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Álvarez-Fernández C, Romero-Saldaña M, Álvarez-López C, Molina-Luque R, Molina-Recio G, Vaquero-Abellán M. Gender differences and health inequality: Evolution of cardiovascular risk in workers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 76:406-413. [PMID: 33625316 DOI: 10.1080/19338244.2021.1891017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim was to find out if there are any such differences due to gender in a cohort of workers followed for ten years, comparing their lifestyles and following the evolution of the main cardiovascular risk factors (CVRF) and their impact on cardiovascular risk. An observational longitudinal study of 698 civil servants workers (186 women and 512 men) of a local government office from Córdoba (Spain), was conducted over the period 2003-2014. We compared the initial and final prevalence of physical activity, smoking, obesity, hypertension, metabolic syndrome and diabetes. Cardiovascular risk was also assessed using the REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) equations. There was a greater rise in the prevalence of hypertension and hypercholesterolemia in the cohort in women than in men (94.2% vs. 38% and 92% vs 21.1%), while the reduction in smoking also differed by gender (26.4% vs. 36.5%). It could be that since women present a lower cardiovascular risk profile, they are treated less or less effort is made to keep the risk factors low, resulting in a worse evolution of smoking, hypercholesterolemia and hypertension in women.
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Affiliation(s)
- C Álvarez-Fernández
- Department of Safety and Occupational Health, City Council of Cordoba, Cordoba, Spain
| | - M Romero-Saldaña
- Department of Nursing, Faculty of Medicine and Nursing, University of Cordoba, Cordoba, Spain
- Grupo Asociado de Investigación Estilos de vida, Innovación y Salud. Insituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - R Molina-Luque
- Grupo Asociado de Investigación Estilos de vida, Innovación y Salud. Insituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - G Molina-Recio
- Department of Nursing, Faculty of Medicine and Nursing, University of Cordoba, Cordoba, Spain
- Grupo Asociado de Investigación Estilos de vida, Innovación y Salud. Insituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - M Vaquero-Abellán
- Department of Nursing, Faculty of Medicine and Nursing, University of Cordoba, Cordoba, Spain
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2
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Perrino C, Ferdinandy P, Bøtker HE, Brundel BJJM, Collins P, Davidson SM, den Ruijter HM, Engel FB, Gerdts E, Girao H, Gyöngyösi M, Hausenloy DJ, Lecour S, Madonna R, Marber M, Murphy E, Pesce M, Regitz-Zagrosek V, Sluijter JPG, Steffens S, Gollmann-Tepeköylü C, Van Laake LW, Van Linthout S, Schulz R, Ytrehus K. Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart. Cardiovasc Res 2020; 117:367-385. [PMID: 32484892 DOI: 10.1093/cvr/cvaa155] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/29/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.
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Affiliation(s)
- Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary.,Pharmahungary Group, Hajnoczy str. 6., H-6722 Szeged, Hungary
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam, 1108 HV, the Netherlands
| | - Peter Collins
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, South Kensington Campus, London SW7 2AZ, UK.,Royal Brompton Hospital, Sydney St, Chelsea, London SW3 6NP, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, WC1E 6HX London, UK
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Muscle Research Center Erlangen (MURCE), Schwabachanlage 12, 91054 Erlangen, Germany
| | - Eva Gerdts
- Department for Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Henrique Girao
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548 Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, and Clinical Academic Centre of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228, Singapore.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Chris Barnard Building, University of Cape Town, Private Bag X3 7935 Observatory, Cape Town, South Africa
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Lungarno Antonio Pacinotti 43, 56126 Pisa, Italy.,Department of Internal Medicine, University of Texas Medical School in Houston, 6410 Fannin St #1014, Houston, TX 77030, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Elizabeth Murphy
- Laboratory of Cardiac Physiology, Cardiovascular Branch, NHLBI, NIH, 10 Center Drive, Bethesda, MD 20892, USA
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS Via Parea, 4, I-20138 Milan, Italy
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender in Medicine, Center for Cardiovascular Research, DZHK, partner site Berlin, Geschäftsstelle Potsdamer Str. 58, 10785 Berlin, Germany.,University of Zürich, Rämistrasse 71, 8006 Zürich, Germany
