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Bassett E, Broadbent J, Gill D, Burgess S, Mason AM. Inconsistency in UK Biobank Event Definitions From Different Data Sources and Its Impact on Bias and Generalizability: A Case Study of Venous Thromboembolism. Am J Epidemiol 2024; 193:787-797. [PMID: 37981722 PMCID: PMC11074710 DOI: 10.1093/aje/kwad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
The UK Biobank study contains several sources of diagnostic data, including hospital inpatient data and data on self-reported conditions for approximately 500,000 participants and primary-care data for approximately 177,000 participants (35%). Epidemiologic investigations require a primary disease definition, but whether to combine data sources to maximize statistical power or focus on only 1 source to ensure a consistent outcome is not clear. The consistency of disease definitions was investigated for venous thromboembolism (VTE) by evaluating overlap when defining cases from 3 sources: hospital inpatient data, primary-care reports, and self-reported questionnaires. VTE cases showed little overlap between data sources, with only 6% of reported events for persons with primary-care data being identified by all 3 sources (hospital, primary-care, and self-reports), while 71% appeared in only 1 source. Deep vein thrombosis-only events represented 68% of self-reported VTE cases and 36% of hospital-reported VTE cases, while pulmonary embolism-only events represented 20% of self-reported VTE cases and 50% of hospital-reported VTE cases. Additionally, different distributions of sociodemographic characteristics were observed; for example, patients in 46% of hospital-reported VTE cases were female, compared with 58% of self-reported VTE cases. These results illustrate how seemingly neutral decisions taken to improve data quality can affect the representativeness of a data set.
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Affiliation(s)
| | | | | | | | - Amy M Mason
- Correspondence to Dr. Amy M. Mason, Victor Phillip Dahdaleh Heart and Lung Research Institute, Biomedical Campus, Papworth Road, Trumpington, Cambridge CB2 0BB, United Kingdom (e-mail: )
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Nielsen RR, Anker N, Stødkilde-Jørgensen N, Thrane PG, Hansen MK, Pryds K, Mortensen MB, Olesen KKW, Maeng M. Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction. JACC. HEART FAILURE 2023; 11:1653-1663. [PMID: 37632494 DOI: 10.1016/j.jchf.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The representation of women in heart failure studies has been inadequate, resulting in a knowledge gap regarding the prognostic impact of coronary artery disease (CAD) on all-cause mortality in women with newly diagnosed heart failure and reduced ejection fraction (HFrEF). OBJECTIVES This study aims to assess the prognostic impact of CAD in women with HFrEF. METHODS Using the Western Denmark Heart Registry, the authors identified 891 women and 2,403 men referred for first-time coronary angiography because of HFrEF. The authors stratified for presence of CAD, estimated 10-year all-cause mortality, and calculated crude and adjusted HRs (aHRs) with 95% CIs. RESULTS The 10-year mortality was 60% in women with CAD and 27% in women without CAD; for men, the corresponding numbers were 54% and 36%. When adjusted for comorbidities, women without CAD had a lower relative 10-year mortality than men without CAD (aHR: 0.73; 95% CI: 0.58-0.91), whereas women with CAD had similar relative mortality as men with CAD (aHR: 1.00; 95% CI: 0.81-1.24) (Pinteraction = 0.037). Assessed by the number of coronary vessels with significant stenosis, CAD extent was associated with mortality for both women (P < 0.01) and men (P < 0.01). However, compared to those without CAD, the aHR was higher for women with any degree of CAD (aHR ranging from 1.61 [95% CI: 1.09-2.38] for diffuse CAD to 2.01 [95% CI: 1.19-3.40] for 3-vessel disease) than for men with 3-vessel disease (aHR: 1.51; 95% CI: 1.19-1.91). CONCLUSIONS In patients with newly diagnosed HFrEF, the presence and extent of CAD has significantly greater prognostic impact among women than among men.
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Affiliation(s)
- Roni Ranghoej Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.
| | - Nanna Anker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | - Nina Stødkilde-Jørgensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | | | | | - Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark; Department of Cardiology, Johns Hopkins, Baltimore, Maryland, USA
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
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Chen MH, Epstein SF. Tailored to a Woman's Heart: Gender Cardio-Oncology Across the Lifespan. Curr Cardiol Rep 2023; 25:1461-1474. [PMID: 37819431 PMCID: PMC11034750 DOI: 10.1007/s11886-023-01967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Females outnumber males among long-term cancer survivors, primarily as a result of the prevalence of breast cancer. Late cardiovascular effects of cancer develop over several decades, which for many women, may overlap with reproductive and lifecycle events. Thus, women require longitudinal cardio-oncology care that anticipates and responds to their evolving cardiovascular risk. RECENT FINDINGS Women may experience greater cardiotoxicity from cancer treatments compared to men and a range of treatment-associated hormonal changes that increase cardiometabolic risk. Biological changes at critical life stages, including menarche, pregnancy, and menopause, put female cancer patients and survivors at a unique risk of cardiovascular disease. Women also face distinct psychosocial and physical barriers to accessing cardiovascular care. We describe the need for a lifespan-based approach to cardio-oncology for women. Cardio-oncology care tailored to women should rigorously consider cancer treatment/outcomes and concurrent reproductive/hormonal changes, which collectively shape quality of life and cardiovascular outcomes.
