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Ang SP, Chia JE, Krittanawong C, Lee K, Iglesias J, Misra K, Mukherjee D. Sex Differences and Clinical Outcomes in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: A Meta-Analysis. J Am Heart Assoc 2024; 13:e035329. [PMID: 39082413 DOI: 10.1161/jaha.124.035329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Although myocardial infarction with nonobstructive coronary arteries (MINOCA) is more common in women, it is unknown whether sex is a risk factor for adverse outcomes in patients with MINOCA. We aimed to investigate the relationship between sex differences and outcomes of patients with MINOCA. METHODS AND RESULTS A systematic literature search was performed in PubMed, Embase, and Cochrane databases from their inception until August 2023 for relevant studies. End points were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model as odds ratio (OR) with 95% CIs. Nine studies, involving 30 281 patients with MINOCA (comprising 18 079 women and 12 202 men), were included in the study. Women were older and had a higher prevalence of hypertension, diabetes, and stroke compared with men. The median duration of follow-up was 3.5 years, with an interquartile range of 2.2 to 4.2 years. Pooled analysis revealed no statistically significant difference in the risk of all-cause mortality (OR, 1.03 [95% CI, 0.87-1.22]), major adverse cardiovascular events (OR, 1.18 [95% CI, 0.89-1.58]), heart failure (OR, 1.32 [95% CI, 0.57-3.03]), stroke (OR, 1.13 [95% CI, 0.56-2.26]), and myocardial infarction (OR, 1.04 [95% CI, 0.29-3.76]) between the 2 groups. Regarding short-term outcomes, women had a significantly higher risk of in-hospital major adverse cardiovascular events compared with men (OR, 1.33 [95% CI, 1.16-1.53]) whereas there was no significant difference in the risk of in-hospital mortality (OR, 0.90 [95% CI, 0.64-1.28]) between the 2 patient groups. CONCLUSIONS Despite the differences in demographics and comorbidity profiles, there was no significant difference in the long-term outcomes for patients with MINOCA between sexes. However, it is noteworthy that women experienced a higher risk of in-hospital major adverse cardiovascular events compared with men.
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Affiliation(s)
- Song P Ang
- Department of Internal Medicine Rutgers Health/Community Medical Center Toms River NJ
| | - Jia E Chia
- Department of Internal Medicine Texas Tech University Health Science Center El Paso TX
| | | | - Kwan Lee
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Jose Iglesias
- Department of Internal Medicine Rutgers Health/Community Medical Center Toms River NJ
- Department of Internal Medicine Hackensack Meridian School of Medicine Nutley NJ
| | - Kanchan Misra
- Department of Radiology Rutgers Robert Wood Johnson Medical School New Brunswick NJ
| | - Debabrata Mukherjee
- Department of Internal Medicine Texas Tech University Health Science Center El Paso TX
- Department of Cardiovascular Medicine Texas Tech University Health Science Center El Paso TX
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2
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Martin TG, Leinwand LA. Hearts apart: sex differences in cardiac remodeling in health and disease. J Clin Invest 2024; 134:e180074. [PMID: 38949027 PMCID: PMC11213513 DOI: 10.1172/jci180074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Biological sex is an important modifier of physiology and influences pathobiology in many diseases. While heart disease is the number one cause of death worldwide in both men and women, sex differences exist at the organ and cellular scales, affecting clinical presentation, diagnosis, and treatment. In this Review, we highlight baseline sex differences in cardiac structure, function, and cellular signaling and discuss the contribution of sex hormones and chromosomes to these characteristics. The heart is a remarkably plastic organ and rapidly responds to physiological and pathological cues by modifying form and function. The nature and extent of cardiac remodeling in response to these stimuli are often dependent on biological sex. We discuss organ- and molecular-level sex differences in adaptive physiological remodeling and pathological cardiac remodeling from pressure and volume overload, ischemia, and genetic heart disease. Finally, we offer a perspective on key future directions for research into cardiac sex differences.
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Affiliation(s)
- Thomas G. Martin
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Leslie A. Leinwand
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
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3
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Gonçalves A, Moutinho E, Santos A, Teixeira T. Myocardial native T1 mapping at 3T cardiac magnetic resonance-closing the full-vendor reporting cycle of normal values. Clin Radiol 2024; 79:473-478. [PMID: 38582631 DOI: 10.1016/j.crad.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/26/2024] [Accepted: 02/21/2024] [Indexed: 04/08/2024]
Abstract
AIM Cardiac magnetic resonance is currently an indispensable tool in the diagnosis of cardiac pathologies, with mapping techniques being one of the most recent advances in this area. T1 mapping is a robust tool that uses the T1 magnetic relaxation time as a quantitative marker of myocardial tissue composition. However, multiple T1 mapping sequences are used, and data comparing them, especially on different vendors, is limited. This study aims to determine the T1 relaxation values in the cardiac muscle of healthy individuals using GE's Discovery 3T scanner, allowing the use of the T1 mapping technique in patients on a sustained basis. MATERIAL AND METHODS Thirty-one healthy volunteers were submitted to T1 mapping at 3T magnetic resonance imaging (MRI) equipment, with 3 being excluded from the analysis (54% women; mean age: 39.2 ± 13.9 years). The MOLLI 5(3)3 sequence was used, acquiring one short axis slice at midventricular level. Native T1 values were presented as means (± standard deviation), and t-student independent samples tests evaluated gender differences in T1 values. RESULTS The results show an average global native T1 value of 1193 ± 39 ms, with women's values being statistically higher than men (1211 ± 40 vs 1173 ± 27 ms, respectively, p<0.006). Gender remained the only determinant of native T1 times on a multiple linear regression model that included age, ejection fraction, and T2 status. CONCLUSION This study has established one of the few native T1 values for a 3T GE Discovery scanner that are on par with those already reported by other vendors for a similar sequence, closing the circle in full-vendor reporting.
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Affiliation(s)
| | | | - A Santos
- Atrys Advanced Medical Centre, Portugal
| | - T Teixeira
- Atrys Advanced Medical Centre, Portugal.
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4
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Anelli V, Armeni E, Paschou SA, Lambrinoudaki I. Statin use and incident type 2 diabetes mellitus in women after menopause. Maturitas 2024; 181:107914. [PMID: 38245965 DOI: 10.1016/j.maturitas.2024.107914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Menopause is associated with adverse cardiometabolic changes which increase the risk of new-onset type 2 diabetes (T2DM) and cardiovascular disease (CVD). Statins are widely used for primary and secondary CVD prevention, given their beneficial effects on the lipid profile and the vessel wall. On the other hand, statins increase the risk of T2DM. This association has been evaluated mainly in mixed-gender studies, without gender-specific evaluation. This narrative review evaluates the use of statins and the related risk of new-onset T2DM among postmenopausal women. Studies that incorporated a gender-specific analysis report a higher risk of new-onset T2DM in women than in men on treatment with statins. Fewer studies evaluated female-only samples; these confirm the observed association between statin use and new-onset T2DM. Factors influencing the association between statin use and T2DM include the type and dose of statin and the baseline metabolic status. Women may benefit from stratification of their metabolic risk before initiating a statin for CVD prevention.
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Affiliation(s)
- Valentina Anelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Eleni Armeni
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece; Royal Free Hospital NHS Trust, Medical School, University College London, London, UK
| | - Stavroula A Paschou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.