| | - Joost P G Sluijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands.,Circulatory Health Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Pettenkoferstr. 9, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Can Gollmann-Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstr.35, A - 6020 Innsbruck, Austria
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, 10178 Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Ludwigstraße 23, 35390 Giessen, Germany
| | - Kirsti Ytrehus
- Department of Medical Biology, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9037 Tromsø, Norway
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Pelczarska A, Jakubczyk M, Jakubiak-Lasocka J, Banach M, Myśliwiec M, Gruchała M, Niewada M. The cost-effectiveness of screening strategies for familial hypercholesterolaemia in Poland. Atherosclerosis 2018; 270:132-138. [PMID: 29407882 DOI: 10.1016/j.atherosclerosis.2018.01.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/26/2017] [Accepted: 01/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolaemia (FH) elevates the cholesterol level and increases the risk of coronary events and death. Early detection and treatment reduce this risk. We aimed to determine the cost-effectiveness of FH screening in Poland in children, first job takers, and after an acute coronary syndrome (ACS) event, each followed by a cascade screening in the relatives of the positively-diagnosed subjects. METHODS A decision tree was constructed to model the diagnosis process. We considered scenarios with and without genetic testing. A life-time Markov was built to investigate the effectiveness (life years gained, LYG; and quality-adjusted life years, QALY) and cost (public payer perspective) of treatment in FH-affected subjects. The clinical benefits result from early treatment reducing the risk of coronary heart disease (and death, in result). Model parameters were based on published data and experts' opinions. The costs (patients visits, tests, drugs) were estimated from the National Health Fund data and other publicly-available sources. RESULTS Screening ACS patients below 55/65 years of age in men/women is the most cost-effective strategy: the cost of one LYG (QALY) amounts to 100 EUR (110 EUR). Removing the age limit or using genetic tests reduced cost-effectiveness; nonetheless, all strategies remained cost effective: the cost of one LYG or QALY was <5040 EUR, much lower than the official threshold of ca. 29,800 EUR/QALY. CONCLUSIONS Screening for FH is highly cost-effective in Poland. The strategies are complementary, and using a combination thereof is recommended.
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Affiliation(s)
| | - Michał Jakubczyk
- Decision Analysis and Support Unit, SGH Warsaw School of Economics, Poland
| | | | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, Poland
| | - Małgorzata Myśliwiec
- Chair and Clinics of Paediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Poland
| | - Marcin Gruchała
- Department of Cardiology I, Medical University of Gdańsk, Poland
| | - Maciej Niewada
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Poland.
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Chhabra ST, Masson S, Kaur T, Gupta R, Sharma S, Goyal A, Singh B, Tandon R, Aslam N, Mohan B, Wander GS. Gender bias in cardiovascular healthcare of a tertiary care centre of North India. HEART ASIA 2016; 8:42-5. [PMID: 27326231 DOI: 10.1136/heartasia-2015-010710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse the gender bias in paediatric patients referred for free cardiac treatment as part of School Health Programme at a tertiary care centre in North India. METHODS A total of 537 children were referred for further management of congenital heart disease or rheumatic heart disease. Of these, 519 underwent cardiac intervention, and the data from their records were analysed retrospectively to determine any gender disparity in the utilisation of cardiac surgery. RESULTS Of the 519 children studied, only 195 (37.6%) were girls, while the remaining 324 (62.4%) were boys (male-to-female ratio of 1.66:1, p<0.0001), indicating a large gender divide. Gender bias was found to be prevalent across all the age groups irrespective of the type of cardiac ailment. Moreover, no statistically significant difference was found between the urban and rural populations (male-to-female ratio of 1.64:1 in rural and 1.71:1 in urban populations; p=0.823) in terms of gender disparity. CONCLUSIONS Significant gender discrepancies exist in healthcare-seeking behaviour of patients in North India despite the provision of free cardiac treatment. An equal prevalence of gender bias in urban and rural communities points towards deep-rooted social norms beyond just the economic constraints. Healthcare policies ensuring equal treatment of male and female children should be promulgated to ensure a complete eradication of this social evil.
