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Dippe T, Cunha CLPD, Cerci RJ, Stier AL, Vítola JV. Study of Myocardial Perfusion in Obese Individuals without Known Ischemic Heart Disease. Arq Bras Cardiol 2018; 112:121-128. [PMID: 30570066 PMCID: PMC6371823 DOI: 10.5935/abc.20180250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Obesity is associated with an increased risk of type 2 diabetes mellitus
(DM), ischemic heart disease (IHD) and cardiovascular mortality. Several
studies have demonstrated the diagnostic and prognostic value of single
photon computed tomography-myocardial perfusion scintigraphy (SPECT-MPI) in
the evaluation of patients with suspected IHD, including in obese
population. Data on clinical risk factors and their association with
abnormal myocardial perfusion in obese patients are scarce in the Brazilian
population. Objective To determine the factors associated with abnormal myocardial perfusion in
obese individuals without known IHD. Methods We studied obese patients without known IHD who were referred for evaluation
through SPECT-MPI between January 2011 and December 2016. Clinical variables
and results of SPECT-MPI were obtained systematically. The distribution of
continuous variables was assessed using the Shapiro-Wilk and Shapiro-Francia
tests. We used the unpaired Student t test to compare the means of
continuous variables with normal distribution and the Chi Square test for
binomial variables analysis. A p value < 0.05 was considered
statistically significant. The association of the clinical variables for the
presence of factors associated with abnormal myocardial perfusion was
determined by univariate and multivariate logistic regression analysis, and
respective odds ratios (OR) and 95% confidence intervals (CI). Results The study sample consisted of 5,526 obese patients. Mean body mass index
(BMI) of our patients was 33.9 ± 3.7 kg/m2, 31% had DM,
and myocardial perfusion abnormalities was observed in 23% of the total
sample. The factors associated with abnormal myocardial perfusion on
multivariate analysis were: age (OR: 1.02, 95% CI 1.01-1.03, p < 0.001),
DM (OR: 1.57, 95% CI 1.31-1.88, p < 0.001), typical angina before the
test (OR: 2.45, 95% CI: 1.82-3.31, p < 0.001), need for pharmacologic
stress test (OR: 1.61, 95% CI: 1.26-2.07, p < 0.001), less physical
effort evaluated in metabolic equivalents (METs) during the exercise
treadmill test (OR: 0.89, 95% CI: 0.85-0.94, p < 0.001) and a lower
post-stress left ventricular ejection fraction after stress (LVEF; OR:
0.989, 95% CI: 0.984-0.994, p < 0.001). Conclusion The factors associated with abnormal myocardial perfusion in obese patients
without known IHD were age, DM, presence of typical angina, ventricular
dysfunction, and inability to undergo physical stress as clinical variables,
in addition to functional capacity during physical stress.
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Affiliation(s)
- Tufi Dippe
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR - Brazil
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Lundberg GP, Mehta LS, Volgman AS. Specialized Care for Women: the Impact of Women's Heart Centers. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:76. [PMID: 30091012 DOI: 10.1007/s11936-018-0656-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF THE REVIEW Cardiovascular disease (CVD) has been and remains the leading cause of mortality in women in the United States. For decades, more women died every year of CVD compared to men. Heart centers for women (HCW) are developed in response to the need for greater patient and physician awareness of CVD in women and to conduct sex-specific research in women. Today, many HCW provide multispecialty and focused areas of cardiovascular care for women. HCW provide their female patients with expertise over the many stages of a woman's life. And HCW partner with national organizations to advance research and education through specialized and focused care for women. The purpose of this review is to review the historical development of heart centers for women and discuss the types of care they provide for women. RECENT FINDINGS Mortality rates from cardiovascular disease in women are finally reaching the levels of men after decades of focus on awareness, prevention, and evidence-based guideline-directed care for women. Heart centers for women have evolved to provide subspecialty and comprehensive care for women that includes education and research. Heart centers for women are partnering with many other disease-based and patient advocacy organizations to provide care for all women at all stages of life. Alarmingly, there has been increasing CVD mortality in both men and women recently.
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Affiliation(s)
- Gina P Lundberg
- Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Laxmi S Mehta
- Women's Cardiovascular Program, The Ohio State University, Columbus, OH, USA
| | - Annabelle S Volgman
- Rush Heart Center for Women, Rush University Medical Center, Chicago, IL, USA
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Humphries KH, Pilote L. Research in Women's Cardiovascular Health-Progress at Last? Can J Cardiol 2017; 34:349-353. [PMID: 29290365 DOI: 10.1016/j.cjca.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Karin H Humphries
- BC Center for Improved Cardiovascular Health, Vancouver, British Columbia, Canada.
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, Research Institute, McGill University Health Center, Montréal, Québec, Canada
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Shaw LJ, Blankstein R, Jacobs JE, Leipsic JA, Kwong RY, Taqueti VR, Beanlands RSB, Mieres JH, Flamm SD, Gerber TC, Spertus J, Di Carli MF. Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2017; 10:e000017. [PMID: 29242239 PMCID: PMC5926771 DOI: 10.1161/hci.0000000000000017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality.
