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3. Drinking pattern and mortality in Danish nurses

Author

Morch, L.S., Johansen, D., Lokkegaard, E., Hundrup, Y.A., and Gronbaek, M.

Subjects
Mortality -- Denmark, Mortality -- Demographic aspects, Drinking of alcoholic beverages -- Health aspects
Abstract

Background/Objective: Moderate alcohol consumption has beneficial effects on survival. Sex differences, however, have been suggested implying less beneficial effect among women. We examined the impact of alcohol consumed on weekdays and at weekends, respectively, on risk of death among women. Subjects and methods: At baseline in 1993, a total of 17 772 female members of the Danish Nurse Association completed questionnaires on alcohol intake and other lifestyle factors. The influence of alcohol intake on risk of death was analyzed using Cox proportional hazard model. Results: Alcohol intake of 1-3 drinks per week was associated with the lowest risk of death. Intake above six drinks per weekend (Friday through Sunday) increased risk of death from all causes by 3% for each additional drink consumed per weekend (corresponding to an increased risk by 9% per drink per weekend day). Consumption of one or more drinks per weekday (Monday, Tuesday, Wednesday or Thursday) increased risk by 4% for each additional drink consumed per day. Conclusions: The results indicated an increasing risk of death for intake above six drinks per weekend and of one or more drinks per weekday. doi:10.1038/sj.ejcn.1602799; published online 23 May 2007 Keywords: alcohol; weekend; weekday; women; survival, Introduction Several population studies, predominantly among men, have shown that light to moderate alcohol intake is associated with a reduced risk of death from all causes. This reduction in mortality [...]

Published
2008

7. Malignant Hypertension in Association with Low Estrogen Dose Oral Contraceptives: Case Report and Review of Literature

Author

Frans M. Helmerhorst, Kluthcovsky Acgc, Sonia Afshariyamchlou, Issac Sachmechi, David A. Grimes, Nestler Je, Casey E, Bizeli R, Lokkegaard E, Chacra Apm, Gagnon C, Nanda K, Nigl F, Essah Pa, Reese M, Kai I. Cheang, C.W. Skovlund, Wickham Ep rd, Dickey Rp, Okafor E, L.H. Nielsen, O. Lidegaard, Skjeldestad Fe, Sharma S, Gallo Mf, Okamoto Jm, Laureen M Lopez, Cajoeiro Po, Dhaher Yy, Kenneth F. Schulz, Arash Ardabilygazir, Danial Mir, Schrut Gca, Chun D, Stumpf Mam, and van Vliet Ha

Subjects
education.field_of_study, business.industry, Service delivery framework, medicine.medical_treatment, Population, General Engineering, 030204 cardiovascular system & hematology, Intrauterine device, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Family planning, medicine, Levonorgestrel, Emergency contraception, 030212 general & internal medicine, Medical emergency, business, education, Developed country, Reproductive health, medicine.drug
Abstract

The Consortium has produced these medical and service delivery guidelines about oral emergency contraceptive pills to assist family planning programs and providers in assuring that the women they serve can use these regimens effectively and safely. This document reflects the latest available evidence and has been reviewed by internationally recognized reproductive health experts. Local programs are welcome to adapt these guidelines as needed to comply with national or other requirements. These guidelines do not discuss the use of the copper-bearing intrauterine device for emergency contraception. This device is the most effective emergency contraceptive option and should be offered to women when appropriate. Some of the new research and data updated include: New details on the hormone UPA and new studies on the influence of BMI on effectiveness are briefly discussed as well as how ECP regimens work their efficacy and safety guidelines on repeat use and considerations for starting or resuming regular contraceptives following ECP regimens. This update includes a Clinical Summary document (https://www.cecinfo.org/wp-content/uploads/2018/12/18-209_ICEC-Clinical-Summary_121918.pdf) which highlights essential takeaways.

Published
2018
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9. Relation between hormone replacement therapy and ischaemic heart disease in women: prospective observational study. (Primary care)

Author

Lokkegaard, E, Pedersen, AT, Heitmann, BL, Jovanovic, Z, Keiding, N, Hundrup, YA, Obel, EB, and Ottesen, B

Subjects
Heart diseases -- Risk factors, Hormone therapy -- Health aspects, Health, Risk factors, Health aspects
Abstract

Abstract Objective To investigate the risk of ischaemic heart disease and myocardial infarction among women using hormone replacement therapy, especially the potential modifying effect of cardiovascular risk factors. Design Prospective [...]

