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Affiliation(s)
- Richmond W. Jeremy
- Central Clinical School, Faculty of Medicine and Health, University of Sydney. Sydney, New South Wales, Australia
- Marfan and Aortic Disease Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Øhman EA, Fossli M, Ottestad I, Holven KB, Ulven SM, Løland BF, Brekke HK. Dietary treatment postpartum in women with obesity reduces weight and prevents weight gain: a randomised controlled trial. BMC Pregnancy Childbirth 2023; 23:695. [PMID: 37752466 PMCID: PMC10521473 DOI: 10.1186/s12884-023-05976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Women with pre-pregnancy obesity have an increased risk of retaining or gaining weight postpartum and may benefit from weight loss treatment. However, evidence is lacking for weight loss strategies in women with BMIs in the higher obesity classes. A dietary treatment for postpartum weight loss resulted in a 10% weight reduction in lactating women with a mean BMI of 30 kg/m2. We aimed to examine the effects of this dietary treatment on changes in weight, markers of lipid and glucose metabolism, waist and hip circumference and postpartum weight retention (PPWR) in postpartum women with higher BMIs than tested previously. METHODS At baseline, approximately 8 weeks postpartum, 29 women with a mean (SD) BMI = 40.0 (5.2) kg/m2 were randomised to a 12-week dietary treatment (n 14) or to a control treatment (n 15). Measurements were made at baseline and after 3 and 12 months. Data was analysed using mixed model. RESULTS The mean weight change in the diet group was -2.3 (3.1) kg compared to 1.7 (3.1) kg in the control group after 3 months (P = 0.003) and -4.2 (5.6) kg compared to 4.8 (11.8) kg in the control group after 12 months (P = 0.02). The dietary treatment led to reduced waist circumference (P < 0.04) and PPWR (P < 0.01) compared to the control treatment at both time points. The treatment lowered fasting blood glucose at 12 months (P = 0.007) as the only effect on markers of lipid and glucose metabolism. CONCLUSION The dietary treatment postpartum reduced weight and prevented weight retention or weight gain in women with obesity. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov (NCT03579667) 06/07/2018. In a randomised, controlled trial, 29 postpartum women with obesity were allocated to a dietary treatment or a control treatment. The dietary treatment reduced weight and prevented postpartum weight retention or weight gain after 12 months. Reference: Adapted from "Randomized, Placebo-Controlled, Parallel Study Design (2 Arms, Graphical)", by BioRender.com (2022). Retrieved from https://app.biorender.com/biorender-templates .
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Affiliation(s)
- Elisabeth A Øhman
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Maria Fossli
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Adipol, Women's Clinic, Oslo University Hospital, Oslo, Norway
- The Clinical Nutrition Outpatient Clinic, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Beate F Løland
- Unit for Breastfeeding, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Adam L, Baretella O, Feller M, Blum MR, Papazoglou DD, Boland B, Aujesky D, Baggio S, Rodondi N. Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population. Front Cardiovasc Med 2023; 10:1236547. [PMID: 37808883 PMCID: PMC10551156 DOI: 10.3389/fcvm.2023.1236547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Statin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential benefits against potential side effects, drug-drug interactions, and limited life expectancy. Aim To assess the prevalence and determinants of potentially inappropriate statin therapy in multimorbid older patients. Methods We conducted a cross-sectional analysis of patients aged ≥70 years with multimorbidity and polypharmacy in the Swiss study center of OPERAM, a cluster-randomized trial on pharmacotherapy optimization to reduce drug-related hospital admissions. We assessed potential underuse (no statin but formal indication) and potential overuse (statin but no formal indication, including predicted >60% one-year mortality based on the Walter Score) based on current guidelines for patients in secondary and primary cardiovascular prevention. We assessed the association of potential statin overuse and underuse with six patient characteristics (age, gender, number of diagnoses, number of medications, mental impairment, being housebound) in LASSO-selection analyses. Results Of 715 multimorbid older adults (79.7 ± 6.5 years, 39.9% women), 337 (47%) were on statin. Statin therapy was appropriate in 474 (66.3%), underused in 130 (18.2%), and overused in 111 (15.5%) patients. In participants in secondary cardiovascular prevention (n = 437), being female (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.67-4.22) was significantly associated with potential underuse while being housebound (OR 3.53, 95%CI 1.32-9.46) and taking ≥10 medications (OR 1.95,95%CI 1.05-3.67) were associated with potential overuse. In participants in primary cardiovascular prevention (n = 278), 28.1% were potentially under- (9%) or overusing (19%) a statin, with no identified risk factor. Conclusion A third of hospitalized multimorbid older patients with polypharmacy potentially (either) overused or underused statin therapy. Among patients in secondary cardiovascular prevention, women were at risk for potential statin underuse. Housebound patients and those taking ≥10 medications were at risk for potential overuse of a statin. Physicians should carefully evaluate the indication for statin prescription in multimorbid older patients with polypharmacy.
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Affiliation(s)
- Luise Adam
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Gefässzentrum, Kantonsspital Baden, Baden, Switzerland
| | - Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuel Raphael Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitrios David Papazoglou
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benoit Boland
- Geriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Health Science Research Institute, UCLouvain, Louvain, Belgium
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bai Y, Wu B, Gou L, Fang Z, Xu T, Zhang T, Li Y. Cardiovascular Safety Evaluation of Febuxostat and Allopurinol: Findings from the FDA Adverse Event Reporting System. J Clin Med 2023; 12:6089. [PMID: 37763029 PMCID: PMC10531992 DOI: 10.3390/jcm12186089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Febuxostat and allopurinol are the most commonly used uric acid-lowering medications, and their safety is of great concern, especially the cardiovascular adverse reactions associated with febuxostat. We propose to study the cardiovascular toxicity of febuxostat and allopurinol using the FDA Adverse Event Reporting System (FAERS) database. METHODS A total of 64 quarters of FAERS data were downloaded from 2004 to 2019. Febuxostat- and allopurinol-related cardiovascular adverse events were extracted after data cleaning. Signal detection was conducted by reporting odds ratio (ROR) and proportional reporting ratio (PRR). RESULTS There were 2939 and 25,219 reports of febuxostat- and allopurinol-related cardiovascular adverse events (CVAEs), respectively. The most frequent CVAEs with febuxostat and allopurinol were edema peripheral (14.38%) and peripheral swelling (8.76%), respectively. In elderly gout patients, febuxostat is associated with an increased risk of heart failure, ischemic heart disease, hypertension, and cardiomyopathy. Febuxostat in combination with acetic acid derivatives nonsteroidal anti-inflammatory drug (NSAIDS) also increases the risk of cardiovascular adverse events. CONCLUSIONS Compared with allopurinol, febuxostat may increase cardiovascular toxicity in patients with gout.
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Affiliation(s)
- Yang Bai
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Liangwen Gou
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Zhenwei Fang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Tiejun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
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Marschner S, Mukherjee S, Watts M, Min H, Beale AL, O'Brien J, Juneja A, Tremmel JA, Zaman S. Prevention of Cardiovascular Disease in Women With Pregnancy-Related Risk Factors: A Prospective Women's Heart Clinic Study. J Am Heart Assoc 2023; 12:e030015. [PMID: 37642017 PMCID: PMC10547318 DOI: 10.1161/jaha.123.030015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P=0.004), with no significant change in lipid targets (80.6% to 83.7%, P=0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], P<0.001), body mass index (-0.6 kg/m2 [95% CI, -0.8 to -0.3], P<0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], P=0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] P=0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P=0.012), decreased fast food consumption (33.8% to 11.0%, P<0.001), and increased physical activity (84.0% to 92.9%, P=0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Swati Mukherjee
- Department of CardiologyCabrini HealthMelbourneAustralia
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneAustralia
| | - Monique Watts
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medical EducationUniversity of MelbourneMelbourneAustralia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Anna L. Beale
- Department of CardiologyAlfred HospitalMelbourneAustralia
| | | | - Aashima Juneja
- Department of MedicineThe Northern HospitalMelbourneAustralia
| | - Jennifer A. Tremmel
- Department of Medicine (Cardiovascular)Stanford University School of MedicineStanfordCA
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
- Department of CardiologyWestmead HospitalSydneyAustralia
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Georgiopoulos G, Delialis D, Aivalioti E, Georgakis V, Mavraganis G, Angelidakis L, Bampatsias D, Armeni E, Maneta E, Patras R, Dimopoulou MA, Oikonomou E, Kanakakis I, Lambrinoudaki I, Lagiou A, Xenos P, Stamatelopoulos K. Implementation of risk enhancers in ASCVD risk estimation and hypolipidemic treatment eligibility: A sex-specific analysis. Hellenic J Cardiol 2023; 73:16-23. [PMID: 36805072 DOI: 10.1016/j.hjc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Sex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high-sensitivity C-reactive protein (hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention of atherosclerotic cardiovascular disease (ASCVD). METHODS We aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n = 698, 50.9% women and Menopause Clinic n = 373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2 (SCORE2) tools. The presence of carotid plaque and hsCRP ≥2 mg/L were integrated as risk modifiers. RESULTS Men had increased odds to achieve target LDL-C levels based on ASCVD risk (23.8% vs. 17.7%, OR: 1.45 95% CI: 1.05-2.00, p = 0.023, for men vs. women). Additionally, considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation (11.5% vs. 26.4%, p < 0.001) compared with men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in a higher relative increase in hypolipidemic treatment eligibility in women (from 11.5% to 70.9% vs. 26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs. 26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs. 26.4% to 75% for their combination, all for women vs. men, pforinteraction < 0.001 for all) than men. CONCLUSIONS Implementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than in men. The impact on clinical outcomes in these untreated patients merits further investigation.
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vasileios Georgakis
- Department of Statistics and Insurance Science, School of Finance and Statistics, University of Piraeus, Piraeus, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Lasthenis Angelidakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Elena Armeni
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria Angeliki Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ermioni Oikonomou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Areti Lagiou
- Department of Public and Community Health, Faculty of Public Health, University of West Attica, Athens, Greece
| | - Panos Xenos
- Department of Statistics and Insurance Science, School of Finance and Statistics, University of Piraeus, Piraeus, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece.
