[Acute coronary syndrome in women. Gender differences]

Educational intervention on cardiovascular parameters in perimenopausal women with a cardiovascular risk factor. Randomised clinical trial

BACKGROUND AND OBJECTIVE

Randomised clinical trial performed in two urban health centres in Spain. To evaluate if educational intervention in women of perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia could achieve significant changes in the reduction of biochemical and haemodynamic risk parameters.

PATIENTS AND METHODS

The study included 320 women aged between 45 and 60 years old who were diagnosed with hypertension, diabetes mellitus and/or dyslipidaemia. They were randomly assigned to the experimental group (n=160) and the control group (n=160). The intervention group received three educational sessions and the control group received an informative leaflet sent by mail. Haemodynamic and biochemical variables were evaluated at baseline and one year later in both groups.

RESULTS

Women in the intervention group showed a decrease in low density lipoprotein (P=.034), (-5.89±29.8; 95% CI: -13.1/0.27) and an increase in high density lipoprotein (P=.013), (2.71±10.6; 95% CI: -1.36/6.20), as well as improvements in systolic blood pressure (P=.016), (-2.16±11.8; 95% CI: -4.4/0.01) and frequency (P=.003), (-1.46±10.3; 95% CI: -3.34/0.42) compared to women in the control group. Women in the control group significantly increased glucose (P=.04), (4.84±15.5; 95% CI: -0.75/31.3) and gamma-glutamyltranspeptidase (P=.031), (3.61±14.7; 95% CI: 0.87/6.36) levels more than those in the experimental group.

CONCLUSIONS

An educational intervention can be an effective method of reducing the parameters associated with an increased likelihood of cardiovascular disease in women at perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia.

Género y efectividad de la metodología enfermera en pacientes con insuficiencia cardiaca

Estudios recientes demostraron que una intervención enfermera de educación sanitaria en la Insuficiencia Cardiaca (IC) evita descompensaciones. Por otro lado, dado que existen diferencias de género en los patrones de la IC, las intervenciones tendrán también efectos diferentes. Objetivo: determinar la existencia de posibles diferencias según el género de los pacientes, en el efecto de una intervención enfermera respecto al autocuidado. Material y método: Se realizó un estudio cuasi experimental con pacientes atendidos en consulta de IC (129). Seleccionados en dos tiempos, primer trimestre año grupo control (62), y segundo trimestre año grupo intervención (67).Todos se evaluaron tres veces, primera consulta, tres y seis meses. Al grupo intervención se aplicó en cada visita una intervención enfermera que consistía en la educación terapéutica, control y seguimiento de su IC. Resultados: inicio: T.A. sistólica hombres 133.90±0.96(DE 27.77), mujeres 119.64±0.57 (DE18.72). Cuidador 93% hombres, 63% mujeres. Conducta terapéutica 2.07+0.02 (DE0.20) hombres,3.04+0.01 (DE 0.31) mujeres. Final: autocuidado -16.00±2.08 (DE10.99) hombres, -9.68±2.22 (DE12.92) mujeres. Adherencia terapéutica1.32±0.35 (DE1.83) hombres, 2.94±1.87 (DE10.93) mujeres. Mejoría muy similar de los NOC en todos. Conclusiones: en el grupo de estudio, participaron más mujeres que hombres,estos[1] últimos tuvieron mayor co morbilidad, consumo de tabaco y alcohol que lasmujeres y disponían de una cuidadora informal. Con relación al autocuidado y adherencia al tratamiento, en la valoración inicial, no se encontró una diferencia significativa entre ambos géneros, mientras que en la calidad de vida el resultado fue mejor en los hombres. Después de la intervención, se encontró que todos los pacientes mejoraron los resultados en calidad de vida y en el NOC (Nursing outcomesclassification), así como el autocuidado y la adhesión terapéutica en todos los participantes. [2] Es importante destacar que los hombres doblaron la puntuación en autocuidado y las mujeres en adhesión terapéutica.

Prevalence, Treatment, and Control of Hypercholesterolemia in High Cardiovascular Risk Patients: Evidences from a Systematic Literature Review in Spain

INTRODUCTION

Cardiovascular diseases (CVDs) represent a major Public Health burden. High serum cholesterol levels have been linked to major CV risk. The objectives of this study were to review the epidemiology of hypercholesterolemia in high risk CV patients from Spain, by assessing its prevalence, the proportion of diagnosed patients undergoing pharmacological treatment and the degree of attained lipid control.

METHODS

A systematic literature review was carried out using Medline and two Spanish databases. Manuscripts containing information on hypercholesterolemia in several high CV risk groups [diabetes mellitus (DM), Systematic COronary Risk Evaluation (SCORE) risk >5, or documented CVD], published between January 2010 and October 2014, were included.

RESULTS

Of the 1947 published references initially retrieved, a full-text review was done on 264 manuscripts and 120 were finally included. Prevalence of hypercholesterolemia ranged from 50 to 84% in diabetics, 30-60% in patients with DM or elevated SCORE risk, 64-74% with coronary heart disease, 40-70% in stroke patients, and 60-80% in those with peripheral artery disease. Despite the finding that most of them were on pharmacological treatment, acceptable control of serum lipids was very variable, ranging from 15% to 65%. Among those with heterozygous familial hypercholesterolemia, 95-100% received treatment but less than 50% achieved their therapeutic goals.

CONCLUSIONS

An elevated prevalence of hypercholesterolemia can be found in targeted groups at high CV risk. Although most patients are receiving pharmacological treatment, rates of lipid control continue to be low, both in primary and secondary prevention.

Sex differences in the treatment and outcome of patients with acute coronary syndrome after percutaneous coronary intervention: a population-based study

BACKGROUND

This study was performed to assess the influence of sex on drug therapy and long-term outcomes in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).

METHODS

This is a retrospective cohort study of ACS patients who underwent PCI [women (n=8,884) and men (n=23,937)] between January 1, 2006, and December 31, 2007, with at least a 1-year follow-up, based on the National Health Insurance Research Database in Taiwan. Propensity score was used to identify a 1:1 matched cohort (n=17,768) for multivariable adjustment. The influence of sex on drug therapy and outcomes was examined by multivariate logistic regression and multivariable Cox proportional hazards regression.

RESULTS

Female patients had an 18% and 12% lower likelihood of receiving aspirin (adjusted odds ratio [OR(adj)]=0.82, 95% confidence interval [CI]=0.77-0.88) and clopidogrel (OR(adj)=0.88, 95% CI=0.81-0.95), respectively, than male patients but had a 17% and 22% higher likelihood of receiving beta-blockers (OR(adj)=1.17, 95% CI=1.10-1.24) and statins (OR(adj)=1.22, 95% CI=1.14-1.29), respectively, than male patients in the matched cohort. The adjusted hazard ratio (HR(adj)) of rehospitalization for revascularization in women was 0.84 (95% CI=0.79-0.90) compared with men after at least a 1-year follow-up in the matched cohort.

CONCLUSIONS

Female patients with ACS who underwent PCI were less likely to receive aspirin and clopidogrel but were more likely to receive beta-blockers and statins than male patients. Male sex was associated with a higher risk of rehospitalization for revascularization than female sex.

[Relationship between short-term exposure to atmospheric sulfur dioxide and obstructive lesions in acute coronary syndrome]

BACKGROUND AND OBJECTIVES

Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries.

PATIENTS AND METHODS

Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL.

RESULTS

Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93 ± 8.33 versus 9.31 ± 6.77 μg/m(3); P = .004). Multivariate analysis shows that for every 10 μg/m(3) increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P = .028).

CONCLUSIONS

In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL.