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Subsequent Risk (subsequent + risk)
Selected AbstractsJ-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individualsDIABETIC MEDICINE, Issue 8 2009M. Sakurai Abstract Aims, This study investigated the relationship between waist circumference and the subsequent incidence of Type 2 diabetes and the association with insulin resistance and pancreatic B-cell function in relatively lean Japanese individuals. Methods, The study participants were 3992 employees (2533 men and 1459 women, aged 35,55 years) of a metal-products factory in Japan. The incidence of diabetes was determined in annual medical examinations during an 8-year follow-up. We calculated age- and sex-adjusted hazard ratios (HRs) according to the sex-specific quintile of waist circumference at baseline. Differences in baseline insulin resistance [homeostatis model assessment (HOMA)-IR] and pancreatic B-cell function (HOMA-B) were compared between participants who developed diabetes and those who did not. Results, During the follow-up, 218 participants developed diabetes. Age- and sex-adjusted HRs across the quintiles of waist circumference were 1.78, 1.00 (reference), 1.59, 3.11 and 3.30, respectively (P for trend, < 0.0001). The HR for the lowest quintile was significantly higher than that for the second quintile. Among participants with waist circumference of the lowest quintile, HOMA-B was lower in those who developed diabetes than in those who did not [33.1 (24.1,45.0) vs. 54.3 (37.9,74.6) median (interquartile range), P < 0.0001], but HOMA-IR did not differ between these groups. Conclusions, There was a J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes in relatively lean Japanese individuals; lower pancreatic B-cell function may also increase the risk of diabetes in very lean Japanese people. [source] Preschool diet and adult risk of breast cancerINTERNATIONAL JOURNAL OF CANCER, Issue 3 2006Karin B. Michels Abstract Events before puberty may affect adult risk of breast cancer. We examined whether diet during preschool age may affect a woman's risk of breast cancer later in life. We conducted a case-control study including 582 women with breast cancer and 1,569 controls free of breast cancer selected from participants in the Nurses' Health Study and the Nurses' Health Study II. Information concerning childhood diet of the nurses at ages 3,5 years was obtained from the mothers of the participants with a 30-item food-frequency questionnaire. An increased risk of breast cancer was observed among woman who had frequently consumed French fries at preschool age. For one additional serving of French fries per week, the odds ratio (OR) for breast cancer adjusted for adult life breast cancer risk factors was 1.27 (95% confidence interval [CI] = 1.12,1.44). Consumption of whole milk was associated with a slightly decreased risk of breast cancer (covariate-adjusted OR for every additional glass of milk per day = 0.90; 95% CI = 0.82,0.99). Intake of none of the nutrients calculated was related to the risk of breast cancer risk in this study. These data suggest a possible association between diet before puberty and the subsequent risk of breast cancer. Differential recall of preschool diet by the mothers of cases and controls has to be considered as a possible explanation for the observed associations. Further studies are needed to evaluate whether the association between preschool diet and breast cancer is reproducible in prospective data not subject to recall bias. © 2005 Wiley-Liss, Inc. [source] Preeclampsia: Exposing Future Cardiovascular Risk in Mothers and Their ChildrenJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2007Cindy M. Anderson There is an increased risk for future cardiovascular disease in women who have had preeclampsia. In infants born to mothers with preeclampsia, there is growing evidence of increased risk for both cardiovascular disease and preeclampsia. Epidemiologic and experimental data provide a strong link between intrauterine exposure to preeclampsia and subsequent risk for the development of cardiovascular disease in women. JOGNN, 36, 3-8; 2007. DOI: 10.1111/J.1552-6909.2006.00115.x [source] ORIGINAL ARTICLE: Venous thromboembolism and subsequent diagnosis of subarachnoid hemorrhage: a 20-year cohort studyJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2010H. T. SØRENSEN Summary.,Background:,Venous thromboembolism is a predictor of subsequent risk of ischemic stroke and intracerebral hemorrhage, but no data are available regarding its association with risk of subarachnoid hemorrhage. Objectives:,To examine this issue, we conducted a nationwide cohort study in Denmark. Patients and methods: Between 1977 and 2007, we identified 97 558 patients with a