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Affiliation(s)
- Shibba Takkar Chhabra
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarbjit Masson
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Tripat Kaur
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Rajiv Gupta
- Department of Cardiovascular and Thoracic Surgery , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarit Sharma
- Department of Community Medicine , Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Abishek Goyal
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bhupinder Singh
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Rohit Tandon
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Naved Aslam
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bishav Mohan
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Gurpreet Singh Wander
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
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5
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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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Unni SK, Quek RGW, Biskupiak J, Lee VC, Ye X, Gandra SR. Assessment of statin therapy, LDL-C levels, and cardiovascular events among high-risk patients in the United States. J Clin Lipidol 2015; 10:63-71.e1-3. [PMID: 26892122 DOI: 10.1016/j.jacl.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/06/2015] [Accepted: 09/14/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Statins have demonstrated significant benefit in reducing cardiovascular disease (CVD) risk. OBJECTIVE To evaluate statin treatment patterns by intensity, elevated low-density lipoprotein cholesterol (LDL-C) levels, and cardiovascular (CV) events in high-risk CVD patients. METHODS Patients included were aged ≥ 18 years, with a coronary heart disease (CHD; Jan 1, 2007-Dec 31, 2011, index date) or CHD risk equivalent (CHD RE) diagnosis (Jan 1, 2007-Dec 31, 2010, index date), in the Truven MarketScan claims database, continuously enrolled for 2 years pre- and up to 1 (CHD) or 2 (CHD RE) years post-index. Patients with CHD, CHD RE, rhabdomyolysis, or chronic kidney disease any time pre-index were excluded. Statin therapy was assessed at baseline, 30, 90, and 365 days post-index. LDL-C values were captured in patients with available data at 30-day intervals up to 1 year. CV events were evaluated up to 1 year post-index. Descriptive statistics were used to report results. RESULTS There were 175,103 CHD and 68,290 CHD RE patients; 3333 CHD RE patients had post-index CV events. At 1 year, 38.7% of CHD patients and 44.3% of CHD RE patients with post-index CV events were not prescribed statins. Most patients who were prescribed statins, received a moderate-intensity statin. The percentage of patients with LDL-C ≥ 100 mg/dL reduced over time, but at 1 year, 29.3% of CHD and 30.0% of CHD RE patients with post-index CV events had LDL-C ≥ 100 mg/dL. At 1 year post-index, 9.9% CHD and 7.3% CHD RE patients had at least 1 CV event. CONCLUSION There is room for better LDL-C management among high-risk CVD patients to reduce their overall CV risk.
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Affiliation(s)
- Sudhir K Unni
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
| | - Ruben G W Quek
- Global Health Economics, Amgen Inc., Thousand Oaks, CA, USA
| | - Joseph Biskupiak
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Vinson C Lee
- US Scientific Affairs, Amgen, Inc., Thousand Oaks, CA, USA
| | - Xiangyang Ye
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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Johansen ME, Green LA, Sen A, Kircher S, Richardson CR. Cardiovascular risk and statin use in the United States. Ann Fam Med 2014; 12:215-23. [PMID: 24821892 PMCID: PMC4018369 DOI: 10.1370/afm.1641] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Statins reduce the risk of mortality and coronary artery disease in individuals at high cardiovascular risk. Using nationally representative data, we examined the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors. METHODS We analyzed data from the 2010 Medical Expenditure Panel Survey, a nationally representative survey of the U.S. civilian noninstitutionalized population. The study sample had a total of 16,712 individuals aged 30 to 79 years. Those who reported filling at least 2 statin prescriptions were classified as statin users. We created multiple logistic regression models for statin use as the dependent variable, with cardiovascular risk factors and sociodemographic factors as independent variables. RESULTS Overall, 58.2% (95% CI, 54.6%-61.7%) of individuals with coronary artery disease and 52.0% (95% CI, 49.4%-54.6%) of individuals with diabetes aged older than 40 years were statin users. After adjusting for cardiovascular risk factors and sociodemographic factors, the probability of being on a statin was significantly higher among individuals with both hyperlipidemia and coronary artery disease, at 0.44 (95% CI, 0.40-0.48), or hyperlipidemia only, at 0.32 (95% CI, 0.30-0.33), than among those with coronary artery disease only, at 0.11 (95% CI, 0.07-0.15). A similar pattern was seen in people with diabetes. CONCLUSIONS In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events. This undertreatment appears to be related to placing too much emphasis on hyperlipidemia and not enough on cardiovascular risk. Recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.
