Uncertainty about postmenopausal estrogen: time for action, not debate

Article Abstract:

In the September 12, 1991 issue of The New England Journal of Medicine, researchers present data indicating that the use of estrogen by postmenopausal women might significantly reduce the risk of heart attacks and coronary artery disease. Although the findings of this research study are important, they also illustrate the slow rate at which medical science is resolving serious questions about the use of estrogen. Among menopausal women, estrogen has both positive and negative effects. The hormone decreases the rate of bone mineral loss, which causes osteoporosis and raises the risk of bone fractures in the elderly. Current studies indicate estrogen reduces the rate of heart attack, and it is certain that the hormone can reduce some of the unpleasant side effects of menopause. However, estrogen is associated with an increased risk of cancer of the endometrial lining of the uterus, and perhaps breast cancer as well. It is clear that high quality research data should be available to help the physician balance the risks and benefits in deciding on proper treatment for a menopausal patient. Unfortunately, such data are not available. It seems likely that much debate will continue on the proper role of estrogen therapy among postmenopausal women. What is needed is a randomized controlled study among a large number of women to answer these questions once and for all. However, it might be anticipated that even the proposal of such a study will draw criticism, since some women must be assigned to placebo groups and may suffer a higher rate of heart disease. Nevertheless, without such a study, millions of women may be subjected to inappropriate treatment based on inadequate data. Such a large-scale study will be elaborate and expensive, but the need is critical and the undertaking should begin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Women, Prevention, Heart attack, Women's health, Menopause, Estrogen, Estrogens, editorial

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Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery

Article Abstract:

Peripheral vascular surgery is performed to correct diseased blood vessels of the extremities. Peripheral arteries can become diseased with atherosclerosis, the build-up of plaque which narrows the inside of blood vessels. Patients having peripheral vascular disease may have pain while walking or have had a stroke before surgery which limits their physical activity. Since atherosclerosis can affect the vessels supplying the heart as well, tests are required to establish whether the heart muscle is receiving an inadequate blood supply, a condition known as cardiac ischemia. Patients having cardiac ischemia may or may not experience angina, a painful tightening in the chest which may precede a heart attack. Proper assessment of the heart requires a physical exercise test, often difficult to perform with patients who have peripheral vascular disease. Ambulatory electrocardiographic monitoring, a mobile device used to detect abnormal heart activity, is a test that can be performed to check the blood supply in the heart muscle in patients whose physical movements are limited. This test was performed on 176 patients preparing for vascular surgery to see whether it could predict patients at risk for cardiac ischemia. Monitoring before surgery revealed 18 percent (32 patients) of the patients had ischemia, and seven percent (13 patients) had a complication in the heart after the operation. Of these patients four had a heart attack, one of which was fatal. The remaining nine patients had other cardiac complications. In the 144 patients not having any indication of poor heart function before the operation, only one had an cardiac event after surgery. Ambulatory electrocardiographic monitoring was able to detect cardiac ischemia in patients preparing for elective vascular surgery.

Diagnosis, Surgery, Electrocardiography, Peripheral vascular diseases, Ischemia

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Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing

Article Abstract:

Most patients who require a cardiac pacemaker will benefit from either a ventricular or a dual-chamber pacemaker. A ventricular pacemaker stimulates only the heart ventricles, but the dual-chamber pacemaker stimulates both the atria and the ventricles. Researchers evaluated 407 patients who were given a dual-chamber pacemaker and then randomly assigned to receive ventricular stimulation only or dual-chamber stimulation. There were no significant differences in health outcomes between the groups overall, but patients with sinus-node dysfunction appeared to benefit more from dual-chamber pacing.

Evaluation, Measurement, Quality of life, Pacemaker, Artificial (Heart), Pacemakers

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