1
|
Shahalaei M, Azad AK, Sulaiman WMAW, Derakhshani A, Mofakham EB, Mallandrich M, Kumarasamy V, Subramaniyan V. A review of metallic nanoparticles: present issues and prospects focused on the preparation methods, characterization techniques, and their theranostic applications. Front Chem 2024; 12:1398979. [PMID: 39206442 PMCID: PMC11351095 DOI: 10.3389/fchem.2024.1398979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024] Open
Abstract
Metallic nanoparticles (MNPs) have garnered significant attention due to their ability to improve the therapeutic index of medications by reducing multidrug resistance and effectively delivering therapeutic agents through active targeting. In addition to drug delivery, MNPs have several medical applications, including in vitro and in vivo diagnostics, and they improve the biocompatibility of materials and nutraceuticals. MNPs have several advantages in drug delivery systems and genetic manipulation, such as improved stability and half-life in circulation, passive or active targeting into the desired target selective tissue, and gene manipulation by delivering genetic materials. The main goal of this review is to provide current information on the present issues and prospects of MNPs in drug and gene delivery systems. The current study focused on MNP preparation methods and their characterization by different techniques, their applications to targeted delivery, non-viral vectors in genetic manipulation, and challenges in clinical trial translation.
Collapse
Affiliation(s)
- Mona Shahalaei
- Biomaterial Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center, Karaj, Iran
| | - Abul Kalam Azad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University College of MAIWP International (UCMI), Kuala Lumpur, Malaysia
| | - Wan Mohd Azizi Wan Sulaiman
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University College of MAIWP International (UCMI), Kuala Lumpur, Malaysia
| | - Atefeh Derakhshani
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Banaee Mofakham
- Biomaterial Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center, Karaj, Iran
| | - Mireia Mallandrich
- Department of Pharmacy, Pharmaceutical Technology and Physical-Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Vetriselvan Subramaniyan
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Sunway, Malaysia
| |
Collapse
|
2
|
Wijemunige N, van Baal P, Rannan-Eliya RP, O'Donnell O. Health outcomes and healthcare utilization associated with four undiagnosed chronic conditions: evidence from nationally representative survey data in Sri Lanka. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:45. [PMID: 38983904 PMCID: PMC11228003 DOI: 10.1186/s44263-024-00075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
Background Low awareness of chronic conditions raises the risk of poorer health outcomes and may result in healthcare utilization and spending in response to symptoms of undiagnosed conditions. Little evidence exists, particularly from lower-middle-income countries, on the health and healthcare use of undiagnosed people with an indication of a condition. This study aimed to compare health (physical, mental, and health-related quality of life (HRQoL)) and healthcare (inpatient and outpatient visits and out-of-pocket (OOP) medical spending) outcomes of undiagnosed Sri Lankans with an indication of coronary heart disease (CHD), hypertension, diabetes, and depression with the outcomes of their compatriots who were diagnosed or had no indication of these conditions. Methods This study used a nationally representative survey of Sri Lankan adults to identify people with an indication of CHD, hypertension, diabetes, or depression, and ascertain if they were diagnosed. Outcomes were self-reported measures of physical and mental functioning (12-Item Short Form Survey (SF-12)), HRQoL (EQ-5D-5L), inpatient and outpatient visits, and OOP spending. For each condition, we estimated the mean of each outcome for respondents with (a) no indication, (b) an indication without diagnosis, and (c) a diagnosis. We adjusted the group differences in these means for socio-demographic covariates using ordinary least squares (OLS) regression for physical and mental function, Tobit regression for HRQoL, and a generalized linear model (GLM) for healthcare visits and OOP spending. Results An indication of each of CHD and depression, which are typically symptomatic, was associated with a lower adjusted mean of physical (CHD -2.65, 95% CI -3.66, -1.63; depression -5.78, 95% CI -6.91, -4.64) and mental functioning (CHD -2.25, 95% CI -3.38, -1.12; depression -6.70, 95% CI -7.97, -5.43) and, for CHD, more annual outpatient visits (2.13, 95% CI 0.81, 3.44) compared with no indication of the respective condition. There were no such differences for indications of hypertension and diabetes, which are often asymptomatic. Conclusions Living with undiagnosed CHD and depression was associated with worse health and, for CHD, greater utilization of healthcare. Diagnosis and management of these symptomatic conditions can potentially improve health partly through substitution of effective healthcare for that which primarily responds to symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00075-0.
Collapse
Affiliation(s)
- Nilmini Wijemunige
- Institute for Health Policy, Colombo, Sri Lanka
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Owen O'Donnell
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Gu L, Wan X, Liu Y, Gong Z, Huang R, Shi Y, Liu H. Mesenchymal stem cells may alleviate angiotensin II-induced myocardial fibrosis and hypertrophy by upregulating SFRS3 expression. Rev Port Cardiol 2024:S0870-2551(24)00221-X. [PMID: 38986812 DOI: 10.1016/j.repc.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The development of cardiac fibrosis (CF) and hypertrophy (CH) can lead to heart failure. Mesenchymal stem cells (MSCs) have shown promise in treating cardiac diseases. However, the relationship between MSCs and splicing factor arginine/serine rich-3 (SFRS3) remains unclear. In this study, our objectives are to investigate the effect of MSCs on SFRS3 expression, and their impact on CF and CH. Additionally, we aim to explore the function of the overexpression of SFRS3 in angiotensin II (Ang II)-treated cardiac fibroblasts (CFBs) and cardiac myocytes (CMCs). METHODS Rat cardiac fibroblasts (rCFBs) or rat cardiac myocytes (rCMCs) were co-cultured with rat MSCs (rMSCs). The function of SFRS3 in Ang II-induced rCFBs and rCMCs was studied by overexpressing SFRS3 in these cells, both with and without the presence of rMSCs. We assessed the expression of SFRS3 and evaluated the cell cycle, proliferation and apoptosis of rCFBs and rCMCs. We also measured the levels of interleukin (IL)-β, IL-6 and tumor necrosis factor (TNF)-α and assessed the degree of fibrosis in rCFBs and hypertrophy in rCMCs. RESULTS rMSCs induced SFRS3 expression and promoted cell cycle, proliferation, while reducing apoptosis of Ang II-treated rCFBs and rCMCs. Co-culture of rMSCs with these cells also repressed cytokine production and mitigated the fibrosis of rCFBs, as well as hypertrophy of rCMCs triggered by Ang II. Overexpression of SFRS3 in the rCFBs and rCMCs yielded identical effects to rMSC co-culture. CONCLUSION MSCs may alleviate Ang II-induced cardiac fibrosis and cardiomyocyte hypertrophy by increasing SFRS3 expression in vitro.
Collapse
Affiliation(s)
- Ling Gu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| | - Xin Wan
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| | - Ying Liu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| | - Zhenbin Gong
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| | - Rijin Huang
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| | - Yundi Shi
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China.
| | - Huogen Liu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, Fujian, China
| |
Collapse
|
4
|
Zeng J, Lin S, Li Z, Sun R, Yu X, Lian X, Zhao Y, Ji X, Zheng Z. Association between gait video information and general cardiovascular diseases: a prospective cross-sectional study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:469-480. [PMID: 39081942 PMCID: PMC11284013 DOI: 10.1093/ehjdh/ztae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 08/02/2024]
Abstract
Aims Cardiovascular disease (CVD) may not be detected in time with conventional clinical approaches. Abnormal gait patterns have been associated with pathological conditions and can be monitored continuously by gait video. We aim to test the association between non-contact, video-based gait information and general CVD status. Methods and results Individuals undergoing confirmatory CVD evaluation were included in a prospective, cross-sectional study. Gait videos were recorded with a Kinect camera. Gait features were extracted from gait videos to correlate with the composite and individual components of CVD, including coronary artery disease, peripheral artery disease, heart failure, and cerebrovascular events. The incremental value of incorporating gait information with traditional CVD clinical variables was also evaluated. Three hundred fifty-two participants were included in the final analysis [mean (standard deviation) age, 59.4 (9.8) years; 25.3% were female]. Compared with the baseline clinical variable model [area under the receiver operating curve (AUC) 0.717, (0.690-0.743)], the gait feature model demonstrated statistically better performance [AUC 0.753, (0.726-0.780)] in predicting the composite CVD, with further incremental value when incorporated with the clinical variables [AUC 0.764, (0.741-0.786)]. Notably, gait features exhibited varied association with different CVD component conditions, especially for peripheral artery disease [AUC 0.752, (0.728-0.775)] and heart failure [0.733, (0.707-0.758)]. Additional analyses also revealed association of gait information with CVD risk factors and the established CVD risk score. Conclusion We demonstrated the association and predictive value of non-contact, video-based gait information for general CVD status. Further studies for gait video-based daily living CVD monitoring are promising.