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Wise JM, Jackson EA, Kempf MC, Oates GR, Wang Z, Overton ET, Siddiqui M, Woodward M, Rosenson RS, Muntner P. Sex differences in incident atherosclerotic cardiovascular disease events among women and men with HIV. AIDS 2023; 37:1661-1669. [PMID: 37195280 DOI: 10.1097/qad.0000000000003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The protective advantage against atherosclerotic cardiovascular disease (ASCVD) experienced by women compared to men in the general population is diminished in some high- risk populations. People with HIV have a higher risk for ASCVD compared to the general population. OBJECTIVE Compare the incidence of ASCVD among women versus men with HIV. METHODS We analyzed data from women ( n = 17 118) versus men ( n = 88 840) with HIV, and women ( n = 68 472) and men ( n = 355 360) matched on age, sex, and calendar year of enrollment without HIV who had commercial health insurance in the MarketScan database between 2011 and 2019. ASCVD events during follow-up, including myocardial infarction, stroke, and lower-extremity artery disease, were identified using validated claims-based algorithms. RESULTS Among those with and without HIV, the majority of women (81.7%) and men (83.6%) were <55 years old. Over a mean follow-up of 2.25-2.36 years depending on sex-HIV sub-group, the ASCVD incidence rate per 1000 person-years was 2.87 [95% confidence interval (CI) 2.35, 3.40] and 3.61 (3.35, 3.88) among women and men with HIV, respectively, and 1.24 (1.07, 1.42) and 2.57 (2.46, 2.67) among women and men without HIV, respectively. After multivariable adjustment, the hazard ratio for ASCVD comparing women to men was 0.70 (95% CI 0.58, 0.86) among those with HIV and 0.47 (0.40, 0.54) among those without HIV ( P -interaction = 0.001). CONCLUSION The protective advantage of female sex against ASCVD observed in the general population is diminished among women with HIV. Earlier and more intensive treatment strategies are needed to reduce sex-based disparities.
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Affiliation(s)
- Jenni M Wise
- Department of Family, Community, and Health Systems
| | | | - Mirjam-Colette Kempf
- Department of Family, Community, and Health Systems
- Department of Medicine
- Department of Epidemiology
- Department of Health Behavior
| | - Gabriela R Oates
- Department of Medicine
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Mark Woodward
- The George Institute for Global Health, Camperdown, New South Wales
- Department of Medical Statistics, University of New South Wales, Sydney, Australia
- Department of Statistics, Epidemiology, and Women's Health, Imperial College, London, UK
| | - Robert S Rosenson
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Muntner
- Department of Medicine
- Department of Epidemiology
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Dei Cas A, Aldigeri R, Mantovani A, Masulli M, Palmisano L, Cavalot F, Bonomo K, Baroni MG, Cossu E, Cavallo G, Cimini FA, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Morieri ML, Pollis RM, Targher G, Vigili de Kreutzenberg S. Sex Differences in Cardiovascular Disease and Cardiovascular Risk Estimation in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:e789-e798. [PMID: 36881927 DOI: 10.1210/clinem/dgad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
CONTEXT Patients with type 1 diabetes (T1D) have higher cardiovascular disease (CVD) risk than the general population. OBJECTIVE This observational study aims to evaluate sex-related differences in CVD prevalence and CVD risk estimates in a large cohort of T1D adults. METHODS We conducted a multicenter, cross-sectional study involving 2041 patients with T1D (mean age 46 years; 44.9% women). In patients without pre-existing CVD (primary prevention), we used the Steno type 1 risk engine to estimate the 10-year risk of developing CVD events. RESULTS CVD prevalence (n = 116) was higher in men than in women aged ≥55 years (19.2 vs 12.8%, P = .036), but comparable between the 2 sexes in those aged <55 years (P = .91). In patients without pre-existing CVD (n = 1925), mean 10-year estimated CVD risk was 15.4 ± 0.4% without any significant sex difference. However, stratifying this patient group by age, the 10-year estimated CVD risk was significantly higher in men than in women until age 55 years (P < .001), but this risk equalized after this age. Carotid artery plaque burden was significantly associated with age ≥55 years and with a medium and high 10-year estimated CVD risk, without any significant sex difference. Diabetic retinopathy and sensory-motor neuropathy were also associated with higher 10-year CVD risk and female sex. CONCLUSION Both men and women with T1D are at high CVD risk. The 10-year estimated CVD risk was higher in men aged <55 years than in women of similar age, but these sex differences disappeared at age ≥55 years, suggesting that female sex was no longer protective.
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Affiliation(s)
- Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Raffaella Aldigeri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Franco Cavalot
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Efisio Cossu
- Unit of Diabetology, Policlinico Universitario of Cagliari, 09124 Cagliari, Italy
| | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | | | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, 00185 Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS, Casa Sollievo della Sofferenza Hospital, 71013 San Giovanni Rotondo (FG), Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, 35128 Padua, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
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Xie J, Wang J, Zeng R, Xie Y. Association between Helicobacter pylori infection and triglyceride levels: a nested cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1220347. [PMID: 37664839 PMCID: PMC10468968 DOI: 10.3389/fendo.2023.1220347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Currently, the available evidence regarding the relationship between the lipid profile and Helicobacter pylori (H. pylori) infection is limited and conflicting. There is also a dearth of studies that have explored the possibility of sex-specific differences in the association between H. pylori infection and triglyceride levels. Methods We conducted a cross-sectional study involving 1,146 participants utilizing data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 conducted in the United States. A logistic regression model was employed to evaluate the association between H. pylori seropositivity and triglyceride levels. Subgroup analyses stratified by sex were conducted to explore sex-specific differences in this association. Results Serum triglyceride levels were significantly higher in H. pylori-seropositive participants than in H. pylori-seronegative participants. In the logistic regression analysis, there was a positive correlation between H. pylori seropositivity and triglyceride levels (OR=1.231; 95% CI, 1.016-1.491; P=0.033). In the subgroup analysis, the adjusted association between serum triglycerides and H. pylori seropositivity was significant in females (OR=1.732; 95% CI, 1.113-2.696; P=0.015) but not in males (OR=1.091; 95% CI, 0.698-1.705; P=0.704). Conclusion The association between high triglyceride levels and H. pylori infection is specific to the female population.
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Affiliation(s)
- Jun Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinyun Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rong Zeng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Kilanowski-Doroh IM, McNally AB, Wong T, Visniauskas B, Blessinger SA, Imulinde Sugi A, Richard C, Diaz Z, Horton A, Natale CA, Ogola BO, Lindsey SH. Ovariectomy-Induced Arterial Stiffening Differs from Vascular Aging and is Reversed by GPER Activation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.10.552881. [PMID: 37645992 PMCID: PMC10462036 DOI: 10.1101/2023.08.10.552881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Arterial stiffness is a cardiovascular risk factor and dramatically increases as women transition through menopause. The current study assessed whether a mouse model of menopause increases arterial stiffness in a similar manner to aging, and whether activation of the G protein-coupled estrogen receptor (GPER) could reverse stiffness. Female C57Bl/6J mice were ovariectomized (OVX) at 10 weeks of age or aged to 52 weeks, and some mice were treated with GPER agonists. OVX and aging increased pulse wave velocity to a similar extent independent of changes in blood pressure. Aging increased carotid wall thickness, while OVX increased material stiffness without altering vascular geometry. RNA-Seq analysis revealed that OVX downregulated smooth muscle contractile genes. The enantiomerically pure GPER agonist, LNS8801, reversed stiffness in OVX mice to a greater degree than the racemic agonist G-1. In summary, OVX and aging induced arterial stiffening via potentially different mechanisms. Aging was associated with inward remodeling while OVX induced material stiffness independent of geometry and a loss of the contractile phenotype. This study helps to further our understanding of the impact of menopause on vascular health and identifies LNS8801 as a potential therapy to counteract this detrimental process in women.
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Mattioli AV, Doltra A, Prieto C, Gallina S. Editorial: Women in cardiovascular imaging. Front Cardiovasc Med 2023; 10:1249983. [PMID: 37600041 PMCID: PMC10434246 DOI: 10.3389/fcvm.2023.1249983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Adelina Doltra
- Non-invasive Imaging Section, Cardiovascular Institute Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Claudia Prieto
- King's College London, London, United Kingdom
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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Morgan T, Ralston A, Davey A, Holliday EG, Nelson M, Fielding A, van Driel M, Tapley A, Moad D, Ball J, Presser J, Spike N, Magin P. Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study. Fam Med Community Health 2023; 11:e002251. [PMID: 37604595 PMCID: PMC10445344 DOI: 10.1136/fmch-2023-002251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). DESIGN A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). SETTING Three GP regional training organisations (RTOs) across three Australian states. PARTICIPANTS GP registrars training within participating RTOs. RESULTS 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). CONCLUSION Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups.
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Affiliation(s)
- Toby Morgan
- School of Population Health, University of New South Wales Faculty of Medicine, Kensington, New South Wales, Australia
| | - Anna Ralston
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth G Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Nelson
- University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia
- University of Tasmania School of Medicine, Hobart, Tasmania, Australia
| | - Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominica Moad
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jennifer Presser
- University of Tasmania School of Medicine, Hobart, Tasmania, Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, The University of Melbourne, Carlton, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Madar H, Lalanne-Mistrih ML, Lebbar M, Wu Z, Robitaille Y, Pelletier J, Grou C, Brazeau AS, Rabasa-Lhoret R. Cardiovascular Risk Factors and Adherence to Cardiovascular Protection Practice Guidelines in Adults With Type 1 Diabetes: A BETTER Registry Cross-sectional Analysis. Can J Diabetes 2023; 47:473-481.e1. [PMID: 37059389 DOI: 10.1016/j.jcjd.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/12/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD) is a major cause of morbidity and mortality in people with type 1 diabetes (PWT1D). We assessed cardiovascular risk factors and pharmacologic treatment in a large Canadian cohort of PWT1D. METHODS This cross-sectional study used data from adult PWT1D in the BETTER registry (n=974). CVD risk factor status, diabetes complications, and treatments (used as proxy for blood pressure and dyslipidemia) were self-reported through online questionnaires. Objective data were available for a subgroup of PWT1D (23%, n=224). RESULTS Participants were adults (43.9±14.8 years) with a diabetes duration of 23.3±15.2 years; 34.8% reported glycated hemoglobin (A1C) levels of ≤7%, 67.2% reported a very high cardiovascular risk, and 27.2% reported at least 3 CVD risk factors. Most participants received care for CVD in accordance with the Diabetes Canada Clinical Practice Guidelines (DC-CPG), with a median recommended pharmacologic treatment score of 75.0%. However, 3 subgroups of participants with lower adherence (<70%) to DC-CPG were identified: 1) those with microvascular complications and receiving a statin (60.8%, 208 of 342) or renin-angiotensin axis nephroprotective therapy (52.6%, 180 of 342); 2) those aged ≥40 years and receiving statin therapy (67.1%, 369 of 550); and 3) those aged ≥30 years with a diabetes duration of ≥15 years and receiving statin therapy (58.9%, 344 of 584). Among a subgroup of participants with recent laboratory results, only 24.5% of PWT1D (26 of 106) achieved both A1C and low-density lipoprotein cholesterol targets. CONCLUSIONS Most PWT1D received recommended pharmacologic cardiovascular protection, but specific subgroups required special attention. Target achievement for key risk factors remains suboptimal.
