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PubMed1984

Family-directed preventive cardiology.

Cardiovascular events continue as the leading cause of death in the United States, despite a decline in recent years. Epidemiological evidence has confirmed that in adults smoking, high blood pressure, hypercholesterolemia, a family history of atherosclerotic disease at an early age, diabetes mellitus, and certain behavioral patterns are associated with a higher risk for myocardial infarction and other manifestations of coronary artery occlusion. In addition, a lack of regular physical activity, being overweight, and excess ethanol consumption are associated with increased cardiac disease rates. Since these indicators of risk may appear in childhood, and the earliest manifestations of atherosclerosis or hypertension can become manifest soon thereafter, the prevention of cardiovascular events must begin early. This paper reviews the evidence for the origins of cardiovascular risk in childhood, and offers recommendations to family physicians to help them provide parents with the proper information, motivation, and skills to teach their children healthy nutritional, exercise, and behavioral patterns.

Adolescent↗
PubMed1983

Hemostatic system changes induced by 50 micrograms and 30 micrograms estrogen/progestogen oral contraceptives. Modification of estrogen effects by levonorgestrel.

Three oral contraceptive preparations were compared for effects on blood coagulation, fibrinolysis and platelet function in a total of 86 healthy young women. Two of the preparations contained 30 micrograms ethinyl estradiol combined with levonorgestrel or norethindrone acetate, and the third contained 50 micrograms mestranol and norethindrone. Tests were conducted before use of the agents, at intervals over 48 weeks' use and after discontinuation. This study showed that the changes in coagulation activity and fibrinolysis were largely related to the dose of estrogen in the contraceptive preparation; the smallest changes occurred with the low-dose (30 micrograms) preparations. This study also showed that changes occurring in certain coagulation factors and inhibitors were significantly smaller in the preparation containing 30 micrograms of ethinyl estradiol combined with levonorgestrel, suggesting that the progestogen used in these combination oral contraceptives modifies the estrogen effects.

Adolescent↗
PubMed1987

Airway responsiveness to methacholine during the natural menstrual cycle and the effect of oral contraceptives.

Exacerbations of symptoms have been reported in some women with asthma just prior to and during menstruation. We examined changes in airway responsiveness to methacholine during 2 consecutive menstrual cycles in 17 well-controlled asthmatics with a wide range of airway responsiveness. In 10 women with regular natural cycles, measurements were made 1 wk before and 1 wk after the start of menstruation to coincide with the highest and lowest progesterone levels. The mean concentration of methacholine to cause a fall in FEV1 of 20% (PC20) premenstruation was 1.49 mg/ml, which was not significantly different from the mean postmenstruation PC20 of 1.34 mg/ml (p = 0.45). Although there were only 10 subjects, the power was 96%, indicating little likelihood of any difference between the 2 phases. In 7 women taking oral contraceptives, the mean PC20, measured within 1 wk of completing a 21-day course, was 1.19 mg/ml, which was not different from the mean PC20 of 0.97 mg/ml measured after the start of menstruation but before restarting medication (p = 0.17). The power was 98%. In both groups, there was no difference in FEV1 or medication use during the cycle, but symptoms were worse during menstruation. The results suggest that the fluctuations in serum progesterone levels that occur during natural menstrual cycles are insufficient to alter airway responsiveness in an unselected sample of asthmatic women. They also demonstrate that changes in symptoms occur during the cycle both in women with natural cycles and those using contraceptives and that these changes are not related to serum progesterone levels or airway responsiveness.

Adult↗
PubMed1985

The interaction between sex hormone binding globulin and levonorgestrel released from vaginal rings in women.

The levels of levonorgestrel (L-NOG), progesterone and estradiol were measured in plasma samples of 17 normally menstruating women during a control cycle and during a subsequent period (90 days) with a L-NOG-releasing vaginal ring. During days 38-66 after the insertion of the vaginal ring the concentrations of sex hormone binding globulin binding sites (hereafter: SHBG levels) were also assayed. Significant correlations were found not only between the corresponding levels of SHBG and L-NOG during exposure to the latter compound (r = 0.44; P less than 0.05), but also between the levels of SHBG in the control cycle and the levels of L-NOG measured during exposure (r = 0.60; P less than 0.01). Furthermore, the decrease in SHBG levels during the vaginal administration of L-NOG was directly proportional to the levels of SHBG in the pretreatment cycle (r = 0.64; P less than 0.01). A significant relationship was found between the levels of L-NOG (and, hence - indirectly - the levels of SHBG) and the degree of suppression of ovarian function. Thus the levels of L-NOG were lower (P less than 0.01) in the subjects (n = 8) with an apparently normal or partially suppressed ovulatory-like pattern of progesterone than in those subjects (n = 9) in whom progesterone levels were completely suppressed.