Published
2003

10. Menopausal hormone use and ovarian cancer risk : Individual participant meta-analysis of 52 epidemiological studies

Author

Gapstur, S. M., Patel, A. V., Banks, E., Dal Maso, L., Talamini, R., Chetrit, A., Hirsh-Yechezkel, G., Lubin, F., Sadetzki, S., Beral, V., Bull, D., Cairns, B., Crossley, B., Gaitskell, K., Goodill, A., Green, J., Hermon, C., Key, T., Moser, K., Reeves, G., Sitas, F., Collins, R., Peto, R., Gonzalez, C. A., Lee, N., Marchbanks, P., Ory, H. W., Peterson, H. B., Wingo, P. A., Martin, N., Silpisornkosol, S., Theetranont, C., Boosiri, B., Chutivongse, S., Jimakorn, P., Virutamasen, P., Wongsrichanalai, C., Goodman, M. T., Lidegaard, O., Kjaer, S. K., Morch, L. S., Tjonneland, A., Byers, T., Rohan, T., Mosgaard, B., Vessey, M., Yeates, D., Freudenheim, J. L., Titus, L. J., Chang-Claude, J., Kaaks, R., Anderson, K. E., Lazovich, D., Robien, K., Hampton, J., Newcomb, P. A., Rossing, M. A., Thomas, D. B., Weiss, N. S., Lokkegaard, E., Riboli, E., Clavel-Chapelon, F., Cramer, D., Hankinson, S. E., Tamimi, R. M., Tworoger, S. S., Franceschi, S., La Vecchia, C., Negri, E., Adami, H. O., Magnusson, C., Riman, T., Weiderpass, E., Wolk, A., Schouten, L. J., van den Brandt, P. A., Chantarakul, N., Koetsawang, S., Rachawat, D., Palli, D., Black, A., Brinton, L. A., Freedman, D. M., Hartge, P., Hsing, A. W., Jnr, J. V. Lacey, Lissowska, J., Hoover, R. N., Schairer, C., Babb, C., Urban, M., Graff-Iversen, S., Selmer, R., Bain, C. J., Green, A. C., Purdie, D. M., Siskind, V., Webb, P. M., Moysich, K., McCann, S. E., Hannaford, P., Kay, C., Binns, C. W., Lee, A. H., Zhang, M., Ness, R. B., Nasca, P., Coogan, P. F., Palmer, J. R., Rosenberg, L., Whittemore, A., Katsouyanni, K., Trichopoulou, A., Trichopoulos, D., Tzonou, A., Dabancens, A., Martinez, L., Molina, R., Salas, O., Lurie, G., Carney, M. E., Wilkens, L. R., Werner Hartman, Linda, Manjer, Jonas, Olsson, Håkan, Kumle, M., Grisso, J. A., Morgan, M., Wheeler, J. E., Edwards, R. P., Kelley, J. L., Modugno, F., Onland-Moret, N. C., Peeters, P. H. M., Casagrande, J., Pike, M. C., Wu, A. H., Canfell, K., Miller, A. B., Gram, I. T., Lund, E., McGowan, L., Shu, X. O., Zheng, W., Farley, T. M. M., Holck, S., Meirik, O., Risch, H. A., S. M. Gapstur, A. V. Patel, E. Bank, L. Dal Maso, R. Talamini, A. Chetrit, G. Hirsh Yechezkel, F. Lubin, S. Sadetzki, V. Beral, D. Bull, B. Cairn, B. Crossley, K. Gaitskell, A. Goodill, J. Green, C. Hermon, T. Key, K. Moser, G. Reeve, F. Sita, R. Collin, R. Peto, C. A. Gonzalez, N. Lee, P. Marchbank, H. W. Ory, H. B. Peterson, P. A. Wingo, N. Martin, S. Silpisornkosol, C. Theetranont, B. Boosiri, S. Chutivongse, P. Jimakorn, P. Virutamasen, C. Wongsrichanalai, M. T. Goodman, O. Lidegaard, S. K. Kjaer, L. S. Morch, A. Tjonneland, T. Byer, T. Rohan, B. Mosgaard, M. Vessey, D. Yeate, J. L. Freudenheim, L. J. Titu, J. Chang Claude, R. Kaak, K. E. Anderson, D. Lazovich, K. Robien, J. Hampton, P. A. Newcomb, M. A. Rossing, D. B. Thoma, N. S. Wei, E. Lokkegaard, E. Riboli, F. Clavel Chapelon, D. Cramer, S. E. Hankinson, R. M. Tamimi, S. S. Tworoger, S. Franceschi, C. La Vecchia, E. Negri, H. O. Adami, C. Magnusson, T. Riman, E. Weiderpa, A. Wolk, L. J. Schouten, P. A. van den Brandt, N. Chantarakul, S. Koetsawang, D. Rachawat, D. Palli, A. Black, L. A. Brinton, D. M. Freedman, P. Hartge, A. W. Hsing, J. V. L. Jnr, J. Lissowska, R. N. Hoover, C. Schairer, C. Babb, M. Urban, S. Graff Iversen, R. Selmer, C. J. Bain, A. C. Green, D. M. Purdie, V. Siskind, P. M. Webb, K. Moysich, S. E. McCann, P. Hannaford, C. Kay, C. W. Binn, A. H. Lee, M. Zhang, R. B. Ne, P. Nasca, P. F. Coogan, J. R. Palmer, L. Rosenberg, A. Whittemore, K. Katsouyanni, A. Trichopoulou, D. Trichopoulo, A. Tzonou, A. Dabancen, L. Martinez, R. Molina, O. Sala, G. Lurie, M. E. Carney, L. R. Wilken, L. Hartman, J. Manjer, H. Olsson, M. Kumle, J. A. Grisso, M. Morgan, J. E. Wheeler, R. P. Edward, J. L. Kelley, F. Modugno, N. C. Onland Moret, P. H. M. Peeter, J. Casagrande, M. C. Pike, A. H. Wu, K. Canfell, A. B. Miller, I. T. Gram, E. Lund, L. McGowan, X. O. Shu, W. Zheng, T. M. M. Farley, S. Holck, O. Meirik, H. A. Risch, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, RS: CAPHRI - R5 - Optimising Patient Care, RS: GROW - Oncology, and RS: GROW - R1 - Prevention