Collapse
Affiliation(s)
- Juntong Zeng
- National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, People’s Republic of China
| | - Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, People’s Republic of China
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Key Laboratory of Coronary Heart Disease Risk Prediction and Precision Therapy, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| | - Zhigang Li
- Department of Automation, Tsinghua University, Room 711A, Main Building, Haidian District, Beijing 100084, People’s Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Haidian District, Beijing 100084, People’s Republic of China
| | - Runchen Sun
- National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, People’s Republic of China
| | - Xuexin Yu
- Department of Automation, Tsinghua University, Room 711A, Main Building, Haidian District, Beijing 100084, People’s Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Haidian District, Beijing 100084, People’s Republic of China
| | - Xiaocong Lian
- Department of Automation, Tsinghua University, Room 711A, Main Building, Haidian District, Beijing 100084, People’s Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Haidian District, Beijing 100084, People’s Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Key Laboratory of Coronary Heart Disease Risk Prediction and Precision Therapy, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| | - Xiangyang Ji
- Department of Automation, Tsinghua University, Room 711A, Main Building, Haidian District, Beijing 100084, People’s Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Haidian District, Beijing 100084, People’s Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, People’s Republic of China
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
- Key Laboratory of Coronary Heart Disease Risk Prediction and Precision Therapy, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| |
Collapse
|
5
|
Wijemunige N, Rannan-Eliya RP, Herath HMM, O’Donnell O. The Prevalence and Epidemiological Features of Ischaemic Heart Disease in Sri Lanka. Glob Heart 2024; 19:49. [PMID: 38854432 PMCID: PMC11160409 DOI: 10.5334/gh.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/18/2024] [Indexed: 06/11/2024] Open
Abstract
Background There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs. Objectives To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES. Methods We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies. Conclusions We estimated prevalence of History+ of 3.9% (95% CI 3.3%-4.4%) and Angina+ of 3.0% (95% CI 2.4%-3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.
Collapse
Affiliation(s)
- Nilmini Wijemunige
- Institute for Health Policy, 72 Park Street, Colombo 00200, Sri Lanka
- Erasmus School of Economics and Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | | | - H. M. M. Herath
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Karapitiya, Galle, Sri Lanka
| | - Owen O’Donnell
- Erasmus School of Economics and Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| |
Collapse
|
6
|
Sinha T, Bakht D, Bokhari SFH, Amir M, Fatima R, Bakht K, Amir A, Aslam A, Hussain M, Tariq T. Gender Matters: A Multidimensional Approach to Optimizing Cardiovascular Health in Women. Cureus 2024; 16:e61810. [PMID: 38975366 PMCID: PMC11227286 DOI: 10.7759/cureus.61810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Cardiovascular diseases remain a leading cause of mortality among women, yet they are often underestimated and insufficiently addressed. This narrative review delves into the gender disparities in cardiovascular health, underscoring the critical importance of recognizing and addressing the unique challenges women face. The article explores the pathophysiological differences between men and women, highlighting the role of hormonal factors, such as estrogen and menopause, in conferring cardioprotection or increasing risk. It examines the complexities of diagnosis and assessment, including differences in symptom presentation, diagnostic accuracy, and the challenges of interpreting non-invasive testing in women. The review also highlights the need for tailored risk assessment and prevention strategies, incorporating sex-specific conditions and pregnancy-related factors. It emphasizes the importance of lifestyle modifications and interventions, as well as the potential benefits of personalized treatment approaches, considering gender-specific variations in medication responses and cardiac interventions. Furthermore, the article sheds light on the impact of psychosocial and sociocultural factors, such as gender norms, mental health considerations, and access to healthcare, on women's cardiovascular health. It also addresses the significant gaps and challenges in research, including the historical underrepresentation of women in clinical trials and the lack of sex- and gender-sensitive studies. Finally, the review advocates for a multidisciplinary approach, involving patient-centered care, shared decision-making, and collaboration among policymakers, stakeholders, and healthcare systems. This comprehensive strategy aims to enhance awareness, prevention, diagnosis, and treatment of cardiovascular disease in women, ultimately improving health outcomes and reducing the burden of this often overlooked epidemic.
Collapse
Affiliation(s)
- Tanya Sinha
- Internal Medicine, Tribhuvan University, Kathmandu, NPL
| | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | | | - Maaz Amir
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Rida Fatima
- Medicine and Surgery, Fatima Jinnah Medical University, Lahore, PAK
| | - Kinza Bakht
- Internal Medicine, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Aisha Amir
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Asma Aslam
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | | | - Tamseer Tariq
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| |
Collapse
|
7
|
Gaffey AE, Spatz ES. Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan. Curr Atheroscler Rep 2024; 26:45-58. [PMID: 38240928 PMCID: PMC11219074 DOI: 10.1007/s11883-023-01185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE OF REVIEW Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women. RECENT FINDINGS For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.
Collapse
Affiliation(s)
- Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Erica S Spatz
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| |
Collapse
|
8
|
Al Hamid A, Beckett R, Wilson M, Jalal Z, Cheema E, Al-Jumeily Obe D, Coombs T, Ralebitso-Senior K, Assi S. Gender Bias in Diagnosis, Prevention, and Treatment of Cardiovascular Diseases: A Systematic Review. Cureus 2024; 16:e54264. [PMID: 38500942 PMCID: PMC10945154 DOI: 10.7759/cureus.54264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Cardiovascular disease (CVDs) has been perceived as a 'man's disease', and this impacted women's referral to CVD diagnosis and treatment. This study systematically reviewed the evidence regarding gender bias in the diagnosis, prevention, and treatment of CVDs. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched CINAHL, PubMed, Medline, Web of Science, British Nursing Index, Scopus, and Google Scholar. The included studies were assessed for quality using risk bias tools. Data extracted from the included studies were exported into Statistical Product and Service Solutions (SPSS, v26; IBM SPSS Statistics for Windows, Armonk, NY), where descriptive statistics were applied. A total of 19 studies were analysed. CVDs were less reported among women who either showed milder symptoms than men or had their symptoms misdiagnosed as gastrointestinal or anxiety-related symptoms. Hence, women had their risk factors under-considered by physicians (especially by male physicians). Subsequently, women were offered fewer diagnostic tests, such as coronary angiography, ergometry, electrocardiogram (ECG), and cardiac enzymes, and were referred to less to cardiologists and/or hospitalisation. Furthermore, if hospitalised, women were less likely to receive a coronary intervention. Similarly, women were prescribed cardiovascular medicines than men, with the exception of antihypertensive and anti-anginal medicines. When it comes to the perception of CVD, women considered themselves at lower risk of CVDs than men. This systematic review showed that women were offered fewer diagnostic tests for CVDs and medicines than men and that in turn influenced their disease outcomes. This could be attributed to the inadequate knowledge regarding the differences in manifestations among both genders.
