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Smith BJ, Maiorana A, Ntoumanis N, McVeigh JA, McCaffrey TA, Kerr DA, Hillis G, Wright H, Ng H, Legrand S, Donald F, Hunt K, McDonald MD, Quested E. An Australian Football Themed Health Behaviour Change Intervention for Men With Cardiovascular Disease is Feasible and Acceptable: Results From a Feasibility Randomised Trial. Heart Lung Circ 2024; 33:1365-1378. [PMID: 38824056 DOI: 10.1016/j.hlc.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Physical activity (PA) and weight management are critical for cardiovascular disease (CVD) secondary prevention. However, PA adherence during or after cardiac rehabilitation is low. Here, we assess the feasibility and acceptability of the Australian football-themed Aussie Fans in Training (Aussie-FIT) program and associated trial procedures when adapted for men with CVD. METHOD A pragmatic randomised control trial, with waitlist control arm, and follow-up measures at 3 and 6 months. Men with a CVD diagnosis and body mass index ≥25 kg/m2 were recruited from community and clinical settings, and randomised, following baseline measures of health and health behaviours. The intervention arm attended 12 face-to-face football-themed education and PA sessions. Feasibility (recruitment, retention, attendance, and adherence to trial procedures) was assessed via mixed methods. RESULTS A total of 74% (64/86) of participants expressing interest met the eligibility criteria. Of those, 49 men (mean age=61.4, standard deviation=9.5, mean body mass index=31.3, standard deviation=4.2) were randomised. Program attendance rates (87% attended ≥80% of sessions) and retention (92%) were high. Trial retention at the primary end point (3 months) was high (86%) and at the 6-month follow-ups reduced to 67%. Program and trial procedures were acceptable, except for the request to visit a pathologist for the blood draw. CONCLUSIONS Using a football theme and setting may be a feasible way to engage men with CVD in health behaviour change. Given the existing pilot evidence for men at risk of CVD, and that recruitment rates were under the target, trialling a program for men with or at risk of CVD is recommended.
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Affiliation(s)
- Brendan J Smith
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Andrew Maiorana
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia; Exercise Physiology Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
| | - Joanne A McVeigh
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Vic, Australia
| | - Deborah A Kerr
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia
| | - Hayley Wright
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Heidi Ng
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Vic, Australia
| | - Samara Legrand
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Vic, Australia
| | - Fraser Donald
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Matthew D McDonald
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Eleanor Quested
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia.
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Loh WJ, Watts GF. Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander. Curr Opin Endocrinol Diabetes Obes 2024:01266029-990000000-00104. [PMID: 39221620 DOI: 10.1097/med.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW The aim of this review was to discuss cardiometabolic risk factors that affect women. RECENT FINDINGS Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women. SUMMARY Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.
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Affiliation(s)
- Wann Jia Loh
- Department of Endocrinology, Changi General Hospital
- Duke-NUS Medical School, Singapore
- Medical School, University of Western Australia
| | - Gerald F Watts
- Medical School, University of Western Australia
- Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia
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3
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Hammoudeh AJ, Jallad M, Khader Y, Badaineh Y, Tabbalat RA, Zammar H, Al-Makhamreh H, Basha A, AlAtteili L, Abuhalimeh R, Fkheideh T, Ababneh A, Ababneh L, Mahmoud SA, Alhaddad IA. Atherosclerotic Cardiovascular Disease Novel and Traditional Risk Factors in Middle Eastern Young Women. The ANCORS-YW Study. Glob Heart 2024; 19:59. [PMID: 39035774 PMCID: PMC11259120 DOI: 10.5334/gh.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024] Open
Abstract
Background There is paucity of data on the prevalence of novel and traditional cardiovascular risk factors in young women with atherosclerotic cardiovascular disease (ASCVD) in the Middle East. We sought to evaluate clinical profiles and prevalence of novel and traditional risk factors in Middle Eastern young women with ASCVD compared with age-matched controls. Methods Women 18-50 years of age who have ASCVD were enrolled and each was aged-matched with two women with no ASCVD. Prevalence of novel and traditional risk factors was compared in the two groups. Multivariable analyzes examined the independent association of 16 factors with ASCVD. Results Of 627 young women enrolled mean age 44.1 ± 5.2 years; 209 had ASCVD and 418 served as controls. Women with ASCVD had significantly higher prevalence of five of the studied traditional risk factors (hypertension, type 2 diabetes [T2D], smoking, low-density lipoprotein cholesterol serum levels, and family history of premature ASCVD [FHx]) than women with no ASCVD. Additionally, of the 11 novel and psychosocial risk factors studied, four showed significantly higher prevalence in young women with ASCVD (preterm delivery, hypertensive disease of pregnancy gestational diabetes, and low level of education). Multivariable analyzes showed hypertension, T2D, smoking, FHx, persistent weight gain after pregnancy and low level of education were independently associated with ASCVD. Conclusions In this study of young Middle Eastern women; traditional risk factors as well as persistent weight gain after pregnancy were more prevalent in women with ASCVD compared with controls.The study is registered with ClinicalTrials.gov, unique identifier number NCT04975503.
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Affiliation(s)
- Ayman J. Hammoudeh
- Department of Cardiology, 44 Kindi Street, Istishari Hospital, Amman 11184, Jordan
| | - Majeda Jallad
- Department of Obstetrics and Gynecology, 44 Kindi Street, Istishari Hospital, Amman 11184, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology School of Medicine, 3300 Ramtha Road, Irbid 22110, Jordan
| | - Yahya Badaineh
- Department of Cardiology, 44 Kindi Street, Istishari Hospital, Amman 11184, Jordan
| | - Ramzi A. Tabbalat
- Department of Cardiology, Abdali Hospital, 1 Al-Istethmar Street, Abdali Boulevard, Amman 11191, Jordan
| | - Hasan Zammar
- Department of Cardiology, European Gaza Hospital, 12 Khan Yunis Street, Gaza P950, Gaza Strip, Palestine
| | - Hanna Al-Makhamreh
- Department of Internal Medicine, Section of Cardiology, Jordan University Hospital, 100 Queen Rania Street, Amman 11910, Jordan
| | - Asma Basha
- Department of Obstetrics and Gynecology, Jordan University Hospital, 100 Queen Rania Street, Amman 11910, Jordan
| | - Liyan AlAtteili
- Department of Medical Education, University of Jordan School of Medicine, 100 Queen Rania Street, Amman 11910, Jordan
| | - Raghad Abuhalimeh
- Department of Medical Education, University of Jordan School of Medicine, 100 Queen Rania Street, Amman 11910, Jordan
| | - Taima Fkheideh
- Department of Medical Education, University of Jordan School of Medicine, 100 Queen Rania Street, Amman 11910, Jordan
| | - Amr Ababneh
- Department of Medical Education, Jordan University of Science and Technology School of Medicine, Department of Medical Education, 3300 Ramtha Road, Irbid 22110, Jordan
| | - Layan Ababneh
- Department of Medical Education, Jordan University of Science and Technology School of Medicine, Department of Medical Education, 3300 Ramtha Road, Irbid 22110, Jordan
| | - Saad A. Mahmoud
- Department of Internal Medicine, King Abdullah University Hospital, 3300 Ramtha Road, Irbid 22110, Jordan
| | - Imad A. Alhaddad
- Jordan Cardiovascular Center, Jordan Hospital, 55 Queen Noor Street, Amman 11152, Jordan
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4
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Jiménez A, Vlacho B, Mata-Cases M, Real J, Mauricio D, Franch-Nadal J, Ortega E. Sex and age significantly modulate cardiovascular disease presentation in type 2 diabetes: a large population-based cohort study. Front Endocrinol (Lausanne) 2024; 15:1344007. [PMID: 38828412 PMCID: PMC11140096 DOI: 10.3389/fendo.2024.1344007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Aims We aimed to describe and compare the incidence of the first cardiovascular event and its major subtypes, coronary heart disease (CHD), cerebrovascular disease, heart failure (HF), or peripheral artery disease (PAD), according to age and sex in a population-based cohort of individuals with type 2 diabetes (T2D) from a Mediterranean region. Material and methods We used linked primary care electronic medical reports, pharmacy-invoicing data, and hospital admission disease registry records from the SIDIAP database, which contains linked data for 74% of the Catalonian population. We selected individuals with T2D aged 30 to 89 years free of cardiovascular disease (CVD). The primary outcome was the first presentation of CVD. Results The study cohort included 247,751 individuals (48.6% women, 66.8 ± 11.9 years). During a 6.99-year follow-up, the cumulative incidence of the first cardiovascular event was 23.4%. Men were at higher risk for CVD (hazard ratio [HR]: 1.47 95%CI: 1.45-1.50), CHD (HR: 1.52 95%CI: 1.47-1.57), cerebrovascular disease (HR:1.07 95%CI: 1.03-1.10) and PAD (HR: 2.30 95%CI: 2.21-2.39) than women but at a lower risk for HF (HR:0.70 95%CI: 0.68-0.73). CHD and PAD were the most frequent CVD presentations among men (28.1% and 27.5%) and HF (40.1%) in women. CHD predominated among young participants of both sexes, while HF predominated among women older than 65 and men older than 75. Conclusions In individuals with T2D, the overall risk and the type of first CVD manifestation largely varied by sex and age. This epidemiological evidence should be considered in clinical practice.
