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Burgess A, Eichelman E, Rhodes B. Lactation Patterns in Women with Hypertensive Disorders of Pregnancy: An Analysis of Illinois 2012-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) Data. Matern Child Health J 2020; 25:666-675. [PMID: 33200325 DOI: 10.1007/s10995-020-03069-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy have lifelong implications on maternal cardiovascular health. Breastfeeding has a variety of maternal benefits, including improved lifelong maternal cardiovascular outcomes, with longer periods of lactation resulting in further improvement. Women with hypertensive disorders of pregnancy encounter many barriers to breastfeeding. Little is known about lactation initiation and duration rates in women with hypertensive disorders of pregnancy. The purpose of this study is to describe lactation patterns in women with HDP, hypertensive disorders of pregnancy, compared to normotensive controls using data from the phase 7 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS). SUBJECTS AND METHODS Illinois PRAMS 2012-2015 (Phase 7) data was used to assess lactation patterns as well as rationale for not initiating breastfeeding or earlier cessation. Women who delivered during this time period were eligible to participate in the PRAMS survey, 5285 were included the analysis. RESULTS Overall, 17.6% of all women in the study reported their healthcare provider did not speak with them prenatally about breastfeeding. Women who reported they had HDP, were significantly less likely (p ≤ 0.001) to ever breastfeed or pump breast milk to feed their baby, even for a short period, than those women without an HDP. At the time the PRAMS survey was completed, more women without an HDP were still breastfeeding or providing their baby with pumped milk (54.9 v. 48%; p = 0.002). More women with HDP reported stopping breastfeeding because they got sick or had to stop for medical reasons (p = 0.002) and/or because their baby was jaundiced (p = 0.007). CONCLUSION Cardiovascular disease remains the leading cause of death among women and women with a history of HDP are at increased risk for cardiovascular related morbidity and mortality. Obstetrical providers and nurses caring for this high-risk population should ensure they educate women about the increased cardiovascular risk associated with HDP and the maternal cardiovascular benefits associated with lactation in order to promote and support lactation in this population of women.
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Affiliation(s)
- Adriane Burgess
- WellSpan Health, Women and Children Service Line, 1001 S. George St, York, PA, 17405, USA.
| | - Emily Eichelman
- Neonatal Intensive Care Unit, Studer Family Children's Hospital, 1 Bubba Watson Drive, Pensacola, FL, 32504, USA
| | - Brittney Rhodes
- MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD, 21237, USA
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Madsen TE, Guo D. Sex differences in modifiable stroke risk factors: The next step in personalized stroke prevention. Neurology 2020; 95:891-892. [PMID: 33067407 DOI: 10.1212/wnl.0000000000010983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (D.G.), Medical College of Soochow University, Suzhou, China; and Department of Epidemiology, (D.G.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.
| | - Daoxia Guo
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (D.G.), Medical College of Soochow University, Suzhou, China; and Department of Epidemiology, (D.G.), School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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203
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Yu AYX, Hill MD, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV, Demchuk AM, Field TS, Goyal M, Krause M, Mandzia J, Menon BK, Mikulik R, Moreau F, Penn AM, Swartz RH, Coutts SB. Sex Differences in Diagnosis and Diagnostic Revision of Suspected Minor Cerebral Ischemic Events. Neurology 2020; 96:e732-e739. [PMID: 33184228 DOI: 10.1212/wnl.0000000000011212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurologic events. METHODS We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes. RESULTS Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women vs 42% of men, adjusted odds ratio (OR) 1.60, 95% confidence interval [CI] 1.24-2.07), and women were overall less likely to have ischemia on MRI (10% vs 17%, OR 0.52, 95% CI 0.36-0.76). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% vs 20%, OR 0.53, 95% CI 0.32-0.88) but were equally likely to have acute ischemia on MRI (5% vs 8%, OR 0.56, 95% CI 0.26-1.21). CONCLUSIONS Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurologic events.
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Affiliation(s)
- Amy Y X Yu
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada.
| | - Michael D Hill
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Negar Asdaghi
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jean-Martin Boulanger
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Marie-Christine Camden
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bruce C V Campbell
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Demchuk
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Thalia S Field
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Mayank Goyal
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Martin Krause
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jennifer Mandzia
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bijoy K Menon
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Robert Mikulik
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Francois Moreau
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Penn
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Richard H Swartz
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Shelagh B Coutts
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
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Kim HH, Choi S, Jung YS, Min YG, Yoon D, Lee SE. Stroke Incidence in Survivors of Carbon Monoxide Poisoning in South Korea: A Population-Based Longitudinal Study. Med Sci Monit 2020; 26:e926116. [PMID: 33106468 PMCID: PMC7602366 DOI: 10.12659/msm.926116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Carbon monoxide (CO) poisoning is a suspected risk factor for stroke. However, the association between stroke occurrence and carbon monoxide poisoning remains unclear. This nationwide study in Korea analyzed the incidence of stroke in survivors of CO poisoning. Material/Methods In this nationwide, population-based longitudinal study, the database of the Health Insurance Review and Assessment Service was searched to identify patients diagnosed with CO poisoning from 2012 to 2018. Their incidence of ischemic and hemorrhagic strokes, the patterns of stroke incidences, the annual incidence rates in sequential time, the standardized incidence ratio (SIR), and the effects of hyperbaric oxygen therapy (HBOT) were analyzed. Results Of the 29 301 patients diagnosed with CO poisoning during the study period, 984 (3.36%) were diagnosed with stroke after CO poisoning, with approximately 50% occurring within 1 year after CO poisoning. The overall SIR for stroke was 19.49 (95% confidence interval [CI], 17.92–21.12) during the first year, decreasing to 5.64 (95% CI, 4.75–6.66) during the second year. Overall stroke hazard ratio (HR) in the patients admitted to the ICU for CO poisoning was 2.28 (95% CI, 1.19–2.27), compared with 2.35 (95% CI, 1.94–2.84) for ischemic stroke and 1.76 (95% CI, 1.11–2.78) for hemorrhagic stroke. Cumulative HRs did not differ between patients who were and were not treated with HBOT for stroke. Conclusions CO poisoning is a high-risk factor for the development of stroke, evidenced by high incidences of stroke after CO poisoning. Practical strategies for preventing stroke after CO poisoning are needed, because stroke after CO poisoning affects adults of almost all ages, significantly increasing their socioeconomic burden.
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Affiliation(s)
- Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Sangchun Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Yoon Seok Jung
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Eun Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
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205
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Lichota A, Szewczyk EM, Gwozdzinski K. Factors Affecting the Formation and Treatment of Thrombosis by Natural and Synthetic Compounds. Int J Mol Sci 2020; 21:E7975. [PMID: 33121005 PMCID: PMC7663413 DOI: 10.3390/ijms21217975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT), whose consequence may be a pulmonary embolism (PE). Thrombosis is associated with significant morbidity and mortality and is the third most common cardiovascular disease after myocardial infarction and stroke. DVT is associated with the formation of a blood clot in a deep vein in the body. Thrombosis promotes slowed blood flow, hypoxia, cell activation, and the associated release of many active substances involved in blood clot formation. All thrombi which adhere to endothelium consist of fibrin, platelets, and trapped red and white blood cells. In this review, we summarise the impact of various factors affecting haemostatic disorders leading to blood clot formation. The paper discusses the causes of thrombosis, the mechanism of blood clot formation, and factors such as hypoxia, the involvement of endothelial cells (ECs), and the activation of platelets and neutrophils along with the effects of bacteria and reactive oxygen species (ROS). Mechanisms related to the action of anticoagulants affecting coagulation factors including antiplatelet drugs have also been discussed. However, many aspects related to the pathogenesis of thrombosis still need to be clarified. A review of the drugs used to treat and prevent thrombosis and natural anticoagulants that occur in the plant world and are traditionally used in Far Eastern medicine has also been carried out.
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Affiliation(s)
- Anna Lichota
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Eligia M. Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Krzysztof Gwozdzinski
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
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206
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Dykstra-Aiello C, Sharp FR, Jickling GC, Hull H, Hamade F, Shroff N, Durocher M, Cheng X, Zhan X, Liu D, Ander BP, Stamova BS. Alternative Splicing of Putative Stroke/Vascular Risk Factor Genes Expressed in Blood Following Ischemic Stroke Is Sexually Dimorphic and Cause-Specific. Front Neurol 2020; 11:584695. [PMID: 33193047 PMCID: PMC7642687 DOI: 10.3389/fneur.2020.584695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Genome-wide association studies have identified putative ischemic stroke risk genes, yet, their expression after stroke is unexplored in spite of growing interest in elucidating their specific role and identifying candidate genes for stroke treatment. Thus, we took an exploratory approach to investigate sexual dimorphism, alternative splicing, and etiology in putative risk gene expression in blood following cardioembolic, atherosclerotic large vessel disease and small vessel disease/lacunar causes of ischemic stroke in each sex compared to controls. Whole transcriptome arrays assessed 71 putative stroke/vascular risk factor genes for blood RNA expression at gene-, exon-, and alternative splicing-levels. Male (n = 122) and female (n = 123) stroke and control volunteers from three university medical centers were matched for race, age, vascular risk factors, and blood draw time since stroke onset. Exclusion criteria included: previous stroke, drug abuse, subarachnoid or intracerebral hemorrhage, hemorrhagic transformation, infection, dialysis, cancer, hematological abnormalities, thrombolytics, anticoagulants or immunosuppressants. Significant differential gene expression (fold change > |1.2|, p < 0.05, partial correlation > |0.4|) and alternative splicing (false discovery rate p < 0.3) were assessed. At gene level, few were differentially expressed: ALDH2, ALOX5AP, F13A1, and IMPA2 (males, all stroke); ITGB3 (females, cardioembolic); ADD1 (males, atherosclerotic); F13A1, IMPA2 (males, lacunar); and WNK1 (females, lacunar). GP1BA and ITGA2B were alternatively spliced in both sexes (all patients vs. controls). Six genes in males, five in females, were alternatively spliced in all stroke compared to controls. Alternative splicing and exon-level analyses associated many genes with specific etiology in either sex. Of 71 genes, 70 had differential exon-level expression in stroke patients compared to control subjects. Among stroke patients, 24 genes represented by differentially expressed exons were male-specific, six were common between sexes, and two were female-specific. In lacunar stroke, expression of 19 differentially expressed exons representing six genes (ADD1, NINJ2, PCSK9, PEMT, SMARCA4, WNK1) decreased in males and increased in females. Results demonstrate alternative splicing and sexually dimorphic expression of most putative risk genes in stroke patients' blood. Since expression was also often cause-specific, sex, and etiology are factors to consider in stroke treatment trials and genetic association studies as society trends toward more personalized medicine.
