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Terra L, Hooning MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mom C, van Dorst EBL, Mourits MJE, Slangen BFM, Gaarenstroom KN, Zillikens MC, Leiner T, van der Kolk L, Collee M, Wevers M, Ausems MGEM, van Engelen K, Berger LP, van Asperen CJ, Gomez-Garcia EB, van de Beek I, Rookus MA, Hauptmann M, Bleiker EM, Schagen SB, Aaronson NK, Maas AHEM, van Leeuwen FE. Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study). JMIR Res Protoc 2021; 10:e24414. [PMID: 33480862 PMCID: PMC7864779 DOI: 10.2196/24414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID) DERR1-10.2196/24414
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Affiliation(s)
- Lara Terra
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Marc van Beurden
- Department of Gynaecology, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne A de Hullu
- Department for Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantijne Mom
- Department of Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eleonora B L van Dorst
- Department for Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte F M Slangen
- Department for Gynaecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- Department Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Margriet Collee
- Department for Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaartje van Engelen
- Department for Clinical Genetics, Amsterdam University Medical Centers, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Lieke Pv Berger
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Irma van de Beek
- Department for Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Matti A Rookus
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Eveline M Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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Paratz ED, Costello B, Rowsell L, Morgan N, Smith K, Thompson T, Semsarian C, Pflaumer A, James P, Stub D, La Gerche A, Zentner D, Parsons S. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death? Forensic Sci Med Pathol 2020; 17:27-35. [PMID: 33190173 DOI: 10.1007/s12024-020-00335-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia. .,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia. .,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Ben Costello
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Luke Rowsell
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Karen Smith
- , Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Chris Semsarian
- Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paul James
- Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
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Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol 2018; 72:434-447. [PMID: 30025580 PMCID: PMC6056023 DOI: 10.1016/j.jacc.2018.05.027] [Citation(s) in RCA: 506] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. On the basis of single-center and multicenter clinical and population-based studies with short-term and long-term outcomes data (up to 15-year follow-up), CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost effective across a broad range of baseline risk. This review summarizes evidence concerning CAC, including its pathobiology, modalities for detection, predictive role, use in prediction scoring algorithms, CAC progression, evidence that CAC changes the clinical approach to the patient and patient behavior, novel applications of CAC, future directions in scoring CAC scans, and new CAC guidelines.
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Affiliation(s)
- Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland. https://twitter.com/MichaelJBlaha
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Clinic, Essen, Germany
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. https://twitter.com/kewatson
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