hospital diagnosis of venous thromboembolism and obtained information on risk of subsequent subarachnoid hemorrhage during follow-up in the Danish Registry of Patients. The incidence of subarachnoid hemorrhage in the venous thromboembolism cohort was compared with that of 453 406 population control cohort members. Results:,For patients with pulmonary embolism (PE), there was clearly an increased risk of subarachnoid hemorrhage, both during the first year of follow-up [relative risk 2.69; 95% confidence interval (CI), 1.32,5.48] and during later follow-up of 2,20 years (relative risk 1.40; 95% CI, 1.05,1.87). For patients with deep venous thrombosis (DVT) the risk was likewise clearly increased during the first year of follow-up (relative risk 1.91; 95% CI, 1.13,3.22), but not during later follow-up (relative risk 1.04; 95% CI, 0.81,1.32). Conclusions:,We found evidence that PE is associated with an increased long-term risk of subarachnoid hemorrhage. The two diseases might share etiologic pathways affecting the vessel wall or share unknown risk factors. [source] Cancer and subsequent risk of venous thromboembolismJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2006H. T. SØRENSEN [source] Liver transplantation and subsequent risk of cancer: Findings from a Canadian cohort study,LIVER TRANSPLANTATION, Issue 11 2008Ying Jiang Characterization of the long-term cancer risks among liver transplant patients has been hampered by the paucity of sufficiently large cohorts. The increase over time in the number of liver transplants coupled with improved survival underscores the need to better understand associated long-term health effects. This is a cohort study whose subjects were assembled with data from the population-based Canadian Organ Replacement Registry. Analyses are based on 2034 patients who received a liver transplant between June 1983 and October 1998. Incident cases of cancer were identified through record linkage to the Canadian Cancer Registry. We compared site-specific cancer incidence rates in the cohort and the general Canadian population by using the standardized incidence ratio (SIR). Stratified analyses were performed to examine variations in risk according to age at transplantation, sex, time since transplantation, and year of transplantation. Liver transplant recipients had cancer incidence rates that were 2.5 times higher than those of the general population [95% confidence interval (CI) = 2.1, 3.0]. The highest SIR was observed for non-Hodgkin's lymphoma (SIR = 20.8, 95% CI = 14.9, 28.3), whereas a statistically significant excess was observed for colorectal cancer (SIR = 2.6, 95% CI = 1.4, 4.4). Risks were more pronounced during the first year of follow-up and among younger transplant patients. In conclusion, our findings indicate that liver transplant patients face increased risks of developing cancer with respect to the general population. Increased surveillance in this patient population, particularly in the first year following transplantation, and screening for colorectal cancer with modalities for which benefits are already well recognized should be pursued. Liver Transpl 14:1588,1597, 2008. © 2008 AASLD. [source] Predictors of Fracture Risk of a Small Caliber Implantable Cardioverter Defibrillator LeadPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2010ANDREW C.T. Introduction: The Sprint Fidelis 6949 implantable cardioverter defibrillator (ICD; Medtronic Inc., Minneapolis, MN, USA) lead has a high rate of fracture. Identification of predictors of subsequent fracture is useful in decision making about lead replacement and for future lead design. We sought to determine if there are clinical, procedural, or radiological features associated with a greater risk of subsequent lead fracture. Methods: Patients with Sprint Fidelis 6949 lead fractures (Fracture group) were identified from our institutional database. Each patient in the Fracture group was matched to two controls, immediately preceeding and succeeding Sprint Fidelis 6949 implant. Clinical and procedural characteristics were compared. Chest radiographs performed 2 weeks after ICD implant were reviewed by an observer blinded to outcomes. The following features were assessed: ICD tip location, lead slack, kinking of the lead body (,90°), and presence of lead "crimping" within the anchoring sleeve. Results: Twenty-six patients with Sprint Fidelis 6949 lead fractures were identified and were matched to 52 control patients. On univariate analysis, a higher left ventricular ejection fraction (LVEF), prior ipsilateral device implant, history of prior ICD lead fracture, and noncephalic venous access were associated with risk of lead fracture. On multivariate analysis, a higher LVEF was the only independent predictor of lead fracture (P = 0.006). Radiological features were similar between the two groups. Conclusions: In this study, a higher LVEF was associated with a greater risk of lead fracture in patients with Sprint Fidelis 6949 ICD leads. Radiographic features did not predict subsequent risk of lead fracture in our population. (PACE 2010; 437,443) [source] Modelling sequence of prior pregnancies on subsequent risk of very preterm birthPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2010Lyndsey F. Watson Summary Watson LF, Rayner J-A, King J, Jolley D, Forster D, Lumley J. Modelling sequence of prior pregnancies on subsequent risk of very preterm birth. Paediatric and Perinatal Epidemiology 2010. The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population-based case,control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women having a singleton birth between 20 and <32 weeks gestation (very preterm births including terminations of pregnancy). The controls were 796 randomly selected women from the population having a singleton birth of at least 37 completed weeks gestation. Unconditional logistic regression was used to assess the association of very preterm birth with sequence of pregnancies defined by their outcome (prior abortion , spontaneous or induced, and prior preterm or term birth) with adjustment for sociodemographic factors. The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births. [source] Non-stress-related factors associated with maternal corticotrophin-releasing hormone (CRH) concentrationPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2010Michael S. Kramer Summary Kramer MS, Lydon J, Séguin L, Goulet L, Kahn SR, McNamara H, Genest J, Sharma S, Meaney MJ, Libman M, Dahhou M, Platt RW. Non-stress-related factors associated with maternal corticotrophin-releasing hormone (CRH) concentration. Paediatric and Perinatal Epidemiology 2010. During pregnancy, most maternal corticotrophin-releasing hormone (CRH) is secreted by the placenta, not the hypothalamus. Second trimester maternal CRH concentration is robustly associated with the subsequent risk of preterm birth, and it is often assumed that physiological and/or psychological stress stimulates placental CRH release. Evidence supporting the latter assumption is weak, however, and other factors affecting maternal CRH have received little attention from investigators. We carried out a case,control study nested within a large, multicentre prospective cohort of pregnant women to examine potential ,upstream' factors associated with maternal CRH concentration measured at 24,26 weeks of gestation. The predictors studied included maternal age, parity, birthplace (as a proxy for ethnic origin), pre-pregnancy body mass index, height, smoking, bacterial vaginosis and vaginal fetal fibronectin (FFN) concentration. Women with high (above the median) plasma CRH concentration were significantly less likely to have been born in Sub-Saharan Africa or the Caribbean, less likely to be overweight or obese, and more likely to be smokers. Associations with maternal birthplace and BMI persisted in logistic regression analyses controlling for potential confounding variables and when restricted to term controls. A strong (but imprecise and statistically non-significant) association was also observed with high vaginal FFN concentration. Further studies are indicated both in animal models and human populations to better understand the biochemical and physiological pathways to CRH secretion and their aetiological role, if any, in preterm birth. [source] Radiation and breast carcinogenesis,PEDIATRIC BLOOD & CANCER, Issue 5 2001John D. Boice Jr. Abstract With the possible exception of radiation-induced leukemia, more is known about radiation-induced breast cancer than any other malignancy [1, 2]. Fourteen cohort studies have provided quantitative information on the level of risk following a wide range of doses in different populations around the world. Comprehensive studies have been conducted in Canada, Germany, Japan, Sweden and other Nordic countries, the United Kingdom, and the USA (Table I). Key features are the linearity in the dose response (i.e., a straight line adequately fits the observed data), and the effect modification of age at exposure (i.e., risk is inversely related to exposure age and exposures past the menopausal ages appear to carry a very low risk); and the minimal effect of fractionating dose on subsequent risk [3]. A recent combined analysis of almost 78,000 women and 1,500 breast cancer cases from eight cohorts confirmed the downturn in risk at the highest dose levels (related in part to the killing of cells rather than transformation) and that fractionation of dose has little influence on risk, at least on an absolute scale [4]. It is not known whether persons predisposed to cancer are at enhanced risk of radiation-induced breast cancer from low-dose exposures, although this seems unlikely [5]. New data on the effects of high doses following childhood exposures will be forthcoming from long-term studies of the survivors of childhood cancer (6,8). Med. Pediatr. Oncol. 