Collapse
Affiliation(s)
| | - Rachel Beckett
- Forensic Science, Liverpool John Moores University, Liverpool, GBR
| | - Megan Wilson
- Forensic Science, Liverpool John Moores University, Liverpool, GBR
| | - Zahra Jalal
- Pharmacology and Therapeutics, Birmingham University, Birmingham, GBR
| | - Ejaz Cheema
- Pharmacy, University of Management and Technology, Lahore, PAK
| | - Dhiya Al-Jumeily Obe
- Computer Science and Mathematics, Liverpool John Moores University, Liverpool, GBR
| | - Thomas Coombs
- Toxicology, British American Tobacco, Southampton, GBR
| | | | - Sulaf Assi
- Pharmacy, Liverpool John Moores University, Liverpool, GBR
| |
Collapse
|
9
|
Lin J, Mars N, Fu Y, Ripatti P, Kiiskinen T, Tukiainen T, Ripatti S, Pirinen M. Integration of Biomarker Polygenic Risk Score Improves Prediction of Coronary Heart Disease. JACC Basic Transl Sci 2023; 8:1489-1499. [PMID: 38205343 PMCID: PMC10774750 DOI: 10.1016/j.jacbts.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 01/12/2024]
Abstract
There are several established biomarkers for coronary heart disease (CHD), including blood pressure, cholesterol, and lipoproteins. It is of high interest to determine how a combined polygenic risk score (PRS) of CHD-associated biomarkers (BioPRS) can further improve genetic prediction of CHD. We developed CHDBioPRS, combining BioPRS with PRS of CHD in the UK Biobank and tested it on FinnGen. We found that BioPRS was clearly predictive of CHD and that CHDBioPRS improved the standard CHD PRS. The largest effect was observed with early onset cases in FinnGen, with HRs above 2 per standard deviation of CHDBioPRS.
Collapse
Affiliation(s)
- Jake Lin
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Nina Mars
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Yu Fu
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Pietari Ripatti
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - FinnGen study
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Broad Institute of Massachusetts Institute of Technology, Harvard University, Cambridge, Massachusetts, USA
- Massachusetts General Hospital, Cambridge, Massachusetts, USA
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Taru Tukiainen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Broad Institute of Massachusetts Institute of Technology, Harvard University, Cambridge, Massachusetts, USA
- Massachusetts General Hospital, Cambridge, Massachusetts, USA
| | - Matti Pirinen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| |
Collapse
|
10
|
Kiang SC, Lee MM, Dakour-Aridi H, Hassan M, Afifi RO. Presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females, existing gaps, and future directions: A descriptive review. Semin Vasc Surg 2023; 36:501-507. [PMID: 38030324 DOI: 10.1053/j.semvascsurg.2023.10.004] [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: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023]
Abstract
Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females have also benefited less from the research and treatment of those diseases than men. Understanding sex- and sex-specific differences in thoracic and thoracoabdominal aortic aneurysms can improve care delivery, reduce disparities, and optimize outcomes for females with thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. The authors reviewed the literature on the presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females, discussing the existing gaps and future directions to address them.
Collapse
Affiliation(s)
- Sharon C Kiang
- Vascular Division, Department of Surgery, Loma Linda Veterans Healthcare System, Loma Linda, CA
| | - Mary M Lee
- Vascular Division, Department of Surgery, Loma Linda Veterans Healthcare System, Loma Linda, CA
| | - Hanaa Dakour-Aridi
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Madiha Hassan
- McGovern Medical School at UTHealth Houston, 6400 Fannin Street, Suite 2850, Houston, TX, 77030
| | - Rana O Afifi
- McGovern Medical School at UTHealth Houston, 6400 Fannin Street, Suite 2850, Houston, TX, 77030.
| |
Collapse
|
11
|
Naumann M, Scharfenberg SR, Seleznova Y, Wein B, Bruder O, Stock S, Simic D, Scheckel B, Müller D. Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany. BMC Health Serv Res 2023; 23:655. [PMID: 37340434 DOI: 10.1186/s12913-023-09587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Chronic coronary syndrome (CCS) is a potentially progressive clinical presentation of coronary artery disease (CAD). Clinical practice guidelines (CPGs) are available for prevention, diagnosis, and treatment. Embedded in the "ENLIGHT-KHK" healthcare project, a qualitative study was conducted to identify factors that influence guideline adherence from the perspective of general practitioners (GPs) and cardiologists (CA) in the ambulatory care sector in Germany. METHODS GPs and CAs were surveyed via telephone using an interview guide. The respondents were first asked about their individual approach to caring for patients with suspected CCS. Subsequently, the accordance of their approach with guideline recommendations was addressed. Finally, potential measures for assisting with guideline adherence were discussed. The semi-structured interviews were transcribed verbatim and analysed using a qualitative content analysis in accordance with Kuckartz and Rädiker. Factors influencing adherence to CPGs were categorised by assessing whether they (i) inhibited or facilitated guideline adherence, (ii) played a role in patients at risk of CCS or with suspected or known CCS, (iii) were mentioned in implicit or explicit thematic reference to CPGs, and (iv) were declared a practical problem. RESULTS Based on interviews with ten GPs and five CAs, 35 potential influencing factors were identified. These emerged at four levels: patients, healthcare providers, CPGs, and the healthcare system. The most commonly cited barrier to guideline adherence among the respondents was structural aspects at the system level, including reachability of providers and services, waiting times, reimbursement through statutory health insurance (SHI) providers, and contract offers. There was a strong emphasis on interdependencies between factors acting at different levels. For instance, poor reachability of providers and services at the system level may result in inexpedience of guideline recommendations at the CPG level. Likewise, poor reachability of providers and services at the system level may be aggravated or alleviated by factors such as diagnostic preferences at the patient level or collaborations at the provider level. CONCLUSIONS To assist with adherence to CPGs regarding CCS, promoting measures may be needed that account for interdependencies between barriers and facilitators at various healthcare levels. Respective measures should consider medically justified deviations from guideline recommendations in individual cases. TRIAL REGISTRATION German Clinical Trials Register: DRKS00015638; Universal Trial Number (UTN): U1111-1227-8055.
Collapse
Affiliation(s)
- Marie Naumann
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Simon Robin Scharfenberg
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Bastian Wein
- Cardiology - Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
- Ruhr University Bochum, Bochum, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dusan Simic
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Benjamin Scheckel
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| |
Collapse
|
12
|
Sorrentino L, Chiolero A, Carmeli C. Cardiovascular mortality trends in Switzerland 1995-2018. Eur J Public Health 2022; 32:891-893. [PMID: 36351001 PMCID: PMC9713456 DOI: 10.1093/eurpub/ckac164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Mortality rates due to coronary heart disease (CHD) and stroke have declined in the last century in high-income countries, including Switzerland. However, these rates have plateaued in several countries. We assessed CHD and stroke mortality trends (1995-2018) in Switzerland. We estimated annual rate changes via JoinPoint regression. Rates decreased steadily in most sex and age groups; however, in those aged 60-74, stroke rates plateaued after 2012 among men and CHD rates plateaued after 2015 among women. Cardiovascular mortality continues to decrease in most of the Swiss population. Prevention efforts should be maintained, especially in individuals aged 60-74.
Collapse
Affiliation(s)
- Lisa Sorrentino
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
13
|
Virzi NE, Krantz DS, Bittner VA, Merz CNB, Reis SE, Handberg EM, Pepine CJ, Vaccarino V, Rutledge T. Depression Symptom Patterns as Predictors of Metabolic Syndrome and Cardiac Events in Symptomatic Women with Suspected Myocardial Ischemia: The Women's Ischemia Syndrome Evaluation (WISE and WISE-CVD) Projects. HEART AND MIND 2022; 6:254-261. [PMID: 36994354 PMCID: PMC10047568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background Ischemic heart disease (IHD) risk in women includes biomedical, behavioral, and psychosocial contributors. The purpose of this study was to build upon previous research suggesting that in women, somatic symptoms (SS) of depression may be important to the development of IHD risk factors and major adverse cardiovascular events (MACE). Based on previous findings, we hypothesized that: (1) SS would be associated with robust biomedical predictors of heart disease and functional capacity, while cognitive symptoms (CS) of depression would not, and (2) SS would independently predict adverse health outcomes while CS would not. Methods We examined the relationships between symptoms of depression (SS/CS), metabolic syndrome (MetS), inflammatory markers (IM), coronary artery disease (CAD) severity, and functional capacity in two independent cohorts of women with suspected IHD. In the Women's Ischemia Syndrome Evaluation (WISE), we also examined these variables as predictors of all-cause mortality (ACM) + MACE over a median 9.3-year follow-up. The WISE sample included 641 women with suspected ischemia with or without obstructive CAD. The WISE-Coronary Vascular Dysfunction (WISE-CVD) sample consisted of 359 women with suspected ischemia and no obstructive CAD. All study measures were collected uniformly at baseline. Depressive symptoms were measured via the Beck Depression Inventory. MetS was assessed according to Adult Treatment Panel III (ATP-III) criteria. Results In both studies, SS was associated with MetS (Cohen's d = 0.18, 0.26, P < 0.05, respectively), while CS was not. Within WISE, using Cox Proportional Hazard Regression, SS (Hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.01-1.15; HR = 1.07, 95% CI = 1.00-1.13) and MetS (HR = 1.89, 95% CI = 1.16-3.08; HR = 1.74, 95% CI=1.07-2.84) were independent predictors of ACM + MACE after controlling for demographics, IM, and CAD severity, while CS was not. Conclusions In two independent samples of women undergoing coronary angiography due to suspected ischemia, SS but not CS of depression were associated with MetS, and both SS and MetS independently predicted ACM and MACE. These results add to previous studies suggesting that SS of depression may warrant specific attention in women with elevated cardiovascular disease (CVD) risk. Future research evaluating the biobehavioral basis of the relationship between depression, MetS, and CVD is needed.
