The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?
|
|
- Meagan Cummings
- 8 years ago
- Views:
Transcription
1 AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division of Preventive Medicine Brigham and Women's Hospital Principal Investigator, Boston site of the WHI Professor of Medicine and the Michael and Lee Bell Professor of Women s Health Harvard Medical School, Boston, Massachusetts Take Home Points : Menopausal hormone therapy (HT) continues to have an important clinical role in the management of menopausal symptoms. Current evidence does not support the use of HT for the prevention of cardiovascular disease or other chronic diseases. The best candidates for systemic HT tend to be recently menopausal and symptomatic women who are in generally good health, due to their low absolute risks of adverse events and greater potential for quality-of-life benefits. Risk stratification and a personalized approach to HT decision making is recommended. Summary and Tables: Menopausal hormone therapy (HT) has complex biological effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. Findings from the Women s Health Initiative (WHI), which led to a dramatic reduction in HT use, are summarized in Table 1 (overall study population) and stratified by by age group in Table 2. WHI and other randomized clinical trials have helped to clarify the benefits and risks of HT and provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong predictors of health outcomes and absolute risks on HT, especially for estrogen alone. In the Women s Health Initiative trial of conjugated equine estrogens (CEE) alone, younger women (50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index (P values for trend by age <0.05), but not for stroke and venous thrombosis. Age trends were less clear for CEE+MPA, due to increased risks of breast cancer, stroke, and venous thrombosis in all age groups. Absolute risks of adverse events were lower in younger than older women in both trials, however. Other predictors of lower risk from HT include favorable lipid status and absence of the metabolic syndrome (Table 3). Transdermal administration may be associated with lower risks of venous thrombosis and stroke, but additional research is needed. The use of risk stratification and personalized risk assessment offers promise for improved benefit:risk profile and safety of HT. 1
2 Table 1. Benefits and risks (absolute risks per 10,000 women per yr, rate differences, and relative risks) of postmenopausal hormone therapy on chronic disease outcomes in the overall study population of women aged 50 to 79 years in the Women s Health Initiative (WHI) estrogen-progestin and estrogen-alone trials a Outcome Estrogen-progestin trial (n=16,608) Estrogen-alone trial (n=10,739) Number of cases per 10,000 women per year Number of cases per 10,000 women per year E+P Placebo Difference b RR (95% CI) b ET Placebo Difference b RR (95% CI) b Benefits (not including vasomotor sx) Hip fracture ( ) ( ) Type 2 diabetes ( ) ( ) Risks Stroke ( ) ( ) Pulmonary embolism ( ) ( ) Deep vein thrombosis ( ) ( ) Breast cancer c ( ) ( ) Gallbladder disease ( ) ( ) Neutral or uncertain risks and benefits d Coronary heart disease e ( ) ( ) Myocardial infarction ( ) ( ) Ovarian cancer ( ) Not available Colorectal cancer ( ) ( ) Dementia (age 65) ( ) ( ) Total mortality ( ) ( ) Global index d,f ( ) ( ) a. The estrogen-progestin arm of the WHI assessed 5.6 years of conjugated equine estrogen (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) versus placebo. The estrogen-alone arm of the WHI assessed 7.1 years of conjugated equine estrogen (0.625 mg/d) versus placebo. b. RR, relative risk; CI, confidence interval. c. Divergent results for the two interventions. d. Also includes outcomes with divergent results for the two interventions. e. Coronary heart disease is defined as nonfatal myocardial infarction or coronary death. f. The global index is a composite outcome representing the first event for each participant from among the following: coronary heart disease, stroke, pulmonary embolism, breast cancer, colorectal cancer, endometrial cancer (estrogenprogestin trial only), hip fracture, and death. Because participants can experience more than one type of event, the global index cannot be derived by a simple summing of the component events. Source: Manson JE, Chlebowski RT, Stefanick ML, et al. JAMA 2013; 310(13):