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Affiliation(s)
- Amanda Jiménez
- Department of Endocrinology & Nutrition, Hospital Clinic Barcelona, Barcelona, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Emilio Ortega
- Department of Endocrinology & Nutrition, Hospital Clinic Barcelona, Barcelona, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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5
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Bararu Bojan I, Dobreanu S, Vladeanu MC, Ciocoiu M, Badescu C, Plesoianu C, Filip N, Iliescu D, Frasinariu O, Bojan A, Tudor R, Badulescu OV. The Etiology of the Thrombotic Phenomena Involved in the Process of Coronary Artery Disease-What Is the Role of Thrombophilic Genes in the Development of This Pathology? Int J Mol Sci 2024; 25:5228. [PMID: 38791267 PMCID: PMC11120830 DOI: 10.3390/ijms25105228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Cardiovascular diseases, among which includes coronary artery disease, represent one of the most important causes of mortality and morbidity worldwide. Research aimed at determining the risk factors involved recognizes a group of "traditional" risk factors, but also more recent studies identified over 100 "novel" ones which may have a role in the disease. Among the latter is the thrombophilia profile of a patient, a pathology well-established for its involvement in venous thromboembolism, but with less studied implications in arterial thrombosis. This paper reviews the literature, explaining the pathophysiology of the thrombophilia causes associated most with coronary thrombosis events. Results of several studies on the subject, including a meta-analysis with over 60,000 subjects, determined the significant involvement of factor V Leiden, prothrombin G20210A mutation, plasminogen activator inhibitor-1 and antiphospholipid syndrome in the development of coronary artery disease. The mechanisms involved are currently at different stages of research, with some already established and used as therapeutic targets.
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Affiliation(s)
- Iris Bararu Bojan
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Stefan Dobreanu
- Recuperare Hospital Iasi, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania (C.B.)
| | - Maria Cristina Vladeanu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Codruta Badescu
- Recuperare Hospital Iasi, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania (C.B.)
| | - Carmen Plesoianu
- Department of Internal Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Nina Filip
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Dan Iliescu
- Department of Internal Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Otilia Frasinariu
- Department of Pediatry, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Andrei Bojan
- Department of Surgical Sciences, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Razvan Tudor
- Department of Orthopedy, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
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6
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Grant E, Sanghavi M. Ischemic Heart Disease in Women. Med Clin North Am 2024; 108:567-579. [PMID: 38548464 DOI: 10.1016/j.mcna.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
This review synthesizes the current understanding of ischemic heart disease in women, briefly discussing differences in risk factors, presentation, and treatment. We have underscored the unique clinical phenotype of IHD in women with a higher prevalence of ischemia with non-obstructive coronary arteries. Further research is needed to elucidate the complexities of ischemic heart disease in women, understand the discordance between ischemic burden and clinical symptoms, and optimize treatment strategies.
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Affiliation(s)
- Eleonore Grant
- Department of Internal Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Monika Sanghavi
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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7
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Nathani M, Vogel B, Mehran R. Closing the gap: cardiovascular disease in women. Climacteric 2024; 27:16-21. [PMID: 38174697 DOI: 10.1080/13697137.2023.2281935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
Cardiovascular disease (CVD) in women remains understudied, under-recognized, underdiagnosed and undertreated. Initiatives such as the Lancet Women and Cardiovascular Disease Commission help to identify sex and gender-related gaps in research, care and outcomes and to guide next steps in addressing them. This article highlights important aspects of the Lancet Commission report and expands on the evidence and proposed strategies for reducing the global burden of CVD in women. Furthermore, the article explores the benefits of cross-specialty collaborations for the treatment and prevention of CVD in women and discusses the impact of gender-related disparities in academic cardiology.
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Affiliation(s)
- M Nathani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Carcel C, Haupt S, Arnott C, Yap ML, Henry A, Hirst JE, Woodward M, Norton R. A life-course approach to tackling noncommunicable diseases in women. Nat Med 2024; 30:51-60. [PMID: 38242981 DOI: 10.1038/s41591-023-02738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - Sue Haupt
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South-West Sydney Local Health District, Sydney, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), South-Western Sydney Clinical School, Ingham Institute, UNSW, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda Henry
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Jane E Hirst
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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9
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Olic JJ, Baessler A, Fischer M. [Chest pain and cardiovascular diseases in women : Diagnostics and treatment]. Herz 2023; 48:487-498. [PMID: 37930367 DOI: 10.1007/s00059-023-05215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of global mortality not only in men but also in women. The incidence of CVD significantly increases in women, especially after the menopause. Sex and gender differences in the incidence, prevalence and mortality of CVD are due to hormonal, anatomical, and sociocultural differences. As part of the primary and secondary prevention of coronary heart disease (CHD), risk factors specific for women, such as autoimmune diseases and pregnancy-associated diseases (e.g., gestational diabetes and pre-eclampsia) should also be taken into account in addition to the classical cardiovascular risk factors. Furthermore, in women with angina pectoris it should be considered that women in particular frequently suffer from ischemia with nonobstructive coronary arteries (INOCA) that can be caused, for example, by coronary microvascular dysfunction (CMD) or coronary spasms. Based on this, the diagnostics should not be terminated in symptomatic women after coronary angiography with normal epicardial vessels. A targeted diagnostics for CMD and coronary spasms should be carried out at an early stage.
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Affiliation(s)
- Janet-Jacqueline Olic
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Andrea Baessler
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Marcus Fischer
- Caritas-Krankenhaus St. Lukas, Traubenweg 3, 93309, Kelheim, Deutschland
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10
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Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health 2023; 26:851-855. [PMID: 37594562 PMCID: PMC10632230 DOI: 10.1007/s00737-023-01356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
Patients with Attention Deficit Hyperactivity Disorder (ADHD) are at greater cardiovascular risk. We investigated the association between ADHD symptoms and cardiovascular disease in women at a specialized Dutch cardiological clinic. Lifetime ADHD symptoms were found in 35% of women (n = 300) with cardiac complaints. Women with ADHD symptoms compared to those without were significantly younger but had no different cardiological profile. To protect women's health, further research and multidisciplinary cooperation is required to better understand the relationship between ADHD and cardiovascular disease.
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Affiliation(s)
- L S Ter Beek
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M N Böhmer
- Dutch Expertise Center Adult ADHD at PsyQ, The Hague, The Netherlands.
| | | | - J J S Kooij
- Dutch Expertise Center Adult ADHD at PsyQ, The Hague, The Netherlands
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Watts GF, Gidding SS, Hegele RA, Raal FJ, Sturm AC, Jones LK, Sarkies MN, Al-Rasadi K, Blom DJ, Daccord M, de Ferranti SD, Folco E, Libby P, Mata P, Nawawi HM, Ramaswami U, Ray KK, Stefanutti C, Yamashita S, Pang J, Thompson GR, Santos RD. International Atherosclerosis Society guidance for implementing best practice in the care of familial hypercholesterolaemia. Nat Rev Cardiol 2023; 20:845-869. [PMID: 37322181 DOI: 10.1038/s41569-023-00892-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
This contemporary, international, evidence-informed guidance aims to achieve the greatest good for the greatest number of people with familial hypercholesterolaemia (FH) across different countries. FH, a family of monogenic defects in the hepatic LDL clearance pathway, is a preventable cause of premature coronary artery disease and death. Worldwide, 35 million people have FH, but most remain undiagnosed or undertreated. Current FH care is guided by a useful and diverse group of evidence-based guidelines, with some primarily directed at cholesterol management and some that are country-specific. However, none of these guidelines provides a comprehensive overview of FH care that includes both the lifelong components of clinical practice and strategies for implementation. Therefore, a group of international experts systematically developed this guidance to compile clinical strategies from existing evidence-based guidelines for the detection (screening, diagnosis, genetic testing and counselling) and management (risk stratification, treatment of adults or children with heterozygous or homozygous FH, therapy during pregnancy and use of apheresis) of patients with FH, update evidence-informed clinical recommendations, and develop and integrate consensus-based implementation strategies at the patient, provider and health-care system levels, with the aim of maximizing the potential benefit for at-risk patients and their families worldwide.
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Affiliation(s)
- Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, WA, Australia.
| | | | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine, Western University, London, ON, Canada
| | - Frederick J Raal
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy C Sturm
- Department of Genomic Health, Geisinger, Danville, PA, USA
- 23andMe, Sunnyvale, CA, USA
| | - Laney K Jones
- Department of Genomic Health, Geisinger, Danville, PA, USA
| | - Mitchell N Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Khalid Al-Rasadi
- Medical Research Centre, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Dirk J Blom
- Division of Lipidology and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Hapizah M Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Specialist Lipid and Coronary Risk Prevention Clinics, Hospital Al-Sultan Abdullah (HASA) and Clinical Training Centre, Puncak Alam and Sungai Buloh Campuses, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Uma Ramaswami
- Royal Free London NHS Foundation Trust, University College London, London, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | - Claudia Stefanutti
- Department of Molecular Medicine, Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Regional Centre for Rare Diseases, Immunohematology and Transfusion Medicine, Umberto I Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Shizuya Yamashita
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Jing Pang
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Raul D Santos
- Lipid Clinic, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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12
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Ramírez-Hernández D, López-Sánchez P, Lezama-Martínez D, Kuyoc-Arroyo NM, Rodríguez-Rodríguez JE, Fonseca-Coronado S, Valencia-Hernández I, Flores-Monroy J. Timing Matters: Effects of Early and Late Estrogen Replacement Therapy on Glucose Metabolism and Vascular Reactivity in Ovariectomized Aged Wistar Rats. J Renin Angiotensin Aldosterone Syst 2023; 2023:6683989. [PMID: 38025203 PMCID: PMC10665112 DOI: 10.1155/2023/6683989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiovascular disease incidence increases after menopause due to the loss of estrogen cardioprotective effects. However, there are conflicting data regarding the timing of estrogen therapy (ERT) and its effect on vascular dysfunction associated with impaired glucose metabolism. The aim of this work was to evaluate the effect of early and late ERT on blood glucose/insulin balance and vascular reactivity in aged ovariectomized Wistar rats. Eighteen-month-old female Wistar rats were randomized as follows: (1) sham, (2) 10-week postovariectomy (10 w), (3) 10 w postovariectomy+early estradiol therapy (10 w-early E2), (4) 20-week postovariectomy (20 w), and (5) 20-week postovariectomy+late estradiol therapy (20 w-late E2). Early E2 was administered 3 days after ovariectomy and late therapy after 10 weeks, in both groups. 17β-Estradiol (E2) was administered daily for 10 weeks (5 μg/kg/day). Concentration-response curves to angiotensin II, KCl, and acetylcholine (ACh) were performed. Heart rate (HR), diastolic and systolic blood pressure (DBP and SBP), glucose, insulin, HOMA-IR, and nitric oxide (NO) levels were determined. Higher glucose levels were found in all groups compared to the sham group, except the 20 w-late E2 group. Insulin was increased in all ovariectomized groups compared to sham. The HOMA-IR index showed insulin resistance in all ovariectomized groups, except for the 10 w-early E2 group. The 10 w-early E2 group increased NO levels vs. the 10 w group. After 10 w postovariectomy, the vascular response to KCl and Ach increases, despite early E2 administration. Early and late E2 treatment decreased vascular reactivity to Ang II. At 20-week postovariectomy, DBP increased, even with E2 administration, while SBP and HR remained unchanged. The effects of E2 therapy on blood glucose/insulin balance and vascular reactivity depend on the timing of therapy. Early ERT may provide some protective effects on insulin resistance and vascular function, whereas late ERT may not have the same benefits.
