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Metlock FE, Kwapong YA, Evans C, Ouyang P, Vaidya D, Aryee EK, Nasir K, Mehta LS, Blumenthal RS, Douglas PS, Hall J, Commodore-Mensah Y, Sharma G. Design and rationale of the social determinants of the risk of hypertension in women of reproductive age (SAFE HEART) study: An American Heart Association research goes red initiative. Am Heart J 2024; 275:151-162. [PMID: 38862074 DOI: 10.1016/j.ahj.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/15/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Cardiovascular health literacy (CVHL) and social determinants of health (SDoH) play interconnected and critical roles in shaping cardiovascular health (CVH) outcomes. However, awareness of CVH risk has declined markedly, from 65% of women being aware that cardiovascular disease (CVD) is the leading cause of death for women in 2009 to just 44% being aware in 2019. The American Heart Association Research Goes Red (RGR) initiative seeks to develop an open-source, longitudinal, dynamic registry that will help women to be aware of and participate in research studies, and to learn about CVD prevention. We proposed to leverage this platform, particularly among Black and Hispanic women of reproductive age, to address CVHL gaps and advance health equity. METHODS The primary objective of the study is to evaluate the cross-sectional association of CVHL, SDoH using a polysocial score, and CVH in women of reproductive age at increased risk of developing hypertension (HTN). To achieve this we will use a cross-sectional study design, that engages women already enrolled in the RGR registry (registry-enrolled). To enhance the racial and ethnic/social economic diversity of the cohort, we will additionally enroll 300 women from the Baltimore and Washington D.C. community into the Social Determinants of the Risk of Hypertension in Women of Reproductive Age (SAFE HEART) Study. Community-enrolled and registry-enrolled women will undergo baseline social phenotyping including detailed SDoH questionnaire, CVH metrics assessment, and CVHL assessment. The secondary objective is to assess whether a 4-month active health education intervention will result in a change in CVHL in the 300 community-enrolled women. DISCUSSION The SAFE HEART study examines the association between CVHL, SDoH, and CVH, with a focus on racial and ethnic minority groups and socioeconomically disadvantaged women of reproductive age, and the ability to improve these parameters by an educational intervention. These findings will inform the future development of community-engaged strategies that address CVHL and SDoH among women of reproductive age.
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Affiliation(s)
| | - Yaa A Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD
| | - Crystal Evans
- Institute of Clinical and Translational Research, Johns Hopkins University School of Medicine
| | - Pamela Ouyang
- Institute of Clinical and Translational Research, Johns Hopkins University School of Medicine
| | | | - Ebenezer Kobbie Aryee
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD
| | | | | | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke School of Medicine, Durham, NC
| | | | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Garima Sharma
- Inova Health System, Falls Church, VA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD.
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Khalilian Ekrami N, Baron DK, Benjamin EJ, Mulder BA, Van Gelder IC, Rienstra M. Participation of women in clinical studies of atrial fibrillation in the Northern Netherlands. Neth Heart J 2024; 32:326-331. [PMID: 39105898 PMCID: PMC11335698 DOI: 10.1007/s12471-024-01887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Concerns exist of women underrepresentation in atrial fibrillation (AF) studies, potentially limiting the generalisability of study findings to women with AF. We assessed the participation of women in AF clinical studies performed at a tertiary care centre in the Northern Netherlands. METHODS Eight AF clinical studies with screening logs were available for analysis. To identify sex-specific differences, patient inclusion and exclusion and reasons for exclusion were assessed. Participation-to-prevalence ratios (PPRs) were calculated to evaluate the representation of women in the studies relative to the AF sex distribution of the general population in the Netherlands (2019 Global Burden of Disease study). RESULTS We included 1739 screened patients with AF in the analysis, of whom 722 (41.5%) were women. Of the patients screened, 161 (9%) were enrolled. Median age of screened patients was 69 years (interquartile range (IQR): 61-77), and women were older than men (71 years; IQR: 63-79 vs 68 years; IQR: 60-75; p < 0.001). Women were not underscreened compared with men (PPR: 1.09; 95% confidence interval (CI): 1.08-1.10), disproportionally excluded (92% vs 90%; p = 0.10) or less willing to participate (17% vs 15%; p = 0.36). Women had an overall PPR of 1.05 (95% CI: 1.05-1.06) compared with the general AF population. CONCLUSION At our tertiary hospital in the Northern Netherlands, women appeared to be well-represented in AF studies. The current study advocates for the adoption of a more comprehensive measure of equity, such as the PPR, and screening log evaluation to improve the generalisability of study findings to the entire clinical AF population.
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Affiliation(s)
- Neda Khalilian Ekrami
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dawid K Baron
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Centre, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Bart A Mulder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
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Nicholls SJ, Lam CSP, Nelson AJ. Cardiovascular Clinical Trials in the Asia-Pacific Region. JAMA 2024; 332:367-368. [PMID: 38949917 DOI: 10.1001/jama.2024.6313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
This Viewpoint discusses the potential challenges to the operational conduct of clinical trials in the Asia-Pacific region, where there is a high rate of cardiovascular disease, and provides possible solutions.
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Affiliation(s)
- Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore, Singapore
| | - Adam J Nelson
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
- University of Adelaide, Adelaide, South Australia, Australia
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Mattioli AV, Bucciarelli V, Gallina S. Teaching gender medicine can enhance the quality of healthcare. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 44:100418. [PMID: 39036011 PMCID: PMC11259991 DOI: 10.1016/j.ahjo.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/18/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
Teaching gender and sex differences is fundamental in medical classes because it has a strong impact in reducing disparity in treatment, in defining effective and personalized therapies that respect the different physiology and pathophysiology of women. Furthermore, it is the prerequisite for the pharmacoequity.
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Affiliation(s)
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
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Holtzman JN, Redberg RF. Prioritizing Women's Inclusion in Clinical Trials of Medical Devices. JAMA Intern Med 2024; 184:979-980. [PMID: 38856989 DOI: 10.1001/jamainternmed.2024.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
| | - Rita F Redberg
- Department of Medicine, University of California, San Francisco
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Landi A, Heg D, Frigoli E, Routledge H, Malik FTN, Pourbaix S, Alasnag M, Smits PC, Valgimigli M. Negative selection bias for women inclusion in a clinical trial. Int J Cardiol 2024; 408:132138. [PMID: 38705207 DOI: 10.1016/j.ijcard.2024.132138] [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: 02/21/2024] [Revised: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Despite the growing awareness towards the importance of adequate representation of women in clinical trials among patients treated with percutaneous coronary intervention (PCI), available evidence continues to demonstrate a skewed distribution of study populations in favour of men. METHODS AND RESULTS In this pre-specified analysis from the MASTER DAPT screening log and trial, we aimed to investigate the existence of a negative selection bias for women inclusion in a randomized clinical trial. A total of 2847 consecutive patients who underwent coronary revascularization across 65 participating sites, during a median of 14 days, were entered in the screening log, including 1749 (61.4%) non-high bleeding risk (HBR) and 1098 (38.6%) HBR patients, of whom 109 (9.9%) consented for trial participation. Female patients were less represented in consented versus non-consented HBR patients (22% versus 30%, absolute standardized difference: 0.18) and among non-consented eligible versus consented eligible patients (absolute standardized difference 0.14). The observed sex gap was primarily due investigators' choice not to offer study participation to females because deemed at very high risk of bleeding and/or ischemic complications, and only marginally to a slightly higher propensity of females compared to males to refuse study participation. CONCLUSIONS Female HBR patients undergoing PCI are less prevalent, but also less likely to participate in the trial than male patients, mainly due to investigators' preference.
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Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), CH-6900 Lugano, Switzerland; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Dik Heg
- Department of Clinical Research, University of Bern, Switzerland
| | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), CH-6900 Lugano, Switzerland
| | | | | | | | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), CH-6900 Lugano, Switzerland; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; University of Bern, Bern, Switzerland.
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Naser A, Puttur A, Saleh S, Ta'ani OA, Caudill A, Radhakrishnan A. Trends in female representation in cardiology and its subspecialties: The current state and the desired state. Curr Probl Cardiol 2024; 49:102617. [PMID: 38718932 DOI: 10.1016/j.cpcardiol.2024.102617] [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: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Women have been historically underrepresented in Cardiology and its subspecialties. However, limited research has been done to examine the trends of representation of women in cardiology and its subspecialties over time. Our study aims to examine these trends and compare them to other internal medicine subspecialties. METHODS We used data from the Accreditation Council for Graduate Medical Education (ACGME) to conduct a retrospective analysis of the gender trends of cardiology and its subspecialties over a decade from 2013 to 2023. Chi-square statistical testing was used to compare representation percentages across groups. A p-value <0.05 was considered statistically significant. RESULTS Compared to all internal medicine subspecialties, cardiology and its subspecialties continues to remain the least represented by women. We found a statistically significant increase in women's representation in cardiovascular disease and interventional cardiology. However, there was no statistically significant changes in the representation of women in electrophysiology and advanced heart failure. We have found over the last decade that there was a positive trend in overall women fellows choosing cardiology and its subspecialties, especially since 2018. CONCLUSION While strides have been made in increasing the number of female fellows in cardiology, it still lags compared to other internal medicine subspecialties. As we celebrate this minor milestone, it is crucial to emphasize the importance of persistently overcoming obstacles and fostering a supportive environment throughout all training phases to attract, retain, and mentor female trainees.
