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Klevmoen M, Mulder JWCM, Roeters van Lennep JE, Holven KB. Sex Differences in Familial Hypercholesterolemia. Curr Atheroscler Rep 2023; 25:861-868. [PMID: 37815650 PMCID: PMC10618303 DOI: 10.1007/s11883-023-01155-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the existing research on sex differences in familial hypercholesterolemia (FH) across the lifespan. RECENT FINDINGS From childhood onward, total- and low-density lipoprotein cholesterol (LDL-C) levels in girls are higher than those in boys with FH. By the age of 30 years, women with FH have a higher LDL-C burden than men. In adulthood, women are diagnosed later than men, receive less lipid-lowering treatment, and consequently have higher LDL-C levels. An excessive atherosclerotic cardiovascular disease risk is reported in young female compared to male FH patients. The periods of pregnancy and breastfeeding contribute to treatment loss and increased cholesterol burden. Earlier initiation of treatment, especially in girls with FH, and lifelong treatment during all life stages are important. Future research should aim to recruit both women and men, report sex-specific data, and investigate the impact of the female life course on cardiovascular outcomes. Future guidelines should include sex-specific aspects.
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Affiliation(s)
- Marianne Klevmoen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Janneke W C M Mulder
- Department of Internal Medicine, Cardiovascular Institute, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Cardiovascular Institute, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.
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Osoti AO, Page ST, Richardson BA, Guthrie BL, Kinuthia J, Polyak SJ, Farquhar C. Postpartum metabolic syndrome after gestational hypertension and preeclampsia, a prospective cohort study. Pregnancy Hypertens 2019; 18:35-41. [PMID: 31493627 PMCID: PMC6884686 DOI: 10.1016/j.preghy.2019.08.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/29/2019] [Accepted: 08/17/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We evaluated the 6-month postpartum risk of metabolic syndrome (MetS), a marker of future cardiovascular disease (CVD) risk, comparing women whose most recent pregnancies were complicated with gestational hypertension (GH) or preeclampsia (PE) versus those who had normotensive pregnancies. STUDY DESIGN This was a prospective cohort study in which women with GH or PE and normotensive women were actively enrolled during the first 12 weeks after delivery in Nairobi, Kenya. Participants were interviewed, blood pressures and anthropometric measurements including waist circumference obtained at enrollment and 6 months postpartum. Fasting lipid profile and plasma glucose were measured at 6 months postpartum. A generalized linear regression model with Poisson distribution was used to estimate crude relative risk (RR) of 6-month postpartum MetS and adjusted RR (ARR) after adjusting for apriori potential confounders. RESULTS Among 194 postpartum women, 63 (32%) had experienced GH or PE. Prevalence of MetS at 6 months postpartum was higher among women whose pregnancies were complicated with GH or PE (34.9%) compared to those who were normotensive (11.5%). GH and PE were associated with a 3-fold or greater risk of MetS (ARR) 3.01; 95% Confidence interval [CI] 1.58, 5.71; p < 0.001) overall and three of the five components, namely hypertension (ARR 3.35 [2.04, 5.51], p < 0.001), hypertriglyceridemia (ARR 3.25 [1.16-9.10], p = 0.01), and fasting hyperglycemia (ARR 6.20 [1.07-35.76], p = 0.03), compared to having normal blood pressures during pregnancy. CONCLUSION At 6 months postpartum, GH and PE were associated with three-fold or higher risk of MetS and especially hypertension, fasting hypertriglyceridemia, and fasting hyperglycemia.
