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or this newest suggestion;
white matter hyperintensities (WMH)
The blood of healthy postmenopausal women may offer signs of
increased risk of small areas of brain damage, dubbed white matter
hyperintensities (WMH), which have been linked to memory loss,
researchers reported.
In a prospective observational study, women who began with higher
levels of thrombogenic microvesicles were more likely to have greater
volumes of WMH 4 years later, according to Kejal Kantarci, MD, of the
Mayo Clinic in Minneapolis, and colleagues.
One implication is that preventing formation of thrombogenic
microvesicles may reduce the burden of WMH, which have been associated
with memory loss and the risk of stroke, Kantarci and colleagues argued
in the Feb. 13 issue of Neurology.
Thrombogenic microvesicles are shed by activated platelets, the
researchers noted, and may affect the brain's microstructure along with
conventional risk factors such as hypertension, age, and smoking.
"This study suggests that these microvesicles in the blood may
contribute to the development of white matter hyperintensities in women
who have recently gone through menopause," Kantarci said in a statement.
"Preventing the platelets from developing these microvesicles could
be a way to stop the progression of white matter hyperintensities in the
brain," she added.
Because most studies examining the effects of WMH have been conducted
in older and mainly male groups, Kantarci and colleagues analyzed
members of a cohort of recently menopausal women enrolled in a
randomized trial of hormone therapy to slow the progression of
atherosclerosis.
Women taking part in the main study were asked to take part in the
substudy, in which MRI was used to measure changes in WMH before
randomization and at 18, 36, and 48 months afterward.
At baseline, the researchers measured conventional cardiovascular
risk factors, carotid intima-media thickness, coronary arterial
calcification, plasma lipids, markers of platelet activation, and
numbers of thrombogenic microvesicles.
They correlated those with changes in WMH volume, adjusting for age,
months past menopause, and whether or not participants had the APOE e4 gene, which is associated with Alzheimer's risk.
All told, 95 women (average age 53) were included in the analysis.
All had at least some WMH at baseline, with an average of 0.88% of the
total white matter volume, Kantarci and colleagues reported.
On average, the volume of WMH rose by 63 mm3 at 18 months, 122 mm3 at 36 months, and 155 mm3 at 48 months, but only the 36- and 48-month levels were significantly different from baseline, Kantarci and colleagues found.
Nevertheless, the 36- and 48-month levels were significantly correlated (P=0.03)
with the numbers of platelet-derived and total thrombogenic
microvesicles observed at baseline, although not with most other
measured risk factors.
"Neither smoking status nor the history of medication-controlled
migraines modified the WMH load and longitudinal change in WMH volume at
the specified time points (P>0.05)," the authors explained.
The associations "suggest that in vivo platelet activation may
contribute to a cascade of events leading to development of WMH in
recently menopausal women," the researchers concluded.
But they cautioned that there might be several unexamined mechanisms,
such as genetic variation, underlying the progression of WMH. They also
noted that the study population consists of healthy, well-educated and
mostly nonsmoking women, so the results may not reflect the general
postmenopausal population.
Finally, the findings need to be confirmed in a larger and longer study, they said.
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