Subjects
medicine.medical_specialty, medicine.medical_treatment, Etiology - Endogenous Factors in the Origin and Cause of Cancer, ovarian neoplasm, THERAPY, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Epidemiology, middle aged, medicine, Cancer Type - Ovarian Cancer, estrogen replacement therapy, human, Prospective cohort study, medicine (all), Gynecology, Science & Technology, business.industry, drug administration schedule, WOMEN, risk assessment, Retrospective cohort study, General Medicine, 11 Medical And Health Sciences, medicine.disease, postmenopause, female, Meta-analysis, Relative risk, Cancer and Oncology, incidence, Hormone therapy, HEALTH, Risk assessment, Ovarian cancer, business, Life Sciences & Biomedicine
Abstract

SummaryBackgroundHalf the epidemiological studies with information about menopausal hormone therapy and ovarian cancer risk remain unpublished, and some retrospective studies could have been biased by selective participation or recall. We aimed to assess with minimal bias the effects of hormone therapy on ovarian cancer risk.MethodsIndividual participant datasets from 52 epidemiological studies were analysed centrally. The principal analyses involved the prospective studies (with last hormone therapy use extrapolated forwards for up to 4 years). Sensitivity analyses included the retrospective studies. Adjusted Poisson regressions yielded relative risks (RRs) versus never-use.FindingsDuring prospective follow-up, 12 110 postmenopausal women, 55% (6601) of whom had used hormone therapy, developed ovarian cancer. Among women last recorded as current users, risk was increased even with