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Affiliation(s)
- Abdallah Naser
- Department of Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15222, USA.
| | - Anushree Puttur
- Department of Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15222, USA
| | - Saleh Saleh
- Department of Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15222, USA
| | - Omar Al Ta'ani
- Department of Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15222, USA
| | - Andrea Caudill
- Department of Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15222, USA
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Smereka Y, Ezekowitz JA. HFpEF and sex: understanding the role of sex differences. Can J Physiol Pharmacol 2024; 102:465-475. [PMID: 38447124 DOI: 10.1139/cjpp-2023-0403] [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: 03/08/2024]
Abstract
Heart failure is a complex clinical syndrome with many etiological factors and complex pathophysiology affecting millions worldwide. Males and females can have distinct clinical presentation and prognosis, and there is an emerging understanding of the factors that highlight the similarities and differences to synthesize and present available data for sex-specific differences in heart failure with preserved ejection fraction (HFpEF). While the majority of data demonstrate more similarities than differences between females and males in terms of heart failure, there are key differences. Data showed that females have a higher risk of developing HFpEF, but a lower risk of mortality and hospitalization. This can be conditioned by different profiles of comorbidities, postmenopausal changes in sex hormone levels, higher levels of inflammation and chronic microvascular dysfunction in females. These factors, combined with different left ventricular dimensions and function, which are more pronounced with age, lead to a higher prevalence of LV diastolic dysfunction at rest and exercise. As a result, females have lower exercise capacity and quality of life when compared to males. Females also have different activities of systems responsible for drug transformation, leading to different efficacy of drugs as well as higher risk of adverse drug reactions. These data prove the necessity for creating sex-specific risk stratification scales and treatment plans.
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Affiliation(s)
- Yuliia Smereka
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Edmonton, AB, Canada
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La Rovere MT, Gorini A. Bridging the gender gap in cardiovascular research: The role of cognitive biases in selection bias in clinical trials. Int J Cardiol 2024; 413:132347. [PMID: 39002801 DOI: 10.1016/j.ijcard.2024.132347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Affiliation(s)
| | - Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS, Milano Camaldoli, Italy; Dipartimento di Scienze Cliniche e di Comunità, Dipartimento di Eccellenza 2023-2027, Università degli Studi di Milano, Italy
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10
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Sandner S, Redfors B, An KR, Harik L, Heise R, Di Franco A, Fremes SE, Hare DL, Kulik A, Lamy A, Peper J, Ruel M, Ten Berg JM, Willemsen LM, Zhao Q, Zhu Y, Wojdyla DM, Bhatt DL, Alexander JH, Gaudino M. Coronary Artery Bypass Graft Failure in Women: Incidence and Clinical Implications. J Am Coll Cardiol 2024; 84:182-191. [PMID: 38960512 DOI: 10.1016/j.jacc.2024.04.046] [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: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Women have worse outcomes after coronary artery bypass surgery (CABG) than men. OBJECTIVES This study aimed to determine the incidence of CABG graft failure in women, its association with cardiac events, and whether it contributes to sex-related differences in outcomes. METHODS A pooled analysis of individual patient data from randomized clinical trials with systematic imaging follow-up was performed. Multivariable logistic regression models were used to assess the association of graft failure with myocardial infarction and repeat revascularization between CABG and imaging (primary outcome) and death after imaging (secondary outcome). Mediation analysis was performed to evaluate the effect of graft failure on the association between female sex and risk of death. RESULTS Seven randomized clinical trials (N = 4,413, 777 women) were included. At a median imaging follow-up of 1.03 years, graft failure was significantly more frequent among women than men (37.3% vs 32.9% at the patient-level and 20.5% vs 15.8% at the graft level; P = 0.02 and P < 0.001, respectively). In women, graft failure was associated with an increased risk of myocardial infarction and repeat revascularization (OR: 3.94; 95% CI: 1.79-8.67) and death (OR: 3.18; 95% CI: 1.73-5.85). Female sex was independently associated with the risk of death (direct effect, HR: 1.84; 95% CI: 1.35-2.50) but the association was not mediated by graft failure (indirect effect, HR: 1.04; 95% CI: 0.86-1.26). CONCLUSIONS Graft failure is more frequent in women and is associated with adverse cardiac events. The excess mortality risk associated with female sex among CABG patients is not mediated by graft failure.
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Affiliation(s)
- Sigrid Sandner
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Björn Redfors
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rachel Heise
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David L Hare
- Department of Cardiology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Kulik
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital, Boca Raton, Florida, USA
| | - Andre Lamy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Joyce Peper
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jurrien M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Laura M Willemsen
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Qiang Zhao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunpeng Zhu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daniel M Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - John H Alexander
- Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
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Sarma AA, Spitz JA. Sex Differences, Graft Failure, and Mortality: An Ounce of Prevention After the Pound of Cure. J Am Coll Cardiol 2024; 84:192-194. [PMID: 38960513 DOI: 10.1016/j.jacc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Amy A Sarma
- Massachusetts General Hospital, Boston Massachusetts, USA.
| | - Jared A Spitz
- Inova Schar Heart and Vascular, Fairfax, Virginia, USA
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Jones MM, Tangel V, White RS, Rong L. The IMPACT Score: Does Sex Matter? J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00442-7. [PMID: 39069380 DOI: 10.1053/j.jvca.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score is a quantitative risk index that predicts 1-year mortality risk, derived from United Network for Organ Sharing data in which women are underrepresented. The validity of the IMPACT score in 1-year mortality risk after OHT in women is unknown. The objective of this study was to assess differences in score performance by sex. We hypothesized that the IMPACT score is a poor predictor of 1-year mortality risk after orthotopic heart transplantation (OHT) in women. DESIGN In this external validation study, demographic and clinical characteristics were compared by sex. The IMPACT score was calculated and regression models were constructed for the entire sample and stratified by sex. Model discrimination was assessed with the area under the receiver operating characteristic curve, and calibration was assessed graphically. PARTICIPANTS Patients 18 years and older who were first-time single OHT recipients from the International Society for Heart and Lung Transplantation registry from 2009 to 2018. MEASUREMENTS AND MAIN RESULTS For 1-year mortality, the area under the receiver operating characteristic curve (95% confidence interval) for the full sample was 0.59 (0.57-0.60): 0.58 (0.55-0.61) for women and 0.59 (0.58-0.61) for men. The 1-year mortality was 9.4% in the overall cohort, with no difference in mortality by sex (9.0% v 9.6% women v men, p = 0.22). CONCLUSIONS The IMPACT score exhibited poor discrimination and calibration in the International Society for Heart and Lung Transplantation 2009-2019 cohort, overall and by sex. There was no difference in 1-year mortality between women and men.
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Affiliation(s)
- Mandisa-Maia Jones
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY.
| | - Virginia Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Robert S White
- Department of Anesthesiology, Division of Obstetric Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY
| | - Lisa Rong
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY
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Goel R, Sartori S, Vogel B, Okoli K, Franklin-Bedel K, Ortega R, Wang DD, Douglas PS, Wang TY, Mehran R. Geographic Mapping of Gender Disparities in Authorship of Cardiovascular Literature. J Am Coll Cardiol 2024; 83:2458-2468. [PMID: 38866449 DOI: 10.1016/j.jacc.2024.03.427] [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: 01/25/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Women in cardiology experience considerable gender disparities in publications, which hinders their career advancements to higher faculty and senior leadership positions. However, the extent of these disparities across different types of cardiovascular literature is not well understood. OBJECTIVES We investigated gender differences in authorship across various cardiovascular publications over a decade and examined geographic variations in the representation of women authors. METHODS All papers published from January 1, 2010, to December 31, 2019, in 4 major cardiovascular journals (Journal of the American College of Cardiology, European Heart Journal, Journal of the American Medical Association Cardiology, and Nature Reviews Cardiology) were reviewed. RESULTS Of the 18,535 papers with 111,562 authors, 20.6% of the authors were women, and 47.7% of the papers had no women authors. Over 10 years, the proportion of women authors remained low (20.7% in 2010 to 21.4% in 2019), with the lowest proportion in editorial papers (14.8%) and the highest in research papers (21.8%). More women as first (34.6%) and last (47.6%) authors were affiliated with institutions in the United States compared with other countries. The proportion of women middle-order authors was higher on papers with women as first authors (29.4% vs 20.5%) or last authors (30.6% vs 21.3%), compared with papers with men as first or last authors, respectively. CONCLUSIONS Over the past decade, the proportion of women authors across all article types in major cardiovascular journals remained low. A call to action is needed to promote women in cardiology and provide them with equitable opportunities.
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Affiliation(s)
- Ridhima Goel
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA; Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA
| | - Kimberly Okoli
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA
| | - Kayla Franklin-Bedel
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Ortega
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Pamela S Douglas
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tracy Y Wang
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School Medicine at Mount Sinai, New York, New York, USA.
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Spagnolo M, Capodanno D. Gender equality in medical research: A cardiology-informed examination. Am Heart J 2024; 272:113-115. [PMID: 38705638 DOI: 10.1016/j.ahj.2024.03.011] [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: 02/14/2024] [Revised: 03/16/2024] [Accepted: 03/16/2024] [Indexed: 05/07/2024]
Abstract
Despite a perceived increase in attention to gender differences in medicine, a comprehensive assessment of gender equality research, particularly in cardiology, remains underexplored. This observational retrospective study, focusing on documents related to "Gender Equality" according to the Sustainable Development Goals, reveals cardiology as a significant area for gender equality research, albeit with a decline in publications post-2018. The analysis highlighted a concentrated effort in the United States and a considerable impact gap between gender-focused and general cardiology research. The global academic community must intensify research into gender disparities, which is essential for achieving professional gender equality and addressing the burden of cardiovascular diseases.
