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Hanna M, Wabnitz A, Grewal P. Sex and stroke risk factors: A review of differences and impact. J Stroke Cerebrovasc Dis 2024; 33:107624. [PMID: 38316283 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107624] [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: 09/01/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES There is an increase in stroke incidence risk over the lifetime of women, given their longer life expectancy. However, an alarming trend for sex disparities, particularly in certain stroke risk factors, shows a concerning need for focus on sex differences in stroke prevention and treatment for women. In this article, we are addressing sex differences in both traditional and sex-specific stroke risk factors. METHODS We searched PubMed from inception to December 2022 for articles related to sex differences and risk factors for stroke. We reviewed full-text articles for relevance and ultimately included 152 articles for this focused review. RESULTS Women are at increased risk for stroke from both traditional and non-traditional stroke risk factors. As women age, they have a higher disease burden of atrial fibrillation, increased risk of stroke related to diabetes, worsening lipid profiles, and higher prevalence of hypertension and obesity compared to men. Further, women carry sex hormone-specific risk factors for stroke, including the age of menarche, menopause, pregnancy, and its complications, as well as hormonal therapy. Men have a higher prevalence of tobacco use and atrial fibrillation, as well as an increased risk for stroke related to hyperlipidemia. Additionally, men have sex-specific risks related to low testosterone levels. CONCLUSIONS By identifying biological sex-specific risk factors for stroke, developing robust collaborations, researching, and applying the knowledge for risk reduction strategies, we can begin to tailor prevention and reduce the global burden of stroke morbidity and mortality.
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Affiliation(s)
- Mckay Hanna
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ashley Wabnitz
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Parneet Grewal
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Women with familial hypercholesterolemia phenotype are undertreated and poorly controlled compared to men. Sci Rep 2023; 13:1492. [PMID: 36707646 PMCID: PMC9883524 DOI: 10.1038/s41598-023-27963-z] [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: 08/17/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disease that has a prevalence of approximately 1/250 inhabitants and is the most frequent cause of early coronary heart disease (CHD). We included 1.343.973 women and 1.210.671 men with at least one LDL-c measurement from the Catalan primary care database. We identified 14.699 subjects with Familial hypercholesterolemia-Phenotype (FH-P) based on LDL-c cut-off points by age (7.033 and 919 women, and 5.088 and 1659 men in primary and secondary prevention, respectively). Lipid lower therapy (LLT), medication possession ratio (MPR) as an indicator of adherence, and number of patients that reached their goal on lipid levels were compared by sex. In primary and secondary prevention, 69% and 54% of women (P = 0.001) and 64% and 51% of men (P = 0.001) were on low-to-moderate-potency LLT. Adherence to LLT was reduced in women older than 55 years, especially in secondary prevention (P = 0.03), where the percentage of women and men with LDL-c > 1.81 mmol/L were 99.9% and 98.9%, respectively (P = 0.001). Women with FH-P are less often treated with high-intensity LLT, less adherent to LLT, and have a lower probability of meeting their LDL-c goals than men, especially in secondary prevention.