36:508,513, 2001. © 2001 Wiley-Liss, Inc. [source] Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: Findings from The Health and Retirement SurveyAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2004William T. Gallo PhD Abstract Background The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States. Methods We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals. Results The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR,=,1.89; 95% CI,=,0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR,=,2.64; 95% CI,=,1.01, 6.94). Conclusions Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers. Am. J. Ind. Med. 45:408,416, 2004. © 2004 Wiley-Liss, Inc. [source] Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with CinacalcetAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2006N. Leca Bone disease is a common clinical problem following renal transplantation. In renal transplant recipients, multiple underlying factors determine the extent of bone loss and the subsequent risk of fractures. In addition to the well-recognized risk to bone disease posed by steroids, calcineurin inhibitors and pre-existing bone disease, persistent hyperparathyroidism (HPT) contributes to post-transplant bone loss. HPT is usually treated with vitamin D supplements combined with calcium. Patients whose HPT is associated with hypercalcemia pose a difficult therapeutic dilemma which often requires parathyroidectomy. Cinacalcet, a calcium mimetic agent, offers a unique pharmacologic approach to the treatment of patients with post-transplant hypercalcemia and HPT. In this paper, we describe the clinical course and biochemical changes in 10 renal transplant recipients with hypercalcemia and severe HPT early after renal transplantation treated with cinacalcet. Cinacalcet therapy corrected hypercalcemia and decreased parathyroid hormone (PTH) levels in all cases. A transient rise in the level of alkaline phosphatase was noted following initiation of cinacalcet therapy. In this patient population, correction of HPT was not permanent as discontinuing cinacalcet therapy led to a rapid rise in PTH level. [source] Coffee consumption and risk of rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 11 2003Elizabeth W. Karlson Objective Recent reports have suggested an association between consumption of coffee or decaffeinated coffee and the risk of rheumatoid arthritis (RA), although data are sparse and somewhat inconsistent. Furthermore, existing studies measured dietary exposures and potential confounders only at baseline and did not consider possible changes in diet or lifestyle over the followup period. We studied whether coffee, decaffeinated coffee, total coffee, tea, or overall caffeine consumption was associated with the risk of RA, using the Nurses' Health Study, a longitudinal cohort study of 121,701 women. Methods Information on beverage consumption was assessed with a food frequency questionnaire (FFQ) that was completed every 4 years, from baseline in 1980 through 1998. Among the 83,124 women who completed the FFQ at baseline, the diagnosis of incident RA (between 1980 and 2000) was confirmed in 480 women by a connective tissue disease screening questionnaire and medical record review for American College of Rheumatology criteria. Relationships between intake of various beverages and the risk of RA were assessed in age-adjusted models and in multivariate Cox proportional hazards models including the cumulative average intake of each beverage during the followup period, adjusted for numerous potential confounders. In addition, for direct comparisons with prior reports, multivariate analyses were repeated using only baseline beverage information. Results We did not find a significant association between decaffeinated coffee consumption of ,4 cups/day (compared with no decaffeinated coffee consumption) and subsequent risk of incident RA, in either an adjusted multivariate model (relative risk [RR] 1.1, 95% confidence interval [95% CI] 0.5,2.2) or a multivariate model using only baseline reports of decaffeinated coffee consumption (RR 1.0, 95% CI 0.6,1.7). Similarly, there was no relationship between cumulative caffeinated coffee consumption and RA risk (RR 1.1, 95% CI 0.8,1.6 for ,4 cups per day versus none) or between tea consumption and RA risk (RR 1.1, 95% CI 0.7,1.8 for >3 cups/day versus none). Total coffee and total caffeine consumption were also not associated with the risk of RA. Conclusion In this large, prospective study, we find little evidence of an association between coffee, decaffeinated coffee, or tea consumption and the risk of RA among women. [source] Simple modification to the punch biopsy technique to minimize handling and crush artefactAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2005Alexander J Chamberlain SUMMARY A number of techniques have been described to retrieve the tissue core after punch biopsy. We describe a simple modification to the punch-biopsy technique that minimizes instrumentation, handling and the subsequent risk of crush artefact. Our technique is simple, quick and economical and essentially involves rotation of the punch through 90° then lateral extraction with a degree of upward traction, which usually leaves the tissue core deposited beside the skin defect. At this point it can be easily grasped with a square of gauze or detached if required using scissors or a scalpel blade. [source] Mid-trimester amniotic fluid C-reactive protein, ferritin and lactate dehydrogenase concentrations and subsequent risk of spontaneous preterm labourAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Sedigheh BORNA Background: Preterm delivery is a serious problem in obstetrics. A pre-existing inflammation in the first half of gestation has been proposed as a possible condition that leads to preterm delivery. Aim: Our aim was to compare C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) concentrations in mid-trimester amniotic fluid of patients with preterm and term deliveries and to found out their predictive values for preterm delivery. Methods: The study was conducted on 90 pregnant women who underwent genetic amniocentesis between the 15th and the 20th weeks of gestation. The samples were carried immediately to the laboratory for cytogenetic and biochemical examination. Non-parametric tests and receiver-operating characteristic curve analysis were used for statistical purpose. Results: This study showed women with preterm delivery at < 37 weeks (n = 17) had a higher median of amniotic fluid LDH concentration than those women who delivered at term (n = 73) (P = 0.003). Amniotic fluid LDH concentration of > 120 IU/L had a sensitivity of 59% and a specificity of 81% in the prediction of spontaneous preterm delivery at < 37 weeks. Maternal serum alpha-fetoprotein levels were higher in patients delivered preterm compared with term deliveries (P = 0.036). Conclusion: Mid-trimester LDH is found to be quite effective in the prediction of preterm delivery. Pre-existing intrauterine inflammatory process early in gestation may be an important risk factor for preterm delivery. [source] The incidence of high-grade prostatic intraepithelial neoplasia and atypical glands suspicious for carcinoma on first-time saturation needle biopsy, and the subsequent risk of cancerBJU INTERNATIONAL, Issue 4 2007Lynn Schoenfield OBJECTIVE To investigate the detection rate and extent of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands (AG) suspicious for prostate cancer, and the cancer risk in subsequent biopsies, diagnosed by a first 24-core saturation biopsy, as although the optimum extent of biopsy is controversial there is a trend to increase the number of cores taken, and apart from detecting prostate cancer, identifying HGPIN and AG is associated with a greater risk of finding cancer in subsequent biopsies, thus warranting a closer follow-up. PATIENTS AND METHODS The study included 100 men with consecutive first-time saturation biopsies; the indications for biopsy were an abnormal digital rectal examination and/or a serum prostate-specific antigen (PSA) level of >2.5 ng/mL. Each biopsy specimen was reviewed retrospectively by two pathologists to confirm the histological diagnosis. The number and percentage of cores positive for HGPIN, bilateral involvement and multifocality (HGPIN involving two or more cores) were recorded in each case. The presence of AG and cancer was also recorded. An extended (10,12 cores) repeat biopsy was available in 23 patients. RESULTS The median (range) age and PSA level of the patients was 63 (41,80) years and 4.9 (1.5,67.0) ng/mL, respectively. Of the 100 patients, 34% had normal findings (benign prostatic tissue, BPT), 39% had cancer, 26% had HGPIN and cancer, 22% had HGPIN alone, and 5% had AG. Repeat biopsies were available in nine of the 22 (41%) patients with HGPIN, four of five with AG, and 10 of the 34 (29%) with BPT. The median (range) interval between the first and second biopsy was 13 (4,36) months. Prostate cancer was detected at the second biopsy in a third of patients with isolated HGPIN on the first biopsy, and one of the four with AG. None of the patients with BPT had cancer on re-biopsy. The cancer detection rate was significantly greater in patients with multifocal than in those with unifocal HGPIN (80% vs none, P = 0.010). The median number of cores and percentage of tissue involved by HGPIN was 3.5 (2,5) and 1.0 (0.5,1.2)%, respectively, in patients with cancer detected in repeat biopsies, compared to 1.0 (1,3) and 0.2 (0.2,0.6)% in patients without cancer on repeat biopsy (P = 0.023 and 0.015, respectively). CONCLUSION Identifying multifocal HGPIN on first saturation biopsy is associated with an overall cancer detection rate of 80% on repeat 10,12-core biopsy. Although there were few patients, the detection of multifocal HGPIN warrants additional searches for concurrent invasive carcinoma by repeated biopsy. [source] Assessment of acitretin-treated female patients of childbearing age and subsequent risk of teratogenicityBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2001H. Maier [source] A meta-analysis of the association between Caesarean section and childhood asthmaCLINICAL & EXPERIMENTAL ALLERGY, Issue 4 2008S. Thavagnanam Summary Background Children born by Caesarean section have modified intestinal bacterial colonization and consequently may have an increased risk of developing asthma under the hygiene hypothesis. The results of previous studies that have investigated the association between Caesarean section and asthma have been conflicting. Objective To review published literature and perform a meta-analysis summarizing the evidence in support of an association between children born by Caesarean section and asthma. Methods MEDLINE, Web Science, Google Scholar and PubMed were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated for each study from the reported prevalence of asthma in children born by Caesarean section and in control children. Meta-analysis was then used to derive a combined OR and test for heterogeneity in the findings between studies. Results Twenty-three studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by Caesarean section (OR=1.22, 95% CI 1.14, 1.29). However, in this analysis, there was evidence of heterogeneity (I2=46%) that was statistically significant (P<0.001). Restricting the analysis to childhood studies, this heterogeneity was markedly decreased (I2=32%) and no longer attained statistical significance (P=0.08). In these studies, there was also evidence of an increase (P<0.001) in the risk of asthma after Caesarean section (OR=1.20, 95% CI 1.14, 12.6). Conclusion In this meta-analysis, we found a 20% increase in the subsequent risk of asthma in children who had been delivered by Caesarean section. [source] Recent concerns surrounding HRTCLINICAL ENDOCRINOLOGY, Issue 2 2003Mary Armitage Summary Millions of women are treated with hormone replacement therapy (HRT) for relief of menopausal symptoms, including vasomotor flushes and sweats for which oestrogen is uniquely and highly effective. Others may continue longer-term treatment in the hope that HRT will help to prevent chronic disease. The preservation of bone mass with continuing oestrogen therapy and reduction of subsequent risk of fracture is well established. Observational studies of the metabolic and vascular effects of oestrogens have suggested a potential benefit in reducing the risk of vascular disease, but recently published randomized controlled trials demonstrate no evidence of benefit in women with established vascular disease or in apparently healthy women. The increased risks of breast cancer and thromboembolic disease have been confirmed in these trials, with evidence of increased risk of stroke. Observational data suggest there may be a small increased risk of ovarian cancer associated with longer-term use of HRT. The premature termination of one arm of the Women's Health Initiative randomized controlled trial caused concern among patients, doctors and pharmaceutical companies. There are difficulties in extrapolating the results from trials using a specific HRT product to advise women on the wide range of other hormone products, doses, combinations and routes of administration. However, in the absence of evidence that other products are safer, the data suggest that for many women the risks associated with long-term use of HRT outweigh the benefits. There are nonhormonal strategies for the prevention and treatment of osteoporosis. HRT is not, and has never been, licensed in the UK for the prevention or treatment of vascular disease, and the data suggesting potential benefit should now be regarded as biased. The absolute incidence of an adverse event is low, and the risk in an individual woman in a single year is very small, but the risks are cumulative over time with long-term use. The risk,benefit balance of each woman needs regular reappraisal with continued use. [source] | ||||||||||||||||||||||