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Affiliation(s)
- Cheryl Dykstra-Aiello
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Frank R Sharp
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Glen C Jickling
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Heather Hull
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Farah Hamade
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Natasha Shroff
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Marc Durocher
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Xiyuan Cheng
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Xinhua Zhan
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - DaZhi Liu
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Bradley P Ander
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Boryana S Stamova
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
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207
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Kouvari M, Souliotis K, Yannakoulia M, Panagiotakos DB. Cardiovascular Diseases in Women: Policies and Practices Around the Globe to Achieve Gender Equity in Cardiac Health. Risk Manag Healthc Policy 2020; 13:2079-2094. [PMID: 33116988 PMCID: PMC7567535 DOI: 10.2147/rmhp.s264672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
The women's global health agenda has recently been reformulated to address more accurately cardiovascular disease (CVD) prevention, diagnosis, and treatment. The aim of the present work was to review the global and national policies and practices that address sex equality in health with a focus on CVDs in women. Scientific databases and health organizations' websites that presented/discussed policies and initiative targeting to enhance a sex-centered approach regarding general health and/or specifically cardiac health care were reviewed in a systematic way. In total, 61 relevant documents were selected. The selected policies and initiatives included position statements, national action plans, evidence-based guidelines, guidance/recommendations, awareness campaigns, regulations/legislation, and state-of-the art reports by national/international projects and conferences. The target audiences of large stakeholders (eg, American Heart Association, European Society of Cardiology, Centers for Disease Control and Prevention) were female citizens, health professionals, and researchers. Much as policy-makers have recognized the sex/gender gap in the CVD field, there is still much to be done. Thereby, tailor-made strategies should be designed, evaluated, and delivered on a global and most importantly a national basis to achieve gender equity with regard to CVDs.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Bruce, Canberra, Australia
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208
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Okoth K, Chandan JS, Marshall T, Thangaratinam S, Thomas GN, Nirantharakumar K, Adderley NJ. Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ 2020; 371:m3502. [PMID: 33028606 PMCID: PMC7537472 DOI: 10.1136/bmj.m3502] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN Umbrella review. DATA SOURCES Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019120076.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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209
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Branyan TE, Sohrabji F. Sex differences in stroke co-morbidities. Exp Neurol 2020; 332:113384. [PMID: 32585156 PMCID: PMC7418167 DOI: 10.1016/j.expneurol.2020.113384] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
Males and females possess distinct biological differences that manifest in diverse risk profiles for acute and chronic diseases. A well-documented example of this is ischemic stroke. It has been demonstrated that older females have greater prevalence of, and worse outcome after, ischemic stroke than do males and younger females. Loss of estrogen after menopause is heavily implicated as a contributing factor for this phenomenon; however, there is mounting evidence to suggest that certain risk factors tend to occur more often in older females, such as hypertension and atrial fibrillation, while others more adversely affect females than they do males, such as diabetes and smoking. Sex-specific risk factors, such as oral contraceptive use and menopause, could also contribute to the discrepancy in stroke prevalence and outcome. Additionally, there is evidence to suggest that females tend to present with more nontraditional symptoms of acute stroke than do males, making it more difficult for clinicians to correctly identify the occurrence of a stroke, which may delay the administration of thrombolytic intervention. Finally, certain sociodemographic factors, such as the fact that females were more likely to live alone prior to stroke, may contribute to poorer recovery in females. This review will explore the various co-morbidities and sociodemographic factors that contribute to the greater prevalence of and poorer outcome after stroke in older females and will highlight the critical need for considering sex as a predisposing biological variable in stroke studies.
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Affiliation(s)
- Taylor E Branyan
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA.
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210
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Carcel C, Woodward M, Wang X, Bushnell C, Sandset EC. Sex matters in stroke: A review of recent evidence on the differences between women and men. Front Neuroendocrinol 2020; 59:100870. [PMID: 32882229 DOI: 10.1016/j.yfrne.2020.100870] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
For the most part, stroke is a disease of old age. With the predicted increase in the aged population and longer life expectancies, the number and proportion of people living with stroke is expected to increase, especially among women and the elderly. For those who suffer stroke, there is a high likelihood of experiencing death and severe disability. Therefore, the issue of stroke amongst women (and men) is a key priority in global public health. In this review, we consider sex and gender differences in ischemic and hemorrhagic stroke, and we summarize data that outlines the epidemiology, risk factor, treatment recovery and prevention of stroke. We discuss possible mechanisms for the sex differences, specifically in areas of biology, medical management and social and behavioral context. With evidence showing that women and men experience stroke differently, sex must be taken into account when treating patients and when designing clinical trials.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The University of Sydney, Sydney School of Public Health, Sydney Medical School, New South Wales, Australia.
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
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211
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Amegadzie JE, Gamble JM, Farrell J, Gao Z. Gender Differences in Inhaled Pharmacotherapy Utilization in Patients with Obstructive Airway Diseases (OADs): A Population-Based Study. Int J Chron Obstruct Pulmon Dis 2020; 15:2355-2366. [PMID: 33061353 PMCID: PMC7533228 DOI: 10.2147/copd.s264580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Gender differences in the incidence, susceptibility and severity of many obstructive airway diseases (OADs) have been well recognized. However, gender differences in the inhaled pharmacotherapy profile are not well characterized. Methods We conducted a retrospective cohort study to investigate gender differences in new-users of inhaled corticosteroids (ICS), short-or long-acting beta2-agonist (SABA or LABA), ICS/LABA, short-or long-acting muscarinic antagonist (SAMA or LAMA) among patients with asthma, COPD or asthma-COPD overlap (ACO). We used Clinical Practice Research Datalink to identify OAD patients, 18 years and older, who were new-users (1-year washout period) from 01-January-1998 to 31-July-2018. Multivariable logistic regression was used to examine gender differences in each of the inhaled pharmacotherapies after controlling for potential confounders. Results A total of 242,079 new-users (asthma: 84.93%; COPD: 10.19%; ACO: 4.88%) of inhaled pharmacotherapies were identified. The multivariable analyses showed that males with COPD were more likely to be a new user of a LABA (odds ratio [OR] 1.29; 95% confidence interval [CI], 1.12–1.49), LAMA (OR 1.21; 95% CI 1.10–1.33), SAMA (OR 1.11; 95% CI 1.01–1.21) and less likely to be a new user of a SABA (OR 0.84; 95% CI, 0.80–0.89) compared to females. Similar patterns were also observed for patients with ACO; males were more likely to be prescribed with LABA (OR 1.26; 95% CI 1.03–1.55), LAMA (OR 1.28; 95% CI 1.11–1.48), SAMA (OR 1.28; 95% CI 1.11–1.48), and less likely to be a new user of a SABA (OR 0.89; 95% CI, 0.82–0.96). Also, males with asthma were more likely to be a new-user of ICS/LABA (OR 1.15; 95% CI, 1.08–1.23) and less likely to start an ICS (OR 0.97; 95% CI, 0.95–0.99) in comparison with females. Conclusion Our study showed significant gender differences in new-users of inhaled pharmacotherapies among OAD patients. Adjusting for proxies of disease severity, calendar year, smoking and socioeconomic status did not change the association by gender.
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Affiliation(s)
| | - John-Michael Gamble
- Faculty of Science, School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Jamie Farrell
- Faculty of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
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212
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Lefferts WK, DeBlois JP, Augustine JA, Keller AP, Heffernan KS. Age, sex, and the vascular contributors to cerebral pulsatility and pulsatile damping. J Appl Physiol (1985) 2020; 129:1092-1101. [PMID: 32940561 PMCID: PMC7790130 DOI: 10.1152/japplphysiol.00500.2020] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral pulsatility reflects a balance between the transmission and damping of pulsatility in the cerebrovasculature. Females experience greater cerebral pulsatility with aging, which may have implications for sex differences in stroke risk and cognitive decline. This study sought to explore vascular contributors to cerebral pulsatility and pulsatile damping in men and women. Adults (n = 282, 53% female) underwent measurements of cerebral (middle cerebral artery) pulsatility, pulsatile damping (ratio of cerebral to carotid pulsatility), large artery stiffening (ratio of aortic to carotid pulse wave velocity), and carotid wave transmission/reflection dynamics using wave intensity analysis. Multiple regression revealed that older age, female sex, greater large artery stiffening, higher carotid pulse pressure, and greater forward wave energy was associated with increased cerebral pulsatility (adjusted R2 = 0.44, P < 0.05). Contributors to decreased cerebral pulsatile damping included older age, female sex, and lower wave reflection index (adjusted R2 = 0.51, P < 0.05). Our data link greater large artery stiffening, carotid pulse pressure, and forward wave energy to greater cerebral pulsatility, while greater carotid wave reflection may enhance cerebral pulsatile damping. Lower cerebral pulsatile damping among females may contribute to greater age-associated cerebral pulsatile burden compared with males. NEW & NOTEWORTHY Cerebral pulsatility contributes to brain health and depends on a balance between transmission and damping of pulsatile hemodynamics into the cerebrovasculature. Our data indicate that cerebral pulsatility increases with age, female sex, extracranial artery stiffening, forward wave energy, and pulse pressure, whereas pulsatile damping decreases with age and female sex and increases with greater carotid wave reflections. These novel data identify pulsatile damping as a potential contributor to sex differences in cerebral pulsatile burden.
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Affiliation(s)
- Wesley K Lefferts
- Department of Exercise Science, Syracuse University, Syracuse, New York.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.,Department of Kinesiology, Iowa State University, Ames, Iowa
| | - Jacob P DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Jacqueline A Augustine
- Department of Exercise Science, Syracuse University, Syracuse, New York.,Department of Kinesiology, SUNY Cortland, Cortland, New York
| | - Allison P Keller
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, New York
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213
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Feng YW, Wu C, Liang FY, Lin T, Li WQ, Jing YH, Dai P, Yu HX, Lan Y, Pei Z, Xu GQ. hUCMSCs Mitigate LPS-Induced Trained Immunity in Ischemic Stroke. Front Immunol 2020; 11:1746. [PMID: 33013828 PMCID: PMC7516337 DOI: 10.3389/fimmu.2020.01746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Innate immune memory is a part of the innate immune system that facilitates the elimination of pathogens. However, it may exacerbate neuropathology. In this study, we found that innate immune memory is detrimental in stroke, because it promotes the acute immune response and exacerbates ischemic infarcts. Mesenchymal stem cell therapy has been widely studied for its therapeutic potential in various diseases including stroke, but whether it diminishes innate immune memory has not been studied. Here, our study demonstrates that, after the activation of innate immune memory by lipopolysaccharide, mesenchymal stem cell therapy can diminish innate immune memory though down-regulation of H3 methylation and subsequently protect against stroke. Our results demonstrate that innate immune memory is detrimental in stroke, and we describe a novel potential therapeutic target involving the use of mesenchymal stem cells to treat stroke patients.
