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Zipursky RT, Press MC, Srikanthan P, Gornbein J, McClelland R, Watson K, Horwich TB. Relation of Stress Hormones (Urinary Catecholamines/Cortisol) to Coronary Artery Calcium in Men Versus Women (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2017; 119:1963-1971. [PMID: 28456316 DOI: 10.1016/j.amjcard.2017.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
The relation between high levels of psychosocial stress and the development of coronary artery disease (CAD) has been increasingly recognized, especially in women. We hypothesized that simple biomarkers of stress, urinary catecholamines/cortisol levels, are associated with more coronary artery calcium (CAC), an indicator of CAD, and that this relation is stronger in women compared with men. Using data from the Multi-Ethnic Study of Atherosclerosis Stress study, we examined the relation between urinary catecholamines/cortisol and CAC. The study cohort (n = 654) was 53% women, and 56.4% of the cohort had detectable CAC. Multivariable regression analyses assessed the relation between urinary catecholamines/cortisol and CAC (odds CAC >0 through logistic and ln CAC through Tobit model). There was an association between increased cortisol and increased CAC and an inverse association between dopamine and CAC. These relations were seen in men and women, with no difference between the genders. In conclusion, higher cortisol and lower dopamine levels are independently associated with higher CAC to a similar degree in men and women. These simple urinary biomarkers contribute to our understanding of the role of stress in the pathogenesis of CAD and may be incorporated into future strategies to prevent and treat CAD.
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Abstract
OBJECTIVE The aim of the study was to examine how psychological stress changes over time in young and middle-aged patients after experiencing an acute myocardial infarction (AMI) and whether these changes differ between men and women. METHODS We analyzed data obtained from 2358 women and 1151 men aged 18 to 55 years hospitalized for AMI. Psychological stress was measured using the 14-item Perceived Stress Scale (PSS-14) at initial hospitalization and at 1 month and 12 months after AMI. We used linear mixed-effects models to examine changes in PSS-14 scores over time and sex differences in these changes, while adjusting for patient characteristics and accounting for correlation among repeated observations within patients. RESULTS Overall, patients' perceived stress decreased over time, especially during the first month after AMI. Women had higher levels of perceived stress than men throughout the 12-month period (difference in PSS-14 score = 3.63, 95% confidence interval = 3.08 to 4.18, p < .001), but they did not differ in how stress changed over time. Adjustment for patient characteristics did not alter the overall pattern of sex difference in changes of perceived stress over time other than attenuating the magnitude of sex difference in PSS-14 score (difference between women and men = 1.74, 95% confidence interval = 1.32 to 2.16, p < .001). The magnitude of sex differences in perceived stress was similar in patients with versus without post-AMI angina, even though patients with angina experienced less improvement in PSS-14 score than those without angina. CONCLUSIONS In young and middle-aged patients with AMI, women reported higher levels of perceived stress than men throughout the first 12 months of recovery. However, women and men had a similar pattern in how perceived stress changed over time.
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Franconi F, Rosano G, Basili S, Montella A, Campesi I. Human cells involved in atherosclerosis have a sex. Int J Cardiol 2016; 228:983-1001. [PMID: 27915217 DOI: 10.1016/j.ijcard.2016.11.118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/06/2016] [Indexed: 12/30/2022]
Abstract
The influence of sex has been largely described in cardiovascular diseases. Atherosclerosis is a complex process that involves many cell types such as vessel cells, immune cells and endothelial progenitor cells; however, many, if not all, studies do not report the sex of the cells. This review focuses on sex differences in human cells involved in the atherosclerotic process, emphasizing the role of sex hormones. Furthermore, we report sex differences and issues related to the processes that determine the fate of the cells such as apoptotic and autophagic mechanisms. The analysis of the data reveals that there are still many gaps in our knowledge regarding sex influences in atherosclerosis, largely for the cell types that have not been well studied, stressing the urgent need for a clear definition of experimental conditions and the inclusion of both sexes in preclinical studies.