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Affiliation(s)
- Alfred O Osoti
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
| | - Stephanie T Page
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Diabetes Institute, University of Washington, Seattle, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Vaccine and Infectious Disease Division, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA; Department of Research and Programs and Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle, USA
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Rashid NA, Nawi AM, Khadijah S. Exploratory analysis of traditional risk factors of ischemic heart disease (IHD) among predominantly Malay Malaysian women. BMC Public Health 2019; 19:545. [PMID: 31196022 PMCID: PMC6565533 DOI: 10.1186/s12889-019-6855-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background The risk factors of ischemic heart disease (IHD) specific for women are less well studied. However, knowing the risk factors of IHD for women will empower women themselves to be better informed and thus can help them in decision making concerning their health condition. The objective of this study is to explore the commonly studied risk factors of ischemic heart disease (IHD) among a group of Malaysian women. Methods A case control study was conducted among 142 newly diagnosed IHD women patients registered in government hospitals in Terengganu, Malaysia and their 1:1 frequency matched population controls. Data on sociodemographic and socioeconomic profile, co-morbidities, lifestyle factors related to physical activities, dietary fat intake, stress, passive smoking history, anthropometric measurements and biochemical markers were obtained. Results Middle aged women were recruited with women diagnosed with diabetes (aOR = 1.92, 95% CI: 1.11–3.31), having low HDL-C (aOR = 3.30, 95% CI: 1.28–8.27), those with positive family history of IHD (aOR = 1.92, 95% CI:1.13–3.26) and passive smokers (aOR = 2.99, 95% CI:1.81–4.94) were at higher odds of IHD. Conclusions The findings are useful for public health interventions and policy making focusing on specific women population.
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Affiliation(s)
- Norafidah Abdul Rashid
- Vector Borne Disease Control Office, Terengganu State Health Department, Ministry of Health Malaysia, Jalan Kuala Terengganu-Kuala Berang, 21400, Marang, Terengganu, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Shamsuddin Khadijah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
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Balder JW, Rimbert A, Zhang X, Viel M, Kanninga R, van Dijk F, Lansberg P, Sinke R, Kuivenhoven JA. Genetics, Lifestyle, and Low-Density Lipoprotein Cholesterol in Young and Apparently Healthy Women. Circulation 2018; 137:820-831. [DOI: 10.1161/circulationaha.117.032479] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/08/2018] [Indexed: 01/02/2023]
Abstract
Background:
Atherosclerosis starts in childhood but low-density lipoprotein cholesterol (LDL-C), a causal risk factor, is mostly studied and dealt with when clinical events have occurred. Women are usually affected later in life than men and are underdiagnosed, undertreated, and understudied in cardiovascular trials and research. This study aims at a better understanding of lifestyle and genetic factors that affect LDL-C in young women.
Methods:
We randomly selected for every year of age 8 women with LDL-C ≤1st percentile (≤50 mg/dL) and 8 women with LDL-C ≥99th percentile (≥186 mg/dL) from 28 000 female participants aged between 25 to 40 years of a population-based cohort study. The resulting groups include 119 and 121 women, respectively, of an average 33 years of age. A gene-sequencing panel was used to assess established monogenic and polygenic origins of these phenotypes. Information on lifestyle was extracted from questionnaires. A healthy lifestyle score was allocated based on a recently developed algorithm.
Results:
Of the women with LDL-C ≤1st percentile, 19 (15.7%) carried mutations that are causing monogenic hypocholesterolemia and 60 (49.6%) were genetically predisposed to low LDL-C on the basis of an extremely low weighted genetic risk score. In comparison with control groups, a healthier lifestyle was not associated with low LDL-C in women without genetic predispositions. Among women with LDL-C ≥99th percentile, 20 women (16.8%) carried mutations that cause familial hypercholesterolemia, whereas 25 (21%) were predisposed to high LDL-C on the basis of a high-weighted genetic risk score. The women in whom no genetic origin for hypercholesterolemia could be identified were found to exhibit a significantly unfavorable lifestyle in comparison with controls.
Conclusions:
This study highlights the need for early assessment of the cardiovascular risk profile in apparently healthy young women to identify those with LDL-C ≥99th percentile for their age: first, because, in this study, 17% of the cases were molecularly diagnosed with familial hypercholesterolemia, which needs further attention; second, because our data indicate that an unfavorable lifestyle is significantly associated with severe hypercholesterolemia in genetically unaffected women, which may also need further attention.
