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Bujak M, Malinowski K, Siudak Z, Ćmiel A, Lesiak M, Bartuś S, Legutko J, Wańha W, Witkowski A, Dudek D, Gąsior M, Gil R, Protasiewicz M, Kubica J, Godek P, Wojakowski W, Gąsior P. Sex Differences in Fractional Flow Reserve Utilization. J Clin Med 2024; 13:4028. [PMID: 39064067 PMCID: PMC11277883 DOI: 10.3390/jcm13144028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The literature review shows that female patients are more frequently underdiagnosed or suffer from delayed diagnosis. Recognition of sex-related differences is crucial for implementing strategies to improve cardiovascular outcomes. We aimed to assess sex-related disparities in the frequency of fractional flow reserve (FFR)-guided procedures in patients who underwent angiography and/or percutaneous coronary intervention (PCI). Methods: We have derived the data from the national registry of percutaneous coronary interventions and retrospectively analyzed the data of more than 1.4 million angiography and/or PCI procedures [1,454,121 patients (62.54% men and 37.46% women)] between 2014 and 2022. The logistic regression analysis was conducted to explore whether female sex was associated with FFR utilization. Results: The FFR was performed in 61,305 (4.22%) patients and more frequently in men than women (4.15% vs. 3.45%, p < 0.001). FFR was more frequently assessed in females with acute coronary syndrome than males (27.75% vs. 26.08%, p < 0.001); however, women with chronic coronary syndrome had FFR performed less often than men (72.25% vs. 73.92%, p < 0.001). Females with FFR-guided procedures were older than men (69.07 (±8.87) vs. 65.45 (±9.38) p < 0.001); however. less often had a history of myocardial infarction (MI) (24.79% vs. 36.73%, p < 0.001), CABG (1.62% vs. 2.55%, p < 0.005) or PCI (36.6% vs. 24.79%, p < 0.001) compared to men. Crude comparison has shown that male sex was associated with a higher frequency of FFR assessment (OR = 1.2152-1.2361, p < 0.005). Conclusions: Despite a substantial rise in FFR utilization, adoption in women remains lower than in men. Female sex was found to be an independent negative predictor of FFR use.
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Affiliation(s)
- Marta Bujak
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
| | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland;
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Anna Ćmiel
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland;
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warszawa, Poland;
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
- Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
| | - Robert Gil
- Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland;
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 87-100 Toruń, Poland;
| | - Piotr Godek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (A.Ć.); (W.W.); (P.G.); (W.W.); (P.G.)
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Harik L, Yamamoto K, Kimura T, Rong LQ, Vogel B, Mehran R, Bairey-Merz CN, Gaudino M. Patient-physician sex concordance and outcomes in cardiovascular disease: a systematic review. Eur Heart J 2024; 45:1505-1511. [PMID: 38551446 PMCID: PMC11075930 DOI: 10.1093/eurheartj/ehae121] [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] [Received: 09/12/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/09/2024] Open
Abstract
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
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Affiliation(s)
- Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Ko Yamamoto
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Noel Bairey-Merz
- Barbara Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
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Campesi I, Franconi F, Serra PA. The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender. Life (Basel) 2024; 14:234. [PMID: 38398743 PMCID: PMC10890141 DOI: 10.3390/life14020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs' complexity is rising, and to ensure their appropriate use they must have a sex-gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.
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Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Flavia Franconi
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Pier Andrea Serra
- Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, 07100 Sassari, Italy;
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Pujolar-Díaz G, Miró Catalina Q, Fuster-Casanovas A, Sola Reguant L, Vidal-Alaball J. A Sex- and Gender-Based Approach to Chronic Conditions in Central Catalonia (Spain): A Descriptive Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:152. [PMID: 38397643 PMCID: PMC10887657 DOI: 10.3390/ijerph21020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
The growth of chronic conditions worldwide poses a challenge for both health systems and the quality of life of people with these conditions. However, sex- and gender-based approaches are scarce in this field. Adopting this perspective, this study aims to describe the prevalence of chronic conditions in the Bages-Moianès region (Catalonia, Spain), and analyse the associations of chronic conditions with sex and age. This cross-sectional study used data from the population assigned to the Catalan Health Institute primary care settings in this area between 2018 and 2021 (n = 163,024). A total of 26 chronic conditions (grouped into 7 typologies), sex and age were the analysis variables. A total of 75,936 individuals presented at least one chronic condition, representing 46.6% of the analysed population. The prevalence was higher among women and older individuals. Being male was associated with a greater probability of presenting cardiovascular diseases, neurodevelopmental disorders and metabolic diseases and a lower probability of presenting neurodegenerative diseases, chronic pain and mental health disorders. Adjusting by sex, a positive age gradient was observed in most groups, except for respiratory diseases and mental health disorders. Chronic conditions have a high prevalence in the Bages-Moianès region, showing differences in typology, sex and age. Adopting gender perspectives (both in health systems and future research) is crucial when dealing with chronic conditions in order to take into account their differential impact.
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Affiliation(s)
- Georgina Pujolar-Díaz
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitos de Bages, Spain; (Q.M.C.); (A.F.-C.); (L.S.R.); (J.V.-A.)
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitos de Bages, Spain; (Q.M.C.); (A.F.-C.); (L.S.R.); (J.V.-A.)
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitos de Bages, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitos de Bages, Spain; (Q.M.C.); (A.F.-C.); (L.S.R.); (J.V.-A.)
