Heart Disease and Stroke

• ‘Go Red for Women’ Raises Awareness. [Times-West Virginian] “Go Red for Women” is being observed during the month of February as part of the American Heart Association’s nationwide movement to make women aware that they are as much at risk for heart problems as men. “Many women are not aware than heart disease is the No. 1 killer of women in the United States,” said Alanna Wyant, manager of cardiac rehab at FGH. “Heart disease is not just a man’s disease anymore.” “We’re observing the month to bring out public awareness for women,” she said. “We’re having a luncheon at Muriale’s Feb. 26 with several guest speakers. And we’re planning something special at Fairmont General on Feb. 14.”

• New Study Finds Genetic Link Between Women And Heart Disease. [Medical News Today, UK] Scientists at Children's Hospital Oakland Research Institute (CHORI), the University of Iowa and Roche Molecular Systems are the first to identify a new gene variant that makes women more susceptible to developing heart disease. The affected gene is called Leukotriene C4 Synthase (LTC4S) and its variant could be identified through a genetic test at birth. The use of such a test would allow physicians to initiate preventative treatments to reduce or even eliminate the risk of heart disease in those women possessing the variant gene.

• Minority Women Know Less About Heart Disease. [Indianapolis Star] Black and Hispanic women in the U.S., who have some of the highest rates of cardiovascular disease, are less likely to know how to prevent illnesses such as heart disease and stroke than white women, according to a survey in this month's Journal of Women's Health. Thirty-one% of black women and 29% of Hispanic women said they knew cardiovascular disease is the No. 1 killer of women in the U.S., compared with 68% of white women, according to the American Heart Association survey of 1,000 women. "We still face the challenge to reduce ethnic disparities and maximize knowledge among all racial and ethnic groups," said Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital, who led the study.

• Study: Pollution Puts Women's Hearts at Risk. [Indianapolis Star] The fine grit in polluted air boosts the risk of heart disease in older women much more powerfully than scientists realized, a big federally funded study has found, raising questions of whether U.S. environmental standards are strict enough. The Environmental Protection Agency tightened its daily limit for these tiny specks, known as fine particulates, in September. But it left the average annual limit untouched, allowing a concentration of 15 millionths of a gram for every cubic meter of air. In this study of 65,893 women, the average exposure was 13 units, with two-thirds of the subjects falling under the national standard. But every increase of 10 units, starting at 0, lifted the risk of fatal cardiovascular disease by about 75%. That is several times higher than in a study by the American Cancer Society.

• Female Breast Cancer and Ways to Combat It. [News Today, India] A part from skin cancer, the breast is the most common site of cancer in women. It is second only to lung cancer as a cause of death from cancer among women. The probability of developing the disease increases throughout the life, says Dr S Sathyanarayanan of Sage Surgical Centre, Nanganallur, a suburb in Chennai.. Though the incidence of breast cancer continues to increase, mortality has seen to decrease. This is due to both early detection and increased use of systemic therapy. Women whose mothers or sisters had breast cancer are three to four times likely to develop it and the risk is further more in patients whose mothers' or sisters' breast cancers occurred before menopause or were bilateral and in those with a family history of breast cancer in two or more first-degree relatives.

• Exercise Helps Women with Breast Cancer: Study. [ABC News] Women with breast cancer benefit from improved mood and well-being if they take part in group exercise, a study found. Treatments like chemotherapy and radiotherapy can affect the quality of life of patients and leave them feeling low and exhausted. But researchers in Scotland found that group exercise programs helped women being treated for early-stage breast cancer. More than 170 women took part in the study over a six-month period.

• New Survey Shows Nearly 50% of Women over 40 Do Not Receive Recommended Annual Mammogram. [Genetic Engineering News] Adult women show a strong awareness of the threat of breast cancer, but many still are failing to take the suggested preventative health measures to detect the disease at its earliest stages when it is most treatable. In fact, nearly half (49.6%) of women aged 40 and older say they do not receive an annual mammogram as recommended by the American Cancer Society. These were the primary findings of a recent online survey of more than 680 women conducted by Eastman Kodak Company's Health Group and Zoomerang in December 2006. A large percentage of women indicate they are aware of the significant threat breast cancer poses and the frequency with which they should receive a mammogram examination, but cite a number of reasons as why they do not. More than 37% of women say they do not know how often they should have a mammogram based on their age and risk level. Of those that do know how often they should have a mammogram examination, 32% said they do not follow the recommended timeframes. The biggest reasons for not following these recommendations include lack of medical insurance (19%), followed by not considering it a high priority (15%) and not believing they are at risk (12%).

