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de Araújo PX, Moreira P, de Almeida DC, de Souza AA, do Carmo Franco M. Oral contraceptives in adolescents: a retrospective population-based study on blood pressure and metabolic dysregulation. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03671-z. [PMID: 38554180 DOI: 10.1007/s00228-024-03671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE This study aimed to explore the relationship between oral contraceptive use and blood pressure values and in a national cohort of women adolescents and to investigate the level of coexistence of the high blood pressure levels, dyslipidemia or insulin resistance. METHODS This is a retrospective cohort study that evaluated data form 14,299 adolescents aged 14 to 17 years. Crude and race-and age-adjusted analyses were performed using Poisson regression to estimate the prevalence ratios. Data clustering analysis was performed using machine learning approaches supported by an unsupervised neural network of self-organizing maps. RESULTS We found that 14.5% (n = 2076) of the women adolescents use oral contraceptives. Moreover, an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance (all P < 0.001) was observed among adolescents who use oral contraceptives as compared to those who do not. Our analysis also showed that 2.3% of adolescents using oral contraceptives had both high blood pressure levels and dyslipidemia, whereas 3.2% had high blood pressure levels combined with insulin resistance (all P < 0.001). The algorithmic investigative approach demonstrated that total cholesterol, LDLc, HDLc, insulin, and HOMA-IR were the most predicted variables to assist classificatory association in the context of oral contraceptive use among women adolescents with high blood pressure. CONCLUSIONS These findings suggest that oral contraceptives were associated with an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance among women adolescents. Although the indication of this therapy is adequate to avoid unintended pregnancies, their use must be based on rigorous individual evaluation and under constant control of the cardiometabolic risk factors.
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Affiliation(s)
| | - Priscila Moreira
- Program of Translational Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Alexandra Aparecida de Souza
- Laboratory of Applied Computing-LABCOM3, Federal Institute of Education, Science and Technology of São Paulo, São Paulo, Brazil
| | - Maria do Carmo Franco
- Physiology Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
- LiTiVasC - Laboratory of Translational Research in Vascular and Molecular Physiology, School of Medicine, Federal University of São Paulo. Rua Botucatu, 862 - 5° floor - , São Paulo, SP, 04023-062, Brazil.
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2
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Parvand M, Ghadiri S, Théberge E, Comber L, Mullen KA, Bhalla NP, Johnson D, McKinley G, Sedlak TL. Sex, Gender, and Women's Heart Health: How Women's Heart Programs Address the Knowledge Gap. CJC Open 2024; 6:442-453. [PMID: 38487062 PMCID: PMC10935996 DOI: 10.1016/j.cjco.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/15/2023] [Indexed: 03/17/2024] Open
Abstract
This article aims to bridge existing knowledge gaps that impact clinical cardiovascular care and outcomes for women in Canada. The authors discuss various aspects of women's heart health, emphasizing the efficacy of multidisciplinary care in promoting women's well-being. The article also identifies the impact of national women's heart health campaigns and the value of peer support in improving outcomes. The article addresses the particular risks that women face, such as pregnancy-related complications and hormone replacement therapy, all of which are associated with cardiovascular events, and highlights the differences in ischemic symptoms between men and women. Despite improvements in acute event outcomes, challenges persist in accessing timely ambulatory care, particularly for women. Canada has responded to these challenges by introducing Women Heart Programs, which offer tailored programs, support groups, and specialized testing. However, these programs remain few in number and are found only in urban settings. Overall, this review identifies sex and gender factors related to women's heart health, underscoring the importance of specialized programs and multidisciplinary care in improving women's cardiovascular health.
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Affiliation(s)
- Mahraz Parvand
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Siavash Ghadiri
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Emilie Théberge
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Lisa Comber
- Ottawa Heart Institute Research Corporation (OHIRC), Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Ottawa Heart Institute Research Corporation (OHIRC), Ottawa, Ontario, Canada
| | | | - Denise Johnson
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gayl McKinley
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara L. Sedlak
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital, Vancouver, British Columbia, Canada
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3
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Bruno RM, Varbiro S, Pucci G, Nemcsik J, Lønnebakken MT, Kublickiene K, Schluchter H, Park C, Mozos I, Guala A, Hametner B, Seeland U, Boutouyrie P. Vascular function in hypertension: does gender dimension matter? J Hum Hypertens 2023; 37:634-643. [PMID: 37061653 DOI: 10.1038/s41371-023-00826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023]
Abstract
Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while "toxic masculinity" traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women's vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.
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Affiliation(s)
- Rosa-Maria Bruno
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France.
| | - Szabolcs Varbiro
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Giacomo Pucci
- Internal Medicine Unit, "Santa Maria" Terni Hospital and Department of Medicine and Surgery-University of Perugia, Perugia, Italy
| | - János Nemcsik
- Department of Family Medicine and Health Service of Zuglo (ZESZ), Semmelweis University, Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Karolina Kublickiene
- Institution for Clinical Science, Intervention and Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Schluchter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria
| | - Ute Seeland
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France
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4
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Yang J, Gwini SM, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori TA. Effect of Oral Contraception on Screening Tests for Primary Aldosteronism: A 10-Year Longitudinal Study. J Clin Endocrinol Metab 2023; 108:1686-1695. [PMID: 36633572 DOI: 10.1210/clinem/dgad010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
CONTEXT Primary aldosteronism (PA) and oral contraception (OC) can both cause hypertension in young women. However, the effect of OC on the screening test for PA, the aldosterone to renin ratio (ARR), is not clear. OBJECTIVE We evaluated the impact of OC on the screening test for PA. METHODS In this retrospective cohort study, we analyzed data from the female offspring (Gen2) of women enrolled in the Raine Study, a population-based birth cohort, who had blood pressure (BP) measurements, blood samples, and information about OC use at age 17 years (N = 484) and/or age 27 years (N = 486). RESULTS Aldosterone concentration was significantly higher in OC users than nonusers at 17 years (median 486 pmol/L vs 347 pmol/L, P < 0.001). Renin concentration was significantly lower in OC users at both 17 years (13.4 mU/L vs 20.6 mU/L) and 27 years (9.2 mU/L vs 11.8 mU/L), hence the ARR was significantly higher in OC users compared to nonusers at both 17 years (31.5 vs 18.3) and 27 years (27.3 vs 21.1). The proportion of participants with ARR > 70 pmol/mU (current threshold for PA detection) was significantly higher in OC users at both 17 years (12.6% vs 2.1%) and 27 years (6.4% vs 0.4%); however, they had comparable BP to those with ARR < 70. OC use at any age abolished the relationship between ARR and BP that is observed in nonusers. CONCLUSION OC can increase the ARR and cause a false positive PA screening result. Until more reliable criteria for PA screening in OC users are established, alternative contraception should be considered during screening.
