Previous analyses from the Women's Health Initiative Memory Study (WHIMS)
showed that conjugated equine estrogen (CEE) and medroxyprogesterone vs placebo
increased risk of dementia but not mild cognitive impairment or changes in
global cognition in women aged 65 to 70 years. Whether estrogen therapy alone
protects women from cognitive decline is unknown. This issue of JAMA reports
results from the CEE-alone arm of the WHIMS. In one article, Shumaker and
colleaguesArticle report that women taking CEE had similar
risks of dementia and mild cognitive impairment as women taking placebo. When
data from the CEE-alone and the CEE-plus-progestin arms were combined, a significant
increase in the risk for a combined outcome of dementia and mild cognitive
impairment was found. In a second article that describes results for global
cognitive function over a mean 5.4 years of follow-up, Espeland and
colleaguesArticle report that women taking CEE had greater decline in cognitive
function than women taking placebo. In an editorial,Article Schneider reviews the
evidence linking estrogen therapy to cognitive decline and suggests what might
be learned from long-term follow-up of the WHI participants.
Variations in the estrogen receptor α gene (ESR1) have been associated with an increased cardiovascular disease
(CVD) risk. Schuit and colleaguesArticle investigated whether
specific estrogen receptor gene polymorphisms are associated with myocardial
infarction (MI) and ischemic heart disease (IHD) in a population-based, prospective
cohort study in the Netherlands. They found that in women, presence of 1 ESR1
haplotype (−397 T allele
and −351 A allele) was associated with a 2-fold
increased risk of MI and IHD events, which was independent of known cardiovascular
risk factors, whereas no association was found in men. In an editorial, O'Donnell
and Newton-ChehArticle discuss criteria to assess the validity
and strength of genetic epidemiologic associations.
Prior studies have found that men who are lean and physically active
are at lower risk of erectile dysfunction (ED). Esposito and colleaguesArticle
sought to determine the effect of a program incorporating
intensive advice about weight reduction and increased physical activity on
erectile and endothelial function in obese men with ED. After 2 years, men
randomized to the intervention had lost significantly more weight, increased
their physical activity, experienced favorable changes in physiologic measures
of endothelial dysfunction, and had significant improvement in their ED score
compared with men in the control group. In an editorial, SaigalArticle
discusses the potential benefits of weight loss and exercise as a first-line treatment for ED.
In 1996 the US Preventive Services Task Force recommended that Papanicolaou
(Pap) smear screening for cervical cancer is not necessary for women who have
had a complete hysterectomy for benign disease. To investigate whether screening
practices have changed in response to the recommendation, Sirovich and Welch
reviewed national data on Pap smears for 1992-2002 and found no change in
the estimated 50% of women with a hysterectomy who continued to have Pap smears.
"Only from a place of such hopelessness and suffering can I fully cherish
the sunlight, hear the music of the wind, and know the sacredness of birds
singing at sunrise." From "Normal Is a Place I Visit."
A clinical trial is under way to determine whether using gene chips
to generate gene-expression profiles of tumors can help guide therapy for
patients with breast cancer.
An emphasis on genetics to explain racial and ethnic disparities in
health status may reinforce racial stereotyping and contribute to, rather
than resolve, disparities.
Mr G is a 66-year-old man with decreased libido and erectile dysfunction
(ED). Morgentaler discusses the causes and pathophysiology of ED, patient
evaluation, and treatment options.
For your patients: Information about male sexual dysfunction.
This Week in JAMA. JAMA. 2004;291(24):2911. doi:10.1001/jama.291.24.2911