Physical activity and body mass index (BMI) independently alter the risk of coronary heart disease (CHD); however, their combined effect on CHD is not established. Weinstein et al prospectively studied the combined association of physical activity and BMI on incident CHD in a cohort of 38 987 healthy women in the Women's Health Study. The risk of CHD associated with elevated BMI was considerably reduced by increasing physical activity levels. Increasing levels of walking also resulted in significant reductions in CHD risk for overweight and obese individuals. However, the risk was not completely eliminated by physical activity, reinforcing the importance of being lean and physically active.
In a prospective, observational analysis in the Nurses' Health Study, Grodstein et al found a significantly increased risk of stroke for women currently receiving hormone therapy (HT). This increased risk was observed for women initiating HT at young ages or near menopause and at older ages or more than 10 years after menopause. Short-term HT initiated at younger ages was not associated with a clear increase in stroke; however, this was based on a small number of cases. There was a strong trend of decreasing risk of stroke with decreasing dose of oral conjugated estrogen. Overall, HT increases the risk of stroke, and this elevation does not appear related to timing of initiation. In younger women with lower stroke risk, the attributable risk of stroke due to hormone use is modest and might be minimized by lower doses and shorter treatment duration.
In a population-based cohort study of more than 25 000 individuals, Åsvold et al studied the association of thyrotropin levels with fatal coronary heart disease (CHD). Thyrotropin level within the reference range (0.50-3.5 mIU/L) was positively and linearly associated with CHD mortality (P value for trend, .01); the trend was statistically significant in women but not in men. The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal CHD.
Huang et al analyzed self-reported data from 3167 older postmenopausal women to gain insight into why hot flushes persist for some women but not others. In this cohort of women who were predominantly 5 or more years postmenopausal, 12% reported hot flushes that were bothersome or interfered with their lives. Women were more likely to report hot flushes if they had fewer years of education, were more recently menopausal, had previously used estrogen, had previously undergone hysterectomy, or had other symptoms of menopause. Hot flushes were also associated with higher body mass index, higher follicle-stimulating hormone levels, and lower high-density lipoprotein cholesterol levels but not estradiol levels. Nearly half of women with bothersome hot flushes at baseline continued to have symptoms 3 years later, suggesting that for a substantial minority of women, hot flushes are a persistent source of discomfort well into the late postmenopausal years.
Antihypertensive drugs that block the renin-angiotensin system (RAS) and a low blood pressure (BP) goal are recommended in patients with chronic kidney disease (CKD). In the African American Study of Kidney Disease and Hypertension, Appel et al assessed the long-term effects of these therapies in 1094 African Americans with hypertensive CKD. Over the course of follow-up, 569 participants experienced the primary outcome (doubling of serum creatinine level, end-stage renal disease, or death). The 10-year cumulative incidence rate was 54%. Of the 569 participants with at least 7 years of follow-up, just 34% experienced a slow decline in kidney function. Despite the benefits of RAS-blocking therapy on CKD progression, most African Americans with hypertensive CKD who are treated with currently recommended BP therapy continue to progress over the long term.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2008;168(8):790. doi:10.1001/archinte.168.8.790