Collapse
Affiliation(s)
- Nicole E. Virzi
- Department of Clinical Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego, California
| | - David S. Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland
| | - Vera A. Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen M. Handberg
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Carl J. Pepine
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - Thomas Rutledge
- Psychology Service, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California, USA
| |
Collapse
|
14
|
Darbà J, Marsà A. Burden of ischemic heart disease in Spain: incidence, hospital mortality and costs of hospital care. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1147-1152. [PMID: 36001004 DOI: 10.1080/14737167.2022.2108794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading global cause of death and is assumed to entail a significant social and economic burden globally. This study aimed to evaluate incidence and mortality trends of IHD in Spain and to estimate direct medical costs. METHODS Admission files corresponding to patients with IHD registered between 2011 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective study. RESULTS Admission data corresponding to 814,740 patients with IHD was analyzed. The majority of patients were males, and about half of the hospitalizations were due to an acute myocardial infarction. Incidence decreased significantly in most age groups over time, while hospital mortality rate remained stable (4.4%). Additionally, mortality rate was significantly higher among females (6.6%). Median admission cost was €5175; the higher costs per admission were found in patients with an acute myocardial infarction and in admissions with an ICU stay. The annual cost of hospital care was €693.8 million. CONCLUSIONS Despite the decreasing trends described in the general population, hospital mortality rate was constant among hospitalized patients during the study period. The higher hospital mortality rate described among females should be considered in further studies and protocol revisions.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
| |
Collapse
|
15
|
Stevens CJ, Shaffer JA, Edwards KS, Masters KS, Leon KK, Wood MJ, Pittman Wagers T. Younger Age Impacts Perceptions of Care Received in the Emergency Department Among Women with Spontaneous Coronary Artery Dissection. J Womens Health (Larchmt) 2022; 31:1165-1172. [PMID: 35172115 PMCID: PMC9378767 DOI: 10.1089/jwh.2021.0162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic etiology of acute coronary syndrome (ACS) that primarily affects younger women with few traditional cardiovascular disease risk factors. The primary objective of this study was to evaluate how younger age impacts the perception of care women receive in the emergency department (ED) at the time of their first or only SCAD. Methods: SCAD survivors were recruited using SCAD Alliance social media platforms to complete a one-time online survey regarding their experiences of seeking treatment for SCAD in the ED and their post-SCAD recovery. A total of 409 participants consented to participate in the parent study and data collected from the 367 participants who reported female gender were further analyzed. Results: Fewer participants <50 years old than would be expected under the null hypothesis (i.e., 65.5% observed vs. 71.2% expected, p = 0.009) reported perceived serious treatment by ED staff, more participants <50 years than would be expected under the null hypothesis (i.e., 12.0% observed vs. 9.3% expected, p = 0.049) reported perceived dismissive treatment by ED staff, and more participants <50 years than would be expected under the null hypothesis (i.e., 13.3% observed vs. 10.8% expected, p = 0.02) reported discharge from the ED without a diagnosis. Conclusions: Results of this study highlight the different experiences of younger SCAD survivors' engaging with providers in the ED. Further research regarding strategies for increasing ED providers' clinical interrogation of SCAD when treating and evaluating younger female patients presenting with ACS symptoms is indicated.
Collapse
Affiliation(s)
- Courtney J. Stevens
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jonathan A. Shaffer
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | | | - Kevin S. Masters
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
- Anschutz Health and Wellness Center, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Malissa J. Wood
- Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Tina Pittman Wagers
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| |
Collapse
|
16
|
Al Barmawi M, Al Hadid LA, Al Kharabshah M. Reasons for delay in seeking healthcare among women with acute coronary syndrome from rural and urban areas in Jordan. Health Care Women Int 2021; 43:293-308. [PMID: 34586975 DOI: 10.1080/07399332.2021.1955889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to explore reasons for delay in seeking healthcare among women with acute coronary syndrome (ACS) for the first time from urban and rural areas in Jordan. A qualitative descriptive design was used through face-to-face interviews with 33 women. Themes that explained why women delayed seeking healthcare when experiencing ACS were: Knowledge deficit about coronary artery disease; the effect of disparity in healthcare services on women decision; and life priorities of women during the ACS attack. Educational needs should be addressed based on variations in both areas.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.1955889 .
Collapse
Affiliation(s)
- Marwa Al Barmawi
- Faculty of Nursing, Department of Nursing, Alzaytoonah University of Jordan (ZUJ), Amman, Jordan
| | | | | |
Collapse
|
17
|
Elgebaly SA, Christenson RH, Kandil H, El-Khazragy N, Rashed L, Yacoub B, Eldeeb H, Ali M, Sharafieh R, Klueh U, Kreutzer DL. Nourin-Dependent miR-137 and miR-106b: Novel Early Inflammatory Diagnostic Biomarkers for Unstable Angina Patients. Biomolecules 2021; 11:368. [PMID: 33670982 PMCID: PMC7997347 DOI: 10.3390/biom11030368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/19/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, no blood biomarkers exist that can diagnose unstable angina (UA) patients. Nourin is an early inflammatory mediator rapidly released within 5 min by reversible ischemic myocardium, and if ischemia persists, it is also released by necrosis. Nourin is elevated in acute coronary syndrome (ACS) patients but not in symptomatic noncardiac and healthy subjects. Recently, circulating microRNAs (miRNAs) have been established as markers of disease, including cardiac injury and inflammation. OBJECTIVES To profile and validate the potential diagnostic value of Nourin-dependent miR-137 (marker of cell damage) and miR-106b-5p (marker of inflammation) as early biomarkers in suspected UA patients and to investigate the association of their target and regulating genes. METHODS Using Nourin amino acid sequence, an integrated bioinformatics analysis was conducted. Analysis indicated that Nourin is a direct target for miR-137 and miR-106b-5p in myocardial ischemic injury. Two linked molecular networks of lncRNA/miRNAs/mRNAs were also retrieved, including CTB89H12.4/miR-137/FTHL-17 and CTB89H12.4/miR-106b-5p/ANAPC11. Gene expression profiling was assessed in serum samples collected at presentation to an emergency department (ED) from: (1) UA patients (n = 30) (confirmed by invasive coronary angiography with stenosis greater than 50% and troponin level below the clinical decision limit); (2) patients with acute ST elevation myocardial infarction (STEMI) (n = 16) (confirmed by persistent ST-segment changes and elevated troponin level); and 3) healthy subjects (n = 16). RESULTS Gene expression profiles showed that miR-137 and miR-106b-5p were significantly upregulated by 1382-fold and 192-fold in UA compared to healthy, and by 2.5-fold and 4.6-fold in STEMI compared to UA, respectively. Healthy subjects showed minimal expression profile. Receiver operator characteristics (ROC) analysis revealed that the two miRNAs were sensitive and specific biomarkers for assessment of UA and STEMI patients. Additionally, Spearman's correlation analysis revealed a significant association of miRNAs with the associated mRNA targets and the regulating lncRNA. CONCLUSIONS Nourin-dependent gene expression of miR-137 and miR-106b-5p are novel blood-based biomarkers that can diagnose UA and STEMI patients at presentation and stratify severity of myocardial ischemia, with higher expression in STEMI compared to UA. Early diagnosis of suspected UA patients using the novel Nourin biomarkers is key for initiating guideline-based therapy that improves patients' health outcomes.