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitos de Bages, Spain
| | - Laia Sola Reguant
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitos de Bages, Spain; (Q.M.C.); (A.F.-C.); (L.S.R.); (J.V.-A.)
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitos de Bages, Spain; (Q.M.C.); (A.F.-C.); (L.S.R.); (J.V.-A.)
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitos de Bages, Spain
- Faculty of Medicine, Universitat de Vic—Universitat de Catalunya Central, 08500 Vic, Spain
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Secemsky EA, Giri J, Brodmann M, Gouëffic Y, Fu W, Greenberg-Worisek AJ, Jaff MR, Kirksey L, Kohi MP. Implementing methods in the ELEGANCE registry to increase diversity in clinical research. J Vasc Surg 2024; 79:136-145.e3. [PMID: 37742734 DOI: 10.1016/j.jvs.2023.08.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Women and underrepresented minorities (URMs) who are at an increased risk of presenting with severe peripheral artery disease (PAD) and have different responses to treatment compared with non-Hispanic White males yet are underrepresented in PAD research. METHODS ELEGANCE is a global, prospective, multi-center, post-market registry of PAD patients treated with drug-eluting device that aims to enroll at least 40% women and 40% URMs. The study design incorporates strategies to increase enrollment of women and URMs. Inclusion criteria are age ≥18 years and treatment with any commercially available Boston Scientific Corporation drug-eluting device marketed for peripheral vasculature lesions; exclusion criterion is life expectancy <1 year. RESULTS Of 750 patients currently enrolled (951 lesions) across 39 sites, 324 (43.2%) are female and 350 (47.3%) are URMs (21.6% Black, 11.2% Asian, 8.5% Hispanic/Latino, and 5.3% other). Rutherford classification is distributed differently between sexes (P = .019). Treatment indication differs among race/ethnicity groups (P = .003). Chronic limb-threatening ischemia was higher for Black (38.3%) and Hispanic/Latino (28.1%) patients compared with non-Hispanic White (21.8%) and Asian patients (21.4%). De-novo stenosis was higher in Asian patients (92.3%) compared with Black, non-Hispanic White, and Hispanic/Latino patients (72.2%, 68.7%, and 77.8%, respectively; P < .001). Mean lesion length was longest for Black patients (162.7 mm), then non-Hispanic White (135.2 mm), Asian (134.8 mm), and Hispanic/Latino patients (128.1 mm; P = .008). CONCLUSIONS Analyses of data from the ELEGANCE registry show that differences exist in baseline disease characteristics by sex and race/ethnicity; these may be the result of other underlying factors, including time to diagnosis, burden of undermanaged comorbidities, and access to care.
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Affiliation(s)
- Eric A Secemsky
- Department of Vascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Jay Giri
- Department of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Yann Gouëffic
- Vascular Center, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Michael R Jaff
- Peripheral Interventions, Boston Scientific Corporation, Marlborough, MA
| | - Lee Kirksey
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Carberry J, Aubiniere-Robb L, Kamdar A, Lomholt-Welch H, Berry C. Reappraising Ischemic Heart Disease in Women. Rev Cardiovasc Med 2023; 24:118. [PMID: 39076281 PMCID: PMC11273011 DOI: 10.31083/j.rcm2404118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 07/31/2024] Open
Abstract
Despite advances in the management of ischemic heart disease worldwide, mortality in women remains disproportionally high in comparison to men, particularly in women under the age of 55. The greater prevalence of ischemia with non-obstructive coronary arteries (INOCA) in women has been highlighted as a potential cause of this disparity. Moreover, current guideline recommendations for computed tomography coronary angiography (CTCA) as the first line of investigation for stable chest pain may further amplify this inequality. Traditional cardiovascular risk factors carry greater influence in women than men in the development of ischemic heart disease. Despite this, women have been consistently under-represented in large-scale clinical trials. Chest pain in women is more likely to be overlooked due to the higher likelihood of atypical presentation and normal anatomical imaging, despite persistent symptoms and decreased quality of life indicators. Accordingly, we call into question a CTCA-first approach in clinical guidelines; instead, we favor a personalized, patient first approach. Due to the misdiagnosis of ischemic heart disease in women, a large proportion are denied access to preventative therapy. This is especially true of women with INOCA, for which there is a critical lack of specific guidelines and rigorous evidence-based therapies. Ongoing clinical trials aim to identify potential management options that may benefit those with INOCA, bringing the field closer to eliminating sex-related disparities in the diagnosis, management and prognosis of ischemic heart disease.
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Affiliation(s)
- Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
- The West of Scotland Heart and Lung Centre, NHS Golden Jubilee, G81 4DY Glasgow, Scotland, UK
| | - Louise Aubiniere-Robb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - Anna Kamdar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - Harriet Lomholt-Welch
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
- The West of Scotland Heart and Lung Centre, NHS Golden Jubilee, G81 4DY Glasgow, Scotland, UK
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de Miguel-Balsa E. Risk stratification and health inequalities in women with acute coronary syndrome: time to move on. Lancet 2022; 400:710-711. [PMID: 36049492 DOI: 10.1016/s0140-6736(22)01607-5] [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: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Eva de Miguel-Balsa
- Intensive and Coronary Care Unit, Intensive Care Medicine, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández, Elche 03203, Spain.
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