Cardiovascular disease among diabetic women with bilateral oophorectomy.

Cardiovascular Disease (CVD) is the leading cause of death in women and the risk is increased threefold in diabetics. In postmenopausal diabetics, the ovary responds to hyperinsulinemia by increasing secretion of testosterone precursors which increases the risk of CVD. Data from the National Health and Nutrition Examination Survey (1988-2010) and the Study of Osteoporotic Fractures were used to test the hypothesis that a history of bilateral oophorectomy -surgical removal of both ovaries-would decrease the risk of CVD among postmenopausal diabetic women due to reduced androgen levels. Logistic regression, discrete time logit model, B-Spline regression and Cox proportional hazards models were performed with adjusted estimates and 95% confidence intervals (CIs) calculated. Overall, the studies comprised of 17,549 postmenopausal women with approximately 17.1 % having a history of diabetes Mellitus. Additionally, 24.1% of diabetic women had undergone bilateral oophorectomy with 55% of these having the surgery before age 45 years. Diabetics were more likely to be obese, live a more sedentary lifestyle, have dyslipidemia and were more likely to report a higher prevalence of stroke and myocardial infarction than non diabetics at baseline. Women who had oophorectomy before age 45 years were more likely to be nulliparous and report a family history of myocardial infarction. Diabetic women with oophorectomy had lower levels of total testosterone compared to diabetic women with intact ovaries or naturally menopausal non-diabetic women, which was independent of age and body mass index (p=0.016). In multivariable regression models, bilateral oophorectomy was predictive of prevalent CVD in diabetics (Odds ratio: 1.63 (95% CI: 1.16 - 2.30) with the odds limited to women who had this procedure before age 45 years (OR: 2.11, CI: 1.45-3.08). Although ovarian status did not influence incident CVD in diabetic women (OR: 0.78, CI: 0.56-1.09), women with oophorectomy before the average age at menopause (51 years), with or without diabetes were observed to have elevated CVD risk in spline regression models. Furthermore, the risk of CVD mortality was elevated for diabetic women irrespective of ovarian status, although women with no ovaries had an increased risk (Hazard ratio: 2.57, CI: 1.18-3.67) than those with intact ovaries (HR: 1.99, CI: 1.65-2.39). This present analyses consisting of three different population-based samples of postmenopausal women did not support oophorectomy having a protective effect on cardiovascular health in diabetic women; however, our interpretation of these data is that oophorectomy was performed more often in younger women who inherited a risk factor for heart disease

Association of Age at Menopause With Incident Heart Failure: A Prospective Cohort Study and Meta‐Analysis

BACKGROUND: Early age (<45 years) at menopause has been postulated to be associated with increased cardiovascular disease risk; however, evidence of its relation with heart failure (HF) incidence is limited. We examined whether age at menopause is associated inversely with HF incidence in the Atherosclerosis Risk In Communities (ARIC) study and summarized all existing data in a meta-analysis. METHODS AND RESULTS: In ARIC, data were obtained from 5629 postmenopausal women (mean age 56 years, 26% with bilateral oophorectomy) without HF. During a median follow-up of 21.4 years, 965 incident HF events occurred. In a Cox regression model adjusted for reproductive health and HF risk factors, the hazard ratios for incident HF across categories of age at menopause (<45, 45-49, 50-54, and ≥55 years) were 1.32, 1.17, 1.00 (referent), and 1.12, respectively. Compared with women with later onset of menopause (aged ≥45 years), those with early menopause had elevated HF risk (hazard ratio 1.20, 95% CI 1.01-1.43). For the meta-analysis, we searched Medline and Embase for articles published through December 2015 that prospectively evaluated age at menopause and HF risk. Summarized estimates from the 3 included studies (3568 events) showed higher HF risk among women with early menopause compared with those with later menopause (hazard ratio 1.33, 95% CI 1.15-1.53). CONCLUSIONS: These results provided evidence that early age at menopause is associated with a modestly greater risk of HF. Identification of women with early menopause offers a window of opportunity to implement interventions that will improve overall cardiovascular health during the postmenopausal years

Relationship between age at menopause, obesity, and incident heart failure: The Atherosclerosis Risk in Communities Study