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Affiliation(s)
- Ming Hui Chen
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA, USA.
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
| | - Sonia F Epstein
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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Yoo A, Auinger P, Tolbert J, Paul D, Lyness JM, George BP. Institutional Variability in Representation of Women and Racial and Ethnic Minority Groups Among Medical School Faculty. JAMA Netw Open 2022; 5:e2247640. [PMID: 36538331 PMCID: PMC9857368 DOI: 10.1001/jamanetworkopen.2022.47640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Bolstering the ranks of women and underrepresented groups in medicine (URM) among medical faculty can help address ongoing health care disparities and therefore constitutes a critical public health need. There are increasing proportions of URM faculty, but comparisons of these changes with shifts in regional populations are lacking. OBJECTIVE To quantify the representation of women and URM and assess changes and variability in representation by individual US medical schools. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study assessed US medical school faculty rosters for women and URM, including American Indian and Alaska Native, Black, Hispanic, and Native Hawaiian or other Pacific Islander faculty. US allopathic medical schools participating in the Association of American Medical Colleges (AAMC) Faculty Administrative Management Online User System from 1990 to 2019 (updated December 31 for each year), were included. Faculty data were analyzed from yearly cross-sections updated as of December 31 for each year from 1990 to 2019. For census data, decennial census data were used for years 1990, 2000, and 2010. Intercensal estimates were used for all other years from 1990 to 2019. MAIN OUTCOMES AND MEASURES Trends and variability in representation quotient (RQ), defined as representation of a group within an institution's faculty compared to its respective US county. RESULTS There were 121 AAMC member institutions (72 076 faculty) in 1990, which increased to 144 institutions (184 577 faculty) in 2019. The median RQ of women faculty increased from 0.42 (IQR, 0.37-0.46) to 0.80 (IQR, 0.74-0.89) (slope, +1.4% per year; P < .001). The median RQ of Black faculty increased from 0.10 (IQR, 0.06-0.22) to 0.22 (IQR, 0.14-0.41) (slope, +0.5% per year; P < .001), but remained low. In contrast, the median RQ of Hispanic faculty decreased from 0.44 (IQR, 0.19-1.22) to 0.34 (IQR, 0.23-0.62) (slope, -1.7% per year; P < .001) between 1990 and 2019. Absolute total change in RQ of URM showed an increase; however, the 30-year slope did not differ from zero (+0.1% per year; P = .052). Although RQ of women faculty increased for most institutions (127 [88.2%]), large variability in URM faculty trends were observed (57 institutions [39.6%] with increased RQ and 10 institutions [6.9%] with decreased RQ). Nearly one-quarter of institutions shifted from the top to bottom 50th percentile institutional ranking by URM RQ with county vs national comparisons. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that representation of women in academic medicine improved with time, while URM overall experienced only modest increases with wide variability across institutions. Among URM, the Hispanic population has lost representational ground. County-based population comparisons provide new insights into institutional variation in representation among medical school faculty.
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Affiliation(s)
- Alexander Yoo
- Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Peggy Auinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- University of Rochester Center for Health and Technology, Rochester, New York
| | - Jane Tolbert
- Office of Academic Affairs, School of Medicine & Dentistry, University of Rochester, Rochester, New York
| | - David Paul
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M. Lyness
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- Office of Academic Affairs, School of Medicine & Dentistry, University of Rochester, Rochester, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
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Cardiovascular Risk Screening among Women Veterans: Identifying Provider and Patient Barriers and Facilitators to Develop a Clinical Toolkit. Womens Health Issues 2022; 32:284-292. [PMID: 35115227 DOI: 10.1016/j.whi.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cardiovascular (CV) disease is the leading cause of death among women in the United States, making CV risk screening and management a women's health priority. Objectives were to elicit barriers and facilitators to CV risk identification and reduction among women veterans, and iteratively cocreate clinical tools to identify CV risk factors and promote goal-setting for lifestyle changes. METHODS We conducted three exploratory focus groups with 21 Veterans Health Administration primary care team members and piloted patient CV screeners with brief interviews with 19 patients from two Veterans Health Administration women's clinics to inform toolkit development. We then conducted two focus groups and one interview for feedback from a total of 12 staff on the proposed toolkit components. Transcripts were summarized, and a matrix analysis was used to synthesize qualitative findings. RESULTS Provider-identified barriers included difficulties disseminating CV information in clinic, limited patient knowledge, and lack of organized resources for provider communication and available referrals. Women's complex health needs were notable challenges to CV risk reduction. Facilitators included having a single place to track patient CV risks (e.g., an electronic template note), a patient screening worksheet, and aids to complete referrals. Patient-identified barriers included difficulties balancing health, finances, and physical and mental health concerns. Facilitators included resources for accountability and gender-specific information about CV risks and complications. Providers requested easy, accessible tools in the electronic record with gender-specific CV data and resources linked. Patients requested lifestyle change supports, including trustworthy sources vetted by providers. CONCLUSIONS Iteratively eliciting end-users' perspectives is critical to developing user-friendly, clinically relevant tools. CV risk reduction among women veterans will require multilevel tools and resources that meet providers' and women's needs.