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Affiliation(s)
- Houssein Madar
- Montreal Clinical Research Institute, Montréal, Québec, Canada
| | - Marie-Laure Lalanne-Mistrih
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, University Hospital, Abymes, Guadeloupe, France; UFR Medicine, French West Indies University, Abymes, Guadeloupe, France
| | - Maha Lebbar
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Zekai Wu
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Robitaille
- Centre de Médecine Métabolique de Lanaudière, Terrebone, Québec, Canada
| | | | - Caroline Grou
- Montreal Clinical Research Institute, Montréal, Québec, Canada
| | - Anne-Sophie Brazeau
- Montreal Clinical Research Institute, Montréal, Québec, Canada; School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Québec, Canada; Montréal Diabetes Research Center, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Montréal Diabetes Research Center, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal Endocrinology Division and CHUM Research Center, Montréal, Québec, Canada.
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Vicent L, Rosillo N, Moreno G, Salguero-Bodes R, Goñi C, Bernal JL, Seara G, Bueno H. Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis. Front Cardiovasc Med 2023; 10:1202960. [PMID: 37588036 PMCID: PMC10425536 DOI: 10.3389/fcvm.2023.1202960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
Aims Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Methods and results Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. Conclusion There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Nicolás Rosillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Guillermo Moreno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Clara Goñi
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - José Luis Bernal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Control Management Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Germán Seara
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Poznyak AV, Sukhorukov VN, Guo S, Postnov AY, Orekhov AN. Sex Differences Define the Vulnerability to Atherosclerosis. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2023; 17:11795468231189044. [PMID: 37529084 PMCID: PMC10387777 DOI: 10.1177/11795468231189044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
For several decades, atherosclerosis has attracted the attention of researchers around the world. Even being a major cause of serious cardiovascular disease and events, atherosclerosis is still not fully understood. Despite the fact that the main players in the pathogenesis of atherosclerosis are well known, many mechanisms of their implementation and interactions remain unknown. The same can be said about the risk factors for atherosclerosis. Many of them are known, but exactly how they work remains to be seen. The main objective of this review is to summarize the latest data on sex as a biological variable in atherosclerosis in humans and animals; to determine what we do not still know about how sex affects the process of growth and complications of atherosclerosis. In this review, we summarized data on sex differences at 3 atherosclerotic aspects: inflammation, vascular remodeling, and plaque morphology. With all overviewed data, we came to the conclusion on the atheroprotective role of female sex.
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Affiliation(s)
| | - Vasiliy N Sukhorukov
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Shuzhen Guo
- Diabetes Research Center, School of Traditional Chinese Medicine, Beijing University of Chinese, Beijing, China
| | - Anton Y Postnov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Federal State Budgetary Scientific Institution «Petrovsky National Research Centre of Surgery» (FSBSI “Petrovsky NRCS”), Moscow, Russia
| | - Alexander N Orekhov
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Moscow, Russia
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Bani Hani S, Ahmad M. Effective Prediction of Mortality by Heart Disease Among Women in Jordan Using the Chi-Squared Automatic Interaction Detection Model: Retrospective Validation Study. JMIR Cardio 2023; 7:e48795. [PMID: 37471126 PMCID: PMC10401188 DOI: 10.2196/48795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Many current studies have claimed that the actual risk of heart disease among women is equal to that in men. Using a large machine learning algorithm (MLA) data set to predict mortality in women, data mining techniques have been used to identify significant aspects of variables that help in identifying the primary causes of mortality within this target category of the population. OBJECTIVE This study aims to predict mortality caused by heart disease among women, using an artificial intelligence technique-based MLA. METHODS A retrospective design was used to retrieve big data from the electronic health records of 2028 women with heart disease. Data were collected for Jordanian women who were admitted to public health hospitals from 2015 to the end of 2021. We checked the extracted data for noise, consistency issues, and missing values. After categorizing, organizing, and cleaning the extracted data, the redundant data were eliminated. RESULTS Out of 9 artificial intelligence models, the Chi-squared Automatic Interaction Detection model had the highest accuracy (93.25%) and area under the curve (0.825) among the build models. The participants were 62.6 (SD 15.4) years old on average. Angina pectoris was the most frequent diagnosis in the women's extracted files (n=1,264,000, 62.3%), followed by congestive heart failure (n=764,000, 37.7%). Age, systolic blood pressure readings with a cutoff value of >187 mm Hg, medical diagnosis (women diagnosed with congestive heart failure were at a higher risk of death [n=31, 16.58%]), pulse pressure with a cutoff value of 98 mm Hg, and oxygen saturation (measured using pulse oximetry) with a cutoff value of 93% were the main predictors for death among women. CONCLUSIONS To predict the outcomes in this study, we used big data that were extracted from the clinical variables from the electronic health records. The Chi-squared Automatic Interaction Detection model-an MLA-confirmed the precise identification of the key predictors of cardiovascular mortality among women and can be used as a practical tool for clinical prediction.
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Affiliation(s)
- Salam Bani Hani
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Burrowes KS, Ruppage M, Lowry A, Zhao D. Sex matters: the frequently overlooked importance of considering sex in computational models. Front Physiol 2023; 14:1186646. [PMID: 37520817 PMCID: PMC10374267 DOI: 10.3389/fphys.2023.1186646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Personalised medicine and the development of a virtual human or a digital twin comprises visions of the future of medicine. To realise these innovations, an understanding of the biology and physiology of all people are required if we wish to apply these technologies at a population level. Sex differences in health and biology is one aspect that has frequently been overlooked, with young white males being seen as the "average" human being. This has not been helped by the lack of inclusion of female cells and animals in biomedical research and preclinical studies or the historic exclusion, and still low in proportion, of women in clinical trials. However, there are many known differences in health between the sexes across all scales of biology which can manifest in differences in susceptibility to diseases, symptoms in a given disease, and outcomes to a given treatment. Neglecting these important differences in the development of any health technologies could lead to adverse outcomes for both males and females. Here we highlight just some of the sex differences in the cardio-respiratory systems with the goal of raising awareness that these differences exist. We discuss modelling studies that have considered sex differences and touch on how and when to create sex-specific models. Scientific studies should ensure sex differences are included right from the study planning phase and results reported using sex as a biological variable. Computational models must have sex-specific versions to ensure a movement towards personalised medicine is realised.
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Affiliation(s)
- K. S. Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - M. Ruppage
- Department of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. Lowry
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - D. Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Heizmann AN, Chapelle C, Laporte S, Roche F, Hupin D, Le Hello C. Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e069966. [PMID: 37433730 DOI: 10.1136/bmjopen-2022-069966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To systematically review randomised controlled trials (RCTs) using a wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in patients with cardiovascular disease (CVD). DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES PubMed, Embase and Web of Science from inception to June 2022. ELIGIBILITY CRITERIA Randomised controlled studies including patients with CVD over 18 years of age at the end of a cardiac rehabilitation programme comparing an intervention group using a wearable physical activity monitoring device with feedback with usual care or with a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walk test (6-MWT) or a change in peak oxygen uptake (V̇O2peak) as endpoints. RESULTS Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27); p<0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI (0.27; 1.16); p<0.01), but no significant interaction was found between subgroups (p=0.55). 6-MWT distance and V̇O2peak showed only small effects (SMD 0.34; 95% CI (-0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03); p=0.07, respectively). CONCLUSION The use of wearable physical activity monitoring devices appears to help patients with CVD to increase their daily walking activity and thus their physical activity, particularly in the short term. PROSPERO REGISTRATION NUMBER CRD42022300423.
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Affiliation(s)
- Anne-Noëlle Heizmann
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
| | - Céline Chapelle
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Silvy Laporte
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
| | - Frederic Roche
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - David Hupin
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Claire Le Hello
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Vascular and Therapeutic Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
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69
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Tang X, Zhan ZY, Rao Z, Fang H, Jiang J, Hu X, Hu Z. A spatiotemporal analysis of the association between carbon productivity, socioeconomics, medical resources and cardiovascular diseases in southeast rural China. Front Public Health 2023; 11:1079702. [PMID: 37483926 PMCID: PMC10359911 DOI: 10.3389/fpubh.2023.1079702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/20/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction With China's rapid industrialization and urbanization, China has been increasing its carbon productivity annually. Understanding the association between carbon productivity, socioeconomics, and medical resources with cardiovascular diseases (CVDs) may help reduce CVDs burden. However, relevant studies are limited. Objectives The study aimed to describe the temporal and spatial distribution pattern of CVDs hospitalization in southeast rural China and to explore its influencing factors. Methods In this study, 1,925,129 hospitalization records of rural residents in southeast China with CVDs were analyzed from the New Rural Cooperative Medical Scheme (NRCMS). The spatial distribution patterns were explored using Global Moran's I and Local Indicators of Spatial Association (LISA). The relationships with influencing factors were detected using both a geographically and temporally weighted regression model (GTWR) and multiscale geographically weighted regression (MGWR). Results In southeast China, rural inpatients with CVDs increased by 95.29% from 2010 to 2016. The main groups affected were elderly and women, with essential hypertension (26.06%), cerebral infarction (17.97%), and chronic ischemic heart disease (13.81%) being the leading CVD subtypes. The results of LISA shows that central and midwestern counties, including Meilie, Sanyuan, Mingxi, Jiangle, and Shaxian, showed a high-high cluster pattern of CVDs hospitalization rates. Negative associations were observed between CVDs hospitalization rates and carbon productivity, and positive associations with per capita GDP and hospital beds in most counties (p < 0.05). The association between CVDs hospitalization rates and carbon productivity and per capita GDP was stronger in central and midwestern counties, while the relationship with hospital bed resources was stronger in northern counties. Conclusion Rural hospitalizations for CVDs have increased dramatically, with spatial heterogeneity observed in hospitalization rates. Negative associations were found with carbon productivity, and positive associations with socioeconomic status and medical resources. Based on our findings, we recommend low-carbon development, use of carbon productivity as an environmental health metric, and rational allocation of medical resources in rural China.