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5
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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6
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Wang X, Jering KS, Cikes M, Tokmakova MP, Mehran R, Han Y, East C, Mody FV, Wang Y, Lewis EF, Claggett B, McMurray JJV, Granger CB, Pfeffer MA, Solomon SD. Sex Differences in Clinical Characteristics and Outcomes After Myocardial Infarction With Low Ejection Fraction: Insights From PARADISE-MI. J Am Heart Assoc 2023; 12:e028942. [PMID: 37609931 PMCID: PMC10547323 DOI: 10.1161/jaha.122.028942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/08/2023] [Indexed: 08/24/2023]
Abstract
Background Studies demonstrated sex differences in outcomes following acute myocardial infarction, with women more likely to develop heart failure (HF). Sacubitril/valsartan has been shown to reduce cardiovascular death and HF hospitalizations in patients with HF with reduced ejection fraction. Methods and Results A total of 5661 patients (1363 women [24%]) with acute myocardial infarction complicated by reduced left ventricular ejection fraction (≤40%), pulmonary congestion, or both and ≥1 of 8 risk-augmenting factors were randomized to receive sacubitril/valsartan or ramipril. The primary outcome was cardiovascular death or incident HF. Baseline characteristics, clinical outcomes, and safety events were compared according to sex, a prespecified subgroup. Female participants were older and had more comorbidities. After multivariable adjustment, women and men were at similar risks for cardiovascular death or all-cause death. Women were more likely to have first HF hospitalization (hazard ratio [HR], 1.34 [95% CI, 1.05-1.70]; P=0.02) and total HF hospitalizations (HR, 1.39 [95% CI, 1.05-1.84]; P=0.02). Sex did not significantly modify the treatment effect of sacubitril/valsartan compared with ramipril on the primary outcome (P for interaction=0.11). Conclusions In contemporary patients who presented with reduced left ventricular ejection fraction, pulmonary congestion, or both, following acute myocardial infarction, women had a higher incidence of HF during follow-up. Sex did not modify the treatment effect of sacubitril/valsartan relative to ramipril. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02924727.
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Affiliation(s)
- Xiaowen Wang
- Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | | | - Maja Cikes
- University Hospital Centre ZagrebZagrebCroatia
| | - Mariya P. Tokmakova
- University Multiprofile Hospital for Active Treatment Sv. Georgi Medical University PlovdivPlovdivBulgaria
| | | | - Yaling Han
- General Hospital of Northern Theater CommandShenyangChina
| | | | - Freny Vaghaiwalla Mody
- David Geffen School of Medicine at University of California, Los AngelesVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
| | - Yi Wang
- Novartis Pharmaceuticals CorporationEast HanoverNJ
| | | | - Brian Claggett
- Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - John J. V. McMurray
- British Heart Foundation Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowScotlandUnited Kingdom
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7
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Docherty KF, Jackson AM, Macartney M, Campbell RT, Petrie MC, Pfeffer MA, McMurray JJ, Jhund PS. Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016. Eur J Heart Fail 2023; 25:1213-1224. [PMID: 37401485 PMCID: PMC10946471 DOI: 10.1002/ejhf.2965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years. METHODS AND RESULTS All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years. CONCLUSION The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.
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Affiliation(s)
| | - Alice M. Jackson
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | | | - Ross T. Campbell
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Mark C. Petrie
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Marc A. Pfeffer
- Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
| | | | - Pardeep S. Jhund
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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8
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Grilo GA, Cakir SN, Shaver PR, Iyer RP, Whitehead K, McClung JM, Vahdati A, de Castro Brás LE. Collagen matricryptin promotes cardiac function by mediating scar formation. Life Sci 2023; 321:121598. [PMID: 36963720 PMCID: PMC10120348 DOI: 10.1016/j.lfs.2023.121598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
AIMS A peptide mimetic of a collagen-derived matricryptin (p1159) was shown to reduce left ventricular (LV) dilation and fibrosis after 7 days delivery in a mouse model of myocardial infarction (MI). This suggested p1159 long-term treatment post-MI could have beneficial effects and reduce/prevent adverse LV remodeling. This study aimed to test the potential of p1159 to reduce adverse cardiac remodeling in a chronic MI model and to elucidate p1159 mode-of-action. MATERIALS AND METHODS Using a permanent occlusion MI rodent model, animals received p1159 or vehicle solution up to 28 days. We assessed peptide treatment effects on scar composition and structure and on systolic function. To assess peptide effects on scar vascularization, a cohort of mice were injected with Griffonia simplicifolia isolectin-B4. To investigate p1159 mode-of-action, LV fibroblasts from naïve animals were treated with increasing doses of p1159. KEY FINDINGS Matricryptin p1159 significantly improved systolic function post-MI (2-fold greater EF compared to controls) by reducing left ventricular dilation and inducing the formation of a compliant and organized infarct scar, which promoted LV contractility and preserved the structural integrity of the heart. Specifically, infarcted scars from p1159-treated animals displayed collagen fibers aligned parallel to the epicardium, to resist circumferential stretching, with reduced levels of cross-linking, and improved tissue perfusion. In addition, we found that p1159 increases cardiac fibroblast migration by activating RhoA pathways via the membrane receptor integrin α4. SIGNIFICANCE Our data indicate p1159 treatment reduced adverse LV remodeling post-MI by modulating the deposition, arrangement, and perfusion of the fibrotic scar.
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Affiliation(s)
- Gabriel A Grilo
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Sirin N Cakir
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Patti R Shaver
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Rugmani P Iyer
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Kaitlin Whitehead
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Joseph M McClung
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America; Department of Cardiovascular Sciences, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America; East Carolina Diabetes and Obesity Institute, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America
| | - Ali Vahdati
- Department of Engineering, East Carolina University, Greenville, NC 27858, United States of America
| | - Lisandra E de Castro Brás
- Department of Physiology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America; Department of Cardiovascular Sciences, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States of America.
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9
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Rongali P, Jain K, Nakka S, Kumar A. Gender Differences in Heart Failure Hospitalization Post-Myocardial Infarction. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/mm_ijcdw_471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objectives:
Patients with post-myocardial infarction (MI) are more likely to die later from heart failure (HF), arrhythmic events, or reinfarction. According to recent studies, mortality rates were noticeably higher in women, than in men. This has been linked to variations in age, comorbidities, symptom presentation, and pathophysiology of the underlying coronary artery disease. There is little information on how these typical gender disparities affect post- MI survival. Studies on individuals with coronary artery disease have primarily focused on men, with women typically being left out of most series. Despite the relatively high prevalence of ischemic heart disease in women, there is a lack of information regarding the clinical course of the condition, its management, and clinical outcomes in this particular population due to the underrepresentation of women in the medical literature in this field. The gender disparities in post-MI patients who present with HF will be briefly discussed in this article.
Materials and Methods:
A total of 50 patients that presented with HF and had a previous history of MI were included in this study after taking consent. After taking history and detailed physical examination, investigations that were sent were reviewed and the subjects followed up in the hospital stay to look for outcomes. The data are compiled and subjected to statistical analysis.
Results:
It is observed that among the 50 subjects, 32% of them had recurrent HF (13 of the 30 females and three of the 20 males). p = 0.04 is statistically significant. Among the study subjects, the hospital outcomes observed showed that, out of 50 subjects, 47 subjects recovered and the other three died in hospital stay. All the three deaths are women. p = 0.15 is not statistically significant.
Conclusion:
This study concludes that women are more likely than males to require hospitalization for recurrent HF following a MI. This study also demonstrates that, despite the higher risk of recurrent HF, women do not have a higher mortality risk than males.
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Affiliation(s)
- Pradeep Rongali
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Kala Jain
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Srikanth Nakka
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Achukatla Kumar
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
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10
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Lunova T, Komorovsky R, Klishch I. Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Curr Cardiol Rev 2023; 19:e300622206530. [PMID: 35786190 PMCID: PMC10201882 DOI: 10.2174/1573403x18666220630120259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS. METHODS We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately. RESULTS Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs. CONCLUSION Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.