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Ohman RE, Yang EH, Abel ML. Inequity in Cardio-Oncology: Identifying Disparities in Cardiotoxicity and Links to Cardiac and Cancer Outcomes. J Am Heart Assoc 2021; 10:e023852. [PMID: 34913366 PMCID: PMC9075267 DOI: 10.1161/jaha.121.023852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Minority and underresourced communities experience disproportionately high rates of fatal cancer and cardiovascular disease. The intersection of these disparities within the multidisciplinary field of cardio‐oncology is in critical need of examination, given the risk of perpetuating health inequities in the growing vulnerable population of patients with cancer and cardiovascular disease. This review identifies 13 cohort studies and 2 meta‐analyses investigating disparate outcomes in treatment‐associated cardiotoxicity and situates these data within the context of oncologic disparities, preexisting cardiovascular disparities, and potential system‐level inequities. Black survivors of breast cancer have elevated risks of cardiotoxicity morbidity and mortality compared with White counterparts. Adolescent and young adult survivors of cancer with lower socioeconomic status experience worsened cardiovascular outcomes compared with those of higher socioeconomic status. Female patients treated with anthracyclines or radiation have higher risks of cardiotoxicity compared with male patients. Given the paucity of data, our understanding of these racial and ethnic, socioeconomic, and sex and gender disparities remains limited and large‐scale studies are needed for elucidation. Prioritizing this research while addressing clinical trial inclusion and access to specialist care is paramount to reducing health inequity.
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Affiliation(s)
- Rachel E Ohman
- Department of Medicine University of California Los Angeles Los Angeles CA
| | - Eric H Yang
- UCLA Cardio-Oncology Program Division of Cardiology Department of Medicine University of California at Los Angeles CA
| | - Melissa L Abel
- Center for Cancer Research National Cancer Institute Bethesda MD
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Women discontinue antihypertensive drug therapy more than men. Evidence from an Italian population-based study. J Hypertens 2020; 38:142-149. [PMID: 31464801 DOI: 10.1097/hjh.0000000000002222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several factors affect adherence to antihypertensive drug treatment, but whether these factors include a sex difference is unclear. Aim of the study was to compare persistence with antihypertensive drug therapy between men and women in a large cohort of patients. METHODS The 60 526 residents of the Italian Lombardy Region aged 40-80 years newly treated with antihypertensive drugs during 2010 were identified and followed for 1 year after the first prescription. Discontinuation of treatment was defined as lack of prescription renewal for at least 90 days. Log-binomial regression models were fitted to estimate the risk ratio of treatment discontinuation in relation to sex. Other than for the whole population, analyses were stratified according to age, comorbidity status and the initial antihypertensive treatment strategy. RESULTS Thirty-seven percent of the patients discontinued the drug treatment during follow-up. Compared with women, men had a 10% lower risk of discontinuation of drug treatment (95% confidence interval: 8-12). Persistence on antihypertensive treatment was better in men than in women, this being the case in both younger (40-64 years) and older patients (65-80 years), in patients starting treatment with any major antihypertensive drug and in patients who had a low comorbidity status. There was no evidence that men and women had a different risk of treatment discontinuation when their comorbidity status was worse, or initial antihypertensive treatment was based on drug combinations. CONCLUSION Our data show that in a real-life setting, men are more persistent to antihypertensive drug therapy than women.
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Sun LY, Mielniczuk LM, Liu PP, Beanlands RS, Chih S, Davies R, Coutinho T, Lee DS, Austin PC, Bader Eddeen A, Tu JV. Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study. BMJ Open 2020; 10:e044126. [PMID: 33243819 PMCID: PMC7692840 DOI: 10.1136/bmjopen-2020-044126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF. DESIGN Retrospective cohort study SETTING: Outpatient PARTICIPANTS: Ontario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models. RESULTS A total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013). CONCLUSION Among patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cardiovasulcar Research Program, ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa M Mielniczuk
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Peter P Liu
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob S Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon Chih
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ross Davies
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas S Lee
- Cardiovasulcar Research Program, ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- Cardiovasulcar Research Program, ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Anan Bader Eddeen
- Cardiovasulcar Research Program, ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Jack V Tu
- Cardiovasulcar Research Program, ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada
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From Proteomics to Therapeutics: Sex Differences in Cardiovascular Disease Risk Do Matter. J Am Coll Cardiol 2020; 74:1554-1556. [PMID: 31537264 DOI: 10.1016/j.jacc.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022]
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Sun LY, Tu JV, Coutinho T, Turek M, Rubens FD, McDonnell L, Tulloch H, Eddeen AB, Mielniczuk LM. Sex differences in outcomes of heart failure in an ambulatory, population-based cohort from 2009 to 2013. CMAJ 2019; 190:E848-E854. [PMID: 30012800 DOI: 10.1503/cmaj.180177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Heart failure remains a substantial cause of morbidity and mortality in women. We examined the sex differences in heart failure incidence, mortality and hospital admission in a population-based cohort. METHODS All Ontario residents who were diagnosed with heart failure in an ambulatory setting between Apr. 1, 2009, and Mar. 31, 2014, were included in this study. Incident cases of heart failure were captured through physician billing using a validated algorithm. Outcomes were mortality and hospital admission for heart failure within 1 year of the diagnosis. Probability of death and hospital admission were calculated using the Kaplan-Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. RESULTS A total of 90 707 diagnoses of heart failure were made in an ambulatory setting during the study period (47% women). Women were more likely to be older and more frail, and had different comorbidities than men. The incidence of heart failure decreased during the study period in both sexes. The mortality rate decreased in both sexes, but remained higher in women than men. The female age-standardized mortality rate was 89 (95% confidence interval [CI] 80-100) per 1000 in 2009 and 85 (95% CI 75-95) in 2013, versus male age-standardized mortality rates of 88 (95% CI 80-97) in 2009 and 83 (95% CI 75-91) in 2013. Conversely, the rates of incident heart failure hospital admissions after heart failure diagnosis decreased in men and increased in women. INTERPRETATION Despite decreases in overall heart failure incidence and mortality in ambulatory patients, mortality rates remain higher in women than in men, and rates of hospital admission for heart failure increased in women and declined in men. Further studies should focus on sex differences in health-seeking behaviour, medical therapy and response to therapy to provide guidance for personalized care.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont.
