Diabetes is associated with abnormal autonomic function and increased mortality. Abnormal heart rate recovery after exercise, a measure of autonomic dysfunction, is also associated with increased mortality. The objective of this study was to determine the association of fasting plasma glucose with abnormal heart rate recovery and its prognostic importance in healthy adults. We studied 5,190 healthy adults who did not have medically treated diabetes (mean age 45 years, 39% women), were enrolled in the Lipid Research Clinics' Prevalence Study, and underwent exercise testing. Heart rate recovery was defined as the change from peak heart rate to that after 2 min of recovery; an abnormal value was <42 bpm. All-cause mortality was assessed over 12 years. A total of 504 participants (10%) had impaired fasting glucose, and 131 (3%) had untreated diabetes. An abnormal heart rate recovery was found in 1,699 (33%). Compared with participants who had normal fasting plasma glucose, abnormal heart rate recovery was more common among those with impaired fasting glucose (42 vs. 31%; relative risk, 1.34; 95% confidence interval [CI], 1.20 -1.50; P < 0.0001) and those with diabetes (50 vs. 31%; relative risk, 1.61; 95% CI, 1.35-1.92; P < 0.0001). Fasting plasma glucose remained an independent predictor of abnormal heart rate recovery even after adjustment for age, sex, and other confounders (P ؍ 0.0003). An abnormal heart rate recovery added to impaired fasting plasma glucose for the prediction of death. Fasting plasma glucose is strongly and independently associated with abnormal heart rate recovery, even at nondiabetic levels. Diabetes 51:803-807, 2002 D iabetes and impaired fasting glucose are associated with increased mortality, particularly from cardiovascular causes (1-3). Diabetes is frequently complicated by an autonomic neuropathy (4), which can be detected by noting reduced heart rate variability (5,6). The Framingham Heart Study demonstrated a reduction of heart rate variability, along with a sympathetic-parasympathetic imbalance, not only in patients with diabetes but also in individuals with impaired fasting glucose (7).Abnormal heart rate recovery after exercise is an easyto-measure marker of reduced parasympathetic activity (8,9) and has been found to be an independent predictor of mortality in submaximal as well as in symptom-limited exercise stress testing (10 -12). Given the known associations among diabetes, impaired fasting glucose, and autonomic dysfunction, we hypothesized that increasing levels of fasting glucose would be associated with higher rates of abnormal heart rate recovery and that this association would be of prognostic importance. We tested these hypotheses in a healthy, population-based cohort of adults who did not have medically treated diabetes. RESEARCH DESIGN AND METHODSPopulation sample. The study population, derived from the Lipid Research Clinics Prevalence Study, a cross-sectional survey among North Americans assembled to determine the prevalence of dyslipidemia and its association wit...
Introduction Oral contraceptives (OCs) have been the preferred method of birth control because of their high rate of effectiveness. OC use, however, has been associated with women's sexual health complaints and androgen insufficiency. OC use is associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormone-binding globulin (SHBG). There have been limited studies assessing SHBG values after discontinuation of OC use. Aim To retrospectively investigate SHBG levels before and after discontinuation of OC use. Main Outcome Measure Sex hormone-binding globulin values were compared at baseline, while on the OC, and well beyond the 7-day half-life of SHBG at 49–120 (mean 80) days and >120 (mean 196) days after discontinuation of OCs. Methods A total of 124 premenopausal women with sexual health complaints for >6 months met inclusion/exclusion criteria. Three groups of women were defined: (i) “Continued-Users” (N = 62; mean age 32 years) had been on OCs for >6 months and continued taking them; (ii) “Discontinued-Users” (N = 39; mean age 33 years) had been on OCs for >6 months and discontinued them; and (iii) “Never-Users” (N = 23; mean age 36 years) had never taken OCs. Results Sex hormone-binding globulin values in the “Continued-Users” were four times higher than those in the “Never-User” group (mean 157 ± 13 nmol/L vs. 41 ± 4 nmol/L; P < 0.0001). Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels in “Discontinued-Users” remained elevated in comparison with “Never-Users” (N = 26; P < 0.0001 for >120 days). Conclusion In women with sexual dysfunction, SHBG changes in “Discontinued-Users” did not decrease to values consistent with “Never-Users.” Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation. Does prolonged exposure to the synthetic estrogens of OCs induce gene imprinting and increased gene expression of SHBG in the liver in some women? Prospective research is needed.
Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves' disease but is an alternative in patients who are noncompliant with or have reactions to antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or who refuse (131)I therapy and/or long-term antithyroid drug therapy. Seventeen clinically and biochemically severely thyrotoxic patients (16 female, mean age of 35 yr), all but one with large goiters, underwent TX after rapid preparation. The potent inhibitors of the deiodination of T(4) to T(3), iopanoic acid (IOP) (500 mg twice a day) and dexamethasone (DEX) (1 mg twice a day), were given with propylthiouracil or methimazole, when possible, and beta-blockers. Thyroid function tests were obtained before treatment and at TX. All patients were thyrotoxic (mean +/- SE: T(4), 21.6 +/- 1.2 micro g/dl; free T(4) index (FTI), 10.3 +/- 0.8; total T(3), 510 +/- 48 ng/dl). IOP and DEX rapidly lowered T(3) values (P < 0.0001; total T(3), 147 +/- 13 ng/dl) with a smaller but significant (P < 0.05) decrease in T(4)/FTI (T(4), 17.9 +/- 1.3 micro g/dl; FTI, 7.9 +/- 0.6). All patients were clinically euthyroid before surgery. None developed hypoparathyroidism, laryngeal nerve damage, or worsening of ophthalmopathy after surgery. The restoration of hyperthyroid Graves' disease to euthyroidism is rapidly accomplished with IOP and DEX, beta-blockers, and, when possible, antithyroid drugs. This is especially relevant in noncompliant patients with large goiters.
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