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Hamade H, Jabri A, Mishra P, Butt MU, Sallam S, Karim S. Gender, ethnic, and socioeconomic differences in access to catheter ablation therapy in patients with atrial fibrillation. Front Cardiovasc Med 2023; 9:966383. [PMID: 36684570 PMCID: PMC9846247 DOI: 10.3389/fcvm.2022.966383] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Female patients, patients from racial minorities, and patient with low socioeconomic status have been noted to have less access to catheter ablation for atrial fibrillation. Methods This is a cross-sectional, retrospective study using a large population database (Explorys) to evaluate the gender, racial and socioeconomic differences in access of catheter ablation therapy in patient with atrial fibrillation. Results A total of 2.2 million patients were identified as having atrial fibrillation and 62,760 underwent ablation. Females had ablation in 2.1% of cases while males received ablation in 3.4% of cases. Caucasians had ablation in 3.3% of cases, African Americans in 1.5% of cases and other minorities in 1.2% of cases. Individuals on medicaid underwent ablation in 1.6% of cases, individuals on medicare and private insurance had higher rates (2.8 and 2.9%, respectively). Logistic regression showed that female patients (OR 0.608, CI 0.597-0.618, p < 0.0001), patients who are African American (OR 0.483, CI 0.465-0.502, p < 0.0001), or from other racial minorities (OR 0.343, CI 0.332-0.355, p < 0.0001) were less likely to undergo ablation. Patient with medicare (OR 1.444, CI 1.37-1.522, p < 0.0001) and private insurance (OR 1.572, CI 1.491-1.658, p < 0.0001) were more likely to undergo ablation. Conclusion Female gender, racial minorities, low socioeconomic status are all associated with lower rates of catheter ablation in management of atrial fibrillation.
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Affiliation(s)
- Hani Hamade
- Department of Internal Medicine, The Metrohealth System, Cleveland, OH, United States
| | - Ahmad Jabri
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States
| | - Pooja Mishra
- Advocate Heart Institute, Advocate Healthcare, Chicago, IL, United States
| | - Muhammad Umer Butt
- Department of Cardiology, New York University Langone Health, New York, NY, United States
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals, Cleveland, OH, United States
| | - Saima Karim
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States,*Correspondence: Saima Karim ✉
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2
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Dela Justina V, Miguez JSG, Priviero F, Sullivan JC, Giachini FR, Webb RC. Sex Differences in Molecular Mechanisms of Cardiovascular Aging. FRONTIERS IN AGING 2022; 2:725884. [PMID: 35822017 PMCID: PMC9261391 DOI: 10.3389/fragi.2021.725884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/25/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is still the leading cause of illness and death in the Western world. Cardiovascular aging is a progressive modification occurring in cardiac and vascular morphology and physiology where increased endothelial dysfunction and arterial stiffness are observed, generally accompanied by increased systolic blood pressure and augmented pulse pressure. The effects of biological sex on cardiovascular pathophysiology have long been known. The incidence of hypertension is higher in men, and it increases in postmenopausal women. Premenopausal women are protected from CVD compared with age-matched men and this protective effect is lost with menopause, suggesting that sex-hormones influence blood pressure regulation. In parallel, the heart progressively remodels over the course of life and the pattern of cardiac remodeling also differs between the sexes. Lower autonomic tone, reduced baroreceptor response, and greater vascular function are observed in premenopausal women than men of similar age. However, postmenopausal women have stiffer arteries than their male counterparts. The biological mechanisms responsible for sex-related differences observed in cardiovascular aging are being unraveled over the last several decades. This review focuses on molecular mechanisms underlying the sex-differences of CVD in aging.
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Affiliation(s)
- Vanessa Dela Justina
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | | | - Fernanda Priviero
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC, United States
| | - Jennifer C Sullivan
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Fernanda R Giachini
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil.,Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - R Clinton Webb
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC, United States
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The Influence of Atrial Fibrillation on In-Hospital Mortality in People with Hospital-Acquired Pneumonia: An Observational, Sex-Stratified Study. J Clin Med 2022; 11:jcm11051179. [PMID: 35268270 PMCID: PMC8910951 DOI: 10.3390/jcm11051179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: The study aimed to analyze the influence of atrial fibrillation (AF) prior to hospital admission (“prevalent”) and new-onset AF diagnosed during hospital admission (“incident”) on in-hospital mortality (IHM) in women and men who developed hospital-acquired pneumonia (HAP) in Spain (2016−2019). (2) Methods: We used the Spanish Register of Specialized Care-Basic Minimum Database. (3) Results: We analyzed 38,814 cases of HAP (34.6% women; 13.5% ventilator-associated). Prevalent AF was coded in 19.9% (n = 7742), and incident AF in 5.5% (n = 2136) of HAP. Crude IHM was significantly higher for prevalent AF (34.22% vs. 27.35%, p < 0.001) and for incident AF (35.81% vs. 28.31%, p < 0.001) compared to no AF. After propensity score matching, IHM among women and men with prevalent AF was higher than among women and men with no AF (among women, 32.89% vs. 30.11%, p = 0.021; among men, 35.05% vs. 32.46%, p = 0.008). Similarly, IHM among women and men with incident AF was higher than among women and men with no AF (among women, 36.23% vs. 29.90%, p = 0.013; among men, 35.62% vs. 30.47%; p = 0.003). Sex was associated with a higher IHM only in people with incident AF (for female, OR = 1.21; 95% CI: 1.01−1.57). (4) Conclusions: Both prevalent and incident AF were associated with higher IHM in people who developed HAP. Female sex was associated with a higher IHM in incident AF.