3 Table 2. Effects of postmenopausal hormone therapy on cardiovascular outcomes in the Women s Health Initiative estrogen-progestin and estrogen-alone trials, according to age at study entry Intervention phase (5.6 years of randomized treatment) Outcome Estrogen-progestin Estrogen alone RR (95% CI) P RR (95% CI) P Coronary heart disease * y 1.34 ( ) ( ) y 1.01 ( ) 0.95 ( ) y 1.31 ( ) 1.09 ( ) Myocardial infarction y 1.32 ( ) ( ) y 1.05 ( ) 0.95 ( ) y 1.46 ( ) 1.24 ( ) Stroke y 1.51 ( ) ( ) y 1.45 ( ) 1.55 ( ) y 1.22 ( ) 1.29 ( ) Pulmonary embolism y 2.05 ( ) ( ) y 1.69 ( ) 1.72 ( ) y 2.54 ( ) 0.85 ( ) RR, relative risk; CI, confidence interval. *Coronary heart disease is defined as nonfatal myocardial infarction or coronary death. Source: Manson JE, Chlebowski RT, Stefanick ML, et al. JAMA 2013; 310(13):
4 Table 3. CHD risk in the Women s Health Initiative estrogen-progestin and estrogen-alone trials, according to baseline levels of selected markers Marker OR (95% CI) for HT treatment effect P for interaction LDL cholesterol (mg/dl) < ( ) ( ) LDL/HDL cholesterol ratio < ( ) ( ) C-reactive protein < ( ) ( ) Metabolic syndrome * No 0.97 ( ) 0.03 Yes 2.26 ( ) Waist circumference 88 cm 1.03 ( ) 0.12 >88 cm 1.93 ( ) OR, odds ratio; CI, confidence interval. * Metabolic syndrome was defined as having three or more of the following: waist size >88 cm (>80 cm for Asians and Native Americans); systolic blood pressure >130 mm/hg or diastolic blood pressure >85 mm Hg; fasting glucose >100 mg/dl; HDL cholesterol <50 mg/dl; triglycerides >150 mg/dl. Sources: Bray PF et al. Am J Cardiol 2008;101: , and Wild RA et al. Menopause 2013;20:
5 References/Suggested Readings Santen RJ, Allred DC, Ardoin SP, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab 2010;95:S1-S66. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA 2013;310: Rossouw JE, Prentice RL, Manson JE, et al. Effects of postmenopausal hormone therapy on cardiovascular disease by age and years since menopause. JAMA 2007;297: Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003;349: Hsia J, Langer RD, Manson JE, et al. Conjugated equine estrogens and the risk of coronary heart disease: the Women's Health Initiative. Arch Intern Med 2006;166: Manson JE, Bassuk SS. The menopause transition and postmenopausal hormone therapy. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jamison JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine: McGraw-Hill; Rossouw JE, Cushman M, Greenland P, et al. Inflammatory, lipid, thrombotic, and genetic markers of coronary heart disease risk in the Women's Health Initiative trials of hormone therapy. Arch Intern Med 2008;168: Wassertheil-Smoller S, Hendrix SL, Limacher M, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women's Health Initiative: a randomized trial. JAMA 2003;289: Bray PF, Larson JC, Lacroix AZ, Manson J, Limacher MC, Rossouw JE, Lasser NL, Lawson WE, Stefanick ML, Langer RD, Margolis KL. Usefulness of baseline lipids and C-reactive protein in women receiving menopausal hormone therapy as predictors of treatment-related coronary events. Am J Cardiol 2008;101: Wild RA, Wu C, Curb JD, Martin LW, Phillips L, Stefanick M, Trevisan M, Manson JE. Coronary heart disease events in the Women's Health Initiative hormone trials: effect modification by metabolic syndrome: a nested case-control study within the Women's Health Initiative randomized clinical trials. Menopause 2013;20: Manson JE. The role of personalized medicine in identifying appropriate candidates for menopausal estrogen therapy. Metabolism 2013;62 Suppl 1:S Rossouw J, Bray P, Liu J, Kooperberg C, Hsia J, Lewis C, Cushman M, Bonds D, Hendrix S, Papanicolaou G, Howard T, Herrington D. Estrogen receptor polymorphisms and the vascular effects of hormone therapy. Arterioscler Thromb Vasc Biol 2011;31:
The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention
The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health
More informationThe Women s Health Initiative where are we a decade later?