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Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Stella May Gwini
- Department of Biostatistics, University Hospital Geelong, Barwon Health, Victoria 3220, Australia
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Lawrence J Beilin
- Medical School, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia - Royal Perth Hospital Campus, Perth, Western Australia 6000, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth 6000, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Victoria 3004, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Crawley, Western Australia 6009, Australia
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Herzig M, Bertsche A, Hilbert C, Kiess W, Bertsche T, Neininger MP. Pharmacoepidemiological Analysis of Oral Contraceptive Use in Adolescents in a German Longitudinal Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:393. [PMID: 36832522 PMCID: PMC9955156 DOI: 10.3390/children10020393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
To assess the use of oral contraceptives (OC) in adolescents, using data from a longitudinal, population-based pediatric cohort study (LIFE Child). We also investigated associations between OC use and socioeconomic status (SES), and associations between OC use and potential adverse drug reactions such as effects on blood pressure. We included 609 female participants of the LIFE Child cohort, aged ≥13 to <21 years, who visited the study center between 2012 and 2019. Data collection compromised drug use in the past 14 days, SES, and anthropometric data such as blood pressure. An analysis of covariance was used to detect potential associations between participants' blood pressure and OC. Multivariate binary logistic regression was used to obtain odds ratios (aOR) adjusted for age and 95% confidence intervals (95% CI). The prevalence of OC use was 25.8%. OC intake was less common in participants with a high SES (aOR 0.30, 95% CI 0.15, 0.62). The mean age at OC initiation did not change between 2012 and 2019. We observed an increased use of second-generation OC (2013: 17.9%, 2019: 48.5%; p = 0.013) and a decreased use of fourth-generation OC (2013: 71.8%, 2019: 45.5%; p = 0.027). We found a higher systolic (mean: 111.74 mmHg, p < 0.001) and diastolic (69.15 mmHg, p = 0.004) blood pressure in OC users compared to non-users (systolic: 108.60 mmHg; diastolic: 67.24 mmHg). Every fourth adolescent took an OC. The share of second-generation OC increased during the study period. OC intake was associated with low SES. OC users had a slightly higher blood pressure than non-users.
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Affiliation(s)
- Markus Herzig
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Fleischmannstr. 8, 17475 Greifswald, Germany
| | - Cornelia Hilbert
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- LIFE Leipzig Research Centre for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- LIFE Leipzig Research Centre for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
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6
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Ott I. Geschlechtsspezifische Unterschiede bei koronarer
Herzerkrankung. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1692-0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDie koronare Herzerkrankung ist die häufigste Herzerkrankung bei Frauen und Männern.
Geschlechtsspezifische Unterschiede in der Symptomatik, der Prognose und der Behandlung
bei Patienten mit koronarer Herzerkrankung wurden bereits in zahlreichen Studien
untersucht. Frauen sind älter, besitzen mehr Komorbiditäten, beklagen eher atypische
Symptome, suchen später ärztliche Hilfe auf und werden weniger leitliniengerecht
behandelt. In dem Artikel sollen geschlechtsspezifische Unterschiede bei Patienten mit
akutem und chronischem Koronarsyndrom zusammengefasst werden.
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Affiliation(s)
- Ilka Ott
- 1. Med. Klinik, HELIOS Klinikum Pforzheim GmbH, Pforzheim,
Deutschland
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7
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Payseur DK, Belhumeur JR, Curtin LA, Moody AM, Collier SR. The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:509-516. [PMID: 32369424 DOI: 10.1080/07448481.2020.1756826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.
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Affiliation(s)
- Daniel K Payseur
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | | | - Lisa A Curtin
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Anne M Moody
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | - Scott R Collier
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
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8
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Barros BDS, Kuschnir MCC, Kuschnir FC, Jordão ÉADOC. ERICA: cardiovascular risks associated with oral contraceptive use among Brazilian adolescents. J Pediatr (Rio J) 2022; 98:53-59. [PMID: 34000229 PMCID: PMC9432124 DOI: 10.1016/j.jped.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. METHOD This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. RESULTS This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. CONCLUSION The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.
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Affiliation(s)
- Bruna de Siqueira Barros
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciência Médicas, Núcleo de Estudos da Saúde do Adolescente, Programa de Pós-Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil.
| | - Maria Cristina Caetano Kuschnir
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciência Médicas, Núcleo de Estudos da Saúde do Adolescente, Programa de Pós-Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
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Adegoke TE, Sabinari IW, Areola ED, Ajao F, Asafa OO, Soluoku TK, Bello A, Adesanmi AM, Yusuf SO, Omoleye A, Ayinla MT, Olatunji LA. Inhibition of dipeptidyl peptidase-4 averts free fatty acids deposition in the hearts of oral estrogen-progestin contraceptive-induced hyperinsulinemic female rats. Can J Physiol Pharmacol 2021; 99:1316-1323. [PMID: 34310895 DOI: 10.1139/cjpp-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Free fatty acid (FFA) deposition in non-adipose tissues such as the heart is a characteristic of insulin resistant states which feature hyperinsulinemia and dipeptidyl peptidase-4 (DPP-4) activation. Estrogen-progestin oral contraceptives (OC) treatment reportedly increased DPP-4 activity in rat tissue, and DPP-4 inhibitors have anti-diabetic and anti-inflammatory properties. This study aims to investigate the effects of DPP-4 inhibition on cardiac FFA deposition in estrogen-progestin-treated female rats. From our data, estrogen-progestin OC exposure in female rats led to elevated plasma insulin, cardiac DPP-4 activity, FFA and triglyceride (TG) accumulation, TG/high-density lipoprotein cholesterol (TG/HDL-C) ratio, adenosine deaminase/xanthine oxidase/uric acid pathway (ADA/XO/UA), lipid peroxidation, glycogen synthase activity, and alanine phosphatase; whereas cardiac glucose-6-phosphate dehydrogenase, Na+/K+-ATPase and nitric oxide (NO) were decreased. However, DPP-4 inhibition resulted in decreased plasma insulin, cardiac DPP-4 activity, FFA, TG, TG/HDL-C ratio, and alkaline phosphatase. These were accompanied by reduced ADA/XO/UA pathway, lipid peroxidation, and augmented NO and Na+/K+-ATPase in estrogen-progestin OC-treated rats. DPP-4 inhibition attenuated cardiac lipid deposition accompanied by reduced activity in the ADA/XO/UA pathway in estrogen-progestin OC-treated female rats. DPP-4 is therefore a plausible therapeutic target in cardiometabolic disorders.