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Affiliation(s)
- Jan-Willem Balder
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
- Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B.)
| | - Antoine Rimbert
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
| | - Xiang Zhang
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands (X.Z.)
| | - Martijn Viel
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Roan Kanninga
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Freerk van Dijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Peter Lansberg
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
| | - Richard Sinke
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Jan Albert Kuivenhoven
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
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5
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Ruiz-Cabello P, Coll-Risco I, Acosta-Manzano P, Borges-Cosic M, Gallo-Vallejo FJ, Aranda P, López-Jurado M, Aparicio VA. Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project. Nutr Metab Cardiovasc Dis 2017; 27:217-224. [PMID: 28003111 DOI: 10.1016/j.numecd.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The Mediterranean diet (MD) has been associated with reduced morbidity from cardiovascular diseases in the general population. The aim of this study was to assess whether different degrees of adherence to the MD were associated with the cardiometabolic risk in peri and menopausal women. METHODS AND RESULTS This cross-sectional study included 198 peri and menopausal women participating in the Flamenco project. Validated questionnaires were used to assess menopause health-related quality of life and degree of adherence to the MD (low, medium and high). The following cardiometabolic risk factors were assessed: fat mass percentage, waist circumference, blood pressure and resting heart rate, plasma markers (total cholesterol, high and low-density lipoprotein cholesterol [HDL-C and LDL-C, respectively], total cholesterol/HDL ratio, triglycerides, C-reactive protein and fasting glucose), Physical activity levels and smoking status. The degree of adherence to the MD among the study sample was 27%, 40% and 30% for low, medium and high adherence, respectively. After controlling for potential confounders, women with a high adherence to the MD showed lower plasma total cholesterol (p = 0.025), resting heart rate (p = 0.005), LDL-C (p = 0.019), triglycerides (p = 0.046) and C-reactive protein (p = 0.009) compared to those with a low adherence. Likewise women with high adherence to the MD showed lower total cholesterol/HDL-C ratio (p = 0.020) compared to those with a medium adherence. The high MD adherence group also showed lower clustered cardiometabolic risk (p = 0.004). Moreover, when analysing specific MD components, whole grain cereals, pulses (both p < 0.05) and red wine (p < 0.01) consumption were inversely associated with the clustered cardiometabolic risk. CONCLUSION The present findings suggest that a high but not medium adherence to the MD is associated with a cardioprotective effect in peri and menopausal women. As a low percentage of the sample showed a high adherence to the MD, future research aimed at increasing the adherence to this dietary pattern for a better cardiometabolic status during peri and menopause is warranted.
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Affiliation(s)
- P Ruiz-Cabello
- Department of Physiology, Faculty of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Spain.
| | - I Coll-Risco
- Department of Physiology, Faculty of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Spain
| | - P Acosta-Manzano
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Borges-Cosic
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - F J Gallo-Vallejo
- Zaidín-Sur Primary Care Center, Distrito Granada Metropolitano, Servicio Andaluz de Salud, Spain
| | - P Aranda
- Department of Physiology, Faculty of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Spain
| | - M López-Jurado
- Department of Physiology, Faculty of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Spain
| | - V A Aparicio
- Department of Physiology, Faculty of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Spain; VU University Medical Centre, Department of Public and Occupational Health y EMGO + Institute for Health and Care Research, Amsterdam, The Netherlands
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6
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Kim CW, Chang Y, Zhao D, Cainzos-Achirica M, Ryu S, Jung HS, Yun KE, Choi Y, Ahn J, Zhang Y, Rampal S, Baek Y, Lima JA, Shin H, Guallar E, Cho J, Sung E. Sleep Duration, Sleep Quality, and Markers of Subclinical Arterial Disease in Healthy Men and Women. Arterioscler Thromb Vasc Biol 2015; 35:2238-45. [DOI: 10.1161/atvbaha.115.306110] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/24/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Chan-Won Kim
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yoosoo Chang
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Di Zhao
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Miguel Cainzos-Achirica
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Seungho Ryu
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Hyun-Suk Jung
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Kyung Eun Yun
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yuni Choi
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Jiin Ahn
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yiyi Zhang
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Sanjay Rampal
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Youngji Baek