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8
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Abstract
Gender-based discrimination is reported across the spectrum of paediatric healthcare including emergency, inpatient, outpatient and preventive care and is mostly reported from South Asia and China with sporadic reports from Africa and South America. Biases against young girls have been documented even in immunisation percentage, home food allocation, seeking medical care for childhood ailments and percentage of household healthcare expenditures allocated to them. Such gender discrimination in access to medical care is likely to have an influence on the overall health of female children. Over the last five decades, the under-5 sex ratios are worsening in India with declining number of girls. Deliberate parental neglect of girls' essential and life-saving medical care is also an important contributing factor apart from sex-selective abortions to the declining gender ratios. Corrective measures and focused action are needed.
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Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, , Iowa City, USA
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9
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Westin GG, Armstrong EJ, Bang H, Yeo KK, Anderson D, Dawson DL, Pevec WC, Amsterdam EA, Laird JR. Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. J Am Coll Cardiol 2014; 63:682-690. [PMID: 24315911 PMCID: PMC3944094 DOI: 10.1016/j.jacc.2013.09.073] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients. BACKGROUND CLI is an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. METHODS We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. RESULTS Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. CONCLUSIONS Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
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Affiliation(s)
- Gregory G Westin
- School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - Ehrin J Armstrong
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, UC Davis, Davis, California
| | - Khung-Keong Yeo
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - David Anderson
- School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - David L Dawson
- Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California
| | - William C Pevec
- Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California
| | - Ezra A Amsterdam
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
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Hosseini SK, Tahvildari M, Alemzadeh Ansari MJ, Nakhjavani M, Esteghamati A, Lotfi Tokaldany M. Clinical lipid control success rate before and after percutaneous coronary intervention in iran; a single center study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:467-72. [PMID: 24349743 PMCID: PMC3840832 DOI: 10.5812/ircmj.3370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND High cholesterol levels have long been considered an independent risk factor for cardiovascular disease (CVD). OBJECTIVE Controlling risk factors such as dyslipidemia in patients with coronary artery disease is necessary. We aimed to evaluate the success rate of lipid control, during 9 months follow-up after percutaneous coronary intervention (PCI). PATIENTS AND METHODS A total of 195 patients (67.7% men, mean age = 57.8 ± 9.4 years) who underwent PCI in Tehran Heart Center were included. Serum lipid profiles were measured in all the patients before PCI and at 9-month follow-up. Dyslipidemia was defined as serum levels of LDL-C ≥ 100 or TG ≥ 150 or TC ≥ 200 or HDL-C ≤ 40 mg/dl in the men and ≤ 50 mg/dl or less in the women, or non-HDL-C ≥ 130 mg/dl with or without the consumption of lipid-lowering agents. During follow up, all patients were given atorvastatin 20-40 mg/day. RESULTS Overall, 26.2% had diabetes mellitus, 42.6% had hypertension, and 34.9% were smokers. Dyslipidemia was more common in the women. At 9-month follow-up, there was no significant changes in terms of the prevalence of high HDL-C or low TG in patients; however, a significant increase was seen in the prevalence low TC in patients (63.6% vs. 80.5%; p value < 0.001), LDL-C (47.2% vs. 65.6%; p value < 0.001), and non-HDL-C (40.0% vs. 63.1%; p value < 0.001). CONCLUSIONS Although by current treatments, the prevalence of patients with low TC, LDL-C and non-HDL-C has significantly increased; dyslipidemia persisted in a considerable proportion of patients. These results necessitate further investigations into the relationship between high serum lipids and long-term outcome of patients after PCI as well as further evaluations of the dyslipidemia treatment strategies.