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Affiliation(s)
- Tolulope Eniola Adegoke
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Isaiah Woru Sabinari
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Damilare Areola
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Folasade Ajao
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Olayinka Olawale Asafa
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Talha Kolade Soluoku
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Abdullahi Bello
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Adejoke Mosunmade Adesanmi
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Shukurat Olaide Yusuf
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - AyokunleOlusuyi Omoleye
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Mariam Tayo Ayinla
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Lawrence Aderemi Olatunji
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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10
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Yang J, May Gwini S, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori TA. Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study. Hypertension 2021; 78:387-396. [PMID: 34120455 DOI: 10.1161/hypertensionaha.121.17336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.).,Department of Medicine (J.Y.), Monash University, Clayton, Victoria, Australia
| | - Stella May Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine (S.M.G.), Monash University, Clayton, Victoria, Australia.,University Hospital Geelong, Barwon Health, Victoria, Australia (S.M.G.)
| | - Lawrence J Beilin
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia, Royal Perth Hospital Campus (M. Schlaich).,Departments of Cardiology and Nephrology, Royal Perth Hospital, Australia (M. Schlaich).,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M. Schlaich)
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia (M. Stowasser)
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Victoria, Australia (M.J. Young)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.)
| | - Trevor A Mori
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
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Insight into the longitudinal relationship between chronic subclinical inflammation and obesity from adolescence to early adulthood: a dual trajectory analysis. Inflamm Res 2021; 70:799-809. [PMID: 34076706 DOI: 10.1007/s00011-021-01474-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES AND DESIGN This study aimed to understand the longitudinal relationship between C-reactive protein (CRP) and body mass index (BMI) from adolescence to early adulthood. METHODS CRP and BMI were collected from participants of the Raine Study Gen2 at 14-, 17-, 20- and 22-year follow-ups (n = 1312). A dual trajectory analysis was conducted to assess the association between CRP and BMI trajectories, providing conditional probabilities of membership of CRP trajectory membership given BMI trajectory membership. Best model fit was assessed by systematically fitting two to eight trajectory groups with linear and quadratic terms and comparing models according to the Bayesian Information Criterion statistic. RESULTS The three CRP trajectories were; "stable-low" (71.0%), "low-to-high" (13.8%) and "stable-high" (15.2%). Participants in a "high-increasing" BMI trajectory had a higher probability of being in the "stable-high" CRP trajectory (60.4% of participants). In contrast, individuals in the "medium-increasing" BMI trajectory did not have a significantly increased probability of being in the "stable-high" CRP trajectory. CONCLUSIONS These findings support that chronic sub-clinical inflammation is present through adolescence into early adulthood in some individuals. Targeting chronic sub-clinical inflammation though obesity prevention strategies may be important for improving future health outcomes.
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Le-Ha C, Beilin LJ, Burrows S, Keelan JA, Hickey M, Mori TA. Prenatal Testosterone Associates With Blood Pressure in Young Adults: A Prospective Cohort Study. Hypertension 2021; 77:1756-1764. [PMID: 33775121 DOI: 10.1161/hypertensionaha.120.16256] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Chi Le-Ha
- From the Medical School, Royal Perth Hospital Campus (C.L-H, L.J.B., S.B., T.A.M.), the University of Western Australia, Perth
| | - Lawrence J Beilin
- From the Medical School, Royal Perth Hospital Campus (C.L-H, L.J.B., S.B., T.A.M.), the University of Western Australia, Perth
| | - Sally Burrows
- From the Medical School, Royal Perth Hospital Campus (C.L-H, L.J.B., S.B., T.A.M.), the University of Western Australia, Perth
| | - Jeffrey A Keelan
- the School of Biomedical Sciences (J.A.K.), the University of Western Australia, Perth
| | - Martha Hickey
- the Department of Obstetrics and Gynaecology and Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (M.H.)
| | - Trevor A Mori
- From the Medical School, Royal Perth Hospital Campus (C.L-H, L.J.B., S.B., T.A.M.), the University of Western Australia, Perth
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Lee SSY, Beales DJ, Chen FK, Yazar S, Alonso-Caneiro D, Mackey DA. Associations between seven-year C-reactive protein trajectory or pack-years smoked with choroidal or retinal thicknesses in young adults. Sci Rep 2021; 11:6147. [PMID: 33731739 PMCID: PMC7969753 DOI: 10.1038/s41598-021-85626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammation and cigarette smoking predispose to macular diseases, and choroidal and retinal thinning. We explored the choroidal and retinal thicknesses in young adults against their 7-year C-reactive protein (CRP) level trajectory and pack-years smoked. Participants from the Raine study, a longitudinal cohort study, had serum CRP levels analysed at the 14-, 17-, and 20-year follow-ups. Group-based trajectory modelling was used to classify participants according to their 7-year CRP levels. At the 20-year follow-up (at 18–22 years old), participants completed questionnaires on their smoking history, and underwent optical coherence tomography imaging to obtain their choroidal and retinal thicknesses at the macula. Three CRP trajectories were identified: consistently low CRP levels (78% of sample), increasing (11%), or consistently high (11%). 340 and 1035 participants were included in the choroidal and retinal thickness analyses, respectively. Compared to those in the “Low” trajectory group, participants in the “Increasing” and “High” groups had 14–21 μm thinner choroids at most macular regions. Every additional pack-year smoked was linked with a 0.06–0.10 μm thinner retina at the inner and outer macular rings, suggesting a dose-dependent relationship between smoking and thinner retinas. These associations may suggest that an increased risk of future visual impairment or eye disease associated with these risk factors may be present since young adulthood.