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Krysiak R, Kowalcze K, Okopień B. Rosuvastatin potentiates the thyrotropin-lowering effect of metformin in men with non-autoimmune subclinical hypothyroidism and prediabetes. J Clin Pharm Ther 2022; 47:2030-2040. [PMID: 35899679 DOI: 10.1111/jcpt.13746] [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: 03/28/2022] [Revised: 05/28/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Metformin treatment decreases thyrotropin levels in individuals with hypothyroidism and this effect seems to be mediated by the 5'-adenosine monophosphate-activated protein kinase pathway in the pituitary. The activity of this pathway is also stimulated by statins. The current study was aimed at investigating whether the impact of metformin on hypothalamic-pituitary-thyroid axis activity is affected by statin use. METHODS The study included three matched groups of men with non-autoimmune hypothyroidism and prediabetes: patients treated for at least 6 months with high-intensity rosuvastatin therapy (20-40 mg daily) [groups A (n = 24) and C (n = 19)] and men not receiving statin therapy [group B (n = 24)]. Over the entire study period (6 months), groups A and B received metformin (2.55-3 g daily). Moreover, groups A and C continued rosuvastatin therapy. The lipid profile, glucose homeostasis markers, and plasma concentrations of thyrotropin, total and free thyroid hormones, prolactin, FSH, LH, ACTH and insulin-like growth factor-1 were determined at baseline and 6 months later. RESULTS AND DISCUSSION Fifty-nine patients completed the study. There were differences between groups A and C and group B in baseline values of total cholesterol, LDL-cholesterol, gonadotropins and ACTH. Although observed in both groups of metformin-treated patients, the effect on thyrotropin levels was more pronounced in group A than in group B. The impact on fasting glucose and insulin sensitivity was stronger in group B than group A. In turn, only in group A metformin tended to reduce gonadotropin levels. There were no differences between follow-up and baseline values of lipids, total and free thyroid hormones, prolactin, ACTH and insulin-like growth factor-1 in both these groups. In group C, all assessed variables remained at a similar level. WHAT IS NEW AND CONCLUSION The results of the current study suggest that rosuvastatin potentiates the inhibitory effect of metformin on thyrotrope secretory function.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalcze
- Department of Pediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Andersen CJ, Vance TM. Sex-Specific Associations Between Serum Lipids, Antinuclear Antibodies, and Statin Use in National Health and Nutrition Examination Surveys 1999-2004. Front Med (Lausanne) 2022; 9:887741. [PMID: 35721098 PMCID: PMC9198832 DOI: 10.3389/fmed.2022.887741] [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] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
Lipid metabolism contributes to the regulation of leukocyte activity and immune responses, and may serve as a therapeutic target in the pathophysiology and clinical management of autoimmune disorders. In addition to lipid-lowering properties, statins have been shown to exert anti-inflammatory and immunomodulatory effects within the context of autoimmunity. Importantly, autoimmune incidence and lipid markers differ between men and women, suggesting that the relationship between lipid metabolism and immune function may vary by sex. Therefore, we investigated whether a predictive, sex-specific relationship exists between serum lipids, statin use, and antinuclear antibodies (ANA)—a routine clinical marker of autoimmunity and immune dysfunction—in U.S. men and women (>20 years old; n = 1,526) from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Within this population, a greater proportion of women were positive for ANA (ANA+) and had higher ANA titers, as compared to men. While we did not observe statistical differences in average total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), or triglyceride levels in ANA positive (ANA+) vs. ANA negative (ANA–) men or women, we observed that a greater proportion of ANA+ women had high total cholesterol levels (>240 mg/dL) when compared to ANA+ men (13.0 vs. 9.0%), and that a greater percentage of ANA+ women had low HDL-C as compared to ANA+ men (29.2 vs. 19.6%). However, in logistic regression models, total cholesterol, LDL-C, and HDL-C levels were not able to predict ANA status, whereas elevated serum triglycerides (150 to < 200 mg/dL) were significantly less likely to be ANA+ vs. ANA– (OR 0.33; 95% CI 0.11–0.92) in men only. Interestingly, women who reported taking statins have significantly lower odds of being ANA+ (OR 0.25; 95% CI 0.09–0.76), whereas no significant association between statin use and ANA status was observed in men. Together, our findings provide novel insight into the relationship between lipid metabolism and autoimmunity by elucidating the limited, albeit sex-specific utility of routine clinical serum lipid levels to predict ANA status at the population level, while further identifying a sex-specific and protective role for statins in predicting ANA status in women.
