PubMed · 7378246
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R K Mirakhur, J W Dundee, J D Connolly. 1980. Anticholinergic premedication.. https://doi.org/10.1093/bja%2F52.4.467
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BACKGROUND AND OBJECTIVE: Obesity is associated with cardiovascular risk factors and heart failure. SUBJECTS AND METHOD: Thirty children with overweight or obesity were matched with 30 healthy children. Corrected QT interval (QTc) and QT dispersion (QTd), left ventricular mass, left ventricular mass index, fractional shortening and fractional ejection, were measured. RESULTS: QTc and QTd were significantly greater in patients with overweight or obesity than in the control group. Left ventricular mass and left ventricular mass index were significantly higher in overweight or obese children than in controls. CONCLUSIONS: Children with overweight-obesity have an increase of corrected QT and QT interval dispersion and of the volume and mass of the left ventricle and a greater risk of arrhythmia, in relation to controls. These results make consider the need for a special cardiac monitoring of obese children, especially in the severe forms.
In the climacteric, about 40% of the women have occult breast tumors the growth of which may be stimulated by hormones. Many genetic, reproductive and lifestyle factors may influence the incidence of breast cancer. Epidemiological data suggest that the increase in the relative risk (RR) of breast cancer induced by hormone replacement therapy (HRT) is comparable with that associated with early menarche, late menopause, late first birth, alcohol consumption, etc. One of the most important risk factors is obesity which exceeds the effect of HRT by far, and in overweight postmenopausal women the elevated risk of breast cancer is not further increased by HRT. As in the WHI study the majority of women was overweight or obese, this trial was unsuitable for the investigation of breast cancer risk. In the women treated with an estrogen/progestin combination, the RR of breast cancer rose only in those women who have been treated with hormones prior to the study, suggesting a selection bias. In the women not pretreated with hormones, it was not elevated. In the estrogen-only arm of the WHI study, there was no increase but a steady decrease in the RR of breast cancer during 6.8 years of estrogen therapy. This result was unexpected, as estrogens are known to facilitate the development and growth of breast tumors, and the effect is enhanced by the addition of progestins. Obese women are at high risk to develop a metabolic syndrome including insulin resistance and hyperinsulinemia. In postmenopausal women, elevated insulin levels are not only associated with an increased risk for cardiovascular disease, but also for breast cancer. This might explain the effects observed in both arms of the WHI study: HRT with relative low doses of estrogens may improve insulin resistance and, hence, reduce the elevated breast cancer risk in obese patients, whereas this beneficial estrogen effect may be antagonized by progestins. The principal options for the reduction of breast cancer risk in postmenopausal women are the prevention of overweight and obesity to avoid the development of hyperinsulinemia, the medical treatment of insulin resistance, the use of low doses of estrogens and the reduction of exposure to progestins. The latter might include long-cycles with the sequential use of appropriate progestins every 3 months for 14 days. There are large inter-individual variations in the proliferative response to estrogens of the endometrium. Control by vaginalsonography and progestin challenge tests may help to identify those women who may be candidates for low-dose estrogen-only therapy.
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