Objective: Atherosclerosis is a complex process characterized by an increase in vascular wall thickness owing to the accumulation of cells and extracellular matrix between the endothelium and the smooth muscle cell wall. There is evidence thatfemales are at lower risk ofdeveloping cardiovascular disease (CVD) as compared to males. This has led to an interest in examining the contribution of genetic background and sex hormones to the development of CVD. The objective of this review is to provide an overview of factors, including those related to gender, that influence CVD. Methods: Evidence analysis from PubMed and individual searches concerning biochemical and endocrine influences and gender differences, which affect the origin and development of CVD. Results: Although still controversial, evidence suggests that hormones including estradiol and androgens are responsible for subtle cardiovascular changes long before the development of overt atherosclerosis. Conclusion: Exposure to sex hormones throughout an individualis lifespan modulates many endocrine factors involved in atherosclerosis.

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Gender differences in cardiovascular disease: hormonal and biochemical influences.

Background and Purpose—Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries. Methods—A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation. Results—After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65–2.89), 2.40 (1.56–3.67), and 2.73 (1.83–4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (<15 μmol/L), the hazard ratios (95% confidence i...

Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients A Population-Based, Prospective Cohort Study

Elevated plasma homocysteine level is associated with ischemic stroke in Chinese hypertensive patients

Phytoestrogen α-zearalanol improves vascular function in ovariectomized hyperhomocysteinemic rats.

Objective: To describe the perceptions of women with premenstrual syndrome regarding the behavior of their spouses in face of this event. Methods: It is a qualitative research, with the method of the five stages of narrative analysis to know the representations of the women that experience the conjugal behavior. Results: The experiences of 20 women interviewed are represented in the following categories: Difficulties in identifying the syndrome and in adopting care practices, lack of knowledge and sensitivity of men and, its impact on the couple relationship. Conclusion: It is necessary to provide systematized guidance on Premenstrual Syndrome to all people, before menarche, to avoid problems arising from the ignorance of the syndrome and its consequences in the women’s person, family and social areas.

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Male behavior in front of women with Premenstrual Syndrome: narratives of women

A sindrome da tensao pre-menstrual (STPM) envolve a presenca de sintomas fisicos e comportamentais na segunda metade do ciclo menstrual, que frequentemente comprometem a boa qualidade do desempenho profissional e dos relacionamentos pessoais. Acomete aproximadamente 40% das mulheres entre 15 e 45 anos de idade. Desequilibrio entre estrogenio e progesterona, excesso de prolactina, deficiencia de vitaminas B6 e E, atividade inapropriada de prostaglandina e alteracoes na acao das endorfinas e serotonina sao alguns dos fatores frequentemente relacionados a sua ocorrencia. O diagnostico baseia-se exclusivamente no quadro clinico e o tratamento envolve a mudanca de habitos comportamentais, como a realizacao de atividade fisica regular e a ingestao de uma dieta rica em proteinas e pobre em sal na segunda fase do ciclo e, tambem, o uso de medicamentos, tais como diureticos, antidepressivos, progesterona ou fitoterapicos.

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Síndrome da tensão pré-menstrual – o estado atual dos conhecimentos

Objective. To evaluate the correlation between homocysteine levels and carotid vascular resistance in menopausal women submitted to estrogen and estrogen–progestogen therapy.Methods. Eighty-six women with a mean age of 52 years were enrolled in a prospective, randomized, double-blind, 6-month study. Patients were allocated to use one of three oral therapies: placebo (n = 26), micronized estradiol 2 mg/day (n = 30) or micronized estradiol 2 mg/day plus norethisterone acetate 1 mg/day (n = 30). Evaluation of homocysteine levels and Doppler sonography of the common carotid artery, used to calculate pulsatility index (PI), were carried out prior to initiating therapy and at the end of the study. The correlation between these two parameters was evaluated using Pearson's coefficient of correlation.Results. There was a significant reduction in homocysteine levels in the groups treated with estrogen alone or estrogen combined with norethisterone. PI was significantly lower only in users of estrogen alone; however...

Effects of estrogen and estrogen-progestogen therapy on homocysteine levels and their correlation with carotid vascular resistance.

The authors have reviewed the main aspects of the polycystic ovary syndrome (PCOS) with respect to its etiopathogenic, clinical, diagnostic and therapeutic features, highlighting the psychological distresses that frequently arise in the syndrome. They also make considerations on the importance of an effective clinical treatment as well as on the approaches and psychological support, aiming to improve women’s well-being and quality of life.