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Affiliation(s)
- Diana Ramírez-Hernández
- Myocardial Pharmacology Laboratory, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, 54740 State of Mexico, Mexico
| | - Pedro López-Sánchez
- Laboratorio de Farmacología Molecular, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico
| | - Diego Lezama-Martínez
- Myocardial Pharmacology Laboratory, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, 54740 State of Mexico, Mexico
| | - Neidy M. Kuyoc-Arroyo
- Myocardial Pharmacology Laboratory, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, 54740 State of Mexico, Mexico
| | - Jessica E. Rodríguez-Rodríguez
- Biological Pharmaceutical Chemist Career, Faculty of Higher Education Zaragoza, National Autonomous University of Mexico, Batalla 5 de Mayo S/N, Ejército de Oriente, Iztapalapa, 09230 Mexico City, Mexico
- Laboratory 7, Biomedicine Unit, Faculty of Higher Education Iztacala, National Autonomous University of Mexico, Avenida de los Barrios 1, Los Reyes Ixtacala, 54090 Tlalnepantla de Baz, Mexico
| | - Salvador Fonseca-Coronado
- Immunology Laboratory, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, 54740 State of Mexico, Mexico
| | - Ignacio Valencia-Hernández
- Laboratorio de Farmacología Cardiovascular, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico
| | - Jazmin Flores-Monroy
- Myocardial Pharmacology Laboratory, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, 54740 State of Mexico, Mexico
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13
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Hiles M, Simmons A, Hilleman D, Gibson CA, Backes JM. Atherosclerotic Cardiovascular Disease in Women: Providing Protection With Lipid-altering Agents. Clin Ther 2023; 45:1127-1136. [PMID: 37770308 DOI: 10.1016/j.clinthera.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in women, yet it remains underdiagnosed, undertreated, and understudied in women compared with men. Although estrogen has provided observational evidence of cardioprotection, randomized controlled trials using hormone replacement therapy have generally produced unfavorable results. METHODS For this narrative review, a literature search was performed using the key words cardiovascular disease, women, and dyslipidemia in PubMed and Google Scholar with no date limitations. References within each article were also reviewed for additional relevant articles. FINDINGS Sex-specific risk factors and underrecognized conditions more predominant in women elevate ASCVD risk, creating further clinical challenges, such as the need for accurate risk stratification, compared with in men. Dyslipidemia frequently manifests or worsens during the menopausal transition. Therefore, identification during midlife and implementing lipid-lowering strategies to reduce ASCVD risk is imperative. Women have historically been poorly represented in cardiovascular (CV) outcome trials. However, more recent studies and meta-analyses have indicated that lipid-lowering therapies are equally effective in women and produce similar reductions in CV events and total mortality. Major cholesterol guidelines address many of the challenges that clinicians face when assessing ASCVD risk in women. Key points specific to women include obtaining a detailed history of pregnancy-related conditions, identification of common autoimmune disorders associated with systemic inflammation, and use of 10-year ASCVD risk calculators and imaging modalities (coronary artery calcium) to optimize ASCVD assessment. In terms of treatment, similar to men, women with existing ASCVD or high-risk primary prevention patients should be treated aggressively to achieve ≥50% LDL-C reductions and/or LDL-C goals as low as <55 mg/dL. Appropriate lipid-lowering therapies include high-intensity statins with or without ezetimibe and proprotein convertase subtilisin kexin/type 9 inhibitors. Women with lower ASCVD risk may be considered for low- to moderate-intensity statin therapy (approximately 30%-50% LDL-C reduction). All women, regardless of ASCVD risk category, should implement therapeutic lifestyle changes, which improve many common age-related cardiometabolic conditions. IMPLICATIONS Although ASCVD and current risk factor trends in women are concerning, numerous evidence-based approaches are available to protect women with ASCVD risk from life-changing CV events.
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Affiliation(s)
- Megan Hiles
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashley Simmons
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Daniel Hilleman
- Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - James M Backes
- Departments of Pharmacy Practice and Medicine, Atherosclerosis and LDL-Apheresis Center, University of Kansas Medical Center, Kansas City, Kansas.
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14
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Tocantins C, Martins JD, Rodrigues ÓM, Grilo LF, Diniz MS, Stevanovic-Silva J, Beleza J, Coxito P, Rizo-Roca D, Santos-Alves E, Rios M, Carvalho L, Moreno AJ, Ascensão A, Magalhães J, Oliveira PJ, Pereira SP. Metabolic mitochondrial alterations prevail in the female rat heart 8 weeks after exercise cessation. Eur J Clin Invest 2023; 53:e14069. [PMID: 37525474 DOI: 10.1111/eci.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The consumption of high-caloric diets strongly contributes to the development of non-communicable diseases (NCDs), including cardiovascular disease, the leading cause of mortality worldwide. Exercise (along with diet intervention) is one of the primary non-pharmacological approaches to promote a healthier lifestyle and counteract the rampant prevalence of NCDs. The present study evaluated the effects of exercise cessation after a short period training on the cardiac metabolic and mitochondrial function of female rats. METHODS Seven-week-old female Sprague-Dawley rats were fed a control or a high-fat, high-sugar (HFHS) diet and, after 7 weeks, the animals were kept on a sedentary lifestyle or submitted to endurance exercise for 3 weeks (6 days per week, 20-60 min/day). The cardiac samples were analysed 8 weeks after exercise cessation. RESULTS The consumption of the HFHS diet triggered impaired glucose tolerance, whereas the HFHS diet and physical exercise resulted in different responses in plasma adiponectin and leptin levels. Cardiac mitochondrial respiration efficiency was decreased by the HFHS diet consumption, which led to reduced ATP and increased NAD(P)H mitochondrial levels, which remained prevented by exercise 8 weeks after cessation. Exercise training-induced cardiac adaptations in redox balance, namely increased relative expression of Nrf2 and downstream antioxidant enzymes persist after an eight-week exercise cessation period. CONCLUSIONS Endurance exercise modulated cardiac redox balance and mitochondrial efficiency in female rats fed a HFHS diet. These findings suggest that exercise may elicit cardiac adaptations crucial for its role as a non-pharmacological intervention for individuals at risk of developing NCDs.
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Affiliation(s)
- Carolina Tocantins
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - João D Martins
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Óscar M Rodrigues
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Luís F Grilo
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Mariana S Diniz
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Jelena Stevanovic-Silva
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Jorge Beleza
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Pedro Coxito
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - David Rizo-Roca
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- Department of Cell Biology, Physiology & Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Estela Santos-Alves
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Manoel Rios
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Lina Carvalho
- Institute of Anatomical and Molecular Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - António J Moreno
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, School of Sciences and Technology, University of Coimbra, Coimbra, Portugal
| | - António Ascensão
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - José Magalhães
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Paulo J Oliveira
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Susana P Pereira
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
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15
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Mazón-Ramos P, Rey-Aldana D, Garcia-Vega D, Portela-Romero M, Rodríguez-Mañero M, Lage-Fernández R, Cinza-Sanjurjo S, González-Juanatey JR. Gender differences on healthcare accessibility and outcomes of a electronic inter-clinician consultation program at the cardiology department in a Galician Health Area. Eur J Clin Invest 2023; 53:e14012. [PMID: 37114978 DOI: 10.1111/eci.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 04/29/2023]
Abstract
AIMS To assess the longer-term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e-consultation in our outpatient care programme. METHODS We selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e-consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in-person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all-cause hospital admissions and mortality during the one-year after cardiology consultation. RESULTS The introduction of e-consultation substantially decreased waiting times to cardiology care; during the in-person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e-consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e-consultation implantation, there was a significant reduction in the 1-year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93-0.96] for HF, 0.90 [0.89-0.91] for CV and 0.70 [0.69-0.71] for all-cause hospitalization; and 0.93 [0.92-0.95] for HF, 0.86 [0.86-0.87] for CV and 0.88 [0.87-0.89] for all-cause mortality in women; and 0.91 [0.89-0.92] for HF, 0.90 [0.89-0.91] for CV and 0.72 [0.71-0.73] for all-cause hospitalization; and 0.96 [0.93-0.97] for HF, 0.87 [95% CI: 0.86-0.87] for CV and 0.87 [0.86-0.87] for all-cause mortality, in men. CONCLUSION Compared with the in-person consultation period, an outpatient care programme that includes an e-consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differences.