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Affiliation(s)
- Catherine J Andersen
- Department of Biology, Fairfield University, Fairfield, CT, United States.,Department of Nutritional Sciences, University of Connecticut, Storrs, CT, United States
| | - Terrence M Vance
- Department of Exercise and Nutrition Sciences, The State University of New York Plattsburgh, Plattsburgh, NY, United States
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Singh N, Ding L, Devera J, Magee GA, Garg PK. Prescribing of Statins After Lower Extremity Revascularization Procedures in the US. JAMA Netw Open 2021; 4:e2136014. [PMID: 34860245 PMCID: PMC8642785 DOI: 10.1001/jamanetworkopen.2021.36014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE The use of statins in patients with symptomatic peripheral artery disease remains suboptimal despite strong clinical practice guideline recommendations; however, it is unknown whether rates are associated with substantial improvements after lower extremity revascularization. OBJECTIVE To report longitudinal trends of statin use in patients with peripheral artery disease undergoing lower extremity revascularization and to identify the clinical and procedural characteristics associated with prescriptions for new statin therapy at discharge. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cross-sectional study using data from the Vascular Quality Initiative registry of patients who underwent lower extremity peripheral artery disease revascularization from January 1, 2014, through December 31, 2019. The Vascular Quality Initiative is a multicenter registry database including academic and community-based hospitals throughout the US. Patients aged 18 years or older undergoing lower extremity revascularization with available statin data (preprocedure and postprocedure) were included. Those not receiving statin therapy for medical reasons were excluded from final analyses. EXPOSURES Patients undergoing lower extremity revascularization for whom statin therapy is indicated. MAIN OUTCOMES AND MEASURES Multivariate logistic regression was used to determine the clinical and procedural characteristics associated with new statin prescription for patients not already taking a statin preprocedure. The overall rates of statin prescription as well as rates of new statin prescription at discharge were determined. In addition, the clinical, demographic, and procedural characteristics associated with new statin prescription were analyzed. RESULTS There were 172 025 procedures corresponding to 125 791 patients (mean [SD] age, 67.7 [11.0] years; 107 800 men [62.7%]; and 135 405 White [78.7%]) included in the analysis. Overall rates of statin prescription at discharge improved from 17 299 of 23 093 (75%) in 2014 to 29 804 of 34 231 (87%) in 2019. However, only 12 790 of 42 020 patients (30%) not already taking a statin at the time of revascularization during the study period were newly discharged with a statin medication. New statin prescription rates were substantially lower after endovascular intervention (7745 of 29 581 [26%]) than after lower extremity bypass (5045 of 12 439 [41%]). Body mass index of 30 or greater (odds ratio [OR], 1.13; 95% CI, 1.04-1.24; P < .001), diabetes (diet-controlled vs no diabetes, OR, 1.22; 95% CI, 1.05-1.41; P = .01), smoking (current vs never, OR, 1.32; 95% CI, 1.21-1.45; P < .001), hypertension (OR, 1.19; 95% CI, 1.09-1.29; P < .001), and coronary heart disease (OR, 1.26; 95% CI, 1.17-1.35; P < .001) were associated with an increased likelihood of new statin prescription after endovascular intervention, whereas female sex, older age, antiplatelet use, and prior peripheral revascularization were associated with a decreased likelihood. CONCLUSIONS AND RELEVANCE In this cross-sectional study, although statin use was associated with a substantial improvement after lower extremity revascularization, more than two-thirds of patients not already taking a statin preprocedure remained not taking a statin at discharge. Further investigations to understand the clinical implications of these findings and develop clinician- and system-based interventions are needed.
