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Larger and more severe strokes seen with aspirin resistance
Patients with acute ischemic stroke who test positive for aspirin resistance had both larger stroke volume and increased severity, compared with patients without resistance, in an observational study of 311 patients at Korean centers.
Given that previous studies have shown that the use of aspirin is associated with lower stroke severity and decreased infarction growth, the current study’s findings may help to define the effect of aspirin resistance (AR) on stroke severity, since previous studies had provided inconclusive results, Dr. Mi Sun Oh and colleagues at Hallym University Sacred Heart Hospital, Anyang, South Korea, wrote in their abstract. The findings were released Feb. 23 in advance of the annual meeting in April of the American Academy of Neurology.
The investigators enrolled patients with acute ischemic stroke confirmed by diffusion-weighted imaging (DWI) who had received at least 7 days of aspirin therapy before initial stroke symptoms and had been checked for AR within 24 hours of hospital admission. Patients with high prestroke disability scores (modified Rankin Scale score > 2) were excluded, as were those who were taking another antiplatelet or anticoagulant medication concurrently with aspirin on hospital admission.
The abstract did not report detailed patient characteristics or information about type or dose of aspirin; the full results of the study will be presented at the meeting in Washington.
Enrollees were deemed aspirin resistant if a rapid assay detected greater than 550 Aspirin Reaction Units. DWI-observed stroke volume was assessed via a semiautomated threshold technique, and investigators employed the National Institutes of Health Stroke Scale (NIHSS) score to measure initial stroke severity.
Seventy-eight of the 311 patients (25.1%) had AR. Dr. Oh and colleagues reported that median stroke volume was higher for these patients, compared with the aspirin-sensitive group (2.8 cc vs. 1.6 cc), as was least-square mean on multivariate analysis (1.6 cc [95% CI, 1.1-2.1] vs. 1.1 cc [95% CI, 0.7-1.4], P = .036). Median NIHSS scores were also higher for the AR group (4 vs. 3), indicating greater stroke severity, a result that was confirmed by multivariate analysis.
Aspirin resistance is a complicated and heterogeneous concept, and not a well defined entity, according to vascular neurologist Dr. Philip Gorelick, head of the Hauenstein Neuroscience Center at St. Mary’s Health Care in Grand Rapids, Mich. Dr. Gorelick is an honorary member of the Korean Stroke Society but was not involved in the present study. In an interview, he expanded on the diverse mechanisms that can impede the stroke prevention effect of antiplatelet agents such as aspirin (Stroke Res. Treat. 2013;Article ID 727842 [doi:10.1155/2013/727842]).
In contrast to the traditional notion of “resistance” as an inherent or acquired defense or chemical blockage of a drug, whether by a microbe or the host, aspirin resistance may be either a laboratory-defined lack of inhibition of thromboxane A2, or a clinically-defined entity. In either case, a host of factors may contribute, Dr. Gorelick said. Poor adherence to an aspirin therapy regimen may be a primary contributor to AR. Further, enterically coated aspirin may not be as well absorbed in the gut, leading to lower effective aspirin dosing. A host of other factors, including concurrent medication administration, comorbidities impacting platelet turnover, and genetic polymorphisms may also contribute to aspirin failure.
Although patient characteristics were not reported in this study, Dr. Gorelick did issue a general note of caution: “Another major issue in these types of studies,” he noted, is to determine if “patients are similar in terms of background factors. Patients on aspirin therapy may be more likely to have more severe preexisting vascular disease,” predisposing them to more severe stroke.
The Korea Healthcare Technology R&D Project, Ministry of Health and Family Welfare, and the Republic of Korea supported the study. The authors had no disclosures.
Patients with acute ischemic stroke who test positive for aspirin resistance had both larger stroke volume and increased severity, compared with patients without resistance, in an observational study of 311 patients at Korean centers.
Given that previous studies have shown that the use of aspirin is associated with lower stroke severity and decreased infarction growth, the current study’s findings may help to define the effect of aspirin resistance (AR) on stroke severity, since previous studies had provided inconclusive results, Dr. Mi Sun Oh and colleagues at Hallym University Sacred Heart Hospital, Anyang, South Korea, wrote in their abstract. The findings were released Feb. 23 in advance of the annual meeting in April of the American Academy of Neurology.