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Affiliation(s)
- Pilar Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Rey-Aldana
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- A Estrada Health Center, Santiago de Compostela Health Area, SERGAS, Pontevedra, Spain
| | - David Garcia-Vega
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Portela-Romero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Concepción Arenal Health Center. Santiago de Compostela Health Area, SERGAS, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Lage-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sergio Cinza-Sanjurjo
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Milladoiro Health Center, Santiago de Compostela Health Area, SERGAS, A Coruña, Spain
| | - José R González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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16
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Barton JC, Wozniak A, Scott C, Chatterjee A, Titterton GN, Corrigan AE, Kuri A, Shah V, Soh I, Kaski JC. Between-Sex Differences in Risk Factors for Cardiovascular Disease among Patients with Myocardial Infarction-A Systematic Review. J Clin Med 2023; 12:5163. [PMID: 37568564 PMCID: PMC10420061 DOI: 10.3390/jcm12155163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work.
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Affiliation(s)
- Jack Charles Barton
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Anna Wozniak
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Chloe Scott
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Abhisekh Chatterjee
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Greg Nathan Titterton
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | | | - Ashvin Kuri
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Ian Soh
- St. George’s University of London, London SW17 0RE, UK;
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK;
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17
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de Ruiter SC, Schmidt AF, Grobbee DE, den Ruijter HM, Peters SAE. Sex-specific Mendelian randomisation to assess the causality of sex differences in the effects of risk factors and treatment: spotlight on hypertension. J Hum Hypertens 2023; 37:602-608. [PMID: 37024639 PMCID: PMC10403357 DOI: 10.1038/s41371-023-00821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
Hypertension is a key modifiable risk factor for cardiovascular disease. Several observational studies have found a stronger association of blood pressure and cardiovascular disease risk in women compared to men. Since observational studies can be affected by sex-specific residual confounding and reverse causation, it remains unclear whether these differences reflect actual differential effects. Other study designs are needed to uncover the causality of sex differences in the strength of risk factor and treatment effects. Mendelian randomisation (MR) uses genetic variants as instrumental variables to provide evidence about putative causal relations between risk factors and outcomes. By exploiting the random allocation of genes at gamete forming, MR is unaffected by confounding and results in more reliable causal effect estimates. In this review, we discuss why and how sex-specific MR and cis-MR could be used to study sex differences in risk factor and drug target effects. Sex-specific MR can be helpful to strengthen causal inferences in the field of sex differences, where it is often challenging to distinguish nature from nurture. The challenge of sex-specific (drug target) MR lays in leveraging robust genetic instruments from sex-specific GWAS studies which are not commonly available. Knowledge on sex-specific causal effects of hypertension, or other risk factors, could improve clinical practice and health policies by tailoring interventions based on personalised risk. Drug target MR can help to determine the anticipated on-target effects of a drug compound and to identify targets to pursue in drug development.
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Affiliation(s)
- Sophie C de Ruiter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Floriaan Schmidt
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator Centre, London, UK
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
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18
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Moscucci F, Sciomer S, Maffei S, Meloni A, Lospinuso I, Carnovale M, Corrao A, Di Diego I, Caltabiano C, Mezzadri M, Mattioli AV, Gallina S, Rossi P, Magrì D, Piccirillo G. Sex Differences in Repolarization Markers: Telemonitoring for Chronic Heart Failure Patients. J Clin Med 2023; 12:4714. [PMID: 37510828 PMCID: PMC10381165 DOI: 10.3390/jcm12144714] [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: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of the electrocardiogram (ECG) repolarization phase. Recently, some short period repolarization-dispersion parameters have been proposed as markers of acute decompensation and of mortality risk in CHF patients. Some important differences in repolarization between sexes are known, but their impact on ECG markers remains unstudied. The aim of this study was to evaluate possible differences between men and women in ECG repolarization markers for the telemonitoring of CHF patients. METHOD 5 min ECG recordings were collected to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 215 decompensated CHF (age range: from 49 to 103 years). Thirty-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. RESULTS A total of 34 patients (16%) died during the 30-day follow-up, without differences between sexes. Women showed a more preserved ejection fraction and higher LDL and total cholesterol levels. Among female patients, implantable cardioverter devices, statins, and antiplatelet agents were less used. Data for Te mean showed increased values among deceased men and women compared to survival, but TeSD was shown to be the most reliable marker for CHF reacutization in both sexes. CONCLUSION TeSD could be considered a risk factor for CHF worsening and complications for female and male patients, but different cut offs should be taken into account. (ClinicalTrials.gov number, NCT04127162.).
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Affiliation(s)
- Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Silvia Maffei
- Endocrinologia Cardiovascolare Ginecologica ed Osteoporosi, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Myriam Carnovale
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Andrea Corrao
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Ilaria Di Diego
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Cristina Caltabiano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Mezzadri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G. D'Annunzio" University, 66100 Chieti, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
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19
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Ohkuma T, Iwase M, Fujii H, Kitazono T. Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry. Biol Sex Differ 2023; 14:32. [PMID: 37211595 PMCID: PMC10201708 DOI: 10.1186/s13293-023-00517-8] [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: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND The excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes. METHODS A total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models. RESULTS Women were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease. CONCLUSIONS We observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.
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Affiliation(s)
- Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Masanori Iwase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 812-8582, Japan
- Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan
| | - Hiroki Fujii
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 812-8582, Japan
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 812-8582, Japan
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20
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Liang X, He H, Zeng H, Wei L, Yang J, Wen Y, Fan S, Fan J. The relationship between polycystic ovary syndrome and coronary heart disease: a bibliometric analysis. Front Endocrinol (Lausanne) 2023; 14:1172750. [PMID: 37223024 PMCID: PMC10200869 DOI: 10.3389/fendo.2023.1172750] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine diseases for women of puberty and reproductive age. PCOS can affect women's health for the rest of their lives since the incidence of coronary heart disease (CHD) may increase in the perimenopausal and senile periods among PCOS women compared with non-PCOS women. Method A literature retrieval based on the Science Citation Index Expanded (SCI-E) database. All obtained records results were downloaded in plain text format for subsequent analysis. VOSviewer v1.6.10, Citespace and Microsoft Excel 2010 software were utilized for analyzing the following terms: countries, institutions, authors, journals, references and keywords. Results There were 312 articles retrieved from January 1, 2000 to February 8, 2023, and the frequency of citations was 23,587. The United States, England, and Italy contributed the majority of the records. Harvard University, the University of Athens, and Monash University were the top 3 most productive institutions with publications on the relationship between PCOS and CHD. Journal of clinical endocrinology & metabolism ranked first with the highest publications (24 records), followed by Fertility and sterility (18 records). The keywords were divided into six clusters in the overlay keywords network: (1) the correlation between CHD risk factors and PCOS women; (2) the relationship between cardiovascular disease and female reproductive system hormone secretion; (3) the interaction between CHD and metabolic syndrome; (4) the relationship between c-reactive protein and endothelial function and oxidative stress in PCOS patients; (5) the potential positive effect of metformin on reducing CHD risk factors in PCOS patients; (6) the study of serum cholesterol and body-fat distribution in patients with CHD in PCOS. Oxidative stress, genome-wide association, obesity, primary prevention, and sex difference were main hotspots in this field in recent five years according to the keyword citation burst analysis. Conclusion The article obtained the hotspots and trends and provided a reference for subsequent research on the association between PCOS and CHD. Moreover, it is hypothesized that oxidative stress and genome-wide association were frontier hotspots in studies that explore the relationship between PCOS and CHD, and prevention research may be valued in the future.
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Affiliation(s)
- Xuzhi Liang
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Haijing He
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Hao Zeng
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Liuyi Wei
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Jiahuang Yang
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Yuqi Wen
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Siqi Fan
- Department of Ophthalmology, University of Bonn, Bonn, North Rhin-Westphalia, Germany
| | - Jiangtao Fan
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
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21
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Pant A, Gribbin S, McIntyre D, Trivedi R, Marschner S, Laranjo L, Mamas MA, Flood V, Chow CK, Zaman S. Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis. Heart 2023:heartjnl-2022-321930. [PMID: 36918266 DOI: 10.1136/heartjnl-2022-321930] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Dietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic reviews have evaluated this relationship specifically in women. OBJECTIVE To determine the association between higher versus lower adherence to a Mediterranean diet and incident CVD and total mortality in women. METHODS A systematic search of Medline, Embase, CINAHL, Scopus, and Web of Science (2003-21) was performed. Randomised controlled trials and prospective cohort studies with participants without previous CVD were included. Studies were eligible if they reported a Mediterranean diet score and comprised either all female participants or stratified outcomes by sex. The primary outcome was CVD and/or total mortality. A random effects meta-analysis was conducted to calculate pooled hazard ratios (HRs) and confidence intervals (CIs). RESULTS Sixteen prospective cohort studies were included in the meta-analysis (n=7 22 495 female participants). In women, higher adherence to a Mediterranean diet was associated with a lower CVD incidence (HR 0.76, 95% CI 0.72 to 0.81; I2=39%, p test for heterogeneity=0.07), total mortality (HR 0.77, 95% CI 0.74 to 0.80; I2=21%, p test for heterogeneity=0.28), and coronary heart disease (HR 0.75, 95% CI 0.65 to 0.87; I2=21%, p test for heterogeneity=0.28). Stroke incidence was lower in women with higher Mediterranean diet adherence (HR 0.87, 95% CI 0.76 to 1.01; I2=0%, p test for heterogeneity=0.89), but this result was not statistically significant. CONCLUSION This study supports a beneficial effect of the Mediterranean diet on primary prevention of CVD and death in women, and is an important step in enabling sex specific guidelines.