• Gene May Protect Some Women Against Breast Cancer. [Scotsman, UK] Scientists have identified a gene variation found in about 13% of women of European descent that reduces their risk of developing breast cancer, a study released said. The gene is called CASP8, and women with a certain mutation of the gene were 10% less likely than other women to develop breast cancer, according to the study. The international team of researchers used data on 33,000 women from 14 different studies for their report. Most of the statistics involved women of European descent, the researchers reported in the journal Nature Genetics.

• Transplants? Breast cancer? Over 40? [Boston Herald] High-risk pregnancies are on the rise in the United States and may be more common now than at any other time since modern obstetric care became available. Why? More forty-something moms are having babies, and epidemics of diabetes, obesity and high blood pressure are causing pregnancy and birth complications. But in this otherwise troubling trend is also some good news: A small but growing number of women are successfully having children despite life-threatening conditions that once made a safe pregnancy almost inconceivable. Exact numbers are not available, but doctors say that tens of thousands of organ transplant recipients, breast cancer survivors, women with heart defects, and even women with the AIDS virus have decided to risk childbearing in the last several years.

• HPV Vaccine No Easy Decision for Parents. [DigitalJournal.com, Canada] Doctors are urging parents to vaccinate daughters as young as nine against human papillomavirus. This virus is sexually transmitted and can cause genital warts and cervical cancer. The vaccine is costly, but some parents say that is not a problem. A bigger problem are the ethical issues. "I think the issue is: When is the best time -- the most effective time -- to give the vaccine and do you want to give your daughter that protection?" said Dr. Renee Jenkins of the American Academy of Pediatrics. Three in four Canadians will have at least one HPV infection in their lifetime. HPV is also linked to vaginal, anal and vulvar cancers.

• 20% of Women with Lung Cancer Never Smoked. [WSAW] A new study suggests secondhand smoke may be to blame for a high percentage of women who develop lung cancer. A survey of more than a million people found up to 20% of women who develop lung cancer have never smoked. The same was true for just 8% of men. One of the study’s leaders said because more men smoke than women, women may be more likely to be exposed to secondhand smoke even when they are classified as having never smoked.

• Lung Cancer Rates Higher Among Female Nonsmokers Than Previously Thought. [Science Daily] Not all lung cancer is due to a lifetime of smoking cigarettes. Sometimes the diagnosis is a mystery, and the stigma surrounding the disease makes it hard for patients to talk about. Now, researchers at the Stanford University School of Medicine and the Northern California Cancer Center have taken the first steps toward analyzing why people who never smoked get lung cancer. Their data, to be published in the Feb. 10 issue of the Journal of Clinical Oncology, shows that never-smokers get lung cancer more often than thought, with women even more at risk than men. "People tend to banter about this number of 10 to 15% of lung cancer cases being in people who have never smoked," explained lead author Heather Wakelee, MD, assistant professor of medicine at Stanford. "But when you actually try to find the hard data to show that, it's very limited."

• Women Risking Pregnancy. [The News - International, Pakistan] High-risk pregnancies are on the rise in the United States and may be more common now than at any other time since modern obstetric care became available. Why? More forty something moms are having babies, and epidemics of diabetes, obesity and high blood pressure are causing pregnancy and birth complications. But in this otherwise troubling trend is also some good news: A small but growing number of women are successfully having children despite life-threatening conditions that once made a safe pregnancy almost inconceivable.

• Older, Affluent Women Drinking While Pregnant. [Daily Telegraph, Australia] Almost half of expectant mothers drink alcohol during pregnancy, despite the risk to their babies. A study says as many as 47% of Australian women are drinking while pregnant or while breast feeding. Lead researcher Cate Wallace, from the National Drug and Alcohol Research Centre, said the main culprits were tertiary educated, older and relatively affluent women. The study will be published in the February issue of the Australian and New Zealand Journal of Public Health. "Women are having babies later in life and older women tend to have entrenched patterns of alcohol consumption," Ms Wallace said.