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Affiliation(s)
- Samantha Sze-Yee Lee
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), University of Western Australia, 2 Verdun St, Nedlands, WA, 6009, Australia.
| | - Darren John Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), University of Western Australia, 2 Verdun St, Nedlands, WA, 6009, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), University of Western Australia, 2 Verdun St, Nedlands, WA, 6009, Australia.,Single Cell and Computational Genomics Lab, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), University of Western Australia, 2 Verdun St, Nedlands, WA, 6009, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Tasmania, Australia
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Vine DF, Beilin LJ, Burrows S, Huang RC, Hickey M, Hart R, Proctor SD, Mori TA. ApoB48-Lipoproteins Are Associated with Cardiometabolic Risk in Adolescents with and without Polycystic Ovary Syndrome. J Endocr Soc 2020; 4:bvaa061. [PMID: 32803089 PMCID: PMC7417872 DOI: 10.1210/jendso/bvaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
CONTEXT Adolescents with polycystic ovary syndrome (PCOS) have increased incidence of cardiometabolic risk factors including dyslipidemia. Atherogenic apolipoprotein (apo) B-lipoprotein remnants are associated with increased cardiovascular disease (CVD) risk. OBJECTIVE The aim of this study was to determine the concentrations of fasting plasma apoB-lipoprotein remnants, apoB48 and apoB100, and their association with cardiometabolic risk factors and androgen indices in adolescent girls with and without PCOS. DESIGN SETTING AND PARTICIPANTS Participants (n = 184) aged 17 years were recruited in the Menstruation in Teenagers Study from the Western Australian Pregnancy Cohort (Raine) Study. THE MAIN OUTCOME MEASURES Fasting plasma apo-B48 and -B100 lipoprotein remnant concentrations in adolescent girls with and without PCOS. RESULTS Fasting plasma apoB48-lipoprotein remnants but not apoB100-lipoprotein remnants were elevated in adolescent girls with increased cardiometabolic risk compared with those with lower cardiometabolic risk (13.91 ± 5.06 vs 12.09 ± 4.47 µg/mL, P < .01). ApoB48-lipoprotein remnants were positively correlated with fasting plasma triglycerides (b = .43, P < .0001). The prevalence of increased cardiometabolic risk factors was 2-fold higher in those diagnosed with PCOS (35.3%) than in those without PCOS (16.3%).Conclusion: Adolescents with PCOS have a 2-fold higher incidence of cardiometabolic risk factors than those without PCOS. Fasting apoB48-lipoprotein remnants are elevated in adolescent girls with a high prevalence of cardiometabolic risk factors.
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Affiliation(s)
- Donna F Vine
- Metabolic and Cardiovascular Disease Laboratory, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence J Beilin
- Medical School, University of Western Australia, Royal Perth Hospital Unit, Perth, Australia
| | - Sally Burrows
- Medical School, University of Western Australia, Royal Perth Hospital Unit, Perth, Australia
| | - Rae-Chi Huang
- The Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Victoria, Australia
| | - Roger Hart
- Medical School, University of Western Australia, Royal Perth Hospital Unit, Perth, Australia
| | - Spencer D Proctor
- Metabolic and Cardiovascular Disease Laboratory, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Trevor A Mori
- Medical School, University of Western Australia, Royal Perth Hospital Unit, Perth, Australia
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Adeyanju OA, Michael OS, Soladoye AO, Olatunji LA. Blockade of mineralocorticoid receptor ameliorates oral contraceptive-induced insulin resistance by suppressing elevated uric acid and glycogen synthase kinase-3 instead of circulating mineralocorticoid. Arch Physiol Biochem 2020; 126:225-234. [PMID: 30318954 DOI: 10.1080/13813455.2018.1509220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Context: Estrogen-progestin combined oral contraceptive (COC) has been connected to mineralocorticoid receptor (MR) activation and adverse cardiometabolic events. We consequently hypothesised that insulin resistance (IR), hyperuricemia, and elevated circulating GSK-3 induced by COC is through activation of MR via mineralocorticoid and glucocorticoid pathways.Methods: Female Wistar rats aged 12 weeks received (po) vehicle and COC (1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel) with or without MR blocker (0.25 mg/kg spironolactone; Spl), daily for eight weeks.Results: Data showed that COC treatment led to increased IR, 1-hour postload glucose level, insulinemia, triglyceride/HDL-cholesterol ratio, total cholesterol/HDL-cholesterol ratio, uric acid, GSK-3, aldosterone, corticosterone values, impaired glucose tolerance and pancreatic β-cell function. However, MR blockade by Spl ameliorated all these alterations except that of aldosterone.Conclusion: The results demonstrate that COC induces IR, hyperuricemia and high GSK-3 levels through activation of MR via glucocorticoid dependent pathway.
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Affiliation(s)
- O A Adeyanju
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Medicine and Health sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - O S Michael
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Health sciences, Bowen University, Iwo, Nigeria
| | - A O Soladoye
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, College of Health sciences, Bowen University, Iwo, Nigeria
| | - L A Olatunji
- HOPE Cardiometabolic Research Team, Department of Physiology, University of Ilorin, Ilorin, Nigeria
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16
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Krysa JA, Vine DF, Beilin LJ, Burrows S, Huang RC, Mori TA, Proctor SD. ApoB48-remnant lipoproteins are associated with increased cardiometabolic risk in adolescents. Atherosclerosis 2020; 302:20-26. [DOI: 10.1016/j.atherosclerosis.2020.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/24/2022]
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17
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Quality of life and mental health in adolescent users of oral contraceptives. Results from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Qual Life Res 2020; 29:2209-2218. [PMID: 32144614 PMCID: PMC7363664 DOI: 10.1007/s11136-020-02456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
Abstract
Objective Using data from the nationwide, cross-sectional KiGGS (German Health Interview and Examination Survey for Children and Adolescents) study, we investigated whether hormonal contraception in adolescents aged 15 to 17 years was linked to health-related quality of life and mental health problems. Methods Study participants had undergone standardized recordings of blood pressure and measurements of serum 25-hydroxyvitamin D [25(OH)D]. Quality of life was assessed by self- and parent-rated KINDL-R questionnaires, whereas mental health problems were screened by means of the Strengths and Difficulties Questionnaire (SDQ). Results Self-rated quality of life was similar between users (n = 522) and non-users (n = 1173, 69.2%) of oral contraceptives (69.2 ± 11.2 vs. 69.2 ± 11.0, p = 0.943), as was the parent-rated version (72.9 ± 10.6 vs. 72.9 ± 10.5, p = 0.985). Likewise, no significant differences were observed between the two groups with respect to both self- (10.9 ± 4.4 vs. 10.8 ± 4.6, p = 0.732) and parent-rated SDQ scores (7.2 ± 4.8 vs. 7.0 ± 4.6. p = 0.390). However, serum 25(OH)D (59.5 ± 32.9 vs. 46.1 ± 28.0 nmol/L, p < 0.001) and mean arterial blood pressure (88.2 ± 7.4 vs. 86.5 ± 7.7 mmHg, p < 0.001) were significantly higher in users than in non-users. There was a trend towards a higher rate of psychotropic drug prescription in participants taking oral contraceptive pills as compared to those not receiving hormonal contraception (17.8% vs. 14.4%, p = 0.052). A series of linear regression models with either KINDL-R or SDQ as dependent variable confirmed that there were no associations between components of mental well-being and contraceptive drug use, irrespective of whether self- or parent-ratings were included in these models. Conclusions In a large, representative sample of German adolescents, exposure to exogenous contraceptive hormones was associated with higher arterial blood pressure and serum 25(OH)D concentration, whereas hormonal contraception was not linked to health-related quality of life or mental well-being.