Síndrome da anovulação crônica hiperandrogênica e transtornos psíquicos Hyperandrogenic chronic anovulation and psychologic disturbances

Síndrome dos ovários policísticos: uma visão atual

In August 2019, the safety of menopausal hormone therapy (MHT) returned to the scene again. Oncemore, its association with breast cancer risk came up, this time in an article published in the prestigious The Lancet (online in August and printed in September/2019). The subject is not new, and authors of the article are not newcomers either. By representing the Collaborative Group on Hormonal Factors in Breast Cancer, they brought a reanalysis of data from studies on the subject published so far.1 In summary, they evaluated data from 58 studies, out of which 24 were prospective and 34 were retrospective studies, covering almost 144 thousand postmenopausal women with breast cancer (cases) and close to 425 thousandwithout the disease (controls). A higher risk for developing breast cancer was found among MHT users. Women taking combinedMHT for 1 to 4 years had a relative risk (RR) of 1.60with a 95% confidence interval (CI) from 1.52 to 1.69, and for estrogen alone, it was observed a RR of 1.17 (95%CI: 1.10–1.26). For more prolonged use (5 to 14 years), RRs were 2.08 and 1.33, respectively.1 Thefirst important pointwhen evaluating this study is the fact that it is a reanalysis of data from other studies. In other words, data from other 58 studies were obtained and compiled, a total databasewas generated, and then analyzed. This was not a meta-analysis or systematic review, neither were data obtained from a same population at the same time or using the same method. Soon after publication, the International Menopause Society (IMS) came public with their interpretation2 and found an echo in the Associação Brasileira de Climatério (SOBRAC, in the Portuguese acronym), which endorsed the IMS position and translated it into Portuguese under authorization.3 In their comments, the IMS mentioned that much information brought in the recent article is not new.2,3 In fact, the previous publication of the Collaborative Group on Hormonal Factors in Breast Cancer itself, dating from 1997 and covering 51 studies brought similar data, with a RR of 1.35 for breast cancer associated with MHT use for 5 years.4 The Million Women Study also found similar values. The RR for breast cancer inMHTuserswas 1.66, in combinedMHT users it was 2.00, and in users of estrogen MHT alone the RR was 1.30.5 What differs in the study published in The Lancet in 2019 regards the use of estrogen alone, because in this study, the use of estrogen alone presented higher risk, as well as the observational studies previouslymentioned. However, in the Women’s Health Initiative (WHI), the only large randomized study that assessed MHT effects on the risk for breast cancer, this effect was not observed. In the WHI, the RR for invasive breast cancer in users of estrogenMHT alone compared with placebo was 0.80 (95%CI: 0.62–1.04).6 In time, the WHI revealed that estrogen plus progestogen MHT increased the risk, but to a lesser extent than that reported by the Collaborative Group last August.7 Note that data from no randomized study, not even from the WHI, were included in this 2019 reanalysis of the Collaborative Group. On the other hand, although this article did not bring much novelty in terms of MHT-associated breast cancer risk, there is a problem thatmay seemmore relevant from the IMS perspective: most of the MHT assessed does not represent the most common current practices for this type of therapy. This is a result of the fact that in the Collaborative Group reanalysis, the median year of diagnosis of breast cancer cases for the entire database was 2002, whereas for retrospective studies, the median was year 1995. For American prospective studies, the median of the year of breast cancer diagnosis was 1999, and for Europeans it was 2007. Furthermore, in prospective studies, the average time of using MHT was 10 years in users diagnosedwhile using the therapy, and 7 years in former users.1 Therefore, much of the exposure to MHT preceded the first publication of the WHI study, after which the prescription practices changed substantially.2,3 Another relevant criticism of this reanalysis involves the context of womenwho startedMHT before the age of 45. In the presentation of results, the effect of MHT in this context was compared with women in the same age group that were not

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César Eduardo Fernandes

Papers

Síndrome da tensão pré-menstrual – o estado atual dos conhecimentos

Effects of estrogen and estrogen-progestogen therapy on homocysteine levels and their correlation with carotid vascular resistance.

Síndrome da anovulação crônica hiperandrogênica e transtornos psíquicos Hyperandrogenic chronic anovulation and psychologic disturbances

Síndrome dos ovários policísticos: uma visão atual

Hormone Therapy, Breast Cancer Risk and the Collaborative Group on Hormonal Factors in Breast Cancer Article