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Affiliation(s)
- Yi-Wei Feng
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng-Yin Liang
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou, China
| | - Wan-Qi Li
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou, China
| | - Ying-Hua Jing
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Pei Dai
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hui-Xian Yu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yue Lan
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou, China
| | - Zhong Pei
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guang-Qing Xu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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214
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Cirillo M, Coccia ME, Fatini C. Lifestyle and Comorbidities: Do We Take Enough Care of Preconception Health in Assisted Reproduction? J Family Reprod Health 2020; 14:150-157. [PMID: 33603806 PMCID: PMC7868650 DOI: 10.18502/jfrh.v14i3.4667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The preconception period is largely neglected, whereas it represents an opportunity to identify and modify clinical and behavioral risks, particularly in infertile women characterized by an unfavorable vascular burden. The present study was performed to strengthen previous findings and to increase the awareness of clinicians who should envision a broader preconception approach in infertile women, beyond their reproductive health. Materials and methods: In this cross-sectional study, we investigated 1003 Caucasian women, referred to the Internal Medicine Clinic at the Assisted Reproductive Technologies Center, Florence. Results: A high prevalence of dyslipidemia (57.4%), overweight/obesity (29.1%) and, smoking habit (26.6%) were found. We provided evidence of unhealthy lifestyle habits, represented by a closer adherence to the Mediterranean diet in the 9.5% only and by a sedentary behavior in 73%. A significant correlation between the Mediterranean Diet score and both anthropometric and metabolic parameters was found. We also observed a lower score adherence with both metabolic syndrome and diabetes (for both p=0.02), but not with hypertension. Conclusion: Before infertility treatment, the correction and the management of modifiable and non-modifiable cardiovascular risk factors are mandatory and represent the main goal for a safe pregnancy, and lifetime women's health.
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Affiliation(s)
- Michela Cirillo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Maria Elisabetta Coccia
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Cinzia Fatini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
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215
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Salehi Omran S, Parikh NS, Poisson S, Armstrong J, Merkler AE, Prabhu M, Navi BB, Riley LE, Fink ME, Kamel H. Association between Pregnancy and Cervical Artery Dissection. Ann Neurol 2020; 88:596-602. [PMID: 32525238 PMCID: PMC10001425 DOI: 10.1002/ana.25813] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We wanted to determine whether pregnancy is associated with cervical artery dissection. METHODS We performed a case-control study using claims data from all nonfederal emergency departments and acute care hospitals in New York and Florida between 2005 and 2015. Cases were women 12-42 years of age hospitalized with cervical artery dissection, defined using validated diagnosis codes for carotid/vertebral artery dissection. Controls were women 12-42 years of age with a primary diagnosis of renal colic. Cases and controls were matched 1:1 on age, race, insurance, income, state, and visit year. The exposure variable was pregnancy, defined as labor and delivery within 90 days before or 6 months after the index visit. Logistic regression was used to compare the odds of pregnancy between cases and controls. We performed a secondary cohort-crossover study comparing the risk of cervical artery dissection during pregnancy versus the same time period 1 year later. RESULTS Pregnancy was twice as common among 826 women with cervical artery dissection compared with the 826 matched controls with renal colic (odds ratio, 2.5; 95% confidence interval [CI], 1.3-4.7). In our secondary analysis, pregnancy was associated with a higher risk of cervical artery dissection (incidence rate ratio [IRR], 2.2; 95% CI, 1.3-3.5), with the heightened risk limited to the postpartum period (IRR, 5.5; 95% CI, 2.6-11.7). INTERPRETATION Pregnancy, specifically the postpartum period, was associated with hospitalization for cervical artery dissection. Although these findings might in part reflect ascertainment bias, our results suggest that arterial dissection is one mechanism by which pregnancy can lead to stroke. ANN NEUROL 2020;88:596-602.
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Affiliation(s)
- Setareh Salehi Omran
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sharon Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer Armstrong
- Department of Pediatrics (Neurology) and Obstetrics and Gynecology, University of Colorado Anschutz School of Medicine & Children's Hospital Colorado, Denver, CO, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Alexander C, Caras A, Miller WK, Tahir R, Mansour TR, Medhkour A, Marin H. M2 segment thrombectomy is not associated with increased complication risk compared to M1 segment: A meta-analysis of recent literature. J Stroke Cerebrovasc Dis 2020; 29:105018. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/31/2022] Open
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217
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Lewey J, Levine LD, Yang L, Triebwasser JE, Groeneveld PW. Patterns of Postpartum Ambulatory Care Follow-up Care Among Women With Hypertensive Disorders of Pregnancy. J Am Heart Assoc 2020; 9:e016357. [PMID: 32851901 PMCID: PMC7660757 DOI: 10.1161/jaha.120.016357] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow‐up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. Methods and Results We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits (P<0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6‐month follow‐up with any continuity provider compared with 47% of women without hypertension (P<0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow‐up (adjusted odds ratio, 1.16; 95% CI, 1.2–1.21). Factors associated with a lower likelihood of any follow‐up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Conclusions Rates of continuity care follow‐up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Lisa D Levine
- Department of Obstetrics & Gynecology Maternal and Child Health Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Lin Yang
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Jourdan E Triebwasser
- Department of Obstetrics & Gynecology Maternal and Child Health Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA
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218
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Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A. Sex and gender: modifiers of health, disease, and medicine. Lancet 2020; 396:565-582. [PMID: 32828189 PMCID: PMC7440877 DOI: 10.1016/s0140-6736(20)31561-0] [Citation(s) in RCA: 871] [Impact Index Per Article: 217.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/09/2023]
Abstract
Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
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Affiliation(s)
- Franck Mauvais-Jarvis
- Diabetes Discovery & Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine and Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, LA, USA.
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Peter J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Roberta D Brinton
- Department of Pharmacology and Department of Neurology, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics and Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dawn L DeMeo
- Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geert J De Vries
- Neuroscience Institute and Department of Biology, Georgia State University, Atlanta, GA, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sabra L Klein
- W Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amedeo Lonardo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Pauline M Maki
- Department of Psychiatry, Department of Psychology, and Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology, University Hospital Zürich, University of Zürich, Switzerland
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua B Rubin
- Department of Medicine, Department of Paediatrics, and Department of Neuroscience, Washington University School of Medicine St Louis, MO, USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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219
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Kantorowska A, Heiselman CJ, Halpern TA, Akerman MB, Elsayad A, Muscat JC, Sicuranza GB, Vintzileos AM, Heo HJ. Identification of factors associated with delayed treatment of obstetric hypertensive emergencies. Am J Obstet Gynecol 2020; 223:250.e1-250.e11. [PMID: 32067968 DOI: 10.1016/j.ajog.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obstetric hypertensive emergency is defined as having systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg, confirmed 15 minutes apart. The American College of Obstetricians and Gynecologists recommends that acute-onset, severe hypertension be treated with first line-therapy (intravenous labetalol, intravenous hydralazine or oral nifedipine) within 60 minutes to reduce risk of maternal morbidity and death. OBJECTIVE Our objective was to identify barriers that lead to delayed treatment of obstetric hypertensive emergency. STUDY DESIGN A retrospective cohort study was performed that compared women who were treated appropriately within 60 minutes vs those with delay in first-line therapy. We identified 604 patients with discharge diagnoses of chronic hypertension, gestational hypertension, or preeclampsia using International Classification of Diseases-10 codes and obstetric antihypertensive usage in a pharmacy database at 1 academic institution from January 2017 through June 2018. Of these, 267 women (44.2%) experienced obstetric hypertensive emergency in the intrapartum period or within 2 days of delivery; the results from 213 women were used for analysis. We evaluated maternal characteristics, presenting symptoms and circumstances, timing of hypertensive emergency, gestational age at presentation, and administered medications. Chi square, Fisher's exact, Wilcoxon rank-sum, and sample t-tests were used to compare the 2 groups. Univariable logistic regression was applied to determine predictors of delayed treatment. Multivariable regression model was also performed; C-statistic and Hosmer and Lemeshow goodness-of-fit test were used to assess the model fit. A result was considered statistically significant at P<.05. RESULTS Of the 213 women, 110 (51.6%) had delayed treatment vs 103 (48.4%) who were treated within 60 minutes. Patients who had delayed treatment were 3.2 times more likely to have an initial blood pressure in the nonsevere range vs those who had timely treatment (odds ratio, 3.24; 95% confidence interval, 1.85-5.68). Timeliness of treatment was associated with presence or absence of preeclampsia symptoms; patients without preeclampsia symptoms were 2.7 times more likely to have delayed treatment (odds ratio, 2.68; 95% confidence interval, 1.50-4.80). Patients with hypertensive emergencies that occurred overnight between 10 pm and 6 am were 2.7 times more likely to have delayed treatment vs those emergencies that occurred between 6 am and 10 pm (odds ratio, 2.72; 95% confidence interval, 1.27-5.83). Delayed treatment also had an association with race, with white patients being 1.8 times more likely to have delayed treatment (odds ratio, 1.79; 95% confidence interval, 1.04-3.08). Patients who were treated at <60 minutes had a lower gestational age at presentation vs those with delayed treatment (34.6±5 vs 36.6±4 weeks, respectively; P<.001). For every 1-week increase in gestational age at presentation, there was a 9% increase in the likelihood of delayed treatment (odds ratio, 1.11; 95% confidence interval, 1.04-1.19). Another factor that was associated with delay of treatment was having a complaint of labor symptoms, which made patients 2.2 times as likely to experience treatment delay (odds ratio, 2.17; 95% confidence interval, 1.07-4.41). CONCLUSION Initial blood pressure in the nonsevere range, absence of preeclampsia symptoms, presentation overnight, white race, having complaint of labor symptoms, and increasing gestational age at presentation are barriers that lead to a delay in the treatment of obstetric hypertensive emergency. Quality improvement initiatives that target these barriers should be instituted to improve timely treatment.