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Affiliation(s)
- Xuwei Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhi-Ying Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhixiang Rao
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Haiyin Fang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jian Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Medical Department of Fujian Provincial Hospital, Fuzhou, China
| | - Xiangju Hu
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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Luntz A, Creary K, Bruessow D. Managing patients with sex-, race-, or ethnicity-based cardiovascular health inequities. JAAPA 2023; 36:16-24. [PMID: 37306606 DOI: 10.1097/01.jaa.0000937264.73482.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ABSTRACT Cardiovascular health inequities are experienced among cisgender women, gender minorities, Black and Indigenous people, and people with lower socioeconomic status. Early identification and treatment of patients at risk for disparate and adverse cardiac health outcomes are essential.
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Affiliation(s)
- Allison Luntz
- Allison Luntz is a PA surgical resident at Norwalk Hospital/Yale Physician Assistant Surgical Residency in Norwalk, Conn. Kashif Creary is assistant director of PA services at NYU Langone Hospital-Brooklyn in New York City, N.Y. Diane Bruessow is director of justice, equity, diversity, and inclusion in the Yale PA Online Program and assistant professor adjunct in the Department of Internal Medicine at Yale School of Medicine in New Haven, Conn., and a clinically practicing PA in transgender medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Stranges TN, Namchuk AB, Splinter TFL, Moore KN, Galea LAM. Are we moving the dial? Canadian health research funding trends for women's health, 2S/LGBTQ + health, sex, or gender considerations. Biol Sex Differ 2023; 14:40. [PMID: 37322516 PMCID: PMC10273719 DOI: 10.1186/s13293-023-00524-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Sex and gender impacts health outcomes and disease risk throughout life. The health of women and members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (2S/LGBTQ +) community is often compromised as they experience delays in diagnosis. Distinct knowledge gaps in the health of these populations have prompted funding agencies to mandate incorporation of sex and gender into research. Sex- and gender-informed research perspectives and methodology increases rigor, promotes discovery, and expands the relevance of health research. Thus, the Canadian Institutes of Health Research (CIHR) implemented a sex and gender-based analysis (SGBA) framework recommending the inclusion of SGBA in project proposals in 2010 and then mandating the incorporation of SGBA into grant proposals in 2019. To examine whether this mandate resulted in increased mention of sex or gender in funded research abstracts, we searched the publicly available database of grant abstracts funded by CIHR to analyze the percentage of abstracts that mentioned sex or gender of the population to be studied in the funded research. To better understand broader health equity issues we also examined whether the funded grant abstracts mentioned either female-specific health research or research within the 2S/LGBTQ + community. RESULTS We categorized a total of 8,964 Project and Operating grant abstracts awarded from 2009 to 2020 based on their study of female-specific or a 2S/LGBTQ + populations or their mention of sex or gender. Overall, under 3% of grant abstracts funded by CIHR explicitly mentioned sex and/or gender, as 1.94% of grant abstracts mentioned sex, and 0.66% mentioned gender. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% of grant abstracts mentioned female-specific outcomes, and 0.35% of grant abstracts focused on the 2S/LGBTQ + community. CONCLUSIONS Although there was an increased number of funded grants with abstracts that mentioned sex and 2S/LGBTQ + health across time, these increases were less than 2% between 2009 and 2020. The percentage of funded grants with abstracts mentioning female-specific health or gender differences did not change significantly over time. The percentage of funding dollars allocated to grants in which the abstracts mentioned sex or gender also did not change substantially from 2009 to 2020, with grant abstracts mentioning sex or female-specific research increasing by 1.26% and 3.47%, respectively, funding allocated to research mentioning gender decreasing by 0.49% and no change for 2S/LGBTQ +-specific health. Our findings suggest more work needs to be done to ensure the public can evaluate what populations will be examined with the funded research with respect to sex and gender to advance awareness and health equity in research.
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Affiliation(s)
- Tori N. Stranges
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, BC Canada
| | - Amanda B. Namchuk
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada
| | | | - Katherine N. Moore
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
| | - Liisa A. M. Galea
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada
- Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Lyell I, Khan SS, Limmer M, O'Flaherty M, Head A. Association between gender social norms and cardiovascular disease mortality and life expectancy: an ecological study. BMJ Open 2023; 13:e065486. [PMID: 37105692 PMCID: PMC10151956 DOI: 10.1136/bmjopen-2022-065486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Examine the association between country-level gender social norms and (1) cardiovascular disease mortality rates; (2) female to male cardiovascular disease mortality ratios; and (3) life expectancy. DESIGN Ecological study with the country as the unit of analysis. SETTING Global, country-level data. PARTICIPANTS Global population of countries with data available on gender social norms as measured by the Gender Social Norms Index (developed by the United Nations Development Programme). MAIN OUTCOME MEASURES Country-level female and male age-standardised cardiovascular disease mortality rates, population age-standardised cardiovascular disease mortality rates, female to male cardiovascular disease mortality ratios, female and male life expectancy at birth. Outcome measure data were retrieved from the WHO and the Institute for Health Metrics and Evaluation. Multivariable linear regression models were fitted to explore the relationship between gender social norms and the outcome variables. RESULTS Higher levels of biased gender social norms, as measured by the Gender Social Norms Index, were associated with higher female, male and population cardiovascular disease mortality rates in the multivariable models (β 4.86, 95% CIs 3.18 to 6.54; β 5.28, 95% CIs 3.42 to 7.15; β 4.89, 95% CIs 3.18 to 6.60), and lower female and male life expectancy (β -0.07, 95% CIs -0.11 to -0.03; β -0.05, 95% CIs -0.10 to -0.01). These results included adjustment within the models for potentially confounding country-level factors including gross domestic product per capita, population mean years of schooling, physicians per 1000 population, year of Gender Social Norms Index data collection and maternal mortality ratio. CONCLUSIONS Our analysis suggests that higher levels of biased gender social norms are associated with higher rates of population cardiovascular disease mortality and lower life expectancy for both sexes. Future research should explore this relationship further, to define its causal role and promote public health action.
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Affiliation(s)
- Iona Lyell
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sadiya S Khan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark Limmer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Petermann-Rocha F, Deo S, Celis-Morales C, Ho FK, Bahuguna P, McAllister D, Sattar N, Pell JP. An Opportunity for Prevention: Associations Between the Life's Essential 8 Score and Cardiovascular Incidence Using Prospective Data from UK Biobank. Curr Probl Cardiol 2023; 48:101540. [PMID: 36528209 DOI: 10.1016/j.cpcardiol.2022.101540] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
To investigate the association between the Life's Essential 8 (LE8) score and the incidence of four cardiovascular outcomes (ischemic heart disease, myocardial infarction, stroke, and heart failure [HF]) - separately and as a composite outcome of major adverse cardiovascular events (MACE) - in UK Biobank. 250,825 participants were included in this prospective study. Smoking, non-HDL cholesterol, blood pressure, body mass index, HbA1c, physical activity, diet, and sleep were used to create a modified version of the LE8 score. Associations between the score (both as a continuous score and as quartiles) and outcomes were investigated using adjusted Cox proportional hazard models. The potential impact fractions of two scenarios were also calculated. Over a median follow-up of 10.4 years, there were 25,068 MACE. Compared to individuals in the highest quartile of the score (healthiest), those in the lowest quartile (least healthy) had 2.07 (95% CI: 1.99; 2.16) higher risk for MACE. The highest relative risk gradient of the individual outcomes was observed for HF (HRlowest quartile: 2.67 [95% CI: 2.42; 2.94]). The magnitude of association was stronger in participants below 50 years, women, and ethnic minorities. A targeted intervention that increased, by 10-points, the score among individuals in the lowest quartile could have prevented 9.2% of MACE. Individuals with a lower LE8 score experienced more MACE, driven especially by incident HF. Our scenarios suggested that relevant interventions targeted towards those in the lowest quartile may have a greater impact than interventions producing small equal changes across all quartiles.
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Affiliation(s)
- Fanny Petermann-Rocha
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Salil Deo
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK; Louis Stokes Cleveland VA Medical Center, Cleveland USA; Department of Surgery, Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Carlos Celis-Morales
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Pankaj Bahuguna
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Naveed Sattar
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK.
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Conlon FL, Arnold AP. Sex chromosome mechanisms in cardiac development and disease. NATURE CARDIOVASCULAR RESEARCH 2023; 2:340-350. [PMID: 37808586 PMCID: PMC10558115 DOI: 10.1038/s44161-023-00256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/13/2023] [Indexed: 10/10/2023]
Abstract
Many human diseases, including cardiovascular disease, show differences between men and women in pathology and treatment outcomes. In the case of cardiac disease, sex differences are exemplified by differences in the frequency of specific types of congenital and adult-onset heart disease. Clinical studies have suggested that gonadal hormones are a factor in sex bias. However, recent research has shown that gene and protein networks under non-hormonal control also account for cardiac sex differences. In this review, we describe the sex chromosome pathways that lead to sex differences in the development and function of the heart and highlight how these findings affect future care and treatment of cardiac disease.
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Affiliation(s)
- Frank L Conlon
- Departments of Biology and Genetics, McAllister Heart Institute, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Arthur P Arnold
- Department of Integrative Biology & Physiology, University of California, Los Angeles, CA, 90095, USA
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Nugraheni WP, Retnaningsih E, Mubasyiroh R, Rachmawati T. Effects of the COVID-19 pandemic on cardiovascular disease financing in Indonesia (JKN claims data analysis 2019–2020). Front Public Health 2023; 11:1148394. [PMID: 37064689 PMCID: PMC10102516 DOI: 10.3389/fpubh.2023.1148394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
The disease burden related to non-communicable diseases is a major public health problem in Indonesia. About one-third of all deaths in Indonesia are caused by cardiovascular disease. This study describes the cost of cardiovascular disease from claims data for Advanced Referral Health Facilities at BPJS Kesehatan before and during the COVID-19 pandemic. We analyzed claims data on the National Health Insurance system managed by BPJS. The data comes from referral health facilities throughout Indonesia in 2019 and 2020. Cardiovascular service claims data by sex and age group were analyzed descriptively and with different tests between years. There was a decrease in the number of patients accessing cardiovascular services at referral health facilities for all genders, age groups, and types of main diagnoses, by around 27.8%, from 933,017 (2019) to 673,801 (2020). There was a significant decrease in total claims for all types of cardiovascular disease during the COVID-19 pandemic compared to before, especially the reduction in aneurysms and aortic dissection (40.2%) and hypertensive heart disease (39.6%). The decline also occurred in all sexes and age groups, with an average percentage decline of 31.2%. Our findings show that the reduction in the cost of cardiovascular disease claims goes hand in hand with the decrease in the number of cardiovascular patient visits. To guarantee treatment for cardiovascular disease patients during the COVID-19 pandemic, BPJS can maximize the telemedicine services that have been built. The organizer of the National Health Insurance program in Indonesia has developed a JKN mobile application that has the potential for telemedicine services guaranteed by JKN. On the other hand, BPJS needs to limit promotive and preventive budgets related to CVD so that it does not become a potential catastrophic financing.
