Brain volumes, cognitive impairment, and conjugated equine estrogens.

BACKGROUND: Postmenopausal conjugated equine estrogens (CEE) therapies increase the risk of cognitive impairment in women aged 65 years or older and are associated with smaller regional brain volumes; however, the link between these two phenomena has not been established. METHODS: Standardized magnetic resonance imaging was performed on 1,403 women, 1-4 years after they had participated in randomized placebo-controlled clinical trials of CEE-based therapies. Women included in this report were aged 65-80 years and free of dementia and mild cognitive impairment (MCI) when originally enrolled in the trials, which lasted an average of 4-6 years and were conducted at 14 academic U.S. medical centers. The associations that regional brain volumes and ischemic lesion volumes had with the development of cognitive impairment (i.e., dementia or MCI) were contrasted between treatment groups using analyses of covariance. RESULTS: Fifty-three women developed MCI or probable dementia during follow-up. Among women who had been prescribed CEE-based therapies, cognitive impairment was associated with relatively smaller hippocampal (p = .0002) and total brain volumes (p = .03). Qualitatively, these associations appeared to be independent of their level of pretreatment cognitive function. Among women who had been prescribed placebo, these relationships were not evident; instead, cognitive impairment was associated with greater ischemic lesion volume in the frontal lobe (p = .007) and overall (p = .02). CONCLUSION: A mechanism by which CEE-based postmenopausal hormone therapy induces cognitive impairment appears to be through increased brain atrophy.

Correlates of sexual satisfaction among sexually active postmenopausal women in the Women's Health Initiative-Observational Study.

BACKGROUND: Satisfaction with sexual activity is important for health-related quality of life, but little is known about the sexual health of postmenopausal women. OBJECTIVE: Describe factors associated with sexual satisfaction among sexually active postmenopausal women. DESIGN: Cross-sectional analysis. PARTICIPANTS: All members of the Women's Health Initiative-Observational Study (WHI-OS), ages 50-79, excluding women who did not respond to the sexual satisfaction question or reported no partnered sexual activity in the past year (N = 46,525). PRIMARY OUTCOME: dichotomous response to the question, "How satisfied are you with your sexual activity (satisfied versus unsatisfied)?" Covariates included sociodemographic factors, measures of physical and mental health, and gynecological variables, medications, and health behaviors related to female sexual health. RESULTS: Of the cohort, 52% reported sexual activity with a partner in the past year, and 96% of these answered the sexual satisfaction question. Nonmodifiable factors associated with sexual dissatisfaction included age, identification with certain racial or ethnic groups, marital status, parity, and smoking history. Potentially modifiable factors included lower mental health status and use of SSRIs. The final model yielded a c-statistic of 0.613, reflecting only a modest ability to discriminate between the sexually satisfied and dissatisfied. CONCLUSIONS: Among postmenopausal women, the variables selected for examination yielded modest ability to discriminate between sexually satisfied and dissatisfied participants. Further study is necessary to better describe the cofactors associated with sexual satisfaction in postmenopausal women.

Measurement characteristics of the ankle-brachial index: results from the Action for Health in Diabetes study.

Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

Sexual satisfaction and cardiovascular disease: the Women's Health Initiative.