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Affiliation(s)
- Marco Spagnolo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy.
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15
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McClain AK, Monteleone PP, Zoldan J. Sex in cardiovascular disease: Why this biological variable should be considered in in vitro models. SCIENCE ADVANCES 2024; 10:eadn3510. [PMID: 38728407 PMCID: PMC11086622 DOI: 10.1126/sciadv.adn3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
Cardiovascular disease (CVD), the world's leading cause of death, exhibits notable epidemiological, clinical, and pathophysiological differences between sexes. Many such differences can be linked back to cardiovascular sexual dimorphism, yet sex-specific in vitro models are still not the norm. A lack of sex reporting and apparent male bias raises the question of whether in vitro CVD models faithfully recapitulate the biology of intended treatment recipients. To ensure equitable treatment for the overlooked female patient population, sex as a biological variable (SABV) inclusion must become commonplace in CVD preclinical research. Here, we discuss the role of sex in CVD and underlying cardiovascular (patho)physiology. We review shortcomings in current SABV practices, describe the relevance of sex, and highlight emerging strategies for SABV inclusion in three major in vitro model types: primary cell, stem cell, and three-dimensional models. Last, we identify key barriers to inclusive design and suggest techniques for overcoming them.
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Affiliation(s)
- Anna K. McClain
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78751, USA
| | - Peter P. Monteleone
- Ascension Texas Cardiovascular, Austin, TX 78705, USA
- Dell School of Medicine, The University of Texas at Austin, Austin, TX 78712, USA
| | - Janet Zoldan
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78751, USA
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16
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Satish P, Avenatti E, Patel J, Agarwala A. Understanding the spectrum of cardiovascular risk in women - A primer for prevention. Prog Cardiovasc Dis 2024; 84:34-42. [PMID: 38710313 DOI: 10.1016/j.pcad.2024.05.003] [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: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.
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Affiliation(s)
- Priyanka Satish
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Eleonora Avenatti
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA.
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17
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Tucker B, Goonetilleke N, Patel S, Keech A. Colchicine in atherosclerotic cardiovascular disease. Heart 2024; 110:618-625. [PMID: 38331560 DOI: 10.1136/heartjnl-2023-323177] [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: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
Inflammation has a direct role in the development of atherosclerotic vascular disease, and oral colchicine displays broad anti-inflammatory properties. Several large, randomised controlled trials (RCTs) have evaluated colchicine's impact on cardiovascular outcomes. Results from a meta-analysis of these trials demonstrate that colchicine reduces the risk of recurrent major adverse cardiovascular events (MACEs) by 25%, leading to its recent approval by the Food and Drug Administration for the treatment and prevention of cardiovascular disease. Despite this, colchicine has not been shown to confer any survival benefit in these trials. The non-significant reduction in cardiovascular death of 18% (95% CI: 45% decrease to 23% increase) is outweighed by a more prominent, borderline non-significant increase in the risk of non-cardiovascular death by 38% (95% CI: 1% decrease to 92% increase). Key populations including those with heart failure, those undergoing surgical revascularisation, women, elderly individuals and non-Caucasians are under-represented in completed trials, which limits generalisability. C reactive protein has been proposed as a biomarker for colchicine response and shows promise for identifying a high-risk population where the benefit on MACE reduction and specifically reduced cardiovascular death might outweigh any real increased risk of non-cardiovascular death; however, this approach is still to be validated in ongoing RCTs. In conclusion, while colchicine shows promise in reducing MACE, its net risk-benefit profile requires further elucidation before its widespread adoption into clinical practice for the secondary prevention of atherosclerotic cardiovascular disease. Much more large-scale, long-term trial data are still needed in this space.
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Affiliation(s)
- Bradley Tucker
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Sanjay Patel
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anthony Keech
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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18
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Prichard R, Maneze D, Straiton N, Inglis SC, McDonagh J. Strategies for improving diversity, equity, and inclusion in cardiovascular research: a primer. Eur J Cardiovasc Nurs 2024; 23:313-322. [PMID: 38190724 DOI: 10.1093/eurjcn/zvae002] [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: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
This paper aims to empower cardiovascular (CV) researchers by promoting diversity, equity, and inclusion (DE&I) principles throughout the research cycle. It defines DE&I and introduces practical strategies for implementation in recruitment, retention, and team dynamics within CV research. Evidence-based approaches supporting underrepresented populations' participation are outlined for each research phase. Emphasizing the significance of inclusive research environments, the paper offers guidance and resources. We invite CV researchers to actively embrace DE&I principles, enhancing research relevance and addressing longstanding CV health disparities.
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Affiliation(s)
- Roslyn Prichard
- Faculty of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556 Queensland, Australia
| | - Della Maneze
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicola Straiton
- St Vincent's Health Network, Nursing Research Institute, Australian Catholic University, Sydney, New South Wales, Australia
| | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Julee McDonagh
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Chronic and Complex Care Research, Blacktown Hospital, Blacktown, New South Wales, Australia
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19
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Metcalfe A, Stephenson N, Cairncross ZF, Scime NV, Fidler‐Benaoudia M. Exclusion of pregnant and lactating persons from breast cancer clinical trials: a review of active trials registered on ClinicalTrials.gov. Acta Obstet Gynecol Scand 2024; 103:707-715. [PMID: 37377224 PMCID: PMC10993330 DOI: 10.1111/aogs.14599] [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: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Treatment of pregnancy-associated breast cancer is complex, as providers try to balance risks to the pregnant person and the developing fetus. Given increased case fatality and increasing incidence, there is a pressing need understand the efficacy and safety of different treatment regimens in this population; however, pregnant and lactating people have traditionally been excluded from participating in randomized controlled trials (RCTs). Given recent efforts to expand the inclusion criteria for oncology RCTs, this study aimed to review the inclusion/exclusion criteria of current breast cancer RCTs to assess what proportion of trials permitted enrollment of pregnant and lactating persons. MATERIAL AND METHODS We conducted a comprehensive search of ClinicalTrials.gov in January 2022 to identify interventional studies of breast cancer in adults that were actively recruiting. The primary outcomes were the exclusion of pregnant and lactating people. RESULTS The search identified 1706 studies, of which 1451 met eligibility criteria. Overall, 69.4% and 54.8% of studies excluded pregnant and lactating people, respectively. The exclusion of pregnant and lactating persons differed by study characteristics but extended across all trial designs, locations, phases and interventions. Exclusion of pregnant and lactating persons was most common in trials where the intervention was biological (86.3%), drug (83.5%) or radiation (81.5%). CONCLUSIONS The exclusion of pregnant and lactating people from clinical trials contributes to evidence gaps in how to treat this population. A paradigm shift is needed that focuses on how research can be used to protect pregnant people from future harms, instead of protecting pregnant people from research-related risks.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and GynaecologyUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
- Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Nikki Stephenson
- Department of Obstetrics and GynaecologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Zoe F. Cairncross
- Department of Obstetrics and GynaecologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Natalie V. Scime
- Department of Health & SocietyUniversity of Toronto ScarboroughTorontoOntarioCanada
| | - Miranda Fidler‐Benaoudia
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health ServicesCalgaryAlbertaCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
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20
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Lau ES, Aggarwal NR, Briller JE, Crousillat DR, Economy KE, Harrington CM, Lindley KJ, Malhamé I, Mattina DJ, Meng ML, Mohammed SF, Quesada O, Scott NS. Recommendations for the Management of High-Risk Cardiac Delivery: ACC Cardiovascular Disease in Women Committee Panel. JACC. ADVANCES 2024; 3:100901. [PMID: 38939671 PMCID: PMC11198580 DOI: 10.1016/j.jacadv.2024.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 06/29/2024]
Abstract
Maternal mortality is a major public health crisis in the United States. Cardiovascular disease (CVD) is a leading cause of maternal mortality and morbidity. Labor and delivery is a vulnerable time for pregnant individuals with CVD but there is significant heterogeneity in the management of labor and delivery in high-risk patients due in part to paucity of high-quality randomized data. The authors have convened a multidisciplinary panel of cardio-obstetrics experts including cardiologists, obstetricians and maternal fetal medicine physicians, critical care physicians, and anesthesiologists to provide a practical approach to the management of labor and delivery in high-risk individuals with CVD. This expert panel will review key elements of management from mode, timing, and location of delivery to use of invasive monitoring, cardiac devices, and mechanical circulatory support.
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Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniela R. Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Colleen M. Harrington
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Selma F. Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Odayme Quesada
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - ACC Cardiovascular Disease in Women Committee
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
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21
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Anastasi JK, Capili B, Norton M, McMahon DJ, Marder K. Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations. FRONTIERS IN PAIN RESEARCH 2024; 4:1330937. [PMID: 38606348 PMCID: PMC11006977 DOI: 10.3389/fpain.2023.1330937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024] Open
Abstract
This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.
