Gender Differences in Blood Pressure Appears As Early As Adolescence, With Girls Faring Worse

The female hormone estrogen is known to offer protection for the heart, but obesity may be taking away that edge in adolescent girls. Research from the University of California at Merced finds that although obesity does not help teens of either gender, it has a greater impact on girls’ blood pressure than it does on boys’. In a study of more than 1,700 adolescents between 13 and 17 years old, obese boys were 3.5 times more likely to develop elevated systolic blood pressure (SBP) than non-obese boys, but similarly obese girls were 9 times more likely to develop elevated systolic blood pressure than their non-obese peers.

Systolic blood pressure, which is represented by the top number in a blood pressure reading, is the amount of force that blood exerts on blood vessel walls when the heart beats. High systolic measurements indicate risk for heart disease and stroke. Rudy M. Ortiz, PhD, Associate Professor of Physiology and Nutrition and his team obtained their data by direct measurements during the school district’s health surveys and physicals to assess the teenagers’ systolic blood pressure (SBP) against two health indicators: body mass index (BMI), which was categorized as normal weight, overweight, or obese, and blood pressure, which was categorized as normal, pre-elevated, or elevated. The researchers found that the teenagers’ mean BMI was significantly correlated with mean SPB for both sexes when both BMI and blood pressure assessments were used. They also found a significant correlation between BMI and SBP as a function of blood pressure, suggesting that the effect of body mass on SBP is much greater when it is assessed using blood pressure categories. “We were able to categorize the students in different ways, first based on BMI within each of three blood pressure categories. Then we flipped that around and looked at each category of blood pressure for different weight categories. In each case, we are looking at SBP as the dependent variable,” said Dr. Ortiz. An odds ratio analysis revealed that obese boys were 2 and 3.5 times more likely to develop pre-elevated and elevated SBP, respectively, than boys who were normal weight. Obese girls were 4 and 9 times more likely to develop pre-elevated and elevated SBP, respectively, than girls who were normal weight.

According to Dr. Ortiz, the results do not bode well for obese teens later in life, especially for the girls. “Overall, there is a higher likelihood that those who present with both higher BMI and blood pressure will succumb to cardiovascular complications as adults. But the findings suggest that obese females may have a higher risk of developing these problems [than males].” As for why obesity has a greater impact on SBP in girls than in boys, Dr. Ortiz has a hunch. “This may be where physical activity comes into play. We know, for example, that obese adolescent females participate in 50 to 60% less physical activity than boys in the population surveyed.”

It's important to take steps to prevent obesity at its first onset--for both adolescent boys and girls. Being active and eating healthy foods are great initial steps towards healthy living!

Early Alzheimer's Detection a Possibility in the Future

No methods currently exist for the early detection of Alzheimer’s disease, which affects one out of nine people over the age of 65. However, an interdisciplinary team of Northwestern University scientists and engineers has developed a noninvasive MRI approach that can detect the disease in a living animal. And it can do so at the earliest stages of the disease, well before typical Alzheimer’s symptoms appear.

Led by neuroscientist William L. Klein and materials scientist Vinayak P. Dravid, the research team developed an MRI (magnetic resonance imaging) probe that pairs a magnetic nanostructure (MNS) with an antibody that seeks out the amyloid beta brain toxins responsible for onset of the disease. The accumulated toxins, because of the associated magnetic nanostructures, show up as dark areas in MRI scans of the brain.

This ability to detect the molecular toxins may one day enable scientists to both spot trouble early and better design drugs or therapies to combat and monitor the disease. And, while not the focus of the study, early evidence suggests the MRI probe improves memory, too, by binding to the toxins to render them “handcuffed” to do further damage.

“Using MRI, we can see the toxins attached to neurons in the brain,” Klein said. “We expect to use this tool to detect this disease early and to help identify drugs that can effectively eliminate the toxin and improve health.”

With the successful demonstration of the MRI probe, Northwestern researchers now have established the molecular basis for the cause, detection by non-invasive MR imaging and treatment of Alzheimer’s disease. Dravid introduced this magnetic nanostructure MRI contrast enhancement approach for Alzheimer’s following his earlier work utilizing MNS as smart nanotechnology carriers for targeted cancer diagnostics and therapy. (A MNS is typically 10 to 15 nanometers in diameter; one nanometer is one billionth of a meter.)

Details of the new Alzheimer’s disease diagnostic were published by the journal Nature Nanotechnology. Klein and Dravid are co-corresponding authors.

The emotional and economic impacts of Alzheimer’s disease are devastating. This year, the direct cost of the disease in the United States is more than $200 billion, according to the Alzheimer’s Association’s “2014 Alzheimer’s Disease Facts and Figures.” By the year 2050, that cost is expected to be $1.1 trillion as baby boomers age. And these figures do not account for the lost time of caregivers.

This new MRI probe technology is detecting something different from conventional technology: toxic amyloid beta oligomers instead of plaques, which occur at a stage of Alzheimer’s when therapeutic intervention would be very late. Amyloid beta oligomers now are widely believed to be the culprit in the onset of Alzheimer’s disease and subsequent memory loss.

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New Report on Women's Participation in NIH-Funded Clinical Research

Although women make up over half the U.S. population, they have, historically been underrepresented in clinical research. As a result, clinical trials that included both men and women largely examined the average reactions in treatments across both sexes, instead of examining sex as a variable. This is problematic becuase researchers are unable to learn how women and men may react in unique ways to new drugs or therapies; indeed, there have been higher instances of women having adverse effects than men in medications and other treatments. 