Collapse
Affiliation(s)
- Salwa A. Elgebaly
- Research & Development, Nour Heart, Inc., Vienna, VA 22180, USA
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Hossam Kandil
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Nashwa El-Khazragy
- Department of Clinical Pathology-Hematology, Ain Shams Medical Research Institute (MASRI), Faculty of Medicine, Ain Shams University, Cairo 11566, Egyp;
| | - Laila Rashed
- Department of Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt;
| | - Beshoy Yacoub
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Heba Eldeeb
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Mahmoud Ali
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (B.Y.); (H.E.); (M.A.)
| | - Roshanak Sharafieh
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
| | - Ulrike Klueh
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
- Integrative Biosciences Center (IBio), Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, USA
| | - Donald L. Kreutzer
- Department of Surgery, School of Medicine, UConn Health, Farmington, CT 06032, USA; (R.S.); (D.L.K.)
- Cell & Molecular Tissue Engineering, LLC Farmington, CT 06032, USA;
| |
Collapse
|
18
|
Kubra G, Saghir T, Rasheed S, Rehan FH, Ali A, Abbas S. In-Hospital Outcomes of Female Patients With Inferior Wall Myocardial Infarction. Cureus 2021; 13:e13274. [PMID: 33728209 PMCID: PMC7950460 DOI: 10.7759/cureus.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to determine the in-hospital outcome of female patients with inferior wall myocardial infarction (MI). Methodology This study was conducted from January to December 2017 at the Department of Cardiology, National Institute of Cardiovascular Disease, Karachi. A total of 59 women admitted with inferior wall MI were enrolled in the study. In all patients, in-hospital outcomes were observed. Descriptive statistics were applied. Stratification was done using chi-square test, and p-value of ≤0.05 was considered significant. Results The mean age of study participants was 58.80 ± 9.17 years, while 247 (79.7%) participants were above 50 years of age. The mean onset of duration of sign and symptoms of inferior wall MI was 3.48 ± 1.53 hours. There were 36 (61.0%) patients who had diabetes mellitus, 46 (78.0%) had hypertension, 17 (28.8%) were obese, nine (15.3%) had a family history of MI, and three (5.1%) were smokers. There were 43 (72.9%) patients who were illiterate. In our study, eight (13.6%) females were found to have sinus bradycardia, seven (11.9%) had sinus tachycardia, three (5.1%) had atrial fibrillation, and 24 (40.7%) had complete heart block. Mortality was noted in five (8.5%) patients. Conclusions Women with an acute inferior wall MI had a higher rate of complete heart block and adverse in-hospital outcomes. Female gender itself with inferior wall MI may be at risk for in-hospital adverse outcomes.
Collapse
Affiliation(s)
- Ghulam Kubra
- Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tahir Saghir
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Shazia Rasheed
- Echocardiography, National Institute of Cardiovascular Diseases, Karachi, PAK
| | | | - Asad Ali
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Syed Abbas
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| |
Collapse
|
19
|
Combined Femoral and Carotid Plaque Burden Identifies Obstructive Coronary Artery Disease in Women. J Am Soc Echocardiogr 2020; 33:90-100. [DOI: 10.1016/j.echo.2019.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 01/14/2023]
|
20
|
Biscaglia S, Campo G, Sorbets E, Ford I, Fox KM, Greenlaw N, Parkhomenko A, Tardif JC, Tavazzi L, Tendera M, Wetherall K, Ferrari R, Steg PG. Relationship between physical activity and long-term outcomes in patients with stable coronary artery disease. Eur J Prev Cardiol 2019; 27:426-436. [PMID: 31558054 DOI: 10.1177/2047487319871217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS The aims of this study were to ascertain the relationship between level of physical activity and outcomes and to discriminate the determinants of physical activity performance or avoidance. METHODS CLARIFY is an international prospective registry of 32,370 consecutive outpatients with stable coronary artery disease who were followed for up to five years. Patients were grouped according to the level and frequency of physical activity: i) sedentary (n = 5223; 16.1%); ii) only light physical activity most weeks (light; n = 16,634; 51.4%); iii) vigorous physical activity once or twice per week (vigorous ≤ 2×; n = 5427; 16.8%); iv) vigorous physical activity three or more times per week (vigorous >2×; n = 5086; 15.7%). The primary outcome was the composite of cardiovascular death, myocardial infarction and stroke. RESULTS Patients performing vigorous physical activity ≤2 × had the lowest risk of the primary outcome (hazard ratio, 0.82; 95% confidence interval, 0.71-0.93; p = 0.0031) taking the light group as reference. Engaging in more frequent exercise did not result in further outcome benefit. All-cause death, cardiovascular death, and stroke occurred less frequently in patients performing vigorous physical activity ≤2×. However, the rate of myocardial infarction was comparable between the four physical activity groups. Female sex, peripheral artery disease, diabetes, previous myocardial infarction or stroke, pulmonary disease and body mass index all emerged as independent predictors of lower physical activity. CONCLUSION Vigorous physical activity once or twice per week was associated with superior cardiac outcomes compared with patients performing no or a low level of physical activity in outpatients with stable coronary artery disease.
Collapse
Affiliation(s)
- Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Emmanuel Sorbets
- Hôpital Avicenne, Assistance Publique Hôpitaux de Paris & Université Paris 13, Bobigny, France.,FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.,National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
| | | | - Kim M Fox
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
| | | | | | | | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Michal Tendera
- Medical University of Silesia, School of Medicine in Katowice, Department of Cardiology and Structural Heart Disease, Poland
| | | | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Ph Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.,National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris and Université de Paris, France
| | | |
Collapse
|
21
|
Pershad A, Gulati M, Karmpaliotis D, Moses J, Nicholson WJ, Nugent K, Tang Y, Sapontis J, Lombardi W, Grantham JA. A sex stratified outcome analysis from the OPEN-CTO registry. Catheter Cardiovasc Interv 2019; 93:1041-1047. [PMID: 30569618 DOI: 10.1002/ccd.28023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/11/2018] [Accepted: 11/25/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Women have been under-represented in trials. Due to the dearth of information about CTO-PCI in women and discordance of previous results, sex differences in outcomes in the OPEN-CTO Trial were investigated. METHODS OPEN-CTO is an investigator-initiated, multicenter, prospective observational registry of consecutive CTO patients undergoing PCI at 12 U.S. centers. The one-year outcomes of this trial stratified by sex were examined. Optimal propensity matching was performed to compare outcomes between sexes. Multivariate conditional logistic regression modeling for predictors of procedural success was performed. RESULTS Women represented 19.6% of the cohort (196/1,000 patients). Women were more likely to report dyspnea as their predominant symptom. Women reported statistically worse physical limitation and poorer quality of life as compared to men. J-CTO scores were similar in males and females. Technical, procedural success and MACE rates were similar in both sexes. Contrast and radiation doses were however significantly lower in women. The SAQ- summary score, RDS, EQ-5D VAS, PHQ-8 scores were all improved to the same degree at 1 year in women as compared to men. Predictors of procedural success revealed that younger age, lower J-CTO score and absence of prior CABG were predictors of procedural success. Sex did not predict procedural success or 1-year MACE in this regression model. CONCLUSION This real-world registry revealed that women derive the same benefit from CTO-PCI as men without additional complications and with favorable health status outcomes at 1 year. Consideration of revascularization by PCI in symptomatic women should be considered as part of the treatment when appropriate.