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Affiliation(s)
- Tetiana Lunova
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Roman Komorovsky
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Ivan Klishch
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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11
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Wang S, Zhang Y, Cheng Q, Qi D, Wang X, Zhu Z, Li M, Zhang J, Hu D, Gao C, Henan STEMI registry study group OBO. Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry. Cardiol Res Pract 2022; 2022:2835485. [PMID: 36105435 PMCID: PMC9467791 DOI: 10.1155/2022/2835485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016-2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, P < 0.001) and diabetes (24.5% vs. 15.2%, P < 0.001). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, P < 0.001); the onset to first medical contact (FMC) (255 vs. 190 minutes, P < 0.001), onset to fibrinolysis (218 vs. 185 minutes, P < 0.001), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, P < 0.001) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, P < 0.001), death or treatment withdrawal (14.5% vs. 5.6%, P < 0.001), and MACCE (18.5% vs. 9.4%, P < 0.001) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12-2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26-2.24), and MACCE (OR: 1.37, 95% CI: 1.08-1.74) after adjustment for covariates. Among possible explanatory factors, age (-58.46%, -59.04%, -62.20%) and cardiovascular risk factors (-40.77%, -39.36%, -41.73%) accounted for most of the gender-associated risk differences. Conclusions Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.
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Affiliation(s)
- Shan Wang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - You Zhang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianqian Cheng
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Datun Qi
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianpei Wang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongyu Zhu
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Muwei Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhui Zhang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Dayi Hu
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing, China
| | - Chuanyu Gao
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - On behalf of Henan STEMI registry study group
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
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12
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Saleh ZT, Alraoush AT, Aqel AA, Shawashi TO, Chung M, Lennie TA. Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:386-393. [PMID: 37707972 PMCID: PMC8733054 DOI: 10.1097/jcn.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined. AIM The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables. METHOD This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF. RESULTS There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation. CONCLUSION These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.
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Affiliation(s)
- Zyad T. Saleh
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Ahmad T. Alraoush
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan 22110
| | - Ahmad A. Aqel
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Tagreed O. Shawashi
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Misook Chung
- College of Nursing, University of Kentucky, 315 College of Nursing Building, 751 Rose Street, Lexington, KY 40536
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, 315 College of Nursing Building, 751 Rose Street, Lexington, KY 40536
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13
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Zettersten E, Jäderling G, Bell M, Larsson E. A cohort study investigating the occurrence of differences in care provided to men and women in an intensive care unit. Sci Rep 2021; 11:23396. [PMID: 34862443 PMCID: PMC8642468 DOI: 10.1038/s41598-021-02815-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
It has been reported that there are differences in the care given within the intensive care unit (ICU) between men and women. The aim of this study is to investigate if any differences still exist between men and women regarding the level of intensive care provided, using prespecified intensive care items. This is a retrospective cohort study of 9017 ICU patients admitted to a university hospital between 2006 and 2016. Differences in use of mechanical ventilation, invasive monitoring, vasoactive treatment, inotropic treatment, echocardiography, renal replacement therapy and central venous catheters based on the sex of the patient were analysed using univariate and multivariable logistic regressions. Subgroup analyses were performed on patients diagnosed with sepsis, cardiac arrest and respiratory disease. Approximately one third of the patients were women. Overall, men received more mechanical ventilation, more dialysis and more vasoactive treatment. Among patients admitted with a respiratory disease, men were more likely to receive mechanical ventilation. Furthermore, men were more likely to receive levosimendan if admitted with cardiac arrest. We conclude that differences in the level of intensive care provided to men and women still exist.
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Affiliation(s)
- Erik Zettersten
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden. .,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
| | - Gabriella Jäderling
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Max Bell
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Emma Larsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.,Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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14
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Aimo A, Panichella G, Barison A, Maffei S, Cameli M, Coiro S, D'Ascenzi F, Di Mario C, Liga R, Marcucci R, Morrone D, Olivotto I, Tritto I, Emdin M. Sex-related differences in ventricular remodeling after myocardial infarction. Int J Cardiol 2021; 339:62-69. [PMID: 34314766 DOI: 10.1016/j.ijcard.2021.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
The epidemiology, clinical features and outcome of myocardial infarction (MI) display significant differences between men and women. Prominent sex differences have also been suggested in left ventricular (LV) remodeling after MI. Ventricular remodeling refers to a deterioration of LV geometry and function often leading to heart failure (HF) development and an increased risk of adverse cardiovascular events. Women have a lower propensity to the acquisition of a spherical geometry and LV dysfunction. These differences can be attributed at least partially to a lower frequency of transmural infarction and smaller areas of microvascular obstruction in women, as well as to a less prominent activation of neuroendocrine systems and apoptotic, inflammatory and profibrotic pathways in women. Estrogens might play a role in this difference, which could partially persist even after the menopause because of a persisting intramyocardial synthesis of estrogens in women. Conversely, androgens may exert a detrimental influence. Future studies should better clarify sex differences in the predictors, clinical correlates, prognostic impact and disease mechanisms of remodeling, as well as the existence of sex-specific therapeutic targets. This research effort should hopefully allow to optimize the treatment of MI during the acute and post-acute phase, possibly through different therapeutic strategies in men and women, with the goal of reducing the risk of HF development and improving patient outcome.
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Affiliation(s)
- Alberto Aimo
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Andrea Barison
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Rossella Marcucci
- Experimental and Clinical Medicine, University of Florence, Atherothrombotic Center, AOU Careggi, Florence, Italy
| | - Doralisa Morrone
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Iacopo Olivotto
- Cardiomiopathy Unit, AOU Careggi, Florence, Italy. Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra
| | | | - Michele Emdin
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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15
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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16
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Ruberti OM, Rodrigues B. Estrogen Deprivation and Myocardial Infarction: Role of Aerobic Exercise Training, Inflammation and Metabolomics. Curr Cardiol Rev 2021; 16:292-305. [PMID: 31362678 PMCID: PMC7903506 DOI: 10.2174/1573403x15666190729153026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022] Open
Abstract
In general, postmenopausal women present higher mortality, and worse prognosis after myocardial infarction (MI) compared to men, due to estrogen deficiency. After MI, cardiovascular alterations occur such as the autonomic imbalance and the pro-inflammatory cytokines increase. In this sense, therapies that aim to minimize deleterious effects caused by myocardial ischemia are important. Aerobic training has been proposed as a promising intervention in the prevention of cardiovascular diseases. On the other hand, some studies have attempted to identify potential biomarkers for cardiovascular diseases or specifically for MI. For this purpose, metabolomics has been used as a tool in the discovery of cardiovascular biomarkers. Therefore, the objective of this work is to discuss the changes involved in ovariectomy, myocardial infarction, and aerobic training, with emphasis on inflammation and metabolism.