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Affiliation(s)
- Wahyu Pudji Nugraheni
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bogor, Indonesia
| | - Ekowati Retnaningsih
- Regional Research and Development Agency South Sumatra Province, Palembang, Indonesia
- *Correspondence: Ekowati Retnaningsih
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bogor, Indonesia
| | - Tety Rachmawati
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bogor, Indonesia
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Kundu J, James KS, Hossain B, Chakraborty R. Gender differences in premature mortality for cardiovascular disease in India, 2017-18. BMC Public Health 2023; 23:547. [PMID: 36949397 PMCID: PMC10035272 DOI: 10.1186/s12889-023-15454-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017-18. METHODS The information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson's correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied. RESULTS Men have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50-54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1-4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women). CONCLUSION YLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.
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Affiliation(s)
- Jhumki Kundu
- International Institute for Population Sciences, 400088, Mumbai, India
| | - K S James
- International Institute for Population Sciences, 400088, Mumbai, India
| | - Babul Hossain
- International Institute for Population Sciences, 400088, Mumbai, India.
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Akram W, Rihan M, Ahmed S, Arora S, Ahmad S, Vashishth R. Marine-Derived Compounds Applied in Cardiovascular Diseases: Submerged Medicinal Industry. Mar Drugs 2023; 21:md21030193. [PMID: 36976242 PMCID: PMC10052127 DOI: 10.3390/md21030193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Cardiovascular diseases (CVDs) are among the most impactful illnesses globally. Currently, the available therapeutic option has several side effects, including hypotension, bradycardia, arrhythmia, and alteration in different ion concentrations. Recently, bioactive compounds from natural sources, including plants, microorganisms, and marine creatures, have gained a lot of interest. Marine sources serve as reservoirs for new bioactive metabolites with various pharmacological activities. The marine-derived compound such as omega-3 acid ethyl esters, xyloketal B, asperlin, and saringosterol showed promising results in several CVDs. The present review focuses on marine-derived compounds' cardioprotective potential for hypertension, ischemic heart disease, myocardial infarction, and atherosclerosis. In addition to therapeutic alternatives, the current use of marine-derived components, the future trajectory, and restrictions are also reviewed.
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Affiliation(s)
- Wasim Akram
- Department of Pharmacology, SPER, Jamia Hamdard, New Delhi 110062, India
| | - Mohd Rihan
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Mohali 160062, India
| | - Sakeel Ahmed
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Mohali 160062, India
| | - Swamita Arora
- Department of Pharmacology, R. V. Northland Institute of Pharmacy, Dadri 203207, India
| | - Sameer Ahmad
- Department of Food Technology Jamia Hamdard, New Delhi 110062, India
| | - Rahul Vashishth
- School of BioSciences and Technology-Food Technology, Vellore Institute of Technology, Vellore 632014, India
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A Sex-Specific Comparative Analysis of Oxidative Stress Biomarkers Predicting the Risk of Cardiovascular Events and All-Cause Mortality in the General Population: A Prospective Cohort Study. Antioxidants (Basel) 2023; 12:antiox12030690. [PMID: 36978938 PMCID: PMC10044882 DOI: 10.3390/antiox12030690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Oxidative stress plays a pivotal role in cardiovascular (CV) disease, but current biomarkers used to predict CV events are still insufficient. In this study, we comparatively assessed the utility of redox-related biomarkers in predicting the risk of CV events and all-cause mortality in male and female subjects from the general population. Subjects (n = 5955) of the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) population-based cohort study were included. Blood homocysteine, gamma-GT, HDL cholesterol, bilirubin and protein-adjusted free thiol (R-SH, sulfhydryl groups) levels were quantified at baseline and were prospectively analyzed in association with the risk of CV events and all-cause mortality. After adjustment for potentially confounding factors, protein-adjusted R-SH and homocysteine levels were significantly associated with the risk of CV events in men (HR 0.63 [0.40–0.99], p = 0.045 and HR 1.58 [1.20–2.08], p = 0.001, respectively). Protein-adjusted R-SH and HDL cholesterol levels were significantly associated with the risk of all-cause mortality in men (HR 0.52 [0.32–0.85], p = 0.009 and HR 0.90 [0.85–0.94], p < 0.001, respectively), while the same was observed for bilirubin and homocysteine levels in women (HR 0.68 [0.48–0.98], p = 0.040 and HR 2.30 [1.14–3.76], p < 0.001, respectively). Lower levels of protein-adjusted R-SH were robustly associated with an increased risk of CV events and all-cause mortality in men. Our results highlight the value of R-SH levels in cardiovascular risk assessment and their potential significance as being amenable to therapeutic intervention, while reaffirming the importance of other oxidative stress-related biomarkers, such as homocysteine, HDL cholesterol and bilirubin.
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Venkat V, Abdelhalim H, DeGroat W, Zeeshan S, Ahmed Z. Investigating genes associated with heart failure, atrial fibrillation, and other cardiovascular diseases, and predicting disease using machine learning techniques for translational research and precision medicine. Genomics 2023; 115:110584. [PMID: 36813091 DOI: 10.1016/j.ygeno.2023.110584] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality and loss of disability adjusted life years (DALYs) globally. CVDs like Heart Failure (HF) and Atrial Fibrillation (AF) are associated with physical effects on the heart muscles. As a result of the complex nature, progression, inherent genetic makeup, and heterogeneity of CVDs, personalized treatments are believed to be critical. Rightful application of artificial intelligence (AI) and machine learning (ML) approaches can lead to new insights into CVDs for providing better personalized treatments with predictive analysis and deep phenotyping. In this study we focused on implementing AI/ML techniques on RNA-seq driven gene-expression data to investigate genes associated with HF, AF, and other CVDs, and predict disease with high accuracy. The study involved generating RNA-seq data derived from the serum of consented CVD patients. Next, we processed the sequenced data using our RNA-seq pipeline and applied GVViZ for gene-disease data annotation and expression analysis. To achieve our research objectives, we developed a new Findable, Accessible, Intelligent, and Reproducible (FAIR) approach that includes a five-level biostatistical evaluation, primarily based on the Random Forest (RF) algorithm. During our AI/ML analysis, we have fitted, trained, and implemented our model to classify and distinguish high-risk CVD patients based on their age, gender, and race. With the successful execution of our model, we predicted the association of highly significant HF, AF, and other CVDs genes with demographic variables.
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Affiliation(s)
- Vignesh Venkat
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick, NJ, USA
| | - Habiba Abdelhalim
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick, NJ, USA
| | - William DeGroat
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick, NJ, USA
| | - Saman Zeeshan
- Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St, New Brunswick, NJ, USA
| | - Zeeshan Ahmed
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick, NJ, USA; Department of Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, 125 Paterson St, New Brunswick, NJ, USA.
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Abstract
PURPOSE OF REVIEW Endothelial dysfunction is a major risk factor for many cardiovascular diseases, notably hypertension. Obesity increases the risk of endothelial dysfunction in association with increasing production of the adipokine leptin. Preclinical studies have begun to unravel the mechanisms whereby leptin leads to the development of endothelial dysfunction, which are sex-specific. This review will summarize recent findings of mechanisms of leptin-induced endothelial impairment in both male and females and in pregnancy. RECENT FINDINGS Leptin receptors are found in high concentrations in the central nervous system (CNS), via which leptin promotes appetite suppression and upregulates sympathetic nervous system activation. However, leptin receptors are expressed in many other tissues, including the vascular endothelial cells and smooth muscle cells. Recent studies in mice with vascular endothelial or smooth muscle-specific knockdown demonstrate that endothelial leptin receptor activation plays a protective role against endothelial dysfunction in male animals, but not necessarily in females. Clinical studies indicate that women may be more sensitive to obesity-associated vascular endothelial dysfunction. Emerging preclinical data indicates that leptin and progesterone increase aldosterone production and endothelial mineralocorticoid receptor activation, respectively. Furthermore, decades of clinical studies indicate that leptin levels increase in the hypertensive pregnancy disorder preeclampsia, which is characterized by systemic endothelial dysfunction. Leptin infusion in mice induces the clinical characteristics of preeclampsia, including endothelial dysfunction. SUMMARY Novel preclinical data indicate that the mechanisms whereby leptin promotes endothelial dysfunction are sex-specific. Leptin-induced endothelial dysfunction may also play a role in hypertensive pregnancy as well.
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Affiliation(s)
- Elisabeth Mellott
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Jessica L Faulkner
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA
- Department of OBGYN, Medical College of Georgia at Augusta University, Augusta, GA
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81
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Kuo WC, Ersig AL, Johnson HM, Brown RL, Oakley LD, Hagen EW, Barnet JH, Peppard PE. Association between stressful life events and non-optimal lipid levels among women with hyperlipidaemia. Eur J Cardiovasc Nurs 2023; 22:210-219. [PMID: 35714051 DOI: 10.1093/eurjcn/zvac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022]
Abstract
AIMS Psychological stress has been linked to lipid dysregulation with noticeable gender differences, but it remains unclear whether women are more susceptible to non-optimal lipid levels than men, when experiencing stressful life events. This study aims to examine the association between stressful life events and non-optimal lipid levels among persons with hyperlipidaemia and whether the association differs between men and women. METHODS AND RESULTS A nested case-control study was performed using data from the Wisconsin Sleep Cohort (WSC) Study from 2011 to 2015, including 224 participants with hyperlipidaemia and without a history of myocardial infarction or heart failure. Among them, 63 participants with non-optimal LDL cholesterol or triglyceride levels were identified as cases, and 161 participants with optimal LDL cholesterol and triglyceride levels were identified as controls. Cases and controls were traced back to their self-reported life events collected through the Retirement and Sleep Trajectories study during 2010-11. The association between stressful life events and non-optimal lipid levels was examined using multivariable logistic regression; confounding effects were addressed using propensity score weighting and Mahalanobis distance matching; gender differences were examined using subgroup analysis. Results showed that a higher number of stressful life events during 2010-11 was associated with greater odds of non-optimal lipid levels during 2011-15 (odds ratio = 1.45, P = 0.03) among women with hyperlipidaemia, whereas the association was not significant among men with hyperlipidaemia (P = 0.910). CONCLUSION Future studies are needed to examine the underlying mechanisms that explain gender differences in the association between stressful life events and non-optimal lipid levels. REGISTRATION ClinicalTrials.gov NCT00005557.