Due to the growing body of research that indicates diseases manifest themselves differently in men and women (meaning treatments need to be tailored to each sex), the United States Government Accountability Office (GAO) was comissioned to provide information on women's participation in NIH research. The GAO "examined (1) women's enrollment and NIH's efforts to monitor this enrollment in NIH-funded clinical research; and (2) NIH's efforts to ensure that NIH-funded clinical trials are designed and conducted to analyze potential sex differences, when applicable." Their 57 page report classifies their findings and provides recommendations moving forward. This is an important step in increasing the number of women in clinical studies as well as improving the outcomes of these studies by examining sex as a variable!

If you live in Illinois and want to participate in clinical studies, please consider joining the Illinois Women's Health Registry or the Illinois Men's Health Registry

Please visit the GAO website to view the full report. 

Treating the Symptoms of Menopause: How to Guide Your Patients Towards the Best Treatments for Them

The Endocrine Society recently released their guidelines for the treatment and symptoms of menopuse. Chaired by Cynthia A. Stuenkel, MD, these clinical practice guidelines provide new recommendations on the importance of tailoring treatments to suit a woman's individual symptoms, health history, and preferences. Teaching your patients that menopause is a normal, natural transition in life that begins between the ages of 35-55 may help them through this transitional phase. Every woman will experience menopause differently, so your clinical practices must be tailored to each patient. 

Your patients may have heard that one of the ways to manage the symptoms associated with menopause is to replace the hormones they are losing with one of several types of prescription drugs known as hormone therapy (HT)--but they might have some questions about hormone therapy or have heard rumors that it is not safe. There are many types of hormone therapies, and if you are interested in exploring these different options with your patients, please watch the Endocrine Society's online lecture discussing the Treatments of the Symptoms of Menopause (found here!). This lecture, complete with audio and slides will review the primary therapies available to patients so that you might help them decide which option is best in regards to their symptoms, health history, and preferences. Once you learn more about your options as a clinician, you can help your patient make informed decisions as they go through the stages of menopause! Also consider inviting your patients to take the Women's Health Research Institute's Menopause Self-Assessment, as this may help them place their own menopause experience in a personal context.

Teresa Woodruff, PhD Raises Awareness on Sex Inclusion in Basic Science at WHRI October Forum

Last Tuesday, Women's Health Research Institute Director, Dr. Teresa Woodruff launched our 2015-2016 research forum lectures with her presentation entitled "Sex Inclusion in Basic Research: Disruptive Technology, Adaptive Behavior, Sound Investment, Better Medicine." Over 200 people were in attendance as Woodruff gave an overview of sex inclusion from bench to bedside, operating under her hypothesis that the next generation of biomedical advances that improve the lives of all people will require fundamental discovery research that includes sex as a variable. The current climate in science--which operates under the null hypothesis that sex does not matter in care--is upsetting and flawed, seeing as there are several ways sex (whether people or cells are male or female) impacts basic science and clinical care. 

Women in the United States have shorter lifespans when compared to other developed countries. This is in part because the United States has yet to adopt a nation-wide understanding that healthcare for women varies from men in important, life-saving ways. One example is founded in cardiology--where women present symptoms of heart attacks differently than men, and women are more likely to downplay their symptoms in emergency situations, which many care providers may perceive as less critical. An important takeaway from the lecture is that our genes, hormones, environment, and anatomy all play important roles in our health and the sex-inclusion equation. Understanding how our biology impacts our health is a necessary step for the increased inclusion of female cells and animals in basic science, as well as female-inclusion as a variable in clinical science.

Watch the video of Dr. Woodruff's presentation, in case you missed it and check out our October eNewsletter, which outlines ways to get involved in clinical research.

How Women's Pain May Be Taken Less Seriously Than Men's

In a recent editorial in the Atlantic, writer Joe Fassler discusses an experience he had with his wife who needed emergency surgury to remove her ovary--but here's the thing, the ER team didn't believe it was an emergency. After seeing his wife Rachel in excruciating pain one morning, Joe calls the ambulance to rush Rachel to the hospital where they believed she would get immediate treatment--seeing as she described her pain as an "11" on a 1 to 10 scale. However, once they reached the hospitals, nurses told her she would have to "wait her turn" while others dismissed her by saying, “You’re just feeling a little pain, honey." The nursing team and the overseeing physician--who only asked questions and never did a physical examination on Rachel--diagnosed the pain as stones, AKA a "non-emergency" that the CT scan results would most certainly show.

However, after hours and hours of waiting on the CT scan results, the couple learned the doctor who had overseen Rachel's case had left for the day. When a new doctor was brought up to speed--and when Joe demanded the CT scan results be analyzed--the doctor discovered that Rachel did not have stones; she had what is called ovarian torsion--a phenomenon where the fallopian tube twists and cuts off blood flow. This creates a kind of organ-failure pain that is described as excruciating. Rachel was rushed into surgery, 14 and a half hours from when her pain had started.

In typical emergency-room situations, patients are to be immediately assessed and treated according to the urgency of their condition. Most hospitals use the Emergency Severity Index, a five-level system that categorizes patients on a scale from “resuscitate” (treat immediately) to “non-urgent” (treat within two to 24 hours). That being said, there are acute differences in the wait time for men and women in emergency situations. Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. 

Writer Leslie Jamison expresses this concept in her essay "Grand Unified Theory of Female Pain" which examines how oftentimes female suffering is minimized, mocked, or coaxed into silence. Researchers at the University of Maryland have also conducted research on this phenomenon and outline their finding is their paper "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain." Rachel's experience in the ER unfortunately embodies these biases in a very real way, and hopefully do not reflect the experienes of all women who enter the hospital--but it's a sobering thought.