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Affiliation(s)
- Joyce K. Anastasi
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Bernadette Capili
- Heilbrunn Family Center for Research Nursing, The Rockefeller University, New York, NY, United States
| | - Margaret Norton
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
- Department of Nursing, St. Joseph's University, Brooklyn, NY, United States
| | - Donald J. McMahon
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Karen Marder
- Irving Medical Center, Columbia University, New York, NY, United States
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22
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Mendieta G, Zannad F. Strategies for rejuvenating clinical trialists' leadership. Eur Heart J 2024; 45:864-866. [PMID: 38190316 DOI: 10.1093/eurheartj/ehad851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Affiliation(s)
- Guiomar Mendieta
- Servei de Cardiologia, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, c/Villarroel 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c/del Rosselló 149, 08036 Barcelona, Spain
| | - Faiez Zannad
- Centre d'Investigation Clinique-Plurithématique Inserm 1433, Centre Hospitalier Regional Universitaire, Université de Lorraine, 4, rue du Morvan 54500 Vandoeuvre les Nancy, Nancy Brabois, France
- Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 4, rue du Morvan 54500 Vandoeuvre les Nancy, Nancy, France
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23
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Matthews S, Cook S, Clayton T, Murray S, Wynne R, Sanders J. Factors affecting women's participation in cardiovascular research: a scoping review. Eur J Cardiovasc Nurs 2024; 23:107-114. [PMID: 37201192 DOI: 10.1093/eurjcn/zvad048] [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] [Received: 10/03/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
AIMS Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies. METHODS AND RESULTS Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate.From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention. CONCLUSION This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women's participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women's participation in cardiovascular research. REGISTRATION The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.
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Affiliation(s)
- Stacey Matthews
- National Heart Foundation of Australia, 850 Collins Street, Melbourne VIC 3000, Australia
- Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia
| | - Samantha Cook
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Tim Clayton
- Department of Medical Statistics, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sarah Murray
- Society of Cardiothoracic Surgery of Great Britain and Ireland, London WC2A 3PE, UK
| | - Rochelle Wynne
- Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong, NSW 2522, Australia
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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24
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Elscot JJ, Kakar H, Dekker WKD, Bennett J, Sabaté M, Esposito G, Daemen J, Boersma E, Van Mieghem NM, Diletti R. Complete Revascularization Strategies in Women and Men With Acute Coronary Syndrome and Multivessel Disease. Am J Cardiol 2024; 214:25-32. [PMID: 38163579 DOI: 10.1016/j.amjcard.2023.12.044] [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: 10/16/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
This prespecified substudy of the randomized Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndromes and Multivessel Disease (BIOVASC) trial aimed to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients with acute coronary syndrome and multivessel disease, stratified by gender. The primary end point consisted of a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events at 1-year follow-up. The secondary end points included the individual components of the primary composite and major bleedings. We used Cox regression models to relate randomized treatment with study end points. We evaluated the multiplicative and additive interactions between gender and randomized treatment. The BIOVASC trial enrolled 338 women and 1,187 men. Women were older than men (median age 71.6 vs 63.7 years, p <0.001) and had a higher prevalence of chronic obstructive pulmonary disease (10.1% vs 5.6%, p = 0.003), renal insufficiency (7.7% vs 4.4%, p = 0.015), and hypertension (60.4% vs 51.7%, p = 0.005). In women, the composite primary outcome occurred in 7.3% versus 12.9% (hazard ratio 0.53, 95% confidence interval 0.26 to 1.08) in patients randomly allocated to ICR and SCR, respectively, and in men in 7.7% versus 8.4% (hazard ratio 0.89, 95% confidence interval 0.60 to 1.34), with no evidence of a differential effect (interaction pmultiplicative = 0.20, padditive = 0.87). No evidence of heterogeneity between women and men was found when comparing ICR with SCR in terms of the secondary outcomes. In conclusion, no differential treatment effect was found when comparing ICR versus SCR in women or men presenting with acute coronary syndrome and multivessel disease.
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Affiliation(s)
- Jacob J Elscot
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Hala Kakar
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Wijnand K den Dekker
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | - Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Joost Daemen
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Eric Boersma
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Roberto Diletti
- Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands.
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25
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Lindsey ML, Usselman CW, Ripplinger CM, Carter JR, DeLeon-Pennell KY. Sex as a biological variable for cardiovascular physiology. Am J Physiol Heart Circ Physiol 2024; 326:H459-H469. [PMID: 38099847 PMCID: PMC11219053 DOI: 10.1152/ajpheart.00727.2023] [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: 11/20/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 02/03/2024]
Abstract
There have been ongoing efforts by federal agencies and scientific communities since the early 1990s to incorporate sex and/or gender in all aspects of cardiovascular research. Scientific journals provide a critical function as change agents to influence transformation by encouraging submissions for topic areas, and by setting standards and expectations for articles submitted to the journal. As part of ongoing efforts to advance sex and gender in cardiovascular physiology research, the American Journal of Physiology-Heart and Circulatory Physiology recently launched a call for papers on Considering Sex as a Biological Variable. This call was an overwhelming success, resulting in 78 articles published in this collection. This review summarizes the major themes of the collection, including Sex as a Biological Variable Within: Endothelial Cell and Vascular Physiology, Cardiovascular Immunity and Inflammation, Metabolism and Mitochondrial Energy, Extracellular Matrix Turnover and Fibrosis, Neurohormonal Signaling, and Cardiovascular Clinical and Epidemiology Assessments. Several articles also focused on establishing rigor and reproducibility of key physiological measurements involved in cardiovascular health and disease, as well as recommendations and considerations for study design. Combined, these articles summarize our current understanding of sex and gender influences on cardiovascular physiology and pathophysiology and provide insight into future directions needed to further expand our knowledge.
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Affiliation(s)
- Merry L Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, United States
- Research Service, Nashville Veterans Affairs Medical Center, Nashville, Tennessee, United States
| | - Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Crystal M Ripplinger
- Department of Pharmacology, UC Davis School of Medicine, Davis, California, United States
| | - Jason R Carter
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States
| | - Kristine Y DeLeon-Pennell
- Division of Cardiology, Department of Medicine, School of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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Clancy CE, Parkash R, Shah M, Tedrow U. Empowering Women in Electrophysiology: Insights on National Women's Heart Day. JACC Clin Electrophysiol 2024; 10:189-192. [PMID: 38310490 DOI: 10.1016/j.jacep.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Affiliation(s)
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maully Shah
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Usha Tedrow
- Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Sheikh H, Walczak N, Rana H, Tseng NW, Syed MK, Collier C, Rezk M, Gong IY, Tan NS, Ali SH, Yan AT, Randhawa VK, Banks L. Temporal Trends of Enrollment by Sex and Race in Major Cardiovascular Randomized Clinical Trials. CJC Open 2024; 6:454-462. [PMID: 38487060 PMCID: PMC10935985 DOI: 10.1016/j.cjco.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024] Open
Abstract
Background Women and racialized minorities continue to be underrepresented in cardiovascular (CV) trial outcomes data, despite comprising a significant global burden of CV disease. This study evaluated the impact of trial characteristics on the temporal enrollment of women and racialized minorities in prominent CV trials published in the period 1986-2023. Methods MEDLINE was searched for CV trials published in The Lancet, the Journal of the American Medical Association, and the New England Journal of Medicine. Participant and investigator demographics, types of interventions, clinical indications, and funding sources were compared according to the enrollment of women or racialized minorities. Results From 799 studies, including 4,071,921 patients, the enrollment of women and racialized minorities significantly increased from 1986 to 2023 (both P ≤ 0.001). Although the enrollment of women varied by trial indication, comprising 25.0% of coronary artery disease, 35.2% of noncoronary and/or vascular disease, 13.8% of heart failure, 17.0% of arrhythmia, and 28.7% of other CV trials (P ≤ 0.001), it did not differ by peer-reviewed vs industry funding. First authors who were women were more likely than first authors who were men to enroll significantly more women (P = 0.01). Conclusions Active efforts to increase diverse enrollment, along with improved reporting, including of sex and race, in future CV trials may increase the generalizability of their findings and applicability to global populations.
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Affiliation(s)
- Hassan Sheikh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Walczak
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Haaris Rana
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas W.H. Tseng
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad K. Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Chris Collier
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Moemin Rezk
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Inna Y. Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nigel S. Tan
- Division of Cardiology, Niagara Health System, Niagara, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sammy H. Ali
- Department of Medicine, St Mary’s General Hospital, Toronto, Ontario, Canada
| | - Andrew T. Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Terrence Donnelly Heart Centre, St. Michael’s Hospital, Kitchener, Ontario, Canada
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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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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Gonzalez-Franco J, Caicedo-Espinosa J, Cardona-Tobon C, Jaramillo-Jara N, Aguilar-Molina O, Jaimes-Barragan FA, Saldarriaga-Giraldo CI. Application of eligibility criteria from DAPA-HF, EMPEROR-Reduced, and PARADIGM-HF trials to a population with heart failure with reduced ejection fraction at a specialized cardiology Clinic in Medellin, Colombia: A retrospective cohort study. Curr Probl Cardiol 2024; 49:102193. [PMID: 37952788 DOI: 10.1016/j.cpcardiol.2023.102193] [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: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The evidence supporting pharmacological heart failure treatment relies on randomized clinical trials with stringent inclusion and exclusion criteria. OBJECTIVES Assess the eligibility of outpatients with chronic heart failure for the trials DAPA-HF, EMPEROR-reduced, and PARADIGM-HF, while exploring potential differences among study populations. METHODS By reviewing medical records, we determined the eligibility rate for each study and evaluated the incidence of heart failure hospitalizations and all-cause mortality during this period. RESULTS A total of 446 patients were included in the cohort. Approximately 75% would be ineligible for the trials, mainly because of their comorbidities. Ineligible patients had a higher all-cause mortality, but a similar incidence of hospitalization. CONCLUSION Approximately 1 in 4 patients from a heart failure clinic in Medellin, Colombia would meet the eligibility criteria for the DAPA-HF, EMPEROR-reduced, and PARADIGM-HF trials. These findings highlight the need to complement randomized clinical trials with real-world data.