Collapse
Affiliation(s)
- Ashish Pershad
- University of Arizona College of Medicine, Phoenix, Arizona.,Banner University Medical Center, Phoenix, Arizona
| | - Martha Gulati
- University of Arizona College of Medicine, Phoenix, Arizona.,Banner University Medical Center, Phoenix, Arizona
| | | | - Jeffery Moses
- Columbia University, New York Presbyterian Hospital, New York, New York
| | | | - Karen Nugent
- St. Lukes Mid America Heart Institute, Kansas City, Missouri
| | - Yuanyuan Tang
- St. Lukes Mid America Heart Institute, Kansas City, Missouri
| | | | | | | | | |
Collapse
|
22
|
Louis XL, Raj P, Chan L, Zieroth S, Netticadan T, Wigle JT. Are the cardioprotective effects of the phytoestrogen resveratrol sex-dependent? 1. Can J Physiol Pharmacol 2018; 97:503-514. [PMID: 30576226 DOI: 10.1139/cjpp-2018-0544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease (CVD) is the number one cause of death in both men and women. Younger women have a lower risk for CVD, but their risk increases considerably after menopause when estrogen levels decrease. The cardiovascular protective properties of estrogen are mediated through decreasing vascular inflammation and progression of atherosclerosis, decreasing endothelial cell damage by preventing apoptosis and anti-hypertrophic mechanisms. Estrogen also regulates glucose and lipid levels, which are 2 important risk factors for CVD. Resveratrol (RES), a cardioprotective polyphenolic compound, is classified as a phytoestrogen due its capacity to bind to and modulate estrogen receptor signalling. Due to its estrogen-like property, we speculate that the cardioprotective effects of RES treatment could be sex-dependent. Based on earlier reports and more recent data from our lab presented here, we found that RES treatment may have more favourable cardiovascular outcomes in females than in males. This review will discuss estrogen- and phytoestrogen-mediated cardioprotection, with a specific focus on sex-dependent effects reported in preclinical and clinical studies.
Collapse
Affiliation(s)
- Xavier Lieben Louis
- a Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada.,b Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R2E 3N4, Canada
| | - Pema Raj
- c Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R2E 0J9, Canada.,d Canadian Centre for Agri-Food Research in Health and Medicine, St. Boniface Hospital Albrechtsen, Research Centre, Winnipeg, MB R2H 2A6, Canada
| | - Laura Chan
- a Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada.,b Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R2E 3N4, Canada
| | - Shelley Zieroth
- c Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R2E 0J9, Canada.,e Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Thomas Netticadan
- d Canadian Centre for Agri-Food Research in Health and Medicine, St. Boniface Hospital Albrechtsen, Research Centre, Winnipeg, MB R2H 2A6, Canada.,f Agriculture and Agri-Food Canada, Winnipeg, MB R3C 3G7, Canada
| | - Jeffrey T Wigle
- a Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada.,b Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R2E 3N4, Canada
| |
Collapse
|
23
|
Medina-Inojosa JR, Vinnakota S, Garcia M, Arciniegas Calle M, Mulvagh SL, Lopez-Jimenez F, Bhagra A. Role of Stress and Psychosocial Determinants on Women's Cardiovascular Risk and Disease Development. J Womens Health (Larchmt) 2018; 28:483-489. [PMID: 30457922 DOI: 10.1089/jwh.2018.7035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The notion that cardiovascular disease (CVD) primarily occurs in men is slowly disappearing. More women than men die of CVD every year, and when women survive, the burden and consequences are worse than in men. Markers of stress and other psychosocial factors have been associated with poor outcomes. Multiple studies have demonstrated sex-based differences in the vascular and endothelial responses to mental stress. Psychosocial stressors were also found to be independent risk factors for the development and progression of CVD. This review arises from accumulating evidence suggesting that psychological well-being may improve cardiac-related outcomes, independent of cardiac risk factors. Despite the fact that positive physician-patient engagement is likely to play a critical role in promoting positive psychological traits and healthy behaviors, current physician awareness and advocacy are rather suboptimal, despite active awareness campaigns such as the American Heart Association's Go Red for Women®. There is a need to further study the role and management of stress as a CVD risk factor, especially in women, who are disproportionately affected.
Collapse
Affiliation(s)
- Jose R Medina-Inojosa
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shravya Vinnakota
- 2 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mariana Garcia
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maria Arciniegas Calle
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharon L Mulvagh
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,3 Division of Cardiology, Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | - Francisco Lopez-Jimenez
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anjali Bhagra
- 2 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
24
|
Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach. Sex Med Rev 2018; 6:525-534. [PMID: 29661689 DOI: 10.1016/j.sxmr.2018.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Although basic science and clinical research indicate that the vascular physiopathology of male and female sexual dysfunction (FSD) is similar, to date the association between FSD and cardiovascular (CV) diseases has been only marginally explored. AIM To discuss the potential reasons for differences in the role of CV diseases and risk factors in sexual function in women vs men in the 2nd part of a 2-part review. METHODS A thorough literature search of peer-reviewed publications on the topic was performed using the PubMed database. MAIN OUTCOME MEASURES We present a review of the main factors that could account for this gap: (i) actual physiologic discrepancies and (ii) factors related to the inadequacy of the methodologic approach used to investigate CV risk in patients with FSD. A summary of the available methods to assess female sexual response, focusing on genital vascularization, is reported. RESULTS The microanatomy and biochemistry of the male and female peripheral arousal response are similar; in contrast, there are differences in the interplay between the metabolic profile and sex steroid milieu, in the relative weighting of cardiometabolic risk factors in the pathogenesis of CV disease, and their clinical presentation and management. CV diseases in women are under-recognized, leading to less aggressive treatment strategies and poorer outcomes. Moreover, evaluation of hemodynamic events that regulate the female sexual response has thus far been plagued by methodologic problems. CONCLUSION To clarify whether sexuality can be a mirror for CV health in women, the female genital vascular district should be objectively assessed with standardized and validated methods. Studies designed to establish normative values and longitudinal intervention trials on the effect of the treatment of CV risk factors on FSD are urgently needed. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach. Sex Med Rev 2018;6:525-534.
Collapse
Affiliation(s)
- Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
| |
Collapse
|
25
|
Shaw LJ, Pepine CJ, Xie J, Mehta PK, Morris AA, Dickert NW, Ferdinand KC, Gulati M, Reynolds H, Hayes SN, Itchhaporia D, Mieres JH, Ofili E, Wenger NK, Bairey Merz CN. Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine. J Am Coll Cardiol 2017; 70:373-388. [PMID: 28705320 DOI: 10.1016/j.jacc.2017.05.051] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 12/20/2022]
Abstract
The present review synthesizes evidence and discusses issues related to health care quality and equity for women, including minority population subgroups. The principle of "sameness" or women and men receiving equitable, high-quality care is a near-term target, but optimal population health cannot be achieved without consideration of the unique, gendered structural determinants of health and the development of unique care pathways optimized for women. The aim of this review is to promote enhanced awareness, develop critical thinking in sex and gender science, and identify strategic pathways to improve the cardiovascular health of women. Delineation of the components of high-quality health care, including a women-specific research agenda, remains a vital part of strategic planning to improve the lives of women at risk for or living with cardiovascular disease.
Collapse
Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
| | | | - Joe Xie
- Emory University School of Medicine, Atlanta, Georgia
| | - Puja K Mehta
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Martha Gulati
- University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Ren M, Liu Y, Zhao H, Dong S, Jiang Z, Li K, Tian J. Adenosine triphosphate postconditioning is associated with better preserved global and regional cardiac function during myocardial ischemia and reperfusion: a speckle tracking imaging-based echocardiologic study. Cardiovasc Ther 2017; 34:343-51. [PMID: 27328167 DOI: 10.1111/1755-5922.12205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Effects of ischemic postconditioning (IPostC) and adenosine triphosphate (ATP)-mediated pharmacologic postconditioning (ATP-PPostC) on cardiac function were evaluated by speckle tracking imaging (STI)-based echocardiography. AIMS A myocardial I/R model was induced in rabbits by reversible ligation of the left ventricular branch of coronary artery. Rabbits were randomized into three groups: ischemia and reperfusion (IR) (no further intervention), IPostC, and ATP-PPostC groups. Cardiac function was evaluated by conventional and STI-based echocardiography. Myocardial necrosis, apoptosis, and myocardial mRNAs of apoptosis-related proteins (Bcl-2 and Bax) were evaluated. RESULTS Speckle tracking imaging (STI)-based echocardiography revealed that IPostC and ATP-PPostC were associated with better preserved global and regional cardiac function, as indicated by significantly increased GLSrsys, GLSrd, GLSsys, SrLsys, SrLd, and SLsys in both groups (all P<.5). Subsequent pathologic studies indicate that the percentage of necrotic myocardium and permillage of apoptotic cells were significantly lower in the IPostC and ATP-PPostC groups than in the IR group (all P<.05). Moreover, both IPostC and ATP-PPostC were associated with increased Bcl-2 mRNA levels and reduced Bax mRNA levels. CONCLUSIONS IPostC and ATP-PPostC may exert cardioprotective functions by better preservation of cardiac function during the I/R process and at least partly via attenuation of myocardial apoptosis.