| | - Jack V Tu
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Thais Coutinho
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Michele Turek
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Fraser D Rubens
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Lisa McDonnell
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Heather Tulloch
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Anan Bader Eddeen
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
| | - Lisa M Mielniczuk
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Sun, Tu, Bader Eddeen); Division of Cardiology (Tu), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Division of Cardiology, Department of Medicine (Coutinho, Mielniczuk), University of Ottawa Heart Institute; Division of Cardiac Prevention and Rehabilitation (Coutinho, McDonnell, Tulloch), University of Ottawa Heart Institute; Division of Cardiology, Department of Medicine (Turek), The Ottawa Hospital; Division of Cardiac Surgery, Department of Surgery (Rubens), University of Ottawa Heart Institute, Ottawa, Ont
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Johnston A, Mesana TG, Lee DS, Eddeen AB, Sun LY. Sex Differences in Long-Term Survival After Major Cardiac Surgery: A Population-Based Cohort Study. J Am Heart Assoc 2019; 8:e013260. [PMID: 31438770 PMCID: PMC6755832 DOI: 10.1161/jaha.119.013260] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Little attention has been paid to the importance of sex in the long‐term prognosis of patients undergoing cardiac surgery. Methods and Results We conducted a retrospective cohort study of Ontario residents, aged ≥40 years, who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral, or tricuspid valve surgery between October 1, 2008, and December 31, 2016. The primary outcome was all‐cause mortality. The mortality rate in each surgical group was calculated using the Kaplan‐Meier method. The risk of death was assessed using multivariable Cox proportional hazard models. Sex‐specific mortality risk factors were identified using multiplicative interaction terms. A total of 72 824 patients were included in the study (25% women). The median follow‐up period was 5 (interquartile range, 3–7) years. The long‐term age‐standardized mortality rate was lowest in patients who underwent isolated CABG and highest among those who underwent combined CABG/multiple valve surgery. Women had significantly higher age‐standardized mortality rate than men after CABG and combined CABG/mitral valve surgery. Men had lower rates of long‐term mortality than women after isolated mitral valve repair, whereas women had lower rates of long‐term mortality than men after isolated mitral valve replacement. We observed a statistically significant association between female sex and long‐term mortality after adjustment for key risk factors. Conclusions Female sex was associated with long‐term mortality after cardiac surgery. Perioperative optimization and long‐term follow‐up should be tailored to younger women with a history of myocardial infarction and percutaneous coronary intervention and older men with a history of chronic obstructive pulmonary disease and depression.
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Affiliation(s)
- Amy Johnston
- Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Thierry G Mesana
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences Ontario Canada.,Peter Munk Cardiac Centre University Health Network University of Toronto Toronto Ontario Canada
| | | | - Louise Y Sun
- Institute for Clinical Evaluative Sciences Ontario Canada.,Division of Cardiac Anesthesiology University of Ottawa Heart Institute and School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
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Adeoye AM, Ovbiagele B, Akinyemi JO, Ogah OS, Akinyemi R, Gebregziabher M, Wahab K, Fakunle AG, Akintunde A, Adebayo O, Aje A, Tiwari HK, Arnett D, Agyekum F, Appiah LT, Amusa G, Olunuga TO, Onoja A, Sarfo FS, Akpalu A, Jenkins C, Lackland D, Owolabi L, Komolafe M, Faniyan MM, Arulogun O, Obiako R, Owolabi M. Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study. J Am Heart Assoc 2019; 8:e010814. [PMID: 31142178 PMCID: PMC6585359 DOI: 10.1161/jaha.118.010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1‐month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1‐month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
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Affiliation(s)
- Abiodun M Adeoye
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- 2 Department of Neurology University of California San Francisco CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mayowa Owolabi
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
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Walsh MN, Jessup M, Lindenfeld J. Women With Heart Failure. J Am Coll Cardiol 2019; 73:41-43. [DOI: 10.1016/j.jacc.2018.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
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Adigun RO, Boler AN, Mankad R. Disparities in Cardiac Care of Women: Current Data and Possible Solutions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:87. [PMID: 30242773 DOI: 10.1007/s11936-018-0688-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease remains the leading cause of death in women. The goal of this review is to address known disparities in cardiovascular care with regard to diagnosis and treatment of heart disease in women. RECENT FINDINGS Gender-specific differences in regard to the incidence, treatment, and outcomes of common cardiovascular pathology are increasingly recognized. Particular attention to ischemic heart disease, arrhythmia, congestive heart failure, and structural heart disease are reviewed in this article. There is a clear racial and ethnic discrepancy among women which is particularly concerning with a progressively diverse patient population. Medical and surgical treatment differences between men and women must be addressed by providers in order to optimize long-term outcomes among all patients. Understanding the unique cardiovascular risk profile and barriers to optimal treatment outcomes in women is imperative to eliminate the current disparities in cardiovascular disease.