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Affiliation(s)
- Juliana Gonzalez-Franco
- Department of Internal Medicine, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia.
| | - Javier Caicedo-Espinosa
- Department of Internal Medicine, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | | | - Natalia Jaramillo-Jara
- Department of Internal Medicine, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Clara-Ines Saldarriaga-Giraldo
- CardioVID Clinic, Medellín, Colombia; Department of Internal Medicine, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
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Vidal GA, Chalela P, Curry AN, El-Rayes B, Halmos B, Herrera AF, Kapoor KG, Kaur S, Mahadevan D, Mesa R, Ramirez A, Sleckman B, Wagner AL, Bhagat R, Brown I, Cruz L, Funwie A, Highsmith Q, Richie N, McKenzie M. Advancing Inclusive Research (AIR) Site Alliance: Facilitating the inclusion of historically underrepresented people in oncology and ophthalmology clinical research. Contemp Clin Trials 2024; 137:107416. [PMID: 38109966 DOI: 10.1016/j.cct.2023.107416] [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: 08/24/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The Advancing Inclusive Research (AIR) Site Alliance is composed of clinical research centers that partner with Genentech, a biotechnology company, to advance the representation of diverse patient populations in its oncology and ophthalmology clinical trials, test recruitment, and retention approaches and establish best practices to leverage across the industry to achieve health equity. METHODS Through a data-driven selection process, Genentech identified 6 oncology and 3 ophthalmology partners that focus on reaching historically underrepresented patients in clinical trials and worked collaboratively to share knowledge and explore original ways of increasing clinical study access for every patient, including sites co-creation of a Protocol Entry Criteria Guideline with inclusion principles. RESULTS For patients, three publicly available educational videos about clinical trials were created in multiple languages. The AIR Site Alliance has also defined invoiceable services for sites to enhance patient support; this has been built into the new study budget templates for sustainability. For healthcare professionals (HCPs), the first-of-its-kind AIR Educational Program was developed to focus on identifying and addressing bias and engaging historically underrepresented patient populations in trials. The sites also co-created videos for HCPs and patients on why advancing inclusive research matters. Over 16 regional health equity symposia have been delivered for patients, HCPs, and community leaders. CONCLUSIONS This AIR Site Alliance is a model for other site alliances, including Kenya, South Africa, the United Kingdom, and Canada. Such alliances will build a robust and sustainable research ecosystem that includes diverse patient groups and encourages change across the healthcare system.
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Affiliation(s)
- Gregory A Vidal
- West Cancer Center & Research Institute, Germantown, TN, USA.
| | - Patricia Chalela
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Andrea N Curry
- West Cancer Center & Research Institute, Germantown, TN, USA
| | - Bassel El-Rayes
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
| | | | - Alex F Herrera
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Supreet Kaur
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Daruka Mahadevan
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Amelie Ramirez
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Barry Sleckman
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
| | | | - Ruma Bhagat
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Leia Cruz
- Genentech, Inc., South San Francisco, CA, USA
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Goldstein KM, Kung LCY, Dailey SA, Kroll-Desrosiers A, Burke C, Shepherd-Banigan M, Lumsden R, Sims C, Schexnayder J, Patel D, Cantrell S, Sheahan KL, Gierisch JM. Strategies for enhancing the representation of women in clinical trials: an evidence map. Syst Rev 2024; 13:2. [PMID: 38166994 PMCID: PMC10759390 DOI: 10.1186/s13643-023-02408-w] [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: 04/21/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Equitable sex- and gender-based representation in clinical trials is an essential step to ensuring evidence-based care for women. While multi-institutional actions have led to significant improvements in the inclusion of women in trials, inequity persists in areas like sex-neutral cancers and cardiovascular disease. We sought to identify strategies described or evaluated to boost the inclusion of women in clinical trials. METHODS We used evidence mapping methodology to examine the breadth of relevant literature. We developed an a priori protocol and followed reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis where applicable. We searched MEDLINE® (via PubMed) and EMBASE (via Elsevier) databases from inception through April 4, 2023, and used standardized procedures incorporating duplication and data verification. We included articles that described strategies to improve the recruitment and retention of women in clinical trials. RESULTS We identified 122 articles describing recruitment and retention strategies for 136 trials (377,595 women). Only one article distinguished between the sex and gender identity of participants, and none defined their use of the terms such as "women" or "female". The majority of articles (95%) described recruitment for only women, and 64% were conducted in the USA. Ninety-two articles (75%) described strategies in the context of sex-specific conditions (e.g., gynecologic diagnosis). The majority of included articles evaluated a behavioral intervention (52%), with 23% evaluating pharmacologic interventions and 4% invasive interventions. The most common trial phase for reported strategies was during outreach to potential participants (116 articles), followed by intervention delivery (76), enrollment (40), outcomes assessment (21), analysis and interpretation (3), and dissemination (4). We describe specific types of strategies within each of these phases. CONCLUSIONS Most of the existing literature describing strategies to improve the inclusion of women draws from trials for sex-specific conditions and is largely related to outreach to potential participants. There is little information about how and if studies have attempted to proportionally increase the inclusion of women in trials with both men and women or those focused on invasive and pharmacologic interventions. Future work in this area should focus on how to increase the participation of women in mixed-sex studies and on those areas with remaining inequities in trial participation.
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Affiliation(s)
- Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Lindsay Chi Yan Kung
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Susan Alton Dailey
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, 421 North Main Street, Leeds, MA, 01053, USA
- UMass Chan Medical School, 55 Lake Ave. N, Worcester, MA, 01655, USA
| | - Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Rebecca Lumsden
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Catherine Sims
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Duke Rheumatology Division, 40 Duke Medicine Circle Clinic 1j, Durham, NC, 27710, USA
| | - Julie Schexnayder
- University of Alabama at Birmingham School of Nursing, NB545 1720 2nd, Ave S, Birmingham, AL, 35294, USA
| | - Dhara Patel
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Duke University School of Medicine 10 Searle Drive, Durham, NC, 27710, USA
| | | | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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Ekpo E, Balla S, Ngo S, Witting C, Sarraju A, Furst A, Rodriguez F. Underrepresentation of Women in Reduced Ejection Heart Failure Clinical Trials With Improved Mortality or Hospitalization. JACC. ADVANCES 2024; 3:100743. [PMID: 38405270 PMCID: PMC10890822 DOI: 10.1016/j.jacadv.2023.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), influence current guidelines for therapy. OBJECTIVES The authors evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF. METHODS We queried Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). A PPR of 0.8 to 1.2 was considered representative. RESULTS The final analysis included 33 RCTs. Women represented only 23.2% of all enrolled participants (n = 24,366/104,972), ranging from 11.4% to 40.1% per trial. Overall PPR was 0.58, with per-trial PPR estimates ranging from 0.29 to 1.00. Only 5 trials (15.2%) had a PPR of women representative of the disease population. Representation did not change significantly over time. The proportion of women in North American trials was significantly greater than trials conducted in Europe (P = 0.03). The proportion of women was greater in industry trials compared to government-funded trials (P = 0.05). CONCLUSIONS Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits and influence current guidelines. Representation is key to further delineation of sex-specific differences in major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.
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Affiliation(s)
- Eson Ekpo
- Department of Cardiovascular Medicine, Scripps Clinic, La Jolla, California, USA
| | - Sujana Balla
- Department of Internal Medicine, University of California-San Francisco, Fresno, California, USA
| | - Summer Ngo
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Celeste Witting
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adam Furst
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Palo Alto Veterans Institute for Research (PAVIR), Palo Alto, California, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
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Usselman CW, Lindsey ML, Robinson AT, Habecker BA, Taylor CE, Merryman WD, Kimmerly D, Bender JR, Regensteiner JG, Moreau KL, Pilote L, Wenner MM, O'Brien M, Yarovinsky TO, Stachenfeld NS, Charkoudian N, Denfeld QE, Moreira-Bouchard JD, Pyle WG, DeLeon-Pennell KY. Guidelines on the use of sex and gender in cardiovascular research. Am J Physiol Heart Circ Physiol 2024; 326:H238-H255. [PMID: 37999647 PMCID: PMC11219057 DOI: 10.1152/ajpheart.00535.2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
In cardiovascular research, sex and gender have not typically been considered in research design and reporting until recently. This has resulted in clinical research findings from which not only all women, but also gender-diverse individuals have been excluded. The resulting dearth of data has led to a lack of sex- and gender-specific clinical guidelines and raises serious questions about evidence-based care. Basic research has also excluded considerations of sex. Including sex and/or gender as research variables not only has the potential to improve the health of society overall now, but it also provides a foundation of knowledge on which to build future advances. The goal of this guidelines article is to provide advice on best practices to include sex and gender considerations in study design, as well as data collection, analysis, and interpretation to optimally establish rigor and reproducibility needed to inform clinical decision-making and improve outcomes. In cardiovascular physiology, incorporating sex and gender is a necessary component when optimally designing and executing research plans. The guidelines serve as the first guidance on how to include sex and gender in cardiovascular research. We provide here a beginning path toward achieving this goal and improve the ability of the research community to interpret results through a sex and gender lens to enable comparison across studies and laboratories, resulting in better health for all.