Collapse
Affiliation(s)
- Min Ren
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yujie Liu
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Shixia Dong
- Department of Special Diagnosis, PLA 313 Hospital, Huludao, China
| | - Zhonghui Jiang
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Keting Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| |
Collapse
|
27
|
Musey PI, Kline JA. Do Gender and Race Make a Difference in Acute Coronary Syndrome Pretest Probabilities in the Emergency Department? Acad Emerg Med 2017; 24:142-151. [PMID: 27862670 DOI: 10.1111/acem.13131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective was to test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90-day returns, cost, and chest radiation exposure after these stratifications. METHODS This is a secondary analysis of a prospective outcomes study of ED patients with chest pain and shortness of breath. We performed two separate analyses. The data set was divided by gender for analysis 1 while the analysis 2 stratification was made by race (nonwhite vs. white). For each analysis, groups were compared on several variables: provider visual analog scales (VAS) for likelihood of ACS, PREtest Consult ACS probabilities, rates of ACS, total radiation exposure to the chest, total costs at 30 days, and 90-day recidivism (ED, overnight observations, and inpatient admissions). RESULTS A total of 844 patients were studied. Gender information was present on all 844 subjects, while complete race/ethnicity information was available on 783 (93%) subjects. For the first analysis, female patients made up 57% (478/844) of the population and their mean provider VAS scores for ACS were significantly lower (p = 0.000) at 14% (95% confidence interval [CI] = 13% to 16%) than that of males at 22% (95% CI = 19% to 24%). This was consistent with the objective pretest ACS probabilities subsequently calculated via the validated online tool, PREtest Consult, which were also significantly lower (p = 0.000) at 2.7% (95% CI = 2.4% to 3.1%) for females versus 6.6% (95% CI = 5.9% to 7.3%) for males. However, comparing females to males, there was no significant difference in diagnosis of ACS (3.6% vs. 1.6%), mean chest radiation doses (5.0 mSv vs. 4.9 mSv), total costs at 30 days ($3,451.24 vs. $3,847.68), or return to the ED within 90 days (26% each). For analysis 2 by race, nonwhite patients also comprised 57% (444/783) of individuals. Similar to the gender analysis, mean provider VAS scores for ACS were found to be significantly lower (p = 0.000) at 15% (95% CI = 13% to 16%) for nonwhite versus 20% (95% CI = 18% to 23%) for white subjects. Concordantly, objective pretest ACS probabilities were also significantly lower (p = 0.000) at 3.4% (95% CI = 2.9% to 3.9%) for nonwhite versus 5.3% (95% CI = 4.7% to 5.9%) for white subjects. There were no significant differences in outcomes in nonwhite versus white subjects when compared on diagnosis of ACS (3.2% vs 2.4%), mean chest radiation dose (4.6 mSv vs. 5.0 mSv), cost ($3,156.02 vs. $2,885.18), or 90-day ED returns (28% vs. 23%). CONCLUSIONS Despite consistently estimating the risk for ACS to be lower for both females and minorities concordantly with calculated objective pretest assessments, there does not appear to have been any significant decrease in subsequent evaluation of these perceived lower-risk groups when radiation exposure and costs are taken into account. Further studies on the impact of pretest assessments on gender and racial disparities in ED chest pain evaluation are needed.
Collapse
Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| | - Jeffrey A. Kline
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| |
Collapse
|
28
|
Wright B, O'Shea AMJ, Glasgow JM, Ayyagari P, Vaughan Sarrazin M. Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016666752. [PMID: 27637268 PMCID: PMC5798678 DOI: 10.1177/0046958016666752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
Observation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admitted for similar periods of time as inpatients. The aim was to identify patient characteristics associated with being observed rather than admitted for a short stay (<48 hours) within the Veterans Health Administration (VHA). In our longitudinal analysis, we used logistic regression within a generalized estimating equation framework to model observation stays as a function of patient characteristics, time trends, and hospital fixed effects. To minimize heterogeneity between groups, we limit our sample to patients with a presenting diagnosis of chest pain. Our analysis includes a total of 121 584 hospital events, which consist of all observation and short-stay admissions for chest pain patients at VHA hospitals between 2005 and 2013. Both the absolute and relative use of observation stays increased markedly over time. The odds of an observation stay were higher among women, but lower among older patients and rural residents. Despite strong evidence that chest pain patients are increasingly more likely to be observed than admitted, suggesting a substitution effect, we find little evidence of within-hospital disparities in VHA observation stay use.
Collapse
Affiliation(s)
| | - Amy M J O'Shea
- The University of Iowa, Iowa City, USA The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA
| | - Justin M Glasgow
- The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA Christiana Care Health System, Wilmington, DE, USA
| | | | - Mary Vaughan Sarrazin
- The University of Iowa, Iowa City, USA The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA
| |
Collapse
|
29
|
Mieres JH, Bonow RO. Ischemic Heart Disease in Women: A Need for Sex-Specific Diagnostic Algorithms. JACC Cardiovasc Imaging 2016; 9:347-9. [PMID: 27017235 DOI: 10.1016/j.jcmg.2016.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 01/28/2023]
|
30
|
Zhou X, Niu JM, Ji WJ, Zhang Z, Wang PP, Ling XFB, Li YM. Precision test for precision medicine: opportunities, challenges and perspectives regarding pre-eclampsia as an intervention window for future cardiovascular disease. Am J Transl Res 2016; 8:1920-1934. [PMID: 27347303 PMCID: PMC4891408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/23/2016] [Indexed: 06/06/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) comprise a spectrum of syndromes that range in severity from gestational hypertension and pre-eclamplsia (PE) to eclampsia, as well as chronic hypertension and chronic hypertension with superimposed PE. HDP occur in 2% to 10% of pregnant women worldwide, and impose a substantial burden on maternal and fetal/infant health. Cardiovascular disease (CVD) is the leading cause of death in women. The high prevalence of non-obstructive coronary artery disease and the lack of an efficient diagnostic workup make the identification of CVD in women challenging. Accumulating evidence suggests that a previous history of PE is consistently associated with future CVD risk. Moreover, PE as a maladaptation to pregnancy-induced hemodynamic and metabolic stress may also be regarded as a "precision" testing result that predicts future cardiovascular risk. Therefore, the development of PE provides a tremendous, early opportunity that may lead to changes in maternal and infant future well-being. However, the underlying pathogenesis of PE is not precise, which warrants precision medicine-based approaches to establish a more precise definition and reclassification. In this review, we proposed a stage-specific, PE-targeted algorithm, which may provide novel hypotheses that bridge the gap between Big Data-generating approaches and clinical translational research in terms of PE prediction and prevention, clinical treatment, and long-term CVD management.
Collapse
Affiliation(s)
- Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
| | - Jian-Min Niu
- Guangdong Women and Children HospitalGuangzhou, Guangdong Province 511400, China
| | - Wen-Jie Ji
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of MedicineChicago, Illinois 60611, USA
| | - Peizhong P Wang
- Faculty of Medicine, Memorial University of NewfoundlandNewfoundland and Labrador, 300 Prince Phillip Drive, Canada
| | - Xue-Feng B Ling
- Department of Surgery, Stanford UniversityPalo Alto, California, 94305, USA
| | - Yu-Ming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPFTianjin 300162, China
| |
Collapse
|
31
|
Affiliation(s)
- Jawahar L Mehta
- Medicine and Physiology and Biophysics, Stebbins Chair in Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,
| |
Collapse
|
32
|
Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04160] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
Collapse
Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Barratt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Gywn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École Nationale d’Administration Publique, Ville de Québec, QC, Canada
| | - Kelly Devers
- Health Policy Centre, Urban Institute, Washington, DC, USA
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - Julien Forder
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Gillies
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and NIHR Research Design Service East Midlands, University of Leicester, Leicester, UK
| | - Lucy Goulding
- King’s Improvement Science, Centre for Implementation Science, King’s College London, London, UK
| | - Richard Grieve
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emma Howarth
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, University of Cambridge, Cambridge, UK
| | | | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- Medical Research Council (MRC)/Chief Scientist Office (CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zeynep Or
- Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Imperial College London, London, UK
| | | | | | - Jasjeet Sekhon
- Department of Political Science and Statistics, University of California Berkeley, Berkeley, CA, USA
| | - Simon Turner
- Department of Applied Health Research, University College London, London, UK
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
| |
Collapse
|
33
|
Garcia M, Mulvagh SL, Merz CNB, Buring JE, Manson JE. Cardiovascular Disease in Women: Clinical Perspectives. Circ Res 2016; 118:1273-93. [PMID: 27081110 PMCID: PMC4834856 DOI: 10.1161/circresaha.116.307547] [Citation(s) in RCA: 659] [Impact Index Per Article: 82.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/11/2016] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease continues to be the leading cause of death among women in the United States, accounting for ≈1 of every 3 female deaths. Sex-specific data focused on cardiovascular disease have been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex differences as they relate to clinical practice in the prevention, diagnosis, and treatment of cardiovascular disease. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including myocardial infarction associated with nonobstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other cardiovascular disease entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease, and abdominal aortic aneurysms, are also briefly reviewed. Finally, recommendations for cardiac rehabilitation are addressed.