Adult↗
PubMed1983

Effect of oral contraceptives on plasma glucose, insulin, and glucagon levels.

Effects of oral contraceptive agents (mestranol and norethindrone) on carbohydrate metabolism were evaluated in a group of 18 healthy young women. Plasma glucose, insulin, and glucagon responses were evaluated after a glucose load (oral and intravenous) and an amino acid challenge (oral and intravenous). The oral glucose tolerance was normal and was unaltered by the use of oral contraceptive agents. However, following intravenous administration of glucose, plasma glucose levels were slightly but significantly elevated when subjects were using oral contraceptives. Plasma insulin concentrations were slightly but significantly higher than control values in response to oral and intravenous administration of glucose while subjects were using oral contraceptives. Plasma glucagon concentrations in response to oral and intravenous glucose were similar whether the subjects were using oral contraceptive agents or not. No significant differences from control values were observed after oral and intravenous amino acid challenges when subjects were using oral contraceptive agents. Mild elevations of glucose and insulin without any significant change in glucagon concentrations suggest that glucagon levels do not play a major role in the development of insulin resistance seen in some patients using oral contraceptive agents.

Administration, Oral↗
PubMed1987

Ovarian sonographic findings during intermittent intranasal luteinizing hormone-releasing hormone agonist sequentially combined with an oral progestogen as antiovulatory contraceptive approach.

Ovarian ultrasounds were performed in four groups of six or seven women taking intranasal luteinizing hormone-releasing hormone agonist Buserelin (200 micrograms twice daily or 400 micrograms once daily) for periods of 14 or 21 days. Medroxyprogesterone acetate (5 mg by mouth twice daily) was added on days 15 to 21. A pause of 7 days followed each of the four treatment periods. Between days 12 to 15 of the first Buserelin cycle, sonograms showed in 17 cases (68%) various degrees of follicular stimulation ranging from numerous 4- to 10-mm follicles (24%), to 10- to 27-mm developing follicle(s) (24%), to greater than 27-mm ovarian cysts (20%). At the fourth Buserelin cycle, the predominant observation was large follicle(s) in the 14-day schedules, whereas ovarian scans did not reveal follicular stimulation in 66% of the 21-day schedules. The area under estradiol (E2) curves was above control in cycles with induced large follicles mainly in the 14-day schedules at the 200 micrograms/12 hour dose. Occasional brief and low elevation of progesterone was compatible with luteinized follicles. In the 21-day schedules at 400 micrograms/24 hours, absence of follicular development was frequently associated with serum E2 in the early follicular phase range. The most appropriate dosage regimen for potential contraception was 200 micrograms/12 hours for 21 days because it was associated with small follicles and serum E2 was in the range of control cycles.

Administration, Intranasal↗
PubMed1983

Oral contraceptives and breast cancer: final report of an epidemiological study.

During 1968-1980, 1176 women aged 16-50 years with newly diagnosed breast cancer and a like number of matched controls were interviewed at 9 teaching hospitals in London and Oxford and asked about their use of oral contraceptives. The results were reassuring. A few statistically significant differences in oral contraceptive use were found between the breast cancer and control groups, but the data were subdivided in many ways so that some "significant" differences would have been expected through the play of chance alone. Certainly no patterns of risk emerged which would suggest that any of the associations were causal. It must be stressed, however, that the data are still sparse in some important subcategories--for example, only small numbers of both cases and controls had prolonged oral contraceptive use before their first term pregnancy. For this reason, it is important that information on the possible relationship between pill use and breast cancer should continue to be collected. Women who had never used oral contraceptives presented with appreciably more advanced tumours than those who had been using oral contraceptives during the year before detection of cancer, while past users were in an intermediate position. These differences in staging were reflected in the pattern of survival. Possible explanations for these observations include "surveillance bias" among oral contraceptive users leading to earlier diagnosis and a beneficial biological effect of oral contraceptives on tumour growth and spread. Women with breast cancer reported never having used any method of contraception and heavy cigarette smoking (greater than or equal to 15 per day) significantly less often than controls. We could find no obvious explanation for the former observation, but suspect that the latter reflects the unrepresentative smoking habits of our hospital controls rather than a protective effect of smoking against breast cancer.

Adolescent↗