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Affiliation(s)
- Wan-Chin Kuo
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Anne L Ersig
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Heather M Johnson
- Christine E. Lynn Women's Health and Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Florida Atlantic University, Boca Raton, FL, USA
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda D Oakley
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika W Hagen
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Jodi H Barnet
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul E Peppard
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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82
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Clinical outcomes by atherosclerotic cardiovascular disease risk score and blood pressure level in high risk individuals with type 2 diabetes. J Hum Hypertens 2023; 37:181-188. [PMID: 35184142 DOI: 10.1038/s41371-022-00661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 02/04/2022] [Indexed: 11/09/2022]
Abstract
Clinical practice guidelines for patients with diabetes recommend using blood pressure (BP) and atherosclerotic cardiovascular disease (ASCVD) risk to guide antihypertensive treatment. While this approach directs treatment to patients who should receive a large ASCVD risk reduction, its effect on other outcomes is uncertain. The aim of this study was to assess the contributions of systolic blood pressure level (SBP) and predicted 10-year ASCVD risk using Pooled Cohort risk equations to the prediction of major macrovascular disease, death and major microvascular disease in patients with diabetes. Data came from 7426 individuals with type 2 diabetes (T2D) without macrovascular disease at baseline in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. The risk for major macrovascular events and death increased progressively across ASCVD risk categories. Compared to participants with 10-year predicted ASCVD risk <20% and SBP <130 mmHg, the hazard ratios (HRs) (95% confidence intervals (CIs)) associated with SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% were 1.01 (0.58, 1.77), 1.90 (1.28, 2.84) and 2.82 (1.98, 4.01) for major macrovascular disease, respectively, and 0.83 (0.42, 1.62), 1.79 (1.13, 2.82) and 3.29 (2.22, 4.88) for death, respectively. The risk for major microvascular disease increased with BP regardless of ASCVD risk; HRs for SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% vs. ASCVD risk <20% and SBP <130 mmHg were 1.52 (1.08,2.13), 1.47 (1.10, 1.96) and 1.23 (0.94, 1.60), respectively. ASCVD risk in addition to SBP improved the estimation of major macrovascular events and death but not major microvascular events among individuals with T2D.
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83
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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84
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Zhou TL, Reulen JPH, Van Der Staaij H, Stehouwer CDA, Van Greevenbroek M, Henry RMA, Kroon AA. Cardiovagal baroreflex sensitivity, blood pressure and blood pressure variability - the Maastricht study. J Hypertens 2023; 41:254-261. [PMID: 36385097 DOI: 10.1097/hjh.0000000000003323] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Low baroreflex sensitivity (BRS) has been hypothesized to underlie high blood pressure (BP) and greater BP variability on the longer term, but evidence is scarce. In addition, these associations may differ by sex and (pre)diabetes. Therefore, we investigated whether cardiovagal BRS is associated with short- to mid-term mean BP and BP variability, and differs according to sex and (pre)diabetes. METHODS Cross-sectional data from the population-based Maastricht study (age 60 ± 8 years, 52% men), where office ( n = 2846), 24-h ( n = 2404) and 7-day BP measurements ( n = 2006) were performed. Spontaneous BRS was assessed by cross-correlating systolic BP and instantaneous heart rate. We used linear regression with adjustments for age, sex, BP or BP variability, and cardiovascular risk factors. RESULTS With regard to BP, 1-SD (standard deviation) lower BRS (-5.75 ms/mmHg) was associated with higher office, 24-h and 7-day systolic BP (2.22 mmHg [95% confidence interval [CI]: 1.59; 2.80], 0.95 mmHg [0.54; 1.36], and 1.48 mmHg [0.99; 1.97], respectively) and diastolic BP (1.31 mmHg [0.97; 1.66], 0.57 mmHg [0.30; 0.84], and 0.86 mmHg [0.54; 1.17], respectively). Per 1-SD lower BRS, these associations were stronger in women (0.5-1.5 mmHg higher compared to men), and weaker in those with type 2 diabetes (1-1.5 mmHg lower compared to normal glucose metabolism). With regard to BP variability, BRS was not consistently associated with lower BP variability. CONCLUSIONS Lower cardiovagal BRS is associated with higher mean BP from the short- to mid-term range, and not consistently with BP variability. The associations with mean BP are stronger in women and weaker in those with type 2 diabetes.
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Affiliation(s)
- Tan Lai Zhou
- Department of Internal Medicine, Maastricht University Medical Centre
- CARIM School for Cardiovascular Diseases, Maastricht University
| | | | | | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre
- CARIM School for Cardiovascular Diseases, Maastricht University
| | - Marleen Van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre
- CARIM School for Cardiovascular Diseases, Maastricht University
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre
- CARIM School for Cardiovascular Diseases, Maastricht University
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre
- CARIM School for Cardiovascular Diseases, Maastricht University
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85
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Liu M, Zheng M, He S. Association between tobacco smoking and heart disease in older adults: a cross-sectional study based on the Chinese Longitudinal Healthy Longevity Survey. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:63. [PMID: 36819549 PMCID: PMC9929806 DOI: 10.21037/atm-22-6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Background The association between the risk of heart disease and tobacco smoking has been studied in previous work, but there are arguments among various population. We aimed to investigate the association between heart disease incidence and smoking status among older adults. Methods A cross-sectional analysis was conducted with 10,891 older adults in the 2 most recent waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2011-2014 and 2014-2018. The data included individual weighting variables to ensure they were nationally representative. The parameters consisted of age, sex, body mass index (BMI), smoking status, and disease history was collected. Smoking measures included current/former/never status, pack-years and the time to first cigarette. Heart disease included coronary artery disease, arrhythmias, heart failure, valve diseases and other heart conditions. Respondents with missed values were excluded. Multivariable logistic regression analyses were performed. Results Among the 10,006 respondents included in the analyses, 4,501 (44.9%) were men. The median age was 88 years old [interquartile range (IQR), 78-96]. A total of 6,713 respondents (67.1%) were nonsmokers, 1,695 respondents (16.9%) were former smokers, and 1,598 respondents (16.0%) were current smokers. The incidence of heart disease was significantly higher in smokers compared with nonsmokers (14.5% vs. 12.8%, P=0.018). Female smokers and those over 80 years old had higher morbidity than male smokers. After adjusting for sex, age, BMI, hypertension, diabetes, area of residency, alcohol status, and exercise status, smokers still had an increased risk of heart disease [odds ratio (OR) 1.29, 95% confidential interval (CI): 1.10-1.50, P=0.001]. The incidence of heart disease also increased with higher intensity of smoking for each additional pack-year (OR 1.01, 95% CI: 1.00-1.02, P=0.011). Conclusions For elderly adults, current or former smoking was largely associated with heart disease incidence, especially in females and those over 80 years old. These variables could be considered for inclusion in future heart disease risk prediction models.
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Affiliation(s)
- Ming Liu
- Department of Cardiology, Cardiac Catheterization Room, West China Hospital of Sichuan University, Chengdu, China
| | - Mingxia Zheng
- Department of Cardiology, Cardiac Catheterization Room, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, Cardiac Catheterization Room, West China Hospital of Sichuan University, Chengdu, China
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Risk of cardiovascular events according to the tricyclic antidepressant dosage in patients with chronic pain: a retrospective cohort study. Eur J Clin Pharmacol 2023; 79:159-171. [PMID: 36443528 DOI: 10.1007/s00228-022-03421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to examine the risk of cardiovascular adverse events by tricyclic antidepressant (TCA) dosage among patients with chronic pain. METHODS A retrospective cohort study was conducted using a nationwide sample cohort. Among patients aged ≥ 18 years with a chronic pain diagnosis and no history of cardiovascular events, we extracted users and non-users of TCAs through 1:1 propensity score matching. TCA users were categorized into three groups according to the mean defined daily dose (DDD): very low doses (< 0.15 DDD), low doses (0.15-0.34 DDD), and traditional doses (≥ 0.34 DDD). A 6-month follow-up was conducted with an intention-to-treat approach. We examined the hazard ratio of cardiovascular adverse events using Cox proportional hazards analysis. RESULTS In total, 16,660 matched patients were followed up (8330 TCA users and 8330 non-users). TCA use did not significantly increase cardiovascular adverse events (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.94-1.33). Low-dose (0.15-0.34 DDD) TCAs (HR 1.37, 95% CI 1.08-1.74), particularly low-dose (0.15-0.34 DDD) nortriptyline (HR 2.11, 95% CI 1.44-3.08), was associated with an increased risk of cardiovascular adverse events. Administration of TCAs at the traditional dose (≥ 0.34 DDD) increased the risk of ischemic stroke (HR 2.08, 95% CI 1.11-3.88). CONCLUSION Close monitoring of patients on long-term, low-dose use of TCAs should be conducted to avoid an increase in the cumulative dose, which increases the risk of cardiovascular adverse events.
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87
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Zhao SQ, Zhao LP, Xu XP, You H. Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231214469. [PMID: 38044620 PMCID: PMC10697053 DOI: 10.1177/00469580231214469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.
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Affiliation(s)
| | | | | | - Hua You
- Nanjing Medical University, Nanjing, China
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88
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Yerly A, van der Vorst EPC, Baumgartner I, Bernhard SM, Schindewolf M, Döring Y. Sex-specific and hormone-related differences in vascular remodelling in atherosclerosis. Eur J Clin Invest 2023; 53:e13885. [PMID: 36219492 DOI: 10.1111/eci.13885] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
Atherosclerosis, a lipid-driven inflammatory disease, is the main underlying cause of cardiovascular diseases (CVDs) both in men and women. Sex-related dimorphisms regarding CVDs and atherosclerosis were observed since more than a decade ago. Inflammatory mediators such as cytokines, but also endothelial dysfunction, vascular smooth muscle cell migration and proliferation lead to vascular remodelling but are differentially affected by sex. Each year a greater number of men die of CVDs compared with women and are also affected by CVDs at an earlier age (40-70 years old) while women develop atherosclerosis-related complications mainly after menopause (60+ years). The exact biological reasons behind this discrepancy are still not well-understood. From the numerous animal studies on atherosclerosis, only a few include both sexes and even less investigate and highlight the sex-specific differences that may arise. Endogenous sex hormones such as testosterone and oestrogen modulate the atherosclerotic plaque composition and the frequency of such plaques. In men, testosterone seems to act like a double-edged sword as its decrease with ageing correlates with an increased risk of atherosclerotic CVDs, while testosterone is also reported to promote inflammatory immune cell recruitment into the atherosclerotic plaque. In premenopausal women, oestrogen exerts anti-atherosclerotic effects, which decline together with its level after menopause resulting in increased CVD risk in ageing women. However, the interplay of sex hormones, sex-specific immune responses and other sex-related factors is still incompletely understood. This review highlights reported sex differences in atherosclerotic vascular remodelling and the role of endogenous sex hormones in this process.