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220
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Salehi Omran S, Leppert MH. Are Strokes Declining Among Pregnant Women With Hypertensive Disorders of Pregnancy? J Am Heart Assoc 2020; 9:e017917. [PMID: 32750293 PMCID: PMC7792271 DOI: 10.1161/jaha.120.017917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Michelle Hu Leppert
- Department of Neurology University of Colorado School of Medicine Aurora CO.,Colorado Cardiovascular Outcomes Research Group Denver CO
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221
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Walli-Attaei M, Joseph P, Rosengren A, Chow CK, Rangarajan S, Lear SA, AlHabib KF, Davletov K, Dans A, Lanas F, Yeates K, Poirier P, Teo KK, Bahonar A, Camilo F, Chifamba J, Diaz R, Didkowska JA, Irazola V, Ismail R, Kaur M, Khatib R, Liu X, Mańczuk M, Miranda JJ, Oguz A, Perez-Mayorga M, Szuba A, Tsolekile LP, Prasad Varma R, Yusufali A, Yusuf R, Wei L, Anand SS, Yusuf S. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 396:97-109. [PMID: 32445693 DOI: 10.1016/s0140-6736(20)30543-2] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. METHODS In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. FINDINGS From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease. INTERPRETATION Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Marjan Walli-Attaei
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara K Chow
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kairat Davletov
- The Faculty of Medicine, Health Research Institute, Kazakh National University, Almaty, Kazakhstan
| | - Antonio Dans
- Department of Medicine, University of Philippines, Manila, Philippines
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Felix Camilo
- Facultad de Ciencias Medicas Eugenio Espejo, Universidad Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Joanna A Didkowska
- Department of Epidemiology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute, Warsaw, Poland
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; South American Center of Excellence for Cardiovascular Health, Buenos Aires, Argentina
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Center, Kuala Lumpur, Malaysia
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Marta Mańczuk
- Department of Epidemiology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute, Warsaw, Poland
| | - J Jaime Miranda
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Maritza Perez-Mayorga
- Facultad de Medicina, Universidad Nueva Granada and Clinica de Marly, Bogota, Colombia
| | - Andrzej Szuba
- Wroclaw Medical University, Department of Angiology, Diabetology and Hypertension, Wroclaw, Poland
| | - Lungiswa P Tsolekile
- University of the Western Cape, School of Public Health, Cape Town, South Africa
| | - Ravi Prasad Varma
- Health Action by People, Thiruvananthapuram, India; Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Afzalhussein Yusufali
- Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Li Wei
- National Centre for Cardiovascular Diseases, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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MZe786 Rescues Cardiac Mitochondrial Activity in High sFlt-1 and Low HO-1 Environment. Antioxidants (Basel) 2020; 9:antiox9070598. [PMID: 32660064 PMCID: PMC7402164 DOI: 10.3390/antiox9070598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorder in pregnancy is a major cause of maternal and perinatal mortality worldwide. Women who have had preeclampsia are at three to four times higher risk in later life of developing high blood pressure and heart disease. Soluble Flt-1 (sFlt-1) is elevated in preeclampsia and may remain high postpartum in women with a history of preeclampsia. Heme oxygenase-1 (Hmox1/HO-1) exerts protective effects against oxidative stimuli and is compromised in the placenta of pregnant women with preeclampsia. We hypothesized that sFlt-1 inhibits cardiac mitochondrial activity in HO-1 deficient mice. HO-1 haplo-insufficient mice (Hmox1+/−) were injected with adenovirus encoding sFlt-1 (Ad-sFlt-1) or control virus (Ad-CMV). Subsequently, they were treated daily with either placebo or MZe786 for six days, when the heart tissue was harvested to assess cardiac mitochondrial activity. Here, we show that the loss of HO-1 disturbed cardiac mitochondrial respiration and reduced mitochondrial biogenesis. The overexpression of sFlt-1 resulted in the inhibition of the cardiac mitochondrial activity in Hmox1+/− mice. The present study demonstrates that the hydrogen sulfide (H2S) releasing molecule, MZe786, rescues mitochondrial activity by stimulating cardiac mitochondrial biogenesis and antioxidant defense in Hmox1−/− mice and in Hmox1+/− mice exposed to a high sFlt-1 environment.
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223
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Lorenzano S, Kremer C, Pavlovic A, Jovanovic DR, Sandset EC, Christensen H, Bushnell C, Arsovska A, Sprigg N, Roffe C, Ijäs P, Gdovinova Z, Alexandrov A, Zedde M, Tassi R, Acciaresi M, Lantz M, Sunnerhagen K, Zarkov M, Rantanen K, Perren F, Iversen HK, Kruuse C, Slowik A, Palazzo P, Korv J, Fromm A, Lovrencic-Huzjan A, Korompoki E, Fonseca AC, Gall SL, Brunner F, Caso V, Sacco S. SiPP (Stroke in Pregnancy and Postpartum): A prospective, observational, international, multicentre study on pathophysiological mechanisms, clinical profile, management and outcome of cerebrovascular diseases in pregnant and postpartum women. Eur Stroke J 2020; 5:193-203. [PMID: 32637653 DOI: 10.1177/2396987319893512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
Rationale Cerebrovascular diseases associated with pregnancy and postpartum period are uncommon; however, they can have an important impact on health of both women and foetus or newborn. Aims To evaluate the frequency, characteristics and management of cerebrovascular events in pregnant/postpartum women, to clarify pathophysiological mechanisms underlying the occurrence of these events including biomolecular aspects, and to assess the short- and long-term cerebrovascular and global cardiovascular outcome of these patients, their predictors and infant outcome. Methods and design This is an observational, prospective, multicentre, international case-control study. The study will include patients with cerebrovascular events during pregnancy and/or within six months after delivery. For each included case, two controls will be prospectively recruited: one pregnant or puerperal subject without any history of cerebrovascular event and one non-pregnant or non-puerperal subject with a recent cerebrovascular event. All controls will be matched by age, ethnicity and type of cerebrovascular event with their assigned cases. The pregnant controls will be matched also by pregnancy weeks/trimester. Follow-up will last 24 months for the mother and 12 months for the infant. Summary To better understand causes and outcomes of uncommon conditions like pregnancy/postpartum-related cerebrovascular events, the development of multisite, multidisciplinary registry-based studies, such as the Stroke in Pregnancy and Postpartum study, is needed in order to collect an adequate number of patients, draw reliable conclusions and give definite recommendations on their management.
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Affiliation(s)
- Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Christine Kremer
- Neurology Department, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana R Jovanovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Cheryl Bushnell
- Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC, USA
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University 'Ss Cyril and Methodius', Skopje, Republic of North Macedonia
| | - Nikola Sprigg
- Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Christine Roffe
- Institute for Science and Technology in Medicine, Keele University, c/o Guy Hilton Research Centre, Keele, UK
| | - Petra Ijäs
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Zuzana Gdovinova
- Department of Neurology, Pavol Jozef Safarik University, Košice, Slovak Republic
| | - Anne Alexandrov
- Department of Neurology, College of Nursing and College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marialuisa Zedde
- Neurology and Stroke Units, Azienda Unità Sanitaria Locale, IRCCS Reggio Emilia, Italy
| | - Rossana Tassi
- Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Acciaresi
- Medicina Interna Vascolare - Stroke Unit, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Maria Lantz
- Neurology Department, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Sunnerhagen
- Department of Neurology and Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marija Zarkov
- Clinical Center of Vojvodina, Clinic of Neurology, Novi Sad, Serbia
| | - Kirsi Rantanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | - Fabienne Perren
- Neuroscience Center, University of Geneva, Geneva, Switzerland
| | - Helle K Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology and Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Paola Palazzo
- Department of Neurology, Poitiers University Hospital and University of Poitiers, Poitiers, France
| | - Janika Korv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Eleni Korompoki
- Division of Brain Sciences, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Ana Catarina Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Seana L Gall
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | | | - Valeria Caso
- Stroke Unit, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Simona Sacco
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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224
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Zhou H, Chen W, Pan Y, Suo Y, Meng X, Li H, Wang Y. Effect of sex differences on prognosis of intravenous thrombolysis: data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China). Stroke Vasc Neurol 2020; 6:10-15. [PMID: 32641445 PMCID: PMC8005908 DOI: 10.1136/svn-2020-000351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/15/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy. This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke. METHODS The patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study. The primary outcome was poor functional outcome, defined as a 3-month modified Rankin score of 3-6. The safe outcome was symptomatic intracranial haemorrhage (SICH) and mortality within 7 days and 90 days. Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis. Furthermore, the interaction of preonset Rankin scores, baseline National Institute of Health Stroke Scale (NIHSS) scores and Trial of Org 10172 in Acute Stroke Treatment (TOAST) types was statistically analysed. RESULTS A total of 1440 patients were recruited, including 541 women and 899 men. The baseline information indicated that women were older at the time of onset (66.2±11.2 years vs 61.0±11.3 years, p<0.001), and more likely to have a history of atrial fibrillation (25.3% vs 11.2%, p<0.001), and had a higher NIHSS score on admission (12.3±6.8 vs 11.6±6.7, p=0.04). According to the prognosis analysis of unsatisfactory functional recovery, there was no significant difference between women and men (45.9% vs 37.1%; adjusted OR 1.01, 95% CI 0.75 to 1.37). As for the safe outcome, the proportion of SICH and mortality in women is relatively high but did not reach statistical significance. There was no significant interaction with sex, age, preonset Rankin score, NIHSS score, TOAST classification and the prognosis of intravenous thrombolysis. CONCLUSIONS For Chinese patients with ischaemic stroke, although women are older and more severe at the time of onset, the prognosis after intravenous thrombolysis is not significantly different from men.
