiography)<8 h after clinical onset and follow-up studies. Modified National Institute of Health Stroke Scale was used clinically in both groups. Group 1 showed 38 men, 12 women, clinical onset 2-8 h before CCT and modified National Institute of Health Stroke Scale 0-28. Group 2 included 38 men, 12 women, onset 3-8 h before CCT, modified National Institute of Health Stroke Scale 0-28. Sensitivity was 58.3% in group 1 and 84.2% in group 2. Computed tomography angiography detected nine intracranial occlusions/stenoses. The higher sensitivity of the multimodality CCT protocol justifies its use as a basic diagnostic tool for the set-up of a first-stroke unit in the United Arab Emirates.

Iosimenol, a new non-ionic dimeric contrast medium, does not induce immunoreactivity in the popliteal lymph node assay.

Animal studies in mice were conducted to determine the potential immunoreactivity of the new non-ionic dimeric contrast medium (CM) iosimenol using the PLNA and flow cytometric analyses. Comparative studies were performed with iodixanol. The known immune-reactive substance strepozotocin (STZ) and vehicle injections served as positive and negative controls, respectively. Our experiments did not show any immunological effect of iosimenol, concluding that the new CM iosimenol may be beneficial for use in high-risk patients.

Short version of the CES-D (Burnam screen) for depression in reference to the structured psychiatric interview.

A new screen for depression was compared with clinician diagnoses based on the Structured Clinical Interview for DSM-IV (SCID) as the standard. Post-menopausal women (n=436) completed the Burnam screen, a short version of the Center for Epidemiologic Studies Depression Scale (CES-D). The Burnam screen had a sensitivity of 74% and a specificity of 87% for current major depression and dysthymia, but the positive predictive value was low (20%) and the overall error rate was 14%. For lifetime mood disorders, sensitivity was very low for detecting affected subjects, even though specificity and positive predictive value were higher than for current conditions. Substituting a more sensitive cutpoint slightly improved the screen's ability to detect subjects with lifetime mood disorders. Even algorithms that used coefficients optimized for these data gave little improvement in the psychometric properties of the Burnam screen. These results re-emphasize the difficulty of using a one-stage screen to detect accurately a depressive diagnosis.

Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age, and ethnicity in a population study.

PURPOSE: In this study we assessed the normal common femoral vein (CFV) dimensions and related hemodynamics in a cohort assembled to permit contrasts by means of sex, age, and ethnicity. METHODS: The CFV diameter and the flow velocity were analyzed by means of duplex ultrasonography at rest and with a standardized Valsalva maneuver, with the subject in a 15% reverse Trendelenberg position. Mean levels of each of the CFV measurements were analyzed with age category, sex, and ethnicity, each adjusted for the other two. Multiple linear regression was used as a means of assessing the independent associations of age, sex, ethnicity, body mass index (BMI), and height to the CFV measurements. RESULTS: The average CFV diameter at rest was 11.84 mm, increasing to 14.27 mm during the Valsalva maneuver. There was a significant (P <.0001) decline in both diameter measures beginning in patients 60 years old. The CFV diameter was larger in men (12.90 mm) than in women (11.22 mm; P <.0001). The average CFV diameter in Hispanics, Africian Americans, and Asians was significantly smaller (P <.001) than in the non-Hispanic whites in multivarate analysis. The independence of these associations was confirmed by means of multivariate analysis, and positive associations of CFV diameter with height and BMI were documented. The Valsalva response was higher in men than in women (2.67 mm vs 2.29 mm), but the percentage change was similar. CFV velocity at rest decreased significantly (P <.0001) in patients older than 50 years. The mean CFV velocity was 13.87 cm/s, and the values were significantly (P <.0001) higher in women (14.58 cm/s) than in men (12.67 cm/s). In multivariate analysis CFV velocity was higher in African Americans than in the other ethnic groups. We also documented an independent inverse association of CFV with BMI. The CFV velocity response (peak expiration post-Valsalva) increased significantly at all ages, from 52% to 83%. The percentage increase in women (68%) was slightly higher than that in men (58%). African American subjects had a somewhat higher percentage increase (74%) than the other three ethnic groups (63% to 64%). Because the flow rate is determined more by the diameter than the velocity, CFV flow associations were similar to those for diameter. Because an older age predicted both decreased diameter and velocity, the flow reduction with age was pronounced. CONCLUSION: Quantitative normative data that are age-, sex-, and ethnic group-specific are reported on CFV diameter, velocity, and total flow rate, both at rest and with the Valsalva maneuver. CFV diameter, velocity, and flow rate varied significantly as a function of age, sex, ethnicity, height, and BMI. The data also provide a baseline assessment for subsequent evaluations of changes with time in this cohort.