Published
2015

11. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies

Author

Gapstur, S. M. Patel, A. V. Banks, E. Dal Maso, L. and Talamini, R. Chetrit, A. Hirsh-Yechezkel, G. Lubin, F. and Sadetzki, S. Beral, V. Bull, D. Cairns, B. Crossley, B. and Gaitskell, K. Goodill, A. Green, J. Hermon, C. Key, T. Moser, K. Reeves, G. Sitas, F. Collins, R. Peto, R. Gonzalez, C. A. Lee, N. Marchbanks, P. Ory, H. W. and Peterson, H. B. Wingo, P. A. Martin, N. Silpisornkosol, S. and Theetranont, C. Boosiri, B. Chutivongse, S. Jimakorn, P. and Virutamasen, P. Wongsrichanalai, C. Goodman, M. T. and Lidegaard, O. Kjaer, S. K. Morch, L. S. Tjonneland, A. and Byers, T. Rohan, T. Mosgaard, B. Vessey, M. Yeates, D. and Freudenheim, J. L. Titus, L. J. Chang-Claude, J. Kaaks, R. Anderson, K. E. Lazovich, D. Robien, K. Hampton, J. and Newcomb, P. A. Rossing, M. A. Thomas, D. B. Weiss, N. S. and Lokkegaard, E. Riboli, E. Clavel-Chapelon, F. Cramer, D. and Hankinson, S. E. Tamimi, R. M. Tworoger, S. S. and Franceschi, S. La Vecchia, C. Negri, E. Adami, H. O. and Magnusson, C. Riman, T. Weiderpass, E. Wolk, A. and Schouten, L. J. van den Brandt, P. A. Chantarakul, N. and Koetsawang, S. Rachawat, D. Palli, D. Black, A. Brinton, L. A. Freedman, D. M. Hartge, P. Hsing, A. W. Jnr, J. V. Lacey Lissowska, J. Hoover, R. N. Schairer, C. Babb, C. and Urban, M. Graff-Iversen, S. Selmer, R. Bain, C. J. and Green, A. C. Purdie, D. M. Siskind, V. Webb, P. M. and Moysich, K. McCann, S. E. Hannaford, P. Kay, C. Binns, C. W. Lee, A. H. Zhang, M. Ness, R. B. Nasca, P. and Coogan, P. F. Palmer, J. R. Rosenberg, L. Whittemore, A. and Katsouyanni, K. Trichopoulou, A. Trichopoulos, D. Tzonou, A. and Dabancens, A. Martinez, L. Molina, R. Salas, O. and Lurie, G. Carney, M. E. Wilkens, L. R. Hartman, L. and Manjer, J. Olsson, H. Kumle, M. Grisso, J. A. Morgan, M. and Wheeler, J. E. Edwards, R. P. Kelley, J. L. Modugno, F. and Onland-Moret, N. C. Peeters, P. H. M. Casagrande, J. and Pike, M. C. Wu, A. H. Canfell, K. Miller, A. B. Gram, I. T. Lund, E. McGowan, L. Shu, X. O. Zheng, W. Farley, T. M. M. Holck, S. Meirik, O. Risch, H. A. Collaborative Grp Epidemiological

Abstract

Background Half the epidemiological studies with information about menopausal hormone therapy and ovarian cancer risk remain unpublished, and some retrospective studies could have been biased by selective participation or recall. We aimed to assess with minimal bias the effects of hormone therapy on ovarian cancer risk. Methods Individual participant datasets from 52 epidemiological studies were analysed centrally. The principal analyses involved the prospective studies (with last hormone therapy use extrapolated forwards for up to 4 years). Sensitivity analyses included the retrospective studies. Adjusted Poisson regressions yielded relative risks (RRs) versus never-use. Findings During prospective follow-up, 12 110 postmenopausal women, 55% (6601) of whom had used hormone therapy, developed ovarian cancer. Among women last recorded as current users, risk was increased even with

Published
2015

19. RUBIC (ReproUnion Biobank and Infertility Cohort): A binational clinical foundation to study risk factors, life course, and treatment of infertility and infertility‐related morbidity

Author

Kristian Almstrup, Angel Elenkov, Yvonne Lundberg Giwercman, Nina la Cour Freiesleben, Lars Rylander, Anja Pinborg, Jorge E. Chavarro, Ann Holm Hansen, Lone Schmidt, Ilpo Huhtaniemi, Kristina Wendelboe Olsen, Stephen A. Krawetz, Nathalie F Wang, Ditte Vassard, Henriette Svarre Nielsen, Shalender Bhasin, Marie Louise Grøndahl, E. V. Bräuner, Russ Hauser, Pernille Fog Svendsen, Anders Juul, Sandra Søgaard Tøttenborg, Jorma Toppari, Jonatan Axelsson, Anne Zedeler, Emir Henic, Ellen Leth Løkkegaard, Margareta Laczna Kitlinski, György Marko-Varga, Christian H. Lindh, Anna-Maria Andersson, Niels Jørgensen, Lærke Priskorn, Johan Malm, Kajsa Uglevig Petersen, Laura Smidt Hansen, Andrea Salonia, Sacha Stormlund, Michael L. Eisenberg, Aleksander Giwercman, Selma Kloeve Landersoe, Priskorn, L., Tottenborg, S. S., Almstrup, K., Andersson, A. -M., Axelsson, J., Brauner, E. V., Elenkov, A., Freiesleben, N. L. C., Giwercman, Y. L., Grondahl, M. L., Hansen, A. H., Hansen, L. S., Henic, E., Kitlinski, M. L., Landersoe, S. K., Lindh, C., Lokkegaard, E. L., Malm, J., Olsen, K. W., Petersen, K. U., Schmidt, L., Stormlund, S., Svendsen, P. F., Vassard, D., Wang, N. F., Zedeler, A., Bhasin, S., Chavarro, J., Eisenberg, M. L., Hauser, R., Huhtaniemi, I., Krawetz, S. A., Marko-Varga, G., Salonia, A., Toppari, J., Juul, A., Jorgensen, N., Nielsen, H. S., Pinborg, A., Rylander, L., and Giwercman, A.

