Presidential Healthcare center

We provide the same Preventive Executive Physical Program as received by the President of the United States.


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Hot Flashes in Younger Women May Signal Cardiac Risk

night sweats 2For women in midlife, an earlier age of onset of vasomotor symptoms – hot flashes and night sweats – was linked to impaired endothelial function, a very early marker for cardiovascular disease.

In the first of two related studies, an earlier age of onset for vasomotor symptoms (VMS) was associated with increased endothelial dysfunction as measured by brachial artery ultrasound. Greater frequency of hot flashes was associated with endothelial dysfunction for younger but notnight sweats older participants in the second study.

Though more than 70% of women experience VMS during perimenopause and menopause, these symptoms largely have been viewed as a quality of life issue. However, this emerging research might mean that early onset of hot flashes might serve a potential marker for increased risk for cardiovascular disease, said Rebecca C. Thurston, Ph.D., associate professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh. Her work was presented in a briefing in advance of the annual meeting of the American College of Cardiology in San Diego.

Source: Family Practice News


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Postmenopausal breast cancer risk decreases rapidly with regular physical activity

imagesCAC8YFQZPostmenopausal women who in the past four years had undertaken regular physical activity equivalent to at least four hours of walking per week had a lower risk for invasive breast cancer compared with women who exercised less during those four years, according to data published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

But those benefits quickly disappear if regular physical activity stops.

“Twelve MET-h [metabolic equivalent task-hours] per week corresponds to walking four hours per week or cycling or engaging in other sports two hours per week and it is consistent with the World Cancer Research Fund recommendations of walking at least 30 minutes daily,” said Agnès Fournier, PhD, a researcher in the Centre for Research in Epidemiology and Population Health at the Institut Gustave Roussy in Villejuif, France. “So, our study shows that it is not necessary to engage in vigorous or very frequent activities; even walking 30 minutes per day is beneficial.”

Postmenopausal women who in the previous four years had undertaken 12 or more MET-h of physical activity each week had a 10 percent decreased risk of invasive breast cancer compared with women who were less active. Women who undertook this level of physical activity between five and nine years earlier but were less active in the four years prior to the final data collection did not have a decreased risk for invasive breast cancer.

“Physical activity is thought to decrease a woman’s risk for breast cancer after menopause,” said Fournier. “However, it was not clear how rapidly this association is observed after regular physical activity is begun or for how long it lasts after regular exercise stops.

“Our study answers these questions,” Fournier continued. “We found that recreational physical activity, even of modest intensity, seemed to have a rapid impact on breast cancer risk. However, the decreased breast cancer risk we found associated with physical activity was attenuated when activity stopped. As a result, postmenopausal women who exercise should be encouraged to continue and those who do not exercise should consider starting because their risk of breast cancer may decrease rapidly.”

Fournier and colleagues analyzed data obtained from biennial questionnaires completed by 59,308 postmenopausal women who were enrolled in E3N, the French component of the European Prospective Investigation Into Cancer and Nutrition (EPIC) study. The mean duration of follow-up was 8.5 years, during which time, 2,155 of the women were diagnosed with a first primary invasive breast cancer.

The total amount of self-reported recreational physical activity was calculated in MET-h per week. The breast cancer risk-reducing effects of 12 or more MET-h per week of recreational physical activity were independent of body mass index, weight gain, waist circumference, and the level of activity from five to nine years earlier.

Source: American Association for Cancer Research


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Risks to Bone Health in Treating Chronic Disease in Younger Patients

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Osteoporosis, a loss of bone strength that raises the risk of fractures, is one of the most common and crippling ailments associated with aging in women. Increasingly, it is striking younger patients who have a host of other medical problems.

Researchers call it secondary osteoporosis. They are identifying a growing list of factors that contribute to bone deterioration, including chronic diseases and some of the powerful drugs used to treat them. Alone or in combination, disease and medication can interfere with the way the body naturally breaks down and rebuilds bone tissue, and how well it absorbs bone-building nutrients like calcium and Vitamin D.

Because there often are no symptoms as bone weakens, osteoporosis often hasn’t been diagnosed until a patient suffers a fractured bone.

Now, bone health experts are calling for greater efforts to identify patients earlier who are at risk for secondary osteoporosis, before their bones become more fragile and further raise their risk of injury and disability.

Recommended measures include bone mineral density scans for patients who wouldn’t ordinarily get routine screening, treatment of underlying diseases that contribute to bone loss, lifestyle changes and calcium and vitamin D supplements. Doctors also are prescribing osteoporosis medicines shown to slow bone loss or build new bone.

Secondary osteoporosis is increasingly being diagnosed in younger patients with cancer, celiac disease, rheumatoid arthritis and inflammatory bowel disease, as well as in people taking reflux medications, blood thinners and some depression drugs, researchers say. Patients are at risk of secondary osteoporosis after bariatric surgery for weight loss, as are those receiving hormonal treatments to prevent the recurrence of breast or prostate cancer.

Adverse effects of diabetes on bone health are starting to be recognized. Smoking, excessive alcohol use, eating disorders like anorexia nervosa and inactivity are also linked to declining bone mass.

Anyone taking corticosteroids, such as prednisone, is at risk, according to the American College of Rheumatology. The drugs, prescribed to suppress inflammation in a wide range of illnesses and to prevent organ rejection after transplants, have a direct negative effect on bone cells and can interfere with the body’s handling of calcium.

According to the National Osteoporosis Foundation, nine million adults in the U.S. have osteoporosis and an additional 43 million have low bone mass, or osteopenia, which increases their risk of osteoporosis and broken bones. The foundation projects that by 2030, the number of adults over age 50 with osteoporosis and low bone mass will grow by more than 30% to 68 million.

Primary osteoporosis is most commonly caused by women’s loss of estrogen after menopause. Age-related bone loss affects men starting in their 70s.

Last year, a review by researchers at Loyola University Medical Center in Maywood, Ill., found secondary causes of bone loss are reported in up to 60% of men, more than 50% of premenopausal women and some 30% of postmenopausal women who are diagnosed with osteoporosis.

“When I find a younger patient with osteoporosis, there is likely to be a secondary cause, and if that cause isn’t treated, they will continue to lose bone even if they are on osteoporosis medications,” says Pauline M. Camacho, an endocrinologist at Loyola and co-author of the study.

Source: Wall Street Journal