The Women s Health Initiative where are we a decade later? Henry G. Burger MIMR-PHI Institute & Jean Hailes for Women s Health, Melbourne, Australia Disclosures: Henry Burger Sources of Funding Pharmaceutical
More information(212) 733-2324 mackay.jimeson@pfizer.com
For immediate release: July 9, 2012 Media Contacts: MacKay Jimeson (212) 733-2324 mackay.jimeson@pfizer.com Pfizer Recognizes 10 th Anniversary Of The Women s Health Initiative: A Modern Day Perspective
More informationHormone therapy and breast cancer: conflicting evidence. Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group
Hormone therapy and breast cancer: conflicting evidence Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group The world of hormone therapy in the 1990 s Throughout the 1970s, 1980s and 1990s
More informationHow To Know The Risks And Benefits Of Estrogen Plus Progestin
ORIGINAL CONTRIBUTION JAMA-EXPRESS Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women Principal Results From the Women s Health Initiative Randomized Controlled Trial Writing
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationEndocrinology & Women s Health + Adult Immunizations Exotic Asia CME Cruise June 15 24, 2015. Menopause & Osteoporosis update 2015.
Menopause and Osteoporosis Update 2015 Post WHI-Update CCFP, MHSc, FRCP,FCFP,, NAMS Accredited Menopause Expert Associate Professor University of Toronto www.seacourses.com 1 Canadian Population Pyramid:
More informationRandomized trials versus observational studies
Randomized trials versus observational studies The case of postmenopausal hormone therapy and heart disease Miguel Hernán Harvard School of Public Health www.hsph.harvard.edu/causal Joint work with James
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationCase Study 11: Hormone Replacement Therapy
Case Study 11: Hormone Replacement Therapy October 2000 Scenario Ann McDonnald is a successful 55 year old business executive She starts her first consult with you by saying I m getting hot flushes It
More informationHôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires
Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Prof. J. Philippe Effect of estrogens on glucose metabolism : Fasting Glucose, HbA1c and C-Peptide
More informationADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
More informationBody Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ
Body Composition & Longevity Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ LONGEVITY Genetic 25% Environmental Lifestyle Stress 75% BMI >30 OBESE 25-30 OVERWEIGHT 18-25 NORMAL WEIGHT 18
More informationCardiovascular Disease in Diabetes
Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality
More informationFebruary 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS
February 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS Calvin Hirsch, MD Professor of Clinical Internal Medicine (Geriatrics) UC Davis School of
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationObesity and the Menopause. Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology
Obesity and the Menopause Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology Educational Objectives Review normal menopausal transition Review health risks of obesity
More informationHormone Replacement Therapy : The New Debate. Susan T. Hingle, M.D.
Hormone Replacement Therapy : The New Debate Susan T. Hingle, M.D. Background Hormone replacement therapy (HRT) is extensively used in the United States, especially for: *treatment of menopausal symptoms
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationCase studies of bias in real life epidemiologic studies. Bias File 1. The Rise and Fall of Hormone Replacement Therapy
Case studies of bias in real life epidemiologic studies Bias File 1. The Rise and Fall of Hormone Replacement Therapy Compiled by Madhukar Pai, MD, PhD Jay S Kaufman, PhD Department of Epidemiology, Biostatistics
More informationHealth risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study
DOI 10.1007/s00198-012-2224-2 ORIGINAL ARTICLE Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study R. L. Prentice & M. B. Pettinger
More informationABSTRACT. Home Current Issue All Issues Online First Specialties & Topics CME Multimedia Quizzes For Authors Subscribe
SIGN IN (Create a Free Personal Account) Journals > Specialties & Topics Store Physician Jobs About Mobile Search The JAMA Network Search JAMA Advanced Search Home Current Issue All Issues Online First
More informationMANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING
More informationDIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and
More informationA list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.
FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke
More informationPostmenopausal Hormone Replacement Therapy and Cardiovascular Disease
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ
More informationPROMISE & PITFALLS OF OUTCOMES RESEARCH USING EMR DATABASES. Richard L. Tannen, M.D., Mark Weiner, Dawei Xie
PROMISE & PITFALLS OF OUTCOMES RESEARCH USING EMR DATABASES Richard L. Tannen, M.D., Mark Weiner, Dawei Xie GOALS OF STUDY Determine Whether Studies Using EMR Database Yield Valid Outcome Assessment Major
More informationThe menopausal transition usually has three parts:
The menopausal transition usually has three parts: Perimenopause begins several years before a woman s last menstrual period, when the ovaries gradually produce less estrogen. In the last 1-2 years of
More informationThe Women s Health Initiative (WHI) Clinical Trial of Estrogen plus Progestin in Postmenopausal Women
The Women s Health Initiative (WHI) Clinical Trial of Estrogen plus Progestin in Postmenopausal Women Funded by the National Heart, Lung, and Blood Institute Bethesda, Maryland Conducted by 40 Clinical
More informationThe VITamin D and OmegA-3 TriaL (VITAL)
The VITamin D and OmegA-3 TriaL (VITAL) JoAnn E. Manson, MD, DrPH Principal Investigator, VITAL Brigham and Women's Hospital Professor of Medicine and the Michael and Lee Bell Professor of Women s Health
More informationPsoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
More informationHormone replacement therapy:
www.bpac.org.nz keyword: hrt Hormone replacement therapy: latest evidence and treatment recommendations Key advisor: Dr Helen Roberts, Senior Lecturer, Department of Obstetrics and Gynaecology, Faculty
More informationUse of Hormone Replacement Therapy in the Asymptomatic Postmenopausal Woman: What is the Current Evidence?
