[Effect of elastic stockings on edema related to chronic venous insufficiency. Videocapillaroscopic assessment]. / Effet des bas de compression sur l'oedème de l'insuffisance veineuse chronique. Evaulation par vidéo-capillaroscopie.

AIM: To evaluate the effect of class II (23-32 mm Hg) compression stockings on the edema of the ankle in patients with chronic venous insufficiency (CVI), and to assess the relationship between the microvascular phenomenon and the volume of the leg. MATERIAL AND METHOD: 11 patients (19 limbs, 5 women and 6 men, mean age 57 years) with CVI, CEAP 2-3 were studied through physical examination, Doppler color ultrasound test, measurement of leg volume and videocapillaroscopy. Patients were evaluated before (T0), after 7 days (T1) and 14 days (T2) of daily compression therapy with elastic stockings. Statistical comparisons used the Mac Nemar test for binomial variables and Wilcoxon test for paired quantitative data. RESULTS: All patients experienced significant improvement of symptoms, the volume of the limbs on the average decreased in the first week T0-T1=284.8 cm(3) +/- 307.5 cm(3) (6.27%, p<0.001). During the second week a small increase in volume was observed T2-T1=+ 12.23 cm(3), NS, 0.29%). The width of the capillary halo of edema decreased during the first week by an average of T0-T1=5.77 microm +/- 10.99 microm. During the second week the width of the edema halo continued diminishing, although in smaller proportion (T0-T2=7.89 microm +/- 11.77 microm). CONCLUSION: Daily use of grade II compression stockings induces a reduction in leg volume in patients with CEAP grades 2-3. This improvement of edema is paralleled by a decrease in the size of the pericapillary halo.

Effect of estradiol valerate alone or in association with cyproterone acetate upon vascular function of postmenopausal women at increased risk for cardiovascular disease.

OBJECTIVES: a large body of evidence has been accumulated suggesting that impairment of vascular endothelial function is an initial step in the development of atherosclerosis. Recent studies have shown that estrogen replacement therapy in postmenopausal women (PMW) improves endothelium-dependent, flow-mediated dilatation (FMD) while the cyclical adjunct of a progestin may reverse this effect. METHODS: the purpose of this study was to evaluate endothelium-dependent, FMD in the brachial artery and the plasma levels of Endothelin-1 in menopausal females treated with estradiol valerate with and without cyclical cyproterone acetate in 20 PMW (mean age 64+/-6 years) with more than one risk factor for coronary artery disease. After a baseline evaluation, PMW entered a double-blinded, placebo controlled single cross-over study and were randomized to receive either estradiol valerate (2 mg) for 21 days or estradiol valerate (2 mg) for 11 days and estradiol valerate (2 mg) and cyproterone acetate (1 mg) for 10 days. Patients were crossed-over the complementary treatment 7 days after completing the first treatment phase. The study of forearm blood flow was repeated at the end of each treatment period. RESULTS: estradiol valerate significantly increased FMD as compared with baseline (12+/-3 vs. 7+/-4%, P<0.01) the adjunct of cyproterone acetate did not affect the effect of estradiol valerate upon FMD (12+/-3 vs. 11+/-4%, P=NS). Similarly reactive hyperemic flow increased after estradiol valerate alone (24%) or in association with cyproterone acetate (24%) compared with baseline. Plasma levels of Endothelin-1 were significantly reduced by estradiol valerate alone or in association with cyproterone acetate. CONCLUSIONS: in conclusion hormone replacement therapy with estradiol valerate and cyproterone acetate improves endothelial function and reduces plasma levels of Endothelin-1 in PMW at risk of coronary artery disease. These effects may be relevant for cardioprotection.