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Joao A. Lima
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Hocheol Shin
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Eliseo Guallar
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Juhee Cho
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Eunju Sung
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
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7
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Truthmann J, Busch MA, Scheidt-Nave C, Mensink GBM, Gößwald A, Endres M, Neuhauser H. Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke. BMC Public Health 2015. [PMID: 26205716 PMCID: PMC4513378 DOI: 10.1186/s12889-015-1929-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Control of modifiable cardiovascular disease (CVD) risk factors has substantially reduced CVD mortality, but risk factor levels in populations may change and need continuous monitoring. This study aims to provide current estimates of the prevalence of these risk factors in Germany according to sex and history of coronary heart disease (CHD) or stroke. Methods The analyses were based on data from the German Health Interview and Examination Survey for Adults (DEGS1; age 40–79 years, n = 5101), which is a cross-sectional population-based examination survey. CVD risk factors were defined according to recommendations in the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2012. Results The mean age was 57 years and 52 % were female; 493 participants had prior CHD and 163 participants a prior stroke. The overall prevalence of behavioural risk factors ranged from 17.9 % for high risk alcohol consumption to 90 % for low vegetable intake. Blood pressure ≥ 140/90 mmHg was found in 21 % and 69 % had total cholesterol ≥ 5.0 mmol/l. Only 16 % met the targets for five behavioural factors combined (smoking, physical activity, fruit intake, alcohol intake and obesity), 13 % of those with and 16 % of those without CHD or stroke. The prevalences of most behavioural risk factors were higher among men compared to women. Conclusions There is a high prevention potential from modifiable cardiovascular risk factors in the general population aged 40–79 years in Germany and among those with prior CHD or stroke. Risk factors are often co-occurring, are interrelated and require combined educational, behavioral, medical and policy approaches. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1929-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Truthmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Markus A Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany. .,German Center for Cardiovascular Research (DZHK), Berlin, Germany.
| | - Gert B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany. .,German Center for Cardiovascular Research (DZHK), Berlin, Germany.
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Matthias Endres
- German Center for Cardiovascular Research (DZHK), Berlin, Germany. .,Department and Out-Patient Care of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany. .,Center for Stroke Research Charité, Universitätsmedizin Berlin, Berlin, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany. .,German Center for Cardiovascular Research (DZHK), Berlin, Germany.
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8
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Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns. J Racial Ethn Health Disparities 2015; 2:256-66. [PMID: 26863341 DOI: 10.1007/s40615-015-0088-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. OBJECTIVE To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. METHOD A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. RESULTS African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. CONCLUSION It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.
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9
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Szlachcic Y, Adkins RH, Reiter JC, Yee F, Shaw SJ, Hodis HN. Predictors of subclinical atherosclerosis in women with spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:90-5. [PMID: 25477730 DOI: 10.1310/sci2002-90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic spinal cord injury (SCI) is associated with an increase in risk factors for cardiovascular disease (CVD). In the general population, atherosclerosis in women occurs later than in men and usually presents differently. Associations between risk factors and incidence of CVD have not been studied in women with SCI. OBJECTIVE To determine which risk factors for CVD are associated with increased carotid intima-media thickness (CIMT), a common indicator of atherosclerosis, in women with SCI. METHODS One hundred and twenty-two females older than 18 years with traumatic SCI at least 2 years prior to entering the study were evaluated. Participants were asymptomatic and without evidence of CVD. Exclusion criteria were acute illness, overt heart disease, diabetes, and treatment with cardiac drugs, lipid-lowering medication, or antidiabetic agents. Measures for all participants were age, race, smoking status, level and completeness of injury, duration of injury, body mass index, serum lipids, fasting glucose, hemoglobin A1c, and ultrasonographic measurements of CIMT. Hierarchical multiple linear regression was conducted to predict CIMT from demographic and physiologic variables. RESULTS Several variables were significantly correlated with CIMT during univariate analyses, including glucose, hemoglobin A1c, age, and race/ethnicity; but only age was significant in the hierarchical regression analysis. CONCLUSIONS Our data indicate the importance of CVD in women with SCI.