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Affiliation(s)
- Flavia Franconi
- Assessorato alle Politiche per la Persona of Basilicata Region, Potenza, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St. George's University of London, United Kingdom
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties - Research Center on Gender and Evaluation and Promotion of Quality in Medicine (CEQUAM), Sapienza University of Rome, Italy
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ilaria Campesi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Italy.
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Affiliation(s)
- Anita Wokhlu
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL North Florida/South Georgia VA Medical Center, Gainesville, FL
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
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Vaccarino V, Wilmot K, Al Mheid I, Ramadan R, Pimple P, Shah AJ, Garcia EV, Nye J, Ward L, Hammadah M, Kutner M, Long Q, Bremner JD, Esteves F, Raggi P, Quyyumi AA. Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease. J Am Heart Assoc 2016; 5:JAHA.116.003630. [PMID: 27559072 PMCID: PMC5079026 DOI: 10.1161/jaha.116.003630] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI). METHODS AND RESULTS We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. CONCLUSIONS Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kobina Wilmot
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ibhar Al Mheid
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ronnie Ramadan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathon Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Muhammad Hammadah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Radiology, Emory University School of Medicine, Atlanta, GA Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arshed A Quyyumi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 2016; 74:297-309. [PMID: 27496672 DOI: 10.1016/j.neubiorev.2016.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.
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Abstract
Mental stress and emotional arousal can act as triggers of acute myocardial infarction and other adverse cardiovascular outcomes. Experimental research examining mechanisms of the adverse interplay between mind and heart has led to the discovery of mental stress-induced cardiac dysfunction or myocardial ischemia (MSIMI). Evidence about the prevalence, clinical significance, and mechanistic bases of MSIMI outlines a wide range of central and peripheral bio-pathologic processes that are associated with emotions and behaviors. MSIMI is recognized as an integrated and intermediate biomarker underpinning the negative mind-heart interplay. Particularly, MSIMI research paves the way toward investigations aiming more specifically at recognizing the susceptibilities of individuals who are prone to respond adversely to the psycho-social-environmental stress. This article reviews recent literature on MSIMI research following the comprehensive review of Strike and Steptoe Eur Heart J 24:690-703, 2003. Further, this article outlines the main steps in the identification of the specific bio-pathologic manifestations of the cardiovascular system to emotional stress. Finally, a speculative description is provided of future directions in better searching for areas that may be critical targets in resolving adverse mind-heart interplays.
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Affiliation(s)
- Wei Jiang
- Duke University Medical Center, Box 3366, Durham, NC, 27710, USA,
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Kangas P, Tahvanainen A, Tikkakoski A, Koskela J, Uitto M, Viik J, Kähönen M, Kööbi T, Mustonen J, Pörsti I. Increased Cardiac Workload in the Upright Posture in Men: Noninvasive Hemodynamics in Men Versus Women. J Am Heart Assoc 2016; 5:JAHA.115.002883. [PMID: 27329447 PMCID: PMC4937251 DOI: 10.1161/jaha.115.002883] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Men and women differ in the risk of cardiovascular disease, but the underlying mechanisms are not completely understood. We examined possible sex‐related differences in supine and upright cardiovascular regulation. Methods and Results Hemodynamics were recorded from 167 men and 167 women of matching age (≈45 years) and body mass index (≈26.5) during passive head‐up tilt. None had diabetes mellitus or cardiovascular disease other than hypertension or used antihypertensive medication. Whole‐body impedance cardiography, tonometric radial blood pressure, and heart rate variability were analyzed. Results were adjusted for height, smoking, alcohol intake, mean arterial pressure, plasma lipids, and glucose. Supine hemodynamic differences were minor: Men had lower heart rate (−4%) and higher stroke index (+7.5%) than women (P<0.05 for both). Upright systemic vascular resistance was lower (−10%), but stroke index (+15%), cardiac index (+16%), and left cardiac work were clearly higher (+20%) in men than in women (P<0.001 for all). Corresponding results were observed in a subgroup of men and postmenopausal women (n=76, aged >55 years). Heart rate variability analyses showed higher low:high frequency ratios in supine (P<0.001) and upright (P=0.003) positions in men. Conclusions The foremost difference in cardiovascular regulation between sexes was higher upright hemodynamic workload for the heart in men, a finding not explained by known cardiovascular risk factors or hormonal differences before menopause. Heart rate variability analyses indicated higher sympathovagal balance in men regardless of body position. The deviations in upright hemodynamics could play a role in the differences in cardiovascular risk between men and women. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01742702.