Subjects
Adult, Male, medically assisted reproduction, Infertility, medicine.medical_specialty, Medication history, Denmark, Urology, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Reproductive medicine, Fertility, human microbiome/microbiota, 03 medical and health sciences, Reproductive Techniques, semen quality, 0302 clinical medicine, Endocrinology, Pregnancy, Risk Factors, medicine, Humans, Prospective Studies, Biological Specimen Banks, media_common, Sweden, 030219 obstetrics & reproductive medicine, epigenetics, business.industry, Public health, Pregnancy Outcome, reproductive disorders, medicine.disease, Biobank, Reproductive Medicine, Family medicine, Cohort, Female, infertility, business, Live birth, Biomarkers
Abstract

Background Infertility affects 15-25% of all couples during their reproductive life span. It is a significant societal and public health problem with potential psychological, social, and economic consequences. Furthermore, infertility has been linked to adverse long-term health outcomes. Despite the advanced diagnostic and therapeutic techniques available, approximately 30% of infertile couples do not obtain a live birth after fertility treatment. For these couples, there are no further options to increase their chances of a successful pregnancy and live birth. Objectives Three overall questions will be studied: 1) What are the risk factors and natural life courses of infertility, early embryonic loss, and adverse pregnancy outcomes? 2) Can we develop new diagnostic and prognostic biomarkers for fecundity and treatment success? And 3) what are the health characteristics of women and men in infertile couples at the time of fertility treatment and during long-term follow-up? Material and methods ReproUnion Biobank and Infertility Cohort (RUBIC) is established as an add-on to the routine fertility management at Copenhagen University Hospital Departments in the Capital Region of Denmark and Reproductive Medicine Centre at Skane University Hospital in Sweden. The aim is to include a total of 5000 couples equally distributed between Denmark and Sweden. The first patients were enrolled in June 2020. All eligible infertile couples are prospectively asked to participate in the project. Participants complete an extensive questionnaire and undergo a physical examination and collection of bio-specimens (blood, urine, hair, saliva, rectal swabs, feces, semen, endometrial biopsies, and vaginal swabs). After the cohort is established, the couples will be linked to the Danish and Swedish national registers to obtain information on parental, perinatal, childhood, and adult life histories, including disease and medication history. This will enable us to understand the causes of infertility and identify novel therapeutic options for this important societal problem. This article is protected by copyright. All rights reserved.

Published
2021
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20. Trophoblast-secreted soluble-PD-L1 modulates macrophage polarization and function.

Author

Zhang YH, Aldo P, You Y, Ding J, Kaislasuo J, Petersen JF, Lokkegaard E, Peng G, Paidas MJ, Simpson S, Pal L, Guller S, Liu H, Liao AH, and Mor G

Subjects
Antigens, CD immunology, Cell Differentiation drug effects, Cell Line, Female, Humans, Interferon-beta immunology, Lipopolysaccharides pharmacology, Macrophages cytology, Toll-Like Receptor 4 immunology, Trophoblasts cytology, B7-H1 Antigen immunology, Cell Differentiation immunology, Macrophage Activation, Macrophages immunology, Pregnancy immunology, Trophoblasts immunology
Abstract

