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Perone F, Spadafora L, Pratesi A, Nicolaio G, Pala B, Franco G, Ruzzolini M, Ambrosetti M. Obesity and cardiovascular disease: Risk assessment, physical activity, and management of complications. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 23:200331. [PMID: 39346126 PMCID: PMC11439555 DOI: 10.1016/j.ijcrp.2024.200331] [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: 07/25/2024] [Accepted: 08/31/2024] [Indexed: 10/01/2024]
Abstract
The patient with obesity is at risk of developing cardiovascular disease and risk factors. Obesity negatively impacts prognosis and increases cardiovascular morbidity and mortality. Therefore, a comprehensive risk assessment is needed to define the cardiovascular risk of the patient and, thus, a tailored management and treatment. Chronic and successful management of these patients involves the evaluation of the various therapeutic strategies available (comprehensive lifestyle intervention, weight-loss medications, and bariatric surgery) and the diagnosis and treatment of cardiovascular complications (coronary artery disease, heart failure, and atrial fibrillation). Cardiac rehabilitation in patients with obesity is showing beneficial effect and a positive impact on weight loss, cardiovascular risk factors, mental health, functional capacity, and adherence to lifestyle interventions and pharmacological treatment. Long-term weight loss and maintenance represent a key objective during the management of the patient with obesity to reduce the risk of future adverse events. Multidisciplinary management and interventions are necessary to prevent and reduce overall cardiovascular risk and mortality. The aim of our review is to propose a comprehensive, critical and updated overview regarding risk assessment, physical activity, and the management of cardiovascular complications in patient with obesity.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa delle Magnolie", 81020, Castel Morrone, Caserta, Italy
| | - Luigi Spadafora
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Giulia Nicolaio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Pala
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Giulia Franco
- Cardiac Rehabilitation Unit, Cardiovascular Department, University and Hospital of Trieste, 34122, Trieste, Italy
| | - Matteo Ruzzolini
- Cardiology Department, Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
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Faucon AL, Lambert O, Massy Z, Drüeke TB, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Hauguel-Moreau M, Mansencal N, Alencar de Pinho N, Stengel B. Sex and the Risk of Atheromatous and Nonatheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study. Am J Kidney Dis 2024; 84:546-556.e1. [PMID: 38925506 DOI: 10.1053/j.ajkd.2024.04.013] [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: 11/24/2023] [Revised: 03/26/2024] [Accepted: 04/14/2024] [Indexed: 06/28/2024]
Abstract
RATIONALE & OBJECTIVE Sex differences in cardiovascular disease (CVD) are well established, but whether chronic kidney disease (CKD) modifies these risk differences and whether they differ between atheromatous CVD (ACVD) and nonatheromatous CVD (NACVD) is unknown. Assessing this interaction was the principal goal of this study. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Adults enrolled in the CKD-REIN (CKD-Renal Epidemiology and Information Network) cohort, a nationally representative sample of 40 nephrology clinics in France, from 2013 to 2020. EXPOSURE Sex. OUTCOMES Fatal and nonfatal composite ACVD events (ischemic coronary, cerebral, and peripheral artery disease) and composite NACVD events (heart failure, hemorrhagic stroke, and arrhythmias). ANALYTICAL APPROACH Multivariable cause-specific Cox proportional hazards models. RESULTS 1,044 women and 1,976 men with moderate to severe CKD (median age, 67 vs 69y; mean estimated glomerular filtration rate [eGFR], 32±12 vs 33±12mL/min/1.73m2) were studied. During a median follow-up of 5.0 (IQR, 4.8-5.2) years, the ACVD rate (per 100 patient-years) was significantly lower in women than in men, at 2.1 (95% CI, 1.6-2.5) versus 3.6 (3.2-4.0; P<0.01), whereas the NACVD rate was not, at 5.7 (5.0-6.5) versus 6.4 (5.8-7.0; P=0.55). NACVD had a steeper relationship with eGFR than did ACVD. There was an interaction (P<0.01) between sex and baseline eGFR and the ACVD hazard: the adjusted HR for women versus men was 0.42 (0.25-0.71) at 45mL/min/1.73m2 and gradually attenuated at lower levels of eGFR, reaching 1.00 (0.62-1.63) at 16mL/min/1.73m2. In contrast, the NACVD hazard did not differ between sexes across the eGFR range studied. LIMITATIONS Cardiovascular biomarkers and sex hormones were not assessed. CONCLUSIONS This study shows how the lower risk of ACVD among women versus men attenuates fully with kidney disease progression. The equal risk of NACVD between sexes across CKD stages and its steeper association with eGFR suggest an important contribution of CKD to the development of this CVD type. PLAIN-LANGUAGE SUMMARY Sex differences in the risks of atheromatous and nonatheromatous cardiovascular disease (CVD) are well established in the general population. If or how chronic kidney disease (CKD) might modify these risks is unknown. In this large cohort of 3,010 patients with CKD, women had a lower risk than men of atheromatous CVDs such as coronary artery disease or stroke when they were at an early stage of CKD. This advantage, partly due to women's better cardiovascular risk profile, tended to attenuate as CKD progressed to kidney failure. In contrast, the risk of nonatheromatous CVDs such as heart failure for women with CKD appeared similar to that of men with CKD at all kidney function levels.