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Affiliation(s)
| | - Anna Tahvanainen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Mika Kähönen
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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59
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Zhou X, Niu JM, Ji WJ, Zhang Z, Wang PP, Ling XFB, Li YM. Precision test for precision medicine: opportunities, challenges and perspectives regarding pre-eclampsia as an intervention window for future cardiovascular disease. Am J Transl Res 2016; 8:1920-1934. [PMID: 27347303 PMCID: PMC4891408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/23/2016] [Indexed: 06/06/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) comprise a spectrum of syndromes that range in severity from gestational hypertension and pre-eclamplsia (PE) to eclampsia, as well as chronic hypertension and chronic hypertension with superimposed PE. HDP occur in 2% to 10% of pregnant women worldwide, and impose a substantial burden on maternal and fetal/infant health. Cardiovascular disease (CVD) is the leading cause of death in women. The high prevalence of non-obstructive coronary artery disease and the lack of an efficient diagnostic workup make the identification of CVD in women challenging. Accumulating evidence suggests that a previous history of PE is consistently associated with future CVD risk. Moreover, PE as a maladaptation to pregnancy-induced hemodynamic and metabolic stress may also be regarded as a "precision" testing result that predicts future cardiovascular risk. Therefore, the development of PE provides a tremendous, early opportunity that may lead to changes in maternal and infant future well-being. However, the underlying pathogenesis of PE is not precise, which warrants precision medicine-based approaches to establish a more precise definition and reclassification. In this review, we proposed a stage-specific, PE-targeted algorithm, which may provide novel hypotheses that bridge the gap between Big Data-generating approaches and clinical translational research in terms of PE prediction and prevention, clinical treatment, and long-term CVD management.
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Affiliation(s)
- Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
| | - Jian-Min Niu
- Guangdong Women and Children HospitalGuangzhou, Guangdong Province 511400, China
| | - Wen-Jie Ji
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of MedicineChicago, Illinois 60611, USA
| | - Peizhong P Wang
- Faculty of Medicine, Memorial University of NewfoundlandNewfoundland and Labrador, 300 Prince Phillip Drive, Canada
| | - Xue-Feng B Ling
- Department of Surgery, Stanford UniversityPalo Alto, California, 94305, USA
| | - Yu-Ming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
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Abstract
The different responses of women and men to cardiovascular drugs reflect gender -specific variances in pharmacokinetic profiles and drug sensitivities coupled to inherent differences in the underlying physiology of each sex. Thus, many common cardiovascular drugs exhibit gender -specific therapeutic and adverse effects. For example, the QT interval of the electrocardiogram is longer in women compared to men, and accordingly, drugs that prolong the QT interval are more likely to cause lethal ventricular arrhythmias in female than male patients. As more clinical drug trials include women subjects, our improved knowledge base for assessing the risk/benefit ratio for cardiovascular drugs in women will enable us to consider gender as one factor in prescribing drugs and adjusting drug loading and maintenance dosages. This short review will present evidence for gender- related differences in the responses to common cardiovascular drugs including statins, antiplatelet and antithrombotic agents, β-blockers, digoxin, vasodilator therapies, and drugs associated with the Long QT Syndrome.