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Affiliation(s)
- Olívia M Ruberti
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Bruno Rodrigues
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
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17
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Alkhouli M, Alqahtani F, Jneid H, Al Hajji M, Boubas W, Lerman A. Age-Stratified Sex-Related Differences in the Incidence, Management, and Outcomes of Acute Myocardial Infarction. Mayo Clin Proc 2021; 96:332-341. [PMID: 33483147 DOI: 10.1016/j.mayocp.2020.04.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the impact of female sex on the incidence, management, and outcomes of myocardial infarction (MI) in different age groups. METHODS Patients admitted with ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI), between January 1, 2003, and December 31, 2015, were identified in the National Inpatient Sample. We compared STEMI and NSTEMI rates, management patterns, and in-hospital morbidity and mortality in men and women stratified into 4 age groups (<45, 45 to 64, 65 to 84, and ≥85 years of age). RESULTS A total of 6,720,639 weighted hospitalizations for MI (79.8% NSTEMI, and 20.2% STEMI) were included. The incidence rate of hospitalizations for MI was lower in women than men across all age groups. Women were less likely than men to undergo coronary angiography, revascularization, or to use circulatory-support devices. These differences were consistent across all age groups. Adjusted odds of death for women (vs men) varied by age: odds ratio (95% confidence interval) 1.08 (0.97 to 1.20), 1.05 (1.02 to 1.08), 0.92 (0.91 to 0.94), and 0.86 (0.85 to 0.88) for NSTEMI, and 1.15 (1.04 to 1.27), 1.22 (1.18 to 1.26), 1.09 (1.06 to 1.11), and 0.97 (0.94 to 0.99), for STEMI, in age groups (<45, 45 to 64, 65 to 84, and ≥85), respectively. The magnitude of differences in complications between men and women was higher in younger and middle-age patients. CONCLUSION Compared with men, women have lower incidence of MI and less likelihood of undergoing invasive treatment regardless of age. However, post-MI outcomes are age specific. The negative impact of female sex on most outcomes was most pronounced in young and middle-aged women.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Fahad Alqahtani
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston, TX
| | - Mohammed Al Hajji
- Division of Cardiology, Department of Medicine, West Virginia University Morgantown, WV
| | - Wafaa Boubas
- Division of Cardiology, Department of Medicine, West Virginia University Morgantown, WV
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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18
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Kingma JG, Laher I. Effect of endothelin on sex-dependent regulation of tone in coronary resistance vessels. Biochem Biophys Res Commun 2021; 540:56-60. [PMID: 33445111 DOI: 10.1016/j.bbrc.2020.12.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND/AIMS Sex dependent differences in coronary artery vasoregulation may be due to variations in responses to endogenous vasoactive compounds including endothelin (ET-1) and nitric oxide (NO). METHODS Septal coronary arteries (<200 μm) from healthy, sexually mature male, female and ovariectomized (i.e. surgical menopause) Sprague-Dawley rats were used. Myogenic tone, measured by pressure myography, was initially determined for all vessel segments studied before and after exposure to the nonselective ETA/ETB receptor blocker, bosentan (1 μM). Vasoconstrictor responses (vascular endothelium intact) to cumulative ET-1 (10-12 - 10-9 M) were assessed in a separate set of septal coronary vessels. Additional studies, examined the vasoconstrictor effects of ET-1 after NO blockade with L-NAME (200 μM). RESULTS Myogenic tone was 26 ± 7% in male, 20 ± 7% in female (p = 0.04 versus male) and 24 ± 3% in ovariectomized (p = NS versus male/female) vessels. Antagonism of ET-1 receptors produced a greater reduction in myogenic tone in male, compared to female rats over a similar range of intraluminal pressure (20-80 mmHg). Robust constrictor responses to cumulative concentrations of ET-1 were observed in all vessels; however, male rats exhibited greater sensitivity to vasoconstrictor effects of ET-1. After exposure to L-NAME vessel responses to ET-1 were normalized in male and female (not studied in ovariectomized) groups. CONCLUSIONS These findings confirm marked sex differences for myogenic tone and vessel constrictor responses to ET-1 in coronary resistance vessels. Results also suggest greater sensitivity to vasoconstrictor effects of ET-1 in male coronary resistance vessels.
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Affiliation(s)
- John G Kingma
- Department of Medicine, Faculty of Medicine, Pavillon Ferdinand-Vandry, 1050, Ave de la Médecine, Université Laval, Québec, Qc G1V 0A6, Canada.
| | - Ismail Laher
- Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, 217 - 2176 Health, Sciences Mall, University of British Columbia, Vancouver, BC. V6T 1Z3, Canada
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19
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Yandrapalli S, Malik A, Pemmasani G, Aronow W, Shah F, Lanier G, Cooper H, Jain D, Naidu S, Frishman W, Panza J. Sex differences in heart failure hospitalisation risk following acute myocardial infarction. Heart 2021; 107:1657-1663. [PMID: 33431424 DOI: 10.1136/heartjnl-2020-318306] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We evaluated the sex differences in 6-month heart failure (HF) hospitalisation risk in acute myocardial infarction (AMI) survivors. METHODS For this retrospective cohort analysis, adult survivors of an AMI between January and June 2014 were identified from the US Nationwide Readmissions Database. The primary outcome was a HF hospitalisation within 6 months. Secondary outcomes were fatal HF hospitalisation and the composite of index in-hospital HF or 6-month HF hospitalisation. RESULTS Of 237 549 AMI survivors, females (37.9%) were older (70±14 years vs 65±13 years; p<0.001), had a higher prevalence of cardiac comorbidities and a lower revascularisation rate compared with males. The primary outcome occurred in 12 934 patients (5.4%), at a 49% higher rate in females (6.8% vs 4.6% in males, p<0.001), which was attenuated to a 19% higher risk after multivariable adjustment. Findings were consistent across subgroups of age, AMI type and major risk factors. In the propensity-matched time-to-event analysis, female sex was associated with a 13% higher risk for 6-month HF readmission (6.4% vs 5.8% in males; HR 1.13, 95% CI 1.05 to 1.21, p<0.001), and the increased risk was evident early on after the AMI. Fatal HF rate was similar between groups (4.7% vs 4.6%, p=0.936), but females had a higher rate of the composite HF outcome (36.2% vs 27.5%, p<0.001). CONCLUSION In a large all-comers AMI survivors' cohort, females had a higher HF hospitalisation risk that persisted after adjustment for baseline risk differences. This was consistent across several clinically relevant subgroups and was evident early on after the AMI.
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Affiliation(s)
- Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Gayatri Pemmasani
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Falak Shah
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Gregg Lanier
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Howard Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Diwakar Jain
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Srihari Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - William Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Julio Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
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20
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Alyasin N, Teate A, Strickland K. The experience of women following first acute coronary syndrome: An integrative literature review. J Adv Nurs 2021; 77:2228-2247. [PMID: 33393122 DOI: 10.1111/jan.14677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
AIM There is lack of evidence and research understanding among women's lived experiences following first acute coronary syndrome, thus their recovery process remains poorly understood. To date research has largely focused on men's experience of acute coronary syndrome while this area of health care and recovery has considerable impact on women's health and quality of life. Our aim was to review the literature exploring lived experience of women following first acute coronary syndrome. DESIGN Integrative review of the literature. DATA SOURCE We searched PubMed, MEDLINE, EMBASE, CINAHL and Scopus from 2008-2018 for articles published in English. REVIEW METHOD Of 1675 publications identified, 18 qualitative, quantitative, and mixed method studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. Findings were integrated using thematic synthesis. RESULTS Experiencing acute coronary syndrome was reported to have significant impacts on women's lives. The most common issues reported were physical limitations, fear, and uncertainties about the future, sexual dissatisfaction, and social isolation. Women also reported to have higher short- and long-term mortality rate, stroke, recurrent, and hospital readmissions compared with men. CONCLUSION This review identified current knowledge and gaps about lived experience of women following first acute coronary syndrome. It is anticipated that the information gained from this literature review will support new research aimed at improving the care women receive following acute coronary syndrome and therefore enhance their recovery and quality of life. IMPACT This review contributes to the current body of knowledge by addressing women's physical, psychosocial, and sexual state following acute coronary syndrome. Improvement in women's quality of life after acute coronary syndrome necessitates further research which ultimately results in better management and treatment of women and their recovery following first acute coronary syndrome.