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Affiliation(s)
- Anushriya Pant
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Sarah Gribbin
- Department of General Health, Alfred Hospital, Melbourne, Victoria, Australia
| | - Daniel McIntyre
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Ritu Trivedi
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele, UK
| | - Victoria Flood
- Sydney School of Health Sciences and Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia .,Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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22
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Tegg NL, Desmarais OH, Lindsay MP, McDermott S, Mulvagh SL, Desbiens MM, Norris CM. A Survey of Female-Specific Cardiovascular Protocols in Emergency Departments in Canada. CJC Open 2023; 5:107-111. [PMID: 36880067 PMCID: PMC9984888 DOI: 10.1016/j.cjco.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases (CVD) remain the leading cause of death for women. However, systematic inequalities exist in how women experience clinical cardiovascular (CV) policies, programs, and initiatives. Methods In collaboration with the Heart and Stroke Foundation of Canada, a question regarding female-specific CV protocols in an emergency department (ED), or an inpatient or ambulatory care area of a healthcare site was sent via e-mail to 450 healthcare sites in Canada. Contacts at these sites were established through the larger initiative-the Heart Failure Resources and Services Inventory-conducted by the foundation. Results Responses were received from 282 healthcare sites, with 3 sites confirming the use of a component of a female-specific CV protocol in the ED. Three sites noted using sex-specific troponin levels in the diagnosis of acute coronary syndromes; 2 of the sites are participants in the hs-cTn-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE MI) trial. One site reported the integration of a female-specific CV protocol component into routine use. Conclusions We have identified an absence of female-specific CVD protocols in EDs that may be associated with the identified poorer outcomes in women impacted by CVD. Female-specific CV protocols may serve to increase equity and ensure that women with CV concerns have access to the appropriate care in a timely manner, thereby helping to mitigate some of the current adverse effects experienced by women who present to Canadian EDs with CV symptoms.
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Affiliation(s)
- Nicole L Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanna McDermott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Heart Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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23
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Alizadeh R, Salehi O, Rezaeinezhad N, Hosseini SA. The effect of high intensity interval training with genistein supplementation on mitochondrial function in the heart tissue of elderly rats. Exp Gerontol 2023; 171:112039. [PMID: 36442700 DOI: 10.1016/j.exger.2022.112039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION For the most part, heart disease increases with age; on the other hand, although the role of exercise and antioxidants in the health of the elderly has been reported, the simultaneous effect of these two interventions is a new research topic. Thus, the aim of this study was to evaluate the effect of eight weeks of high intensity interval training (HIIT) and genistein (G) supplementation on oxidative stress, apoptosis and mitochondrial biogenesis in the heart tissue of elderly rats. METHODS In this experimental study, 40 elderly female Sprague-Dawley rats aged 20 ± 2 months and weighing 250 ± 30 g were randomly divided into five groups of eight animals, including: (1) control (C), (2) sham (Sh), (3) HIIT, (4) HIIT + G and (5) G. Also, to evaluate the effect of time passage on the variables, 8 healthy young rats were included in the healthy young control group. HIIT protocol was performed for eight weeks, three sessions with an intensity of 95-90 % VO2max at high intensity intervals and 45-45 % VO2max at low intensity intervals. Ge was received daily at a dose of 60 mg/kg peritoneally. Data analysis was performed using one-way ANOVA with Tukey's post hoc test (P ≤ 0.05). RESULTS In the HIIT and HIIT + G groups, levels of Bax, Bax/Bcl-2 ratio, MDA, PAB, GSSG were lower and levels of PGC-1α, TFAM, GSH, GSH/GSSG ratio and NDUFS7 were higher than the control and sham groups (P ≤ 0.05). In the HIIT + G group, levels of Bcl-2 were significantly higher than the control group (P ≤ 0.05). In the HIIT + G group, levels of Bax, GSSG, Bax/Bcl-2 ratio, and PAB were lower, and levels of GSH/GSSG ratio, Bcl-2, PGC-1α, TFAM and NDUFS7 were higher than the G consumption group (P ≤ 0.05). In the HIIT + G group, levels of PGC-1α and TFAM were significantly higher and levels of MDA and PAB were lower than the HIIT group (P ≤ 0.05). CONCLUSION Both HIIT and G consumption seem to have beneficial effects on reducing oxidative stress; in addition, the interaction of these two variables on the improvement of apoptosis and mitochondrial biogenesis is more favorable than the effect of either one alone. However, more studies are needed on different pathways of apoptosis following G administration.
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Affiliation(s)
- Rostam Alizadeh
- Department of Sports Science, School of Literature and Humanities, Ilam University, Ilam, Iran.
| | - Omidreza Salehi
- Department of Physical Education and Sport Sciences, University of Kurdistan, Sanandaj, Iran
| | | | - Seyed Ali Hosseini
- Department of Sport Physiology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.
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24
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Liu C, Li Z, Li B, Liu W, Zhang S, Qiu K, Zhu W. Relationship between ferroptosis and mitophagy in cardiac ischemia reperfusion injury: a mini-review. PeerJ 2023; 11:e14952. [PMID: 36935924 PMCID: PMC10019339 DOI: 10.7717/peerj.14952] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Cardiovascular diseases (CVD), with high morbidity and mortality, seriously affect people's life and social development. Clinically, reperfusion therapy is typically used to treat ischemic cardiomyopathy, such as severe coronary heart disease and acute myocardial infarction. However, reperfusion therapy can lead to myocardial ischemia reperfusion injury (MIRI), which can affect the prognosis of patients. Studying the mechanisms of MIRI can help us improve the treatment of MIRI. The pathological process of MIRI involves many mechanisms such as ferroptosis and mitophagy. Ferroptosis can exacerbate MIRI, and regulation of mitophagy can alleviate MIRI. Both ferroptosis and mitophagy are closely related to ROS, but there is no clear understanding of the relationship between ferroptosis and mitophagy. In this review, we analyzed the relationship between ferroptosis and mitophagy according to the role of mTOR, NLPR3 and HIF. In addition, simultaneous regulation of mitophagy and ferroptosis may be superior to single therapy for MIRI. We summarized potential drugs that can regulate mitophagy and/or ferroptosis, hoping to provide reference for the development of drugs and methods for MIRI treatment.
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Affiliation(s)
- Cuihua Liu
- Third-Grade Pharmacological Laboratory on Traditional Chinese Medicine, State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, Hubei Province, China
| | - Zunjiang Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Botao Li
- Third-Grade Pharmacological Laboratory on Traditional Chinese Medicine, State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, Hubei Province, China
| | - Wei Liu
- Third-Grade Pharmacological Laboratory on Traditional Chinese Medicine, State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, Hubei Province, China
| | - Shizhong Zhang
- Third-Grade Pharmacological Laboratory on Traditional Chinese Medicine, State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, Hubei Province, China
| | - Kuncheng Qiu
- Third-Grade Pharmacological Laboratory on Traditional Chinese Medicine, State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, Hubei Province, China
| | - Wei Zhu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
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25
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Leal DP, Gonçalinho GHF, Tavoni TM, Kuwabara KL, Paccanaro AP, Freitas FR, Strunz CMC, César LAM, Maranhão RC, Mansur ADP. The Interplay of Sirtuin-1, LDL-Cholesterol, and HDL Function: A Randomized Controlled Trial Comparing the Effects of Energy Restriction and Atorvastatin on Women with Premature Coronary Artery Disease. Antioxidants (Basel) 2022; 11:2363. [PMID: 36552571 PMCID: PMC9774144 DOI: 10.3390/antiox11122363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION HDL function has gained prominence in the literature as there is a greater predictive capacity for risk in early coronary artery disease when compared to the traditional parameters. However, it is unclear how dietary energy restriction and atorvastatin influence HDL function. METHODS A randomized controlled trial with 39 women with early CAD divided into three groups (n = 13): energy restriction (30% of VET), atorvastatin (80 mg), and control. Analyses of traditional biochemical markers (lipid and glucose profile), circulating Sirt-1, and HDL function (lipid composition, lipid transfer, and antioxidant capacity). RESULTS Participants' mean age was 50.5 ± 3.8 years. Energy restriction increased Sirt-1 by 63.6 pg/mL (95%CI: 1.5-125.7; p = 0.045) and reduced BMI by 0.8 kg/m2 (95%CI: -1.349--0.273; p = 0.004) in a manner independent of other cardiometabolic factors. Atorvastatin reduced LDL-c by 40.0 mg/dL (95%CI: -69.910--10.1; p = 0.010). Increased Sirt-1 and reduced BMI were independently associated with reduced phospholipid composition of HDL (respectively, β = -0.071; CI95%:-0.136--0.006; p = 0.033; β = 7.486; CI95%:0.350-14.622; p = 0.040). Reduction in BMI was associated with lower HDL-free cholesterol (β = 0.818; CI95%:0.044-1.593; p = 0.039). LDL-c reduction by statins was associated with reduced maximal lipid peroxide production rate of HDL (β = 0.002; CI95%:0.000-0.003; p = 0.022) and total conjugated diene generation (β = 0.001; CI95%:0.000-0.001; p = 0.029). CONCLUSION This study showed that energy restriction and atorvastatin administration were associated with changes in lipid profile, serum Sirt-1 concentrations, and HDL function.
