Tuesday, July 29, 2008

Oral Contraceptives increase risk of arterial plaques?

This study has recently got a bit of play on Christian sites so I infer that it must by now have reached journal publication -- but where I do not know. Anyway, the results are fairly anomalous. Even other epidemiological studies have not found the same and an experimental study in fact found the opposite. Just part of the rich natural diversity that so excites epidemiologists

A team of Belgian researchers has made the surprise discovery that women who have used oral contraceptives (OCs) for some time appear to be at increased risk of atherosclerosis in the carotid and femoral arteries. They also found that those taking the pill had three times higher C-reactive protein (CRP) levels than those not using it.

Dr Ernest Rietzschel (Ghent University, Belgium) reported the findings at the American Heart Association (AHA) 2007 Scientific Sessions last week. He told heartwire: "This is the first time that this has been documented. It was an accidental finding. We were stunned by the large elevations in CRP that you see in women taking the pill, so we then performed a safety analysis to see whether there was a link between past pill use and atherosclerosis measured by echo in both the carotid and femoral arteries. Our null hypothesis was that we would see no effect, but in hindsight that was probably naive."

He stressed, however, that this research should not mean that women should cease using oral contraceptives: "I'm certainly not advocating stopping use of the pill," he noted. First, the findings need to be replicated, "that's really important," he said, "and then we need more research. It's staggering that for a drug that is being used by 80% of women, there is so little information about the long-term safety. That's really incredible."

Asked to comment on the study for heartwire, Dr Sharonne N Hayes (Women's Heart Clinic, Mayo Clinic, Rochester, MN) said: "This study is important and provocative, because it raises new questions about the long-term safety of a widely used class of drugs. However, it is premature to change practice or our advice to patients for a number of reasons." These include the fact that no other studies reported so far have shown any long-term increase in cardiovascular risk with OCs, she says.

Rietzschel and colleagues started out by assessing novel risk factors for atherosclerosis in women participating in the Asklepios study, a blinded sample of men and women volunteers aged 35 to 55 years in the Belgian population who were free from overt cardiovascular disease. Rietzschel said that there has been one prior report of increased CRP in OC users, from the Cardiovascular Risk in Young Finns study.

Of 1301 women (mean age 45.7 years) in Asklepios, 27.4% were taking OCs and 10.0% were taking hormone replacement therapy (HRT). Past OC use was much higher, however, with 81% of women having taken it for at least one year, with a median exposure of 13 years. After multivariate adjustment, women who were not taking OCs or HRT had high-sensitivity CRP of 1.0 mg/L compared with 1.2 for those currently taking HRT and 3.3 for women currently taking OCs. Effects on other inflammatory markers, such as interleukin-6, were far less pronounced, the researchers note.

"Contraceptive therapy is a major cause of CRP rise. The magnitude of CRP rise (threefold) far exceeds other population-prevalent noninfectious stimuli and is much larger than the CRP rise for HRT. Future research should take into account this effect when reporting CRP data in women, aim to qualify its biological significance, and assess the potential of CRP as a tool to select those women at high thrombotic risk under hormonal therapy," Rietzschel et al say.

This finding spurred Rietzschel and his team to look at past OC use, "something we might not have considered a plausible candidate for atherosclerosis," he explained to heartwire. After multivariate adjustment, they found the odds ratios (OR) per 10 years of OC exposure were 1.17 for carotid plaque and 1.28 for femoral plaque. They also looked at prevalence of bilateral disease as a more stringent phenotype of atherosclerosis and found ORs per 10 years of OC exposure of 1.42 for carotid plaque and 1.34 for femoral plaque.

"Use of contraceptive therapy is very common and is associated with an unexpected increase in the prevalence of carotid and femoral atherosclerosis in otherwise young, apparently healthy women. Our data suggest a 20% to 30% increased prevalence of plaque in the carotid and femoral arteries per 10 years of OC exposure. In the light of widespread and usually prolonged OC use, these results suggest OC use could be an important factor in the global atherosclerotic burden," the scientists observe.

Hayes points out, however, "All other studies on long-term OC safety, while mostly observational, have shown no increase in cardiovascular events years after stopping OCs, and these analyses have been done in very large cohorts. The cross-sectional findings of the current study need to be replicated in other populations and by other investigators to confirm the higher level of plaque observed in past OC users. And the higher plaque level must somehow be translated into higher events if it is to be clinically relevant."

Plus, she notes: "This study may not even be relevant to women currently making decisions about contraception. The OC formulations used by the women in the study early on were very different from those prescribed today (higher doses, different estrogens and progestins, different modes of delivery), so these findings, even if confirmed, may not apply to today's lower-dose pills."