CPD Paper 5 605 Use of Hormone Replacement Therapy in the Asymptomatic Postmenopausal Woman: What is the Current Evidence? F H Loh,*FAMS, MRCOG (Lond), M Med (O & G) Abstract The publication of the Women
More informationFebruary 25, 2014. Dear Dr. Hamburg:
February 25, 2014 Margaret A. Hamburg, M.D. Commissioner Food and Drug Administration Department of Health and Human Services WO 2200 10903 New Hampshire Avenue Silver Spring, MD 20993-0002 Division of
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
More informationHormones and cardiovascular disease, what the Danish Nurse Cohort learned us
Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us Ellen Løkkegaard, Clinical Associate Professor, Ph.d. Dept. Obstetrics and Gynecology. Hillerød Hospital, University of Copenhagen
More informationNeal Rouzier responds to the JAMA article on Men and Testosterone
Neal Rouzier responds to the JAMA article on Men and Testosterone On the first day the JAMA article was released I received 500 emails from physicians and patients requesting my opinion of the article
More informationBarriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness
Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität
More informationMenopause Guidance on management and prescribing HRT for GPs based on NICE guidance 2015
PRIMARY CARE WOMEN S HEALTH FORUM GUIDELINES Menopause Guidance on management and prescribing HRT for GPs based on NICE guidance 2015 Written by Dr Imogen Shaw This guidance is designed to support you
More informationThe Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery
The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke
More informationPROVERA (medroxyprogesterone acetate) Product Monograph Page 34 of 38
PART III: CONSUMER INFORMATION PR PROVERA* (medroxyprogesterone acetate) This leaflet is part III of a three-part "Product Monograph" published when PROVERA was approved for sale in Canada and is designed
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationPostmenopausal hormone replacement therapy (HRT)
Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease Linda L. Humphrey, MD, MPH; Benjamin K.S. Chan, MS; and Harold C. Sox, MD Purpose: To evaluate the value
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationGetting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research?
Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Jody Dushay, MD MMSc Beth Israel Deaconess Medical Center Boston, MA Session 445 No disclosures Disclosure Jody Dushay,
More informationI. Background. II. Eligibility Geographic Scope: United States Only International(specify country/countries) Applicant Eligibility Criteria:
Pfizer Independent Grants for Learning & Change Request for Proposals (RFP) Enabling effective conversations regarding menopausal vasomotor symptoms and other conditions associated with menopause utilizing
More informationNew Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine
New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,
More informationMultiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden
Multiple comorbidities: additive and predictive of cardiovascular risk Peter M. Nilsson Lund University University Hospital Malmö, Sweden Clinical outcomes: major complications of CVD Heart Attack/ACS
More informationTechnology Assessment
Technology Assessment Lifestyle Interventions for Four Conditions: Type 2 Diabetes, Metabolic Syndrome, Breast Cancer, and Prostate Cancer Technology Assessment Program Prepared for: Agency for Healthcare
More informationFlorida Breast Health Specialists Breast Cancer Information and Facts
Definition Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer: Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to
More informationMY TYPE 2 DIABETES NUMBERS
BLOOD SUGAR MANAGEMENT GUIDE MY TYPE 2 DIABETES NUMBERS Understanding and Tracking the ABCs of Type 2 Diabetes 1 BLOOD MY TYPE SUGAR 2 DIABETES MANAGEMENT ABC NUMBERS GUIDE When you have type 2 diabetes,
More informationPOSTMENOPAUSAL ESTROGEN REPLACEMENT THERAPY
POSTMENOPAUSAL ESTROGEN REPLACEMENT THERAPY Dorie W. Schwertz, PhD (2/01) University of Illinois at Chicago Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT) Menopause - loss of
More informationInsulin Resistance and PCOS: A not uncommon reproductive disorder