Decidual macrophages are in close contact with trophoblast cells during placenta development, and an appropriate crosstalk between these cellular compartments is crucial for the establishment and maintenance of a healthy pregnancy. During different phases of gestation, macrophages undergo dynamic changes to adjust to the different stages of fetal development. Trophoblast-secreted factors are considered the main modulators responsible for macrophage differentiation and function. However, the phenotype of these macrophages induced by trophoblast-secreted factors and the factors responsible for their polarization has not been elucidated. In this study, we characterized the phenotype and function of human trophoblast-induced macrophages. Using in vitro models, we found that human trophoblast-educated macrophages were CD14 + CD206 + CD86 - and presented an unusual transcriptional profile in response to TLR4/LPS activation characterized by the expression of type I IFN-β expression. IFN-β further enhances the constitutive production of soluble programmed cell death ligand 1 (PD-L1) from trophoblast cells. PD-1 blockage inhibited trophoblast-induced macrophage differentiation. Soluble PD-L1 (sPD-L1) was detected in the blood of pregnant women and increased throughout the gestation. Collectively, our data suggest the existence of a regulatory circuit at the maternal fetal interface wherein IFN-β promotes sPD-L1 expression/secretion by trophoblast cells, which can then initiate a PD-L1/PD-1-mediated macrophage polarization toward an M2 phenotype, consequently decreasing inflammation. Macrophages then maintain the expression of sPD-L1 by the trophoblasts through IFN-β production induced through TLR4 ligation., (©2020 Society for Leukocyte Biology.)

Published
2020
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21. IL-10 to TNFα ratios throughout early first trimester can discriminate healthy pregnancies from pregnancy losses.

Author

Kaislasuo J, Simpson S, Petersen JF, Peng G, Aldo P, Lokkegaard E, Paidas M, Pal L, Guller S, and Mor G

Subjects
Abortion, Spontaneous blood, Adult, Cohort Studies, Female, Fertilization in Vitro, Humans, Pregnancy, Pregnancy Trimester, First blood, Abortion, Spontaneous immunology, Interleukin-10 blood, Pregnancy Trimester, First immunology, Tumor Necrosis Factor-alpha blood
Abstract

Problem: Embryo implantation and placentation require a careful immunological balance. Cytokines such as IL-10 and TNFα have been implicated as markers of dysregulation, but have only been studied at a single time point or after a pregnancy loss. Our objective was to determine normative patterns of serum levels of IL-10 and TNFα and their ratio throughout the first trimester in healthy pregnancies and to determine if this pattern differs from pregnancy loss., Method of Study: Two prospective longitudinal cohorts of gravidae including in vitro fertilization (IVF) and naturally conceived pregnancies with serial blood draws. Cytokines were assayed using Simple Plex. In the IVF cohort, we monitored from the implantation day up to 6 weeks of gestation; whereas in the naturally conceived cohort, sample collection began at 4 weeks and throughout the whole first trimester., Results: IL-10 concentrations in normal pregnancies were significantly higher than in pregnancies ending in a loss starting at 6-8 weeks of gestation, while TNFα concentrations were significantly lower in normal than in pregnancies ending in a loss starting at 3-5 of gestation weeks. The IL-10 to TNFα ratio in normal pregnancies was significantly higher from 4 to 9 weeks compared to pregnancies that were lost (t test, P < .05). Changes were observed before any symptoms of miscarriage were present., Conclusion: We provide evidences of differences in early immunomodulation in healthy pregnancies vs those destined to end in first-trimester loss. The ratio of IL-10 to TNFα rises significantly higher in viable pregnancies as early as 4.5 weeks compared to pregnancies loss., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Published
2020
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22. Hormone therapy and cardiovascular risk markers and disease: focus on progestagens.

Author

Pedersen SH, Lokkegaard E, and Ottesen B

Abstract

Biological studies have demonstrated estrogen's beneficial effect on cardiovascular risk factors, including plasma lipoproteins, atherogenesis, vascular reactivity, inflammation and antioxidative activity. Additionally, observational studies have supported a cardioprotective effect of hormone therapy (HT), although an underlying healthy-user effect may account for these observations. Progestagens are added to protect against an increased risk of endometrial cancer observed with unopposed estrogen treatment. The inclusion of progestagen in HT has been associated with possible adverse cardiovascular outcomes. Recent, large-scale, randomized clinical studies did not confirm a beneficial cardiovascular effect of HT. On the contrary, an increased risk was found with continuous combined estrogen-progestagen regimens. The progestagen used in these trials was medroxyprogesterone acetate and other progestagen components have only been sparsely elucidated. The purpose of the present review is to outline some of the modifying effects of different progestagens on the actions of estrogen on cardiovascular risk markers and clinical end points observed in biological, observational and clinical studies.

Published
2006
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