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Affiliation(s)
- Amanda J Stolarz
- Department of Pharmacology and Toxicology, College of Medicine, and College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Mail Slot 611, Little Rock, AR, 72205-7199, USA,
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Breen MS, Beliakova-Bethell N, Mujica-Parodi LR, Carlson JM, Ensign WY, Woelk CH, Rana BK. Acute psychological stress induces short-term variable immune response. Brain Behav Immun 2016; 53:172-182. [PMID: 26476140 DOI: 10.1016/j.bbi.2015.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/01/2015] [Accepted: 10/13/2015] [Indexed: 11/19/2022] Open
Abstract
In spite of advances in understanding the cross-talk between the peripheral immune system and the brain, the molecular mechanisms underlying the rapid adaptation of the immune system to an acute psychological stressor remain largely unknown. Conventional approaches to classify molecular factors mediating these responses have targeted relatively few biological measurements or explored cross-sectional study designs, and therefore have restricted characterization of stress-immune interactions. This exploratory study analyzed transcriptional profiles and flow cytometric data of peripheral blood leukocytes with physiological (endocrine, autonomic) measurements collected throughout the sequence of events leading up to, during, and after short-term exposure to physical danger in humans. Immediate immunomodulation to acute psychological stress was defined as a short-term selective up-regulation of natural killer (NK) cell-associated cytotoxic and IL-12 mediated signaling genes that correlated with increased cortisol, catecholamines and NK cells into the periphery. In parallel, we observed down-regulation of innate immune toll-like receptor genes and genes of the MyD88-dependent signaling pathway. Correcting gene expression for an influx of NK cells revealed a molecular signature specific to the adrenal cortex. Subsequently, focusing analyses on discrete groups of coordinately expressed genes (modules) throughout the time-series revealed immune stress responses in modules associated to immune/defense response, response to wounding, cytokine production, TCR signaling and NK cell cytotoxicity which differed between males and females. These results offer a spring-board for future research towards improved treatment of stress-related disease including the impact of stress on cardiovascular and autoimmune disorders, and identifies an immune mechanism by which vulnerabilities to these diseases may be gender-specific.
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Affiliation(s)
- Michael S Breen
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | | | - Lilianne R Mujica-Parodi
- Department of Biomedical Engineering, State University of New York at Stony Brook, Stony Brook, NY 11794-5281, USA
| | - Joshua M Carlson
- Department of Psychology, Northern Michigan University, Marquette, MI 49855, USA
| | - Wayne Y Ensign
- Space and Naval Warfare Systems Center - Pacific, Applied Sciences Division, San Diego, CA 92152, USA
| | - Christopher H Woelk
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Brinda K Rana
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; VA San Diego Center for Stress and Mental Health, La Jolla, CA 92093, USA.
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 742] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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63
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Aspirin dosing frequency in the primary and secondary prevention of cardiovascular events. J Thromb Thrombolysis 2016; 41:493-504. [DOI: 10.1007/s11239-015-1307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Affiliation(s)
- S S Arri
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - M Ryan
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - S R Redwood
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - M S Marber
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
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Welch V, Jull J, Petkovic J, Armstrong R, Boyer Y, Cuervo LG, Edwards S, Lydiatt A, Gough D, Grimshaw J, Kristjansson E, Mbuagbaw L, McGowan J, Moher D, Pantoja T, Petticrew M, Pottie K, Rader T, Shea B, Taljaard M, Waters E, Weijer C, Wells GA, White H, Whitehead M, Tugwell P. Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials. Implement Sci 2015; 10:146. [PMID: 26490367 PMCID: PMC4618136 DOI: 10.1186/s13012-015-0332-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). METHODS/DESIGN A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. DISCUSSION This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.