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Affiliation(s)
- Najmeh Alyasin
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Alison Teate
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Karen Strickland
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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21
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Jaker S, Burgan A, Prakash V, Birkinshaw A, Moosai K, Jacques A, Fluck D, MacGregor M, Lazariashvili O, Sharma P, Fry CH, Han TS. Sex differences in the agreement between left ventricular ejection fraction measured by myocardial perfusion scintigraphy and by echocardiography. JRSM Cardiovasc Dis 2020; 9:2048004020915393. [PMID: 32269771 PMCID: PMC7093695 DOI: 10.1177/2048004020915393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is generally measured by
echocardiography but is increasingly available with myocardial perfusion
scintigraphy. With myocardial perfusion scintigraphy, the threshold of LVEF
below which there is a risk for myocardial infarct or sudden cardiac death
is higher for women (51%) than for men (43%). We tested the hypothesis that
such a sex difference may also occur with echocardiography and myocardial
perfusion scintigraphy. Methods Four hundred and four men, mean age = 67.7 ± SD = 12.3 yr; 339 women,
67.7 ± 11.7 yr had separate myocardial perfusion scintigraphy and
echocardiography examinations within six months. A subset of 327 of these
patients (181 men, 68.8 ± 12.1 yr; 146 women, 66.4 ± 12.1 yr) had
examinations within one month and were additionally analysed as this
sub-group. Myocardial perfusion scintigraphy and echocardiography were used
to measure LVEF at rest and their agreement (neither considered as a
reference method) was assessed by Bland–Altman plots: LVEF difference
(myocardial perfusion scintigraphy minus echocardiography ) against average
LVEF (MPS+Echo2). Results Of patients who had myocardial perfusion scintigraphy and echocardiography
performed within six months, mean LVEF difference = +1.1% (95% limits of
agreement: −19.3 to +21.6) in men but +10.9% (−10.7 to +32.5) in women. LVEF
difference diverged from zero marginally in men (mean difference = +1.1,
95%CI = +0.1 to +2.1, p = 0.028) but more in women
(+10.9, +9.8 to +12.1, p < 0.001). The LVEF difference
correlated with average LVEF itself in both men
(r = 0.305, p < 0.001) and women
(r = 0.361, p < 0.001), and with
age in women (r = 0.117, p = 0.031).
Similar results were observed for the subset. Conclusions Caution should be taken when interpreting LVEF measured by different
techniques due to their wide limits of agreement and systematic bias, more
markedly in women.
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Affiliation(s)
- Sams Jaker
- Department of Radiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - Amjad Burgan
- Department of Radiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - Vineet Prakash
- Department of Radiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | | | - Kishan Moosai
- Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - Adam Jacques
- Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - David Fluck
- Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - Mark MacGregor
- Department of Anesthesia, Ashford & St Peter's Foundation Trust, Chertsey, UK
| | - Otar Lazariashvili
- Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK.,Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
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22
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Jackson AM, Zhang R, Findlay I, Robertson K, Lindsay M, Morris T, Forbes B, Papworth R, McConnachie A, Mangion K, Jhund PS, McCowan C, Berry C. Healthcare disparities for women hospitalized with myocardial infarction and angina. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:156-165. [PMID: 31346604 PMCID: PMC7132925 DOI: 10.1093/ehjqcco/qcz040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Abstract
AIMS Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. METHODS AND RESULTS We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37-1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52-1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16-2.56] and 1 year (adjusted HR 1.38, CI 1.12-1.69). CONCLUSION After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.
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Affiliation(s)
- Alice M Jackson
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Iain Findlay
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
| | - Keith Robertson
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | | | - Brian Forbes
- AstraZeneca UK, Capability Green, Luton LU1 3LU, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Colin McCowan
- School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
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23
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GF, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Marinella Ruospo
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Patrizia Natale
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Robert R Quinn
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Paul E Ronksley
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical Center, Department of Medicine, 3459 Fifth Avenue, Pittsburgh, PA, USA, 15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of Otago, Department of Medicine, Nephrologist, Christchurch, New Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Giovanni Fm Strippoli
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
- The Children's Hospital at Westmead, Cochrane Kidney and Transplant, Centre for Kidney Research, Westmead, NSW, Australia, 2145
| | - Pietro Ravani
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
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24
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Affiliation(s)
- Biykem Bozkurt
- Baylor College of Medicine, DeBakey VA Medical Center, Winters Center for Heart Failure Research, Cardiovascular Research Institute, Houston, TX (B.B.)
| | - Justin Ezekowitz
- Department of Medicine, Division of Cardiology, Katz Group Centre for Pharmacy and Health Research, University of Alberta, Canada (J.E.)
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25
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Sui YG, Teng SY, Qian J, Wu Y, Dou KF, Tang YD, Qiao SB, Wu YJ. Gender differences in treatment strategies among patients ≥80 years old with non-ST-segment elevation myocardial infarction. J Thorac Dis 2019; 11:5258-5265. [PMID: 32030243 DOI: 10.21037/jtd.2019.11.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background This study aims to investigate the gender differences in treatment strategies among non-ST-segment elevation myocardial infarction (NSTEMI) patients ≥80 years old in China. Methods A total of 190 consecutive NSTEMI patients ≥80 years old in Fuwai Hospital were included from 2014 to 2017. These patients were grouped by gender, and sub-grouped by conservative treatment or invasive treatment. The clinical characteristics, medical history, discharge drug used, and prognosis were collected and compared between these two treatment strategies. Results There were significant differences between these two treatment strategies in terms of GRACE grade, history of myocardial infarction (MI), after coronary artery bypass grafting (CABG), III grade, renal dysfunction, anemia, and use of diuretic (P<0.05). In addition, the age, creatinine and Killip class of female patients, and the death and good prognosis of male patients were found to be significantly different between these two treatment strategies (P<0.05). The multivariate logistic regression analysis revealed that the death of males was significantly associated with treatment strategies in the multivariable logistic regression analysis (P<0.05). In addition, the Kaplan-Meier survival analyses revealed that the survival rates of invasive strategy were significantly higher, when compared to that of conservative strategy in males (P=0.001) and females (P=0.015). Conclusions There were gender differences in treatment strategies among NSTEMI patients ≥80 years old. The difference in treatment strategies in males was more pronounced than in females, in terms of long-term survival rate.
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Affiliation(s)
- Yong-Gang Sui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Si-Yong Teng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Jie Qian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Yuan Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Ke-Fei Dou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Yi-Da Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Shu-Bin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
| | - Yong-Jian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing University, Beijing 100037, China
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26
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Zaman S, Deshmukh T, Aslam A, Martin C, Kovoor P. Sex Differences in Electrophysiology, Ventricular Tachyarrhythmia, Cardiac Arrest and Sudden Cardiac Death Following Acute Myocardial Infarction. Heart Lung Circ 2019; 29:1025-1031. [PMID: 31558356 DOI: 10.1016/j.hlc.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women experience less appropriate implantable cardioverter-defibrillator (ICD) interventions and are underrepresented in randomised ICD trials. Sex-differences in inducible and spontaneous ventricular tachycardia/fibrillation (VT/VF), cardiac arrest and sudden cardiac death (SCD) early post-myocardial infarction (MI) require further study. METHODS Consecutive ST-elevation MI patients with left ventricular ejection fraction (LVEF)≤40% underwent electrophysiology study (EPS) to target early prevention of SCD. An ICD was implanted for a positive (inducible monomorphic VT) but not a negative (no arrhythmia or inducible VF) EPS. The combined primary endpoint of VT/VF (spontaneous or ICD-treated), cardiac arrest or SCD was assessed using competing risk survival analysis in women versus men with adjustment for confounders. Logistic regression was used to determine independent predictors of inducible VT at EPS. RESULTS A total of 403 patients (16.9% female) underwent EPS. Women were significantly older than men but with similar LVEF (31.5 ± 6.3 versus 31.6 ± 6.4%, p = 0.91). Electrophysiology study was positive for inducible VT in 22.1% and 33.4% (p = 0.066) and an ICD implanted in 25.0% and 33.4% (p = 0.356) of women versus men. Appropriate ICD activations (VT/VF) occurred in 5.9% of women and 36.6% of men (p = 0.012). The adjusted cumulative primary endpoint incidence was significantly lower in women than men (1.6% versus 26.5%, p = 0.03). Female sex was not an independent predictor of inducible VT at EPS (HR 0.63, 95% CI 0.33-1.23, p = 0.178). CONCLUSIONS Women with early post-MI cardiomyopathy had lower VT/VF, cardiac arrest and SCD, compared to men. In ICD recipients the rate of appropriate activations was six-fold less in women compared to men.
