Risk factors (excluding hormone therapy) for endometrial hyperplasia: a systematic review.
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Abstract
ABC genes, especially ABCB1 (ATP-binding cassette, sub-family B (MDR/TAP), member 1; Doxorubicin resistance; Multidrug resistance 1; Multidrug resistance protein 1; P-glycoprotein 1; P glycoprotein 1/ multiple drug resistance 1;P-gp) (7q21.12), ABCC1 (9q31.1), ABCG2 (White1) (21q22.3), and other genes of this family encode proteins which are essential for drug metabolism and transport. The multidrug efflux transporters P-gp, multidrug-resistance associated protein 4 (MRP4) and breast cancer resistance protein (BCRP), located on endothelial cells lining brain vasculature, play important roles in limiting movement of substances into and enhancing their efflux from the brain. Transporters also cooperate with Phase I/Phase II metabolism enzymes by eliminating drug metabolites. Their major features are their capacity to recognize drugs belonging to unrelated pharmacological classes, and their redundancy, by which a single molecule can act as a substrate for different transporters. This ensures an efficient neuroprotection against xenobiotic invasions. The pharmacological induction of ABC gene expression is a mechanism of drug interaction, which may affect substrates of the up-regulated transporter, and over expression of MDR transporters confers resistance to anticancer agents and CNS drugs [1,2]. Mutations in ABC transpo
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Abstract
Objective: To conduct a systematic review of risk factors associated with the development of Endometrial Hyperplasia (EH).
Data sources: Ovid MEDLINE, EMBASE and Web of Science databases were searched from inception to 30 June 2015.
Study eligibility: Fifteen observational studies that reported on EH risk in relation to lifestyle factors (n=14), medical history (n=11), reproductive and menstrual history (n=9) and measures of socio-economic status (n=2) were identified. Pooled relative risk estimates and corresponding 95% confidence intervals (CI) were able to be derived for EH and Body Mass Index (BMI), smoking, diabetes and hypertension, using random effects models comparing high versus low categories.
Results
The pooled relative risk for EH when comparing women with the highest versus lowest BMI was 1.82 (95% CI 1.22–2.71; n=7 studies, I2=90.4%). No significant associations were observed for EH risk for smokers compared with non-smokers (RR 0.88, 95% CI 0.66-1.17; n=3, I2=0.0%), hypertensive versus normotensive women (RR 1.51, 95% CI 0.72–3.15; n=5 studies, I2=79.1%), or diabetic versus non-diabetic women (RR 1.77, 95% CI 0.79–3.96; n=5 studies, I2=31.8%) respectively although the number of included studies was limited. There were mixed reports on the relationship between age and risk of EH. Too few studies reported on other factors to reach any conclusions in relation to EH risk.
Conclusions
A high BMI was associated with an increased risk of EH, providing additional rationale for women to maintain a normal body weight. No significant associations were detected for other factors and EH risk, however relatively few studies have been conducted and few of the available studies adequately adjusted for relevant confounders. Therefore, further aetiological studies of endometrial hyperplasia are warranted.
Data sources: Ovid MEDLINE, EMBASE and Web of Science databases were searched from inception to 30 June 2015.
Study eligibility: Fifteen observational studies that reported on EH risk in relation to lifestyle factors (n=14), medical history (n=11), reproductive and menstrual history (n=9) and measures of socio-economic status (n=2) were identified. Pooled relative risk estimates and corresponding 95% confidence intervals (CI) were able to be derived for EH and Body Mass Index (BMI), smoking, diabetes and hypertension, using random effects models comparing high versus low categories.
Results
The pooled relative risk for EH when comparing women with the highest versus lowest BMI was 1.82 (95% CI 1.22–2.71; n=7 studies, I2=90.4%). No significant associations were observed for EH risk for smokers compared with non-smokers (RR 0.88, 95% CI 0.66-1.17; n=3, I2=0.0%), hypertensive versus normotensive women (RR 1.51, 95% CI 0.72–3.15; n=5 studies, I2=79.1%), or diabetic versus non-diabetic women (RR 1.77, 95% CI 0.79–3.96; n=5 studies, I2=31.8%) respectively although the number of included studies was limited. There were mixed reports on the relationship between age and risk of EH. Too few studies reported on other factors to reach any conclusions in relation to EH risk.
Conclusions
A high BMI was associated with an increased risk of EH, providing additional rationale for women to maintain a normal body weight. No significant associations were detected for other factors and EH risk, however relatively few studies have been conducted and few of the available studies adequately adjusted for relevant confounders. Therefore, further aetiological studies of endometrial hyperplasia are warranted.
| Original language | English |
|---|---|
| Article number | 229 |
| Number of pages | 15 |
| Journal | Epidemiology: Open Access |
| Volume | 6 |
| Issue number | 3 |
| Early online date | 11 Mar 2016 |
| DOIs | |
| Publication status | Early online date - 11 Mar 2016 |
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SDG 3 Good Health and Well-being
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