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Schamroth Pravda N, Karny-Rahkovich O, Shiyovich A, Schamroth Pravda M, Rapeport N, Vaknin-Assa H, Eisen A, Kornowski R, Porter A. Coronary Artery Disease in Women: A Comprehensive Appraisal. J Clin Med 2021; 10:jcm10204664. [PMID: 34682787 PMCID: PMC8541551 DOI: 10.3390/jcm10204664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023] Open
Abstract
Coronary artery disease (CAD) is a significant cause of illness and death amongst women. The pathophysiology, manifestations, and outcomes of CVD and CAD differ between sexes. These sex differences remain under-recognized. The aim of this review is to highlight and raise awareness of the burden and unique aspects of CAD in women. It details the unique pathophysiology of CAD in women, cardiovascular risk factors in women (both traditional and sex-specific), the clinical presentation of CAD in women, and the range of disease in obstructive and non-obstructive CAD in women.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Correspondence: ; Tel.: +972-544476243
| | - Orith Karny-Rahkovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | | | | | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Avital Porter
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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El Missiri A, Amin SA, Tawfik IR, Shabana AM. Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery. Egypt Heart J 2020; 72:69. [PMID: 33052491 PMCID: PMC7560662 DOI: 10.1186/s43044-020-00107-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Cardiac rehabilitation has been shown to reduce cardiac mortality, improve quality of life, and reduce hospitalizations. Cardiac rehabilitation programs are usually performed over a 12-week period. Studies have shown that similar benefits could be achieved with shorter programs. Abnormal heart rate recovery after exercise has been associated with an increased risk of cardiovascular events and mortality. The main aim of this study was to compare the effect of a 6-week phase 2 cardiac rehabilitation program on heart rate recovery to a 12-week one in patients who had recovered from an anterior wall ST segment elevation myocardial infarction. Results This prospective study included 60 patients enrolled in cardiac rehabilitation programs randomized into two equal groups: a 6-week and a 12-week program. Baseline patient demographics, lipid profile, and left ventricular ejection fraction (LVEF) were assessed. METs achieved, total exercise time, resting heart rate, peak heart rate, and heart rate recovery at 1 min were examined. These were re-assessed at the end of each program. Results showed no difference between both groups at the end of each program regarding lipid profile and LVEF. Patients enrolled in the 12-week cardiac rehabilitation program were able to achieve more METs, had a longer exercise time, a higher peak heart rate, and had a lower resting heart rate at the end of the program. Heart rate recovery was slightly higher in patients enrolled in the 6-week program 26.5 ± 6.78 versus 23.17 ± 6.12 bpm (p = 0.051). On comparing the magnitude of change between both programs, those in the 12-week program had more increase in HDL-C levels, METs achieved, and exercise time. Additionally, they had more reduction of resting heart rate. Heart rate recovery was more increased for those in the 6-week program. Conclusion Although heart rate recovery increases after completion of each of a 6-week and 12-week cardiac rehabilitation program compared to their baseline, there is no difference on comparing heart rate recovery between both programs at their end. Patients enrolled in a standard 12-week cardiac rehabilitation program achieve more METs, have a longer exercise time, a higher peak HR, and a lower resting HR at the end of the program compared to those in the 6-week program.
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Affiliation(s)
- Ahmed El Missiri
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.
