In the largest human study to date on the topic, researchers have uncovered evidence of the possible influence of human sex hormones on the structure and function of the right ventricle (RV) of the heart.

The researchers found that in women receiving hormone therapy, higher estrogen levels were associated with higher RV ejection fraction (ejection refers to the amount of blood pumped out during a contraction; fraction refers to the residue left in the ventricle after the contraction)  with each heart beat and lower RV end-systolic volume — both measures of the RV’s blood-pumping efficiency — but not in women who were not on hormone therapy, nor in men. Conversely, higher testosterone levels were associated with greater RV mass and larger volumes in men, but not in women, and DHEA, an androgen which improves survival in animal models of pulmonary hypertension, was associated with greater RV mass and volumes in women, similar to the findings with testosterone in men.

“This study highlights how little is known about the effects of sex hormones on RV function. It is critical from both research and clinical standpoints to begin to answer these questions,” said Steven Kawut, M.D., M.S.,  director of the Pulmonary Vascular Disease Program at the University of Pennsylvania School of Medicine in Philadelphia.

The study was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Study participants were part of The MESA-Right Ventricle Study (or MESA-RV), an extension of the Multi-Ethnic Study of Atherosclerosis (MESA), a large, NHLBI-supported cohort focused on finding early signs of heart, lung and blood diseases before symptoms appear. Using blood samples and magnetic resonance imaging (MRI) of the heart, researchers measured sex hormones and RV structure and function in 1957 men and 1738 post-menopausal women. Because the MESA population is ethnically mixed and covers a broad age range of apparently healthy people, the results may be widely applicable to the general U.S. population.

“One of the most interesting things about this research is that we are focusing on individuals without clinical cardiovascular disease so that we may learn about determinants of RV morphology before there is frank RV dysfunction, which is an end-stage complication of many heart and lung diseases,” said Dr. Kawut. “When we study people who already have RV failure from long-standing conditions, the horse has already left the barn. We are trying to assess markers that could one day help us identify and intervene in individuals at risk for RV dysfunction before they get really sick.”

Because the RV plays a critical role in supplying blood to the lungs and the rest of the body, RV function is closely tied to clinical outcomes in many diseases where both the heart and lungs are involved, such as pulmonary hypertension, COPD and congestive heart failure. However, the RV is more difficult to study and image than the left ventricle and comparatively little is known about its structure and function and how to treat or prevent right heart failure.

Corey E. Ventetuolo, M.D., lead author of the study from  Columbia University College of Physicians and Surgeons, reported,  “Our results have generated some interesting questions about RV response to the hormonal milieu. For example, the finding that higher levels of testosterone (and DHEA) were associated with greater RV mass would first appear to have adverse clinical consequences, since increasing cardiac mass is traditionally thought to be maladaptive. However, another study from MESA-RV has shown that higher levels of physical activity are also linked to greater RV mass, which would suggest an adaptive effect. So, whether the increased RV mass seen with higher hormone levels is helpful or harmful is not yet clear. The sex-specific nature of the associations we found was unexpected and reflect the complexity of the actions of sex hormones.”

Sex hormone levels could help explain a key paradox in pulmonary arterial hypertension (PAH), where the RV response is an important determinant of survival.  While women are far more likely to develop PAH, they also have better RV function and may have a better survival than men. “It is possible that hormone balance could predispose them to developing PAH, but confer a protective benefit in terms of RV adaptation,” explained Dr. Kawut.

The ultimate goal would be strategies to treat or prevent RV failure in those at high risk.

Source:   American Thoracic Society

Researchers at the University of Texas Southwestern Medical Center report that estrogen therapy after menopause increases a woman's chances of developing kidney stones.  Kidney stones are common among postmenopausal women, affecting between 5% and 7% of the population in the U.S.  Up until now, only observational studies have been done looking at kidney stones and estrogen, and the results have been conflicting.   This study shows new evidence based on a randomized, placebo-controlled trial.

Lead study author, Dr. Naim Maalouf and colleagues conducted trials at 40 U.S. clinical centers where a total 10,739 post-menopausal women with hysterectomies and 16,608 post-menopausal women without hysterectomies were randomized to receive either an estrogen supplement or a placebo. Among those receiving hormones, 335 cases of kidney stones were reported versus 284 cases in the placebo groups.  In general, kidney stones are less common among pre-menopausal women than among men in the same age group, but the disparity lessens after menopause, suggesting that estrogen may have a protective effect.

However, study lead author Maalouf points out the study challenges the belief estrogen may protect against kidney stones.   "This research suggests that the opposite might be true, and it offers new information that might be considered when prescribing estrogen-replacement therapies to post-menopausal women," Maalouf says in a statement.

The study did not detect any link between kidney stone risk and body mass index, age, prior hormone therapy, coffee usage, diuretic usage, or ethnicity.

The exact mechanisms for these findings are yet to be determined.

Source:   Archives of Internal Medicine, October 11, 2010.

On October 15, 2010, the U.S. Food and Drug Administration approved Botox injection (onabotulinumtoxinA) to prevent headaches in adult patients with chronic migraine. Chronic migraine is defined as having a history of migraine and experiencing a headache on most days of the month.   it is estimated that about 6% of men and 18% of women suffer from migraine headaches during any given year.

“Chronic migraine is one of the most disabling forms of headache,” said Russell Katz, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “Patients with chronic migraine experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available.”

Migraine headaches are described as an intense pulsing or throbbing pain in one area of the head. The headaches are often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraine is three times more common in women than in men. Migraine usually begins with intermittent headache attacks 14 days or fewer each month (episodic migraine), but some patients go on to develop the more disabling chronic migraine.

To treat chronic migraines, Botox is given approximately every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Botox has not been shown to work for the treatment of migraine headaches that occur 14 days or less per month, or for other forms of headache. It is important that patients discuss with their physician whether Botox is appropriate for them.

The most common adverse reactions reported by patients being treated for chronic migraine were neck pain and headache (NOTE from this blogger:   FDA should define what kind of headache---treat migraine headaches with a medicine that may cause headaches???).

OnabotulinumtoxinA, marketed as Botox and Botox Cosmetic, has a boxed warning that says the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism. Those symptoms include swallowing and breathing difficulties that can be life-threatening. There has not been a confirmed serious case of spread of toxin effect when Botox has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, or strabismus, or when Botox Cosmetic has been used at the recommended dose to improve frown lines.

Breast Cancer is a major health concern for all women, including women with disabilities. About 30% of women aged 40 years or older have a disability.  In the US in 2008, 76.2% of women aged 40 or older reported having a mammogram in the past two years, while women with a disability have a lower reported mammography rate than women without a disability.  The Center for Disease Control and Prevention (CDC) has prepared a fact sheet that includes tips for women with disabilities to help them eliminate difficulties they may encounter while undergoing screening.    To view the CDC article, click HERE.

October is Breast Cancer Awareness Month----it's a good time for ALL women to be sure they have appropriate screenings.  For the men who read this blog, make sure the women in your lives take care of themselves and find time to be screened.  Remember, too, that about 1% of breast cancer cases  (nearly 2,000 per year) are found in men so if you have an unusual growth or swelling in the chest area, have it checked out!  They sometimes do mammograms on men, too!