Clinical Briefs-By Louis Kuritzky, MD
Clinical Briefs-By Louis Kuritzky, MD
HBP and Sexual Function in Women
Defining sexual dysfunction in women is a more difficult task than in men. Objectively measured end points of sexual dysfunction are not as readily assessable, nor is there a prominent objective background database on female sexual function and dysfunction with which to make comparison. Similarly, there is little information based upon controlled population-based studies of women examining the relationship between hypertension, its treatment, and sexual function.
The study population reported in this article includes a review of 3312 medical records from premenopausal heterosexual women. Of these, 224 women completed a self-administered questionnaire on sexuality and multiple telephone interviews, including determination of their blood pressure status and treatment methods if hypertensive.
Analysis of questions addressing quality of relationship, desire, physical pain, frequency of intercourse, and overall sexual satisfaction, did not demonstrate any significant difference between controls and hypertensives (treated or untreated). On the other hand, hypertensive women (treated or not) had lower scores in response to inquiry about ease of achieving orgasm, vaginal lubrication, and dyspareunia. Of additional note, smokers were also found to have lower scores for orgasm than nonsmokers.
ACE inhibitors, beta blockers, calcium channel blockers, and diuretics, both alone and in combination, were analyzed, without evidence of a detrimental effect upon sexual function. Duncan and associates suggest that sexual dysfunction be sought in hypertensive women, in order that it is appropriately managed; antihypertensive therapy in this population did not appear to worsen likelihood of sexual dysfunction.
Duncan LE, et al. Am J Hypertens 2000;13:640-647.
Statins and the Risk of Fractures
Statins are well-established treatment for lipid disorders, and enjoy significant use for reduction of major cardiovascular end points. Some data have suggested that statins have an effect upon bone mass in animals and may be bone-protective in the face of systemic steroid treatment. A recent trial in diabetic men demonstrated improved femoral bone density, yet whether this improved bone density will be reflected by reduction in fractures has never been shown. Meier and associates analyzed the population of the United Kingdom General Practice Research Databases (n ³ 3 million) to examine the relationship between lipid lowering agents (including statins, fibrates, etc.) and fracture risk.
The analysis addressed three separate groups. Group 1 (n = 28,340) included persons aged 50-89 who had been treated with lipid-lowering agents; group 2 (n = 13,271) included only hyperlipidemic patients who did not receive pharmacotherapy; and group 3 included only patients without a diagnosis of hyperlipidemia and without lipid-lowering agents (n = 50,000).
Fracture risk among hyperlipidemic patients not on therapy was similar to that of persons without hyperlipidemia. Current or past use of statins was associated with a significant 0.51-0.79 odds ratio of fracture. Fibrates and other lipid-lowering agents did not demonstrate any significant reduction in fracture risk. Benefits of statin use in reference to fractures appears to occur quickly, as even short exposure (1-4 months) was associated with reduced fracture risk in a variety of skeletal sites.
Meier et al conclude that their data suggest a favorable effect of statins in men and women older than 50 upon risk of fracture, though confirmatory controlled trials will be needed.
Meier CR, et al. JAMA 2000;283: 3205-3210.
Proteinuria as a Risk for CVD in the Elderly
The presence of albuminuria is a harbinger of end-stage renal disease, both in diabetic and nondiabetic patients. Additionally, albuminuria is associated with cardiovascular morbid and mortal end points, and all-cause mortality. It has been theorized that albuminuria is a surrogate indicator of such abnormalities as insulin resistance, hyperhomocysteinemia, and the coagulation aberrations, which result in adverse effects on cardiovascular complications.
Despite the compelling data in diabetics associating cardiovascular end points with albuminuria, information about the proteinuria in unselected persons older than age 68 has not been well described. To that end, Culleton and colleagues report men and women older than 68 (n = 2586) who are participants in the Framingham Heart Study.
At baseline, proteinuria was found in 17.4% of men, and 12.9% of women (proteinuria defined by ³ 1+ dipstick testing). Over 10.5 years of follow-up, persons with proteinuria demonstrated a significant increase in risk (1.3-1.4 hazard ratio) of cardiovascular mortality as well as all-cause mortality, when compared to those without proteinuria. Culleton et al conclude that proteinuria is a significant risk factor in older adults for cardiovascular mortality and all-cause mortality in both genders.
Culleton BF, et al. Am J Med 2000; 109:1-8.
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