BACKGROUND: Sexual dysfunction in some men is predictive of occult cardiovascular disease. We investigated whether dissatisfaction with sexual activity, a domain of female sexual dysfunction, is associated with prevalent and incident cardiovascular disease in postmenopausal women. METHODS: Data from the Women's Health Initiative-Observational Study were used. Subjects who were sexually active in the past year were classified at baseline as sexually satisfied or dissatisfied. We performed multiple logistic regression analyses modeling baseline cardiovascular conditions including myocardial infarction, stroke, coronary revascularization, peripheral arterial disease, congestive heart failure, and angina. We then created Cox proportional hazards models to determine hazard ratios for incident cardiovascular disease by baseline sexual dissatisfaction status. RESULTS: Dissatisfaction with sexual activity at baseline was significantly associated with prevalent peripheral arterial disease (odds ratio 1.44, 95% confidence interval, 1.15-1.84), but not prevalent myocardial infarction, stroke, coronary revascularization including coronary artery bypass graft and percutaneous transluminal coronary angioplasty, or a composite cardiovascular disease variable. The odds of baseline angina were decreased among those reporting sexual dissatisfaction at baseline (odds ratio 0.77, 95% confidence interval, 0.66-0.86). In both unadjusted and adjusted analyses, dissatisfaction with sexual activity was not significantly related to an increased hazard of any cardiovascular disease. CONCLUSIONS: Dissatisfaction with sexual activity was modestly associated with an increased prevalence of peripheral arterial disease, even after controlling for smoking status. However, dissatisfaction did not predict incident cardiovascular disease. Although this may represent insensitivity of the sexual satisfaction construct to measure sexual dysfunction in women, it might be due to physiological differences in sexual functioning between men and women.

Exercise capacity and cardiovascular/metabolic characteristics of overweight and obese individuals with type 2 diabetes: the Look AHEAD clinical trial.

OBJECTIVE: We examined associations of cardiovascular, metabolic, and body composition measures with exercise capacity using baseline data from 5,145 overweight and/or obese (BMI > or = 25.0 kg/m2) men and women with type 2 diabetes who were randomized participants for the Look AHEAD (Action for Health in Diabetes) clinical trial. RESEARCH DESIGN AND METHODS: Peak exercise capacity expressed as METs and estimated from treadmill speed and grade was measured during a graded exercise test designed to elicit a maximal effort. Other measures included waist circumference, BMI, type 2 diabetes duration, types of medication used, A1C, history of cardiovascular disease, metabolic syndrome, beta-blocker use, and race/ethnicity. RESULTS: Peak exercise capacity was higher for men (8.0 +/- 2.1 METs) than for women (6.7 +/- 1.7 METs) (P < 0.001). Exercise capacity also decreased across each decade of age (P < 0.001) and with increasing BMI and waist circumference levels in both sexes. Older age, increased waist circumference and BMI, a longer duration of diabetes, increased A1C, a history of cardiovascular disease, having metabolic syndrome, beta-blocker use, and being African American compared with being Caucasian were associated with a lower peak exercise capacity for both sexes. Hypertension and use of diabetes medications were associated with lower peak exercise capacity in women. CONCLUSIONS: Individuals with diabetes who are overweight or obese have impaired exercise capacity, which is primarily related to age, female sex, and race, as well as poor metabolic control, BMI, and central obesity.

Enrollment in a brain magnetic resonance study: results from the Women's Health Initiative Memory Study Magnetic Resonance Imaging Study (WHIMS-MRI).

RATIONALE AND OBJECTIVES: The rates of enrollment of volunteers for brain magnetic resonance imaging (MRI) studies vary by demographic and clinical characteristics. We use data from a large MRI study to identify factors associated with differential enrollment and to examine potential biases this may produce in study results. MATERIALS AND METHODS: Results from recruitment of 1,431 women into the MRI substudy of the Women's Health Initiative Memory Study (WHIMS-MRI) are described. A sensitivity analysis was conducted to estimate the degree of bias associated with missing data on estimates of risk factor relationships. RESULTS: Of 2,345 women contacted from an established cohort of women older than 70 years of age, 72% consented to undergo screening for WHIMS-MRI. Scanning was ultimately completed on 61%. Completion rates varied according to a range of sociodemographic, lifestyle, and clinical characteristics that may be related to study outcomes. Plausible levels of selective enrollment in magnetic resonance imaging studies may produce moderate biases (< +/-20%) in characterizations of risk factor relationships. Adverse events, such as claustrophobia, occurred during 1.7% of the attempted scans and, in 0.8% of instances, led to lost data. CONCLUSIONS: Enrollment of older women into brain imaging studies is feasible, although selection biases may limit how well study cohorts reflect more general populations.