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Affiliation(s)
- Rosalyn O Adigun
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA
| | - Amber N Boler
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA
| | - Rekha Mankad
- Department of Cardiovascular Disease, 200 1st street SW, Rochester, MN, 55901, USA.
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15
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Farkas AH, Vanderberg R, McNeil M, Rothenberger S, Contratto E, Dolan BM, Tilstra S. The Impact of Women's Health Residency Tracks on Career Outcomes. J Womens Health (Larchmt) 2018; 27:927-932. [DOI: 10.1089/jwh.2017.6739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy H. Farkas
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Rachel Vanderberg
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott Rothenberger
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erin Contratto
- Department of Internal Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Brigid M. Dolan
- Department of Internal Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine Northwestern University, Chicago, Illinois
| | - Sarah Tilstra
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Sun LY, Tu JV, Bader Eddeen A, Liu PP. Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction. J Am Heart Assoc 2018; 7:e008902. [PMID: 29909401 PMCID: PMC6220539 DOI: 10.1161/jaha.118.008902] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting. METHODS AND RESULTS We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population-based database of all Ontarians with physician-diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all-cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan-Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age-standardized HFpEF mortality rates at 4±2 years of follow-up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men. CONCLUSIONS We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow-up should be focused on women and men with HF rather than on rEF alone.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Jack V Tu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Sunnybrook Schulich Heart Centre, University of Toronto, Ontario, Canada
| | | | - Peter P Liu
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Akl C, Akik C, Ghattas H, Obermeyer CM. Gender disparities in midlife hypertension: a review of the evidence on the Arab region. Womens Midlife Health 2017; 3:1. [PMID: 30766703 PMCID: PMC6299986 DOI: 10.1186/s40695-017-0020-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/10/2017] [Indexed: 01/09/2023] Open
Abstract
Objective While gender differences in hypertension and increased prevalence rates among women at midlife have been documented in multiple settings, the evidence on the Arab world has not been systematically examined. This review summarizes the evidence related to gender disparities in midlife hypertension in this region. Methods We searched MEDLINE and Social Sciences Citation Index (SSCI) databases for studies, published between January 2000 and August 2015, on hypertension in the 22 countries of the Arab region. We abstracted information on the prevalence of hypertension among women and men, in general populations during midlife. Results Nineteen studies provided data on the prevalence of hypertension by gender and age in the Arab world. Higher rates of hypertension were found among Arab women at midlife in most countries. In studies that included subjects younger than 35 years old, a decrease in sex ratios (M/F) at midlife was observed in all countries except Palestine. Higher female prevalence rates are observed in the 4th decade of life in most countries of the region, almost two decades earlier than in other parts of the world. Conclusions This review highlights the need for more systematic examinations of hypertension in the Arab region, its risk factors, and the reasons for the particular patterns of gender differences that are observed. Such research would have considerable implications for prevention, treatment, and improved well-being.
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Affiliation(s)
- Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut 1107-2020 Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut 1107-2020 Lebanon
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut 1107-2020 Lebanon
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut 1107-2020 Lebanon
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Carnes M, Johnson P, Klein W, Jenkins M, Bairey Merz CN. Advancing Women's Health and Women's Leadership With Endowed Chairs in Women's Health. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:167-174. [PMID: 27759706 PMCID: PMC5473431 DOI: 10.1097/acm.0000000000001423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gender-based bias and conflation of gender and status are root causes of disparities in women's health care and the slow advancement of women to leadership in academic medicine. More than a quarter of women physicians train in internal medicine and its subspecialties, and women physicians almost exclusively constitute the women's health focus within internal medicine. Thus, internal medicine has considerable opportunity to develop women leaders in academic medicine and promote women's health equity.To probe whether holding an endowed chair-which confers status-in women's health may be an effective way to advance women leaders in academic medicine and women's health, the authors explored the current status of endowed chairs in women's health in internal medicine. They found that the number of these endowed chairs in North America increased from 7 in 2013 to 19 in 2015, and all were held by women. The perceptions of incumbents and other women's health leaders supported the premise that an endowed chair in women's health would increase women's leadership, the institutional stature of women's health, and activities in women's health research, education, and clinical care.Going forward, it will be important to explore why not all recipients perceived that the endowed chair enhanced their own academic leadership, whether providing women's health leaders with fundraising expertise fosters future success in increasing the number of women's health endowed chairs, and how the conflation of gender and status play out (e.g., salary differences between endowed chairs) as the number of endowed chairs in women's health increases.