• Standard Therapy More Effective Than Diabetes Drug. [Medical News Today, UK] Metformin, a drug used to treat diabetes and once thought to have great promise in overcoming the infertility associated with polycystic ovary syndrome (PCOS), is less effective than the standard fertility drug treatment, clomiphene, according to researchers from the University of Pennsylvania School of Medicine and the National Institutes of Health Reproductive Medicine research network. This is the largest, most comprehensive effort yet to compare the two drugs in helping PCOS patients achieve successful pregnancy. The findings appear in the New England Journal of Medicine.

• Women Over 40 at Three Times the Risk of Stillbirth. [South Asian Women's Forum, India] With an increasing number of women choosing to give birth when they’re in their late 30s or early 40s, a new study has scientists in the US warning that women who have a baby after they turn 40 are at an increased risk of stillbirth. With an increasing number of women choosing to give birth when they’re in their late 30s or early 40s, a new study has scientists in the US warning that women who have a baby after they turn 40 are at an increased risk of stillbirth. Scientists already know that conditions such as pre-eclampsia, problems with the position of the placenta, which hamper natural delivery, and diabetes, can increase the risk of stillbirth. Scientists carried out the study to find whether age is also a factor. As a part of the research they looked at over 11 million babies born to women aged 15 to 44 between 1995 and 1997.

• More Women Opting for Caesarean, Unaware of Consequences. [MedIndia, India] About a quarter of all babies in Germany are delivered with the help of a Caesarean section or c-section, a surgical incision made through the mother's abdominal and uterine walls. Originally a life-saving procedure for mother and child, c-sections are increasingly being performed "just to be on the safe side." Many women know little about their consequences, however. For medical reasons some women have no choice but to have a c-section. If, for example, the baby's heart rate changes during labor, then a c-section is unavoidable. There are also a number of prenatal indications necessitating a c-section, including transverse presentation (the baby lies crosswise in the uterus) and women with extremely deformed pelvises. Doctors assess some medical indications differently. "One of them is breech presentation" (the baby's buttocks are at the bottom of the uterus, its head at the top), said Klaus Vetter, vice president of the Berlin-based German Society of Gynecology and Obstetrics. When a c-section is merely optional, more and more women and their doctors opt for the procedure nowadays. Women with no medical grounds for a c-section are also opting for the surgery more frequently.

• African-American Women Three Times More Likely to Deliver Premature Babies. [News-Medical.net, Australia] African-American women are three times more likely to deliver babies three to 17 weeks prematurely than Caucasian women, according to a review of Missouri birth statistics by researchers at Washington University School of Medicine in St. Louis. In addition, African-American women are more likely to deliver babies prematurely in subsequent pregnancies. The researchers analyzed data from the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997, adjusting for such variables as socioeconomic status, education level, cigarette smoking and maternal medical conditions such as diabetes, hypertension and eclampsia. Full-term birth is considered to be between 37 weeks and 42 weeks of gestation.

• Pregnant Women Benefit from Flu Shots: Study. [CBC Nova Scotia, Canada] Women are at higher risk of flu-related respiratory illnesses, which should be taken into account when weighing the risks and benefits of a flu shot during pregnancy, Canadian researchers say. Currently, Canadian recommendations say that pregnant women should get a flu shot only if they have a pre-existing medical condition that puts them at higher risk, such as asthma or heart disease, or if they live with someone at high risk. Pregnant women have shown higher deaths rates during influenza pandemics, but little is known about their risks during regular flu seasons.

• Watch that Warns Women When They're Most Fertile. [Daily Mail, UK] A new watch-like device predicts a woman's most fertile time of the month. 'For women, knowing the days before ovulation not only lowers stress levels, but it increases her chances of getting pregnant,' say developers Health Watch Systems. A woman's 'fertility window' starts four days before ovulation and continues until the day after. Intercourse on the day of ovulation gives the highest chance of getting pregnant, but intercourse up to four days before ovulation can still result in pregnancy because sperm can survive for as long as six days in the reproductive tract.