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Affiliation(s)
- Anne-Laure Faucon
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif
| | - Ziad Massy
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif; Departments of Nephrology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire (CHU) Ambroise Paré, Boulogne-Billancourt
| | - Tilman B Drüeke
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif
| | - Christian Combe
- Department of Nephrology, Transplantation, Dialysis, CHU de Bordeaux, BioTis, INSERM U1026, Université de Bordeaux, Bordeaux
| | - Denis Fouque
- Department of Nephrology, CHU Lyon-Sud, Université de Lyon, Lyon; CarMeN Laboratory, INSERM U1060, Lyon
| | - Luc Frimat
- Department of Nephrology, Centre Hospitalier Régional Universitaire de Nancy, INSERM Centre d'Investigation Clinique 1433, Clinical Epidemiology Unit, Vandoeuvre-lès-Nancy
| | | | - Maurice Laville
- Department of Nephrology, CHU Lyon-Sud, Université de Lyon, Lyon
| | - Sophie Liabeuf
- Department of Pharmacology, CHU Amiens-Picardie, MP3CV Unit, Université Picardie Jules Verne, Amiens, France
| | | | - Marie Hauguel-Moreau
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif; Cardiology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire (CHU) Ambroise Paré, Boulogne-Billancourt
| | - Nicolas Mansencal
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif; Cardiology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire (CHU) Ambroise Paré, Boulogne-Billancourt
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif.
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Clinical Epidemiology Team, Versailles Saint-Quentin University, Villejuif
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Vogel B, Jou S, Sartori S, Farhan S, Smith K, Snyder C, Spirito A, Nathani M, Kenny Byrne K, Sharma R, Krishnan P, Dangas G, Kini A, Sharma S, Mehran R. Impact of sex on outcomes associated with polyvascular disease in patients after PCI. Am Heart J 2024; 277:39-46. [PMID: 39121918 DOI: 10.1016/j.ahj.2024.08.002] [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: 12/08/2023] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Atherosclerosis in more than 1 vs. 1 arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex. METHODS We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012 and 2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex. RESULTS Women represented 29.2% (N = 5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; P < .001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; P < .001 and aHR 1.31, 95% CI 1.06-1.62; P = .014, respectively; p-interaction = 0.460). CONCLUSION Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.
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Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Jou
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth Smith
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mashal Nathani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katie Kenny Byrne
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raman Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Thakur B, Strenth C, Arnold EM, Schneider FD. Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States. Am J Health Promot 2024; 38:1199-1209. [PMID: 38864762 DOI: 10.1177/08901171241262249] [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: 06/13/2024]
Abstract
PURPOSE This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey data (2013-2018). PARTICIPANTS A total of 14 699 community-dwelling adults (≥20 years). MEASURE The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. ANALYSIS Adjusted prevalence ratios were estimated using a Poisson regression model. RESULTS The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR:1.42, P = .002) and moderately severe to severe depression (aPR:1.72, P = .024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P < .001) compared to males (aPRs range: 1.45 to 1.77, P < .001). CONCLUSION Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.
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Affiliation(s)
- Bhaskar Thakur
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chance Strenth
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Frank David Schneider
- Department of Family & Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Deng D, Nie Z, Wang J, Chen C, Wang W, Zhu Y, Guan Q, Ou Y, Feng Y. Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women. Nutr Metab Cardiovasc Dis 2024; 34:2562-2569. [PMID: 39174425 DOI: 10.1016/j.numecd.2024.04.001] [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: 10/31/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND AND AIM Obesity and metabolic abnormalities were associated with an increased risk of cardiovascular disease. However, it is unclear how metabolic weight phenotypes relate to cardiovascular diseases in postmenopausal women. This study aimed to explore the relationships in postmenopausal women. METHODS AND RESULTS We included 15,575 postmenopausal women aged 35-75 years (median age, 60.6) without cardiovascular disease at baseline from a subcohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. Metabolically unhealthy phenotype was defined as having ≥2 risk factors of metabolic syndrome: blood pressure ≥130/85 mm Hg or current use of antihypertensive drugs, fasting glucose ≥5.6 mmol/L or current use of antidiabetic agents, triglycerides ≥1.7 mmol/L, and high-density lipoprotein cholesterol <1.3 mmol/L. Cox regression analysis was used to evaluate the risks of cardiovascular diseases. Over a median follow-up period of 3.55 (interquartile range, 2.59-4.44) years, a total of 1354 cardiovascular events occurred. Compared to metabolically healthy normal weight, the multivariate-adjusted hazard ratios and their 95% confidence intervals were 1.41 (1.16-1.72) for metabolically unhealthy normal weight, 1.42 (1.16-1.73) for metabolically healthy overweight/obesity, and 1.75 (1.48-2.08) for metabolically unhealthy overweight/obesity. Subdividing overweight/obesity into separate groups revealed higher total cardiovascular disease risk only in metabolically unhealthy individuals across body mass index categories. CONCLUSION In postmenopausal women, both metabolically healthy overweight/obesity and metabolically unhealthy normal weight were associated with a higher risk of cardiovascular disease compared to metabolically healthy normal weight, and the greatest risk was observed in the metabolically unhealthy overweight/obesity category.