| | - Sameh Atteya Amin
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Islam Reda Tawfik
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Adel Mohamed Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
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El Missiri AM, Awadalla HM, Almoudi MM. Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program. Egypt Heart J 2020; 72:15. [PMID: 32232591 PMCID: PMC7105560 DOI: 10.1186/s43044-020-00052-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation programs reduce cardiovascular events and mortality in ischemic heart disease patients. The aim of this study was to assess gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program regarding adherence to the program, as well as, changes in clinical, laboratory, and echocardiographic parameters. RESULTS A prospective study that included 30 men and 30 women with stable ischemic heart disease who had been totally revascularized by percutaneous coronary intervention. Patients were enrolled in a 12-week cardiac rehabilitation program. Assessment of demographics, anthropometric measurements, risk factors, and functional capacity was performed. Lipid profile, glycated hemoglobin, and left ventricular ejection fraction were assessed. Assessments were performed at baseline and after completion of the program. Time to enrollment in the program was prolonged for women 39.17 ± 40.49 vs. 19.77 ± 10.26 days (p = 0.014). At baseline, more women were diabetic (p = 0.004), hypertensive (p = 0.02), had a larger waist circumference (p = 0.022), a higher BMI (p = 0.011), and higher HbA1c (p = 0.033). More men were active smokers (p < 0.001). After completion of the program, it was found that men attended 19.1 ± 4.77 (79.6%) sessions compared to 15.7 ± 5.72 (65.4%) sessions for women (p = 0.015). Women had more reduction in diastolic BP - 10.93 ± 8.94 vs. - 5.47 ± 12.57 mmHg (p = 0.058). The magnitude of reduction in resting heart rate was significant in men (p = 0.018) but not in women (p = 0.376). The magnitude of reduction in serum total cholesterol and triglycerides was more in men (p = 0.018 and p = 0.014). Women showed more reduction in HbA1c (p = 0.052). CONCLUSION Men are more adherent to cardiac rehabilitation programs. Recruitment of women is significantly delayed. Women have a higher cardiovascular risk burden in the form of prevalence of diabetes, hypertension, and obesity. Completion of a cardiac rehabilitation program causes a reduction in BMI, waist circumference, blood pressure measurements, total cholesterol, triglycerides, LDL-C, HDL-C, HbA1c, and LVEDD with an increase in LVEF in both genders. Men show more reduction in resting HR, total cholesterol, and triglyceride levels while women show more reduction in diastolic BP and HBA1c.
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Affiliation(s)
- Ahmed Mohamed El Missiri
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
| | - Hany Mohamed Awadalla
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
| | - Mosadaq Mustafa Almoudi
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
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Roque D, Ferreira J, Monteiro S, Costa M, Gil V. Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. Rev Port Cardiol 2020; 39:57-72. [PMID: 32205012 DOI: 10.1016/j.repc.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality. OBJECTIVE The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods. METHODS We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology. RESULTS A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy. CONCLUSION In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.
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Affiliation(s)
- David Roque
- Cardiology Department, Hospital Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Victor Gil
- Cardiovascular Unit, Hospital dos Lusíadas, Lisbon University, Lisbon, Portugal
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Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Gevaert AB, Adams V, Bahls M, Bowen TS, Cornelissen V, Dörr M, Hansen D, Kemps HM, Leeson P, Van Craenenbroeck EM, Kränkel N. Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2019; 27:1369-1385. [PMID: 31581819 DOI: 10.1177/2047487319877716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.
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Affiliation(s)
- Andreas B Gevaert
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium.,Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Volker Adams
- Department of Molecular and Experimental Cardiology, TU Dresden, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - T Scott Bowen
- School of Biomedical Sciences, University of Leeds, UK
| | | | - Marcus Dörr