• UNFPA Renews Call To End Female Genital Mutilation / Cutting. [Medical News Today, UK] UNFPA, the United Nations Population Fund, has renewed its call for intensified global efforts to save the 3 million girls who still face the risk of female genital mutilation or cutting every year. In her appeal for the International Day Against Female Genital Mutilation, UNFPA Executive Director Thoraya Ahmed Obaid pledged "to increase support for efforts to prevent female genital mutilation or cutting, and advance gender equality and human rights, including the right to sexual and reproductive health". An estimated 120 to 140 million women have been subjected to the practice, which violates the basic rights of women and girls and seriously compromises their health. The practice leaves lasting physical and psychological scars, in addition to the risks it generates during childbirth.

• Female Genital Mutilation Grips Somalia. [Christian Broadcasting Network] Living in a war zone is one thing. Living under the constant fear of the knife is another matter all together. You have to hear the first-hand accounts of the victims to even begin to understand their plight. Even then, you never completely appreciate the level of trauma they experience. Somalia has the dubious distinction of being the one place in the world where women undergo the most barbaric form of mutilation. The practice is called Female Genital Mutilation , often referred to as "female circumcision." The procedure is extremely graphic so I'll leave it to the experts at the World Health Organization to explain FGM. There are different types of female genital mutilation. The Somalis practice the most extreme form. Hoffman interviewed an elderly lady who claimed to have 'cut' more than 250 girls. The good news is that there's a grassroots movement to stop FGM. It's an uphill battle though. Those involved in the fight often face physical and verbal abuse from the community. Our story looks at this horrific practice through the eyes of a Somali Muslim cleric who is fighting religious and cultural traditions to end FGM. He has a personal stake in the outcome. He has three daughters who are not circumcised.

• Lambo Criticizes Female Genital Mutilation. [The Tide, Nigeria] Health Minister, Eyitayo Lambo has said that Female Genital Mutilation (FGM) impacts negatively on the reproductive health rights of women and the girl child. Speaking in Abuja at a joint ministerial briefing on the International Day of Zero Tolerance for FGM, Eyitayo said the youth should be at the centre of the action in the campaign against the practice. He said it was a form of violence against women and infringes on their dignity and human rights. Mrs. Halimah Alao, Minister of State for Health, who represented Lambo, said that WHO conducted a hospital-based study on FGM and Obstetrics in six African countries including Nigeria in 2006, and confirmed that it exposes women and babies to risk during childbirth. The study also found that there was an increased need to resuscitate babies at birth if their mothers were mutilated while an estimated additional 10 to 20 babies die per 1,000 deliveries as a result of FGM.

• Female Genital Mutilation Down 50% in Niger. [Africa News, Netherlands] Female Genital Mutilation (FGM) among women aged between 15 and 49 years, has fallen by 50% from 5% in 1998 to 2.2% in 2006 in Niger, according to latest official statistics. The figures showed ethnic and regional disparities, with 65.9% of women circumcised among the Gourmancé, 12.8% among the Peulhs and 3.4% among Arabs. The practice was most prevalent in Niamey, the nation's capital, as well as in Tillabéry in the west and Diffa east of the country. UNICEF Representative in Niger, Akhil Iyer, said, "youths must spearhead the fight against the practice" to achieve better results. The Niger Committee on Traditional Practices, CONIPRAT, an NGO involved in the fight against FGM, was said to have sensitized some 6,210 pupils in 70 schools against the practice, in the worst hit regions, last year.

• Calcium, Vitamin D Cut Stress Fractures in Active Young Women: Study. [Chicago Sun-Times] Very active young women who took higher-than-recommended doses of calcium and vitamin D supplements for eight weeks had fewer stress fractures than women who were given dummy pills, a study of naval recruits showed. Experts called the results encouraging and of interest to young female athletes as well as women in the military. ''What really surprised us is that calcium/vitamin D supplements made a significant difference in such a short period of time,'' said lead researcher Joan Lappe. ''Frankly, we were not sure we would see any statistically significant results in only eight weeks.'' Stress fractures are the most common type of injury seen in military trainees, particularly women, and are also prevalent in some athletes.

• Doctors Tell Pregnant Women to Eat Fish Again. [Telegraph.co.uk] Women who eat fish and seafood during their pregnancies could have brighter children and should not worry about harmful consequences, researchers say. The new study seems to bear out the old saying that fish is good for the brain. The researchers believe that the benefits of eating any kind of fish or seafood at levels of about 12oz a week outweigh the risks to the brain of the baby that could be caused by ingesting methylmercury. Both British and American governments warn against eating too much fish in pregnancy because of the mercury risk. In Britain, women are advised to avoid shark, swordfish and marlin and to restrict their intake of tuna. In America, mothers-to-be are told not to eat more than 12oz of fish a week.