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Affiliation(s)
- Danying Deng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhiqiang Nie
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chaolei Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenbin Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanchen Zhu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qingyu Guan
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China.
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Qi J, Zhu R, Mao J, Wang X, Xu H, Guo L. Effect of Unfermented Soy Product Consumption on Blood Lipids in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Acad Nutr Diet 2024; 124:1474-1491.e1. [PMID: 38342411 DOI: 10.1016/j.jand.2024.02.006] [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: 04/04/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Clinical studies have reported the beneficial effects of unfermented soy product consumption on blood lipids in various populations. However, contradictory results have been reported regarding the influence of unfermented soy product consumption on blood lipids in postmenopausal women. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the effects of diets with unfermented soy products compared with diets without unfermented soy products on blood lipids in postmenopausal women. METHODS The Cochrane Library, PubMed, Scopus, Web of Science, and Embase electronic databases were searched for eligible randomized controlled trials (RCTs) published up to February 21, 2023. RCTs were included if they were published in English and investigated the effect of unfermented soy product consumption on blood lipids in postmenopausal women who had discontinued hormone replacement therapy at least 3 months before randomization. A random-effects model was used to calculate the overall effect size of the mean difference (MD) and 95% CI. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials, version 2. RESULTS Twenty-nine RCTs involving 2,457 participants were included. The results showed that, compared with the control group that did not consume unfermented soy products, consumption of unfermented soy products significantly reduced total cholesterol (TC) (MD, -9.46 mg/dL [to convert mg/dL cholesterol to mmol/L, multiply mg/dL by 0.0259; to convert mmol/L cholesterol to mg/dL, multiply by 38.7]; 95% CI -15.04 to -3.89 mg/dL; P = .001) and triglycerides (TGs) (MD, -10.86 mg/dL [to convert mg/dL TGs to mmol/L, multiply mg/dL by 0.0113; to convert mmol/L TGs to mg/dL, multiply mmol/L by 88.6]; 95% CI -19.70 to -2.02 mg/dL; P = .016), while significantly increasing high-density lipoprotein cholesterol (MD, 2.32 mg/dL; 95% CI 0.87 to 3.76 mg/dL; P = .002) in postmenopausal women, but had no significant effect on low-density lipoprotein cholesterol (MD, -4.55 mg/dL; 95% CI -10.90 to 1.80 mg/dL; P = .160). Results of soy preparation subgroup analysis showed that soy isolate protein significantly reduced TC and soy protein-containing isoflavones significantly reduced TC and low-density lipoprotein cholesterol and increased high-density lipoprotein cholesterol. Furthermore, unfermented soy product consumption significantly reduced TC, low-density lipoprotein cholesterol, and TG levels in postmenopausal women with lipid disorders and TGs in healthy postmenopausal women. CONCLUSIONS The results showed that unfermented soy product consumption reduced TC and TG levels significantly, and increased high-density lipoprotein cholesterol levels in postmenopausal women. The findings of this review contribute to the evidence-base for dietary management of blood lipids in postmenopausal women.
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Affiliation(s)
- Jiahe Qi
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ruiting Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jing Mao
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xi Wang
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, Jilin, China.
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, Jilin, China.
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Allen TS, Bui QM, Petersen GM, Mantey R, Wang J, Nerlekar N, Eghtedari M, Daniels LB. Automated Breast Arterial Calcification Score Is Associated With Cardiovascular Outcomes and Mortality. JACC. ADVANCES 2024; 3:101283. [PMID: 39399518 PMCID: PMC11470245 DOI: 10.1016/j.jacadv.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 10/15/2024]
Abstract
Background Breast arterial calcification (BAC) on mammograms has emerged as a biomarker of women's cardiovascular disease (CVD) risk, but there is a lack of quantification tools and clinical outcomes studies. Objectives This study assessed the association of BAC (both presence and quantity) with CVD outcomes. Methods This single-center, retrospective study included women with a screening mammogram from 2007 to 2016. BAC was quantified using an artificial intelligence-generated score, which was assessed as both a binary and continuous variable. Regression analyses evaluated the association between BAC and mortality and a composite of acute myocardial infarction, heart failure, stroke, and mortality. Analyses were adjusted for age, race, diabetes, smoking, blood pressure, cholesterol, and history of CVD and chronic kidney disease. Results A total of 18,092 women were included in this study (mean age 56.8 ± 11.0 years; diabetes [13%], hypertension [36%], hyperlipidemia [40%], and smoking [5%]). BAC was present in 4,223 (23%). Over a median follow-up of 6 years, death occurred in 7.8% and 2.3% of women with and without BAC, respectively. The composite occurred in 12.4% and 4.3% of women with and without BAC, respectively. Compared to those without, women with BAC had adjusted HRs of 1.49 (95% CI: 1.33-1.67) for mortality and 1.56 (95% CI: 1.41-1.72) for the composite. Each 10-point increase in the BAC score was associated with higher risk of mortality (HR: 1.08 [95% CI: 1.06-1.11]) and the composite (HR: 1.08 [95% CI: 1.06-1.10]). BAC was especially predictive of future events among younger women. Conclusions BAC is independently associated with mortality and CVD, especially among younger women. Measurement of BAC beyond presence adds incremental risk stratification. Quantifying BAC using an artificial intelligence algorithm is feasible, clinically relevant, and may improve personalized CVD risk stratification.
