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Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane; however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite the recognition of historical events for 200 years starting with Chevreul naming “cholesterine”; later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor (r-LDL), as well as the emergence of different drugs such as fibrates, statins and cetrapibs during this decade promising to increase HDL, and the most recent, ezetimibe and anti-PCSK9 to inhibit the degradation of r-LDL, morbidity has not been reduced in cardiovascular disease. To date, the controversy continues regarding the best and appropriate medical therapy for hypercholesterolemia; likewise, there is the recommendation of a healthy dietary content regarding the amount of sugar as well as the type of fats, either saturated or polyunsaturated. Together, control of circulating cholesterol, amelioration of hypertension, regulation of diabetes, and dietary recommendations might prevent atherosclerosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of low-dose conjugated equine estrogens (E) on circulating neurotransmitters and the efficacy for the treatment of psychological symptoms.Design: Controlled comparative clinical study.Setting: Endocrine Research Unit, Instituto Mexicano del Seguro Social, Mexico.Patient(s): Thirty postmenopausal women received conjugated equine E. Ten women acted as a comparison group.Intervention(s): Conjugated equine E, 0.312 mg/day, for 21 days per cycle during six cycles and added chlormadinone acetate, 2 mg/day, for the last 5 days of each cycle. Green scale for climateric women and Blatt-Kupperman Menopausal Index were used for measuring psychological well-being.Main Outcome Measure(s): Serum levels of dopamine (DA), noradrenaline, serotonin, and β-endorphin were quantified by specific assays at baseline and at the end of treatment.Result(s): Low baseline levels of DA, serotonin, and β-endorphin increased significantly (P<.001) from 181.9 ± 47.8 pg/mL to 202.9 ± 32.8 pg/mL (mean ± SD); from 206.4 ± 94.2 ng/mL to 279.2 ± 67.9 ng/mL; from 11.2 ± 1.8 pmol/L to 13.8 ± 2.4 pmol/L, respectively, after conjugated equine E. In parallel, augmented baseline noradrenaline levels diminished significantly (P<.05) from 30.2 ± 4.7 ng/mL to 24.0 ± 4.7 ng/mL. All neurotransmitter levels had a significant correlation with 17β-E2 concentrations at the end of the study. Alleviation of psychological symptoms was observed in all but eight treated women.Conclusion(s): Low-dose conjugated equine E associated with periodic administration of chlormadinone acetate elicited favorable changes in neurotransmitters and relieved psychological symptoms. [Copyright &y& Elsevier]

Preterm preeclampsia (PE) remains a leading cause of maternal death and perinatal morbidity. The pathophysiological process that underlies PE has been proposed to occur in two episodes, the first is a reduced placental perfusion and then the maternal clinical syndrome. Placental ischemia/hypoxia is believed to result in the release of a variety of placental factors such as cytokines including TNF-α and interleukin 6, activated circulating immune cells and autoantibodies that have profound effects on blood flow and arterial pressure regulation. PE is also associated with decreased formation of vasodilators such as nitric oxide and prostacyclin. It is accompanied by widespread maternal vascular dysfunction and a chronic inflammatory response. Additionally, anti-angiogenic peptides are released, inhibiting vascular remodeling essential for increased blood flow to the growing uteroplacental unit. Although these factors accompany the clinical syndrome of PE, it is suggested that they are secondary to the maternal decrease in placental blood flow. Experimental evidence has demonstrated the importance of these soluble factors to increase blood pressure and stimulate the production of such anti-angiogenic factors, thereby eliciting a vicious cycle existing within the maternal vasculature as well as within the placental unit. These alterations in vascular function not only lead to hypertension but to multi-organ dysfunction. The quantitative importance of the various endothelial and humoral factors that mediate vascular dysfunction and hypertension during PE remains to be elucidated. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of transdermal estradiol therapy (ET) on coagulation and fibrinolysis markers in postmenopausal women. Methods: Prospective open trial study in 59 healthy hysterectomized postmenopausal women. Thirty women received transdermal ET (50 μg per day) during 3 months and 29 women formed the untreated arm. Results: Baseline factor VII-tissue factor complex (VIIa-rTF), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) levels decreased significantly (P<0.01) after therapy. In contrast, tissue-type plasminogen activator antigen (t-PA) levels increased significantly (P<0.01). After ET, there was no difference in protein C activity (PC), protein S activity (PS), plasminogen (PLG), and antithrombin III (ATIII) levels. None of participants reported thromboembolic events. Conclusion: ET elicited a decrement in blood biomarkers implicated in coagulation activation which in turn seemed to improve fibrinolytic activity. These results suggest that transdermal route does not impair thrombotic risk. [Copyright &y& Elsevier]

Background and Aims Pregnancy-related hypertensive disorders are complications in which risk factors are identified such as nulliparity, age, malnutrition, obesity and social issues. Those statements are explained by theories of abnormal placentation, immunological inadequacy, genetics and oxidative stress, but all theories converge in endothelial damage, which is able to mechanically deform and hemolyze erythrocytes as they pass through the capillaries. Given the effects of endothelial damage, the aim of the study was to determine erythrocyte alterations in peripheral blood smear of patients with hypertensive disorders of pregnancy that could be used as prognostic condition. Methods We performed a prospective, descriptive and observational study where all patients with hypertensive disorders admitted to the obstetrics and gynecology service of a specialty hospital were recruited. Patients who provided signed informed consent underwent peripheral blood smear. Results were tabulated in percentage graphics and analyzed with Cramer's V based on χ 2 . The peripheral blood smear consisted of an extended drop of peripheral blood from the patient with subsequent hematological staining done with Romanowsky stain. Results A total of 119 samples were analyzed; 74% showed abnormal morphology of erythrocytes and the most frequent abnormality was the presence of schistocytes in up to 39% of samples. Descriptive analysis showed a degree of association to independent variables with Cramer's V = 0.41 value ( p <0.05). Conclusions A high percentage of patients with hypertensive disorders of pregnancy show some morphologic alterations of erythrocytes in peripheral blood smear. [ABSTRACT FROM AUTHOR]