Sleep detection with an accelerometer actigraph: comparisons with polysomnography.

Two validation studies were conducted to optimize the sleep-detection algorithm of the Actillume. The first study used home recordings of postmenopausal women (age range: 51 to 77 years), which were analyzed to derive the optimal algorithm for detecting sleep and wakefulness from wrist activity data, both for nocturnal in-bed recordings and considering the entire 24 h. The second study explored the optimal algorithm to score in-bed recordings of healthy young adults (age range: 19 to 34 years) monitored in the laboratory. In Study I, the algorithm for in-bed recordings (n=39) showed a minute-by-minute agreement of 85% between Actillume and polysomnography (PSG), a correlation of.98, and a mean measurement error (ME) of 21 min for estimates of sleep duration. Using the same algorithm to score 24-h recordings with Webster's rules, an agreement of 89%, a correlation of.90, and 1 min ME were observed. A different algorithm proved optimal to score in-bed recordings (n=31) of young adults, yielding an agreement of 91%, a correlation of.92, and an ME of 5 min. The strong correlations and agreements between sleep estimates from Actillume and PSG in both studies suggest that the Actillume can reliably monitor sleep and wakefulness both in community-residing elderly and healthy young adults in the laboratory. However, different algorithms are optimal for individuals with different characteristics.

Metabolic syndrome and ischemic heart disease in elderly men and women.

Associations between metabolic syndrome components and prevalent ischemic heart disease (IHD) were investigated in a cross-sectional, community-based study of elderly men (n = 1,015) and women (n = 1,259) in Rancho Bernardo, California, in 1984-1987. In both sexes, there were significant positive associations between IHD defined by resting electrocardiogram criteria and age, systolic blood pressure, fasting and postchallenge hyperglycemia, total cholesterol/high density lipoprotein cholesterol (HDL cholesterol) ratio, and triglycerides and an inverse significant association with HDL cholesterol. High collinearity and interactions between serum insulin and metabolic syndrome variables were accounted for by uncorrelated principal components identified by factor analysis. In both men and women, three uncorrelated principal components were identified, representing a central metabolic factor (body mass index, fasting and 2-hour serum insulin, high serum triglycerides, and low HDL cholesterol), a glucose factor, and a blood pressure factor. In a multivariate model with age and sex, all three factors were significantly associated with IHD by electrocardiogram criteria; central metabolic factor (odds ratio (OR) = 1.6, p = 0.001), glucose factor (OR = 1.4, p < 0.001), blood pressure factor (OR = 1.2, p = 0.005), age (10 years) (OR = 1.8, p < 0.001), and female sex (OR = 0.5, p < 0.02). Similar results were obtained in analyses using clinically manifest IHD as the outcome. These results support the thesis that the metabolic syndrome exerts effects through different risk factors by different mechanisms.

Six-month patient outcomes in a preventive cardiology center.

More effective ways to improve lifestyle behaviors need to be developed. Two hundred forty adult patients at a preventive cardiology clinic were randomly assigned to receive either one or five sessions of behavioral instruction to improve cardiovascular risk behaviors. Results for 102 patients from 6-month follow-up data revealed few significant differences between the two groups. However, in the two groups combined, there were significant reductions in total calories, percent of calories from total fat, percent of calories from saturated and monounsaturated fat, and dietary cholesterol. Reductions were also found in systolic blood pressure, triglycerides, body mass index, and weight. In multiple regression analyses, changes in physiologic variables were primarily associated with baseline and demographic characteristics. Changes in total calories, percent of calories from polyunsaturated fat, and walking were predicted by changes in social support or knowledge. Although most patients improved, the intensity of behavior change instruction was not related to the amount of change in cardiovascular risk factors. (c) 2001 by CHF, Inc.

Sleep-wake patterns among postmenopausal women: a 24-hour unattended polysomnographic study.

BACKGROUND: Circadian sleep-wake profiles in postmenopausal women were examined to explore relationships between nocturnal and out-of-bed sleep. METHODS: Twenty-one home recordings were obtained with unattended polysomnography from women ranging from 56 to 77 years of age. RESULTS: While maintaining their daily routines, volunteers slept an average of 439 minutes throughout the 24-hour recordings. Ten percent of the accumulated sleep time was recorded out of bed. CONCLUSIONS: Greater age was associated with more afternoon-evening sleep. Sleep was also frequently observed shortly after volunteers arose from bed in the morning.