In addition, she argues that pregnancy itself has many cardiovascular risks, and OCs are highly effective for the prevention of pregnancy. "Any risk/benefit analysis of OCs must be weighed against the outcomes of those who become pregnant because they do not use the therapy. The authors do not report that they compared or controlled for numbers of pregnancies when comparing OC users and nonusers. Might the risk be due not to OCs, but to fewer pregnancies? This would be interesting to explore."

While Rietzschel stresses that women should not stop taking the pill on the basis of this research, he says, "Perhaps women should be wary of taking the pill for longer than they need to. At a certain point, don't prolong it out of habit."

Women seeking oral contraception also present a unique opportunity for doctors to give advice on the prevention of cardiovascular disease at an early age, he notes. "Young women have an idea that they won't succumb to cardiovascular disease, which is entirely wrong, because more women die of cardiovascular disease than men. Maybe this is a good time to start talking with young women. Okay, you want to take the pill, but think about the long-term implications. You should stop smoking, check your weight, and be more physically active. Also, we know the pill has effects on blood pressure and lipid profiles, so these should be checked."

The pharmaceutical industry must also contribute, Rietzschel says: "We would like to ask them to develop safer pills." He says he has been approached by some OC manufacturers following his presentation last week but declined to say which ones.

At this time, it is also impossible to say whether any specific type of pill is more hazardous than any other, he noted. "We know that estrogen has a beneficial effect on lipid profiles and it is probably the progestin component of the pill that has adverse effects on lipids, but with regard to the blood-pressure rises seen, it's not clear what raises BP."

Hayes stressed to heartwire that effective alternatives to OCs are needed. "Until then, we need to have women consider all options for birth control and their associated risks (including the emotional, financial, and health risks of unintended pregnancy) and press for better research on this widely used drug class."


Study Finds Lesbians 50 Times More Likely to Self-Harm than General Population

Hard to know what the causal chain is here but it shows that Lesbians are not the paragons of mental health that feminist theory says they are. I found something similar long ago

The habit of "self-harming" is 50 times more likely to occur in lesbians than in the general population of women, a Scottish study has shown. 20 per cent of lesbian and bisexual women, of a total of 500 women surveyed in Scotland had deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population.

The study, Prescription for Change, was conducted by the homosexual lobby organisation Stonewall. It also showed that five per cent of lesbian and bisexual women have attempted suicide in the last year.

Homosexual activists commonly interpret such statistics as support for the doctrine that it is the lack of "acceptance" from the non-homosexual world that causes the problems. Calum Irving, director of Stonewall Scotland, said, "For lesbian and bisexual women the experiences of prejudice, misunderstanding and at times hostility can damage long-term health and wellbeing."

But other research has shown that approaching homosexuality as a serious mental disorder also explains the severe depression, elevated levels of drug and alcohol abuse and self-destructive behaviour that are common among homosexuals.

Even though homosexuality was removed as a disorder from diagnostic manuals in the early 1970s, many in the psychiatric community maintain that homosexuality causes misery and that homosexual activity is a dangerous and emotionally degrading experience.

Dr. Rick Fitzgibbons, a principal contributor to the Catholic Medical Association's statement on "Homosexuality and Hope", told Zenit Catholic news agency that the mental disorder of homosexuality was removed from the diagnostic manuals in 1973 because of political pressure.

The other common assertion of the homosexual political lobby, that Christians hate and fear homosexuals, was refuted last month when a priest of the Russian Orthodox Church expressed his sorrow over their chronic unhappiness. Father Vsevolod Chaplin, said in an interview with newspaper Komsomolskaya Pravda, "Such people are deeply unhappy".

"I know it from confessions and numerous life stories. It's not by chance that they die earlier and there are more suicides, drug addicts and alcoholics among them," he said. "The Church lovingly accepts everyone, including those who have passion for people of the same sex. But just because she loves them, she says unisexual love is a sin. A destructive sin," said Fr. Chaplin.

The Catholic Church holds that homosexuality, and any sexual activity outside of marriage, has natural consequences, regardless of religious belief. This Natural Law teaching is said to be based on reason and observation of the consequences of human behaviour.


1 comment:

Anonymous said...

If societal pressure is the sole reason for pathological behavior amongst homosexuals, wouldn't countries that are more accepting, such as Denmark or Norway have less of this behavior?

Question: What pathologies are seen in homosexuality?

Answer: Besides the family backgrounds, you also see more suicide and depression. Even in cultures where there is little social sanction against homosexuality, such pathology does not disappear