• Women Who Eat Seafood While Pregnant May Boost Their Children's IQ. [Centre Daily Times] Women interested in having smart children might want to stock up on seafood while pregnant. A study published in The Lancet tracked the eating habits of 11,875 pregnant women in Bristol, Britain and found that women who ate more than 340 grams per week of fish or seafood - the equivalent of two or three servings a week - had smarter children with better developmental skills. Children whose mothers ate no seafood were 48% more likely to have a low verbal IQ score, compared to children whose mothers ate high amounts of seafood. The results of the study were surprising, say the authors, and contradict American and British recommendations that pregnant women should limit seafood and fish consumption to avoid potentially high levels of mercury.

Miscellaneous

• Drinking Risky for Women with Hepatitis. [Daily Times, Pakistan] Heavy alcohol use increases mortality with hepatitis C virus to a greater extent in women than in men, according to a report. “Previous studies indicated that alcohol use is a risk factor for HCV disease progression, but they seldom examined the effect on women and men separately,” lead author Dr Chiung Chen said in a statement. “Even fewer studies were able to examine the effect of alcohol on HCV mortality. Our study provides empirical evidence to fill the gap.” Chen and colleagues analyzed 132,468 deaths due to HCV and/or heavy alcohol use entered in National Center for Health Statistics databases between 2000 and 2002. Female hepatitis C patients who were not heavy drinkers died at an average age of 61.0 years, while those who drank died at 49.1 years. By contrast, heavy drinking had less effect on lifespan in men, lowering the average age of death with hepatitis C from 55.1 to 50.0 years. The findings emphasize that heavy drinking is a key factor that influences hepatitis C mortality, the researchers state. More importantly, the study provides the first evidence of a gender difference in alcohol intake-related hepatitis C mortality.

• Influence Of The Menstrual Cycle On The Female Brain. [Science Daily] What influence does the variation in estrogen level have on the activation of the female brain? Using functional Magnetic Resonance Imaging, Jean-Claude Dreher, a researcher at the Cognitive Neuroscience Center (CNRS/Université Lyon 1), in collaboration with an American team from the National Institute of Mental Health (Bethesda, Maryland) directed by Karen Berman, has identified, for the first time, the neural networks involved in processing reward-related functions modulated by female gonadal steroid hormones. This result, which was published online on January 29, 2007 on the PNAS website, is an important step in better comprehension of certain psychiatric and neurological pathologies.

• Women Drawn to Scent of a Man. [Los Angeles Daily News] A chemical in male sweat can boost mood, brain activity and sexual arousal in heterosexual women, according to a new study released just in time for Valentine's Day. The study offers the first direct evidence that humans secrete a scent that can affect the physiology of the opposite sex, said researchers at the University of California, Berkeley. Their findings were published this past week in The Journal of Neuroscience. "This is the first time anyone has demonstrated that a change in women's hormonal levels is induced by sniffing an identified compound of male sweat," said study leader Claire Wyart, a postdoctoral fellow at UC Berkeley. "There is much more going on than we think when we are smelling body odor." The study conducted last year involved 48 undergraduate women who took 20 sniffs from a bottle containing androstadienone, a compound found in male perspiration and other bodily secretions.

• U.Va. Researcher's Book Examines Women's Mediocre Sex Lives. [Daily Press] A University of Virginia psychiatrist says that many women have mediocre sex lives because more of them are becoming achievers and overachievers. Anita H. Clayton, an expert on women's sexuality and mental health, has noticed that the pressure to juggle work and family has caused sexual relations to become less of a priority. "Women keep things going all at once," said Clayton, a psychiatry professor at the University of Virginia Health System.

• Extra Cortisol Protects Women's Mood Under Stress. [Science Daily] German researchers have found additional evidence that the stress hormone cortisol can have positive effects in certain situations. Although chronic stress, which brings long-term elevations of cortisol in the bloodstream, can weaken the immune system and induce depression, this new study adds to mounting evidence that cortisol given near in time to a physical or psychological stress may lessen the stressor's emotional impact. Psychologists are especially interested in what this means for preventing and treating post-traumatic stress disorder. The findings appear in the February issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).