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Affiliation(s)
- Yaga Szlachcic
- Department of Medicine, Rancho Los Amigos National Rehabilitation Center , Downey, California ; Keck School of Medicine of the University of Southern California , Los Angeles, California ; Los Amigos Research and Educational Institute , Downey, California
| | - Rodney H Adkins
- Los Amigos Research and Educational Institute , Downey, California
| | - Jamie C Reiter
- Los Amigos Research and Educational Institute , Downey, California
| | - Florence Yee
- Department of Medicine, Rancho Los Amigos National Rehabilitation Center , Downey, California ; Department of Clinical Medicine, School of Pharmacy at the University of Southern California , Los Angeles, California
| | - Sylvia J Shaw
- Department of Medicine, Rancho Los Amigos National Rehabilitation Center , Downey, California
| | - Howard N Hodis
- Department of Medicine and Preventative Medicine, Keck School of Medicine at the University of Southern California , Los Angeles, California ; Atherosclerosis Research Unit, Keck School of Medicine at the University of Southern California , Los Angeles, California
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10
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Aortas reveal the myth of male privilege. J Mol Med (Berl) 2014; 92:901-3. [PMID: 25104075 DOI: 10.1007/s00109-014-1196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Abstract
Prediabetes, covering individuals with impaired fasting glycemia, impaired glucose tolerance, or high-risk HbA1c levels, is associated with a ∼20 % increased risk of developing cardiovascular disease (CVD) compared with normoglycemic individuals. It is well-known that lifestyle or pharmacologic interventions can prevent diabetes in prediabetic people; however, the evidence is less clear regarding prevention of CVD. Most diabetes prevention trials have failed to show beneficial effects on CVD morbidity and mortality despite significant improvements of CVD risk factors in individuals with prediabetes. Another challenge is how to estimate CVD risk in prediabetic people. In general, prediction models for CVD do not take glucose levels or prediabetes status into account, thereby underestimating CVD risk in these high-risk individuals. More evidence within risk stratification and management of CVD risk in prediabetes is needed in order to recommend useful and effective strategies for early prevention of CVD.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center A/S, Niels Steensens Vej 2, 2820, Gentofte, Denmark,
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12
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Petretta M, Acampa W, Evangelista L, Daniele S, Zampella E, Assante R, Nappi C, Cantoni V, Fiumara G, Cuocolo A. Reclassification of cardiovascular risk by myocardial perfusion imaging in diabetic patients with abnormal resting electrocardiogram. Nutr Metab Cardiovasc Dis 2014; 24:588-593. [PMID: 24472632 DOI: 10.1016/j.numecd.2013.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Despite an extensive use of stress myocardial perfusion single-photon emission computed tomography (MPS), no study addressed the role of perfusion imaging in diabetic patients with abnormal resting electrocardiogram (ECG). We compared analytical approaches to assess the added value of stress MPS variables in estimating coronary heart disease outcomes in diabetic patients with abnormal resting ECG. METHODS AND RESULTS A total of 416 patients with diabetes and abnormal resting ECG who underwent stress MPS were prospectively followed up after the index study. The end point was the occurrence of a major cardiac event, including cardiac death and nonfatal myocardial infarction. At the end of follow-up (median 58 months), 42 patients experienced events. MPS data increased the predictive value of a model including traditional cardiovascular risk factors and left ventricular (LV) ejection fraction (likelihood ratio χ² from 17.54 to 24.15, p < 0.05, with a C statistic of 0.72, 95% confidence interval: 0.65-0.79). The addition of MPS data resulted in reclassification of 25% of the sample with a net reclassification improvement of 0.20 (95% confidence interval: 0.05-0.36). Overall, 63 patients were reclassified to a lower risk category, with a 5-year event rate of 3.5%, and 40 patients were reclassified to a higher risk category, with a 5-year event rate of 20%. CONCLUSION The addition of MPS findings to a model based on traditional cardiovascular risk factors and LV ejection fraction improves risk classification for incident cardiac events in diabetic patients with abnormal resting ECG.