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Affiliation(s)
- Nikhil Singh
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Li Ding
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Justin Devera
- Department of Internal Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California Keck School of Medicine, Los Angeles
| | - Parveen K. Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles
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Clemente GS, Antunes IF, Sijbesma JWA, van Waarde A, Lammertsma AA, Dömling A, Elsinga PH. [ 18F]Atorvastatin Pharmacokinetics and Biodistribution in Healthy Female and Male Rats. Mol Pharm 2021; 18:3378-3386. [PMID: 34351158 PMCID: PMC8424645 DOI: 10.1021/acs.molpharmaceut.1c00305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022]
Abstract
Statins are 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors that are widely used to prevent cardiovascular diseases. However, a series of pleiotropic mechanisms have been associated with statins, particularly with atorvastatin. Therefore, the assessment of [18F]atorvastatin kinetics with positron emission tomography (PET) may elucidate the mechanism of action of statins and the impact of sexual dimorphism, which is one of the most debated interindividual variations influencing the therapeutic efficacy. [18F]Atorvastatin was synthesized via a previously optimized 18F-deoxyfluorination strategy, used for preclinical PET studies in female and male Wistar rats (n = 7 for both groups), and for subsequent ex vivo biodistribution assessment. PET data were fitted to several pharmacokinetic models, which allowed for estimating relevant kinetic parameters. Both PET imaging and biodistribution studies showed negligible uptake of [18F]atorvastatin in all tissues compared with the primary target organ (liver), excretory pathways (kidneys and small intestine), and stomach. Uptake of [18F]atorvastatin was 38 ± 3% higher in the female liver than in the male liver. The irreversible 2-tissue compartment model showed the best fit to describe [18F]atorvastatin kinetics in the liver. A strong correlation (R2 > 0.93) between quantitative Ki (the radiotracer's unidirectional net rate of influx between compartments) and semi-quantitative liver's SUV (standard uptake value), measured between 40 to 90 min, showed potential to use the latter parameter, which circumvents the need for blood sampling as a surrogate of Ki for monitoring [18F]atorvastatin uptake. Preclinical assays showed faster uptake and clearance for female rats compared to males, seemingly related to a higher efficiency for exchanges between the arterial input and the hepatic tissue. Due to the slow [18F]atorvastatin kinetics, equilibrium between the liver and plasma concentration was not reached during the time frame studied, making it difficult to obtain sufficient and accurate kinetic information to quantitatively characterize the radiotracer pharmacokinetics over time. Nevertheless, the reported results suggest that the SUV can potentially be used as a simplified measure, provided all scans are performed at the same time point. Preclinical PET-studies with [18F]atorvastatin showed faster uptake and clearance in female compared to male rats, apparently related to higher efficiency for exchange between arterial blood and hepatic tissue.
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Affiliation(s)
- Gonçalo S Clemente
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Inês F Antunes
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jürgen W A Sijbesma
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Aren van Waarde
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alexander Dömling
- Department of Drug Design, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Philip H Elsinga
- Department of Nuclear Medicine and Molecular Imaging-University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Masana L, Correig E, Rodríguez-Borjabad C, Anoro E, Arroyo JA, Jericó C, Pedragosa A, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Plana N, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Group OBOTSXR. EFFECT oF STATIN THERAPY oN SARS-CoV-2 INFECTION-RELATED. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:157-164. [PMID: 33135047 PMCID: PMC7665420 DOI: 10.1093/ehjcvp/pvaa128] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Aim Assessing the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality. Methods and Results Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients (1234 men, 923 women; age: 67 y/o (IQR 54-78)) admitted to the hospital were retrieved from the clinical records in anonymized manner. 353 deaths occurred. 581 patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on statin therapy than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: p = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared to the GM non-statin group (17.4%; p = 0.045). The Cox model applied to the CSH function (HR = 0.58(CI: 0.39-0.89); p = 0.01) and the competing risks FG model (HR = 0.60(CI: 0.39-0.92); p = 0.02) suggest that statins are associated with reduced COVID-19-related mortality. Conclusions A lower SARS-CoV-2 infection-related mortality was observed in patients treated with statin therapy prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.
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Affiliation(s)
- Lluís Masana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eudald Correig
- Statistics Department, Institut Investigació Sanitaria Pere Virgili, Reus, Spain
| | - Cèlia Rodríguez-Borjabad
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | | | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili., Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | - Núria Plana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
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Schooling CM, Zhao JV, Au Yeung SL, Leung GM. Investigating pleiotropic effects of statins on ischemic heart disease in the UK Biobank using Mendelian randomisation. eLife 2020; 9:e58567. [PMID: 32838838 PMCID: PMC7449694 DOI: 10.7554/elife.58567] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
We examined whether specifically statins, of the major lipid modifiers (statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe) have pleiotropic effects on ischemic heart disease (IHD) via testosterone in men or women. As a validation, we similarly assessed whether a drug that unexpectedly likely increases IHD also operates via testosterone. Using previously published genetic instruments we conducted a sex-specific univariable and multivariable Mendelian randomization study in the UK Biobank, including 179918 men with 25410 IHD cases and 212080 women with 12511 IHD cases. Of these three lipid modifiers, only genetically mimicking the effects of statins in men affected testosterone, which partly mediated effects on IHD. Correspondingly, genetically mimicking effects of anakinra on testosterone and IHD presented a reverse pattern to that for statins. These insights may facilitate the development of new interventions for cardiovascular diseases as well as highlighting the importance of sex-specific explanations, investigations, prevention and treatment.