Collapse
Affiliation(s)
- Mariana Garcia
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G., S.L.M.); Department of Cardiovascular Diseases, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.B., J.E.M.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.B., J.E.M.)
| | - Sharon L Mulvagh
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G., S.L.M.); Department of Cardiovascular Diseases, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.B., J.E.M.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.B., J.E.M.)
| | - C Noel Bairey Merz
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G., S.L.M.); Department of Cardiovascular Diseases, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.B., J.E.M.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.B., J.E.M.)
| | - Julie E Buring
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G., S.L.M.); Department of Cardiovascular Diseases, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.B., J.E.M.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.B., J.E.M.)
| | - JoAnn E Manson
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G., S.L.M.); Department of Cardiovascular Diseases, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.B., J.E.M.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.B., J.E.M.).
| |
Collapse
|
34
|
Jiang Z, Huang X, Huang S, Guo H, Wang L, Li X, Huang X, Wang T, Zhang L, Sun L. Sex-Related Differences of Lipid Metabolism Induced by Triptolide: The Possible Role of the LXRα/SREBP-1 Signaling Pathway. Front Pharmacol 2016; 7:87. [PMID: 27065871 PMCID: PMC4814849 DOI: 10.3389/fphar.2016.00087] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/16/2016] [Indexed: 12/13/2022] Open
Abstract
Triptolide, a diterpenoid isolated from the plant Tripterygium wilfordii Hook. f., exerts a unique bioactive spectrum of anti-inflammatory and anticancer activities. However, triptolide's clinical applications are limited due to its severe toxicities. Fatty liver toxicity occurs in response to triptolide, and this toxic response significantly differs between males and females. This report investigated the pathogenesis underlying the sex-related differences in the dyslipidosis induced by triptolide in rats. Wistar rats were administered 0, 150, 300, or 450 μg triptolide/kg/day by gavage for 28 days. Ultrastructural examination revealed that more lipid droplets were present in female triptolide-treated rats than in male triptolide-treated rats. Furthermore, liver triglyceride, total bile acid and free fatty acid levels were significantly increased in female rats in the 300 and 450 μg/kg dose groups. The expression of liver X receptor α (LXRα) and its target genes, cholesterol 7α-hydroxylase (CYP7A1) and Sterol regulatory element-binding transcription factor 1(SREBP-1), increased following triptolide treatment in both male and female rats; however, the female rats were more sensitive to triptolide than the male rats. In addition, the expression of acetyl-CoA carboxylase 1(ACC1), a target gene of SREBP-1, increased in the female rats treated with 450 μg triptolide/kg/day, and ACC1 expression contributed to the sex-related differences in the triptolide-induced dysfunction of lipid metabolism. Our results demonstrate that the sex-related differences in LXR/SREBP-1-mediated regulation of gene expression in rats are responsible for the sex-related differences in lipid metabolism induced by triptolide, which likely underlie the sex-related differences in triptolide hepatotoxicity. This study will be important for predicting sex-related effects on the pharmacokinetics and toxicity of triptolide and for improving its safety.
Collapse
Affiliation(s)
- Zhenzhou Jiang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical UniversityNanjing, China; Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical UniversityNanjing, China
| | - Xiao Huang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Shan Huang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Hongli Guo
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Lu Wang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Xiaojiaoyang Li
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Xin Huang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical UniversityNanjing, China; Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical UniversityNanjing, China
| | - Tao Wang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University Nanjing, China
| | - Luyong Zhang
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical UniversityNanjing, China; State Key Laboratory of Natural Medicines, China Pharmaceutical UniversityNanjing, China
| | - Lixin Sun
- Jiangsu Key Laboratory of Drug Screening and Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical UniversityNanjing, China; Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical UniversityNanjing, China
| |
Collapse
|
35
|
Garcia M, Miller VM, Gulati M, Hayes SN, Manson JE, Wenger NK, Bairey Merz CN, Mankad R, Pollak AW, Mieres J, Kling J, Mulvagh SL. Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice. Mayo Clin Proc 2016; 91:226-40. [PMID: 26848004 DOI: 10.1016/j.mayocp.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/17/2022]
Abstract
Over the past decade, an emerging clinical research focus on cardiovascular (CV) disease (CVD) risk in women has highlighted sex-specific factors that are uniquely important in the prevention and early detection of coronary atherosclerosis in women. Concurrently, a 30% decrease in the number of female deaths from CVD has been observed. Despite this, CVD continues to be the leading cause of death in women, outnumbering deaths from all other causes combined. Clinical practice approaches that focus on the unique aspects of CV care for women are needed to provide necessary resources for the prevention, diagnosis, and treatment of CVD in women. In addition to increasing opportunities for women to participate in CV research, Women's Heart Clinics offer unique settings in which to deliver comprehensive CV care and education, ensuring appropriate diagnostic testing, while monitoring effectiveness of treatment. This article reviews the emerging need and role of focused CV care to address sex-specific aspects of diagnosis and treatment of CVD in women.
Collapse
Affiliation(s)
- Mariana Garcia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology, Mayo Clinic, Rochester, MN; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Martha Gulati
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA
| | - Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amy W Pollak
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Jennifer Mieres
- Department of Cardiology, Hofstra North Short-LIJ School of Medicine, Hempstead, NY
| | - Juliana Kling
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Sharon L Mulvagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
36
|
Castañeda Valencia CR. Instrumento para la valoración de síntomas coronarios en la mujer. AVANCES EN ENFERMERÍA 2016. [DOI: 10.15446/av.enferm.v33n3.41989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Objetivo: Diseñar y validar un instrumento para la valoración de los síntomas en la mujer con enfermedad coronaria, enmarcada en la Teoría de los Síntomas Desagradables Metodología: Estudio metodológico, psicométrico, orientado por los Síntomas, concepto central de la Teoría de los Síntomas Desagradables de Lenz y colaboradores. Se realizó una crítica teórica del constructo elegido, demostrando su utilidad en la investigación y en la práctica disciplinar. Se ponderaron 260 evidencias por medio de una rigurosa crítica metodológica y empírica, aplicando el Sistema de Revisión Integrativa articulada al Modelo Conceptual Empírico de Fawcett y Garity. Se obtuvieron 30 piezas investigativas utilizadas para la construcción de los ítems. A los síntomas de Lenz se suman los síntomas psicosociales reportados en mujeres con enfermedad coronaria, generándose un primer instrumento compuesto por 87 ítems. Resultados: Se realizó una Validación de Contenido de expertos: Modelo Escobar y Cuervo 2008 (análisis estadístico SPSS 20) obteniéndose un Coeficiente de Correlación de Kendall de 0,682 (0,05), con buena concordancia entre jueces. El Modelo de Lawshe normalizado por Tristán 2008 reportó una Content Validity Ratio de 0,57 y un Index Validity Content de 0,797, demostrando que los ítems son unidades de análisis esenciales. Finalmente, la Validación Facial realizada mediante una prueba piloto a 21 mujeres que cumplieron los criterios de inclusión permitió la discriminación semiótica de los ítems, obteniéndose un instrumento compuesto por 67 ítems. Conclusiones: Éste es un remanente investigativo que requiere nuevas validaciones para elevar su capacidad psicométrica.</p>
Collapse
|