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Affiliation(s)
- Tara Shrout Allen
- Division of Preventive Medicine, University of California-San Diego, La Jolla, California, USA
| | - Quan M. Bui
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA
| | - Gregory M. Petersen
- Internal Medicine Residency Program, University of California-San Diego, La Jolla, California, USA
| | - Richard Mantey
- Research Team, CureMetrix, Inc, La Jolla, California, USA
| | - Junhao Wang
- Research Team, CureMetrix, Inc, La Jolla, California, USA
| | - Nitesh Nerlekar
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Victorian Heart Institute & Monash Health Heart, Monash University, Clayton, Australia
| | - Mohammad Eghtedari
- Department of Radiology, University of California-San Diego, La Jolla, California, USA
| | - Lori B. Daniels
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA
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Zhang Y, Yu S, Chen Z, Liu H, Li H, Long X, Ye F, Luo W, Dai Y, Tu S, Chen W, Kong S, He Y, Xue L, Tan N, Liang H, Zhang Z, He P, Duan C, Liu Y. Gestational diabetes and future cardiovascular diseases: associations by sex-specific genetic data. Eur Heart J 2024:ehae706. [PMID: 39453753 DOI: 10.1093/eurheartj/ehae706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/18/2024] [Accepted: 09/30/2024] [Indexed: 10/27/2024] Open
Abstract
BACKGROUND AND AIMS Observational studies have highlighted that gestational diabetes mellitus is associated with a higher risk of cardiovascular diseases, but the causality remains unclear. Herein, the causality between genetic predisposition to gestational diabetes mellitus and the risk of cardiovascular diseases was investigated using sex-specific Mendelian randomization analysis. METHODS Linkage disequilibrium score regression analysis and two-sample Mendelian randomization analysis were applied to infer the genetic correlation and causality, respectively. Mediation analysis was conducted using a two-step Mendelian randomization approach. Sensitivity analyses were performed to differentiate causality from pleiotropy. The genome-wide association study summary statistics for gestational diabetes mellitus were obtained from FinnGen consortium, while for cardiovascular diseases were generated based on individual-level genetic data from the UK Biobank. RESULTS Linkage disequilibrium score regression analyses revealed that gestational diabetes mellitus had a significant genetic correlation with coronary artery disease and myocardial infarction after Benjamini-Hochberg correction in ever-pregnant women. In Mendelian randomization analyses, odds ratios (95% confidence interval) for coronary artery disease and myocardial infarction were 1.09 (1.01-1.17) and 1.12 (.96-1.31) per unit increase in the log-odds of genetic predisposition to gestational diabetes mellitus in ever-pregnant women, respectively. Further, Type 2 diabetes and hypertension were identified as mediators for the causality of genetic predisposition to gestational diabetes mellitus on coronary artery disease. In sensitivity analyses, the direction of odds ratio for the association between instrumental variables with gestational diabetes mellitus-predominant effects and the risk of coronary artery disease was consistent with the primary results in ever-pregnant women, although not statistically significant. CONCLUSIONS This study demonstrated a suggestive causal relationship between genetic predisposition to gestational diabetes mellitus and the risk of coronary artery disease, which was mainly mediated by Type 2 diabetes and hypertension. These findings highlight targeting modifiable cardiometabolic risk factors may reduce the risk of coronary artery disease in women with a history of gestational diabetes mellitus.
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Affiliation(s)
- Yeshen Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Shijie Yu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Ziying Chen
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Haobin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huixian Li
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xinyang Long
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Fei Ye
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Wenzhi Luo
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yining Dai
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Shan Tu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Weikun Chen
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Siyu Kong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yu He
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Ling Xue
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huiying Liang
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhihui Zhang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Cardiology, Heyuan People's Hospital, Heyuan 517000, China
| | - Chongyang Duan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
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9
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Achtari M, Salihu A, Muller O, Abbé E, Clair C, Schwarz J, Fournier S. Gender Bias in AI's Perception of Cardiovascular Risk. J Med Internet Res 2024; 26:e54242. [PMID: 39437384 DOI: 10.2196/54242] [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: 11/02/2023] [Revised: 06/11/2024] [Accepted: 09/10/2024] [Indexed: 10/25/2024] Open
Abstract
The study investigated gender bias in GPT-4's assessment of coronary artery disease risk by presenting identical clinical vignettes of men and women with and without psychiatric comorbidities. Results suggest that psychiatric conditions may influence GPT-4's coronary artery disease risk assessment among men and women.