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Affiliation(s)
- Dalila Pinheiro Leal
- Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
- Servico de Prevencao, Cardiopatia da Mulher e Reabilitacao Cardiovascular, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
- Laboratorio de Metabolismo de Lipides, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Gustavo Henrique Ferreira Gonçalinho
- Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
- Servico de Prevencao, Cardiopatia da Mulher e Reabilitacao Cardiovascular, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Thauany Martins Tavoni
- Laboratorio de Metabolismo de Lipides, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Karen Lika Kuwabara
- Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
- Servico de Prevencao, Cardiopatia da Mulher e Reabilitacao Cardiovascular, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Ana Paula Paccanaro
- Laboratorio de Metabolismo de Lipides, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Fatima Rodrigues Freitas
- Laboratorio de Metabolismo de Lipides, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Célia Maria Cassaro Strunz
- Laboratorio de Analises Clinicas, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Luiz Antonio Machado César
- Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
- Unidade Clinica de Coronariopatias Cronicas, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
| | - Raul Cavalcante Maranhão
- Laboratorio de Metabolismo de Lipides, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
- Faculdade de Ciencias Farmaceuticas da Universidade de Sao Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
| | - Antonio de Padua Mansur
- Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, Sao Paulo 05508-060, Brazil
- Servico de Prevencao, Cardiopatia da Mulher e Reabilitacao Cardiovascular, Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor-HCFMUSP), Sao Paulo 05403-900, Brazil
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Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol 2022; 18:657-669. [DOI: 10.1038/s41584-022-00833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/08/2022]
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Utilidad de una aplicación web interactiva en la mejora del control de los factores de riesgo cardiovascular. Proyecto Control-RCV. Semergen 2022; 48:411-422. [DOI: 10.1016/j.semerg.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/22/2022]
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Moscucci F, Lavalle F, Politi C, Campanale A, Baggio G, Sciomer S. Acute coronary syndrome in women: a new and specific approach is needed. Eur J Prev Cardiol 2022; 29:e305-e308. [PMID: 35881512 DOI: 10.1093/eurjpc/zwac143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Franco Lavalle
- OMCEO (Provincial Order Council of Surgeons and Dentists), Bari, Italy
- G.I.S.e G. (Gender and Health Italian Group), Italy
| | - Cecilia Politi
- Internal Medicine Department, Gender Medicine Area F.A.D.O.I., Isernia, Italy
| | - Antonella Campanale
- Medical Device and Pharmaceutical Service-Italian Ministry of Health, Rome, Italy
| | - Giovanella Baggio
- Department of Medicine, University of Padua, Padua, Italy
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
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Recent Advances in Nattokinase-Enriched Fermented Soybean Foods: A Review. Foods 2022; 11:foods11131867. [PMID: 35804683 PMCID: PMC9265860 DOI: 10.3390/foods11131867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023] Open
Abstract
With the dramatic increase in mortality of cardiovascular diseases (CVDs) caused by thrombus, this has sparked an interest in seeking more effective thrombolytic drugs or dietary nutriments. The dietary consumption of natto, a traditional Bacillus-fermented food (BFF), can reduce the risk of CVDs. Nattokinase (NK), a natural, safe, efficient and cost-effective thrombolytic enzyme, is the most bioactive ingredient in natto. NK has progressively been considered to have potentially beneficial cardiovascular effects. Microbial synthesis is a cost-effective method of producing NK. Bacillus spp. are the main production strains. While microbial synthesis of NK has been thoroughly explored, NK yield, activity and stability are the critical restrictions. Multiple optimization strategies are an attempt to tackle the current problems to meet commercial demands. We focus on the recent advances in NK, including fermented soybean foods, production strains, optimization strategies, extraction and purification, activity maintenance, biological functions, and safety assessment of NK. In addition, this review systematically discussed the challenges and prospects of NK in actual application. Due to the continuous exploration and rapid progress of NK, NK is expected to be a natural future alternative to CVDs.
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Mamataz T, Ghisi GL, Pakosh M, Grace SL. Outcomes and cost of women-focused cardiac rehabilitation: A systematic review and meta-analysis. Maturitas 2022; 160:32-60. [PMID: 35550706 DOI: 10.1016/j.maturitas.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this systematic review was to investigate the effects of women-focused cardiac rehabilitation (CR) on patient outcomes and cost. METHODS Medline, PubMed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception through to May 2020. Primary studies of any design were included, with adult females with any cardiac diseases. "Women-focused" CR comprised programs or sessions with >50% females, or 1-1 programming tailored to women's preferences. No studies were excluded on the basis of outcome. Two independent reviewers rated citations for potential inclusion, and one extracted data, including on quality, which was checked independently. Random-effects meta-analysis was used where there were ≥3 trials with the same outcome; certainty of evidence for these was determined based on GRADE. For other outcomes, SWiM was applied. RESULTS 3498 unique citations were identified, of which 28 studies (52 papers) were included (3,697 participants; 11 trials). No meta-analysis could be performed for outcomes with "usual care" comparisons. Compared to "active comparison" group, women-focused CR had no meaningful additional effect on functional capacity. Women-focused CR meaningfully improved physical (mean difference [MD]=6.37, 95% confidence interval [CI]=3.14-9.59; I2=0%; moderate-quality evidence) and mental (MD=4.66, 95% CI=0.21-9.11; I2=36%; low-quality evidence) quality of life, as well as scores on seven of the eight SF-36 domains. Qualitatively, results showed women-focused CR was associated with lower morbidity, risk factors, and greater psychosocial well-being. No effect was observed for mortality. One study reported a favorable economic impact and another reported reduced sick days. CONCLUSIONS Women-focused CR is associated with clinical benefit, although there is mixed evidence and more research is needed. PROSPERO REGISTRATION CRD42020189760.
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Affiliation(s)
| | - Gabriela Lm Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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31
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Kuang R, Liao Y, Xie X, Li B, Lin X, Liu Q, Liu X, Yu W. Dynamic physical examination indicators of cardiovascular health: A single-center study in Shanghai, China. PLoS One 2022; 17:e0268358. [PMID: 35550637 PMCID: PMC9098044 DOI: 10.1371/journal.pone.0268358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Dynamic physical examination data can provide both cross-sectional and time-series characteristics of cardiovascular health. However, most physical examination databases containing health and disease information have not been fully utilized in China. Hence, this study aimed to analyze dynamic physical examination indicators for cardiovascular health to provide evidence for precise prevention and control of cardiovascular diseases in the primary prevention domain among healthy population with different demographic characteristics in Shanghai. Three-year continuous data were collected from the physical examination center of a hospital in Shanghai from 2018 to 2020, which included a total of 14,044 participants with an average age of 46.51±15.57 years. The cardiovascular status of overall healthy individuals may have a decreasing trend, which is manifested as a significant year-on-year decrease in high-density lipoprotein cholesterol; a significant year-on-year increase in total cholesterol, low-density lipoprotein cholesterol, and blood glucose levels; and a possible increasing trend of diastolic blood pressure, body mass index, and triglycerides. Healthy population with different sex and age groups have various sensitives to cardiovascular physical examination indicators. To conduct more accurate cardiovascular health management and health promotion for key populations in primary prevention, focusing on the dynamic trends of blood pressure, blood lipids, blood glucose, and body mass index in men and changes in total cholesterol in women over time is especially important. The age group of 50–69 years is key for better prevention and control of cardiovascular health.
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Affiliation(s)
- Rongren Kuang
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yiling Liao
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xinhan Xie
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Biao Li
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaojuan Lin
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qiang Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- * E-mail: (WY); (XL); (QL)
| | - Xiang Liu
- Department of Respiratory Disease, The 903rd Hospital of the People’s Liberation Army, Hangzhou, China
- * E-mail: (WY); (XL); (QL)
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (WY); (XL); (QL)
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32
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Regensteiner JG, Reusch JEB. Sex Differences in Cardiovascular Consequences of Hypertension, Obesity, and Diabetes: JACC Focus Seminar 4/7. J Am Coll Cardiol 2022; 79:1492-1505. [PMID: 35422246 PMCID: PMC9503760 DOI: 10.1016/j.jacc.2022.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
It has long been recognized that there are significant differences between the sexes affecting prevalence, incidence, and severity over a broad range of diseases. Until the early 1990s, the limited research conducted on women's health focused primarily on diseases affecting fertility and reproduction, and women were excluded from most clinical trials. For these reasons, the prevention, diagnosis, and treatment of serious chronic diseases such as cardiovascular disease in women continue to be based primarily on findings in men, and sex-specific clinical guidelines are mostly lacking. Hypertension, obesity, and diabetes, interrelated risk factors for cardiovascular disease, differ by sex in terms of prevalence and adverse effects as well as by genetics and biology. Research is needed to understand sex differences in hypertension, obesity, and diabetes to optimally inform sex-specific prevention, diagnosis, and treatment strategies for women and men. In this way, sex-specific clinical guidelines can be developed where warranted.
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Affiliation(s)
- Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jane E B Reusch
- Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Everitt IK, Trinh KV, Underberg DL, Beach L, Khan SS. Moving the Paradigm Forward for Prediction and Risk-Based Primary Prevention of Heart Failure in Special Populations. Curr Atheroscler Rep 2022; 24:343-356. [PMID: 35235166 DOI: 10.1007/s11883-022-01009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Heart failure (HF) treatment paradigms increasingly recognize the importance of primary prevention. This review explores factors that enhance HF risk, summarizes evidence supporting the pharmacologic primary prevention of HF, and notes barriers to the implementation of primary prevention of HF with a focus on female and sexual and gender minority patients. RECENT FINDINGS HF has pathophysiologic sex-specific distinctions, suggesting that sex-specific preventive strategies may be beneficial. Pharmacologic agents that have shown benefit in reducing the risk of HF address the pathobiology underpinning these sex-specific risk factors. The implementation of pharmacologic therapies for primary prevention of HF needs to consider a risk-based model. Current pharmacotherapies hold mechanistic promise for the primary prevention of HF in females and gender and sexual minorities, although research is needed to understand the specific populations most likely to benefit. There are significant systemic barriers to the equitable provision of HF primary prevention.