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Affiliation(s)
- Sarah Zaman
- Monash University, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash Heart, Melbourne, Vic, Australia.
| | - Tejas Deshmukh
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Anum Aslam
- Monash University, Melbourne, Vic, Australia
| | | | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
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27
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Kala P, Červenka L, Škaroupková P, Táborský M, Kompanowska-Jezierska E, Sadowski J. Sex-linked differences in the mortality in Ren-2 transgenic hypertensive rats with aorto-caval fistula: effects of treatment with angiotensin converting enzyme alone and combined with inhibitor of soluble epoxide hydrolase. Physiol Res 2019; 68:589-601. [DOI: 10.33549/physiolres.934094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We found recently that in Ren-2 transgenic hypertensive rats (TGR) addition of soluble epoxide hydrolase inhibitor (sEHi) to treatment with angiotensin-converting enzyme inhibitor (ACEi), surprisingly, increased the mortality due to heart failure (HF) induced by creation of the aorto-caval fistula (ACF). Since TGR exhibit sex-related differences in mortality, we examined here if such differentiation exists also in the response to the treatment with ACEi (trandolapril), alone or combined with sEHi [cis-4-[4-(3-adamantan-1-yl-ureido)cyclohexyloxy]benzoic acid, (c-AUCB)]. ACEi improved survival in males to 74 % (vs. 0 %) and in females to 65 % (vs. 32 %). ACEi and sEHi combined also improved the survival in male ACF TGR, however, it was significantly less (38 %) than after ACEi alone. In contrast, in females the combined treatment significantly improved the final survival rate (84 %). There were no significant sex-linked differences in survival rate in untreated or treated normotensive Hannover Sprague-Dawley rats. In conclusion, in HF patients with co-existing hypertension and RAS hyperactivity, the sex may co-determine the rate of HF progression, and can influence the effectiveness of the therapeutic measures applied. Therefore, in the relevant pre-clinical studies the sex-linked differences should be seriously considered. Our data indicate that TGR might be an optimal model for such studies.
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Affiliation(s)
| | - L. Červenka
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, 1958/9 Vídeňská, Prague, Czech Republic.
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28
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Lalem T, Devaux Y. Circulating microRNAs to predict heart failure after acute myocardial infarction in women. Clin Biochem 2019; 70:1-7. [DOI: 10.1016/j.clinbiochem.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
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29
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Ravn-Fischer A, Perers E, Karlsson T, Caidahl K, Hartford M. Seventeen-Year Mortality following the Acute Coronary Syndrome: Gender-Specific Baseline Variables and Impact on Outcome. Cardiology 2019; 143:22-31. [PMID: 31352455 DOI: 10.1159/000501166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. OBJECTIVES To assess long-term mortality and explore its association with the baseline variables in women and men. METHODS We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. RESULTS At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. CONCLUSION For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.
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Affiliation(s)
- Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Perers
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Marianne Hartford
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
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30
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kajimoto K, Minami Y, Otsubo S, Sato N. Sex Differences in Left Ventricular Cavity Dilation and Outcomes in Acute Heart Failure Patients With Left Ventricular Systolic Dysfunction. Can J Cardiol 2018; 34:477-484. [DOI: 10.1016/j.cjca.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/20/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022] Open
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Sex Differences in Vascular Reactivity to Angiotensin II During the Evolution of Myocardial Infarction. J Cardiovasc Pharmacol 2018; 71:19-25. [DOI: 10.1097/fjc.0000000000000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kane AE, Howlett SE. Differences in Cardiovascular Aging in Men and Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:389-411. [PMID: 30051398 DOI: 10.1007/978-3-319-77932-4_25] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases increase dramatically with age in both men and women. While it is clear that advanced age allows more time for individuals to be exposed to risk factors in general, there is strong evidence that age itself is a major independent risk factor for cardiovascular disease. Indeed, there are distinct age-dependent cellular, structural, and functional changes in both the heart and blood vessels, even in individuals with no clinical evidence of cardiovascular disease. Studies in older humans and in animal models of aging indicate that this age-related remodeling is maladaptive. An emerging view is that the heart and blood vessels accumulate cellular and subcellular deficits with age and these deficits increase susceptibility to disease in older individuals. Aspects of this age-dependent remodeling of the heart and blood vessels differ between the sexes. There is also new evidence that these maladaptive changes are more prominent in older animals and humans with a high degree of frailty. These observations may help explain why men and women are susceptible to different cardiovascular diseases as they age and why frail older adults are most often affected by these diseases.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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Alabas OA, Gale CP, Hall M, Rutherford MJ, Szummer K, Lawesson SS, Alfredsson J, Lindahl B, Jernberg T. Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry. J Am Heart Assoc 2017; 6:e007123. [PMID: 29242184 PMCID: PMC5779025 DOI: 10.1161/jaha.117.007123] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study assessed sex differences in treatments, all-cause mortality, relative survival, and excess mortality following acute myocardial infarction. METHODS AND RESULTS A population-based cohort of all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART [Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies]) from 2003 to 2013 was included in the analysis. Excess mortality rate ratios (EMRRs), adjusted for clinical characteristics and guideline-indicated treatments after matching by age, sex, and year to background mortality data, were estimated. Although there were no sex differences in all-cause mortality adjusted for age, year of hospitalization, and comorbidities for ST-segment-elevation myocardial infarction (STEMI) and non-STEMI at 1 year (mortality rate ratio: 1.01 [95% confidence interval (CI), 0.96-1.05] and 0.97 [95% CI, 0.95-0.99], respectively) and 5 years (mortality rate ratio: 1.03 [95% CI, 0.99-1.07] and 0.97 [95% CI, 0.95-0.99], respectively), excess mortality was higher among women compared with men for STEMI and non-STEMI at 1 year (EMRR: 1.89 [95% CI, 1.66-2.16] and 1.20 [95% CI, 1.16-1.24], respectively) and 5 years (EMRR: 1.60 [95% CI, 1.48-1.72] and 1.26 [95% CI, 1.21-1.32], respectively). After further adjustment for the use of guideline-indicated treatments, excess mortality among women with non-STEMI was not significant at 1 year (EMRR: 1.01 [95% CI, 0.97-1.04]) and slightly higher at 5 years (EMRR: 1.07 [95% CI, 1.02-1.12]). For STEMI, adjustment for treatments attenuated the excess mortality for women at 1 year (EMRR: 1.43 [95% CI, 1.26-1.62]) and 5 years (EMRR: 1.31 [95% CI, 1.19-1.43]). CONCLUSIONS Women with acute myocardial infarction did not have statistically different all-cause mortality, but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline-indicated treatments. This suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02952417.