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Affiliation(s)
- Margaux Achtari
- Health and Gender Unit, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Adil Salihu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Abbé
- Institute of Mathematics and School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Carole Clair
- Health and Gender Unit, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joëlle Schwarz
- Health and Gender Unit, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Klisic A, Kotur-Stevuljevic J, Gluscevic S, Sahin SB, Mercantepe F. Biochemical markers and carotid intima-media thickness in relation to cardiovascular risk in young women. Sci Rep 2024; 14:24776. [PMID: 39433538 PMCID: PMC11494121 DOI: 10.1038/s41598-024-75409-x] [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: 05/03/2024] [Accepted: 10/04/2024] [Indexed: 10/23/2024] Open
Abstract
Cardiovascular disease (CVD) is a major cause of death in the female population. The current study aimed to examine the relationship between CVD risk and novel endothelial dysfunction biomarkers [i.e., endocan, adiponectin and intercellular adhesion molecule (ICAM)-1] and carotid intima-media thickness (cIMT), respectively in a cohort of disease-free women of reproductive age. A total of 129 women were selected. Serum endocan, adiponectin and ICAM-1 were measured by a commercial enzyme-linked immunosorbent assay and cITM was determined by ultrasound. Cardiovascular risk score (CVRS) was calculated. The lowest endocan (p for trend = 0.051) and adiponectin (p for trend = 0.040) levels were found in a group of subjects with the highest CVRS. The cIMT values were the highest in second tertile subgroups, with the highest 75th percentile in a third tertile CVRS group, while the lowest cIMT values were detected in the lowest CVRS tertile group (p for trend = 0.001). A significant positive correlation between cIMT and CVRS (ρ = 0.307, p < 0.001), and a negative correlation between adiponectin and endocan with CVRS, respectively (ρ = - 0.252, p = 0.004; ρ = - 0.179, p = 0.043) were observed, but only endocan retained the independent association with CVRS (p = 0.030) in the multiple linear regression analysis. Endocan could be useful diagnostic tool in the estimation of cardiovascular risk in young women.
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Affiliation(s)
- Aleksandra Klisic
- University of Montenegro-Faculty of Medicine, Podgorica, Montenegro.
- Center for Laboratory Diagnostics, Primary Health Care Center, Podgorica, Montenegro.
- Center for Laboratory Diagnostics, Primary Health Care Center, University of Montenegro-Faculty of Medicine, Trg Nikole Kovacevica 6, 81000, Podgorica, Montenegro.
| | - Jelena Kotur-Stevuljevic
- Department for Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Belgrade, Serbia
| | - Sanja Gluscevic
- Department of Neurology, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Filiz Mercantepe
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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11
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Brguljan Hitij J, Gaciong Z, Simić D, Vajer P, Zelveian P, Chazova IE, Jelaković B. Differences in sex and age response to single pill combination based antihypertensive therapy reflecting in blood pressure and arterial stiffness. J Hypertens 2024:00004872-990000000-00566. [PMID: 39445609 DOI: 10.1097/hjh.0000000000003901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 09/29/2024] [Indexed: 10/25/2024]
Abstract
OBJECTIVE There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women. METHODS Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years. RESULTS Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline. CONCLUSIONS The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03738761.
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Affiliation(s)
- Jana Brguljan Hitij
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Slovenia
| | - Zbigniew Gaciong
- University Clinical Center of the Medical University of Warsaw, Department of Internal Medicine, Hypertension and Vascular Diseases, Warsaw, Poland
| | | | - Péter Vajer
- Semmelweis University Budapest, Family Medicine Department, Budapest, Hungary
| | - Parounak Zelveian
- Center of Preventive Cardiology, Research Institute of Cardiology, Yerevan, Armenia
| | - Irina E Chazova
- Federal State Budgetary Institution "National Research Medical Center for Cardiology" of the Ministry of Health, Moscow, Russian Federation
| | - Bojan Jelaković
- University Hospital Centre Zagreb, Department of Internal Medicine, Department of Nephrology, Arterial hypertension, Dialysis and Transplantation, Zagreb, Croatia
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12
