Wednesday Bubble: heart disease, depression and menopause
Today’s Bubble is not exactly bursting with good news. On the other hand, it more a matter of erring on the side of caution.
Depression in menopause and midlife is a common occurrence. Although researchers are not quite sure of the exact reasons for its surge during the transition, (e.g. declining hormone, life stress, prior history), many women tend to suffer the blues during this time. In addition to physical activity or herbs, many practitioners recommend that women incorporate a low-dose antidepressant into their daily strategy. Yet, while this might help to maintain mood balance, researchers are starting to question whether or not using antidepressants may increase the risk for dying from heart disease during menopause. Yikes! So, we are given drugs to help boost our moods during menopause but they may end up killing us in the long run? Somehow the old adage, ‘what doesn’t kill you makes you stronger’ doesn’t make me feel better this time.
In a study that appears in the Archives of Internal Medicine, researchers examined information collected from over 136,000 women who had participated in the Women’s Health Initiative Study who either were or were not taking antidepressants over a period of about 6 years. The findings? Women who used SSRI antidepressants had a 45% increased risk of stroke, and a 32% increased risk of death. This risk remained even after researchers took other heart disease risk factors into account, such as diabetes, high cholesterol and smoking.
Here’s the rub: depression is a known risk factor for heart disease and death from heart disease, and has also been linked to an increased risk for stroke. So, researchers are not certain if it’s the chicken (depression) or the egg (antidepressants) that is accounting for these study results.
So, what can you do? Should you throw away the pills?
Not so fast. Speak to your doctor. Get tested for known heart disease risk factors, such as overweight, high blood pressure, high cholesterol, family history, diabetes and of course, smoking. Incorporate heart healthy changes into your life, such as physical activity, a better diet, yoga, meditation and laughter. And then figure out if the benefits of antidepressants are worth the risks. These data are early and inconclusive. Just something to be mindful of if you are in menopause.
Read MoreHRT and heart disease. And the beat goes on….
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Hormone replacement therapy can help prevent heart disease, right?
Think again. Research has shown that use of HRT increases the risk for stroke, blood clots and heart disease. Although increased risk starts to decline within three years of stopping hormone therapy, women are still cautioned to continue rigorous prevention efforts and to see their physicians for any recommended testing.
So, are you asking yourselves why I’m writing about this if doctors know already about the link between HRT and heart disease? Well it appears that in the early 200s, and despite a marked decline in the use of HRT among women following confirmation of the risk, as many as 8% of women with existing heart disease and 14% with two or more identifiable risk factors were still prescribed hormones by their doctors. Writing in the American Journal of Public Health, investigators of a newly-published analysis said that although the reasons are unclear, women continued to receive HRT for heart risks, even though it “was never proven for this indication and ultimately found to be ineffective.”
To add insult to injury, the International Menopause Society, in concert with the European Society of Cardiology, has just issued a statement staying that hormone therapy, in limited doses, does not increase the risk of heart disease and may even decrease risk in younger women.What’s more, they are now saying that in some cases, HRT may even lower blood pressure. Conversely, they recommended that HRT should not be used in women with a history of heart attack, stroke or pulmonary embolism (blockage of one or more lung arteries).
Are you confused yet?
Some experts have questioned the results of the Women’s Health Initiative studies, which were the first to raise the flag about the dangers of HRT. Some argue that the studies looked at women who were older, i.e. 50 to 79 and not menopausal or perimenopausal. However, others have determined that both the timing (i.e. when HRT is started) and length of time on HRT can affect disease risks, as can type of hormone used.
In some respects, these confusing recommendations echo the recent controversy over mammography, in which medical experts have taken sides, some agreeing the screening is overrated and even dangerous, and others, saying that even the small numbers of lives saved make mammography worthwhile in younger women. That, however, is a post for another time.
Meanwhile, what should you do when it comes to HRT and heart disease risk?
As always, I urge women to err on the side of caution and do their due diligence: make an appointment with an informed health provider and discuss the risks and the benefits. There’s no way to make an informed decision without all the facts and information about how they apply specifically to you, your family and personal medical history and your unique set of needs and symptoms. At the same time, the evidence is pretty darn strong that HRT does not protect your heart and may in fact, exacerbate other risk factors for developing a heart attack or stroke.
Is it worth it? Only you and your practitioner can decide.
Read MoreAnd the beat goes on
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More interesting news on the HRT front. Study findings reported in the May issue of the journal Medical Care suggest that a decline in the use of hormone replacement therapy (HRT) may be associated with a decrease in heart attacks among women.
In this trial, researchers examined data from various national databases on causes of death, hospitalizations and population size and combined it with information on HRT use.