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Affiliation(s)
- Molly Carnes
- M. Carnes is director, Center for Women's Health Research, professor, Departments of Medicine, Psychiatry, and Industrial and Systems Engineering, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and director, Women's Health, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin. P. Johnson, at the time this article was written, was executive director, Connors Center for Women's Health and Gender Biology and Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and professor of epidemiology, Harvard Medical School, Boston, Massachusetts. She is now president, Wellesley College, Wellesley, Massachusetts. W. Klein is senior deputy director emerita, Institute for Women's Health, and associate professor emerita, Virginia Commonwealth University, Richmond, Virginia. M. Jenkins is director and chief science officer, Laura W. Bush Institute for Women's Health, and professor of medicine, Texas Tech University Health Sciences Center, Amarillo, Texas. C.N. Bairey Merz is director, Barbra Streisand Women's Heart Center, and professor of medicine, Cedars-Sinai Heart Institute, Los Angeles, California
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Rodriguez F, Olufade TO, Ramey DR, Friedman HS, Navaratnam P, Heithoff K, Foody JM. Gender Disparities in Lipid-Lowering Therapy in Cardiovascular Disease: Insights from a Managed Care Population. J Womens Health (Larchmt) 2016; 25:697-706. [PMID: 26889924 DOI: 10.1089/jwh.2015.5282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Numerous studies have documented the strong inverse relationship between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic cardiovascular disease (ASCVD). However, women are less likely to be screened for hypercholesterolemia, receive lipid-lowering therapy (LLT), and achieve optimal LDL-C levels. MATERIALS AND METHODS Data were extracted from a U.S. administrative claims database between January 2008 and December 2012 for patients with established ASCVD. The earliest date of valid LDL-C value was defined as the index date. Patients were followed for ±12 months from the index date and were stratified by gender, by baseline LDL-C level, and whether they were initially treated with a LLT then propensity score matched by gender using demographic and clinical characteristics. Both descriptive statistics and logistic regression models were used to explore the association of gender with the frequency of LDL-C monitoring, LLT treatment initiation in initially untreated patients, and prescribing patterns in initially treated patients. RESULTS A total of 76,414 subjects with established ASCVD were identified; 42% of the sample was women. In the unmatched cohort, 50.3% of men and 32.0% of women were prescribed a preindex statin (p < 0.0001). Among matched patients (n = 51,764), women initially treated with LLT were significantly less likely to receive a prescription for a higher potency LLT. Even among those with LDL-C levels above 160 mg/dL, women were more likely to discontinue LLT, odds ratio (95% confidence interval) 1.8 (1.2-2.3). Female gender and older age were significant predictors of discontinuation, and the potency of the index medication was the strongest predictor of dose titration. Initially untreated women were less likely to initiate LLT treatment than men, irrespective of index LDL-C levels (p < 0.0001). CONCLUSIONS The observed disparities further reinforce the need for targeted efforts to reduce the gender gap for secondary prevention in women at high risk of cardiovascular disease.
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Affiliation(s)
- Fatima Rodriguez
- 1 Division of Cardiovascular Medicine, Stanford University , Stanford, California
| | | | - Dena R Ramey
- 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania
| | | | | | - Kim Heithoff
- 2 Merck Sharp & Dohme Corp. , North Wales, Pennsylvania
| | - JoAnne M Foody
- 4 Division of Cardiovascular Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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Ballotari P, Ranieri SC, Luberto F, Caroli S, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in cardiovascular mortality in diabetics and nondiabetic subjects: a population-based study (Italy). Int J Endocrinol 2015; 2015:914057. [PMID: 25873959 PMCID: PMC4385659 DOI: 10.1155/2015/914057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 01/14/2023] Open
Abstract
The objective of this study is to assess the impact of diabetes on cardiovascular mortality, focusing on sex differences. The inhabitants of Reggio Emilia province on December 31, 2009, aged 20-84 were followed up for three years for mortality. The exposure was determined using Reggio Emilia diabetes register. The age-adjusted death rates were estimated as well as the incidence rate ratios using Poisson regression model. Interaction terms for diabetes and sex were tested by the Wald test. People with diabetes had an excess of mortality, compared with nondiabetic subjects (all cause: IRR = 1.68; 95%CI 1.60-1.78; CVD: IRR = 1.61; 95%CI 1.47-1.76; AMI: IRR = 1.59; 95%CI 1.27-1.99; renal causes: IRR = 1.71; 95%CI 1.22-2.38). The impact of diabetes is greater in females than males for all causes (P = 0.0321) and for CVD, IMA, and renal causes. Further studies are needed to investigate whether the difference in cardiovascular risk profile or in the quality of care delivered justifies the higher excess of mortality in females with diabetes compared to males.
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Affiliation(s)
- Paola Ballotari
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Sofia Chiatamone Ranieri
- Laboratorio Analisi Chimico Cliniche ed Endocrinologia, IRCCS Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Ferdinando Luberto
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Stefania Caroli
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Marina Greci
- Dipartimento Cure Primarie, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122 Reggio Emilia, Italy
- IRCCS Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy
| | - Valeria Manicardi
- Dipartimento di Medicina Interna, Ospedale di Montecchio, Azienda Unità Sanitaria Locale, Via Barilla 16, 42027 Montecchio, Italy
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Rossi MC, Cristofaro MR, Gentile S, Lucisano G, Manicardi V, Mulas MF, Napoli A, Nicolucci A, Pellegrini F, Suraci C, Giorda C. Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative. Diabetes Care 2013; 36:3162-8. [PMID: 23835692 PMCID: PMC3781503 DOI: 10.2337/dc13-0184] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the quality of type 2 diabetes care according to sex. RESEARCH DESIGN AND METHODS Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated. RESULTS Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c>9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10-1.17]), 42% more likely to have LDL cholesterol (LDL-C)≥130 mg/dL (1.42 [1.38-1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI≥30 kg/m2 (1.50 [1.50-1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure. CONCLUSIONS Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.