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Affiliation(s)
- Anaïs Yerly
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Emiel P C van der Vorst
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.,Institute for Molecular Cardiovascular Research (IMCAR) and Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, Aachen, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Sarah Maike Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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89
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Higuera-Gómez A, Ribot-Rodríguez R, Micó V, Cuevas-Sierra A, San Cristóbal R, Martínez JA. Lifestyle and Health-Related Quality of Life Relationships Concerning Metabolic Disease Phenotypes on the Nutrimdea Online Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:767. [PMID: 36613089 PMCID: PMC9819172 DOI: 10.3390/ijerph20010767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Obesity, diabetes and cardiovascular events are non-communicable diseases (NCDs) directly related to lifestyle and life quality. Rises on NCDs rates are leading to increases in early deaths concerning metabolic morbidities. Health-related quality of life (HRQoL) has been described as a subjective perception about the influence of health and personal features on human well-being. This study aimed to characterize phenotypic and lifestyle roles on the occurrence of metabolic diseases and determine the potential mutual interactions and with HRQoL. Data from an online adult population (NUTRiMDEA study, n = 17,332) were used to estimate an adapted Obesogenic Score (ObS), while logistic regression analyses were fitted in order to examine relevant factors related to the prevalence of different metabolic diseases including HRQoL. Sex and age showed significant differences depending on lifestyle and metabolic health (p < 0.05). Adherence to the Mediterranean diet and physical activity showed a mutual interaction concerning ObS (p < 0.001), as well with metabolic health (p = 0.044). Furthermore, metabolic diseases showed own features related to sociodemographic and lifestyle characteristics in this population. Metabolic syndrome components may be differently influenced by diverse lifestyle or socioeconomic factors which in turn affect the perceived HRQoL. These outcomes should be taken into account individually for a precision medicine and public health purposes.
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Affiliation(s)
- Andrea Higuera-Gómez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - Rosa Ribot-Rodríguez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - Victor Micó
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - Amanda Cuevas-Sierra
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - Rodrigo San Cristóbal
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels de L’Université Laval (INAF), Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
| | - Jose Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
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Greenberg KL, Poupko T, Sorotzkin D, Keidar O, Zwas DR. Development and usage of a health recommendation web tool (HeaRT) designed to inform women of personalized preventive health recommendations. Internet Interv 2022; 31:100599. [PMID: 36618777 PMCID: PMC9813537 DOI: 10.1016/j.invent.2022.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation of guidelines for evidence-based screening and disease prevention remains a core challenge in health care. The lack of access to accurate and personalized health recommendations may contribute to sub-optimal performance of medical screening, and ultimately increased risk for communicable and non-communicable disease. Many women do not monitor their cardiovascular disease (CVD) risk or receive regular medical screenings. A health recommendation tool (HeaRT) that provides women with profiled, individually tailored information about recommended tests and screening was designed to improve women's engagement in preventive health. This study characterized utilization of the tool in a real world setting. OBJECTIVE To describe the development and usage patterns of HeaRT, a novel health web-tool that provides personalized health recommendations for women. METHODS Extracted web-tool data including user input (age, BMI, smoking status and family history of CVD) and time spent in the results screen were analysed. Engagement was assessed by time spent in each results category, number of clicks and whether the user emailed/printed the recommendations. Usage patterns were analysed using multivariate analyses, logistic regression and cluster analyses. RESULTS HeaRT was used 13,749 times in the years between its launch and data extraction three years later. Web-tool analysis found that 68.6 % of users accessed results and approximately 15 % printed or emailed the list of recommendations. Further analysis found that almost all the users entered the nutrition category (78 %), followed by the risk-factor category (69.5 %) and Physical activity category (61.9 %). Three usage patterns were identified by cluster analysis, including a nutrition/physical activity cluster, a risk-factor cluster and an all-categories cluster. Cluster affiliation analysis found BMI and smoking status were not predictors of cluster affiliation, whereas users over the age of 65 were more likely to solely enter the risk-factor tab (P < .001) and users with family history of CVD were more likely to either enter only the risk-factor tab or to enter all tabs (P < .01). CONCLUSIONS HeaRT users looked at health recommendations on a variety of health topics, and 15 % printed or emailed the recommendations. A tailored health recommendation web-tool may empower women to seek preventive-care and health maintenance, and help them interact with health care providers from a position of shared responsibility. This tool and similar programs may enable health care consumers to actively participate in directing their own health maintenance by providing consumers with personalized health recommendations. Additionally, user characteristics may inform future web-tool designers on target population profile and usage patterns.
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Affiliation(s)
- Keren L. Greenberg
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,Corresponding author at: The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel.
| | - Tamar Poupko
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Devorah Sorotzkin
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Osnat Keidar
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,The Braun School of Public Health and Community Medicine, Hebrew University and Hadassah University Medical Center, P.O.B 12272, Jerusalem, Israel
| | - Donna R. Zwas
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
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91
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Dev R, Adams AM, Raparelli V, Norris CM, Pilote L. Sex and Gender Determinants of Vascular Disease in the Global Context. Can J Cardiol 2022; 38:1799-1811. [PMID: 35667597 DOI: 10.1016/j.cjca.2022.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022] Open
Abstract
Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine and School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Cardiovascular and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada.
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92
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Longpré-Poirier C, Dougoud J, Jacmin-Park S, Moussaoui F, Vilme J, Desjardins G, Cartier L, Cipriani E, Kerr P, Le Page C, Juster RP. Sex and Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease. Can J Cardiol 2022; 38:1812-1827. [PMID: 36150584 DOI: 10.1016/j.cjca.2022.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Because many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate sociocultural vs biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seem to disappear as soon as women develop cardiovascular risk factors (eg, type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviours might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated with impaired anthropometric, metabolic, and cardiovascular functioning and women have greater dysregulation in neuroendocrine and immune functioning. Thus gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms by which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.
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Affiliation(s)
- Christophe Longpré-Poirier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.
| | - Jade Dougoud
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Silke Jacmin-Park
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Fadila Moussaoui
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Joanna Vilme
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Gabriel Desjardins
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Louis Cartier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Enzo Cipriani
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Philippe Kerr
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Cécile Le Page
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
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93
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Abstract
Cardiovascular disease is the leading global cause of death in women but remains underdiagnosed and undertreated. Health professionals play an important role in improving the heart health of Australian women. Routine heart health checks should be offered to all women 45 years of age and older and to all Aboriginal and Torres Strait Islander women 30 years of age and older. Cardiovascular risk assessment in women must include traditional and sex-specific risk factors, including their pregnancy history and early-onset menopause. Women with pregnancy-related hypertensive and metabolic disorders have an increased long-term cardiovascular risk and require close monitoring. Women with acute coronary syndrome may not experience classical chest pain. More often, they experience cardiovascular events in the absence of obstructive coronary disease and have poorer cardiovascular outcomes. The recognition of sex-specific differences and more sex-specific trials are key to improving clinical outcomes.
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Affiliation(s)
- Natalie Montarello
- Royal Adelaide and The Queen Elizabeth Hospitals, Central Adelaide Local Health Service, South Australia
| | - Wai Ping Alicia Chan
- Royal Adelaide and The Queen Elizabeth Hospitals, Central Adelaide Local Health Service, South Australia
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94
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Head KJ, Harrington NG, Schnur JB, Margolies L, Montgomery GH. Examining gain- and loss-framed messages in a novel breast cancer screening/cardiovascular context: Does framing matter? PEC INNOVATION 2022; 1:100007. [PMID: 37364030 PMCID: PMC10194377 DOI: 10.1016/j.pecinn.2021.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 06/28/2023]
Abstract
Objective Digital mammography can reveal not only breast cancer but also breast arterial calcification (BAC), which can indicate potential coronary artery disease. To explore ways to inform women of their BAC status in the context of a standard mammography results letter, we conducted a preliminary study comparing gain- and loss-framed messages to encourage follow-up cardiovascular care. Methods U.S. women over age 40 with no heart disease history (N = 227) were randomly assigned to view a mammography letter including BAC information in one of seven ways (three gain-framed messages, three loss-framed messages, one comparison message). Results Post-test measures indicated no significant differences on BAC knowledge, recall of test results and recommendations, perceived message effectiveness, or behavioral intentions for follow-up. Conclusion Despite showing no significant differences between message conditions, results supported the messages' ability to clearly convey BAC information and encourage intention for follow-up cardiovascular care. Innovation This experimental study represents the first published report examining the inclusion of BAC screening results within the mammography letter. It also explored the use of message framing in a dual detection-prevention context and suggests that future work should test the effects of including both framing tactics in messages designed to target dual-focus contexts.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, USA
| | | | - Julie B. Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, USA
| | - Laurie Margolies
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, USA
| | - Guy H. Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, USA
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95
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Wang Z, Lan T, Zhang L, Luo J, Wang J, Li L, Tao Q. Predictive value of the TyG index and rheumatoid factor for cardiovascular disease risk in a rheumatoid arthritis population: data from a survey of 418 patients. Lipids Health Dis 2022; 21:122. [PMID: 36397103 PMCID: PMC9673431 DOI: 10.1186/s12944-022-01735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the correlation between the triglyceride-glucose (TyG) index and rheumatoid factor levels and the existence of cardiovascular disease in patients in the rheumatoid arthritis population and to analyze their potential value in predicting the risk of cardiovascular disease. Methods Patients with rheumatoid arthritis treated by the Traditional Chinese Medicine Department of Rheumatism of the China-Japan Friendship Hospital from 2019–01 to 2021–12 were included in this retrospective study. Regression analysis was performed with multifactor-corrected multimodal logistic models to observe the correlation between the TyG index and rheumatoid factor and cardiovascular disease risk, construct predictive models and assess the potential predictive value of the variables on cardiovascular disease risk with receiver operating characteristic curves. The results were further corrected by sensitivity analysis and trend tests. Results A total of 418 patients with rheumatoid arthritis were included in the study. In the rheumatoid arthritis population, high rheumatoid factor (OR = 1.002, 95% CI = 1.001–1.002, P < 0.001), high TyG index (OR = 1.057, 95% CI = 1.008–1.109, P = 0.022), advanced age (OR = 1.080, 95% CI = 1.050–1.112, P < 0.001), and low physical activity (OR = 2.848, 95% CI = 1.195–6.785, P = 0.018) were independent risk factors for the existence of cardiovascular disease in patients. The combined coefficient calculated on the basis of the TyG index and rheumatoid factor was used to plot the receiver operating characteristic curve with an area under the curve of 0.791, which can be used to predict the potential risk of cardiovascular disease in patients with rheumatoid arthritis. Further sensitivity analysis found that the marker of focus remained associated with cardiovascular disease risk in a high-physical activity population with rheumatoid arthritis. The final trend test found a linear trend between the TyG index, rheumatoid factor levels and the risk of cardiovascular disease. Conclusion In the rheumatoid arthritis population, the TyG index and rheumatoid factor have some potential predictive value in determining the risk of cardiovascular disease, and the predictive efficacy is better when the two tests are combined.