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Affiliation(s)
- Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Merry L Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, United States
- Research Service, Nashville Veterans Affairs Medical Center, Nashville, Tennessee, United States
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama, United States
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry and Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Chloe E Taylor
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - W David Merryman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - Derek Kimmerly
- Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey R Bender
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, New Haven, Connecticut, United States
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Judith G Regensteiner
- Divisions of General Internal Medicine and Cardiology, Department of Medicine, Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Kerrie L Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Megan M Wenner
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Myles O'Brien
- School of Physiotherapy and Department of Medicine, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timur O Yarovinsky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, New Haven, Connecticut, United States
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nina S Stachenfeld
- John B. Pierce Laboratory, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Quin E Denfeld
- School of Nursing and Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Jesse D Moreira-Bouchard
- Q.U.E.E.R. Lab, Programs in Human Physiology, Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - W Glen Pyle
- IMPART Team Canada Network, Dalhousie Medicine, Saint John, New Brunswick, Canada
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kristine Y DeLeon-Pennell
- School of Medicine, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [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: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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Galema-Boers AMH, Mulder JWCM, Steward K, Roeters van Lennep JE. Sex differences in efficacy and safety of PCSK9 monoclonal antibodies: A real-world registry. Atherosclerosis 2023; 384:117108. [PMID: 37059655 DOI: 10.1016/j.atherosclerosis.2023.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin 9 monoclonal antibodies (PCSK9 mAbs) reduce low-density lipoprotein (LDL-c) with a favourable safety profile. Available data from PCSK9 antibody trials suggest LDL-c reduction is lower in women compared to men. Data in real-world setting is scarce. The aim of this study was to assess sex differences in efficacy and safety of PCSK9 antibodies in clinical care. METHODS All patients starting with evolocumab or alirocumab in our lipid clinic were included in a prospective registry. We collected clinical information, including baseline and follow-up mean LDL-C levels after initiation of PCSK9 mAbs treatment. In addition, side effects and PCSK9 mAbs discontinuation were recorded. RESULTS We analysed 436 patients (209 women), mean age 58 ± 11 years. Women had higher baseline LDL-c levels compared to men (4.7 ± 1.6 mmol/L vs 4.1 ± 1.4 mmol/L, p < 0.01). PCSK9 mAbs resulted in less relative LDL-c reduction in women compared to men (50% vs 61% p<0.01), but equal absolute LDL-c reduction (respectively 2.3 ± 1.3 mmol/L vs 2.5 ± 1.1 mmol/L, p = 0.087). Women less often reached LDL-c target levels than men (50% vs 72%). No sex differences were observed in reporting of side effects (women 32% vs men 27% p = 0.26) or PCSK9 mAbs discontinuation (women 13% vs men 10%, p = 0.46). CONCLUSIONS In clinical practice, PCSK9 mAbs are less effective in reducing LDL-c levels in women compared to men and equally safe, implying the importance of sex differences in PCSK9 metabolism.
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Affiliation(s)
| | - Janneke W C M Mulder
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kim Steward
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Benedek T, Wieske V, Szilveszter B, Kofoed KF, Donnelly P, Rodriguez-Palomares J, Erglis A, Veselka J, Šakalytė G, Ađić NČ, Gutberlet M, Diez I, Davis G, Zimmermann E, Kępka C, Vidakovic R, Francone M, Ilnicka-Suckiel M, Plank F, Knuuti J, Faria R, Schröder S, Berry C, Saba L, Ruzsics B, Rieckmann N, Kubiak C, Schultz Hansen K, Müller-Nordhorn J, Merkely B, Sigvardsen PE, Benedek I, Orr C, Valente FX, Zvaigzne L, Horváth M, Jankauskas A, Ađić F, Woinke M, Mulvihill N, Lecumberri I, Thwaite E, Laule M, Kruk M, Stefanovic M, Mancone M, Kuśmierz D, Feuchtner G, Pietilä M, Ribeiro VG, Drosch T, Delles C, Melis M, Fisher M, Boussoussou M, Kragelund C, Aurelian R, Kelly S, Garcia del Blanco B, Rubio A, Károlyi M, Hove JD, Rodean I, Regan S, Calabria HC, Gellér L, Larsen L, Hodas R, Napp AE, Haase R, Feger S, Mohamed M, Serna-Higuita LM, Neumann K, Dreger H, Rief M, Danesh J, Estrella M, Bosserdt M, Martus P, Dodd JD, Dewey M. Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. Diabetes Care 2023; 46:2015-2023. [PMID: 37725834 PMCID: PMC10879471 DOI: 10.2337/dc23-0710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain. RESEARCH DESIGN AND METHODS This prespecified analysis of the multicenter DISCHARGE trial in 16 European countries was performed in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary end point was a major adverse cardiac event (MACE) (cardiovascular death, nonfatal myocardial infarction, or stroke), and the secondary end point was expanded MACE (including transient ischemic attacks and major procedure-related complications). RESULTS Follow-up at a median of 3.5 years was available in 3,541 patients of whom 557 (CT group n = 263 vs. ICA group n = 294) had diabetes and 2,984 (CT group n = 1,536 vs. ICA group n = 1,448) did not. No statistically significant diabetes interaction was found for MACE (P = 0.45), expanded MACE (P = 0.35), or major procedure-related complications (P = 0.49). In both patients with and without diabetes, the rate of MACE did not differ between CT and ICA groups. In patients with diabetes, the expanded MACE end point occurred less frequently in the CT group than in the ICA group (3.8% [10 of 263] vs. 8.2% [24 of 294], hazard ratio [HR] 0.45 [95% CI 0.22-0.95]), as did the major procedure-related complication rate (0.4% [1 of 263] vs. 2.7% [8 of 294], HR 0.30 [95% CI 0.13 - 0.63]). CONCLUSIONS In patients with diabetes referred for ICA for the investigation of stable chest pain, a CT-first strategy compared with an ICA-first strategy showed no difference in MACE and may potentially be associated with a lower rate of expanded MACE and major procedure-related complications.
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Affiliation(s)
- Theodora Benedek
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
- County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania
| | - Viktoria Wieske
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Klaus F. Kofoed
- Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
- Department of Radiology, Copenhagen University Hospital–Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Donnelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, U.K
| | - José Rodriguez-Palomares
- Department of Cardiology, Hospital Universitario Vall d’Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, CIBERCV, Madrid, Spain
| | - Andrejs Erglis
- Department of Cardiology, Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic
| | - Gintarė Šakalytė
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Cardiology Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nada Čemerlić Ađić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
| | - Matthias Gutberlet
- Department of Radiology, University of Leipzig Heart Centre, Leipzig, Germany
| | - Ignacio Diez
- Department of Cardiology, Basurto Hospital, Bilbao, Spain
| | - Gershan Davis
- Department of Cardiology, Aintree University Hospital, Liverpool, U.K
- Edge Hill University, Ormskirk, U.K
| | - Elke Zimmermann
- County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania
| | - Cezary Kępka
- National Institute of Cardiology, Warsaw, Poland
| | - Radosav Vidakovic
- Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marco Francone
- Department of Radiological Sciences, Sapienza University of Rome, Italy
- Department of Biomedical Sciences, Humanitas University, and IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Fabian Plank
- Department of Internal Medicine III, Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Rita Faria
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
| | | | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, U.K
- Golden Jubilee National Hospital, Clydebank, U.K
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Balazs Ruzsics
- Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
- Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, U.K
| | - Nina Rieckmann
- Institute of Public Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine Kubiak
- European Clinical Research Infrastructure Network-European Research Infrastructure Consortium, Paris, France
| | - Kristian Schultz Hansen
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Per E. Sigvardsen
- Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
- Department of Radiology, Copenhagen University Hospital–Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Imre Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania
| | - Clare Orr
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, U.K
| | - Filipa Xavier Valente
- Department of Cardiology, Hospital Universitario Vall d’Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, CIBERCV, Madrid, Spain
| | - Ligita Zvaigzne
- Department of Cardiology, Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Martin Horváth
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic
| | - Antanas Jankauskas
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Cardiology Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Filip Ađić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
| | - Michael Woinke
- Department of Radiology, University of Leipzig Heart Centre, Leipzig, Germany
| | - Niall Mulvihill
- Department of Cardiology, St. Vincent’s University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Erica Thwaite
- Department of Cardiology, Aintree University Hospital, Liverpool, U.K
- Edge Hill University, Ormskirk, U.K
| | - Michael Laule
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
| | - Mariusz Kruk
- National Institute of Cardiology, Warsaw, Poland
| | - Milica Stefanovic
- Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Massimo Mancone
- Department of Radiological Sciences, Sapienza University of Rome, Italy
- Department of Biomedical Sciences, Humanitas University, and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Donata Kuśmierz
- Department of Radiology, Provincial Specialist Hospital in Wrocław, Wrocław, Poland
| | - Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Mikko Pietilä
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Administrative Centre, Health Care District of Southwestern Finland, Turku, Finland
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
| | - Tanja Drosch
- Department of Cardiology, Alb Fils Kliniken, Göppingen, Germany
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, U.K
| | - Marco Melis
- Department of Radiological Sciences, Sapienza University of Rome, Italy
| | - Michael Fisher
- Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
- Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, U.K
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, U.K
| | | | - Charlotte Kragelund
- Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Rosca Aurelian
- Department of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Stephanie Kelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, U.K
| | - Bruno Garcia del Blanco
- Department of Cardiology, Hospital Universitario Vall d’Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, CIBERCV, Madrid, Spain
| | - Ainhoa Rubio
- Department of Cardiology, Basurto Hospital, Bilbao, Spain
| | - Mihály Károlyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jens D. Hove
- Department of Cardiology, Copenhagen University Hospital–Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania
| | - Susan Regan
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, U.K
| | - Hug Cuéllar Calabria
- Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Linnea Larsen
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Roxana Hodas
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Adriane E. Napp
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Haase
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Feger
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mahmoud Mohamed
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lina M. Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Dreger
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - John Danesh
- Department of Public Health and Primary Care at Cambridge University, Cambridge, U.K
| | - Melanie Estrella
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jonathan D. Dodd
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Marc Dewey
- Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin University Alliance, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 601] [Impact Index Per Article: 601.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Makowski L, Engelbertz C, Köppe J, Dröge P, Ruhnke T, Günster C, Gerß J, Freisinger E, Malyar N, Reinecke H, Feld J. Contemporary Treatment and Outcome of Patients with Ischaemic Lower Limb Amputation: A Focus on Sex Differences. Eur J Vasc Endovasc Surg 2023; 66:550-559. [PMID: 37355161 DOI: 10.1016/j.ejvs.2023.06.018] [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: 09/16/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Chronic limb threatening ischaemia (CLTI) has a devastating prognosis with high rates of lower limb amputation (LLA) and deaths. This is an illustration of contemporary management and the long term fate of patients after ischaemic LLA, particularly with respect to sex, using real world data. METHODS This was a multisectoral cross sectional and longitudinal analysis of health claims data from the largest German health insurance database (AOK). Data of 39 796 propensity score matched patients hospitalised for ischaemic LLA between 2010 and 2018 were analysed for cardiovascular comorbidities, treatment, and for subsequent cardiovascular and limb events, with a distinct focus on sex. Matching was performed, to ensure that the rate of major amputations and the age distribution were equal in both groups (in both sexes). An observation period of two years before index and a follow up (FU) period until 2019 were included. RESULTS Before index amputation, 68% of patients had received any kind of peripheral revascularisation. The use of statins (37.0% vs. 42.6%) and antithrombotic substances (54.9% vs. 61.8%) was lower in women than in men (p < .001). During two year FU, cardiovascular and limb events occurred among women and men as follows: limb re-amputation (26.7% vs. 31.2%), myocardial infarction (10.9% vs. 14.5%), stroke (20.8% vs. 20.7%), and death from any cause (51.0% vs. 53.3%, p < .001 except for stroke). After adjustment for cardiovascular comorbidities and vascular procedures, female sex was associated with a higher probability of death (HR 1.04, 95% CI 1.04 - 1.04). CONCLUSION Patients undergoing ischaemic LLA still have a poor prognosis marked by high rates of recurrent cardiovascular and limb events resulting in a > 50% mortality rate within two years. The continuous lack of guideline recommended therapies, particularly in women, may be associated with the persisting poor outcome, necessitating urgent further investigation.