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Affiliation(s)
- Oras A Alabas
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
- Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Marlous Hall
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Karolina Szummer
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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Ubrich R, Barthel P, Haller B, Hnatkova K, Huster KM, Steger A, Müller A, Malik M, Schmidt G. Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies. PLoS One 2017; 12:e0186783. [PMID: 29053758 PMCID: PMC5650173 DOI: 10.1371/journal.pone.0186783] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Mortality rates in females who survived acute myocardial infarction (AMI) exceed those in males. Differences between sexes in age, cardiovascular risk factors and revascularization therapy have been proposed as possible reasons. OBJECTIVE To select sets of female and male patients comparable in respect of relevant risk factors in order to compare the sex-specific risk in a systematic manner. METHODS Data of the ISAR-RISK and ART studies were investigated. Patients were enrolled between 1996 and 2005 and suffered from AMI within 4 weeks prior to enrolment. Patients of each sex were selected with 1:1 equivalent age, previous AMI history, sinus-rhythm presence, hypertension, diabetes mellitus, smoking status, left ventricular ejection fraction (LVEF), and revascularization therapy. Survival times were compared between sex groups in the whole study cohort and in the matched cohort. RESULTS Of 3840 consecutive AMI survivors, 994 (25.9%) were females and 2846 (74.1%) were males. Females were older and suffered more frequently from hypertension and diabetes mellitus. In the whole cohort, females showed an increased mortality with a hazard ratio (HR) of 1.54 compared to males (p<0.0001). The matched cohort comprised 802 patients of each sex and revealed a trend towards poorer survival in females (HR for female sex 1.14; p = 0.359). However, significant mortality differences with a higher risk in matched females was observed during the first year after AMI (HR = 1.61; p = 0.045) but not during the subsequent years. CONCLUSION Matched sub-groups of post-AMI patients showed a comparable long-term mortality. However, a female excess mortality remained during first year after AMI and cannot be explained by differences in age, cardiovascular risk factors, and modes of acute treatment. Other causal factors, including clinical as well as psychological and social aspects, need to be considered. Female post-AMI patients should be followed more actively particularly during the first year after AMI.
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Affiliation(s)
- Romy Ubrich
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London, England
| | - Katharina Maria Huster
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Steger
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Müller
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, England
| | - Georg Schmidt
- Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
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Schüpke S, Mehilli J. Less myocardial scar but greater propensity for heart failure: another gender paradox in myocardial infarction. Eur Heart J 2017; 38:1664-1665. [PMID: 28475753 DOI: 10.1093/eurheartj/ehx230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stefanie Schüpke
- Deutsches Herzzentrum München, ISAResearch Center, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Julinda Mehilli
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany.,Cardiology Department, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
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38
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Santema BT, Lam CS. Heart Failure in Women: Risk Across a Woman's Adult Life. J Card Fail 2017; 23:379-381. [DOI: 10.1016/j.cardfail.2017.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/24/2022]
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Tan JWC, Lam CSP, Kasim SS, Aw TC, Abanilla JM, Chang WT, Dang VP, Iboleon-Dy M, Mumpuni SS, Phommintikul A, Ta MC, Topipat P, Yiu KH, Cullen L. Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI. HEART ASIA 2017; 9:81-87. [PMID: 28466882 PMCID: PMC5388929 DOI: 10.1136/heartasia-2016-010818] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE High-sensitivity troponin (hs-Tn) assays need to be applied appropriately to improve diagnosis and patient outcomes in acute coronary syndromes (ACS). METHODS Experts from Asia Pacific convened in 2015 to provide data-driven consensus-based, region-specific recommendations and develop an algorithm for the appropriate incorporation of this assay into the ACS assessment and treatment pathway. RESULTS Nine recommendations were developed by the expert panel: (1) troponin is the preferred cardiac biomarker for diagnostic assessment of ACS and is indicated for patients with symptoms of possible ACS; (2) hs-Tn assays are recommended; (3) serial testing is required for all patients; (4) testing should be performed at presentation and 3 hours later; (5) gender-specific cut-off values should be used for hs-Tn I assays; (6) hs-Tn I level >10 times the upper limit of normal should be considered to 'rule in' a diagnosis of ACS; (7) dynamic change >50% in hs-Tn I level from presentation to 3-hour retest identifies patients at high risk for ACS; (8) where only point-of-care testing is available, patients with elevated readings should be considered at high risk, while patients with low/undetectable readings should be retested after 6 hours or sent for laboratory testing and (9) regular education on the appropriate use of troponin tests is essential. CONCLUSIONS We propose an algorithm that will potentially reduce delays in discharge by the accurate 'rule out' of non-ACS patients within 3 hours. Appropriate research should be undertaken to ensure the efficacy and safety of the algorithm in clinical practice, with the long-term goal of improvement of care of patients with ACS in Asia Pacific.
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Affiliation(s)
- Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | | | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Joel M Abanilla
- Department of Cardiology, Philippine Heart Center, Manila, Philippines
| | - Wei-Ting Chang
- Department of Cardiology, Chi-Mei Hospital, Tainan, Taiwan
| | - Van Phuoc Dang
- Department of Cardiology, University Medical Center, Ho Chi Minh City, Vietnam
| | - Maria Iboleon-Dy
- Heart Institute, St Luke's Medical Centre, Quezon City, Philippines
| | - Sari Sri Mumpuni
- Department of Cardiology, Pondok Indah Hospital, Jakarta, Indonesia
| | | | - Manh Cuong Ta
- Department of Cardiology, National Cardiology Institute, Hanoi, Vietnam
| | - Punkiat Topipat
- Department of Cardiology, Siriraj Hospital, Bangkok, Thailand
| | - Kai Hang Yiu
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 395] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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41
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Paine NJ, Bacon SL, Pelletier R, Arsenault A, Diodati JG, Lavoie KL. Do Women With Anxiety or Depression Have Higher Rates of Myocardial Ischemia During Exercise Testing Than Men? CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 9:S53-61. [PMID: 26908861 DOI: 10.1161/circoutcomes.115.002491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women diagnosed with coronary artery disease (CAD) typically experience worse outcomes relative to men, possibly through diagnosis and treatment delays. Reasons for these delays may be influenced by mood and anxiety disorders, which are more prevalent in women and have symptoms (eg, palpitations and fatigue) that may be confounded with CAD. Our study examined sex differences in the association between mood and anxiety disorders and myocardial ischemia in patients with and without a CAD history presenting for exercise stress tests. METHODS AND RESULTS A total of 2342 patients (women n=760) completed a single photon emission computed tomographic exercise stress test (standard Bruce Protocol) and underwent a psychiatric interview (The Primary Care Evaluation of Mental Disorders) to assess mood and anxiety disorders. Ischemia was assessed using single photon emission computed tomography, with odds ratio used to calculate the effect of sex and mood/anxiety on the presence of ischemia during stress testing by CAD history in a stratified analyses, adjusted for relevant covariates. There was a sex by anxiety interaction with ischemia in those without a CAD history (P=0.015): women with anxiety were more likely to exhibit ischemia during exercise than women without anxiety (odds ratio, 1.75; 95% confidence interval, 1.05-2.89). No significant effects were observed for men nor mood. CONCLUSIONS Women with anxiety and no CAD history had higher rates of ischemia than women without anxiety. Results suggest that anxiety symptoms, many of which overlap with those of CAD, might mask CAD symptoms among women (but not men) and contribute to referral and diagnostic delays. Further research is needed to confirm this hypothesis.
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Affiliation(s)
- Nicola J Paine
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.)
| | - Simon L Bacon
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.)
| | - Roxanne Pelletier
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.)
| | - André Arsenault
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.)
| | - Jean G Diodati
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.)
| | - Kim L Lavoie
- From the Department of Exercise Science, Concordia University, Montréal, Quebec, Canada (N.J.P., S.L.B.); Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (N.J.P., S.L.B., A.A., K.L.L.); Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada (K.L.L.); Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Quebec, Canada (R.P.); Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada (A.A.); and Research Centre, Hôpital du Sacré-Coeur à Montréal, Montréal, Quebec, Canada (J.G.D.).