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Affiliation(s)
- CM Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
- City University of New York, Graduate School of Public Health and Health PolicyNew YorkUnited States
| | - JV Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - SL Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - GM Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
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Fernandez K, Spielbauer KK, Rusheen A, Wang L, Baker TG, Eyles S, Cunningham LL. Lovastatin protects against cisplatin-induced hearing loss in mice. Hear Res 2020; 389:107905. [PMID: 32062294 DOI: 10.1016/j.heares.2020.107905] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022]
Abstract
Cisplatin is used to treat a variety of solid tumors in both children and adults. However, cisplatin has serious side-effects, some of which may permanently affect patients' quality of life following treatment, such as ototoxicity. There is currently no FDA-approved therapy for the prevention or treatment of cisplatin-induced hearing loss. Herein we examine the potential for statins to prevent cisplatin-induced ototoxicity. Statins, a class of drugs commonly used to prevent or manage hypercholesterolemia, have been of clinical utility for decades with dependable outcomes and reliable safety profiles in humans. Statins are known to be protective in animal models of noise-induced and age-related hearing loss. Moreover, studies have demonstrated an additive benefit of statins in cancer treatment. In the current study, lovastatin reduces cisplatin-induced hearing loss in adult mice. Lovastatin-mediated protection was significantly greater among female than male mice, and the dose of lovastatin required for protection was different between the sexes. Taken together our data indicate that lovastatin reduces cisplatin-induced hearing loss in mice and suggest that concurrent statin and cisplatin therapy may represent a feasible clinical strategy for reducing cisplatin-induced ototoxicity that should be explored for future clinical use.
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Affiliation(s)
- Katharine Fernandez
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Katie K Spielbauer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Aaron Rusheen
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Lizhen Wang
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany G Baker
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Eyles
- Department of Biochemistry and Molecular Biology and Mass Spectrometry, Core, University of Massachusetts, Amherst, MA, USA
| | - Lisa L Cunningham
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA.
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Huff JM, Falter RA, Scheinberg N. Retrospective Comparison of Appropriate Statin Use Between Patients With Diabetes in the Primary Care Setting Managed by Pharmacists or Internal Medicine Providers. Diabetes Spectr 2019; 32:349-354. [PMID: 31798293 PMCID: PMC6858076 DOI: 10.2337/ds18-0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to compare statin prescribing practices according to the American Diabetes Association's Standards of Medical Care in Diabetes-2017 between diabetes patients managed by pharmacists versus those managed by internal medicine providers. DESIGN AND METHODS A retrospective observational study was completed using the electronic health record of a multispecialty private practice. A total of 176 patients were included in the study, with 88 each in the pharmacy and internal medicine groups. Patients were ≥40 years of age with diabetes and managed by an internal medicine provider or a pharmacist between January and December 2017. Descriptive statistics, χ2, and unpaired t tests were used to describe between-group differences. RESULTS More pharmacy than internal medicine patients were prescribed appropriate statin therapy (47.7 vs. 34.1%, P = 0.092), particularly those needing high-intensity statins (44.3 vs. 27.4%, P = 0.03). Females, patients 40-75 years of age, and patients with no history of atherosclerotic cardiovascular disease in the pharmacy group were more likely to receive appropriate treatment (37.5 vs. 15.0%, P = 0.022; 46.8 vs. 29.7%, P = 0.039; and 45.3 vs. 23.5%, P = 0.015, respectively). Overall, more males than females were prescribed appropriate statin therapy (53.1 vs. 26.3%, P = 0.001). CONCLUSION Although there were no overall significant differences in statin prescribing between the pharmacy and internal medicine groups, patients needing high-intensity statins, those who were female, and those who were younger were more likely to receive appropriate therapy when managed by a pharmacist. Appropriate statin prescribing remains low among diabetes patients, and optimization of this therapy should be prioritized.