Insulin Resistance and PCOS: A not uncommon reproductive disorder Joyce L. Ross, MSN, CRNP, CS, FNLA, FPCNA Diplomate Accrediation Council for Clinical Lipidology President Preventive Cardiovascular Nurses
More informationRandomized, double-blind, parallel-group, multicenter, doubledummy
ABOUT RECORD STUDIES FAST FACTS RECORD is a global program of four trials in more than 12,500 patients, comparing Xarelto (rivaroxaban) and enoxaparin in the prevention of venous thromboembolism (VTE)
More informationGuidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes
Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center
More informationAging Well - Part V. Hormone Modulation -- Growth Hormone and Testosterone
Aging Well - Part V Hormone Modulation -- Growth Hormone and Testosterone By: James L. Holly, MD (The Your Life Your Health article published in the December 4th Examiner was a first draft. It was sent
More informationCOMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP)
European Medicines Agency Pre-authorisation Evaluation of Medicines for Human Use London, 13 October 2005 Doc. Ref. EMEA/CHMP/021/97 Rev. 1 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE
More informationEffects of Cholesterol and Inflammation-Sensitive Plasma Proteins on Incidence of Myocardial Infarction and Stroke in Men
Effects of Cholesterol and Inflammation-Sensitive Plasma Proteins on Incidence of Myocardial Infarction and Stroke in Men G. Engström, MD, PhD; P. Lind, MD; B. Hedblad, MD, PhD; L. Stavenow, MD, PhD; L.
More informationBREAST CANCER RISK ASSESSMENT AND PRIMARY PREVENTION FOR HIGH RISK PATIENTS, RACHEL CATHERINE JANKOWITZ, MD 1
FOR HIGH RISK PATIENTS, RACHEL CATHERINE JANKOWITZ, MD 1 Hello, my name is Rachel Jankowitz, I m an assistant professor of medicine in the Division of Hematology Oncology at the University of Pittsburgh
More informationAppendix: Description of the DIETRON model
Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough
More informationClinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.
Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant
More informationKomorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group
Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal
More information25-hydroxyvitamin D: from bone and mineral to general health marker
DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate
More informationLong-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer
Linköping University Medical Dissertations No. 1430 Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer Johan Rosell Linköping University, Faculty of Health Sciences
More informationRed Alert for Women s Hearts Women and Cardiovascular Research in Europe
Red Alert for Women s Hearts Women and Cardiovascular Research in Europe November 2009 Red Alert on Women s Hearts Women and Cardiovascular Research in Europe November 2009 European Heart Health Strategy
More informationPromoting the Fountain of Youth: Low-T and Estrogen Deficiency
Promoting the Fountain of Youth: Low-T and Estrogen Deficiency Adriane Fugh-Berman MD Georgetown University Medical Center ajf29@georgetown.edu Hormone Therapy in Women Animal glandulars became popular
More informationWhat is an Evidence-Based, Value-Based Health Care System? (Part 1)
Evidence-Based Medicine What is an Evidence-Based, Value-Based Health Care System? (Part 1) By Sheri Strite and Michael E. Stuart, MD IN THIS ARTICLE The two biggest issues facing health care organizations
More informationTreatment of Metastatic Breast Cancer: Endocrine Therapies. Robert W. Carlson, M.D. Professor of Medicine Stanford University
Treatment of Metastatic Breast Cancer: Endocrine Therapies Robert W. Carlson, M.D. Professor of Medicine Stanford University MDACC Experience with FAC in Chemotherapy-Naive MBC Greenberg et al, J Clin
More informationABOUT XARELTO CLINICAL STUDIES
ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the
More informationGrand Rounds: Hysterectomy sans oophorectomy: The case for leaving a woman's ovaries alone
Grand Rounds: Hysterectomy sans oophorectomy: The case for leaving a woman's ovaries alone If there's no cancer present, why remove a woman's ovaries during hysterectomy? Does the reduced risk of ovarian
More informationBMC Med 7/19/2007; Simvastatin linked to reduced incidence of dementia, Parkinson s disease.