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Affiliation(s)
- Seyed Kianoosh Hosseini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | | | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Manouchehr Nakhjavani, Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121098214, E-mail:
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Masoumeh Lotfi Tokaldany
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran
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Chen CY, Chuang SY, Fang CC, Huang LC, Hsieh IC, Pan WH, Yeh HI, Wu CC, Yin WH, Chen JW. Gender Difference in Statin Intervention on Blood Lipid Control among Patients with Coronary Heart Disease. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2013.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Bhattacharjee S, Findley PA, Sambamoorthi U. Understanding Gender Differences in Statin Use among Elderly Medicare Beneficiaries. Drugs Aging 2012; 29:971-80. [DOI: 10.1007/s40266-012-0032-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Hyperlipidemia in patients with schizophrenia: a national population-based study. Gen Hosp Psychiatry 2012; 34:360-7. [PMID: 22460002 DOI: 10.1016/j.genhosppsych.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective was to examine hyperlipidemia among Taiwanese patients with schizophrenia. METHODS We obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with at least one primary diagnosis of schizophrenia and with a primary or secondary diagnosis of hyperlipidemia or medication for hyperlipidemia were identified. We compared the prevalence and incidence of hyperlipidemia in schizophrenic patients with the general population. RESULTS The prevalence of hyperlipidemia in patients with schizophrenia was higher than that in the general population (8.15% vs. 8.10%; odds ratio 1.17; 95% confidence interval, 1.04-1.31) in 2005. Compared with the general population, schizophrenic patients had a higher prevalence of hyperlipidemia in individuals aged <50 years, among those with higher insurance amount, and among persons living in northern and central regions and in urban areas. The average annual incidence of hyperlipidemia in schizophrenic patients with second-generation antipsychotic use from 2006 to 2008 was higher than that in the general population (1.57% vs. 1.29%; odds ratio 1.31; 95% confidence interval, 1.11-1.55). CONCLUSIONS Patients with schizophrenia had a much higher prevalence of hyperlipidemia in young adulthood than that in the general population. Schizophrenic patients with second-generation antipsychotic exposure had a higher incidence of hyperlipidemia than individuals in the general population.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Department of Health, Chiayi, Taiwan
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14
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Arnold SV, Spertus JA, Tang F, Krumholz HM, Borden WB, Farmer SA, Ting HH, Chan PS. Statin use in outpatients with obstructive coronary artery disease. Circulation 2011; 124:2405-10. [PMID: 22064595 DOI: 10.1161/circulationaha.111.038265] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials have shown that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD), even among patients with low-density lipoprotein cholesterol levels <100 mg/dL. We sought to determine the extent to which patients with obstructive CAD in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy. METHODS AND RESULTS Within the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry, we examined rates of treatment with statin and nonstatin medications in 38 775 outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Among these patients, 30 160 (77.8%) were prescribed statins, 2042 (5.3%) were treated only with nonstatin lipid-lowering medications, and 6573 (17.0%) were untreated. Lack of medical insurance was associated with no statin treatment, and male sex, coexisting hypertension, and a recent coronary revascularization were associated with statin treatment. Among those not on any lipid-lowering therapy, low-density lipoprotein cholesterol levels were available for 51.2% (3365/6573). Among these untreated patients, low-density lipoprotein cholesterol levels were <100 mg/dL in 1794 patients (53.3%) and ≥ 100 mg/dL in 1571 patients (46.7%). CONCLUSIONS Despite robust clinical trial evidence, a substantial number of patients with obstructive CAD remain untreated with statins. A small proportion were treated with nonstatin therapy, and 1 in 6 patients was simply untreated; half of the untreated patients had low-density lipoprotein cholesterol values <100 mg/dL. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.
