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Bastian-Pétrel K, Rohmann JL, Oertelt-Prigione S, Piccininni M, Gayraud K, Kelly-Irving M, Bajos N. Sex and gender bias in chronic coronary syndromes research: analysis of studies used to inform the 2019 European Society of Cardiology guidelines. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101041. [PMID: 39279866 PMCID: PMC11402417 DOI: 10.1016/j.lanepe.2024.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024]
Abstract
Background Sex and gender inequalities in ischemic heart diseases persist. Although ischemic heart disease is less common in women, they experience worse clinical outcomes and are less likely to receive guideline-recommended treatments. The primary scientific literature from which clinical guideline recommendations are derived may not have considered potential sex- and gender biases. This study aims to determine whether the literature cited in recent cardiovascular guidelines' clinical recommendations contain sex and gender biases. Methods We analysed publications cited in the 2019 European Society of Cardiology (ESC) guideline recommendations on chronic coronary syndromes, using a checklist to guide data extraction and evaluate the individual studies for sex- and gender-related aspects, such as inclusion/exclusion criteria, outcome measures, and demographic data reporting. To assess representation over time, the proportion of women participants in each study was computed and analysed using a beta regression model. We also examined the associations between women's representation, journal impact factor and author gender. Findings Among the 20 ESC recommendations on chronic coronary syndromes, four contained sex-related statements; we did not identify any gender-specific suggestions. The referenced literature upon which these recommendations were based consisted of 108 articles published between 1991 and 2019, encompassing more than 1.6 million study participants (26.8%; 432,284 women). Only three studies incorporated sex-sensitive designs; none were gender-specific. The term "gender" did not occur in 84% (n = 91/108) of the publications; when used, it was exclusively to denote biological sex. The proportion of women (assumed by investigators) among study participants fluctuated over time. Having a woman as first (odds ratio (OR) = 1.68, 95% CI: 1.19-2.39) or last author (OR = 2.28, 95% CI: 1.31-3.97), was significantly associated with having more women participants in the study. Interpretation The data underlying ESC guideline recommendations largely lack reporting of possible sex- and gender-specific aspects, and women are distinctly underrepresented. To what extent these recommendations apply to members of specific population groups who are not well-represented in the underlying evidence base remains unknown. Funding This study is part of the Gender and Health Inequalities (GENDHI) project, ERC-2019-SyG. This project has received funding from the European Research Council (ERC).
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Affiliation(s)
- Kathleen Bastian-Pétrel
- CERPOP-UMR1295, Université de Toulouse III, UPS, Inserm, Toulouse, France
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences Sociales, Politique, Santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jessica L Rohmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Gayraud
- Department of Aviation and Space Psychology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Hamburg, Germany
| | | | - Nathalie Bajos
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences Sociales, Politique, Santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
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Gulamhusein N, Ahmed SB. Getting to the heart of it: sex and gender considerations in the management of cardiovascular disease. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101076. [PMID: 39329095 PMCID: PMC11424935 DOI: 10.1016/j.lanepe.2024.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Nabilah Gulamhusein
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B. Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Regensteiner JG, Templeton K. Review of the Influences of Sex Differences on Health and Disease: What Is the Role of Journals? J Bone Joint Surg Am 2024:00004623-990000000-01215. [PMID: 39325861 DOI: 10.2106/jbjs.24.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
➢ Sex-based differences are understudied, which has potential consequences for the health of everyone.➢ Women's health is particularly affected given a lack of sex-specific data across many disease states.➢ Journals do not consistently require the inclusion of both sexes and the disaggregation of data by sex in cell, animal model, and human studies.➢ Instructions for investigators and journals regarding the inclusion of sex-specific data are found in guidelines such as those by the Sex and Gender Equity in Research (SAGER) group, but these guidelines are underutilized.➢ Consistency in the inclusion of both sexes in studies (except in studies on diseases affecting only 1 sex), as well as in the disaggregation and reporting of results by sex, has the potential to improve health for all people.