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Affiliation(s)
- Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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225
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Ahnstedt H, Patrizz A, Chauhan A, Roy-O’Reilly M, Furr JW, Spychala MS, D’Aigle J, Blixt FW, Zhu L, Alegria JB, McCullough LD. Sex differences in T cell immune responses, gut permeability and outcome after ischemic stroke in aged mice. Brain Behav Immun 2020; 87:556-567. [PMID: 32058038 PMCID: PMC7590503 DOI: 10.1016/j.bbi.2020.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Stroke is a disease that presents with well-known sex differences. While women account for more stroke deaths, recent data show that after adjusting for age and pre-stroke functional status, mortality is higher in men. Immune responses are key determinants of stroke outcome and may differ by sex. This study examined sex differences in central and peripheral T cell immune responses, systemic effects on gut permeability and microbiota diversity and behavioral outcomes after stroke in aged mice. We hypothesized that there are sex differences in the immune response to stroke in aged animals. METHODS C57BL/6CR mice (20-22 months) were subjected to 60 min middle cerebral artery occlusion, or sham surgery. T cells were quantified in brain and blood at 3, 7 and 15 days (d) post-stroke by flow cytometry. Peripheral effects on gut permeability and microbiota diversity, as well as neurological function were assessed up to 14 d, and at 21 d (cognitive function) post-stroke. Brain glial fibrillary acidic protein (GFAP) expression was evaluated at 42 d post-stroke. RESULTS AND DISCUSSION Mortality (50% vs 14%, p < 0.05) and hemorrhagic transformation (44% vs 0%) were significantly higher in males than in females. No difference in infarct size at 3d were observed. Peripherally, stroke induced greater gut permeability of FITC-dextran in males at d3 (p < 0.05), and non-reversible alterations in microbiota diversity in males. Following the sub-acute phase, both sexes demonstrated a time-dependent increase of CD4+ and CD8+ T cells in the brain, with significantly higher levels of CD8+ T cells and Regulatory T cells in males at d15 (p < 0.01). Aged males demonstrated greater neurological deficits up to d5 and impaired sensorimotor function up to d15 when assessed by the corner asymmetry test (p < 0.001 and p < 0.01, respectively). A trend in greater cognitive decline was observed at d21 in males. Increased GFAP expression in the ischemic hemisphere, indicating astroglial activation and gliosis, was demonstrated in both males and females 42d post-stroke. Our findings indicate that despite a similar initial ischemic brain injury, aged male mice experience greater peripheral effects on the gut and ongoing central neuroinflammation past the sub-acute phase after stroke.
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Affiliation(s)
- Hilda Ahnstedt
- BRAINS Research Laboratory, Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
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226
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Wang X, Phan HT, Li J, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Konstantinos V, Parmar P, Krishnamurthi R, Barker-Collo S, Feigin V, Cabral NL, Carolei A, Marini C, Sacco S, Correia M, Appelros P, Kõrv J, Vibo R, Yang SC, Carcel C, Woodward M, Sandset EC, Anderson C, Gall S. Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses. WOMEN'S HEALTH REPORTS 2020; 1:190-202. [PMID: 33786481 PMCID: PMC7784810 DOI: 10.1089/whr.2020.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemic stroke (IS) among people with atrial fibrillation (AF). Methods: We performed a systematic literature search of reports of AF at IS onset according to sex. We undertook an individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conducted in Australasia, Europe, and South America (1993–2014). Poisson regression was used to estimate women:men mortality rate ratios (MRRs). Study-specific MRRs were combined using random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 101 studies, the pooled AF prevalence was 23% (95% confidence interval [CI]: 22%–25%) in women and 17% (15%–18%) in men. Our IPDMA is of 1,862 IS-AF cases, with women (79.2 ± 9.1, years) being older than men (76.5 ± 9.5, years). Crude pooled mortality rate was greater for women than for men (1-year MRR 1.24; 1.01–1.51; 5-year 1.12; 1.03–1.22). However, the sex difference was greatly attenuated after accounting for age, prestroke function, and stroke severity (1-year 1.09; 0.97–1.22; 5-year 0.98; 0.84–1.16). Women were less likely to have anticoagulant prescription at discharge (odds ratio [OR] 0.94; 95% CI: 0.89–0.98) than men when pooling IPDMA and aggregated data. Conclusions: AF was more prevalent after IS among women than among men. Among IS-AF cases, women were less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women was mostly attributable to prestroke factors. Further information needs to be collected in population-based studies to understand the reasons for lower treatment of AF in women.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia.,Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Jingwei Li
- Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Vemmos Konstantinos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Norberto L Cabral
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Manuel Correia
- InstitutodeCiênciasBiomédicasdeAbelSalazar, UniversidadedoPorto, Porto, Portugal
| | - Peter Appelros
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sook Ching Yang
- Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, the University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Seana Gall
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
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Abstract
PURPOSE OF REVIEW This review summarizes recent research in the field of systemic lupus erythematosus (SLE) and pregnancy with focus on clinical and biochemical predictors of adverse pregnancy outcomes (APOs), accumulating evidence for the safety and efficacy of hydroxychloroquine (HCQ) in pregnancy, and the importance of preconception counseling. RECENT FINDINGS Ongoing research from PROMISSE investigators (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) adds to the understanding of risk factors for APOs in SLE pregnancies, including aberrant complement activation, incomplete downregulation of lupus-associated transcription factors, and lower socioeconomic status. Evidence supporting numerous advantages for continuing HCQ in pregnancy, as well as support for low-dose aspirin in preeclampsia prevention is reviewed. Practice gaps exist among rheumatologists in ensuring effective contraception when women of childbearing age are undergoing therapy with potentially fetotoxic medications. The publication of organizational guidelines provides evidence-based recommendations on lupus pregnancy management. SUMMARY Outcomes of lupus pregnancies continue to improve with understanding of risk factors that predict APOs as well as improvements in disease management. Rheumatologists caring for women with SLE should be familiar with the most up-to-date research in order to optimize pregnancy outcomes in this population.
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228
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Ghare MI, Tirziu D, Abbott JD, Altin E, Yang Y, Ng V, Grines C, Lansky A. Sex-Specific Outcomes in Cardiovascular Device Evaluations. J Womens Health (Larchmt) 2020; 29:1246-1255. [PMID: 32543268 DOI: 10.1089/jwh.2019.8068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Females have historically been underrepresented in cardiovascular device trials. As a result, differences in outcomes for males and females are not possible to be determined in subanalyses. Materials and Methods: Against a backdrop of troubling trends in cardiovascular outcomes for females, we provide a narrative review on the differences in outcomes observed in females undergoing device evaluations in multiple fields of cardiovascular medicine, including coronary revascularization, structural heart disease, and heart failure. We also review predictors of cardiovascular trial nonparticipation as it may provide avenues by which female enrollment in cardiovascular device trials can be improved. Results: Advances have been made in structural heart therapy, where female representation in transcatheter aortic valve replacement studies was nearly 50%. For other indications, coronary revascularization and heart failure, there was clearly a disparity in female recruitment. On average, female representation was 25% in major clinical trials evaluating drug eluting stents, implantable cardioverter defibrillators, cardiac resynchronization defibrillators, and ventricular assist devices. As a result, the best treatment recommendations for females in these fields are currently guided by outcomes evaluated primarily in males. Conclusions: Female enrollment in device clinical trials for coronary revascularization and heart failure has lagged, leaving uncertainty in making benefit/risk assessments of device therapy. The predictors of female nonparticipation in clinical trials can inform a comprehensive strategy to facilitate and enrich the enrollment of females in cardiovascular device trials. This is critical to ensure that sex differences can be considered in treatment selection, so that patients can receive the best available care.
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Affiliation(s)
- Mohammed Imran Ghare
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniela Tirziu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jinnette Dawn Abbott
- Department of Medicine, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Elissa Altin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yiping Yang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vivian Ng
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
| | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Barts Heart Center, St Bartholomew's Hospital and William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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229
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Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, Safdar B, Sharma G, Wood M, Valente AM, Volgman AS. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e884-e903. [DOI: 10.1161/cir.0000000000000772] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardio-obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Cardiac conditions during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathies, arrhythmias, valvular disease, thromboembolic disease, aortic disease, and cerebrovascular diseases. Cardiovascular disease is the primary cause of pregnancy-related mortality in the United States. Advancing maternal age and preexisting comorbid conditions have contributed to the increased rates of maternal mortality. Preconception counseling by the multidisciplinary cardio-obstetrics team is essential for women with preexistent cardiac conditions or history of preeclampsia. Early involvement of the cardio-obstetrics team is critical to prevent maternal morbidity and mortality during the length of the pregnancy and 1 year postpartum. A general understanding of cardiovascular disease during pregnancy should be a core knowledge area for all cardiovascular and primary care clinicians. This scientific statement provides an overview of the diagnosis and management of cardiovascular disease during pregnancy.
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230
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Ho CH, Tan TY, Hwang CF, Lin WC, Wu CN, Yang CH. Association of carotid intima-media thickness with the risk of sudden sensorineural hearing loss. PeerJ 2020; 8:e9276. [PMID: 32547881 PMCID: PMC7275684 DOI: 10.7717/peerj.9276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/11/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular factors are associated with the pathophysiological features and risk of sudden sensorineural hearing loss (SSNHL). However, little is known about the link between carotid intima-media thickness (IMT), SSNHL risk, and their respective treatment outcomes. In this study, we retrospectively reviewed 47 SSNHL cases and 33 control subjects from a single medical center and compared their demographic data and clinical characteristics, including their carotid IMT and audiological data. Of the 80 enrolled subjects, the proportion of those with high carotid IMT was greater in the SSNHL group (53.2%) than in the control group (21.2%), with an odds ratio (OR) of 4.22 (95% confidence interval (CI) [1.53–11.61], P = 0.004). Notably, high carotid IMT was more common in female SSNHL patients than females in the control group (54.2% vs. 12.5%; OR, 8.27 (95% CI [1.53–44.62]), P = 0.008), particularly in female patients ≥50 years of age (75% vs. 25%; OR, 9.0 (95% CI [1.27–63.9]), P = 0.032). The multivariate regression analyses showed the association between high carotid IMT and SSNHL with an adjusted OR of 4.655 (95% CI [1.348–16.076], P = 0.015), particularly in female SSNHL patients (adjusted OR, 9.818 (95% CI [1.064–90.587], P = 0.044). The carotid IMT was not associated with the treatment outcomes of SSNHL. Our results indicate that early-stage atherosclerosis may be associated with SSNHL, particularly in female patients more than 50 years old.