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Affiliation(s)
- Ian K Everitt
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine V Trinh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel L Underberg
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren Beach
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Mazgelytė E, Burokienė N, Vysocka A, Narkevičius M, Petrėnas T, Kaminskas A, Songailienė J, Utkus A, Karčiauskaitė D. Higher Levels of Stress-Related Hair Steroid Hormones Are Associated with the Increased SCORE2 Risk Prediction Algorithm in Apparently Healthy Women. J Cardiovasc Dev Dis 2022; 9:jcdd9030070. [PMID: 35323618 PMCID: PMC8955541 DOI: 10.3390/jcdd9030070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 01/27/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the major cause of death worldwide. Although the importance of conventional CVD risk factors, including older age, male gender, hypertension, obesity, dyslipidemia and hyperglycemia, is well-studied, psychosocial stress, which is considered an independent CVD risk factor, requires further investigation. Thus, we aimed to investigate the association between long-term secretion of stress-related steroid hormones, including cortisol, cortisone and dehydroepiandrosterone, and the 10-year fatal and non-fatal CVD risk estimated by the SCORE2 risk prediction algorithm, as well as traditional CVD risk factors in a group of apparently healthy women. A total of 145 women (aged 50–64 years) participating in the national CVD prevention program were enrolled in the study. Sociodemographic, lifestyle, health-related characteristics, stress, anxiety and sleep quality indicators were evaluated using specific questionnaires. Anthropometric and arterial blood pressure measures were assessed by trained personnel, lipid and glucose metabolism biomarkers were measured using routine methods, and hair steroid hormone levels were determined by ultra-high-performance liquid chromatography-tandem mass spectrometry. The results showed that higher levels of hair cortisol and cortisone are associated with increased SCORE2 values. Moreover, significant associations between hair glucocorticoids and individual cardiovascular risk factors, including obesity, hypertension, dyslipidemia and hyperglycemia, were found. These findings indicate that stress-related hair steroid hormones might be valuable biomarkers for CVD prediction and prevention.
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Affiliation(s)
- Eglė Mazgelytė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania;
- Correspondence:
| | - Neringa Burokienė
- Clinics of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (N.B.); (A.V.); (M.N.)
| | - Agata Vysocka
- Clinics of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (N.B.); (A.V.); (M.N.)
| | - Martynas Narkevičius
- Clinics of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (N.B.); (A.V.); (M.N.)
| | - Tomas Petrėnas
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (T.P.); (A.K.); (J.S.); (A.U.)
| | - Andrius Kaminskas
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (T.P.); (A.K.); (J.S.); (A.U.)
| | - Jurgita Songailienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (T.P.); (A.K.); (J.S.); (A.U.)
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania; (T.P.); (A.K.); (J.S.); (A.U.)
| | - Dovilė Karčiauskaitė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21, LT-03101 Vilnius, Lithuania;
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Peters R, Xu Y, Eramudugolla R, Sachdev PS, Cherbuin N, Tully PJ, Mortby ME, Anstey KJ. Diastolic Blood Pressure Variability in Later Life May Be a Key Risk Marker for Cognitive Decline. Hypertension 2022; 79:1037-1044. [PMID: 35176867 DOI: 10.1161/hypertensionaha.121.18799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an increasing awareness of the need to understand the interaction between long-term blood pressure patterns and their impact on the brain and cognition. METHODS Our aim was to investigate the relationship between repeated blood pressure measures and change in cognitive performance over 12 years and imaging data at 12 years using a longitudinal population study. The data consisted of 2 cohorts, one midlife and one later life. Using linear regression, we examined the relationship between blood pressure (systolic, diastolic, change in blood pressure between visits, and visit-to-visit variability), change in cognitive performance and imaging at 12 years. RESULTS Data on cognitive change were available in 1054 at midlife, baseline age 42.7 (SD 1.5) and 1233 in later life, 62.5 (1.5) years. Imaging data were available in 168 and 233, respectively. After adjustment for multiple comparisons greater diastolic blood pressure variability in later life was associated with a -1.95 point decline (95% CI, -2.89 to -1.01) on an attention-based task and a -0.42 point (95% CI, -0.68 to -0.15) decline in performance on a psychomotor task. A higher SD in diastolic pressure across follow-up was associated with greater white matter hyperintensity volume (%increase per 10 mm Hg increase in the SD [1.50 (95% CI, 1.16-1.94]). CONCLUSIONS In a largely normotensive/mildly hypertensive population, our analyses reported no relationships between blood pressure and cognition in midlife but a potential role for diastolic blood pressure variability in later life as a risk marker for cognitive decline. This may indicate an at-risk period or a means to identify an at-risk population at the age where diastolic pressure is starting to decline.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Ying Xu
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Ranmalee Eramudugolla
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Australia. (P.S.S.).,Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney, Australia (P.S.S.)
| | | | | | - Moyra E Mortby
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Kaarin J Anstey
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
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36
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Wang YX, Mínguez-Alarcón L, Gaskins AJ, Wang L, Ding M, Missmer SA, Rich-Edwards JW, Manson JE, Chavarro JE. Pregnancy loss and risk of cardiovascular disease: the Nurses' Health Study II. Eur Heart J 2022; 43:190-199. [PMID: 34718507 PMCID: PMC8790762 DOI: 10.1093/eurheartj/ehab737] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS The aim of this study was to explore the association of pregnancy loss (PL) with the incidence of cardiovascular disease (CVD) and examine the extent to which this relation is mediated by subsequent metabolic disorders. METHODS AND RESULTS We followed 95 465 ever-gravid women participating in the Nurses' Health Study II between 1993 and 2017. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of CVD, including coronary heart disease (CHD), and stroke, according to the occurrence of PL. A mediation analysis was conducted to explore the intermediating effect of subsequent type 2 diabetes, hypertension, or hypercholesterolaemia. During 2 205 392 person-years of follow-up (mean 23.10 years), 2225 (2.3%) incident CVD cases were documented. After adjusting for confounding factors, PL was associated with an HR of 1.21 [95% confidence interval (CI) 1.10-1.33] for CVD during follow-up. A similar association was observed for CHD (HR 1.20; 95% CI 1.07-1.35) and stroke (HR 1.23; 95% CI 1.04-1.44). The risk of CVD increased with the number of PLs [HR 1.18 (95% CI 1.06-1.31) for 1 and 1.34 (95% CI 1.13-1.59) for ≥2 times] and was greater for PL occurring early in reproductive lifespan [HR 1.40 (95% CI 1.21-1.62) for age ≤23 years, 1.25 (95% CI 1.09-1.43) for age 24-29 years, and 1.03 (95% CI 0.88-1.19) for age ≥30 years]. Hypertension, hypercholesterolaemia, and type 2 diabetes all explained <1.80% of the association between PL and CVD. CONCLUSION PL was associated with a greater CVD risk, independently of subsequent development of metabolic disorders.
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Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97343 Waco, TX 76798, USA
| | - Ming Ding
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Stacey A. Missmer
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 400 Monroe Ave NW, Grand Rapids, MI 49503, USA
| | - Janet W. Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02115, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
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Saei Ghare Naz M, Sheidaei A, Aflatounian A, Azizi F, Ramezani Tehrani F. Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study. J Am Heart Assoc 2022; 11:e022349. [PMID: 35016530 PMCID: PMC9238524 DOI: 10.1161/jaha.121.022349] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Background Limited and conflicting evidence is available regarding the predictive value of adding adverse pregnancy outcomes (APOs) to established cardiovascular disease (CVD) risk factors. Hence, the objective of this study was to determine whether adding APOs to the Framingham risk score improves the prediction of CVD events in women. Methods and Results Out of 5413 women who participated in the Tehran Lipid and Glucose Study, 4013 women met the eligibility criteria included for the present study. The exposure and the outcome variables were collected based on the standard protocol. Cox proportional hazard model was used to evaluate the association of APOs and CVDs. The variant of C-statistic for survivals and reclassification of subjects into Framingham risk score categories after adding APOs was reported. Out of the 4013 eligible subjects, a total of 1484 (36.98%) women reported 1 APO, while 395 (9.84%) of the cases reported multiple APOs. Univariate proportional hazard Cox models showed the significant relations between CVD events and APOs. The enhanced model had a higher C-statistic indicating more acceptable discrimination as well as a slight improvement in discrimination (C-statistic differences: 0.0053). Moreover, we observed a greater risk of experiencing a CVD event in women with a history of multiple APOs compared with cases with only 1 APO (1 APO: hazard ratio [HR] = 1.22; 2 APOs: HR; 1.94; ≥3 APOs: HR = 2.48). Conclusions Beyond the established risk factors, re-estimated CVDs risk by adding APOs to the Framingham risk score may improve the accurate risk estimation of CVD. Further observational studies are needed to confirm our findings.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Sheidaei
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Aflatounian
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
- Fertility and Research Centre, School of Women’s & Children’s HealthUniversity of New South Wales SydneyNSWAustralia
| | - Fereidoun Azizi
- Endocrine Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
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38
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Gregory AT, Denniss AR. Heart, Lung and Circulation in the COVID-19 Era: About COVID-19, Not Just About COVID-19. Heart Lung Circ 2021; 30:1792-1799. [PMID: 34742544 PMCID: PMC8563592 DOI: 10.1016/j.hlc.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - A Robert Denniss
- Heart, Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, and University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, and Western Sydney University, Sydney, NSW, Australia.