Background The mechanisms linking menopausal age and heart failure (HF) incidence are controversial. We investigated for heterogeneity by obesity on the relationship between menopausal age and HF incidence. Methods and Results Using postmenopausal women who attended the Atherosclerosis Risk in Communities Study Visit 4, we estimated hazard ratios of incident HF associated with menopausal age using Cox proportional hazards models, testing for effect modification by obesity and adjusting for HF risk factors. Women were categorized by menopausal age: \u3c45 years, 45 to 49 years, 50 to 54 years, and ≥55 years. Among 4441 postmenopausal women, aged 63.5±5.5 years, there were 903 incident HF events over a mean follow-up of 16.5 years. The attributable risk of generalized and central obesity for HF incidence was greatest among women who experienced menopause at age ≥55 years: 11.09/1000 person-years and 7.38/1000 person-years, respectively. There were significant interactions of menopausal age with body mass index and waist circumference for HF incidence

Butler and Post-Analytic Philosophy

This article has two aims: (i) to bring Judith Butler and Wilfrid Sellars into conversation; and (ii) to argue that Butler’s poststructuralist critique of feminist identity politics has metaphilosophical potential, given her pragmatic parallel with Sellars’s critique of conceptual analyses of knowledge. With regard to (i), I argue that Butler’s objections to the definitional practice constitutive of certain ways of construing feminism is comparable to Sellars’s critique of the analytical project geared toward providing definitions of knowledge. Specifically, I propose that moving away from a definition of woman to what one may call poststructuralist sites of woman parallels moving away from a definition of knowledge to a pragmatic account of knowledge as a recognizable standing in the normative space of reasons. With regard to (ii), I argue that the important parallels between Butler’s poststructuralist feminism and Sellars’s antirepresentationalist normative pragmatism about knowledge enable one to think of her poststructuralist feminism as mapping out pragmatic cognitive strategies and visions for doing philosophy. This article starts a conversation between two philosophers whom the literature has yet to fully introduce to each other

A Prospective Population-Based Study of Cardiovascular Disease Mortality following Treatment for Breast Cancer among Men in the United States, 2000&ndash;2019

Male breast cancer is rare but its incidence and mortality are increasing in the United States, with racial/ethnic disparities in survival reported. There is limited evidence for cardiotoxicity of cancer treatment among men with breast cancer. We evaluated the relation between breast cancer treatment and cardiovascular disease (CVD) mortality among men and investigated the salient roles that race/ethnicity play on this relation. Data were from 5216 men with breast cancer aged &ge; 40 years from the Surveillance, Epidemiology, and End Results program who were diagnosed from 2000 to 2019 and underwent surgery. Competing risk models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). During a median follow-up of 5.6 years, 1914 deaths occurred with 25% attributable to CVD. In multivariable-adjusted models, men who received chemotherapy had elevated risk for CVD (HR: 1.55, 95%CI: 1.18&ndash;2.04). This risk was higher among Hispanic men (HR: 3.96, 95%CI: 1.31&ndash;12.02) than non-Hispanic Black and non-Hispanic White men. There was no significant association between radiotherapy and CVD deaths. In this population-based study, treatment with chemotherapy was associated with elevated risk of CVD mortality in men with breast cancer. Racial/ethnic disparities in the association of chemotherapy and CVD mortality were observed

The Influence of Education and Apolipoprotein ε4 on Mortality in Community-Dwelling Elderly Men and Women

We investigated the risk of death in relation to the apolipoprotein ε4 allele and evaluated how it interacts with education in 504 elderly adults (mean age 73 years, 65.3% women) who were enrolled in 1993 into the New Mexico Aging Process Study. During 9 years of follow-up, apolipoprotein ε2 appeared to be associated with a lower risk for all-cause mortality (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.30–1.71) compared to apolipoprotein ε3 carriers in models adjusted for age, sociodemographic variables, medical conditions, adiposity, and lifestyle factors. The apolipoprotein ε4 allele conferred almost a threefold elevated risk of mortality (HR = 2.76, CI: 1.42–5.37). An interaction between education and apolipoprotein e4 (p=0.027) was observed with the HR of mortality among e4 carriers compared to noncarriers being 1.59 (0.64–3.96) for those with ≥college education; 6.66 (1.90–23.4) for those with some college or trade; and 14.1 (3.03–65.6) for participants with ≤high school education. No significant interaction was identified between apolipoprotein E genotype and cognitive function for mortality risk. These findings suggest that genetic (apolipoprotein ε4) and environmental (education) factors act interactively to influences survival in the elderly with higher education attenuating the adverse effect of apolipoprotein ε4 on mortality