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Affiliation(s)
- Chun-Hsien Ho
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Teng-Yeow Tan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Feng Hwang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hui Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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231
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Turbeville HR, Sasser JM. Preeclampsia beyond pregnancy: long-term consequences for mother and child. Am J Physiol Renal Physiol 2020; 318:F1315-F1326. [PMID: 32249616 PMCID: PMC7311709 DOI: 10.1152/ajprenal.00071.2020] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/26/2023] Open
Abstract
Preeclampsia is defined as new-onset hypertension after the 20th wk of gestation along with evidence of maternal organ failure. Rates of preeclampsia have steadily increased over the past 30 yr, affecting ∼4% of pregnancies in the United States and causing a high economic burden (22, 69). The pathogenesis is multifactorial, with acknowledged contributions by placental, vascular, renal, and immunological dysfunction. Treatment is limited, commonly using symptomatic management and/or early delivery of the fetus (6). Along with significant peripartum morbidity and mortality, current research continues to demonstrate that the consequences of preeclampsia extend far beyond preterm delivery. It has lasting effects for both mother and child, resulting in increased susceptibility to hypertension and chronic kidney disease (45, 54, 115, 116), yielding lifelong risk to both individuals. This review discusses recent guideline updates and recommendations along with current research on these long-term consequences of preeclampsia.
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Affiliation(s)
- Hannah R Turbeville
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer M Sasser
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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232
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Øie LR, Kurth T, Gulati S, Dodick DW. Migraine and risk of stroke. J Neurol Neurosurg Psychiatry 2020; 91:593-604. [PMID: 32217787 PMCID: PMC7279194 DOI: 10.1136/jnnp-2018-318254] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. There is growing evidence that migraine increases the overall risk of cerebrovascular diseases. In this review, based on available literature through a PubMed search, we found that ischaemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives and smoking habits. The risk of transient ischaemic attack also seems to be increased in people with migraine, although this issue has not been extensively investigated. Although migraine appears to be associated with haemorrhagic stroke, the migraine aura status has a small influence on this relationship. Neuroimaging studies have revealed a higher prevalence of asymptomatic structural brain lesions in people with migraine. They are also more likely to have unfavourable vascular risk factors; however, the increased risk of stroke seems to be more apparent among people with migraine without traditional risk factors. The mechanism behind the migraine-stroke association is unknown. In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine.
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Affiliation(s)
- Lise R Øie
- Department of Neurology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - David W Dodick
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
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233
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Rosenbloom JI, Stwalley D, Lindley KJ, Michael Nelson D, Olsen MA, Stout MJ. Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications. Pregnancy Hypertens 2020; 21:139-144. [PMID: 32516748 DOI: 10.1016/j.preghy.2020.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test the hypothesis that increasing latency from diagnosis to delivery in patients with preterm hypertensive disorders of pregnancy is associated with an increased maternal risk of cardiovascular admission after delivery. STUDY DESIGN Retrospective cohort from the IBM MarketScan® Commercial Database from 2006 to 2016. Patients age 15-45 years with a preterm delivery complicated by a hypertensive disorder of pregnancy, at least 6 months of continuous insurance coverage prior to delivery and at least 365 days of coverage post-delivery were included. MAIN OUTCOME MEASURES Hospital readmission after delivery for a composite of acute cardiovascular events (cardiomyopathy, heart failure, cardiac arrest, myocardial infarction) or cerebrovascular events. Cox proportional hazards were used to estimate the risk of the primary outcome for each week of latency from diagnosis to delivery. RESULTS There were 34,989 women in the study with a median follow-up of 2.57 years (IQR 1.66 to 1.54 years) with a median time from diagnosis to delivery of three days (IQR 0 to 14 days). An increasing time from diagnosis to delivery was associated with an increased risk of an acute cardiovascular event (adjusted HR 1.06, 95% CI 1.01, 1.11 per week), in models adjusted for maternal comorbidities and demographic factors. Later gestational age at diagnosis was associated with a decreased risk of maternal cardiovascular admission after delivery (aHR 0.94, 95% CI 0.91, 0.98 for each week increase in gestational age). CONCLUSIONS Prolonging expectant management of preterm hypertensive disorders of pregnancy is associated with an increased risk of maternal cardiovascular disease after delivery.
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Affiliation(s)
- Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, USA; Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Dustin Stwalley
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, USA
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - D Michael Nelson
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, USA
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, USA
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234
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Ferreira MJ, Sanches IC, Jorge L, Llesuy SF, Irigoyen MC, De Angelis K. Ovarian status modulates cardiovascular autonomic control and oxidative stress in target organs. Biol Sex Differ 2020; 11:15. [PMID: 32264929 PMCID: PMC7140311 DOI: 10.1186/s13293-020-00290-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/18/2020] [Indexed: 01/08/2023] Open
Abstract
Studies have presented conflicting findings regarding the association between both fluctuation and deprivation of ovarian hormones and cardiovascular autonomic modulation and oxidative stress and their potential impact on resting arterial pressure (AP) and cardiovascular risk. This study aimed to assess cardiovascular autonomic modulation, baroreflex sensitivity (BRS), and oxidative stress in male rats (M) and in female rats during ovulatory (FOV) and non-ovulatory phases (FNOV) of the estrous cycle and after deprivation of ovarian hormones (FO). Direct AP was recorded, and BRS was assessed by using increasing doses of phenylephrine and sodium nitroprusside. AP and heart rate variability were assessed by spectral analysis. Oxidative stress profile was evaluated in cardiac, renal, and muscle tissues. In females, the ovulatory phase and ovarian hormone deprivation induced an increase in AP (FOV and FO ~ 9 mmHg) when compared to the non-ovulatory phase. Ovariectomy promoted increased cardiac sympathovagal balance (~ 17–37%) when compared to other groups. Both FOV and FO groups presented impaired BRS, associated with higher AP variability. In general, antioxidant capacity was higher in the FNOV than in the M group. Ovarian hormone deprivation induced a decrease in catalase activity in cardiac and renal tissues and an increase in lipid peroxidation in all tissues analyzed. Positive correlations (p < 0.05) were found between vascular sympathetic modulation and lipid peroxidation in cardiac (r = 0.60), renal (r = 0.60), and muscle (r = 0.57) tissues. In conclusion, both oscillation and deprivation of ovarian hormones play an important role in cardiovascular autonomic control and oxidative stress profile in target organs, which is reflected in AP changes.
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Affiliation(s)
- Maycon Junior Ferreira
- Physiology Exercise Laboratory, Department of Physiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Iris Callado Sanches
- Human Movement Laboratory, Sao Judas Tadeu University (USJT), Sao Paulo, SP, Brazil
| | - Luciana Jorge
- Hypertension Unit, Heart Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Susana Francisca Llesuy
- University Institute of Italian Hospital, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | | | - Kátia De Angelis
- Physiology Exercise Laboratory, Department of Physiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil. .,Laboratory of Translational Physiology, Nove de Julho University (UNINOVE), Sao Paulo, SP, Brazil.
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235
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Madsen TE, Luo X, Huang M, Park KE, Stefanick ML., Manson JE, Liu S. Circulating SHBG (Sex Hormone-Binding Globulin) and Risk of Ischemic Stroke: Findings From the WHI. Stroke 2020; 51:1257-1264. [PMID: 32078494 PMCID: PMC7144884 DOI: 10.1161/strokeaha.120.028905] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Purpose- Circulating levels of SHBG (sex hormone-binding globulin) have been inversely linked to obesity, diabetes mellitus, and other cardiometabolic disorders. It remains uncertain whether low SHBG is prospectively predictive of stroke risk, particularly in women. We investigated whether SHBG is associated with risk of incident ischemic stroke (IS) among women in the WHI (Women's Health Initiative). Methods- From an observational cohort of 161 808 postmenopausal women enrolled in the WHI at 40 sites across the United States from 1993 to 1998, we identified 13 192 participants free of prevalent stroke at baseline who were included in an ancillary study that measured serum SHBG. We used Cox proportional hazards regression, stratified by SHBG measurement assay, to assess IS risk across quintiles of SHBG (Q1-Q5), adjusting first for demographic variables (model 1), additionally for body mass index, hypertension, alcohol use, and smoking status (model 2), and for physical activity and reproductive risk factors (model 3). In sensitivity analyses, potential mediators (diabetes mellitus status, levels of estradiol, testosterone, and CRP [C-reactive protein]) were included. Results- Of 13 192 participants (mean age, 62.5 years; 67.4% non-Hispanic white, 18.5% black, 7.6% Hispanic, and 5.0% Asian), after following for an average of 11.6 years, 768 IS events were adjudicated. Compared with the highest quintile of SHBG levels (referent), women in the lowest SHBG quintile had a higher risk of IS in all 3 multivariable models (model 1: hazard ratio, 1.88 [95% CI, 1.47-2.41]; model 2: hazard ratio, 1.69 [95% CI, 1.30-2.20]; model 3: hazard ratio, 1.61 [95% CI, 1.19-2.19]; trend tests P<0.05 for all models). Including potential mediators such as diabetes mellitus, estradiol, and testosterone in the models attenuated but did not eliminate significant inverse associations between SHBG and IS. Conclusions- In this prospective cohort of postmenopausal women, there was a statistically significant inverse association between serum SHBG levels and IS risk, which supports the notion that SHBG could be used as a risk stratification tool for predicting IS in women.
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Affiliation(s)
- Tracy E. Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown
University, Providence, RI
| | - Xi Luo
- Department of Biostatistics and Data Science, The University of
Texas Health Science Center at Houston, Houston, TX
| | - Mengna Huang
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women’s Hospital, Boston, MA
| | - Ki E. Park
- Department of Medicine, University of Florida, Gainesville,
FL
| | - Marcia L . Stefanick
- Departments of Medicine and Obstetrics & Gynecology, Stanford
University School of Medicine Stanford, CA
| | - JoAnn E. Manson
- Department of Medicine, Division of Preventive Medicine, Brigham
and Women’s Hospital/Harvard Medical School, Boston, MA
| | - Simin Liu
- Department of Epidemiology, Brown University School of Public Health, Deptartments of Medicine and Surgery, Alpert Medical School of Brown University
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236
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Lederer M, Wong A, Diego D, Nguyen D, Verma U, Chaturvedi S. Tracking the Development of Cerebrovascular Risk Factors Following Pregnancy With Preeclampsia. J Stroke Cerebrovasc Dis 2020; 29:104720. [PMID: 32220554 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the development and management of cerebrovascular risk factors following a pregnancy with preeclampsia. METHODS This is a retrospective chart review including women diagnosed with preeclampsia between 2012 and 2013 with later encounters within 2014-2016. For each subject that met inclusion criteria, the development of cerebrovascular risk factors was determined using ICD codes within the 2014-2016 electronic medical record (EMR). For subjects who developed risk factors, current treatment was determined from the EMR. Demographic data was also documented. Differences in the development and treatment of risk factors were compared among racial groups and age. Descriptive statistics were calculated using SAS statistical software. RESULTS Compared to prepregnancy health status, the incidence of hypertension increased by 1.7 times (P < .05), hyperlipidemia increased by 4.5 (P < .05), migraines increased by 2.2 (P < .05), and diabetes mellitus increased by 2 (P < .05) after a pregnancy with preeclampsia. Black non-Hispanics had highest rates of hypertension, obesity, and migraines (20.5%, 9.1%, and 6.8%, respectively.) Of hypertensives, 73.6% (42/57) were prescribed medication. Of diabetics, 88.9% (16/18) were prescribed medication. No patients with hyperlipidemia were prescribed a statin. Black non-Hispanics had higher rates of risk factor management (74.3% of hypertensives and 100% of diabetics treated) than white Hispanics (55% and 77.8%, respectively). CONCLUSIONS This study shows a significant increased risk of the development of cerebrovascular risk factors such as hypertension, hyperlipidemia, migraines, and diabetes following a diagnosis of preeclampsia. Opportunities exist for the early treatment of these risk factors, which could reduce the long-term rate of stroke in these women.