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Affiliation(s)
- Judith G Regensteiner
- Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Kimberly Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Turino Miranda K, Ahmed SB. Renalism with Renin Angiotensin Aldosterone System Blockade: What Is the Consensus in Advanced Chronic Kidney Disease? Can J Cardiol 2024; 40:1729-1731. [PMID: 38777038 DOI: 10.1016/j.cjca.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Keila Turino Miranda
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
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Templeton K. Sex and Gender in Orthopaedic Research: How Do We Continue to Move the Needle? J Bone Joint Surg Am 2024:00004623-990000000-01142. [PMID: 38905354 DOI: 10.2106/jbjs.24.00605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Affiliation(s)
- Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Fukumoto Y. Impact of female sexual dysfunction on cardiovascular diseases. Eur J Prev Cardiol 2024; 31:780-781. [PMID: 38365264 DOI: 10.1093/eurjpc/zwae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, 830-0011 Kurume, Japan
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Nix KM, Lee-Ann Hawkins T, Vlasschaert M, Ma IW, Nerenberg KA. Understanding Patient Perspectives on Specialized, Longitudinal, Postpartum, Cardiovascular Risk-Reduction Clinics. CJC Open 2024; 6:165-173. [PMID: 38487052 PMCID: PMC10935677 DOI: 10.1016/j.cjco.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 03/17/2024] Open
Abstract
Background Females who experience hypertensive disorders of pregnancy (HDP) have an increased lifelong risk of cardiovascular disease. Thus, Canadian clinical practice guidelines recommend cardiovascular risk reduction follow-up after a patient has HDP. This study examined the experiences of patients with HDP who attended a specialized, longitudinal general internal medicine postpartum cardiovascular risk reduction clinic called PreVASC. PreVASC focuses on comprehensive cardiovascular risk reduction through cardiovascular risk factor screening and management tailored specifically for female patients after they have HDP. Methods This multimethod study examined the experiences of female patients with HDP via the following: (i) a quantitative survey (summarized with descriptive statistics); (ii) semistructured qualitative patient phone interviews (results grouped thematically); and (iii) triangulation of qualitative themes with quantitative survey results. Results Overall, 37% of eligible clinic patients (42 of 115) participated; 79% of participants (n = 33) reported being "very satisfied" with the PreVASC clinic's specialized longitudinal model of care, and 95% (n = 40) reported making at least one preventive health behaviour change after receiving individualized counselling on cardiovascular risk reduction. Qualitative results found improvements in patient-reported cardiovascular health knowledge, health behaviours, and health-related anxiety. A preference for in-person vs phone clinic visits was reported by participants. Conclusions An in-person, general internal medicine specialist-led, longitudinal model of cardiovascular disease preventive care focused specifically on cardiovascular risk reduction after HDP had positive impacts on patient experience, health knowledge, and preventive health behaviours. This novel knowledge on patient preferences for a longitudinal, specialized model of care advances cardiovascular risk reduction tailored specifically for high-risk people after HDP.
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Affiliation(s)
- Kimberley M. Nix
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T. Lee-Ann Hawkins
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Vlasschaert
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Irene W.Y. Ma
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara A. Nerenberg
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Harrington CR, Levy P, Cabrera E, Gao J, Gregory DL, Padilla C, Crespo G, VanWagner LB. Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time. Liver Transpl 2023; 29:581-590. [PMID: 36724875 PMCID: PMC10192050 DOI: 10.1097/lvt.0000000000000013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023]
Abstract
Major adverse cardiovascular events (MACEs) are the leading cause of early (<1 y) complications after liver transplantation (LT). NASH, the leading indication for waitlisting for LT, is associated with high cardiac risk factor burden. The contemporary prevalence and temporal trends in pretransplant cardiac risk factor burden and post-LT MACE among LT recipients (LTRs) with and without NASH are unknown. The aim of this study was to evaluate (1) the evolution of post-LT cardiac risk factors in LTRs over time and (2) post-LT MACE over time, stratified by NASH status. This is a retrospective cohort of 1775 adult LTRs at a single transplant center (2003-2020). MACE was defined as death or hospitalization from myocardial infarction, revascularization, stroke, heart failure during the first post-LT year. Between 2003 and 2020, there was a significant increase in pre-LT NASH ( ptrend <0.05). There was also a significant increase in pre-LT obesity, atherosclerotic cardiovascular (CV) disease, and older age (≥65 y old) ( ptrend <0.05 for all). There was no significant change in the proportion of LTRs with diabetes, chronic kidney disease, or heart failure. Unexpectedly, there were no changes in the rate of post-LT MACE over the study period (-0.1% per year, ptrend =0.44). The lack of change in MACE despite an increase in CV risk factor prevalence may reflect advancement in the identification and management of CV risk factors in LTRs. With projected continued increase in cardiac risk burden and the proportion of patients transplanted for NASH, it is critical for LT programs to develop and implement quality improvement efforts to optimize CV care in LTRs.