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Hareld Mc Kemps
- Fitheid, Leefstijl, Ontwikkeling en Wetenschap (FLOW), Máxima Medical Centre, The Netherlands
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, UK
| | - Emeline M Van Craenenbroeck
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
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Marques TS, Heubel AD, Gimenes C, Arca EA, Pessoa-Santos BV, Martinelli B, Zamunér AR, Barrile SR. LIPID PROFILE, FUNCTIONAL CAPACITY AND ANKLE-BRACHIAL INDEX IN ACTIVE OLDER ADULTS. REV BRAS MED ESPORTE 2019. [DOI: 10.1590/1517-869220192504174345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Regular physical activity prevents cardiovascular diseases (CVD) and atherosclerosis, in addition to improving lipid levels and functional capacity in older adults. Objective: To evaluate and compare the lipid levels, functional performance and ankle brachial index (ABI) of sedentary and active older adults. Methods: This was a comparative cross-sectional study with 84 elderly (≥60 years) male and female subjects, divided into two groups: sedentary group (SG, n = 50) and active group (AG, n = 34) according to the International Physical Activity Questionnaire (IPAQ). Anthropometric and hemodynamic assessments, ankle brachial index (ABI) calculations, and functionality tests (Short Physical Performance Battery - SPPB and 6-minute walking test - 6MWT) were performed. The Shapiro-Wilk normality test was also used, and we conducted the Student's-t and Mann-Whitney tests for the intergroup comparison. For the categorical data, we used Fisher's exact test (p <0.05). Results: Higher values of high-density lipoprotein cholesterol (HDL-c) (p = 0.001) and lower triglycerides (TG) (p = 0.007) were found in AG compared to SG. In the ABI evaluation, AG presented better right (p = 0.012), left (p = 0.015) and end (p = 0.004) ABI rates when compared to SG. AG had better results in functional performance in the SPPB evaluation (p = 0.0007) and in the 6MWT with a greater distance covered (p = 0.0027). In the anthropometric measurements, AG had lower body mass index (BMI) (0.041) and a smaller abdominal circumference (WC) (0.029). In terms of the incidence of referred diseases, intergroup results were only different for hypertension (0.029), while AG had a lower incidence of hypertension. Conclusion: Active older adults had better lipid levels, higher ABI levels, better functional performance, lower body mass, a smaller abdominal circumference, and lower incidence of hypertension, in comparison to sedentary subjects. Level of evidence I; High quality prospective study.
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Witvrouwen I, Van Craenenbroeck EM, Abreu A, Moholdt T, Kränkel N. Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective. Eur J Prev Cardiol 2019; 28:779-790. [PMID: 30889981 DOI: 10.1177/2047487319838221] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation has a class 1A recommendation in coronary artery disease and heart failure based on its beneficial effects on mortality, morbidity and quality of life. However, the inter-individual response to exercise training is highly variable and influenced by both training and patient characteristics. Notably, men and women display a different training response, even when accounting for age, height and lean muscle mass. Most studies investigating exercise effects on various physiological outcomes focus on male patients. Because women are understudied, the scientific evidence for tailored exercise prescription in women is still limited. METHODS This narrative review summarises: (a) the underlying physiological determinants of the response to exercise training in women with cardiovascular disease, in which women rely more on fat than on carbohydrate oxidation during exercise, have lower aerobic capacities and smaller increases in cardiac function during exercise; (b) the benefits and barriers of exercise in women, in whom improving cardiometabolic risk and quality of life is weighed against socioeconomic and psychological needs; and (c) the relevance of different clinical endpoints in exercise trials such as maximum oxygen uptake, morbidity, mortality, training characteristics, quality of life and metabolic or vascular endpoints. RESULTS Finally, we provide a perspective on how to improve referral, enrolment and adherence to exercise training in women, with structured approaches to inform the referring physician as well as the patient, and offering more flexible, gender-tailored or tele/smartphone-based programmes while addressing the socioeconomic and psychological needs of the patients. This may ultimately improve the admission, adherence and outcome of exercise-based cardiac rehabilitation in women.