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Affiliation(s)
- Jamie M Huff
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA
| | - Rebecca A Falter
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA
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Mueller SM, Mueller F, Reinhardt J, Itin P, Navarini A, Stippich C, Borgwardt S. Assessment of the impact of sex in intensity, skin flares and central processing of histaminergic itch—A pilot study. Exp Dermatol 2019; 28:1493-1500. [DOI: 10.1111/exd.14021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
| | - Felix Mueller
- Department of Psychiatry University of Basel Basel Switzerland
| | - Julia Reinhardt
- Division of Diagnostic and Interventional Neuroradiology Department of Radiology University Hospital Basel University of Basel Basel Switzerland
- Department of Neuroradiology Clinical Neuroscience Center University Hospital Zurich University of Zurich Zurich Switzerland
| | - Peter Itin
- Department of Dermatology University of Basel Basel Switzerland
| | | | - Christoph Stippich
- Division of Diagnostic and Interventional Neuroradiology Department of Radiology University Hospital Basel University of Basel Basel Switzerland
- Department of Neuroradiology Clinical Neuroscience Center University Hospital Zurich University of Zurich Zurich Switzerland
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da Silva PM, Aguiar C, Morais J. Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study. Rev Port Cardiol 2019; 38:559-569. [DOI: 10.1016/j.repc.2019.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 12/28/2022] Open
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da Silva PM, Aguiar C, Morais J. Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schmid Y, Navarini A, Thomas ZRM, Pfleiderer B, Krähenbühl S, Mueller SM. Sex differences in the pharmacology of itch therapies-a narrative review. Curr Opin Pharmacol 2019; 46:122-142. [PMID: 31299512 DOI: 10.1016/j.coph.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic itch is the most common skin-related condition, associated with a high psychosocial and economic burden. In recent years, increasing evidence of sex differences in the perception, clinical presentation and treatment requirements of itch points towards potential benefits when using sex-adapted therapies. It is well-known that body composition, absorption, metabolism, elimination and adverse drug reactions (ADRs) differ between sexes, but only little is known about the impact of sex in the pharmacology of itch treatments, which could help to rationalise sex-adapted treatment strategies. AIM To evaluate and review sex effects in the pharmacokinetics and /-dynamics of drugs used to treat itch. METHODS In this narrative review we performed a PubMed and MEDLINE (Ovid) search using the terms (itch OR pruritus) AND (gender OR sex) AND (drug OR medication OR pharmacokinetics OR pharmacodynamics). Additional searches were performed for the topical and systemic drugs recommended by the European Guideline on Chronic Pruritus. RESULTS We found numerous reports with variable levels of evidence of sex effects with respect to the pharmacokinetics and/or pharmacodynamics of 14 drug classes used for the treatment of itch, including a total of 19 systemic and 3 topical drugs. Women seem to present higher plasma levels of several drugs used in itch treatment, including tri- and tetracyclic antidepressants (e.g. doxepin, amitriptyline, mirtazapine), serotonin reuptake inhibitors (e.g. paroxetine, sertraline, fluoxetine), immunosuppressive drugs (e.g. cyclosporine, mycophenolate mofetil), serotonin receptor antagonists (e.g. ondansetron) and betablockers (e.g. propranolol). Adverse drug reactions (ADRs) were generally more common in women. Being female was reported to be an independent risk factor for QTc-prolongation associated with antihistamines and tetracyclic antidepressants. Additionally, women seem to be more prone to sedative effects of antihistamines, and to suffer from a higher frequency as well as severity of side effects with systemic calcineurin inhibitors, opioid agonists, and opioid antagonists. Women were also sensitised more often to topically applied drugs. Of note, apart from only one experimental study with capsaicin, none of these reports were designed specifically to assess the effect of sex (and gender) in the treatment of itch. DISCUSSION/CONCLUSION Our review supports previous reports that sex is of importance in the pharmacokinetics and /-dynamics of several drugs used to treat itch although those drugs were mostly evaluated for non-itch indications. However, the results are limited by methodological limitations evident in most studies such as underrepresentation of women in clinical trials. This emphasises the need to study the impact of sex (and gender) in future itch trials to yield better outcomes and prevent ADRs in both sexes.