A Prospective Population-Based Study of Cardiovascular Disease Mortality following Treatment for Breast Cancer among Men in the United States, 2000–2019

Male breast cancer is rare but its incidence and mortality are increasing in the United States, with racial/ethnic disparities in survival reported. There is limited evidence for cardiotoxicity of cancer treatment among men with breast cancer. We evaluated the relation between breast cancer treatment and cardiovascular disease (CVD) mortality among men and investigated the salient roles that race/ethnicity play on this relation. Data were from 5216 men with breast cancer aged ≥ 40 years from the Surveillance, Epidemiology, and End Results program who were diagnosed from 2000 to 2019 and underwent surgery. Competing risk models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). During a median follow-up of 5.6 years, 1914 deaths occurred with 25% attributable to CVD. In multivariable-adjusted models, men who received chemotherapy had elevated risk for CVD (HR: 1.55, 95%CI: 1.18–2.04). This risk was higher among Hispanic men (HR: 3.96, 95%CI: 1.31–12.02) than non-Hispanic Black and non-Hispanic White men. There was no significant association between radiotherapy and CVD deaths. In this population-based study, treatment with chemotherapy was associated with elevated risk of CVD mortality in men with breast cancer. Racial/ethnic disparities in the association of chemotherapy and CVD mortality were observed

Lack of association of plasma factor XI with incident stroke and coronary heart disease: The Atherosclerosis Risk in Communities (ARIC) Study

Background and aimsAn elevated plasma concentration of intrinsic coagulation factor XI is a risk factor for venous thromboembolism, but its role in the etiology of atherothrombotic outcomes is uncertain. We examined the association of factor XI with incident stroke and coronary heart disease in the prospective Atherosclerosis Risk in Communities (ARIC) Study.MethodsWe measured factor XI on plasma samples collected in 1993-1995 from middle-aged adults (n = 11,439), who were followed through 2012 for incident cardiovascular events.ResultsOver a median of 18 years of follow-up (max = 20 years), 722 participants had incident stroke events (631 ischemic and 91 hemorrhagic) and 1776 had incident coronary events. Although there were weak positive associations between factor XI and total, ischemic, cardioembolic, and nonlacunar stroke, when adjusted for demographics, further adjustment for other stroke risk factors eliminated the associations. Similarly, there was no independent association of factor XI with incident coronary heart disease events.ConclusionA higher basal factor XI concentration in the general population was not a risk marker for stroke or coronary heart disease

A Culturally Sensitive and Theory-Based Intervention on Prevention and Management of Diabetes: A Cluster Randomized Control Trial

Type 2 diabetes is an emerging concern in Kenya. This clustered-randomized trial of peri-urban communities included a theory-based and culturally sensitive intervention to improve diabetes knowledge, health beliefs, dietary intake, physical activity, and weight status among Kenyan adults. Those in the intervention group (IG) received a culturally sensitive diabetes education intervention which applied the Health Belief Model in changing knowledge, health beliefs and behavior. Participants attended daily education sessions for 5 days, each lasting 3 h and received mobile phone messages for an additional 4 weeks. The control group (CG) received standard education on COVID-19. Data was collected at baseline, post-intervention (1 week), and follow-up assessment (5 weeks). Linear mixed effect analysis was performed to assess within and across group differences. Compared to the control, IG significantly increased diabetes knowledge (p p = 0.05), perceived benefits (p = 0.04) and self-efficacy (p = 0.02). IG decreased consumption of oils (p = 0.03), refined grains (p = 0.01), and increased intake of fruits (p = 0.01). Perceived barriers, physical activity, and weight status were not significantly different between both groups. The findings demonstrate the potential of diabetes education in improving diabetes knowledge, health beliefs, and in changing dietary intake of among adults in Kenya