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Shaw LJ, Pepine CJ, Xie J, Mehta PK, Morris AA, Dickert NW, Ferdinand KC, Gulati M, Reynolds H, Hayes SN, Itchhaporia D, Mieres JH, Ofili E, Wenger NK, Bairey Merz CN. Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine. J Am Coll Cardiol 2017; 70:373-388. [PMID: 28705320 DOI: 10.1016/j.jacc.2017.05.051] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 12/20/2022]
Abstract
The present review synthesizes evidence and discusses issues related to health care quality and equity for women, including minority population subgroups. The principle of "sameness" or women and men receiving equitable, high-quality care is a near-term target, but optimal population health cannot be achieved without consideration of the unique, gendered structural determinants of health and the development of unique care pathways optimized for women. The aim of this review is to promote enhanced awareness, develop critical thinking in sex and gender science, and identify strategic pathways to improve the cardiovascular health of women. Delineation of the components of high-quality health care, including a women-specific research agenda, remains a vital part of strategic planning to improve the lives of women at risk for or living with cardiovascular disease.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
| | | | - Joe Xie
- Emory University School of Medicine, Atlanta, Georgia
| | - Puja K Mehta
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Martha Gulati
- University of Arizona College of Medicine, Phoenix, Arizona
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Kander MC, Cui Y, Liu Z. Gender difference in oxidative stress: a new look at the mechanisms for cardiovascular diseases. J Cell Mol Med 2016; 21:1024-1032. [PMID: 27957792 PMCID: PMC5387169 DOI: 10.1111/jcmm.13038] [Citation(s) in RCA: 296] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022] Open
Abstract
Gender differences are present in many diseases and are especially prevalent in cardiovascular disease. Males tend to suffer from myocardial infarctions earlier than females, and a woman's risk of cardiovascular disease increases after menopause, suggesting a cardio-protective role of estrogen. However, hormone replacement therapy did not decrease the risk of cardiovascular disease in post-menopausal women; thus, other mechanisms may be involved besides estrogen. Oxidative stress plays an important role in the development of cardiovascular diseases such as coronary artery disease. Gender is also associated with differences in oxidative stress. Under physiological conditions, females appear to be less susceptible to oxidative stress. This may be due to the antioxidant properties of estrogen, gender differences in NADPH-oxidase activity or other mechanism(s) yet to be defined. This review strives to discuss gender differences in general terms followed by a more detailed examination of gender differences with oxidative stress and various associated diseases and the possible mechanisms underlying these differences.
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Affiliation(s)
- Melissa Christine Kander
- Davis Heart & Lung Research Institute and Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yuqi Cui
- Davis Heart & Lung Research Institute and Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zhenguo Liu
- Davis Heart & Lung Research Institute and Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Desai JR, Vazquez-Benitez G, Xu Z, Schroeder EB, Karter AJ, Steiner JF, Nichols GA, Reynolds K, Xu S, Newton K, Pathak RD, Waitzfelder B, Lafata JE, Butler MG, Kirchner HL, Thomas A, O'Connor PJ. Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study. Circ Cardiovasc Qual Outcomes 2016; 8:508-16. [PMID: 26307132 DOI: 10.1161/circoutcomes.115.001717] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates. METHODS AND RESULTS We conducted an observational cohort study from 2005 to 2011 among 1.25 million diabetic subjects and 1.25 million nondiabetic subjects from 11 health systems that participate in the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) DataLink. Annual rates (per 1000 person-years) of myocardial infarction/acute coronary syndrome (International Classification of Diseases-Ninth Revision, 410.0–410.91, 411.1–411.8), stroke (International Classification of Diseases-Ninth Revision, 430–432.9, 433–434.9), heart failure (International Classification of Diseases-Ninth Revision, 428–428.9), and all-cause mortality were monitored by diabetes mellitus (DM) status, age, sex, race/ethnicity, and a prior cardiovascular history. We observed significant declines in cardiovascular events and mortality rates in subjects with and without DM. However, there was substantial variation by age, sex, race/ethnicity, and prior cardiovascular history. Mortality declined from 44.7 to 27.1 (P<0.0001) for those with DM and cardiovascular disease (CVD), from 11.2 to 10.9 (P=0.03) for those with DM only, and from 18.9 to 13.0 (P<0.0001) for those with CVD only. Yet, in the [almost equal to]85% of subjects with neither DM nor CVD, overall mortality (7.0 to 6.8; P=0.10) and stroke rates (1.6–1.6; P=0.77) did not decline and heart failure rates increased (0.9–1.15; P=0.0005). CONCLUSIONS To sustain improvements in myocardial infarction, stroke, heart failure, and mortality, health systems that have successfully focused on care improvement in high-risk adults with DM or CVD must broaden their improvement strategies to target lower risk adults who have not yet developed DM or CVD.
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Gupta D, Hayes SN, Lewis S, Mieres JH, Shaw L, Wenger N. The X-Factor: Global Impact of Women in the Awareness and Management of Coronary Artery Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bravo K, Velarde GP. Ethnicity and coronary artery disease: the role of high-density lipoprotein - a change in paradigm. Expert Rev Cardiovasc Ther 2015; 13:923-31. [PMID: 26159553 DOI: 10.1586/14779072.2015.1065178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cardiovascular disease (CVD) is the number one killer of men and women across ethnic groups in the USA. Health disparities in CVD, especially coronary artery disease (CAD), are well documented in the diverse American population. Despite efforts taken toward reducing cardiovascular health disparities, there are still gaps in its diagnosis and management. Current risk assessment guidelines consider high high-density lipoprotein (HDL) levels a protective factor against CAD, although its significance across races remains poorly understood. Recent clinical trials focused on increasing HDL levels have been disappointing. In this article, the authors have explored the role of HDL in CAD, have analyzed its significance across gender and ethnic groups and have challenged the broad application of widely used HDL level cutoffs in CAD risk assessment tools across these vulnerable groups. The current evidence suggests a paradigm change from HDL quantity to quality and function in future CVD risk research. This may better explain why some ethnic minority groups with a seemingly more benign lipid profile experience a higher CAD burden.
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Affiliation(s)
- Katia Bravo
- Department of Internal Medicine - Rochester, University of Rochester, New York, NY, USA
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Ischemic Heart Disease in Women: a Nuclear Cardiology Latin America Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9322-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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