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Mubarik S, Naeem S, Shen H, Mubarak R, Luo L, Hussain SR, Hak E, Yu C, Liu X. Population-Level Distribution, Risk Factors, and Burden of Mortality and Disability-Adjusted Life Years Attributable to Major Noncommunicable Diseases in Western Europe (1990-2021): Ecological Analysis. JMIR Public Health Surveill 2024; 10:e57840. [PMID: 39418779 PMCID: PMC11501096 DOI: 10.2196/57840] [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: 02/27/2024] [Revised: 07/28/2024] [Accepted: 08/26/2024] [Indexed: 10/19/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) and neoplasms are leading causes of mortality worldwide. Objective This study aims to provide a comprehensive analysis of the mortality burden and disability-adjusted life years (DALYs) attributable to CVDs and neoplasms in Western Europe, investigate associated risk factors, and identify regional disparities. Additionally, the study evaluates the effectiveness of the Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) in promoting healthier lives in the region. Methods The study collected data on mortality and DALYs due to CVDs and cancers from 24 Western European countries using the Global Burden of Disease Study 2021. The analysis explored age, sex, and country-specific patterns, as well as risk factors contributing to these deaths. Additionally, the study examined time trends by calculating the annual percent change in mortality rates from 1990 to 2021 by region and cause. Results In 2021, CVDs and neoplasms accounted for 27.8% and 27.1% of total deaths in Western Europe, with age-standardized death rates of 106.8 and 125.8 per 100,000, respectively. The top two CVDs in this region were ischemic heart disease and stroke, with age-standardized death rates of 47.27 (95% uncertainty interval [UI] 50.42-41.45) and 27.06 (95% UI 29.17-23.00), respectively. Similarly, the top two neoplasms were lung cancer and colorectal cancer, with age-standardized death rates of 26.4 (95% UI 27.69-24.47) and 15.1 (95% UI 16.25-13.53), respectively. Between 1990 and 2021, CVD mortality rates decreased by 61.9%, while cancer rates decreased by 28.27%. Finland had the highest CVD burden (39.5%), and Monaco had the highest rate of cancer-related deaths (34.8%). Gender differences were observed, with males experiencing a higher burden of both CVDs and cancer. Older individuals were also more at risk. Smoking had a stronger impact on CVD mortality and DALYs in males, while a higher Human Development Index was associated with increased cancer deaths and DALYs in females. Conclusions The study findings highlight the substantial burden of NCDs, particularly CVDs and cancer, in Western Europe. This underscores the critical need for targeted interventions and effective implementation of the Action Plan for the Prevention and Control of NCDs to achieve the goal of ensuring healthy lives for all.
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Affiliation(s)
- Sumaira Mubarik
- PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Shafaq Naeem
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China
| | - Hui Shen
- Department of Communicable Disease Control and Prevention, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Rabia Mubarak
- Department of Economics, Arid Agriculture University, Rawalpindi, Pakistan
| | - Lisha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Syeda Rija Hussain
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Eelko Hak
- PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Global Health Research Division, Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Jiangsu, China
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13
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Nine I, Padrón-Cabo A, Carballeira E, Rial-Vázquez J, Rúa-Alonso M, Fariñas J, Giráldez-García M, Iglesias-Soler E. Acute cardiovascular responses of postmenopausal women to resistance training sessions differing in set configuration: A study protocol for a crossover trial. PLoS One 2024; 19:e0311524. [PMID: 39401188 PMCID: PMC11472946 DOI: 10.1371/journal.pone.0311524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 09/16/2024] [Indexed: 10/17/2024] Open
Abstract
BACKGROUND Resistance training is hardly recommended for postmenopausal women to counteract negative effects of hormonal changes. However, some concern exists about the marked hemodynamic responses caused by high-load resistance exercises. In this regard, studies on young, healthy, physically active individuals suggest that set configuration can modulate acute cardiovascular, metabolic, and cardiac autonomic responses caused by resistance training sessions, but this has not yet been explored in postmenopausal women. METHODS A sample of 60 physically active postmenopausal women (30 normotensive, 30 hypertensive) will participate in this crossover study. After a medical exam, ergometry, familiarization session, and two testing sessions, participants will complete three experimental sessions and one control session in a randomized order. Each experimental session includes 36 repetitions of four exercises (horizontal leg press, bench press, prone leg curl, and lat pull-down) differing in set configuration: 9 sets of 4 repetitions (i.e., 33% intensity of effort) with 45 s of inter-set recovery, 6 sets of 6 repetitions (50% intensity of effort) with 72 s, and 4 sets of 9 repetitions (75% intensity of effort) with 120 s; with 4 min rest between exercises. Before and immediately after each session, arterial stiffness, hemodynamic variables, cardiac autonomic modulation, baroreflex sensitivity, sympathetic vasomotor tone, and resting oxygen uptake will be evaluated. Furthermore, perceived effort, mechanical performance (e.g., power, velocity), heart rate, and lactatemia will be collected throughout sessions. The impact of set configuration on these variables will be analyzed, along with comparisons between normotensive and hypertensive women. DISCUSSION Cardiovascular responses to resistance exercise have been scarcely studied in females, particularly postmenopausal women. The results of this study will provide information about the modulating role of set structure on metabolic and cardiovascular responses of normotensive and hypertensive postmenopausal women to resistance training. CLINICAL TRIAL REGISTRATION NCT05544357 on 7 December 2022.