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Aremu AO, Lilian DC, Olufemi SA, Aderemi OL. Combined but not single treatment with ethinylestradiol/levonorgestrel and spironolactone reduces plasminogen activator inhibitor-1 in insulin-resistant ovariectomised rats. J Renin Angiotensin Aldosterone Syst 2019; 20:1470320319895933. [PMID: 31856649 PMCID: PMC6927203 DOI: 10.1177/1470320319895933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: Increased circulating level of plasminogen activator inhibitor-1 (PAI-1) is
associated with menopausal oestrogen deficiency. We therefore hypothesised
that the combined oral contraceptive (COC) with spironolactone (SPL)
improves insulin resistance (IR) in ovariectomised (OVX) rats by reducing
circulating PAI-1. Methods: Twelve-week-old female Wistar rats were divided into sham-operated (SHM),
OVX, OVX+SPL (0.25 mg/kg), COC (1.0 µg ethinylestradiol and 5.0 µg
levonorgestrel) and OVX+COC+SPL rats treated with COC and SPL daily for
eight weeks. IR was assessed by homeostatic model assessment of IR
(HOMA-IR). Results: Data showed that OVX rats had a higher HOMA-IR value that is associated with
increased visceral adiposity, triglycerides (TG), total
cholesterol/high-density lipoprotein cholesterol (HDL-C), TG/HDL-C, plasma
insulin, GSK-3, corticosterone and decreased 17β-oestradiol. However, these
effects were attenuated in OVX+COC, OVX+SPL and OVX+COC+SPL rats compared to
OVX rats. OVX rats had lower PAI-1 than SHM rats, whereas the beneficial
effect on IR and other parameters by COC or SPL was accompanied with
increased PAI-1. Improvement of IR and other parameters with combined COC
and SPL in OVX rats was accompanied with reduced PAI-1. Conclusion: Taken together, COC or SPL improves IR independent of PAI-1, whereas a
combination of COC and SPL in OVX rats ameliorates IR in a PAI-1-dependent
manner.
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Affiliation(s)
- Adeyanju Oluwaseun Aremu
- HOPE Cardiometabolic Research Team and Department of Physiology, University of Ilorin, Nigeria.,Cardiometabolic Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Nigeria
| | - Dibia Chinaza Lilian
- HOPE Cardiometabolic Research Team and Department of Physiology, University of Ilorin, Nigeria
| | - Soladoye Ayodele Olufemi
- Cardiometabolic Research Unit, Department of Physiology, College of Health sciences, Bowen University, Nigeria
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Adeyanju OA, Soetan OA, Olatunji LA. Drospirenone-containing contraceptive exerts positive effects on cardiac uric acid and PAI-1 but not GSK-3: Improved safety profiles in contraception? ACTA ACUST UNITED AC 2019; 26:227-231. [PMID: 31196791 DOI: 10.1016/j.pathophys.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/01/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
Abstract
The use of combined oral contraceptives (COC) have been associated with increased risk of adverse cardiovascular events and elevated cardiac and circulating plasminogen activator inhibitor-1 (PAI-1) and glycogen synthase kinase-3 (GSK-3) have been implicated in these events. Contraceptives containing drospirenone, a progestin with anti-androgenic actions may have a positive or neutral effect on cardiac PAI-1 and GSK-3 levels. Studies on the favorable effects of oral contraceptives containing drospirenone when compared with other androgenic contraceptives have not been fully elucidated. We therefore sought to compare the effect of a contraceptive containing ethinyl estradiol and drospirenone (DSP) with a contraceptive containing ethinyl estradiol and levonorgestrel (LVG) on cardiac uric acid (UA), PAI-1, GSK-3 and some hematological parameters. Ten weeks old female Wistar rats were divided into three groups; control (CON), LVG or DSP treated rats. The treatment lasted for 8 weeks. Results showed that LVG and not DSP treatment led to increase in plasma and cardiac tissue UA, plasma and cardiac PAI-1 as well as granulocyte-lymphocyte ratio (GLR) and platelet-lymphocyte ratio (PLR). However, the DSP treatment affected the circulating GSK-3. Taken together, the findings showed that LVG and not DSP affected cardiac UA and PAI-1. These results suggest that COC containing drospirenone appears to have positive effects on cardiac UA and PAI-1 levels but do not affect GSK-3, hence, COC containing drospirenone may be a better and safer means of contraception compared to androgenic contraceptives.
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Affiliation(s)
- Oluwaseun A Adeyanju
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria; Cardiometabolic Research Unit, Department of Physiology, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Olaniyi A Soetan
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Lawrence A Olatunji
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.
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Leyvraz M, Chatelan A, da Costa BR, Taffé P, Paradis G, Bovet P, Bochud M, Chiolero A. Sodium intake and blood pressure in children and adolescents: a systematic review and meta-analysis of experimental and observational studies. Int J Epidemiol 2019; 47:1796-1810. [PMID: 29955869 DOI: 10.1093/ije/dyy121] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
Background High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically reviewed the evidence from experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents. Methods A systematic search of the Medline, Embase, CINAHL and CENTRAL databases up to March 2017 was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies involving children or adolescents between 0 and 18 years of age were included. Random-effects meta-analyses were performed by pooling data across all studies, separately for experimental and observational studies, and restricting to studies with sodium intake and blood pressure measurement methods of high quality. Subgroup meta-analyses, sensitivity analyses and meta-regressions were conducted to investigate sources of heterogeneity and confounding. The dose-response relationship was also investigated. Results Of the 6572 publications identified, 85 studies (14 experimental; 71 observational, including 60 cross-sectional, 6 cohort and 5 case-control studies) with 58 531 participants were included. In experimental studies, sodium reduction interventions decreased systolic blood pressure by 0.6 mm Hg [95% confidence interval (CI): 0.5, 0.8] and diastolic blood pressure by 1.2 mm Hg (95% CI: 0.4, 1.9). The meta-analysis of 18 experimental and observational studies (including 3406 participants) with sodium intake and blood pressure measurement methods of high quality showed that, for every additional gram of sodium intake per day, systolic blood pressure increased by 0.8 mm Hg (95% CI: 0.4, 1.3) and diastolic blood pressure by 0.7 mm Hg (95% CI: 0.0, 1.4). The association was stronger among children with overweight and with low potassium intake. A quasi-linear relationship was found between sodium intake and blood pressure. Conclusions Sodium intake is positively associated with blood pressure in children and adolescents, with consistent findings in experimental and observational studies. Since blood pressure tracks across the life course, our findings support the reduction of sodium intake during childhood and adolescence to lower blood pressure and prevent the development of hypertension.