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Affiliation(s)
| | | | | | - Desiree Nguyen
- University of Colorado School of Medicine, Miami, Florida
| | - Usha Verma
- University of Miami Miller School of Medicine, Miami, Florida
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Nagraj S, Kennedy SH, Norton R, Jha V, Praveen D, Hinton L, Hirst JE. Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings. Front Cardiovasc Med 2020; 7:40. [PMID: 32266293 PMCID: PMC7099403 DOI: 10.3389/fcvm.2020.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.
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Affiliation(s)
- Shobhana Nagraj
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vivekananda Jha
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India
| | | | - Lisa Hinton
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
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Lalic-Cosic S, Dopsaj V, Kovac M, Pruner I, Littmann K, Mandic-Markovic V, Mikovic Z, Antovic A. Evaluation of global haemostatic assays and fibrin structure in patients with pre-eclampsia. Int J Lab Hematol 2020; 42:322-330. [PMID: 32190981 DOI: 10.1111/ijlh.13183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Haemostatic balance shifted towards hypercoagulability in normal pregnancy is even more pronounced in pre-eclampsia (P-EC). The aim of this study was to analyse haemostatic disturbances and fibrin clot properties in women with pre-eclampsia and to investigate their association with maternal and foetal outcomes. METHODS Forty-six pregnant women diagnosed with pre-eclampsia were included in the study, with blood sampling done on the morning following admission to hospital, as well as after delivery (mean duration 4.8 days). Two global haemostatic assays-endogenous thrombin potential (ETP) and assay of overall haemostatic potential (OHP)-were employed, including fibrin clot turbidity measurements and scanning electron microscopy (SEM) of representative samples. RESULTS Three thrombin generation parameters (ETP, t_lag and peak height) and OHP were significantly increased in pre-eclampsia compared with controls, whereas overall fibrinolytic potential (OFP-determined as a parameter of the OHP assay) had significantly lower values. Clot lysis time was significantly prolonged in patients with pre-eclampsia. In the pre-eclamptic group after delivery, we observed a significant elevation in the peak height and a reduction in the time to peak and OFP compared with values before delivery. Pre-eclamptic patients with renal complications had significantly higher values for ETP, peak height and D-dimer. Turbidity measurements and SEM revealed dense fibrin structure in patients with pre-eclampsia. CONCLUSION Patients with pre-eclampsia have enhanced coagulation and impaired fibrinolysis before, and even after, delivery. In particular, the presence of multi-organ dysfunction, such as renal dysfunction, may be associated with increased thrombin generation in pre-eclampsia.
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Affiliation(s)
- Sanja Lalic-Cosic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Violeta Dopsaj
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.,Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Kovac
- Faculty of Medicine, University of Belgrade, Blood Transfusion Institute of Serbia, Haemostasis Department, Belgrade, Serbia
| | - Iva Pruner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Karin Littmann
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Vesna Mandic-Markovic
- Faculty of Medicine, University of Belgrade, Gynaecology and Obstetrics Clinic "Narodni Front", Belgrade, Serbia
| | - Zeljko Mikovic
- Faculty of Medicine, University of Belgrade, Gynaecology and Obstetrics Clinic "Narodni Front", Belgrade, Serbia
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology, Karolinska Institutet and Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
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239
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Gao L, Li SC, Moodie M. How Does Preterm Delivery Contribute to the Increased Burden of Cardiovascular Disease? Quantifying the Economic Impact of Cardiovascular Disease in Women with a History of Preterm Delivery. J Womens Health (Larchmt) 2020; 29:1392-1400. [PMID: 32150481 DOI: 10.1089/jwh.2019.7995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: The association between preterm delivery (PTD) and maternal risk of cardiovascular disease (CVD) was demonstrated, but the economic burden of CVD in these women was unknown. Methods: A Markov microsimulation model, comprising no event, postacute coronary event (ACE, including acute myocardial infarction and unstable angina), poststroke, post-ACE and stroke, postheart failure, and death, was constructed to quantify the CVD burden in women with PTD from 2017 to 2066 using the Australian health care system perspective. Both first-ever and recurrent CVD events were accounted for in the model. Population with PTD histories was sourced from Australian Bureau of Statistics and costs of acute hospitalization and long-term management from government websites. Nonmonetary burden as years of life lost (YLL) was compared between women with and without PTD histories. Both dynamic (i.e., new cohort added every cycle) and static (i.e., population was stabilized) approaches were used to measure the CVD burden, with sensitivity analyses examining the robustness of results. Results: The dynamic model showed the total CVD burden caused by PTD as AUD11.4 billion for the next 50 years and the YLL as 0.34/capita, while the static model generated a cost of AUD4.5 billion and the YLL as 0.52/capita. Long-term management cost was the primary cost determinant (AUD9.4 billion and AUD3.7 billion, respectively) in the two models, with the results most sensitive to the discount rate and time horizon. Conclusions: Considering the substantial economic burden, recognizing PTD as a potential risk factor and encouraging women with PTD histories to participate in primary prevention programs would potentially curb the ever-increasing CVD burden.
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Shu-Chuen Li
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre, Institute for Health Transformation, Geelong, Australia
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240
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Muijsers HEC, van der Heijden OWH, de Boer K, van Bijsterveldt C, Buijs C, Pagels J, Tönnies P, Heiden S, Roeleveld N, Maas AHEM. Blood pressure after PREeclampsia/HELLP by SELF monitoring (BP-PRESELF): rationale and design of a multicenter randomized controlled trial. BMC WOMENS HEALTH 2020; 20:41. [PMID: 32131802 PMCID: PMC7055029 DOI: 10.1186/s12905-020-00910-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking. Hypertension is the first emerging risk factor after PE/HELLP pregnancies and is a major risk factor for CVD. Hypertension before the age of 55 years may lead to various manifestations of end-organ damage at relatively young age. Therefore, timely treatment of elevated blood pressure is mandatory, but many of these high-risk women have long-term undetected and untreated hypertension before adequate treatment is initiated. Aim The aim of our study is to assess whether home blood pressure monitoring (HBPM) in women with a previous PE/HELLP pregnancy is a valuable tool for the early detection of hypertension. Methods Women with a history of both early and late PE/HELLP syndrome aged 40–60 years are invited to participate. Patients with a history of CVD, known hypertension and/or use of antihypertensive medication are excluded. Women are randomized between HPBM or ‘usual care’. The primary outcome is feasibility and usability of HBPM after 1 year of follow-up. Secondary outcomes will be the effectiveness of HPBM to detect hypertension, the efficacy of BP treatment, quality of life, health-related symptoms, work ability, and life-style behaviour. The results of this study will provide better strategies for timely detection and prevention of hypertension in women after PE/HELLP. Trial registration ClinicalTrials.gov, NCT03228082. Registered June 15, 2017.
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Affiliation(s)
- Hella E C Muijsers
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynecology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynecology, Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, The Netherlands
| | - Chantal van Bijsterveldt
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands
| | - Ciska Buijs
- Department of Obstetrics and Gynecology, Maasziekenhuis Pantein, Dokter Kopstraat 1, 5835 BV, Beugen, The Netherlands
| | - Jens Pagels
- Department of Obstetrics and Gynecology, St. Josef Hospital Moers, Asberger Strasse 4, 47441, Moers, Germany
| | - Peter Tönnies
- Department of Obstetrics and Gynecology, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany
| | - Susanne Heiden
- Department of Obstetrics and Gynecology, St. Antonius Hospital Kleve, Albersallee 5-7, 47533, Kleve, Germany
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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241
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Buil-Cosiales P, Gómez-García C, Cos X, Franch-Nadal J, Vlacho B, Millaruelo J. Escaso conocimiento entre los profesionales sanitarios sobre las diferencias de género en la asociación entre la diabetes tipo 2 y la enfermedad cardiovascular. Semergen 2020; 46:90-100. [DOI: 10.1016/j.semerg.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
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242
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Collins P, Maas A, Prasad M, Schierbeck L, Lerman A. Endothelial Vascular Function as a Surrogate of Vascular Risk and Aging in Women. Mayo Clin Proc 2020; 95:541-553. [PMID: 31982169 DOI: 10.1016/j.mayocp.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/17/2019] [Accepted: 07/01/2019] [Indexed: 10/25/2022]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in women. We suggest the need to develop a paradigm that connects sex- and age-specific nontraditional risk factors that serve as a common mechanism ultimately leading to an increased risk of cardiovascular events. Vascular injury with abnormal repair leading to functional, rather than structural, abnormalities can be regarded as accelerated vascular aging. It emerges as a common feature that can trigger the early diagnosis and risk stratification for cardiovascular disease in women. We discuss sex-specific risk factors that can contribute to vascular injury with age, and these might not always be considered by cardiovascular physicians. It is important for the primary physician to be aware of these risk factors to enable more intensified management of this at-risk population. Novel technologies that allow the assessment of vascular function noninvasively can serve as key diagnostic and therapeutic tools with which we can identify such individuals and target therapy to manage this important patient population appropriately and effectively. We hope that this article will stimulate interest in this field and encourage further research in these important areas.