The investigators enrolled patients with acute ischemic stroke confirmed by diffusion-weighted imaging (DWI) who had received at least 7 days of aspirin therapy before initial stroke symptoms and had been checked for AR within 24 hours of hospital admission. Patients with high prestroke disability scores (modified Rankin Scale score > 2) were excluded, as were those who were taking another antiplatelet or anticoagulant medication concurrently with aspirin on hospital admission.
The abstract did not report detailed patient characteristics or information about type or dose of aspirin; the full results of the study will be presented at the meeting in Washington.
Enrollees were deemed aspirin resistant if a rapid assay detected greater than 550 Aspirin Reaction Units. DWI-observed stroke volume was assessed via a semiautomated threshold technique, and investigators employed the National Institutes of Health Stroke Scale (NIHSS) score to measure initial stroke severity.
Seventy-eight of the 311 patients (25.1%) had AR. Dr. Oh and colleagues reported that median stroke volume was higher for these patients, compared with the aspirin-sensitive group (2.8 cc vs. 1.6 cc), as was least-square mean on multivariate analysis (1.6 cc [95% CI, 1.1-2.1] vs. 1.1 cc [95% CI, 0.7-1.4], P = .036). Median NIHSS scores were also higher for the AR group (4 vs. 3), indicating greater stroke severity, a result that was confirmed by multivariate analysis.
Aspirin resistance is a complicated and heterogeneous concept, and not a well defined entity, according to vascular neurologist Dr. Philip Gorelick, head of the Hauenstein Neuroscience Center at St. Mary’s Health Care in Grand Rapids, Mich. Dr. Gorelick is an honorary member of the Korean Stroke Society but was not involved in the present study. In an interview, he expanded on the diverse mechanisms that can impede the stroke prevention effect of antiplatelet agents such as aspirin (Stroke Res. Treat. 2013;Article ID 727842 [doi:10.1155/2013/727842]).
In contrast to the traditional notion of “resistance” as an inherent or acquired defense or chemical blockage of a drug, whether by a microbe or the host, aspirin resistance may be either a laboratory-defined lack of inhibition of thromboxane A2, or a clinically-defined entity. In either case, a host of factors may contribute, Dr. Gorelick said. Poor adherence to an aspirin therapy regimen may be a primary contributor to AR. Further, enterically coated aspirin may not be as well absorbed in the gut, leading to lower effective aspirin dosing. A host of other factors, including concurrent medication administration, comorbidities impacting platelet turnover, and genetic polymorphisms may also contribute to aspirin failure.
Although patient characteristics were not reported in this study, Dr. Gorelick did issue a general note of caution: “Another major issue in these types of studies,” he noted, is to determine if “patients are similar in terms of background factors. Patients on aspirin therapy may be more likely to have more severe preexisting vascular disease,” predisposing them to more severe stroke.
The Korea Healthcare Technology R&D Project, Ministry of Health and Family Welfare, and the Republic of Korea supported the study. The authors had no disclosures.
Patients with acute ischemic stroke who test positive for aspirin resistance had both larger stroke volume and increased severity, compared with patients without resistance, in an observational study of 311 patients at Korean centers.
Given that previous studies have shown that the use of aspirin is associated with lower stroke severity and decreased infarction growth, the current study’s findings may help to define the effect of aspirin resistance (AR) on stroke severity, since previous studies had provided inconclusive results, Dr. Mi Sun Oh and colleagues at Hallym University Sacred Heart Hospital, Anyang, South Korea, wrote in their abstract. The findings were released Feb. 23 in advance of the annual meeting in April of the American Academy of Neurology.
The investigators enrolled patients with acute ischemic stroke confirmed by diffusion-weighted imaging (DWI) who had received at least 7 days of aspirin therapy before initial stroke symptoms and had been checked for AR within 24 hours of hospital admission. Patients with high prestroke disability scores (modified Rankin Scale score > 2) were excluded, as were those who were taking another antiplatelet or anticoagulant medication concurrently with aspirin on hospital admission.
The abstract did not report detailed patient characteristics or information about type or dose of aspirin; the full results of the study will be presented at the meeting in Washington.
Enrollees were deemed aspirin resistant if a rapid assay detected greater than 550 Aspirin Reaction Units. DWI-observed stroke volume was assessed via a semiautomated threshold technique, and investigators employed the National Institutes of Health Stroke Scale (NIHSS) score to measure initial stroke severity.