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Affiliation(s)
- Isabel Witvrouwen
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Emeline M Van Craenenbroeck
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Ana Abreu
- 3 Serviço de Cardiologia, Hospital Santa Maria/HPV, CHLN, Lisboa, Portugal
| | - Trine Moholdt
- 4 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Norway
| | - Nicolle Kränkel
- 5 Department of Cardiology, Charité Universitätsmedizin, Germany.,6 German Center for Cardiovascular Research, partner site Berlin, Germany
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Manfredini R, Lamberti N, Manfredini F, Straudi S, Fabbian F, Rodriguez Borrego MA, Basaglia N, Carmona Torres JM, Lopez Soto PJ. Gender Differences in Outcomes Following a Pain-Free, Home-Based Exercise Program for Claudication. J Womens Health (Larchmt) 2018; 28:1313-1321. [PMID: 30222507 PMCID: PMC6743088 DOI: 10.1089/jwh.2018.7113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Peripheral artery disease (PAD) is a common cardiovascular pathology that affects mobility. In previous research, supervised exercise, a recommended treatment for claudication, was less effective in women. This study retrospectively investigated whether functional outcomes exhibit sex differences following a pain-free, home-based exercise program for PAD patients. Materials and Methods: Patients with PAD and claudication enrolled to a structured home-based program from 2003 to 2016 were studied. The program was prescribed at the hospital and based on two daily 10-minute pain-free walking sessions at progressively increasing speed. Outcome measures, which were assessed at baseline and discharge, were pain threshold speed (PTS) and maximal (Smax) during a treadmill test and pain-free walking distance (PFWD) and total distance walked in 6 minutes (6MWD). The ankle-brachial index (ABI), program duration, and patient adherence were determined. Results: A total of 1007 patients (women; n = 264; 26%) were enrolled. At baseline, compared to men, women exhibited similar ABI values but lower PTS and PFWD values (p < 0.001). At discharge, with similar adherence (score 3/4 ± 1 each) in both groups, superimposable improvements were observed for PTS (0.8 ± 0.8 km/h each), Smax (0.4 ± 0.5 km/h each), PFWD (women 95 ± 100; men 86 ± 104), 6MWD (women 32 ± 65; men 35 ± 58), and ABI (women 0.07 ± 0.12; men 0.06 ± 0.11) without between-group differences (confirmed after propensity analysis). Conclusion: A personalized, structured pain-free exercise program for PAD patients performed inside the home for a few minutes a day was equally effective in both sexes. Programs favoring adherence and functional outcomes in women should be tested in prospective studies.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Clinica Medica Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy
- Instituto Maimonides de Investigacion Biomedica de Cordoba, University of Cordoba, Cordoba, Spain
- Address correspondence to: Roberto Manfredini, MD, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 46, Ferrara 44121, Italy
| | - Nicola Lamberti
- Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Instituto Maimonides de Investigacion Biomedica de Cordoba, University of Cordoba, Cordoba, Spain
- Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
- Rehabilitation Medicine Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Sofia Straudi
- Rehabilitation Medicine Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Clinica Medica Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy
- Instituto Maimonides de Investigacion Biomedica de Cordoba, University of Cordoba, Cordoba, Spain
| | | | - Nino Basaglia
- Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
- Rehabilitation Medicine Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | | | - Pablo Jesus Lopez Soto
- Instituto Maimonides de Investigacion Biomedica de Cordoba, University of Cordoba, Cordoba, Spain
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Supervía M, Medina-Inojosa JR, Yeung C, Lopez-Jimenez F, Squires RW, Pérez-Terzic CM, Brewer LC, Leth SE, Thomas RJ. Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions. Mayo Clin Proc 2017; 92:S0025-6196(17)30026-5. [PMID: 28365100 PMCID: PMC5597478 DOI: 10.1016/j.mayocp.2017.01.002] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 10/19/2022]
Abstract
Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.
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Affiliation(s)
- Marta Supervía
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jose R Medina-Inojosa
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Colin Yeung
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Francisco Lopez-Jimenez
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ray W Squires
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Carmen M Pérez-Terzic
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - LaPrincess C Brewer
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Shawn E Leth
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Mehta PK, Wei J, Wenger NK. Ischemic heart disease in women: a focus on risk factors. Trends Cardiovasc Med 2015; 25:140-51. [PMID: 25453985 PMCID: PMC4336825 DOI: 10.1016/j.tcm.2014.10.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 02/08/2023]
Abstract
Heart disease remains a major contributor to morbidity and mortality in women in the United States and worldwide. This review highlights known and emerging risk factors for ischemic heart disease (IHD) in women. Traditional Framingham risk factors such as hypertension, hyperlipidemia, diabetes, smoking, as well as lifestyle habits such as unhealthy diet and sedentary lifestyle are all modifiable. Health care providers should be aware of emerging cardiac risk factors in women such as adverse pregnancy outcomes, systemic autoimmune disorders, obstructive sleep apnea, and radiation-induced heart disease; psychosocial factors such as mental stress, depression, anxiety, low socioeconomic status, and work and marital stress play an important role in IHD in women. Appropriate recognition and management of an array of risk factors is imperative given the growing burden of IHD and need to deliver cost-effective, quality care for women.
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Affiliation(s)
- Puja K Mehta
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048.
| | - Janet Wei
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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