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Affiliation(s)
- Peter Collins
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom.
| | - Angela Maas
- Radboud University Medical Center, Department Cardiology, Nijmegen, the Netherlands
| | - Megha Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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243
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Affiliation(s)
- Mary G. George
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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244
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Norris CM, Yip CY, Nerenberg KA, Jaffer S, Grewal J, Levinsson AL, Mulvagh SL. Introducing the Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Diseases in Women. CJC Open 2020; 2:145-150. [PMID: 32462128 PMCID: PMC7242496 DOI: 10.1016/j.cjco.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/12/2022] Open
Abstract
Despite a global understanding that indicators and outcomes of cardiovascular disease (CVD) are known to differ between men and women, uptake of the recognition of sex and gender influences on the clinical care of women has been slow or absent. The Canadian Women’s Heart Health Alliance (CWHHA) was established as a network of experts and advocates to develop and disseminate evidence-informed strategies to transform clinical practice and augment collaborative action on women’s cardiovascular health in Canada. As an initial project, the CWHHA membership undertook an environmental scan of CVD in women in Canada from which a scientific statement could be developed to summarize critical sex- and gender-specific issues in CVD. This comprehensive review of the evidence focused on the sex- and gender-specific differences in comorbidity, risk factors, disease awareness, presentation, diagnosis, and treatment across the entire spectrum of CVD. In the process of creating the review, it was recognized that the team of CWHHA experts had also assembled an expansive collection of original research articles that were synthesized into detailed chapters reporting on the present state of the evidence unique to each cardiovascular condition in women. This work comprises an “ATLAS” on the epidemiology, diagnosis, and management of CVD in women. The overall goal of the ATLAS is to create a living document that will help clinicians and the public recognize the unique aspects of women’s heart health care and provide policy makers with information they need to ensure equitable care for women with CVD.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author: Dr Colleen M. Norris, Faculty of Nursing, 3rd Floor ECHA, University of Alberta, Edmonton, Alberta T6G 1C9, Canada,. Tel.: +1-780-492-0784; fax: +1-780-492-2551.
| | - Cindy Y.Y. Yip
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Kara A. Nerenberg
- Department of Medicine/Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna L.E. Levinsson
- Montréal Heart Institute, Beaulieu-Saucier Université de Montréal Pharmacogenomics Centre, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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245
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Patel H, Aggarwal NT, Rao A, Bryant E, Sanghani RM, Byrnes M, Kalra D, Dairaghi L, Braun L, Gabriel S, Volgman AS. Microvascular Disease and Small-Vessel Disease: The Nexus of Multiple Diseases of Women. J Womens Health (Larchmt) 2020; 29:770-779. [PMID: 32074468 PMCID: PMC7307673 DOI: 10.1089/jwh.2019.7826] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophysiological basis that differentially affects various organs in some patients. The prevalence of small-vessel disease in the heart has been found to be higher in women compared with men. Additionally, other diseases prominently affecting women, including heart failure with preserved ejection fraction, Takotsubo cardiomyopathy, cerebral small-vessel disease, preeclampsia, pulmonary arterial hypertension (PAH), endothelial dysfunction in diabetes, diabetic cardiomyopathy, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, may have a common etiologic linkage related to microvascular disease. To the best of our knowledge this is the first article to investigate this potential linkage. We sought to identify various diseases with a shared pathophysiology involving microvascular/endothelial dysfunction that primarily affect women, and their potential implications for disease management. Advanced imaging technologies, such as magnetic resonance imaging and positron-emission tomography, enable the detection and increased understanding of microvascular dysfunction in various diseases. Therapies that improve endothelial function, such as those used in PAH, may also be associated with benefits across the full spectrum of microvascular dysfunction. A shared pathology across multiple organ systems highlights the need for a collaborative, multidisciplinary approach among medical subspecialty practitioners who care for women with small-vessel disease. Such an approach may lead to accelerated research in diseases that affect women and their quality of life.
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Affiliation(s)
- Hena Patel
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush Medical College, Rush University, Chicago, Illinois
| | - Anupama Rao
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | | | - Rupa M Sanghani
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Mary Byrnes
- Clinical Nursing, Rush Medical College, Rush University, Chicago, Illinois
| | - Dinesh Kalra
- Department of Cardiology, Rush Medical College, Rush University, Chicago, Illinois
| | - Leigh Dairaghi
- Rush Medical College, Rush University, Chicago, Illinois
| | - Lynne Braun
- Rush College of Nursing and Medicine, Rush University, Chicago, Illinois
| | - Sherine Gabriel
- Department of Rheumatology, Rush Medical College, Rush University, Chicago, Illinois
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Circulating Neutrophils Do Not Predict Subclinical Coronary Artery Disease in Women with Former Preeclampsia. Cells 2020; 9:cells9020468. [PMID: 32085575 PMCID: PMC7072843 DOI: 10.3390/cells9020468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
: Introduction: Preeclampsia (PE) represents a hypertensive pregnancy disorder that is associated with increased cardiovascular disease (CVD) risk. This increased risk has been attributed to accelerated atherosclerosis, with inflammation being a major contributor. Neutrophils play an important role in the onset and progression of atherosclerosis and have been associated with vascular damage in the placenta as well as the chronic inflammatory state in women with PE. We therefore investigated whether circulating neutrophil numbers or reactivity were associated with the presence and severity of subclinical atherosclerosis in women with a history of PE. METHODS Women aged 45-60 years with a 10 to 20 years earlier history of early onset preeclampsia (delivery <34 weeks of gestation) (n = 90), but without symptomatic CVD burden were screened for the presence of subclinical coronary artery disease (CAD) using both contrast-enhanced and non-contrast coronary CT angiography. Subclinical CAD was defined as a coronary artery calcium (CAC) score ≥100 Agatston Units and/or ≥50% coronary luminal stenosis. We assessed whether the numbers and activity of circulating neutrophils were associated with the presence of subclinical CAD and as secondary outcome measurements, with the presence of any calcium (CAC score > 0 AU) or stenosis, categorized as absent (0%), minimal to mild (>0 and <50%), and moderate to severe (≥50%) narrowing of the coronary artery. Blood was drawn just before CT and neutrophil numbers were assessed by flow cytometry. In addition, the presence of the chemokine receptors CXCR2 and CXCR4, which are known to be instrumental in neutrophil recruitment, and neutrophil activity upon stimulation with the bacterial peptide N-Formylmethionyl-leucyl-phenylalanine (fMLF) was assessed by flow cytometry. RESULTS Of the participating women, with an average age of 49 years, 13% (12 out of 90) presented with subclinical signs of CAD (CAC score ≥100 AU and/or ≥50% luminal stenosis), and 37% (33 out of 90) had a positive CAC score (>0). Total white blood cell count and neutrophil counts were not associated with the presence of subclinical CAD or with a positive CAC score. When assessing the presence of the chemokine receptors CXCR4 and CXCR2, we observed a slight decrease of neutrophil CXCR2 expression in women with CAC (median MFI 22.0 [interquartile range (IQR) 20.2-23.8]) compared to women without CAC (23.8 [IQR 21.6-25.6], p = 0.02). We observed no differences regarding neutrophil CXCR4 expression. In addition, expression of the early activity marker CD35 was slightly lower on neutrophils of women with subclinical CAD (median MFI 1.6 [IQR 1.5-1.9] compared to 1.9 [IQR 1.7-2.1] in women without CAD, p = 0.02). However, for all findings, statistical significance disappeared after adjustment for multiple testing. CONCLUSION Our findings indicate that neutrophil counts and (re)activity are not directly associated with silent CAD disease burden and as such are not suitable as biomarkers to predict the presence of subclinical CAD in a high-risk population of women with a history of preeclampsia.
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Loussert L, Vidal F, Parant O, Hamdi SM, Vayssiere C, Guerby P. Aspirin for prevention of preeclampsia and fetal growth restriction. Prenat Diagn 2020; 40:519-527. [PMID: 31955436 DOI: 10.1002/pd.5645] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
For the past decades, growing attention has been given to aspirin use during pregnancy. It favors placentation by its proangiogenic, antithrombotic, and anti-inflammatory effects. Therefore, low doses of aspirin are prescribed in the prevention of placenta-mediated complications, mainly preeclampsia and fetal growth restriction. However, questions regarding its clinical application are still debated. Aspirin is effective in preventing preeclampsia in a high-risk population. Most guidelines recommend that risk stratification should rely on medical history. Nevertheless, screening performances dramatically improve if biochemical and biophysical markers are included. Concerning the appropriate timing and dose, latest studies suggest aspirin should be started before 16 weeks of pregnancy and at a daily dose of 100 mg or more. Further studies are needed to improve the identification of patients likely to benefit from prophylactic aspirin. Besides, the role of aspirin in the prevention of fetal growth restriction is still questioned.
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Affiliation(s)
- Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Fabien Vidal
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Safouane M Hamdi
- Laboratoire de Biochimie et d'Hormonologie, Institut Fédératif de Biologie, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,Inserm U-1048, Université de Toulouse, Toulouse, France
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Vermunt JV, Kennedy SH, Garovic VD. Blood Pressure Variability in Pregnancy: an Opportunity to Develop Improved Prognostic and Risk Assessment Tools. Curr Hypertens Rep 2020; 22:10. [PMID: 32008117 PMCID: PMC7259977 DOI: 10.1007/s11906-019-1014-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW This review discusses the mortality and morbidity of hypertensive disorders of pregnancy (HDP) and the current diagnostic thresholds. It then explores measurement of variability in blood pressure (BP) during pregnancy as an opportunity to identify women at high risk of cardiovascular disease (CVD) later in life. RECENT FINDINGS HDP is known to be associated with increased risk of long-term CVD. Current CVD prognostic tools do not incorporate a history of HDP given a lack of improved risk discrimination. However, HDP diagnostic criteria are currently based on a binary threshold, and there is some evidence for the use of variability in BP throughout gestation as a marker of CVD risk. HDP increases long-term risk of CVD. Future studies investigating changes in diagnostic criteria, including the use of BP variability, may improve long-term CVD risk prediction and be incorporated into future risk assessment tools.
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Affiliation(s)
- Jane V Vermunt
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Division of Nephrology and Hypertension, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
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Predictors of malignant cerebral edema in cerebral artery infarction: A meta-analysis. J Neurol Sci 2020; 409:116607. [DOI: 10.1016/j.jns.2019.116607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/29/2022]
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Lackey AR, Durham F, Voeks JH, Lal BK. Clinical consideration of biologic sex on the choice of revascularization technique: does (should) sex affect the choice of carotid artery stenting versus carotid endarterectomy? ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.19.01435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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