Tratamiento de hiperlipidemia en las mujeres postmenopausicas: Terapia de reemplazo hormonal, estatinas o ambos / Hypercholesterolemic of postmenopausal women: Hormone replacement therapy, statin or both

La menopausia está asociada con un incremento en el colesterol total y con cambios desfavorables en el perfil lipídico. El incremento del colesterol total en el plasma, está asociado con una disminución del colesterol HDL, el cual es un predictor importante de eventos cardíacos en las mujeres y con un incremento de los niveles plasmáticos de colesterol LDL y de la lipoproteína aterogénica (a), Lp a). Varios estudios han mostrado que la administración oral de estrógenos y estrógenos-progestina como TRH, tienen efecto benéfico sobre el perfil lipídico, reduciendo el colesterol total, el colesterol LDL y la Lp (a) e incrementando el colesterol HDL. Aunque esos efectos pueden ser importantes en la programación de prevención primaria, no es claro su efecto en la reducción de eventos cardiovasculares en mujeres con enfermedad arterial coronaria ya establecida. Por otra parte el uso de estatinas para bajar los lípidos ha demostrado ser efectivo en reducir los eventos cardiovasculares en mujeres, cuando se programa para prevención secundaria, mientras hay dudas de su uso en prevención primaria de mujeres postmenopáusicas con hipercolesterolemia leve-moderada. Indudablemente es el único estudio que ha demostrado efecto cardioprotector de esas drogas en mujeres postmenopáusicas hipercolesterolémicas; también encontraron que las estatinas no son una terapia costo-efectiva en aquellos pacientes con riesgo cardiovascular bajo o moderado. La terapia de reemplazo hormonal y las estatinas tienen un efecto diferente sobre el perfil lipídico de mujeres menopáusicas, siendo las estatinas más efectivas en reducir el colesterol total y el LDL, sin afectar la Lp(a) la cual es significantemente reducida sólo por las hormonas ováricas. Datos recientes parecen sugerir que la combinación de estatinas y TRH oral, es más efectiva que uno de los dos tratamientos, en mejorar el perfil lipídico de las mujeres postmenopáusicas hipercolesterolémicas.Al presente la terapia con estatinas representa el tratamiento de elección para mujeres hipercolesterolémicas con enfermedad arterial coronaria establecida mientras la TKH podría ser considerada como el tratamiento de primera línea para las mujeres hipercolesterolémicas postmenopáusicas. En las mujeres que no se reduzca el colesterol por una terapia individual con estatina o TRH, la asociación de ambos medicamentos es el tratamiento de elección

Anti-ischemic effect of chronic oestrogen replacement therapy alone or in combination with medroxyprogesterone acetate in different replacement schemes.

BACKGROUND: Oestrogen replacement therapy in postmenopausal women has a protective effect upon the cardiovascular system and improves exercise-induced myocardial ischemia. Although in hormone replacement schemes progestins are required to reduce the likelihood of uterine malignancies, little is known on the cardiovascular effect of progestins. The purpose of this study was to evaluate the effect of oestrogen replacement alone and two different estrogen-progestin replacement therapy schemes upon exercise induced myocardial ischemia. MATERIAL AND METHOD: The study population included 18 female menopausal patients with coronary artery disease. After a baseline exercise test patients received conjugated equine estrogens (CEE) 0.625 mg alone for 30 days when they underwent a second exercise test and were randomized to receive in a cross-over design medroxyprogesterone acetate (MPA) either in continuous combined therapy (2.5 mg/daily) for 28 days or in cyclical therapy (10 mg o.d. from day 16 to day 28). RESULTS: After CEE alone two patients with a previously positive exercise test showed a negative exercise test. CEE increased time to 1 mm ST compared to baseline (352+/-185 vs 265+/-133 s, P<0.01). In the 2 pts in whom the exercise test was negative after CEE the test remained negative during continuous combined MPA therapy while become positive during cyclical MPA. CEE+continuous combined MPA increased both time to 1 mm ST and exercise time compared to baseline (386+/-165 vs 265+/-133 s, P<0.01 and 545+/-198 vs 465+/-186 s, P<0.05, respectively). No difference was found between baseline and CEE+cyclical MPA in either time to 1 mm ST or exercise time (268+/-164 vs 265+/-133 s, P=NS and 455+/-223 vs 465+/-186 s, P=NS, respectively). CONCLUSION: Continuous combined therapy with CEE+MPA improves exercise-induced myocardial ischemia in female patients with coronary artery disease while the beneficial effect of CEE is reduced by cyclical therapy.