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Affiliation(s)
- Lena Makowski
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
| | - Christiane Engelbertz
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Köppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | | | | | | | - Joachim Gerß
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Nasser Malyar
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jannik Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
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Azizi Z, Adedinsewo D, Rodriguez F, Lewey J, Merchant RM, Brewer LC. Leveraging Digital Health to Improve the Cardiovascular Health of Women. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:205-214. [PMID: 37868625 PMCID: PMC10587029 DOI: 10.1007/s12170-023-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/24/2023]
Abstract
Purpose of Review In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.
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Affiliation(s)
- Zahra Azizi
- Center for Digital Health, Stanford University, Stanford, CA USA
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | | | - Fatima Rodriguez
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | - Jennifer Lewey
- Department of Medicine, Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Raina M. Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN USA
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41
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Petek BJ, Chung EH, Kim JH, Lampert R, Levine BD, Phelan D, Danielian A, Dean PN, Dineen EH, Fernandez AB, Husaini M, Krishnan S, Shah AB, Stewart KM, Wasfy MM. Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:1030-1038. [PMID: 37648352 DOI: 10.1016/j.jacc.2023.05.070] [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: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023]
Abstract
Routine exercise leads to cardiovascular adaptations that differ based on sex. Use of cardiac testing to screen athletes has driven research to define how these sex-based adaptations manifest on the electrocardiogram and cardiac imaging. Importantly, sex-based differences in cardiovascular structure and outcomes in athletes often parallel findings in the general population, underscoring the importance of understanding their mechanisms. Substantial gaps exist in the understanding of why cardiovascular adaptations and outcomes related to exercise differ by sex because of underrepresentation of female participants in research. As female sports participation rates have increased dramatically over several decades, it also remains unknown if differences observed in older athletes reflect biological mechanisms vs less lifetime access to sports in females. In this review, we will assess the effect of sex on cardiovascular adaptations and outcomes related to exercise, identify the impact of sex hormones on exercise performance, and highlight key areas for future research.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eugene H Chung
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan H Kim
- Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Rachel Lampert
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin D Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Dermot Phelan
- Sports & Performance Cardiology Center, Atrium Health, Sanger Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - Alfred Danielian
- Division of Sports Cardiology, Las Vegas Heart Associates, Las Vegas, Nevada, USA
| | - Peter N Dean
- Division of Pediatric Cardiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Elizabeth H Dineen
- Division of Cardiology, University of California Irvine, Irvine, California, USA
| | - Antonio B Fernandez
- Hartford Healthcare Heart and Vascular Institute, Hartford, Connecticut, USA
| | - Mustafa Husaini
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sheela Krishnan
- Sports Cardiology & Fitness Program, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ankit B Shah
- Sports & Performance Cardiology LLC, Chevy Chase, Maryland; Georgetown University School of Medicine, Washington DC
| | - Katie M Stewart
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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42
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Rau Steuernagel C, Lam CSP, Greenhalgh T. Countering sex and gender bias in cardiovascular research requires more than equal recruitment and sex disaggregated analyses. BMJ 2023; 382:e075031. [PMID: 37648271 DOI: 10.1136/bmj-2023-075031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Trisha Greenhalgh
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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Wu Y, Prasanna A, Miller HN, Ogungbe O, Peeler A, Juraschek SP, Turkson-Ocran RA, Plante TB. Female Recruitment Into Cardiovascular Disease Trials. Am J Cardiol 2023; 198:88-91. [PMID: 37210978 PMCID: PMC11067437 DOI: 10.1016/j.amjcard.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Yingfei Wu
- Department of Medicine, New York University Langone Health, New York, New York.
| | | | - Hailey N Miller
- School of Nursing, Duke University, Durham, North Carolina; Institute for Clinical and Translational Research and
| | - Oluwabunmi Ogungbe
- Institute for Clinical and Translational Research and; School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Institute for Clinical and Translational Research and; School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Colchester, Vermont
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Morales-Lara AC, Garzon-Siatoya WT, Fernandez-Campos BA, Adedinsewo D. Advancing Our Understanding of Women's Cardiovascular Health Through Digital Health and Artificial Intelligence. JACC. ADVANCES 2023; 2:100272. [PMID: 38938318 PMCID: PMC11198228 DOI: 10.1016/j.jacadv.2023.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | | | | | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Lerchenmüller C, Zelarayan L, Streckfuss-Bömeke K, Gimenez MR, Schnabel R, Hashemi D, Baldus S, Rudolph TK, Morbach C. Moving toward gender equity in the cardiology and cardiovascular research workforce in Germany: a report from the German Cardiac Society. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead034. [PMID: 37090057 PMCID: PMC10114529 DOI: 10.1093/ehjopen/oead034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023]
Abstract
Aims Although the share of women in cardiology in Germany is growing steadily, this does not translate into leadership positions. Medical societies play a crucial role in shaping the national and international medical and scientific environment. The German Cardiac Society (DGK) aims to serve the public discourse on gender-equity by systematic analysis of data on gender representation within the society and in Germany. Methods and results We present gender disaggregated data collection of members, official organs, working groups, scientific meetings, as well as awards of the DGK based on anonymized exports from the DGK office as well as on data gathered from the DGK web page. From 2000 to 2020, the overall number of DGK members as well as the share of women increased (12.5% to 25.3%). In 2021, the share of women ranged from 40% to 50% in earlier career stages but was substantially lower at senior levels (23.9% of consulting/attending physicians, 7.1% of physicians-in-chief, 3.4% of directors). The share of women serving in DGK working groups had gained overall proportionality, but nuclei and speaker positions were largely held by men. Boards and project groups were predominantly represented by men as well. At the DGK-led scientific meetings, women contributed more often in junior relative to (invited) senior roles. Conclusion Increasing numbers of women in cardiology and in the DGK over the past 20 years did not translate into the respective increase in representation of women in leadership positions. There is an urgent need to identify and, more importantly, to overcome barriers towards gender equity. Transparent presentation of society-related data is the first step for future targeted actions in this regard.
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Affiliation(s)
- Carolin Lerchenmüller
- Department of Cardiology, Angiology, Pulmonology, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Heidelberg/Mannheim, INF 410, 69120 Heidelberg, Germany
| | - Laura Zelarayan
- Institute of Pharmacology and Toxicology, University Medical Center Goettingen, Georg-August University, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Goettingen, Robert-Koch-Straße 40 37075, Göttingen, Germany
| | - Katrin Streckfuss-Bömeke
- DZHK (German Center for Heart and Cardiovascular Research), partner site Goettingen, Robert-Koch-Straße 40 37075, Göttingen, Germany
- Clinic for Cardiology and Pneumonology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- Institute of Pharmacology and Toxicology, Würzburg University, Versbacher Str. 9, 97078 Würzburg, Germany
| | - Maria Rubini Gimenez
- Leipzig Heart Institute, Strümpellstraße 39, 04289 Leipzig, Germany
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Renate Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Martinistr. 52, 20246 Hamburg, Germany
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
| | - Stephan Baldus
- Department of General and Interventional Cardiology, Electrophysiology, Angiology, Pulmonology and Intensive Care, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Köln, Germany
| | - Tanja K Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Caroline Morbach
- Department Internal Medicine I, University Hospital Wuerzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department for Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Wuerzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
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Magni P. The sex-associated burden of atherosclerotic cardiovascular diseases: an update on prevention strategies. Mech Ageing Dev 2023; 212:111805. [PMID: 37001567 DOI: 10.1016/j.mad.2023.111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Cardiovascular diseases (CVDs) are the main cause of morbidity, mortality and disability worldwide. Strong evidence exists that the interplay of sex/gender with age plays a specific and relevant role in the pathophysiology of atherosclerosis and its clinical presentation. As several knowledge gaps are still present regarding this relationship, novel research evidence needs to be obtained, also by increasing women participation to clinical studies. Moreover, the age-related discrimination, or ageism, should also be counteracted since it represents a major limit for access to care for older persons of both sexes. Diagnostic and prevention protocols for CVD management should then be improved according to these considerations, along with innovative biomedical and communication strategies.