• Hormone Fluctuation During Menstrual Cycle Can Make Women Prone To Muscle Injuries. [All Headline News] The sudden rise and drop of hormone levels during women's menstrual cycles can make them prone to muscle injuries, new research has revealed. The fluctuating levels of two hormones, namely estrogen and relaxin, during certain times of the month can weaken muscles and ligaments, thus increasing the risk of injury. According to BBC reports, London's Portland Hospital surveyed 17 women with a regular menstrual cycle and concluded that during the middle of their cycles women experienced a sudden drop in estrogen, a hormone that strengthens muscles and ligaments. Furthermore, as the cycle approaches its end—at around days 24 to 26—levels of the hormone relaxin rise in preparation for the start of the next period. This is to allow the cervix to open to allow menstruation, but it also relaxes the ligaments of a woman's body, which can lead to problems in the lower back and neck. BBC quotes lead researcher Dr. Stephen Sandler, an experienced osteopath, as saying, "There was a clear link between hormone levels and laxity of joints, making women more vulnerable to injury."

• Study Shows Female, Male Drug Trends Different. [ASU Web Devil] Marie Griffin and Nancy Rodriguez, two ASU West professors, concluded that females are more likely to make drug purchases through personal networks, as opposed to other affiliations, and that there is a difference between male offenders and female offenders. The duo researched female drug trends to show their case and to show the effects these trends have on society. Griffin and Rodriguez both work in the School of Criminology and Criminal Justice, as well as the College of Human Services. Griffin also teaches several classes in the area of institutional and community corrections. The opportunity knocked at their door when they were solicited by the National Institute of Justice (NIJ) to conduct data analyses on existing data sets.

• Are Women Germier than Men? [FitSugar.com] A recent study from the University of Arizona has found that a woman's workspace could contain up to four times the germs than those of her male counterpart. Despite her potentially neat appearance, a woman's desk typically has more germ attracting things on it like lotions and/or purses. The women in the study also tended to keep snacks at their desk and food is a prime target of microorganisms. The top spots for a man's germs: His wallet and his PDA. Neither of which are shocking as my husband (and most men) always reach for one or the other. Interesting finding, but before you go getting all bent out of shape about being germier than your man, I do think it is important to point out that Clorox, the king of disinfectant companies, commissioned the study. The earth shattering suggestions to get rid of the germs: Use a hand sanitizer on hands and a disinfectant (like Clorox Wipes, perhaps) on surfaces—Once a day should be sufficient.

• Web Quiz Helps Predict Women's Health. [Harvard University Gazette] Using data collected from more than 24,000 initially healthy American women, researchers from Brigham and Women's Hospital (BWH) have devised a new Web-based formula called the Reynolds Risk Score that for the first time more accurately predicts risk of heart attack or stroke among women. In addition to usual risk factors like cholesterol, blood pressure, and smoking, the new Reynolds Risk Score adds information on two new factors: family history of heart attack prior to age 60 and blood level of C-reactive protein (CRP), a measure of artery inflammation. Using the new risk assessment tool, the researchers found that nearly 50% of women in the study who were estimated to be at "intermediate risk" for heart attack or stroke based on current guidelines were in fact at significantly higher or lower risk levels. For the 10 million American women currently classified at "intermediate risk," use of the Reynolds Risk Score provides doctors and their patients a much clearer picture of who should or should not receive drug therapies such as statins or aspirin, and highlights the critical impact that can be made on heart disease prevention by diet, exercise, and smoking cessation. The findings appear in the Feb. 14 issue of the Journal of the American Medical Association and are available in a user-friendly format for both physicians and their patients at http://www.reynoldsriskscore.org.

• "Female" Knee Implants Sell, But Draw Skepticism. [Scientific American] Debate about whether an artificial knee implant designed specifically for women has scientific merit continues a year after the device was launched, even as the orthopedics manufacturer racks up better-than-expected sales. Many orthopedic surgeons say Zimmer Holdings' female knee is a marketing gimmick, but admit that they will implant them on request. "I don't want to have an argument with the patient over it," said one orthopedist who asked not to be named, noting that the female knee is about twice the price.