Seventy-eight of the 311 patients (25.1%) had AR. Dr. Oh and colleagues reported that median stroke volume was higher for these patients, compared with the aspirin-sensitive group (2.8 cc vs. 1.6 cc), as was least-square mean on multivariate analysis (1.6 cc [95% CI, 1.1-2.1] vs. 1.1 cc [95% CI, 0.7-1.4], P = .036). Median NIHSS scores were also higher for the AR group (4 vs. 3), indicating greater stroke severity, a result that was confirmed by multivariate analysis.
Aspirin resistance is a complicated and heterogeneous concept, and not a well defined entity, according to vascular neurologist Dr. Philip Gorelick, head of the Hauenstein Neuroscience Center at St. Mary’s Health Care in Grand Rapids, Mich. Dr. Gorelick is an honorary member of the Korean Stroke Society but was not involved in the present study. In an interview, he expanded on the diverse mechanisms that can impede the stroke prevention effect of antiplatelet agents such as aspirin (Stroke Res. Treat. 2013;Article ID 727842 [doi:10.1155/2013/727842]).
In contrast to the traditional notion of “resistance” as an inherent or acquired defense or chemical blockage of a drug, whether by a microbe or the host, aspirin resistance may be either a laboratory-defined lack of inhibition of thromboxane A2, or a clinically-defined entity. In either case, a host of factors may contribute, Dr. Gorelick said. Poor adherence to an aspirin therapy regimen may be a primary contributor to AR. Further, enterically coated aspirin may not be as well absorbed in the gut, leading to lower effective aspirin dosing. A host of other factors, including concurrent medication administration, comorbidities impacting platelet turnover, and genetic polymorphisms may also contribute to aspirin failure.
Although patient characteristics were not reported in this study, Dr. Gorelick did issue a general note of caution: “Another major issue in these types of studies,” he noted, is to determine if “patients are similar in terms of background factors. Patients on aspirin therapy may be more likely to have more severe preexisting vascular disease,” predisposing them to more severe stroke.
The Korea Healthcare Technology R&D Project, Ministry of Health and Family Welfare, and the Republic of Korea supported the study. The authors had no disclosures.
FROM THE AAN 2015 ANNUAL MEETING
Key clinical point: Volume and severity of ischemic stroke were larger in patients with aspirin resistance.
Major finding: Patients with acute ischemic stroke and aspirin resistance had greater median stroke volume than did aspirin-sensitive patients (2.8 cc vs. 1.6 cc) and had more severe strokes according to median NIHSS score (4 vs. 3).
Data source: Study of 311 patients with MRI-confirmed acute ischemic stroke and at least 7 days of aspirin therapy preceding stroke.
Disclosures: The Korea Healthcare Technology R&D Project, Ministry of Health and Family Welfare, and the Republic of Korea supported the study. The authors had no disclosures.
More cancer patients surviving longer, but age-based disparities remain
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
FROM JAMA ONCOLOGY
Key clinical point: Cancer survival rates improved less for older than younger patients in a large longitudinal study.
Major finding: All age groups showed improved survival for all cancers with the exception of ovarian cancer, but differences were greater for younger ages.
Data source: Longitudinal analysis of 20 years of data from 1.02 million cancer patients in nine population-based National Cancer Institute registries.
Disclosures: This study was supported by the National Institutes of Health and by funds from Vanderbilt University’s Ingram Professorship and Anne Potter Wilson Chair. Ms. Zeng received support from the Vanderbilt International Scholarship Program. The authors reported no conflicts of interest.
Seven Years of Hot Flashes Common During, After Menopause
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
FROM JAMA INTERNAL MEDICINE
Seven years of hot flashes common during, after menopause
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.
Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.
Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.
Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.
Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).
The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates
African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.
Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).
Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.
Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.
The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Vasomotor symptoms persist for more years and last longer past menopause than previously known.
Major finding: Women experiencing frequent vasomotor symptoms had a median 7.4 years of symptoms, with a median of 4.5 years of symptoms after the final menstrual period.
Data source: Multiracial/multiethnic observational study of 1,449 women in the menopausal transition experiencing frequent vasomotor symptoms.
Disclosures: The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.
