Menopausal women have hypofibrinolysis even in subclinical stage of atherosclerosis.

BACKGROUND: PAI-1 is the main inhibitor of fibrinolysis. Increase in PAI-1 levels has been associated with the risk of coronary disease; however, there are few studies on the relationship between subclinical atherosclerosis and PAI-1 levels. OBJECTIVE: The aim of this study was to analyze the relationship between PAI-1 level and carotid intima-media thickness in premenopausal and postmenopausal women without apparent cardiovascular disease. MATERIAL AND METHODS: A cross-sectional study was conducted in 142 women aged 45 to 60 years with no history of cardiovascular disease. Anthropometric and laboratory measurements were performed, including PAI-1 levels. All participants underwent a B-Mode ultrasound to measure intima-media thickness. Subclinical atherosclerosis was considered when intima-media thickness was ≥ 0.7 mm and/or an atheromatous plaque was observed. RESULTS: Postmenopausal women had greater intima-media thickness than premenopausal women (0.688 ± 0.129 vs. 0.621 ± 0.113 mm; p < 0.05). Compared to women with normal intima-media thickness, women with subclinical atherosclerosis had higher PAI-1 levels (23.2 ± 13.7 vs. 30.4 ± 20.7 ng/ml; p < 0.05). In all participants, intima-media thickness correlated with PAI-1 (r = 0.302; p = 0.01) and with age (r = 0.358; p = 0001). CONCLUSIONS: An increase in intima-media thickness was observed in postmenopausal women compared with premenopausal women. Asymptomatic women with increased intima-media thickness had higher PAI-1 levels. These findings suggest that fibrinolytic activity is low in the subclinical stage of atherosclerosis.

[Frequency of symptoms of the climacteric syndrome]. / Frecuencia de los síntomas del síndrome climatérico.

BACKGROUND: Menopause is the descent in circulating estrogens that manifests clinically for the climacteric symptoms. These symptoms motivate the patient to consult to the physician. OBJECTIVE: To know which are the symptoms that motivate women in the climacteric to begin hormonal therapy. MATERIAL AND METHOD: Atransverse study was settled, 692 patients from the menopause cohort of Endocrine Research Unit, Centro Médico Nacional, IMSS participated. All patients signed the letter of informed consent. Complete clinical evaluation and taking samples of veined blood for the hormonal determinations of LH, FSH and estradiol were carried out. The approach of evaluation of the clinical symptoms was made with the scale of Greene that values six components: psychological, anxiety, depression, somatic, vasomotor and sexual, which quantifies the presence and intensity of the climacteric symptoms. RESULTS: The four main symptoms that accompany the climacteric are: hot flushes, irritability, edginess and sickness. With the registered symptoms, the punctuation of the components in the scale of Greene showed a bigger frequency statistically with difference significant (p < 0.05) for the vasomotor and the depressive component compared with the rest of the components that integrate all the symptoms. CONCLUSIONS: Hot flushes and irritability are the symptoms found in the first time interview, also these are presented in more than half of the patients, therefore these symptoms can be considered as main cause to begin hormonal therapy. In accordance with the scale of Greene that allowed us to evaluate the symptoms in integrated form, the sexual component was a smaller frequency, maybe to that great number of patient does not dare to comment the sexual dysfunctions. However, at the moment has a wide therapeutic arsenal and forms of administration of estrogen therapy that have demonstrated to have a clinical-benefic effect for the control of the climacteric symptoms.

[Hypothyroidism associated to menopause symptoms worsening change with thyroid substitution therapy]. / Modificación de la agudización de los síntomas de la menopausia e hipotiroidismo con tratamiento de sustitución tiroidea.