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96
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Chen Q, Wang H, Wang G, Zhao J, Chen H, Lu X, Chen W. Lactic Acid Bacteria: A Promising Tool for Menopausal Health Management in Women. Nutrients 2022; 14:4466. [PMID: 36364729 PMCID: PMC9654486 DOI: 10.3390/nu14214466] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 08/10/2023] Open
Abstract
Menopause is a period during which women undergo dramatic hormonal changes. These changes lead to physical and mental discomfort, are greatly afflictive, and critically affect women's lives. However, the current safe and effective management measures for women undergoing menopause are insufficient. Several probiotic functions of lactic acid bacteria (LAB) have been recognized, including alleviation of lactose intolerance, protection of digestive tract health, activation of the immune system, protection against infections, improvement of nutrient uptake, and improvement of the microbiota. In this review, we highlight the currently available knowledge of the potential protective effects of LAB on preventing or mitigating menopausal symptoms, particularly in terms of maintaining balance in the vaginal microbiota, reducing bone loss, and regulating the nervous system and lipid metabolism. Given the increasing number of women entering menopause and the emphasis on the management of menopausal symptoms, LAB are likely to soon become an indispensable part of clinical/daily care for menopausal women. Herein, we do not intend to provide a comprehensive analysis of each menopausal disorder or to specifically judge the reliability and safety of complementary therapies; rather, we aim to highlight the potential roles of LAB in individualized treatment strategies for the clinical management of menopause.
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Affiliation(s)
- Qian Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Haojue Wang
- Department of Obstetrics and Gynecology, Wuxi Xishan People’s Hospital, Wuxi 214105, China
| | - Gang Wang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- Yangzhou Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- Yangzhou Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Haiqin Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- Yangzhou Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Xianyi Lu
- Department of Obstetrics and Gynecology, Wuxi Xishan People’s Hospital, Wuxi 214105, China
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
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97
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Poitras M, Narvaez Linares NF, Lambert M, Browndyke JN, Plamondon H. Women with Myocardial Infarction Present Subtle Cognitive Difficulties on a Neuropsychological Battery After Exposure to a Social Stressor. Psychol Res Behav Manag 2022; 15:2761-2771. [PMID: 36176378 PMCID: PMC9514296 DOI: 10.2147/prbm.s379381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Myocardial infarction (MI) is the primary cause of mortality and morbidity in women, but its sequelae remain largely understudied. Given the heart-brain relationship, our study aimed to further understand stress's impact on regulating cognitive function post-MI. Specifically, our study evaluated the effect of stress induced using the Trier Social Stress Test (TSST), on neuropsychological function in women who have or have not experienced MI. Methodology To do so, women (mean age = 59.41 yrs) with (WHxMI = 13) or without () a history of MI were exposed to the TSST prior to completion of a series of standardized neuropsychological tests: the Montreal Cognitive Assessment (MoCA), Control Oral Word Association (COWA), Rey Complex Figure and Recognition (RCFT), Trail Making Test (TMT), and Auditory Consonant Triagrams (ACT). Results Our findings support MI to be associated with impairments in working memory affecting immediate recall of ACT, as well as visuospatial impairments in the RCFT copy trial, marked by poorer drawing accuracy and incorrect placement of figure elements. Overall, WHxMI required more time to complete the neuropsychological assessment (WHxMI 166.57 ± 12, 155.00 ± 6.57; p < 0.01). Conclusion Together, these findings support cognitive impairments noted following a social stressor to remain subtle in WHxMI. Our study highlights the need for the development of more sensitive tools to screen for neuropsychological impairments in women with MI and the importance of assessing performance in a variety of testing conditions.
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Affiliation(s)
- Marilou Poitras
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Maude Lambert
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey N Browndyke
- Department of Psychiatry and Behavioural Medicine, Division of Behavioral Medicine & Neurosciences, Duke University Medical Centre, Durham, NC, USA
| | - Hélène Plamondon
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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98
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Orozco-Beltrán D, Brotons Cuixart C, Banegas Banegas JR, Gil Guillén VF, Cebrián Cuenca AM, Martín Rioboó E, Jordá Baldó A, Vicuña J, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. Aten Primaria 2022; 54 Suppl 1:102444. [PMID: 36435583 PMCID: PMC9705225 DOI: 10.1016/j.aprim.2022.102444] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Medicina Familiar y Comunitaria, Unidad de Investigación Centro de Salud Cabo Huertas, Departamento San Juan de Alicante. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - Carlos Brotons Cuixart
- Medicina Familiar y Comunitaria. Instituto de Investigación Biomédica (IIB) Sant Pau. Equipo de Atención Primaria Sardenya, Barcelona, España
| | - Jose R Banegas Banegas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Vicente F Gil Guillén
- Medicina Familiar y Comunitaria, Hospital Universitario de Elda. Departamento de Medicina Clínica. Universidad Miguel Hernández, San Juan de Alicante, España
| | - Ana M Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco Antiguo, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, España
| | - Enrique Martín Rioboó
- Medicina Familiar y Comunitaria, Especialista en Medicina Familiar y Comunitaria, Centro de Salud Poniente, Córdoba, IMIBIC Hospital Reina Sofía Córdoba. Colaborador del grupo PAPPS
| | - Ariana Jordá Baldó
- Medicina Familiar y Comunitaria, Centro de Salud San Miguel, Plasencia, Badajoz, España
| | - Johanna Vicuña
- Medicina Preventiva y Salud Pública, Hospital de la Sant Creu i Sant Pau, Barcelona, España
| | - Jorge Navarro Pérez
- Medicina Familiar y Comunitaria, Hospital Clínico Universitario. Departamento de Medicina. Universidad de Valencia. Instituto de Investigación INCLIVA, Valencia, España
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Tamargo J, Kaski JC, Kimura T, Barton JC, Yamamoto K, Komiyama M, Drexel H, Lewis BS, Agewall S, Hasegawa K. Racial and ethnic differences in pharmacotherapy to prevent coronary artery disease and thrombotic events. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:738-751. [PMID: 35848895 PMCID: PMC9520447 DOI: 10.1093/ehjcvp/pvac040] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/05/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
Awareness of racial/ethnic disparities represents a key challenge for healthcare systems that attempt to provide effective healthcare and to reduce existing inequalities in the use of and adherence to guideline-recommended cardiovascular drugs to improve clinical outcomes for cardiovascular disease (CVD). In this review, we describe important racial/ethnic differences between and within ethnic groups in the prevalence, risk factors, haemostatic factors, anti-inflammatory and endothelial markers, recurrence, and outcomes of CVD. We discuss important differences in the selection, doses, and response [efficacy and adverse drug reactions (ADRs)] in ethnically diverse patients treated with antithrombotics or lipid-lowering drugs. Differences in drug response are mainly related to racial/ethnic differences in the frequency of polymorphisms in genes encoding drug-metabolizing enzymes (DMEs) and drug transporters. These polymorphisms markedly influence the pharmacokinetics, dose requirements, and safety of warfarin, clopidogrel, and statins. This review aims to support a better understanding of the genetic differences between and among populations to identify patients who may experience an ADR or a lack of drug response, thus optimizing therapy and improving outcomes. The greater the understanding of the differences in the genetic variants of DMEs and transporters that determine the differences in the exposure, efficacy, and safety of cardiovascular drugs between races/ethnicities, the greater the probability that personalized medicine will become a reality.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense , 28040 Madrid , Spain
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London , London SW17 0RE, UK
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University , Kyoto 606-8303, Japan
| | - Jack Charles Barton
- Critical Care and Perioperative Medicine Research Group, Royal London Hospital , London E1 1FR, UK
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University , Kyoto 606-8303, Japan
| | - Maki Komiyama
- Division of Translational Research, National Hospital Organization Kyoto Medical Center , 1-1 Fukakusa Mukaihatacho, Kyoto 612-8555, Japan
| | - Heinz Drexel
- Department of Internal Medicine & Intensive Care, Academic Teaching Hospital Bregenz, 6900 Bregenz, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, 6800 Feldkirch , Austria
| | - Basil S Lewis
- Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology , Haifa 3200003 , Israel
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital , 0424 Oslo, Norway
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center , 1-1 Fukakusa Mukaihatacho, Kyoto 612-8555, Japan
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100
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Diagnosing Arterial Stiffness in Pregnancy and Its Implications in the Cardio-Renal-Metabolic Chain. Diagnostics (Basel) 2022; 12:diagnostics12092221. [PMID: 36140621 PMCID: PMC9497660 DOI: 10.3390/diagnostics12092221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Cardio-renal and metabolic modifications during gestation are crucial determinants of foetal and maternal health in the short and long term. The cardio-renal metabolic syndrome is a vicious circle that starts in the presence of risk factors such as obesity, hypertension, diabetes, kidney disease and ageing, all predisposing to a status dominated by increased arterial stiffness and alteration of the vascular wall, which eventually damages the target organs, such as the heart and kidneys. The literature is scarce regarding cardio-renal metabolic syndrome in pregnancy cohorts. The present paper exposes the current state of the art and emphasises the most important findings of this entity, particularly in pregnant women. The early assessment of arterial function can lead to proper and individualised measures for women predisposed to hypertension, pre-eclampsia, eclampsia, and diabetes mellitus. This review focuses on available information regarding the assessment of arterial function during gestation, possible cut-off values, the possible predictive role for future events and modalities to reverse or control its dysfunction, a fact of crucial importance with excellent outcomes at meagre costs.
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