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Affiliation(s)
- Yasmin Schmid
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | | | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University Hospital Münster and Medical Faculty, University of Münster, Germany; Competence Center Chronic Pruritus (KCP), University of Muenster, Germany
| | - Stephan Krähenbühl
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Switzerland.
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Honarpisheh P, McCullough LD. Sex as a biological variable in the pathology and pharmacology of neurodegenerative and neurovascular diseases. Br J Pharmacol 2019; 176:4173-4192. [PMID: 30950038 DOI: 10.1111/bph.14675] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/14/2022] Open
Abstract
The incidence of dementia, most commonly caused by cerebrovascular and neurodegenerative diseases, continues to grow as our population ages. Alzheimer disease (AD) and vascular cognitive impairment (VCI) are responsible for more than 80% of all cases of dementia. There are few effective, long-term treatments for AD and VCI-related conditions (e.g., stroke and cerebral amyloid angiopathy (CAA)). This review focuses on AD (as the most common "neurodegenerative" cause of dementia), CAA (as an "emerging" cause of dementia), and stroke (as the most common cause of "vascular" dementia). We will discuss the available literature on the pharmacological therapies that demonstrate sex differences, which refer to any combination of structural, chromosomal, gonadal, or hormonal differences between males and females. We will emphasize the importance of considering sex as a biological variable in the design of preclinical and clinical studies that investigate underlying pathologies or response to pharmacological interventions in dementia. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Pedram Honarpisheh
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
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16
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Gender Dictates the Relationship between Serum Lipids and Leukocyte Counts in the National Health and Nutrition Examination Survey 1999⁻2004. J Clin Med 2019; 8:jcm8030365. [PMID: 30875952 PMCID: PMC6463027 DOI: 10.3390/jcm8030365] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
Dyslipidemias and leukocytosis are associated with cardiovascular disease and immune disorders. Mechanistic studies have shown lipoprotein metabolism to play a significant role in the regulation of atherosclerosis development and leukocyte activation, whereas lipid-lowering treatments have been shown to exert beneficial anti-inflammatory and immunomodulatory effects in clinical trials. However, the relationship between clinical markers of lipid metabolism and leukocyte counts has not been extensively evaluated at the population level. We aimed to determine whether clinical blood lipid measures are associated with leukocyte counts in the general U.S. population represented in the National Health and Nutrition Examination Survey (NHANES) 1999–2004, and whether differences exist between men and women (n = 5647). We observed a strong positive linear trend between serum triglycerides vs. blood lymphocyte and basophil counts in both men and women, whereas a positive trend between monocytes vs. triglycerides and lymphocytes vs. total cholesterol and LDL-cholesterol (LDL-C) was only detected in women. Conversely, HDL-C was inversely associated with a greater number of leukocyte subsets in men, whereas inverse trends between HDL-C vs. lymphocytes were observed in both men and women. In multiple regression models, a 10% increase in total cholesterol, LDL-C, and triglycerides was associated with a predicted 1.6%, 0.6%, and 1.4% increase in blood lymphocyte counts in women, respectively, whereas no relationship was observed in men. In both men and women, a 10% increase in triglycerides was additionally associated with higher lymphocyte, neutrophil, and basophil counts, whereas 10% increases in HDL-cholesterol were associated with significantly lower lymphocyte, neutrophil, eosinophil, and basophil counts in men, in addition to lower lymphocyte and monocyte counts in women. These findings suggest that clinical lipid markers may be used to predict blood leukocyte distributions, and that a gender-specific relationship exists between distinct classes of serum lipids and immune cell subsets.