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Affiliation(s)
- Suzanne V Arnold
- MHA, St. Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA.
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McConnell KJ, Morris JL, Delate T, Cymbala AA, Hornak R, Kauffman AB, McGinnis BD. Blood Pressure Level Attainment Among Patients with Coronary Artery Disease and Uncontrolled Blood Pressure. Pharmacotherapy 2011; 31:1063-72. [DOI: 10.1592/phco.31.11.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dayspring TD. Understanding hypertriglyceridemia in women: clinical impact and management with prescription omega-3-acid ethyl esters. Int J Womens Health 2011; 3:87-97. [PMID: 21445284 PMCID: PMC3061852 DOI: 10.2147/ijwh.s16702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Indexed: 12/29/2022] Open
Abstract
Background: Elevated triglycerides (TGs) are a common lipid disorder in the US and are associated with comorbidities such as pancreatitis, obesity, type 2 diabetes, and metabolic syndrome. TGs are generally elevated in postmenopausal women compared with premenopausal women. Meta-analysis has shown that elevated TGs are associated with an increased risk of coronary heart disease (CHD). Objective: This article provides a general overview of TG metabolism and reviews data on the epidemiology and risk of elevated TGs in women, as pregnancy and menopause, in particular, have been associated with unfavorable changes in the lipoprotein profile, including elevations in TGs. In addition, this review seeks to explain the recommended TG goals and treatment options for hypertriglyceridemia with an emphasis on severe hypertriglyceridemia (TGs ≥ 500 mg/dL) and its respective treatment with prescription omega-3-acid ethyl esters (P-OM3). Methods: MedLine was searched for articles published through August 2009 using the terms “hypertriglyceridemia” and “dyslipidemia”, with subheadings for “prevalence”, “women”, “treatment”, “guidelines”, “risk”, and “omega-3 fatty acids”. Publications discussing the epidemiology of hypertriglyceridemia, CHD risk, treatment guidelines for lipid management, or clinical trials involving P-OM3 were selected for review. The reference lists of relevant articles were also examined for additional citations. Results: Hypertriglyceridemia is associated with increased CHD risk. Women, especially those with polycystic ovarian syndrome, type 2 diabetes, or who are postmenopausal, should be monitored regularly for the impact of hypertriglyceridemia on their lipid profile. Cardiovascular risk of TGs can be indirectly assessed by monitoring non-high-density lipoprotein cholesterol (non-HDL-C) levels. There are multiple sets of guidelines providing recommendations for desirable low-density lipoprotein cholesterol, TG, and non-HDL-C levels. Treatment of hypertriglyceridemia includes lifestyle interventions and, if needed, pharmacologic therapy. In patients with severe hypertriglyceridemia, P-OM3 can reduce TGs by up to 45%. Conclusion: Physicians should regularly monitor the lipid profile of their female patients. Any lipid abnormality should be managed promptly according to established guidelines. P-OM3 provide a well-tolerated option for the treatment of severe hypertriglyceridemia.