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Affiliation(s)
- M Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - W Acampa
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - L Evangelista
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - S Daniele
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - E Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - R Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - C Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - V Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - G Fiumara
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | - A Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Colpani V, Oppermann K, Spritzer PM. Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study. BMC Public Health 2014; 14:194. [PMID: 24559309 PMCID: PMC3946596 DOI: 10.1186/1471-2458-14-194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 02/05/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Aging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil. METHODS A longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve. RESULTS There were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938-22.79, p=0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p=0.035) and postmenopausal status (HR=6.216, 95% CI: 0.963-40.143, p=0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR≥0.85) and mortality even after the adjustment for BMI (HR=9.229, 95% IC: 2.083-41.504, p=0.003). CONCLUSION CVD was an important cause of mortality in this cohort and DM and/or central adiposity were associated with all-cause mortality. Lifestyle and dietary factors seem to be related to risk of mortality in middle-aged women.
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Affiliation(s)
- Verônica Colpani
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Karen Oppermann
- Medical School of Universidade de Passo Fundo and São Vicente de Paulo Hospital, Rua Teixeira Soares 885/704, CEP 99010-081 Passo Fundo, RS, Brazil
| | - Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Laboratory of Molecular Endocrinology, Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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14
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Vilahur G, Badimon JJ, Bugiardini R, Badimon L. Perspectives: The burden of cardiovascular risk factors and coronary heart disease in Europe and worldwide. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/sut003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Szlachcic Y, Adkins RH, Govindarajan S, Cao Y, Krause JS. Cardiometabolic changes and disparities among persons with spinal cord injury: a 17-year cohort study. Top Spinal Cord Inj Rehabil 2014; 20:96-104. [PMID: 25477731 PMCID: PMC4252168 DOI: 10.1310/sci2002-96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiometabolic syndrome in individuals who are aging with spinal cord injury (SCI) increases the risk of cardiovascular disease and diabetes. Longitudinal research is needed on the natural progression of cardiometabolic syndrome in SCI. OBJECTIVE To identify the magnitude of changes in biomarkers of cardiometabolic syndrome and diabetes over time in people aging with SCI, and to discern how these biomarkers relate to demographics of race/ethnicity and sex. METHODS This cohort study was a follow-up of a convenience sample of 150 participants (mean age, 51.3; duration of SCI, 27.3 years) from a full cohort of 845 who participated in research in which physiologic and serologic data on cardiovascular disease had been prospectively collected (1993-1997). Inclusion criteria were adults with traumatic-onset SCI. Average years to follow-up were 15.7 ± 0.9. Assessments were age, race, level and completeness of injury, duration of injury, blood pressure, body mass index, waist circumference, serum lipids, fasting glucose, hemoglobin A1c, and medications used. Primary outcome was meeting at least 3 of the criteria for cardiometabolic syndrome. RESULTS The frequency of cardiometabolic syndrome increased significantly from 6.7% to 20.8% or 38.2% according to 2 definitions. It was significantly higher in Hispanics and apparently higher in women. Diabetes increased significantly by a factor of 6.7. CONCLUSION Our data indicate clinically important increases in the frequency of cardiometabolic syndrome, especially among Hispanic and female participants, and a similar increase in diabetes among individuals aging with SCI. Clinical practice guidelines need to be customized for women and Hispanics with SCI.
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Affiliation(s)
- Yaga Szlachcic
- Department of Medicine of Rancho Los Amigos National Rehabilitation Center, Downey, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
- Los Amigos Research and Educational Institute, Downey, California
| | - Rodney H. Adkins
- Los Amigos Research and Educational Institute, Downey, California
| | - Sugantha Govindarajan
- Keck School of Medicine of the University of Southern California, Los Angeles, California
- Department of Pathology, Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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Are sleep difficulties the "canary in the coalmine" for aortic calcification in women? Sleep Med 2013; 14:389-90. [PMID: 23490737 DOI: 10.1016/j.sleep.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 01/06/2023]
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