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Dong R, Haque A, Wu HE, Placide J, Yu L, Zhang X. Sex differences in the association between suicide attempts and glucose disturbances in first-episode and drug naive patients with major depressive disorder. J Affect Disord 2021; 292:559-564. [PMID: 34147968 DOI: 10.1016/j.jad.2021.05.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Glucose metabolism is related to depression, but the relationship between blood glucose and suicide attempts in patients with major depressive disorder (MDD) remains unclear. This large-scale sample explores the relationship between suicide attempts and fasting blood glucose, in addition to sex differences in first-episode and drug naive (FEDN) MDD patients. METHODS 1718 FEDN MDD patients diagnosed for the first time were recruited, and their demographic data, clinical data, and blood glucose indicators were collected. 17-item Hamilton Depression Rating Scale (HAMD), 14-item Hamilton Anxiety Rating Scale (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess their depression, anxiety and psychotic symptoms, respectively. RESULTS The depression, anxiety, psychotic symptoms and blood sugar levels of the suicide attempt group were higher than those of the non-suicide attempt group. Correlation analysis showed that blood glucose was significantly associated with suicide attempts in male and female patients. While binary logistic regression showed that blood glucose levels were significantly associated with suicide attempts in male patients, it showed that suicide attempts were not significantly associated with blood glucose levels in female patients. LIMITATIONS The main limitations are cross-sectional design and inability to control selection bias. CONCLUSIONS In male MDD patients, fasting blood glucose level is a potential biomarker of suicide attempt, which deserves attention to avoid suicide risk. However, in female patients, fasting blood glucose has no significant correlation to suicide attempts.
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Affiliation(s)
- Rui Dong
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Anam Haque
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Placide
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Liling Yu
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Bisson A, Bodin A, Fauchier G, Herbert J, Angoulvant D, Ducluzeau PH, Lip GYH, Fauchier L. Sex, age, type of diabetes and incidence of atrial fibrillation in patients with diabetes mellitus: a nationwide analysis. Cardiovasc Diabetol 2021; 20:24. [PMID: 33482830 PMCID: PMC7821402 DOI: 10.1186/s12933-021-01216-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age. METHODS All patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes). RESULTS In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes. CONCLUSION Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.
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Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France
| | - Grégoire Fauchier
- Service de Médecine Interne, Unité D'Endocrinologie Diabétologie Et Nutrition, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Tours, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France
- Service D'information Médicale, D'épidémiologie Et D'économie de La Santé, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France
- EA4245 T2i, Université de Tours, Tours, France
| | - Pierre Henri Ducluzeau
- Service de Médecine Interne, Unité D'Endocrinologie Diabétologie Et Nutrition, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Tours, France
- INRAE (Institut National de Recherche Pour L'Agriculture, l'Alimentation Et L'Environnement), Unité Mixte de Recherche Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Et Faculté de Médecine, Université de Tours, Hôpital Trousseau, 37044, Tours, France.
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Tian XT, Xu YJ, Yang YQ. Gender Differences in Arrhythmias: Focused on Atrial Fibrillation. J Cardiovasc Transl Res 2019; 13:85-96. [PMID: 31637585 DOI: 10.1007/s12265-019-09918-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
There are significant differences in clinical presentation and treatment of atrial fibrillation (AF) between women and men. The primary goal of AF management is to restore sinus rhythm and to prevent various complications, including stroke and heart failure. In many areas of AF, such as prevalence, clinical manifestations, morbidity, risk factors, pathophysiology, treatment strategies, and complications, gender-specific variability is observed and needs to be further addressed by large-scale population researches or randomized clinical trials, which help to promote the customization of AF treatment programs, hence to maximize the success rate of AF therapy in both sexes. This review highlights our current understanding of these gender differences in AF and how these differences affect treatment decisions on AF.
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Affiliation(s)
- Xiao-Ting Tian
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Yi-Qing Yang
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China.
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Mohanty S, Trivedi C, Gianni C, Natale A. Gender specific considerations in atrial fibrillation treatment: a review. Expert Opin Pharmacother 2018; 19:365-374. [DOI: 10.1080/14656566.2018.1434144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
- Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Cardiology, Stanford University, Stanford, CA, USA
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Kane AE, Howlett SE. Differences in Cardiovascular Aging in Men and Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:389-411. [PMID: 30051398 DOI: 10.1007/978-3-319-77932-4_25] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases increase dramatically with age in both men and women. While it is clear that advanced age allows more time for individuals to be exposed to risk factors in general, there is strong evidence that age itself is a major independent risk factor for cardiovascular disease. Indeed, there are distinct age-dependent cellular, structural, and functional changes in both the heart and blood vessels, even in individuals with no clinical evidence of cardiovascular disease. Studies in older humans and in animal models of aging indicate that this age-related remodeling is maladaptive. An emerging view is that the heart and blood vessels accumulate cellular and subcellular deficits with age and these deficits increase susceptibility to disease in older individuals. Aspects of this age-dependent remodeling of the heart and blood vessels differ between the sexes. There is also new evidence that these maladaptive changes are more prominent in older animals and humans with a high degree of frailty. These observations may help explain why men and women are susceptible to different cardiovascular diseases as they age and why frail older adults are most often affected by these diseases.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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