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Affiliation(s)
- Iván Nine
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | - Alexis Padrón-Cabo
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | - Eduardo Carballeira
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | - Jessica Rial-Vázquez
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Madrid, Spain
| | - María Rúa-Alonso
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
- Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal
- Polytechnic of Guarda, Guarda, Portugal
| | - Juan Fariñas
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | - Manuel Giráldez-García
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | - Eliseo Iglesias-Soler
- Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
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14
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Gilbert-Ouimet M, Sultan-Taïeb H, Ben Charif A, Brisson C, Lavigne-Robichaud M, Milot A, Trudel X, Demers É, Guertin JR. Direct medical costs of cardiovascular diseases: Do cost components vary according to sex and age? PLoS One 2024; 19:e0311599. [PMID: 39388420 PMCID: PMC11466411 DOI: 10.1371/journal.pone.0311599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 09/22/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The aim was to estimate direct medical costs of men and women patients by age group related to cardiovascular diseases (coronary heart disease, strokes) in the province of Quebec, Canada from the economic perspective of the healthcare public system, encompassing five cost components: physician fees, hospitalization (hospital stay, intensive care stay), emergency visits and medication costs. METHODS This matched case-control study involved secondary data from a longitudinal cohort study (1997-2018) of 4584 white-collar workers. Participants were followed for a four-year period. We used an incremental cost method of difference-in-difference. Descriptive analyses using frequency counts, arithmetic means, standardized differences, chi-squared tests, and Student's T-tests were performed. Direct medical costs were estimated using mean and 95% bootstrap confidence interval. RESULTS Direct medical costs per case were CAD $4970 [4344, 5595] for all in the first year after the event. For men patients, direct medical costs were $5351 [4649, 6053] and $4234 [2880, 5588] for women in the first year after the event, $221 [-229, 671] for men and $226 [-727, 1179] for women in the second year, and $11 [-356, 377] for men and $-24 [-612, 564] for women in the third year. This decrease was observed for both men and women, with higher costs for men. Within the first year, physician fees dominated CVD-associated costs among both men and women cases younger than 65. However, hospital stay represented the costliest component among cases aged 65 and older, incurring higher costs in women compared to men. In the subsequent years, the distribution of costs showed variations according to sex and age, with either medication costs or physician fees being the predominant components, depending on the specific subgroups. CONCLUSIONS CVD-associated direct medical costs varied by components, sex, age, and follow-up years. Patients with CVD incurred more than twice the medical costs as compared to patients without CVD of same age and sex.
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Affiliation(s)
- Mahée Gilbert-Ouimet
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, QC, Canada
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski, Lévis, QC, Canada
| | - Hélène Sultan-Taïeb
- School of Management, Université du Québec à Montréal (ESG-UQAM), Montréal, QC, Canada
| | | | - Chantal Brisson
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Mathilde Lavigne-Robichaud
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, Canada
| | - Xavier Trudel
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Éric Demers
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
| | - Jason Robert Guertin
- Population Health and Optimal Health Practices Unit, CHU de Quebec Research Centre, Université Laval, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
- Université Laval’s Research Center: The Tissue Engineering Laboratory (LOEX), Quebec City, Quebec, Canada
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15
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Lin F, Pan Q, Chen Y, Peng Y, Jiang F, Ni H, Lin L, Chen L, Lin Y. Sex-related differences in clinical characteristics and in-hospital outcomes of patients in acute type A aortic dissection. BMC Surg 2024; 24:302. [PMID: 39390480 PMCID: PMC11465527 DOI: 10.1186/s12893-024-02608-8] [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: 03/30/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate sex-related differences in the clinical characteristics and hospital outcomes of patients undergoing surgery for acute type A aortic dissection (AAAD). METHODS This study was a retrospective study. Patients who underwent surgery for AAAD at the Department of Cardiac Surgery, Fujian Medical University Union Hospital, from January 2014 to March 2023 were consecutively included. Data was extracted from electronic medical records. The primary outcome measure was in-hospital mortality, and secondary outcome measures included new-onset postoperative arrhythmia (POA), acute kidney injury (AKI), hepatic dysfunction, neurological complications, gastrointestinal hemorrhage, ICU length of stay, and hospital length of stay. Patients were divided into two groups based on sex, and data analysis was performed using SPSS 25.0 software. RESULTS A total of 1137 subjects were included, with 863 males (75.9%) and 274 females (24.1%). There were statistically significant differences in age and BMI between the two groups (P < 0.05). There was no statistically significant difference in the incidence of pain at the onset between the two groups, but chest tightness in females was higher than in males (22.6% vs. 13.8%). Regarding primary outcomes, the in-hospital mortality rate was 11.1% for males and 10.6% for females (P = 0.803). There were no statistically significant differences between the groups in ICU days, length of hospitalization, neurological complications, or liver dysfunction (P > 0.05). The rate of POA in females was 4.7%, higher than in males (2.2%), but AKI and gastrointestinal hemorrhage were both higher in males than in females (P < 0.05). Multivariate analysis showed that age, white blood cell (WBC) counts, lactic acid, operation duration and prolonged mechanical ventilation (PMV) increased the risk of in-hospital mortality in male patients. Hypertension, WBC counts, lactic acid, and PMV increased the risk of in-hospital mortality in female patients. CONCLUSION Despite significant baseline characteristic differences between male and female AAAD patients, there were no significant differences in onset symptoms. The in-hospital mortality rates were similar between male and female patients, but the risk factors for in-hospital mortality differed.
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Affiliation(s)
- Fen Lin
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Qiong Pan
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Yaqin Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yanchun Peng
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Fei Jiang
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Hong Ni
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Lingyu Lin
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China.