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Clinical and economic burden of emergency department visits due to gastrointestinal diseases in the United States. Am J Gastroenterol 2013; 108:1496-507. [PMID: 23857475 DOI: 10.1038/ajg.2013.199] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/28/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) emergencies may cause substantial morbidity. Our aims were to characterize the national clinical and economic burden of GI visits to emergency departments (EDs) in the United States. METHODS We performed an observational cross-sectional study using the 2007 Nationwide Emergency Department Sample, the largest US all-payer ED database, to identify the leading causes for ED visits due to GI diseases and their associated charges, stratified by age and sex. Logistic regression was used to analyze predictors of hospitalization after an ED visit. RESULTS Of the 122 million ED visits in 2007, 15 million (12%) had a primary GI diagnosis. The leading primary GI diagnoses were abdominal pain (4.7 million visits), nausea and vomiting (1.6 million visits), and functional disorders of the digestive system (0.7 million visits). The leading diagnoses differed by age group. The fraction of ED visits resulting in hospitalization was 21.6% for primary GI diagnoses vs. 14.7% for non-GI visits. Women had more ED visits with a primary GI diagnosis than men (58.5 (95% CI 56.0-60.9) vs. 41.6 (95% CI 39.8-43.3) per 1000 persons), but lower rates of subsequent hospitalization (20.0% (95% CI 19.4-20.7%) vs. 24.0% (95% CI 23.3-24.6%)). There were no differences in hospitalization rates between sexes after adjustment by age, primary GI diagnosis, and Charlson Comorbidity Score. The total charges for ED visits with a primary GI diagnosis in 2007 were $27.9 billion. CONCLUSIONS GI illnesses account for substantial clinical and economic burdens on US emergency medical services.
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Rigal L, Falcoff H, Rahy Z, Flores P, Saurel-Cubizolles MJ, Ringa V. Absence de conseils hygiéno-diététiques donnés aux hypertendus et caractéristiques des patients et de leur médecin généraliste. Glob Health Promot 2013; 20:33-42. [DOI: 10.1177/1757975913483342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le médecin généraliste est essentiel dans la prise en charge des patients hypertendus, qui comprend la dispensation de conseils hygiéno-diététiques. Notre objectif était d’analyser les caractéristiques des patients et de leur généraliste associées au fait que le praticien n’ait pas donné ces conseils. Cinquante-neuf généralistes franciliens ont répondu à des questionnaires à l’aide de leurs dossiers, et leurs 1192 patients hypertendus traités, de 25 à 79 ans, ont été interrogés par téléphone. Les analyses, utilisant des modèles mixtes à intercept aléatoire, ont porté sur « ne pas avoir donné de conseils » concernant le sel, la perte de poids, la diminution de la consommation d’alcool et l’exercice physique. Les médecins dispensaient moins de conseils aux hypertendus ayant un faible risque cardiovasculaire et un suivi récent avec peu de consultations dans l’année. Au contraire, une organisation de la pratique avec des consultations longues, au tarif de l’assurance maladie, et la participation à la formation médicale continue étaient associées à plus de conseil, ainsi que le fait que le médecin soit lui-même hypertendu. En ciblant de manière privilégiée les patients qui reçoivent moins de conseils, le développement de programmes d’éducation thérapeutique pourrait améliorer cette situation.
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Affiliation(s)
- Laurent Rigal
- Département de médecine générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre de recherche en Epidémiologie et Santé des Populations, Unité 1018, Equipe genre, santé sexuelle et reproductive, Villejuif, France
- Université Paris-Sud, Unité Mixte de Recherche en Santé 1018, 82 avenue Général Leclerc, 94276 Villejuif, France
- Institut National des Etudes Démographiques, Paris, France
| | - Hector Falcoff
- Département de médecine générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
| | - Zohra Rahy
- Institut National de la Santé et de la Recherche Médicale, Centre de recherche en Epidémiologie et Santé des Populations, Unité 1018, Equipe genre, santé sexuelle et reproductive, Villejuif, France
- Université Paris-Sud, Unité Mixte de Recherche en Santé 1018, 82 avenue Général Leclerc, 94276 Villejuif, France
- Institut National des Etudes Démographiques, Paris, France
| | - Patrick Flores
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche en Santé 953, Paris, France
- Université Paris VI, Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche en Santé 953, Paris, France
- Université Paris VI, Paris, France
| | - Virginie Ringa
- Institut National de la Santé et de la Recherche Médicale, Centre de recherche en Epidémiologie et Santé des Populations, Unité 1018, Equipe genre, santé sexuelle et reproductive, Villejuif, France
- Université Paris-Sud, Unité Mixte de Recherche en Santé 1018, 82 avenue Général Leclerc, 94276 Villejuif, France
- Institut National des Etudes Démographiques, Paris, France
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Lewey J, Shrank WH, Bowry AD, Kilabuk E, Brennan TA, Choudhry NK. Gender and racial disparities in adherence to statin therapy: a meta-analysis. Am Heart J 2013; 165:665-78, 678.e1. [PMID: 23622903 DOI: 10.1016/j.ahj.2013.02.011] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 02/14/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Significant disparities exist in cardiovascular outcomes based on race/ethnicity and gender. Rates of evidence-based medication use and long-term medication adherence also appear to be lower in racial subgroups and women but have been subject to little attention. Our objective was to evaluate the effect of race/ethnicity and gender on adherence to statin therapy for primary or secondary prevention. METHODS AND RESULTS Studies were identified through a systematic search of MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews (through April 1, 2010) and manual examination of references in selected articles. Studies reporting on adherence to statins by men and women or patients of white and nonwhite race were included. Information on study design, adherence measurement, duration, geographic location, sample size, and patient demographics was extracted using a standardized protocol. From 3,022 potentially relevant publications, 53 studies were included. Compared with men, women had a 10% greater odds of nonadherence (odds ratio 1.10, 95% confidence interval [CI], 1.07-1.13). Nonwhite race patients had a 53% greater odds of nonadherence than white race patients (odds ratio 1.53, 95% CI 1.25-1.87). There was significant heterogeneity in the pooled estimate for gender (I(2) 0.95, P value for heterogeneity <.001) and race (I(2) 0.98, P value for heterogeneity <.001). The overall results remained unchanged in those subgroups that had significantly less heterogeneity. CONCLUSIONS Among patients prescribed statins, women and nonwhite patients are at increased risk for nonadherence. Further research is needed to identify interventions best suited to improve adherence in these populations.
