Hepatitis C and Cardiovascular Risk

Conflicting results have been produced regarding the association between chronic hepatitis C virus (HCV) infection and coronary artery disease, including heart attacks and strokes. It was found in a study about the relationship between HCV infection and risk for incident (newly emerging) coronary artery disease. HCV-positive patients were less likely to have arterial hypertension, dyslipidemias, and diabetes than persons without HCV. HCV-positive patients were more likely to smoke cigarettes and abuse alcohol or drugs. Compared with participants without HCV, patients with HCV had lower mean plasma levels of total cholesterol , low-density lipoprotein (LDL) cholesterol, and triglycerides .

In a multivariate analysis, HCV infection was associated with a 25% higher risk for coronary artery disease. Classic risk factors (older age, hypertension, smoking, diabetes, dyslipidemias) were associated with a higher risk for coronary artery disease. In contrast, nonwhite ethnicity and female sex were associated with a lower risk. It was concluded that people infected with HCV are at increased risk for coronary artery disease despite having fewer other cardiovascular risk factors.

(Butt A, Xiaoqiang W, Budoff M, et al. Hepatitis C virus infection and the risk of coronary disease. Program and abstracts of the 48th ICAAC/46th IDSA; October 25-28, 2008; Washington, DC. Abstract V-4219)

The Pathophysiology of The Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a recurrent luteal phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity. Premenstrual dysphoric disorder (PMDD) is considered a severe form of PMS.
Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B-6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the following etiologies:

• Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels. The symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which are medications that increase the amount of circulating serotonin.
• Magnesium and calcium deficiencies are postulated as nutritional causes of PMS. Studies evaluating supplementation show improvement in physical and emotional symptoms.
• Women with PMS often have an exaggerated response to normal hormonal changes. Although their levels of estrogen and progesterone are similar to women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical responses.
• Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric system (GABA), and hypoprolactinemia.

(Primary Care Companion J Clin Psychiatry. 2003;5:30-9;
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Pediatric and Adolescent Gynecology. 5th ed. Philadelphia, PA: Lippincott-Raven Inc; 2005:461-7;
J Womens Health. Jan-Feb 1999;8(1):75-85;
J Reprod Med. Feb 1991;36(2):131-6)