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39
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Huaman MA, Feria MG, Kityo C, Nalukwago S, Nazzinda R, Zidar DA, Zanni MV, Siedner MJ, Grinspoon SK, Longenecker CT. A Sex-Stratified Analysis of Monocyte Phenotypes Associated with HIV Infection in Uganda. Viruses 2021; 13:v13112135. [PMID: 34834941 PMCID: PMC8620269 DOI: 10.3390/v13112135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Women with HIV may experience higher rates of non-AIDS comorbidities compared to men with HIV, but the underlying mechanisms are not well understood. We investigated sex-related differences in the effects of HIV on monocyte phenotypes within the Ugandan Study of HIV effects on the Myocardium and Atherosclerosis (mUTIMA). Of 133 participants who provided blood for flow cytometry assays, 86 (65%) were women and 91 (68%) were persons living with HIV (PLWH) on antiretroviral therapy. The median age was 57 (interquartile range, 52–63) years. PLWH exhibited a lower proportion of circulating CD14+CD16- classical monocytes (66.3% vs. 75.1%; p < 0.001), and higher proportion of CD14+CD16+ inflammatory monocytes (17% vs. 11.7%; p = 0.005) compared to HIV-uninfected participants. PLWH had an increased expression of the chemokine receptor CX3CR1 in total monocytes (CX3CR1+ monocytes, 24.5% vs. 4.7%; p < 0.001) and monocyte subsets. These findings were generally similar when analyzed by sex, with no significant interactions between sex and HIV status in adjusted models. Our data show that the inflammatory monocyte subset is expanded and monocyte CX3CR1 chemokine receptor expression is enhanced among PLWH, regardless of sex. Whether these parameters differentially affect risk for non-AIDS comorbidities and clinical outcomes in women with HIV requires additional investigation.
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Affiliation(s)
- Moises A. Huaman
- Division of Infectious Diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
- Correspondence:
| | - Manuel G. Feria
- Division of Infectious Diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala P.O. Box 10005, Uganda; (C.K.); (S.N.); (R.N.)
| | - Sophie Nalukwago
- Joint Clinical Research Centre, Kampala P.O. Box 10005, Uganda; (C.K.); (S.N.); (R.N.)
| | - Rashidah Nazzinda
- Joint Clinical Research Centre, Kampala P.O. Box 10005, Uganda; (C.K.); (S.N.); (R.N.)
| | - David A. Zidar
- Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (D.A.Z.); (C.T.L.)
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA
| | - Markella V. Zanni
- Divisions of Infectious Diseases and Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (M.V.Z.); (M.J.S.); (S.K.G.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Mark J. Siedner
- Divisions of Infectious Diseases and Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (M.V.Z.); (M.J.S.); (S.K.G.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Steven K. Grinspoon
- Divisions of Infectious Diseases and Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (M.V.Z.); (M.J.S.); (S.K.G.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Chris T. Longenecker
- Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (D.A.Z.); (C.T.L.)
- University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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40
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review. BMC Cardiovasc Disord 2021; 21:459. [PMID: 34556036 PMCID: PMC8458788 DOI: 10.1186/s12872-021-02267-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception to May 2020. Primary studies of any design were included. Adult females with any cardiac diseases, participating in women-focused CR (i.e., program or sessions included ≥ 50% females, or was 1-1 and tailored to women’s needs) were considered. Two authors rated citations for inclusion. One extracted data, including study quality rated as per the Mixed-Methods Assessment Tool (MMAT), which was checked independently by a second author. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results 3498 unique citations were identified, with 28 studies (53 papers) included (3697 women; ≥ 10 countries). Globally, women-focused CR is offered by 40.9% of countries that have CR, with 32.1% of programs in those countries offering it. Thirteen (46.4%) studies offered women-focused sessions (vs. full program), 17 (60.7%) were women-only, and 11 (39.3%) had gender-tailoring. Five (17.9%) programs offered alternate forms of exercise, and 17 (60.7%) focused on psychosocial aspects. With regard to utilization, women-focused CR cannot be offered as frequently, so could be less accessible. Adherence may be greater with gender-tailored CR, and completion effects are not known. Satisfaction was assessed in 1 trial, and results were equivocal. Conclusions Women-focused CR involves tailoring of content, mode and/or sex composition. Availability is limited. Effects on utilization require further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02267-0.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gabriela L M Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,Peter Munk Cardiac Centre, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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41
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Khandelwal A, Bakir M, Bezaire M, Costello B, Gomez JMD, Hoover V, Nazir NT, Nichols K, Reisenberg A, Rao A, Sanghani R, Tracy M, Volgman AS. Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center. Curr Atheroscler Rep 2021; 23:56. [PMID: 34345945 PMCID: PMC8331213 DOI: 10.1007/s11883-021-00956-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD). RECENT FINDINGS HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.
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Affiliation(s)
- Abha Khandelwal
- Division of Cardiology, Women’s Heart Health, Stanford University, Palo Alto, CA USA
| | - May Bakir
- Division of Cardiology, Women’s Heart Health Center, Loyola University, Chicago, IL USA
| | - Meghan Bezaire
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Briana Costello
- Center for Women’s Heart & Vascular Health, Texas Heart Institute, and Baylor St. Luke’s Medical Center Hospital, Houston, TX USA
| | | | - Valerie Hoover
- Department of Psychology, Stanford University, Palo Alto, CA USA
| | - Noreen T. Nazir
- Division of Cardiology, Department of Medicine, University of Illinois, Chicago, Chicago USA
| | - Katherine Nichols
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, MA USA
| | - Amy Reisenberg
- Stanford Healthcare, Stanford University, Palo Alto, CA USA
| | - Anupama Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Rupa Sanghani
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Melissa Tracy
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Annabelle Santos Volgman
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
- Chicago, USA
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42
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Lakdawala NK, Olivotto I, Day SM, Han L, Ashley EA, Michels M, Ingles J, Semsarian C, Jacoby D, Jefferies JL, Colan SD, Pereira AC, Rossano JW, Wittekind S, Ware JS, Saberi S, Helms AS, Cirino AL, Leinwand LA, Seidman CE, Ho CY. Associations Between Female Sex, Sarcomere Variants, and Clinical Outcomes in Hypertrophic Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 14:e003062. [PMID: 33284039 DOI: 10.1161/circgen.120.003062] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The impact of sex on phenotypic expression in hypertrophic cardiomyopathy (HCM) has not been well characterized in genotyped cohorts. METHODS Retrospective cohort study from an international registry of patients receiving care at experienced HCM centers. Sex-based differences in baseline characteristics and clinical outcomes were assessed. RESULTS Of 5873 patients (3788 genotyped), 2226 (37.9%) were women. At baseline, women were older (49.0±19.9 versus 42.9±18.4 years, P<0.001) and more likely to have pathogenic/likely pathogenic sarcomeric variants (HCM patients with a sarcomere mutation; 51% versus 43%, P<0.001) despite equivalent utilization of genetic testing. Age at diagnosis varied by sex and genotype despite similar distribution of causal genes. Women were 3.6 to 7.1 years older at diagnosis (P<0.02) except for patients with MYH7 variants where age at diagnosis was comparable for women and men (n=492; 34.8±19.2 versus 33.3±16.8 years, P=0.39). Over 7.7 median years of follow-up, New York Heart Association III-IV heart failure was more common in women (hazard ratio, 1.87 [CI, 1.48-2.36], P<0.001), after controlling for their higher burden of symptoms and outflow tract obstruction at baseline, reduced ejection fraction, HCM patients with a sarcomere mutation, age, and hypertension. All-cause mortality was increased in women (hazard ratio, 1.50 [CI, 1.13-1.99], P<0.01) but neither implantable cardioverter-defibrillator utilization nor ventricular arrhythmia varied by sex. CONCLUSIONS In HCM, women are older at diagnosis, partly modified by genetic substrate. Regardless of genotype, women were at higher risk of mortality and developing severe heart failure symptoms. This points to a sex-effect on long-term myocardial performance in HCM, which should be investigated further.
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Affiliation(s)
- Neal K Lakdawala
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Iacopo Olivotto
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Larry Han
- Harvard University, Biostatistics, Boston, MA (L.H.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands (M.M.)
| | - Jodie Ingles
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, NSW, Australia (J.I., C.S.)
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, NSW, Australia (J.I., C.S.)
| | | | | | - Steven D Colan
- Boston Children's Hospital (S.D.C.), Harvard Medical School, MA
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | | | - Sam Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, OH (S.W.)
| | - James S Ware
- National Heart & Lung Institute, Royal Brompton Cardiovascular Research Centre, Imperial College London, United Kingdom (J.S.W.)
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.S., A.S.H.)
| | - Adam S Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.S., A.S.H.)
| | - Allison L Cirino
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Leslie A Leinwand
- MCDB & BioFrontiers Institute, University of Colorado, Boulder (L.A.L.)
| | - Christine E Seidman
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA.,Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Carolyn Y Ho
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
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Zaman S, Chow C, Lam CSP, Saw J, Nicholls SJ, Figtree GA. Heart Disease in Women: Where Are We Now and What is The Future? Heart Lung Circ 2020; 30:1-2. [PMID: 33261741 DOI: 10.1016/j.hlc.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
| | - Clara Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Carolyn S P Lam
- National Heart Center Singapore, and Duke National University of Singapore, Singapore
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, British Columbia, Canada
| | - Stephen J Nicholls
- MonashHeart, Monash Health, Melbourne, Vic, Australia; Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Gemma A Figtree
- Kolling Institute, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
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