BACKGROUND: Hypothyroidism is more frequent in woman and raises with age. It is not clear why do they have greater susceptibility, but it seems to be related with levels of estrogens and hormonal changes. OBJECTIVE: To evaluate changes in symptoms of women with menopause and hypothyroidism after receiving hypothyroidism therapy and later hormonal therapy. PATIENTS AND METHODS: Longitudinal, descriptive and comparative study. Two groups were formed: one with 27 patients with hypothyroidism diagnoses and menopause, and the other with 27 menopausal patients matched by age. Appraisal criterion of hormonal therapy efficacy was Greene scale. Levotiroxine was employed as hypothyroidism therapy, at doses required to get euthyroidism in each patient. RESULTS: Basal climacteric symptoms' intensity was higher in patients with menopause and hypothyroidism, which decrease significantly (p < 0.05) after hypothyroidism therapy. CONCLUSIONS: Climacteric symptoms are more intense in patients with hypothyroidism, but they fall when euthyroidism is maintained. These changes in thyroid function can be associated to changes in estrogens concentrations, and therefore in direct relation to TRH neurohormone (thyroid releasing hormones).

Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women.

INTRODUCTION AND OBJECTIVES: Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women. METHODS: A cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis. RESULTS: A positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm(2); P = .03). CONCLUSIONS: Epicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women.

[Clinical improvement of diabetic neuropathy with carbamazepine or diclofenac treatment]. / Mejoría clínica de la neuropatía diabética con carbamazepina o diclofenaco.

BACKGROUND: diabetic neuropathy (DN) affects diverse aspects of a patient's life and there is not an optimal treatment. We did a comparative study of clinical improvement of DN with carbamazepine versus diclofenac. METHODS: a prospective and longitudinal study of two groups with signs and symptoms of DN was done. One group had 30 patients who used carbamazepine with an initial dose of 200 mg, every 24 hours for one week, with a gradual increase of up to 200 mg every 6 hours for 10 months. The other group had 29 patients who used diclofenac sodium 100 mg every 12 hours. Bimonthly evaluations were made to graduate the pain according to the patients' perception and laboratory studies that included glucose and lipids profile. The statistical test used was ANOVA. RESULTS: the patients who used carbamazepine presented absence of pain after 10 months compared with the diclofenac group (p < 0.01). The presence of cramps, muscular strength, pulses, perception of temperature and pressure improved significantly (p < 0.05) with the use of carbamazepine. On the other hand, muscular strength, tact and perception of temperature were deteriorated with the use of diclofenac. CONCLUSIONS: it is important to provide the appropriate treatment to diabetic patients with DN.

Introducción: la neuropatía diabética afecta diversos aspectos de la vida del paciente, pero aún no hay un tratamiento específico. Se hizo un análisis comparativo de la mejoría clínica con manejo de carbamazepina y diclofenaco. Métodos: estudio prospectivo, longitudinal, de dos grupos de pacientes diabéticos con signos y síntomas de neuropatía diabética: 30 usaron 200 mg de carbamazepina cada 24 horas por una semana, con incremento gradual hasta 200 mg cada seis horas por 10 meses; 29 utilizaron 100 mg de diclofenaco sódico cada 12 horas. Se hicieron evaluaciones bimestrales para graduar el dolor según la percepción del paciente. Los estudios de laboratorio incluyeron glucosa y perfil de lípidos. Se empleó Anova para mediciones repetidas. Resultados: los pacientes tratados con carbamazepina no tuvieron dolor después de 10 meses de tratamiento, a diferencia del grupo con diclofenaco (p < 0.01). Con la carbamazepina disminuyeron los calambres y mejoró la fuerza muscular, la presencia de pulsos y la percepción de temperatura y presión (p < 0.05). Los tres últimos se deterioraron con el diclofenaco. Conclusiones: hay que reconocer la sintomatología en pacientes diabéticos para dar el tratamiento adecuado.