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Moreno-Arellano S, Delgado-de-Mendoza J, Santi-Cano MJ. Sex disparity persists in the prevention of cardiovascular disease in women on statin therapy compared to that in men. Nutr Metab Cardiovasc Dis 2018; 28:810-815. [PMID: 29754716 DOI: 10.1016/j.numecd.2018.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/09/2018] [Accepted: 03/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to assess whether women differ from men with regard to lowering lipid levels, achieving target of optimal lipid levels, and analyzing evidence-based dose and intensity of statin prescription in primary care patients. METHODS AND RESULTS A multicenter cross-sectional survey was conducted among 1046 patients with dyslipidemia (554 women) who were receiving statin therapy from the Primary Health Care of Andalucía (Spain). A random sample was obtained using data from the electronic health record system. The primary outcomes were the prescription of statin therapy (intensity and dose), lowering lipid levels, and achieving target of optimal lipid levels. Women were less likely to be treated with a more potent statin than men (9.2% vs. 14.4%, p = 0.009), and they received lower doses (45 ± 59 mg/day vs. 56 ± 71 mg/day, p = 0.004) than men. Total cholesterol and LDL-C levels were higher in women than in men (5.7 ± 1.3 mmol/l vs. 5.2 ± 1.2 mmol/l, p < 0.0001 and 3.5 ± 1.2 mmol/l vs. 3.1 ± 1.0 mmol/l, p < 0.0001, respectively). Compliance with established goals for total cholesterol (47.7% vs. 31.3%, p < 0.0001) and LDL-C (39.7% vs. 25.4%, p < 0.0001) was superior in men than in women. In multivariate analysis, adjusted for age, the variables male gender and CVD were associated with a higher compliance with total cholesterol and LDL-C target levels, and the variable diabetes mellitus 2 was associated with a lower compliance with HDL-C and triglycerides target levels. CONCLUSIONS Women were less likely to be prescribed high-intensity statin to achieve total cholesterol and LDL-C target levels, and mean doses of statin were lower in women than in men. Dyslipidemia is less closely controlled in women than in men.
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Affiliation(s)
- S Moreno-Arellano
- Accident and Emergency Department, Whipps Cross University Hospital, London, UK
| | | | - M J Santi-Cano
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Spain.
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Kouvari M, Yannakoulia M, Souliotis K, Panagiotakos DB. Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths. Angiology 2018; 69:843-853. [PMID: 29430964 DOI: 10.1177/0003319718756732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.
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Affiliation(s)
- Matina Kouvari
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kyriakos Souliotis
- 2 Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Demosthenes B Panagiotakos
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Kautzky-Willer A, Harreiter J. Sex and gender differences in therapy of type 2 diabetes. Diabetes Res Clin Pract 2017; 131:230-241. [PMID: 28779681 DOI: 10.1016/j.diabres.2017.07.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/09/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Abstract
Clinical guidelines for the management of type 2 diabetes recommend individual therapy considering age, duration of disease, presence of complication and risk of hypoglycaemia. However, at present, the patient's sex has no impact on clinical decisions. Yet, there is mounting data pointing at biological and psychosocial differences between men and women with great impact on progression of disease and complications. Moreover, choices and preferences of therapeutic strategies as well as adherence to lifestyle and pharmacological interventions differ in both sexes. In addition, drug therapy may have sex-specific side effects. Therefore, there is need of more research on biological differences and of evidence-based individualised targeted sex-sensitive therapeutic concepts. Clinical guidelines must consider relevant sex-differences. Development and implementation of sex-specific programs may help to improve adherence to therapy and to reduce progression of disease and development of complications. A more gender-sensitive clinical approach may improve quality of life and increase health and life expectancy in men and women with type 2 diabetes.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Gender Medicine Institute, Gars am Kamp, Austria.
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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