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Affiliation(s)
- Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Angeline Chatelan
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Elmahi E, Leeson P. Cardiometabolic and reproductive health in young women: Making the right choices. Eur J Prev Cardiol 2018; 25:1040-1041. [PMID: 29846120 DOI: 10.1177/2047487318780061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Einas Elmahi
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Parvand M, Rayner-Hartley E, Sedlak T. Recent Developments in Sex-Related Differences in Presentation, Prognosis, and Management of Coronary Artery Disease. Can J Cardiol 2018; 34:390-399. [DOI: 10.1016/j.cjca.2018.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/17/2022] Open
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Reynolds AC, Bucks RS, Paterson JL, Ferguson SA, Mori TA, McArdle N, Straker L, Beilin LJ, Eastwood PR. Working (longer than) 9 to 5: are there cardiometabolic health risks for young Australian workers who report longer than 38-h working weeks? Int Arch Occup Environ Health 2018; 91:403-412. [DOI: 10.1007/s00420-018-1289-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/11/2018] [Indexed: 12/21/2022]
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1912] [Impact Index Per Article: 273.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Olatunji LA, Seok YM, Igunnu A, Kang SH, Kim IK. Combined oral contraceptive-induced hypertension is accompanied by endothelial dysfunction and upregulated intrarenal angiotensin II type 1 receptor gene expression. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:1147-1157. [PMID: 27447455 DOI: 10.1007/s00210-016-1272-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/03/2016] [Indexed: 01/09/2023]
Abstract
Combined oral contraceptive (COC) use is associated with increased risk of developing hypertension. Activation of the intrarenal renin-angiotensin system (RAS) and endothelial dysfunction play an important role in the development of hypertension. We tested the hypothesis that COC causes hypertension that is associated with endothelial dysfunction and upregulation of intrarenal angiotensin-converting enzyme 1 (Ace1) and angiotensin II type 1 receptor (At1r). Female Sprague-Dawley rats aged 12 weeks received (p.o.) olive oil (control) and a combination of 0.1 μg ethinylestradiol and 1.0 μg norgestrel (low COC) or 1.0 μg ethinylestradiol and 10.0 μg norgestrel (high COC) daily for 6 weeks. Blood pressure was recorded by tail cuff plethysmography. Expression of genes in kidney cortex was determined by quantitative real-time polymerase chain reaction. COC treatment led to increased blood pressure, circulating uric acid, C-reactive protein and plasminogen activator inhibitor-1, renal uric acid, and expression of renal Ace1 and At1r. COC treatment resulted in increased contractile responses to phenylephrine in endothelium-denuded aortic rings. Endothelium-dependent relaxation responses to acetylcholine, but not endothelium-independent relaxation responses to nitric oxide (NO) donation by sodium nitroprusside, were attenuated in COC-exposed rings. Impaired relaxation responses to acetylcholine were masked by the presence of NO synthase inhibitor (L-NAME) in the COC-exposed rings, whereas the responses to acetylcholine in the presence of selective cyclooxygenase-2 inhibitor (NS-398) were enhanced. These findings indicate that COC induces hypertension that is accompanied by endothelial dysfunction, upregulated intrarenal Ace1 and At1r expression, and elevated proinflammatory biomarkers.
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Affiliation(s)
- Lawrence A Olatunji
- Department of Physiology, University of Ilorin, Ilorin, Nigeria.,Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - Young-Mi Seok
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,National Development Institute of Korean Medicine, Hwarang-ro 94(Gapje-dong), Gyeongsan, Gyeongbuk, 38540, Republic of Korea
| | - Adedoyin Igunnu
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - Seol-Hee Kang
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,Department of Pharmacology, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,Cell and Matrix Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - In-Kyeom Kim
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,Department of Pharmacology, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,Cell and Matrix Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.
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Olatunji LA, Omolekulo TE, Usman TO, Kim I. Improvement of oral contraceptive-induced glucose dysregulation and dyslipidemia by valproic acid is independent of circulating corticosterone. Arch Physiol Biochem 2016; 122:123-9. [PMID: 26855320 DOI: 10.3109/13813455.2016.1151892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Cardiometabolic disorders are rapidly becoming major public health challenges. Valproic acid (VPA) is a widely prescribed anticonvulsant drug. OBJECTIVE We hypothesized that treatment with VPA would improve the regulation of glucose and atherogenic dyslipidemia through reduction in circulating corticosterone. METHODS Female Wistar rats recieved (p.o.) combined oral contraceptive (COC) containing 1.0 µg ethinylestradiol plus 5.0 µg levonorgestrel and valproic acid (VPA; 20 mg) for 8 weeks. RESULTS Treatment with COC led to elevated fasting blood glucose, insulin, corticosterone, triglycerides (TG), TG/HDL-cholesterol ratio, insulin resistance (IR) and impaired glucose tolerance. VPA significantly attenuated the alterations induced by COC treatment, but did not affect the corticosterone level. However, VPA treatment led to significant increases in plasma insulin, corticosterone, atherogenic lipids and impaired glucose tolerance in rats not treated with COC. CONCLUSION The findings in this study suggest that VPA mitigates against the development of COC-induced insulin resistance and dyslipidemia independent of elevated circulating corticosterone.