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Affiliation(s)
- Claire R Harrington
- Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paul Levy
- Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth Cabrera
- Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jing Gao
- Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dyanna L Gregory
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia Padilla
- Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gonzalo Crespo
- Hepatology and Liver Transplant Unit, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Chang DH, Dumanski SM, Ahmed SB. Female sex-specific considerations to improve rigor and reproducibility in cardiovascular research. Am J Physiol Heart Circ Physiol 2023; 324:H279-H287. [PMID: 36563011 DOI: 10.1152/ajpheart.00462.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease is the leading cause of death in women. Despite recognition of sex-specific differences in cardiovascular health, females are underrepresented across all aspects of cardiovascular research, playing a key role in reducing rigor and reproducibility in cardiovascular research and contributing to these poorer health outcomes. Therefore, we propose a framework to capture factors associated with the female sex at the preclinical, recruitment, data collection, and data analysis stages. In preclinical cardiovascular research, female experimental models are commonly excluded despite similar variability in findings compared with males. To reduce this sex bias, the inclusion of female models and the incorporation of sex as a biological variable are critical to improve reproducibility and inform clinical research and care. Although funding agencies have mandated the inclusion of women in clinical trials, greater efforts are needed to achieve optimal participation-to-prevalence ratio to increase the generalizability of results to real-world settings. Female participants face more stringent exclusion criteria in research compared with males owing to sex-specific factors. However, their routine exclusion from cardiovascular research is not only unethical but limits generalizability and applicability to clinical practice. Identifying sex assigned at birth, collecting information on female sex-specific and -predominant factors associated with cardiovascular health and risk, and stratifying data by sex, including adverse events, are essential to ensure reproducibility and relevance of findings to target populations. Increasing female representation and the incorporation of female sex-specific cardiovascular risk factors in cardiovascular research will not only lead to enhanced rigor and reproducibility but improved cardiovascular health for all.
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Affiliation(s)
- Danica H Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Yan Q, Wu L, Song J, Ye L, Zhang Q, Che X, Zhang X, Wang L. Serum Human Epididymis Protein 4 as a Prognostic Predictor of New-Onset Heart Failure among Women after Acute Coronary Syndrome: A Single-Center Retrospective Study. Cardiology 2023; 148:230-238. [PMID: 36720203 DOI: 10.1159/000529365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the prognostic factors among women with acute coronary syndrome (ACS), partly due to the small number of women included in heart failure (HF) clinical trials. Human epididymis protein 4 (HE4) has been proven to be a new biomarker for acute and chronic HF over the years. We hypothesize that HE4 could be a promising predictor. METHODS This retrospective study analyzed data from Zhejiang Provincial People's Hospital. This study included 302 female patients with ACS between January 1, 2021, and December 1, 2021. The primary outcome was new-onset HF after ACS during the 12-month follow-up period. We used a logistic regression model to evaluate the association between serum HE4 levels and the incidence of HF. Serum HE4 levels were measured at baseline (within 24 h after admission). RESULTS Of the 302 female patients, 70 (23.2%) developed new-onset HF within 12 months. Serum HE4 levels in patients with adverse events were significantly higher than those in patients without events (8.9 [7.3-11.5] pmol/dL versus 5.9 [5.0-6.8] pmol/dL, p < 0.001). The levels of HE4, troponin I peak, left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR) were validated as independent predictors, with HE4 being the best laboratory predictor (area under the curve, 0.863; 95% confidence interval, 0.817-0.909). Serum HE4 concentrations of >6.93 pmol/dL distinguished patients at risk of HF with 82.9% sensitivity and 78.0% specificity (maximum Youden index J, 0.609). Moreover, HE4 levels were associated with an increased risk of HF. DISCUSSION We found a strong relationship between HE4 and the occurrence of HF after ACS among women, which might help identify patients at high risk of HF for whom close or intense management should be mandatory.
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Affiliation(s)
- Qiqi Yan
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China,
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China,
| | - Liuyang Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jikai Song
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qinggang Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xiaoru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xin Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lihong Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Ebong IA, DeFilippis EM, Hamad EA, Hsich EM, Randhawa VK, Billia F, Kassi M, Bhardwaj A, Byku M, Munagala MR, Rao RA, Hackmann AE, Gidea CG, DeMarco T, Hall SA. Special Considerations in the Care of Women With Advanced Heart Failure. Front Cardiovasc Med 2022; 9:890108. [PMID: 35898277 PMCID: PMC9309391 DOI: 10.3389/fcvm.2022.890108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023] Open
Abstract
Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.
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Affiliation(s)
- Imo A. Ebong
- Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, United States
- *Correspondence: Imo A. Ebong
| | - Ersilia M. DeFilippis
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Eman A. Hamad
- Division of Cardiovascular Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Eileen M. Hsich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Filio Billia
- Department of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, United States
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, United States
| | - Mirnela Byku
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mrudala R. Munagala
- Department of Cardiology, Miami Transplant Institute, University of Miami Miller School of Medicine/Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Roopa A. Rao
- Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy E. Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas SouthWestern Medical Center, Dallas, TX, United States
| | - Claudia G. Gidea
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Teresa DeMarco
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Shelley A. Hall
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, United States
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