Grasa epicárdica y factores de riesgo cardiometabólico en la posmenopausia / Epicardial fat and cardiometabolic risk in postmenopausal women

Objetivo. El riesgo cardiovascular aumenta en la etapa posmenopáusica. El tejido adiposo epicárdico ha mostrado utilidad para la identificación del riesgo cardiovascular, sin embargo, la información es aún escasa en la mujer posmenopáusica. El objetivo de este estudio fue analizar la relación entre el tejido adiposo epicárdico y los componentes del síndrome metabólico en mujeres posmenopáusicas. Sujetos y métodos. Estudio transversal comparativo en 50 mujeres posmenopáusicas, se midieron los factores de riesgo cardiometabólico, se les realizó ecocardiograma transtorácico y análisis de composición corporal. Resultados. La grasa epicárdica es más elevada en mujeres con síndrome metabólico en comparación a aquellas sin síndrome metabólico (515,6 ± 130,9 vs. 358,0 ± 138,7, p < 0,001) y presenta un incremento proporcional con el número de componentes del síndrome metabólico (p < 0,001). Conclusiones. El tejido adiposo epicárdico tiene relación con los componentes del síndrome metabólico en la posmenopausia, etapa que se caracteriza por mayor vulnerabilidad a la trombosis (AU)

Objective. Postmenopausal women have an increased risk of cardiovascular disease. Epicardial adipose tissue has been shown to be useful in identifying cardiovascular risk but there is little information in postmenopausal women. The objective of this study was to examine the association between epicardial fat and components of metabolic syndrome in postmenopausal women. Subjects and methods. A cross sectional study was conducted in 50 postmenopausal women. All participants underwent transthoracic echocardiography and body composition analysis. Results. A greater amount of epicardial adipose tissue was found in postmenopausal women with metabolic syndrome than in those without this syndrome (515.6 ± 130.9 vs 358.0 ± 138.7, p < 0.001). The amount of epicardial adipose tissue increased with a greater number of metabolic components (p < 0.001). Conclusions. There is a direct relationship between epicardial fat and cardiometabolic risk after menopause, a period when there is a higher risk of thrombosis (AU)

La grasa epicárdica se relaciona con la visceral, el síndrome metabólico y la resistencia a la insulina en mujeres menopáusicas / Epicardial Adipose Tissue Is Associated With Visceral Fat, Metabolic Syndrome, and Insulin Resistance in Menopausal Women

Introducción y objetivos El tejido adiposo epicárdico se ha asociado con diversos índices de adiposidad y resistencia a insulina. La medición de este tejido por ecocardiografía se considera una herramienta útil y accesible para valorar factores de riesgo cardiometabólico; no obstante, aún no existen suficientes estudios en mujeres posmenopáusicas, que es una etapa en la que se presenta un incremento del riesgo cardiovascular. El objetivo del estudio es analizar la relación entre las mediciones del tejido adiposo epicárdico y tejido adiposo visceral, perímetro de cintura, índice de masa corporal y resistencia a insulina en mujeres posmenopáusicas.MétodosEstudio transversal comparativo en 34 mujeres posmenopáusicas con y sin síndrome metabólico a las que se realizó ecocardiograma transtorácico y análisis de composición corporal.ResultadosSe encontró asociación positiva de las medidas de grasa epicárdica con el tejido adiposo visceral, el índice de masa corporal y el perímetro de cintura; en el surco aortoventricular derecho, las correlaciones fueron r = 0,505 (p < 0,003), r = 0,545 (p < 0,001) y r = 0,515 (p < 0,003) respectivamente. También se observó que las mujeres posmenopáusicas con síndrome metabólico presentaban aumento del tejido adiposo epicárdico en comparación con las que no tienen el síndrome (544,2 ± 122,9 frente a 363,6 ± 162,3 mm2; p = 0,03).ConclusionesEl tejido adiposo epicárdico medido por ecocardiografía se asocia con el tejido adiposo abdominal y corporal en las mujeres posmenopáusicas. Las posmenopáusicas con síndrome metabólico presentan mayor cantidad de grasa epicárdica. La medición del tejido adiposo epicárdico por ecocardiografía puede ser un método de utilidad para evaluar el riesgo cardiovascular en la posmenopausia (AU)

Introduction and objectives Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women.MethodsA cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis.ResultsA positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm2; P = .03).ConclusionsEpicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women (AU)