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Affiliation(s)
- Paolo Magni
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, and IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
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Coughlan JJ, Räber L, Brugaletta S, Kufner S, Maeng M, Jensen LO, Ortega-Paz L, Bär S, Laugwitz KL, Madsen M, Heg D, Aytekin A, Windecker S, Olesen KKW, Sabaté M, Kastrati A, Cassese S. Sex Differences in 10-Year Outcomes After Percutaneous Coronary Intervention With Drug-Eluting Stents: Insights From the DECADE Cooperation. Circulation 2023; 147:575-585. [PMID: 36780380 DOI: 10.1161/circulationaha.122.062049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although some studies have investigated sex-related outcomes up to 5 years after percutaneous coronary intervention (PCI), analyses at longer follow-up (ie, to 10 years) in large cohorts treated exclusively with drug-eluting stent (DES) platforms are lacking. Therefore, this study aimed to define whether sex-related differences in long-term outcomes after PCI persist both in the DES era and at longer-term follow-up. METHODS Individual data of patients treated with DES in 5 randomized controlled trials with 10-year follow-up were pooled. Patients were divided into 2 groups by sex. The analysis of individual participant data was performed using a 1-stage approach by entering a clustering effect by parent study in all univariable and multivariable models focusing on sex. The main outcomes of interest for this analysis included cardiovascular death, myocardial infarction, repeat revascularization, and definite stent thrombosis to 10 years after PCI. Survival was analyzed by the Kaplan-Meier method to estimate the time to first event, and differences between the 2 groups were tested with the log-rank test. Hazard ratios (HRs) and 95% CIs were calculated with a Cox proportional hazards model. Conventional multivariable analyses with adjustment for relevant variables were performed. RESULTS Among 9700 patients undergoing PCI with DES implantation included in the present analysis, 2296 were women and 7404 were men. Through to 10 years, cardiovascular death occurred in 407 of the 2296 female patients and 1012 of the 7404 male patients (adjusted HR [HRadj], 0.94 [95% CI, 0.80-1.11]). Female sex was associated with a lower risk of repeat revascularization of the target lesion (HRadj, 0.80 [95% CI, 0.74-0.87]), target vessel (HRadj, 0.81 [95% CI, 0.76-0.87]), and nontarget vessels (HRadj, 0.69 [95% CI, 0.62-0.77]). Compared with male patients, female patients displayed an increased risk of myocardial infarction in the first 30 days after PCI with DES (HRadj, 1.65 [95% CI, 1.24-2.19]) but a comparable risk of myocardial infarction thereafter. The risk of definite stent thrombosis was not significantly different between female and male patients (HRadj, 1.14 [95% CI, 0.89-1.47]). CONCLUSIONS Through to 10-year follow-up after PCI with DES, female patients are at increased risk of early myocardial infarction, receive fewer repeat revascularizations, and have no difference in cardiovascular mortality compared with male patients.
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Affiliation(s)
- J J Coughlan
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München (J.J.C., S.K., A.A., A.K., S.C.), Technische Universität München, Munich, Germany
| | - Lorenz Räber
- Department of Cardiology, Inselspital (L.R., S. Bär, S.W.), Bern University Hospital, University of Bern, Switzerland
| | - Salvatore Brugaletta
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Spain (S. Brugaletta, L.O.-P.)
| | - Sebastian Kufner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München (J.J.C., S.K., A.A., A.K., S.C.), Technische Universität München, Munich, Germany
| | - Michael Maeng
- Departments of Cardiology (M. Maeng, K.K.W.O.), Aarhus University Hospital, Denmark
| | | | - Luis Ortega-Paz
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Spain (S. Brugaletta, L.O.-P.).,Hospital Clinic, Division of Cardiology, University of Florida College of Medicine, Jacksonville (L.O.-P.)
| | - Sarah Bär
- Department of Cardiology, Inselspital (L.R., S. Bär, S.W.), Bern University Hospital, University of Bern, Switzerland
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar (K.-L.L.), Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (K.-L.L., A.K.)
| | - Morten Madsen
- Clinical Epidemiology (M. Madsen), Aarhus University Hospital, Denmark
| | - Dik Heg
- Clinical Trials Unit Bern (D.H.), Bern University Hospital, University of Bern, Switzerland
| | - Alp Aytekin
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München (J.J.C., S.K., A.A., A.K., S.C.), Technische Universität München, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital (L.R., S. Bär, S.W.), Bern University Hospital, University of Bern, Switzerland
| | | | - Manel Sabaté
- Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV) CB16/11/00411, 28029 Madrid, Spain (M.S.)
| | - Adnan Kastrati
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München (J.J.C., S.K., A.A., A.K., S.C.), Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (K.-L.L., A.K.)
| | - Salvatore Cassese
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München (J.J.C., S.K., A.A., A.K., S.C.), Technische Universität München, Munich, Germany
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A Systematic Review of the Recruitment and Outcome Reporting by Sex and Race/Ethnicity in Stent Device Development Trials for Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2023; 89:353-361. [PMID: 36272665 DOI: 10.1016/j.avsg.2022.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/20/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Women and racial/ethnic minority groups have been shown to experience poor outcomes after endovascular aortic aneurysm repair (EVAR). One potential reason is the rare inclusion of these populations in initial phases of device development. The objective of this systematic review is to understand enrollment and outcome reporting by sex and race/ethnicity in industry-funded EVAR device development trials. METHODS MEDLINE, PubMed, and Embase were searched from inception to January 2022 without language restrictions using the following terminology: "stent", "graft", "endograft", "device", and "abdominal aortic aneurysm" (AAA). CLINICALTRIALS gov was also searched from inception to January 2022 for "AAA." Two independent reviewers screened and extracted data. All phase I-III and postmarket evaluation trials that included patients ≥18 years of age, who underwent EVAR were assessed. Participation-to-prevalence ratios (PPRs) were calculated to estimate representation of participants by sex and race/ethnicity in trials compared with their share of disease burden. RESULTS Among the 4,780 retrieved articles, 55 industry-funded trials met inclusion criteria for this review. A total of 51 trials (93%) reported enrollment by sex/gender, and only 7 trials (13%) reported enrollment by race/ethnicity of the participants. A median of 19 (interquartile range [IQR]: 4.5, 51) women participants were recruited compared to 171 (IQR: 57, 311.5) men, and 17 (IQR: 7.5, 21.5) racial/minority patients were recruited compared to 241 (IQR: 123, 463.5) White participants. Women represent 16.6% of the disease population, and the median PPR is 0.62 (IQR: 0.42, 0.88), which has remained constant over time (Figure 1). None of the device trials reported outcomes based on sex/gender or race/ethnicity. CONCLUSIONS This systematic review highlights the disparities in recruitment and outcome reporting based on sex and race/ethnicity in EVAR device development trials. While most trials may be underpowered to study these differences, recent registry studies show differential outcomes based on sex and race/ethnicity of vascular patients. Therefore, it is imperative to include and report outcomes in these participants, starting from the initial device development phases to improve generalizability of device-use and understand sources of variation in device performance.
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Rivera FB, Tang VAS, De Luna DV, Lerma EV, Vijayaraghavan K, Kazory A, Shah NS, Volgman AS. Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100261. [PMID: 37305172 PMCID: PMC10256233 DOI: 10.1016/j.ahjo.2023.100261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis showed that the use of SGLT-2is among women with diabetes resulted in less reduction in primary composite outcomes compared with men. This study aims to explore potential sex differences in primary composite outcomes among patients with HF treated with SGLT-2is. Methods We systematically searched the medical database from 2017 to 2022 and retrieved all the RCTs using SGLT-2is with specified cardiovascular outcomes. We used the PRISMA (Preferred Reporting Items for a Review and Meta-analysis) method to screen for eligibility. We evaluated the quality of studies using the Cochrane Risk of Bias tool. We pooled the hazard ratio (HR) of the primary composite outcomes in both sexes, performed a meta-analysis, and calculated the odds ratio (OR) of the primary composite outcomes based on sex. Results We included 5 RCTs with a total number of 21,947 patients. Of these, 7837 (35.7 %) were females. Primary composite outcomes were significantly lower in males and females taking SGLT-2is compared to placebo (males - HR 0.77; 95 % CI 0.72 to 0.84; p = 0.00001; females - HR 0.75; 95 % CI 0.67 to 0.84; p = 0.00001). Pooled data from four of the RCTs (n = 20,725) revealed a greater occurrence of the primary composite outcomes in females compared with males (OR 1.32; 95 % CI 1.17 to 1.48; p = 0.0002). Conclusion SGLT-2is reduce the risk of primary composite outcomes in patients with HF, regardless of sex; however, the benefits were less pronounced in women. Further research needs to be done to better explain these observed differences in outcomes.
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Affiliation(s)
| | - Vincent Anthony S. Tang
- Department of Medicine, University of the Philippines – Philippine General Hospital, Metro Manila, Philippines
| | | | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center Oak Lawn, IL, USA
| | | | - Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL, USA
| | - Nilay S. Shah
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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