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Affiliation(s)
- Lawrence A Olatunji
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea , and
| | - Tolulope E Omolekulo
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
| | - Taofeek O Usman
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
| | - InKyeom Kim
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea , and
- c Department of Pharmacology , Kyungpook National University School of Medicine , Daegu , Republic of Korea
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Le-Ha C, Herbison CE, Beilin LJ, Burrows S, Henley DE, Lye SJ, Matthews SG, Pennell CE, Mori TA. Hypothalamic-pituitary-adrenal axis activity under resting conditions and cardiovascular risk factors in adolescents. Psychoneuroendocrinology 2016; 66:118-24. [PMID: 26802599 DOI: 10.1016/j.psyneuen.2016.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 11/29/2015] [Accepted: 01/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Activation of the hypothalamic-pituitary-adrenal (HPA) axis has been associated with higher levels of cardiovascular (CVD) risk factors in adults. This study aimed to assess the relation between measures of HPA axis activity under resting conditions and CVD risk factors in a general population of adolescents at 17 years. METHODS A total of 1134 adolescents from the Western Australian Pregnancy Cohort (Raine) Study had phenotypic and socio-demographic data. The associations between HPA axis measures (plasma ACTH, total cortisol, calculated free cortisol, corticosteroid binding globulin (CBG), and salivary cortisol) and a range of cardiovascular risk factors were examined using multivariable linear regression models, with adjustment for gender, adiposity, birth weight, gestational age, and socio-behavioural factors. RESULTS Plasma total cortisol was positively associated with systolic blood pressure (SBP) (p=0.011), total cholesterol, HDL-cholesterol, and triglycerides (all p<0.001), and hs-CRP (p=0.047). Salivary cortisol was associated positively with HDL-C (p=0.033) and negatively with LDL-cholesterol (p=0.016); plasma calculated free cortisol was positively associated with triglycerides (p=0.006); plasma CBG was positively associated with total cholesterol and HDL-cholesterol (both p<0.001), LDL-cholesterol (p=0.022), and hs-CRP (p=0.001). After correction for multiple comparisons, significant associations remained for total cortisol with total cholesterol, HDL-C, and triglycerides; for calculated free cortisol with triglycerides; and for CBG with HDL-C, total cholesterol, and hs-CRP. Plasma ACTH was not associated with any cardiovascular risk factor. There was no association between BMI and any measure of HPA axis activity. CONCLUSION In an adolescent population, HPA axis measures under resting conditions are associated with a range of CVD risk factors. Clarification of the mechanisms underlying these associations in adolescence would be an important step in understanding the evolution of adult CVD.
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Affiliation(s)
- Chi Le-Ha
- School of Medicine and Pharmacology, University of Western Australia, Australia.
| | - Carly E Herbison
- School of Women's and Infant's Health, University of Western Australia
| | - Lawrence J Beilin
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Sally Burrows
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - David E Henley
- School of Medicine and Pharmacology, University of Western Australia, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Stephen J Lye
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
| | | | - Craig E Pennell
- School of Women's and Infant's Health, University of Western Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, University of Western Australia, Australia
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Association Between Lifestyle and Systemic Arterial Hypertension in Young Adults: A National, Survey-Based, Cross-Sectional Study. High Blood Press Cardiovasc Prev 2016; 23:31-40. [DOI: 10.1007/s40292-016-0135-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/05/2016] [Indexed: 12/19/2022] Open
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Ewald DR, Haldeman PhD LA. Risk Factors in Adolescent Hypertension. Glob Pediatr Health 2016; 3:2333794X15625159. [PMID: 27335997 PMCID: PMC4784559 DOI: 10.1177/2333794x15625159] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.
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Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
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Zatu MC, Van Rooyen JM, Kruger A, Schutte AE. Alcohol intake, hypertension development and mortality in black South Africans. Eur J Prev Cardiol 2014; 23:308-15. [PMID: 25500903 DOI: 10.1177/2047487314563447] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/19/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Excessive alcohol intake is a risk factor for cardiovascular disease (CVD) and predicts cardiovascular and all-cause mortality. We determined which alcohol marker (self-reported alcohol intake, gamma-glutamyltransferase (GGT) or percentage carbohydrate deficient transferrin (%CDT)) relates best with mortality and predicts hypertension development over five years in black South Africans. DESIGN This was a longitudinal study as part of the PURE (Prospective Urban and Rural Epidemiology) study in the North West Province, South Africa. METHOD We included 2010 participants and followed 1471 participants. Over five years, 230 deaths occurred, of which 66 were cardiovascular-related. At enrolment, participants completed questionnaires on alcohol intake (yes, for former and current use; no, for alcohol never used). We measured blood pressure, collected blood samples and measured GGT and %CDT. RESULTS When comparing hazard ratios (HRs) of self-report, GGT and %CDT, we found that only GGT predicted cardiovascular (HR = 2.76 (1.49-5.12)) and all-cause mortality (HR = 2.47 (1.75-3.47)) and hypertension development ((HR = 1.31 (1.06-1.62)). Participants self-reporting yes for alcohol intake had a 30% increased risk of developing hypertension (HR = 1.30 (1.07-1.60)) but not an increased risk for mortality. When adding both GGT and self-report in the prediction model for hypertension, only self-reporting of alcohol was significant (HR = 1.24 (1.01-1.53)). The alcohol marker, %CDT, did not show any significant association with mortality or hypertension development. CONCLUSION GGT independently predicted cardiovascular and all-cause mortality, as well as hypertension development in black South Africans. Despite non-specificity to excessive alcohol consumption, GGT may be a useful general marker for hypertension development and mortality, also due to its significant association with self-reported alcohol intake.
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Affiliation(s)
- Mandlenkosi C Zatu
- Hypertension in Africa Research Team (HART), North-West University, South Africa Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, South Africa Department of Physiology, University of Limpopo (Medunsa), South Africa
| | | | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, South Africa
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Kharbanda EO, Parker ED, Sinaiko AR, Daley MF, Margolis KL, Becker M, Sherwood NE, Magid DJ, O'Connor PJ. Initiation of oral contraceptives and changes in blood pressure and body mass index in healthy adolescents. J Pediatr 2014; 165:1029-33. [PMID: 25189822 PMCID: PMC4252822 DOI: 10.1016/j.jpeds.2014.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/13/2014] [Accepted: 07/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI) associated with initiation and continued use of combined oral contraceptives (COCs) in healthy adolescents. STUDY DESIGN This observational, matched cohort study was conducted in 2 large health systems. Utilizing claims and electronic medical records, we identified adolescents 14-17.9 years of age initiating medium-dose COCs (containing 30 or 35 (μg of ethinyl estradiol or equivalent and a progestin) between July 1, 2007 and December 31, 2009 with a baseline and at least 1 follow-up blood pressure (BP) and BMI. COC-users were matched 1:2 by age, race/ethnicity, and site to controls (COC-nonusers). All BPs and BMIs recorded during outpatient visits starting 1 month prior to COC initiation (index date for controls), through December 31, 2010 were collected. Mixed model linear regression with random intercepts and slopes were then used to estimate changes in SBP, DBP, and BMI over time. RESULTS The 510 adolescent COC-users and 912 controls did not differ significantly by age, race/ethnicity, insurance, and baseline SBP, DBP, or BMI. After adjusting for baseline values, over a median of 18 months follow-up, COC-users had an decrease in SBP of 0.07 mm Hg/mo, and controls had an increase of 0.02 mm Hg/mo (P = .65). Similarly, DBP decreased by 0.007 mm Hg/mo in COC-users vs 0.006 mm Hg/mo in controls (P = .99). BMI increased by 0.04 (kg/m(2))/mo in COC-users vs 0.025 (kg/m(2))/mo in controls (P = .09). CONCLUSIONS These data should provide reassurance to patients and providers regarding the lack of significant associations between COC-use and BMI or BP changes in adolescents.