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Affiliation(s)
- Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Jull
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - R Armstrong
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - Y Boyer
- Canada Research Chair in Aboriginal Health and Wellness, Brandon University, Manitoba, Canada.
| | - L G Cuervo
- Research Promotion and Development Office of Knowledge Management, Bioethics and Research Pan American Health Organization, World Health Organization, Washington, DC, USA.
| | - Sjl Edwards
- Research Ethics and Governance, University College London, London, England.
| | - A Lydiatt
- Cochrane Musculoskeletal Group, London, Ontario, Canada.
| | - D Gough
- Department of Social Science, University College London, London, UK.
| | - J Grimshaw
- Ottawa Hospital Research Institute, Medicine University of Ottawa, Ottawa, Canada.
| | - E Kristjansson
- School of Psychology, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada. .,Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, Yaoundé, Cameroon.
| | - J McGowan
- Department of Medicine, University of Ottawa, Ontario, Canada.
| | - D Moher
- Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - T Pantoja
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Centro Médico San Joaquín Vicuña Mackenna 4686, Macul, Santiago, Chile.
| | - M Petticrew
- Department of Social and Environmental Health Research, Public Health Evaluation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England.
| | - K Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine Primary Care Research Group and Equity Methods Group, Bruyere Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
| | - T Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave Ottawa, Ontario, Canada.
| | - B Shea
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - M Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada.
| | - E Waters
- Public Health Insight, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - C Weijer
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, Ontario, Canada.
| | - G A Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - H White
- Alfred Deakin University, Geelong, Victoria, Australia.
| | - M Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - P Tugwell
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
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Tuckett A, Henwood T, Oliffe JL, Kolbe-Alexander TL, Kim JR. A Comparative Study of Australian and New Zealand Male and Female Nurses' Health: A Sex Comparison and Gender Analysis. Am J Mens Health 2015; 10:450-458. [PMID: 25595018 DOI: 10.1177/1557988314567222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this research was to compare the health and lifestyle behaviors between male and female nursing professionals. Biological, workplace, and lifestyle factors as well as health behaviors and outcomes are reported as different between male and female nurses. Although male nurses show distinct health-related patterns and experience health disparities at work, few studies have investigated health differences by sex in a large cohort group of nursing professionals. This observation study of Australian and New Zealand nurses and midwives drew data from an eCohort survey. A cohort of 342 females was generated by SPSS randomization (total N=3625), to compare against 342 participating males. Measures for comparison include health markers and behaviors, cognitive well-being, workplace and leisure-time vitality, and functional capacity. Findings suggest that male nurses had a higher BMI, sat for longer, slept for less time, and were more likely to be a smoker than their female nurse counterparts. Men were more likely to report restrictions in bending, bathing, and dressing. In relation to disease, male nurses reported greater rates of respiratory disease and cardiovascular disease, including a three times greater incidence of myocardial infarction, and were more likely to have metabolic problems. In contrast, however, male nurses were more likely to report feeling calm and peaceful with less worries about their health. Important for nurse workforce administrators concerned about the well-being of their staff, the current study reveals significant sex differences and supports the need for gender-sensitive approaches to aid the well-being of male nurses.
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Affiliation(s)
- Anthony Tuckett
- School of Nursing and Midwifery, University of Queensland, Herston, Queensland, Australia School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada College of Nursing, Yonsei University Health System, Seodaemun-gu, Seoul, Korea
| | - Tim Henwood
- School of Nursing and Midwifery, Blue Care Research and Practice Development Centre, University of Queensland, Brisbane, Queensland, Australia
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada School of Nursing and Midwifery, Herston, Queensland, Australia
| | - Tracy L Kolbe-Alexander
- Centre for Research in Exercise, Physical Activity and Health, School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
| | - Jae Rin Kim
- College of Nursing, Yonsei University Health System, Seoul, Korea
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Sex differences in mental stress-induced myocardial ischemia: are women from venus? J Am Coll Cardiol 2014; 64:1679-80. [PMID: 25323255 DOI: 10.1016/j.jacc.2014.06.1206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
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