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Metra M, Carubelli V, Ravera A, Stewart Coats AJ. Heart failure 2016: still more questions than answers. Int J Cardiol 2016; 227:766-777. [PMID: 27838123 DOI: 10.1016/j.ijcard.2016.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Heart failure has reached epidemic proportions given the ageing of populations and is associated with high mortality and re-hospitalization rates. This article reviews and summarizes recent advances in the diagnosis, assessment and treatment of the patients with heart failure. Data are discussed based also on the most recent guidelines indications. Open issues and unmet needs are highlighted.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Alice Ravera
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Alehagen U, Olsen RS, Länne T, Matussek A, Wågsäter D. PDGF-D gene polymorphism is associated with increased cardiovascular mortality in elderly men. BMC MEDICAL GENETICS 2016; 17:62. [PMID: 27585990 PMCID: PMC5009508 DOI: 10.1186/s12881-016-0325-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/20/2016] [Indexed: 12/22/2022]
Abstract
Background Platelet-derived growth factor (PDGF) D has been reported to be active in fibroblasts, and in areas of myocardial infarction. In this longitudinal study we evaluated the association between PDGF-D polymorphism and cardiovascular mortality, and attempted to discover whether specific genotype differences regarding risk could be observed, and if gender differences could be seen. Methods Four hundred seventy-six elderly community participants were included in this study. All participants underwent a clinical examination, echocardiography, and blood sampling including PDGF-D single nucleotide polymorphism (SNP) analyses of the rs974819 A/A, G/A and G/G SNP. The follow-up time was 6.7 years. Results No specific genotype of rs974819 demonstrated increased cardiovascular mortality in the total population, however, the male group with genotypes A/A and G/A demonstrated an increased risk that persisted in a multivariate evaluation where adjustments were made for well-known cardiovascular risk factors (2.7 fold compared with the G/G genotype). No corresponding finding was observed in the female group. Conclusion We report here for the first time that the genotypes G/A or A/A of the SNP rs974819 near PDGF-D exhibited a 2.7 fold increased cardiovascular mortality risk in males. Corresponding increased risk could not be observed in either the total population and thus not in the female group. However, the sample size is was small and the results should be regarded as hypothesis-generating, and thus more research in the field is recommended.
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Affiliation(s)
- Urban Alehagen
- Department of Cardiology, University Hospital of Linköping, SE-581 85, Linköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Renate S Olsen
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Laboratory Services, County Hospital Ryhov, Jönköping, Sweden
| | - Toste Länne
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Cardiovascular Medicine/Physiology, University of Linköping, 581 85, Linköping, Sweden
| | - Andreas Matussek
- Department of Laboratory Services, County Hospital Ryhov, Jönköping, Sweden
| | - Dick Wågsäter
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Drug Research/Clinical Pharmacology, University of Linköping, 581 85, Linköping, Sweden
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Dedkov EI, Bogatyryov Y, Pavliak K, Santos AT, Chen YF, Zhang Y, Pingitore A. Sex-related differences in intrinsic myocardial properties influence cardiac function in middle-aged rats during infarction-induced left ventricular remodeling. Physiol Rep 2016; 4:4/11/e12822. [PMID: 27288060 PMCID: PMC4908497 DOI: 10.14814/phy2.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/15/2016] [Indexed: 11/24/2022] Open
Abstract
We previously determined that residual left ventricular (LV) myocardium of middle-aged rats had sex-related differences in regional tissue properties 4 weeks after a large myocardial infarction (MI). However, the impact of such differences on cardiac performance remained unclear. Therefore, our current study aimed to elucidate whether sex-related changes in MI-induced myocardial remodeling can influence cardiac function. A similar-sized MI was induced in 12-month-old male (M-MI) and female (F-MI) Sprague-Dawley rats by ligation of the left coronary artery. The cardiac function was monitored for 2 months after MI and then various LV parameters were compared between sexes. We found that although two sex groups had a similar pattern of MI-induced decline in LV function, F-MI rats had greater cardiac performance compared to M-MI rats, considering the higher values of EF (39.9 ± 3.4% vs. 26.7 ± 7.7%, P < 0.05), SW index (40.4 ± 2.1 mmHg • mL/kg vs. 20.2 ± 3.3 mmHg • mL/kg, P < 0.001), and CI (139.2 ± 7.9 mL/min/kg vs. 74.9 ± 14.7 mL/min/kg, P < 0.01). The poorer pumping capacity in M-MI hearts was associated with markedly reduced LV compliance and prolonged relaxation. On the tissue level, F-MI rats revealed a higher, than in M-MI rats, density of cardiac myocytes in the LV free wall (2383.8 ± 242.6 cells/mm(2) vs. 1785.7 ± 55.9 cells/mm(2), P < 0.05). The latter finding correlated with a lower density of apoptotic cardiac myocytes in residual LV myocardium of F-MI rats (0.18 ± 0.08 cells/mm(2) vs. 0.91 ± 0.30 cells/mm(2) in males, P < 0.01). Thus, our data suggested that F-MI rats had markedly attenuated decline in cardiac performance compared to males due to ability of female rats to better retain functionally favorable intrinsic myocardial properties.
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Affiliation(s)
- Eduard I Dedkov
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
| | - Yevgen Bogatyryov
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
| | - Kristina Pavliak
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
| | - Adora T Santos
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
| | - Yue-Feng Chen
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, New York
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 425] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Moura FA, Figueiredo VN, Teles BS, Barbosa MA, Pereira LR, Costa AP, Carvalho LSF, Cintra RM, Almeida OL, Quinaglia e Silva JC, Nadruz Junior W, Sposito AC. Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients. Atherosclerosis 2015; 243:124-30. [DOI: 10.1016/j.atherosclerosis.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/23/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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Impact of Diet-Induced Obesity and Testosterone Deficiency on the Cardiovascular System: A Novel Rodent Model Representative of Males with Testosterone-Deficient Metabolic Syndrome (TDMetS). PLoS One 2015; 10:e0138019. [PMID: 26366723 PMCID: PMC4569473 DOI: 10.1371/journal.pone.0138019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Current models of obesity utilise normogonadic animals and neglect the strong relationships between obesity-associated metabolic syndrome (MetS) and male testosterone deficiency (TD). The joint presentation of these conditions has complex implications for the cardiovascular system that are not well understood. We have characterised and investigated three models in male rats: one of diet-induced obesity with the MetS; a second using orchiectomised rats mimicking TD; and a third combining MetS with TD which we propose is representative of males with testosterone deficiency and the metabolic syndrome (TDMetS). METHODS Male Wistar rats (n = 24) were randomly assigned to two groups and provided ad libitum access to normal rat chow (CTRL) or a high fat/high sugar/low protein "obesogenic" diet (OGD) for 28 weeks (n = 12/group). These groups were further sub-divided into sham-operated or orchiectomised (ORX) animals to mimic hypogonadism, with and without diet-induced obesity (n = 6/group). Serum lipids, glucose, insulin and sex hormone concentrations were determined. Body composition, cardiovascular structure and function; and myocardial tolerance to ischemia-reperfusion were assessed. RESULTS OGD-fed animals had 72% greater fat mass; 2.4-fold greater serum cholesterol; 2.3-fold greater serum triglycerides and 3-fold greater fasting glucose (indicative of diabetes mellitus) compared to CTRLs (all p<0.05). The ORX animals had reduced serum testosterone and left ventricle mass (p<0.05). In addition to the combined differences observed in each of the isolated models, the OGD, ORX and OGD+ORX models each had greater CK-MB levels following in vivo cardiac ischemia-reperfusion insult compared to CTRLs (p<0.05). CONCLUSION Our findings provide evidence to support that the MetS and TD independently impair myocardial tolerance to ischemia-reperfusion. The combined OGD+ORX phenotype described in this study is a novel animal model with associated cardiovascular risk factors and complex myocardial pathology which may be representative of male patients presenting with TDMetS.
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Metra M. March 2015 at a glance. Eur J Heart Fail 2015; 17:235-6. [DOI: 10.1002/ejhf.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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