Although declines in HRT use were not associated with decreases in stroke deaths or hospitalizations, the data did demonstrate 25 fewer heart attacks for every 10,000 women not using HRT. In contrast, findings from the Women’s Health Initiative (WHI) study found an increase of seven heart attacks for every 10,000 women on HRT. (Note, however, that a more recent analysis of the 2002 WHI data showed that heart attack risk from hormones may not be increased in women who start the hormones less than 10 years after menopause, but is increased in women more than 10 years out.)
In the press release distributed along with the study, a cardiologist from Total Heart Care is NYC is quoted as saying that lower heart attacks rates may be associated with better screening and greater awareness of heart disease in women, and attributable to declining HRT use. Study researchers say that more research is needed to verify their findings.
So far as I am concerned, it’s a win-win. Screening or less HRT. And the beat goes on…
Read MoreWednesday Bubble: I’ve got the blues and it’s all good!
I’ve got the blues this week; blueberries that is. And the news is all good!
Researchers at the University of Michigan at Ann Arbor are reporting that eating a diet rich in blue berries might reduce heart disease, protect against diabetes, and get rid of belly fat! Is this too good to be true? And what does this have to do with menopause anyway?
I’ve written previously on increased risk of heart disease and increased likelihood of gaining weight around the abdominal region as we age. So, if blueberries can potentially help to stave off both, that’s great news, right?
The research team studied the effect of a blueberry-enriched powder added to either a low-fat or high-fat diet in laboratory rats and compared them to rats receiving no blueberry powder. The rats were of a particular breed that are prone to weight gain and being severely overweight.
After 90 days, rats receiving the blueberry powder (which comprised 2% of their total diet) had less abdominal fat, and lower triglycerides and cholesterol levels. They also showed improvements in fasting blood glucose and insulin sensitivity, which measures the risk for diabetes and heart disease (namely metabolic syndrome), respectively.
What’s more, the benefits were even greater among rats fed the powder along with a low-fat diet: they had lower body weight, lower total fat mass, and reduced liver mass (which has been linked to obesity and insulin resistance) than rats in the other study groups. The researchers also reported positive changes in measures such as fat muscle tissue (which relates to fat-burning and storage) in rats fed the blueberry powder and a high-fat diet.
The beneficial effects of blueberries are believed to be possibly related to inherently high levels of an antioxidant known as anthocyanins, which is responsible for blueberries’ colour.
Clearly, further research, is needed, particularly in humans. In the interim, eat some blueberries: they’re high in flavor, a great source of fiber and vitamins C and K, and low in fat. And may help combat some of the less attractive pitfalls of mid-life.
Read MoreMore joys of soy
More news on soy. Researchers have discovered yet another component of soy isoflavones that may prove useful in improving symptoms of menopause: soy aglycons of isoflavones (SAI). Soy aglycons are a group of chemicals found in fermented soybeans and comprise a great portion of diets for Chinese and Japanese individuals. Of note, high cholesterol, coronary heart disease, and menopausal symptoms are often seen in a smaller percentage of these women than their European and American counterparts.
Among the various chemical molecules of soy, SAI are absorbed faster and more efficiently than other components.
In this particular study, which was just published in Nutrition & Metabolism, researchers fed rats whose ovaries had been removed either high or low doses of SAI-supplemented diets. These animals were then compared to rats with intact ovaries who were fed a regular diet.
The researchers found that rats fed supplemental SAI had significantly lower cholesterol and low-density lipoprotein (LDL) values , higher high-density lipoprotein (HDL) levels and faster liver metabolism. The lining of the uterus was also enhanced by dietary SAI supplementation.
They said that these results suggest that SAI may help protect against or lessen symptoms during menopause that are associated with the natural decline of estrogen. SAI might also be an effective and safe alternative to HRT, which has been linked to breast and uterine cancers. In general, SAI may protect against menopausal heart disease.
Read MoreSomething’s fishy
A small study in the online edition of the journal Menopause suggests that a supplement containing omega-3 fatty acids may help reduce hot flashes in menopausal women.
Canadian researchers evaluated the influence of omega-3 supplementation in 120 women (between the ages of 40 and 55) experiencing hot flashes who took either a real pill containing oeicosapentaenoic acid (EPA) or dummy pill for 8 weeks. At the start, study participants had an average of 2.8 hot flashes daily.
At the study’s end, women taking omega-3 fatty acids had 1.5 times fewer hot flashes daily compared to women taking dummy pills, whose hot flash frequency decline by 50%. Hot flash severity, however, remained similar between the groups and the use of omega-3s did not impact mood or other quality of life factors.
Although the researchers caution that more study is needed, it’s important to note that earlier data do suggest that omega-3s may be useful in reducing hot flashes. Regardless, the benefits of incorporating omega-3s in midlife, which include potential protection against heart disease and osteroporosis, should not be overlooked.
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