March 3, 2012 BD Response to FDA statement regarding Statins The Food and Drug Administration announced on Tuesday (February 28, 2012) the changes to the safety information on the labels of statins regarding
More informationDiabetes and Stroke. Understanding the connection between diabetes and the increased risk of stroke
Diabetes and Stroke Understanding the connection between diabetes and the increased risk of stroke Make the Connection Almost 26 million people in the U.S. roughly 8 percent of the population have diabetes.
More informationAbsolute cardiovascular disease risk assessment
Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk
More informationApixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial
Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,
More informationHormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions
Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions IMPORTANCE OF HORMONE BALANCE Importance of Hormone Balance Help you live a long, healthy life Help you
More informationCardiovascular Effects of Drugs to Treat Diabetes
Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:
More informationCohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationTestosterone, Growth Hormone and Bioidentical Hormones Prescription Issues
Testosterone, Growth Hormone and Bioidentical Hormones Prescription Issues T. Brooks Vaughan III, MD Department of Endocrinology UAB July 11, 2015 Brooks Vaughan, MD Associate Professor, Medicine, Pediatrics
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:
More informationSupplements, Vitamin D, Omega-3 Fatty Acids, and Co-Enzyme Q10: What Really Works?
Supplements, Vitamin D, Omega-3 Fatty Acids, and Co-Enzyme Q10: What Really Works? DAVID P. GOWMAN, D.O. S E C T I O N CHIEF, CARDIOLOGY P R O G R A M D I R E C T O R, CARDIOLOGY F E L L O W S H I P B
More informationBayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention
Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Long-term prevention of venous blood clots (VTE): Bayer Initiates Rivaroxaban
More informationKaren Kovach M.S, R.D Chief Scientific Officer Weight Watchers International Inc.
Waking up to real solutions to Chronic Disease: Tackling obesity can reduce the burden of chronic disease and deliver substantial cost savings to struggling European healthcare systems Karen Kovach M.S,
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More informationPDL Class: Topical Androgens
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Class Update: Topical Androgens Month/Year of Review:
More informationMenopause & Hormone Therapy
Menopause & Hormone Therapy The Verdict! In 2012 there were two important medical articles that brought clarity to a decade of fear and confusion regarding the risks and benefits of hormone therapy in
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationAndrogens and CVD. Brandon Orr- Walker April 2014
Androgens and CVD Brandon Orr- Walker April 2014 Agenda What is normal physiology of Aging? Hypogonadism and disease If some is good is more becer? CVD safety Clinical features of Androgen Deficiency
More informationObesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000
P F I Z E R F A C T S Obesity in the United States Workforce Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 p p Obesity in The United States Workforce One
More information4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH
METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?
More informationDo You Know the Health Risks of Being Overweight?
Do You Know the Health Risks of Being Overweight? U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH WIN Weight-control Information Network What are the risks to my health from
More informationMortality Assessment Technology: A New Tool for Life Insurance Underwriting
Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Guizhou Hu, MD, PhD BioSignia, Inc, Durham, North Carolina Abstract The ability to more accurately predict chronic disease morbidity
More informationDietary Composition for Weight Loss and Weight Loss Maintenance
Dietary Composition for Weight Loss and Weight Loss Maintenance Bridget M. Hron, MD Instructor in Pediatrics, Harvard Medical School Staff Physician in Gastroenterology & Nutrition and New Balance Foundation
More informationImproving cardiometabolic health in Major Mental Illness
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
More informationAlbumin and All-Cause Mortality Risk in Insurance Applicants
Copyright E 2010 Journal of Insurance Medicine J Insur Med 2010;42:11 17 MORTALITY Albumin and All-Cause Mortality Risk in Insurance Applicants Michael Fulks, MD; Robert L. Stout, PhD; Vera F. Dolan, MSPH
More informationWith Big Data Comes Big Responsibility
With Big Data Comes Big Responsibility Using health care data to emulate randomized trials when randomized trials are not available Miguel A. Hernán Departments of Epidemiology and Biostatistics Harvard
More informationPrognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
More informationCoronary Heart Disease (CHD) Brief
Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs
More informationDiabetes Complications
Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation
More informationPreventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64
Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral
More informationAfrican Americans & Cardiovascular Diseases
Statistical Fact Sheet 2013 Update African Americans & Cardiovascular Diseases Cardiovascular Disease (CVD) (ICD/10 codes I00-I99, Q20-Q28) (ICD/9 codes 390-459, 745-747) Among non-hispanic blacks age
More information