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Gudmundsdottir H, Høieggen A, Stenehjem A, Waldum B, Os I. Hypertension in women: latest findings and clinical implications. Ther Adv Chronic Dis 2012; 3:137-46. [PMID: 23251774 DOI: 10.1177/2040622312438935] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease claims more women's lives than any other disease. Hypertension is an important risk factor for cardiovascular disease in women but is often underestimated and undiagnosed and there is an ongoing misperception that women are at a lower risk of cardiovascular disease than men. The attainment of clinical blood pressure goals can markedly reduce cardiovascular morbidity and mortality, yet approximately two-thirds of treated hypertensive women have uncontrolled blood pressure. Furthermore, there are special risk factors that are unique for women that needs acknowledgement in order to help prevent the great number of hypertension-related events in women. Guidelines for treatment of hypertension are similar for men and women. More studies on the interaction between gender and response to antihypertensive drugs would be of interest.
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Chang VY, Handa KK, Fernandes M, Yacoub C, Pastana A, Caramelli B, Calderaro D. Improving cardiovascular prevention through patient awareness. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000500011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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30
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Chang VY, Handa KK, Fernandes M, Yacoub C, Pastana A, Caramelli B, Calderaro D. Improving cardiovascular prevention through patient awareness. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70248-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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McSweeney J, Pettey C, Lefler LL, Heo S. Disparities in heart failure and other cardiovascular diseases among women. WOMEN'S HEALTH (LONDON, ENGLAND) 2012; 8:473-85. [PMID: 22757737 PMCID: PMC3459240 DOI: 10.2217/whe.12.22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article reviews literature pertinent to cardiovascular disparities in women, focusing primarily on heart failure (HF). It provides an in-depth look at causes, biological influences, self-management and lack of adherence to HF-treatment guidelines in women. Disparities in treatment of causative factors of HF, such as myocardial infarction and hypertension, contribute to women having poorer HF outcomes than men. This article discusses major contributing reasons for nonadherence to medication regimes for HF in women, including advanced age at time of diagnosis, likelihood of multiple comorbidities, lack of social support and low socioeconomic status. Limited inclusion of women in clinical trials and the scarcity of gender analyses for HF and other cardiovascular diseases continues to limit the applicability of research findings to women.
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Affiliation(s)
- Jean McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Stamatelopoulos KS, Armeni E, Georgiopoulos G, Kazani M, Kyrkou K, Stellos K, Koliviras A, Alexandrou A, Creatsa M, Papamichael C, Lambrinoudaki I. Recently postmenopausal women have the same prevalence of subclinical carotid atherosclerosis as age and traditional risk factor matched men. Atherosclerosis 2012; 221:508-13. [DOI: 10.1016/j.atherosclerosis.2011.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 10/21/2011] [Accepted: 12/03/2011] [Indexed: 01/17/2023]
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Abstract
A gender-specific approach to cardiovascular (CV) diseases has been practiced for decades, although not always to the advantage of women. Based on population data showing that women are at lower risk for CV events than men female gender has generally been regarded as a protective factor for CV disease. Unfortunately, CV risk assessment has therefore received less attention in women. Despite the lower absolute risk of CV events in women compared with age-matched men, the majority of women die from CV diseases. In absolute numbers, since 1984, more women than men died of CV disease each year. Most CV events occur in women with known traditional CV risk factors. Improving risk factor management in women of all ages therefore yields an enormous potential to reduce CV morbidity and mortality in the population. Aside from smoking cessation, hypertension (HTN) control is the single most important intervention to reduce the risk of future CV events in women. This review highlights peculiarities of HTN as they pertain to women, and points out where diagnosis and management of HTN may require a gender-specific focus.
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Affiliation(s)
- Niels Engberding
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
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