Posts tagged with "Brigham and Women’s Hospital"

No sweat? Prolonged use of hormones linked to slightly higher risk of Alzheimer’s disease

March 12, 2019

Hot flashes, mood swings, sleep problems. Many women trade these uncomfortable, annoying—even embarrassing—symptoms of menopause in for a prescription for oral hormone therapy, and never look back.

But now there’s a reason to reevaluate. Researchers reported on March 6 that long-term use of oral hormone therapy may be associated with a small increased risk of Alzheimer’s disease in postmenopausal women.

The study, conducted by researchers affiliated with six Finnish healthcare organizations, looked at nearly 85,000 postmenopausal women, between the ages of 70 and 80, diagnosed with Alzheimer’s disease between 1999 and 2013.

They found that use of oral hormone therapy for ten or more years in women who started the pills before age 60 had a 9% to 17% increased risk for Alzheimer’s disease. Women who used vaginal hormone therapy showed no increased risk.

Interestingly enough, prior research had indicated that hormone therapy reduces the risk of vascular dementia; but the new study found no such good news related to Alzheimer’s.

“It prompted us to do research on Alzheimer’s disease to see if the same results persisted, but it doesn’t look like hormonal therapy provided a protective effect on Alzheimer’s,” lead author Dr. Tomi Mikkola, supervisor for the obstetrics and gynecology doctoral program in clinical research at the University of Helsinki, told NBC News during a recent interview.

The specific reasons behind this increased risk are elusive, but biological differences between Alzheimer’s and vascular dementia may be one reason why, Mikkola said.

“Alzheimer’s is a completely different type of disease, we don’t know the mechanism behind the disease. What we know is that the disease has started decades before we see symptoms of memory loss,” said Mikkola.

It is possible that the hormone therapy speeds up progression of the disease, he added.

Alzheimer’s disease is the sixth-leading cause of death in the United States. And of the nearly 6 million Americans who have been diagnosed with Alzheimer’s; fully  two-thirds (66%) are women—including 200,000 under the age of 65. By 2050, experts predict that this number will rise to nearly 14 million, according to the Alzheimer’s Association.

“Given the lack of effective Alzheimer’s treatments and increased prevalence of the disease, medical and public health efforts have focused on primary prevention, including risk factors and preventive strategies, especially to women,” said Dr. JoAnn E. Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston, in an editorial written in response to the study.

“But the findings should not be a cause for alarm. For the short-term management of hot flashes, night sweats and disruptive sleep, the benefits of hormone therapy seem to outweigh the risk.”

In recent years, considerable attention has been given to the role of menopausal hormone therapy. Two 2017 studies found that the period when a woman starts to produce less estrogen, usually in her 40s, may be a critical point in whether she’ll go on to develop Alzheimer’s or not. Researchers concluded that the hormone estrogen is protective for a woman’s brain, stimulating growth and keeping it healthy. But the natural drop in estrogen during menopause means women lose that layer of protection, NBC News reported..

Both Mikkola and Manson agree that most women under 60 are safe to use short courses of hormone therapy for menopause symptoms.

 “Women should not use hormone therapy for the expressed purpose of trying to improve memory or reduce cognitive decline, but when used for early menopause the benefits are sure to outweigh the risk for short term treatment,” said Manson.

Because the study was observational, it isn’t definite that long-term hormone therapy causes Alzheimer’s disease. Other risk factors, including cardiovascular disease, diabetes, or having the APOE gene weren’t included in the study — these may have also contributed to many of the women’s increased dementia risk.

“Women should not be scared to use hormone therapy if needed,” Mikkola told NBC News. “Women who use hormone therapy for symptom relief have a much better quality of life.”

Research contact: @NBCNews

Harvard Med creates more diverse image by taking down 31 portraits

June 20, 2018

Harvard Medical School is doing a different kind of “scrubbing up” these days, according to a June 15 report by Campus Reform. The school is “cleaning up” its professional and public image—and promoting diversity—by removing 31 portraits of former department heads from a lecture-room wall where they have been hanging for decades. The reason? All of the paintings are of men. And 30 out of 31 of those men are white, while one is Asian.

That made for an uncomfortable contrast, as the Boston Globe noted in its own story on June 14, because the employees and students who regularly gather there include women, blacks, and Hispanics.

“School officials confirmed … that the portraits of 31 medical school deans—which formerly hung in the school’s Louis Bornstein Family Amphitheater [at Brigham and Women’s Hospital]— have been ‘dispersed’ to various lobbies and conference rooms,” Campus Reform disclosed.

The move may have been prompted by a recent call to action by WhiteCoats4BlackLives,a national activist group that aims to eliminate racial bias in the practice of medicine. The group recently targeted Harvard Medical School for allegedly promoting racial bias, the Globe also reported—claiming that there were a “dearth of plaques, statues, portraits, and building names on campuses that acknowledge contributions from physicians of color.”

Indeed, the group published a Racial Justice Report Card this year that found that only 10.7% of medical school graduates in 2016 were Black, Latinx, or Native American.  This represents a major issue because medical schools are the gatekeepers to the health professions

What’s more, the group says, patients of color often are unable to access care at academic medical centers in their communities. For example, black patients in New York City are less than half as likely as white patients to receive care at academic medical centers.

The Racial Justice Report Card, compiled for the first time this year, grades ten major medical schools on 15 anti-racism factors—and provides an overall grade for each institution, as follows: Harvard: B; Johns Hopkins: C+; Mt. Sinai: B-; University of Pennsylvania: C; Thomas Jefferson University: C; UC-San Francisco: B-; University of Michigan: B-; University of Pittsburgh: B-; Washington University in St. Louis: B-; and Yale: C. Not one of them came in with a B+ or an A.

The hospital’s president, Dr. Betsy Nabel, told the Globe that she had considered ending the tradition of hanging pictures of retired chairs in the auditorium for several years, especially as more women and minorities train as doctors at the hospital. “I have watched the faces of individuals as they have come into Bornstein,’’ Nabel said in an interview. “I have watched them look at the walls. I read on their faces ‘Interesting. but I am not represented here.’ That got me thinking maybe it’s time that we think about respecting our past in a different way.’’

Research contact: national@whitecoats4blacklives.org