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Attainment of low-density lipoprotein cholesterol goals in coronary artery disease. J Clin Lipidol 2010; 4:173-80. [DOI: 10.1016/j.jacl.2010.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 03/02/2010] [Accepted: 03/05/2010] [Indexed: 11/22/2022]
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Ford ES, Li C, Pearson WS, Zhao G, Mokdad AH. Trends in hypercholesterolemia, treatment and control among United States adults. Int J Cardiol 2010; 140:226-35. [DOI: 10.1016/j.ijcard.2008.11.033] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/04/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
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Li X, Xu Y, Li J, Hu D. The gender differences in baseline characteristics and statin intervention among outpatients with coronary heart disease in China: the China Cholesterol Education Program. Clin Cardiol 2009; 32:308-14. [PMID: 19569062 PMCID: PMC6653262 DOI: 10.1002/clc.20514] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 08/11/2008] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The China Cholesterol Education Program (CCEP) aimed to investigate the baseline characteristics of outpatients with coronary heart disease (CHD) according to gender, especially lipid levels, statin intervention, and rates of achieving their goal low-density lipoprotein cholesterol (LDL-C) level. METHODS A total of 4778 CHD outpatients were enrolled from 52 centers in 6 Chinese cities from January 2006 to January 2007. RESULTS Female outpatients were significantly older than male outpatients (66+/-10 vs 63+/-11 years, P <0.001). Male outpatients were more likely to smoke than female outpatients (P<0.001). Female outpatients had a higher prevalence of hypertension, diabetes mellitus, LDL-C level, and total cholesterol level (all P values <0.001). About 82% of the participants received statin therapy. The LDL-C levels were 3.06+/-1.08 mmol/L and 2.89+/-0.97 mmol/L in outpatients at high risk and very high risk respectively (P<0.001). Though there were higher rates of statin intervention, only 36.2% of the high risk outpatients got to the target LDL-C level (<2.6 mmol/L); 10.9% of the very high risk outpatients achieved the optimal LDL-C level (<1.82 mmol/L) suggested by National Cholesterol Education Program Adult Treatment Panel III. The rate of achieving target was only 42.2%, even when LDL-C <2.6 mmol/L was the target level for patients at very high risk. Only 19.4% of the outpatients at very high risk achieved the target (LDL-C <2.08 mmol/L) suggested by the updated Chinese guideline for CHD. CONCLUSION Although the outpatients received a higher rate of statin therapy, the rates of achieving the target were lower. There is still a significant gap between the guidelines and clinical practice in statin intervention among these CHD outpatients, particularly for women.
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Affiliation(s)
- Xiankai Li
- Heart, Lung, and Blood Vessel Center of Tongji University
| | - Yawei Xu
- Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai, China
| | - Jue Li
- Heart, Lung, and Blood Vessel Center of Tongji University
| | - Dayi Hu
- Heart, Lung, and Blood Vessel Center of Tongji University
- Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai, China
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Pearson GJ, Olson KL, Panich NE, Majumdar SR, Tsuyuki RT, Gilchrist DM, Damani A, Francis GA. Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience. Vasc Health Risk Manag 2009; 4:1127-35. [PMID: 19183763 PMCID: PMC2605345 DOI: 10.2147/vhrm.s3748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge. Methods: The medical records of consecutive dyslipidemic patients discharged ×6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed. The primary outcome was the change in patients’ lipid levels between the final CRRC visit and the most recent primary care follow-up. A worst-case analysis was conducted to evaluate the potential impact of the patients in whom the follow-up lipid profiles post-discharge from the CRRC were not obtained. Results: Within the CRRC (median follow-up = 1.28 years in 1064 patients), we observed statistically significant improvements in all lipid parameters. In the 411 patients for whom post-discharge lipid profiles were available (median follow-up = 2.41 years), there were no significant differences observed in low-density lipoprotein-cholesterol, total cholesterol (TC), or triglycerides since CRRC discharge; however, there were small improvements in high-density lipoprotein-cholesterol (HDL-C) and TC:HDL ratio (p < 0.05 for both). The unadjusted worst-case analysis (653 patients with no follow-up lipid profiles) demonstrated statistically significant worsening of all lipid parameters between CRRC discharge and the most recent follow-up. However, when the change in lipid parameters between the baseline and the most recent follow-up was assessed in this analysis, the changes in all lipid parameters were significantly improved (p < 0.05). Conclusions: This study demonstrates that a CRRC can improve lipid levels and suggests that these benefits are sustained once patients are returned to the care of their primary physician.
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Affiliation(s)
- Glen J Pearson
- Department of Medicine, Divisions of Cardiology, Cardiovascular Risk Reduction Clinic, University of Alberta Hospital, Edmonton, Alberta, Canada.
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Mehner A, Lindblad U, Råstam L, Boström KB. Cholesterol in women at high cardiovascular risk is less successfully treated than in corresponding men. Eur J Clin Pharmacol 2008; 64:815-20. [DOI: 10.1007/s00228-008-0482-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 02/28/2008] [Indexed: 01/28/2023]
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