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Affiliation(s)
| | - Emily D Parker
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Mary Becker
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - David J Magid
- Kaiser Permanente Institute for Health Research, Denver, CO
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Le-Ha C, Beilin LJ, Burrows S, Oddy WH, Hands B, Mori TA. Gender and the active smoking and high-sensitivity C-reactive protein relation in late adolescence. J Lipid Res 2014; 55:758-64. [PMID: 24577623 DOI: 10.1194/jlr.p045369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
C-reactive protein (CRP), smoking, and oral contraceptive (OC) use are associated with CVD risk in adults. This study examines the effect of smoking on high-sensitivity CRP (hs-CRP) levels, and the interactive effects of sex and OC use on this relationship in an adolescent cohort. A total of 1,050 adolescents (mean age 17 ± 0.25 years) from the Western Australian Pregnancy Cohort (Raine) Study had anthropometric, lifestyle, and metabolic measures recorded. The association between smoking status and log-transformed hs-CRP was analyzed using multivariable Tobit linear regression models, with adjustment for adiposity, lifestyle, and early-life confounders. A three-level variable (girls not using OCs, girls using OCs, and boys) was employed to assess the interactive effects of sex, OC use, and smoking. Smoking associated with higher hs-CRP levels in girls not using OCs (b = 0.571; P = 0.001), but not in girls using OCs (b = -0.117; P = 0.598) or in boys (b = 0.183; P = 0.2). OC use in nonsmoking girls was the strongest factor associated with higher hs-CRP levels (b = 1.189; P < 0.001). This study has demonstrated a more robust effect of smoking on hs-CRP levels in girls not using OCs compared with boys. The findings may explain why CVD risk conferred by smoking is higher in women than in men.
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Affiliation(s)
- Chi Le-Ha
- Royal Perth Hospital Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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Abstract
The occurrence and progression of nephropathy associated with early onset type 2 diabetes (T2D) is a consequence of the ongoing epidemic of childhood obesity. Minimal evidence regarding treatment effectiveness of renovascular comorbidities in youth with early onset T2D is available, due to the relatively recent emergence of T2D in youth and young adults. Extrapolation of adult therapy guidelines is not an ideal approach to making therapeutic decisions in this population. Evolving management and intervention strategies are based on accumulating longitudinal data from cohorts of well characterized youth and young adults with T2D. The degree of similarity in histologic findings and disease specific characteristics of kidney disease in patients with early onset T2D and albuminuria compared with affected adults is not well characterized. Early aggressive therapies to minimize the impact of nephropathy are indicated as the evidence for best therapies in youth with T2D are further explored.
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Affiliation(s)
- Carolina Solis-Herrera
- Resident, Internal Medicine, Texas Tech University Health Science Center at Permian Basin, 5075 East 52 St. #J305, Odessa, TX 79762, Phone: 210-619-3264
| | - Curtis L. Triplitt
- Texas Diabetes Institute, Clinical Assistant Professor, Department of Medicine, Div. of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, Phone:210-358-7228, Fax:210-358-7235
| | - Jane L. Lynch
- Professor of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr. (MS 7806), San Antonio, TX 78229, Phone: 210-567-5213, Fax: 210-567-0492
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Abstract
OBJECTIVE Among adolescents with type 2 diabetes, there is limited information regarding incidence and progression of hypertension and microalbuminuria. Hypertension and microalbuminuria assessments made during the TODAY clinical trial were analyzed for effect of treatment, glycemic control, sex, and race/ethnicity. RESEARCH DESIGN AND METHODS A cohort of 699 adolescents, 10-17 years of age, <2 years duration of type 2 diabetes, BMI ≥ 85%, HbA1c ≤ 8% on metformin therapy, controlled blood pressure (BP), and calculated creatinine clearance >70 mL/min, were randomized to metformin, metformin plus rosiglitazone, or metformin plus intensive lifestyle intervention. Primary study outcome was loss of glycemic control for 6 months or sustained metabolic decompensation requiring insulin. Hypertension and microalbuminuria were managed aggressively with standardized therapy to maintain BP <130/80 or <95th percentile for age, sex, and height and microalbuminuria <30 μg/mg. RESULTS In this cohort, 319 (45.6%) reached primary study outcome, and 11.6% were hypertensive at baseline and 33.8% by end of study (average follow-up 3.9 years). Male sex and higher BMI significantly increased the risk for hypertension. Microalbuminuria was found in 6.3% at baseline and rose to 16.6% by end of study. Diagnosis of microalbuminuria was not significantly different between treatment arms, sex, or race/ethnicity, but higher levels of HbA1c were significantly related to risk of developing microalbuminuria. CONCLUSIONS Prevalence of hypertension and microalbuminuria increased over time among adolescents with type 2 diabetes regardless of diabetes treatment. The greatest risk for hypertension was male sex and higher BMI. The risk for microalbuminuria was more closely related to glycemic control.
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Genuis SJ, Lipp C. Ethical diversity and the role of conscience in clinical medicine. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:587541. [PMID: 24455248 PMCID: PMC3876678 DOI: 10.1155/2013/587541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/09/2013] [Indexed: 05/09/2023]
Abstract
In a climate of plurality about the concept of what is "good," one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience-by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine.
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Affiliation(s)
- Stephen J. Genuis
- University of Alberta, 2935-66 Street, Edmonton, AB, Canada T6K 4C1
- *Stephen J. Genuis:
| | - Chris Lipp
- University of British Columbia, 2329 W Mall, Vancouver, BC, Canada V6T 1Z4
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