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16
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Tchétché D, Mehran R, Blackman DJ, Khalil RF, Möllmann H, Abdel-Wahab M, Ben Ali W, Mahoney PD, Ruge H, Bleiziffer S, Lin L, Szerlip M, Grubb KJ, Byku I, Guerrero M, Gillam LD, Petronio AS, Attizzani GF, Batchelor WB, Gada H, Rogers T, Rovin JD, Whisenant B, Benton S, Gardner B, Padang R, Althouse AD, Herrmann HC. Transcatheter Aortic Valve Implantation by Valve Type in Women With Small Annuli: Results From the SMART Randomized Clinical Trial. JAMA Cardiol 2024:2824178. [PMID: 39382856 DOI: 10.1001/jamacardio.2024.3241] [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] [Indexed: 10/10/2024]
Abstract
Importance Historically, women with aortic stenosis have experienced worse outcomes and inadequate recognition compared to men, being both underdiagnosed and undertreated, while also facing underrepresentation in clinical trials. Objective To determine whether women with small aortic annuli undergoing transcatheter aortic valve replacement have better clinical and hemodynamic outcomes with a self-expanding valve (SEV) or balloon-expandable valve (BEV). Design, Setting, Participants The Small Annuli Randomized to Evolut or SAPIEN Trial (SMART) was a large-scale randomized clinical trial focusing on patients with small aortic annuli undergoing transcatheter aortic valve replacement, randomized to receive SEVs or BEVs and included 716 patients treated at 83 centers in Canada, Europe, Israel, and the US from April 2021 to October 2022. This prespecified secondary analysis reports clinical and hemodynamic findings for all 621 women enrolled in SMART. Data for this report were analyzed from February to April 2024. Interventions Transcatheter aortic valve replacement with an SEV or a BEV. Main Outcomes and Measures The composite coprimary clinical end point comprised death, disabling stroke, or heart failure-related rehospitalization. The coprimary valve function end point was the incidence of bioprosthetic valve dysfunction, both assessed through 12 months. Secondary end points included the incidence of moderate or severe prosthesis-patient mismatch. Results A total of 621 women (mean [SD] age, 80.2 [6.2] years; 312 randomized to the SEV group and 309 to the BEV group) were included in the present analysis. At 12 months, there were no significant differences in the coprimary clinical end point between the SEV and BEV groups (9.4% vs 11.8%, absolute risk difference -2.3%; 95% CI -7.2 to 2.5, P = .35). However, SEV implantation was associated with less bioprosthetic valve dysfunction (8.4% vs 41.8%; absolute risk difference, -33.4%; 95% CI, -40.4 to -26.4; P < .001). SEV implantation resulted in lower aortic valve gradients and larger effective orifice areas at 30 days and 12 months and less mild or greater aortic regurgitation at 12 months compared to BEV implantation. Prosthesis-patient mismatch was significantly lower with SEVs, regardless of the definition used and adjustment for body mass index. Use of SEVs was associated with better quality of life outcomes as assessed by the Valve Academic Research Consortium-3 ordinal quality of life measure. Conclusions and Relevance Among women with severe symptomatic aortic stenosis and small aortic annuli undergoing transcatheter aortic valve replacement, the use of SEVs, compared to BEVs, resulted in similar clinical outcomes and a markedly reduced incidence of bioprosthetic valve dysfunction through 12 months, including a lower risk of prosthesis-patient mismatch and better 12-month quality of life. Trial Registration ClinicalTrials.gov Identifier: NCT04722250.
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Affiliation(s)
- Didier Tchétché
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Ramzi F Khalil
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital Dortmund, Dortmund, Germany
| | | | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul D Mahoney
- Department of Structural Interventional Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum North Rhine-Westphalia, Ruhr-Universität Bochum, Bochum, Germany
| | - Lang Lin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida
| | - Molly Szerlip
- Departments of Cardiology and Cardiac Surgery, Baylor Scott and White Heart Hospital, Plano, Texas
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Georgia
| | - Isida Byku
- Structural Heart and Valve Center, Division of Cardiology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Linda D Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey
| | - Anna Sonia Petronio
- Department of Cardiology, University of Pisa, Azienda Ospedaliera Universitaria Pisana University Hospital, Pisa, Italy
| | - Guilherme F Attizzani
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio
| | - Wayne B Batchelor
- Interventional Heart Program, Inova Schar Heart and Vascular, Falls Church, Virginia
| | - Hemal Gada
- Interventional Cardiology, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Joshua D Rovin
- Center for Advanced Valve and Structural Heart Care, Morton Plant Hospital, Clearwater, Florida
| | - Brian Whisenant
- Division of Cardiology, Intermountain Medical Center, Murray, Utah
| | - Stewart Benton
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania
| | - Blake Gardner
- Department of Structural Heart Disease Cardiology, Intermountain Medical Center, Murray, Utah
| | - Ratnasari Padang
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | | | - Howard C Herrmann
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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17
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Arocha Rodulfo JI, Fariñez GA. The complexity of cardiovascular risk in women. Descriptive review. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(24)00085-8. [PMID: 39384526 DOI: 10.1016/j.arteri.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVES Cardiovascular diseases (CVD) are the greatest threat to the health of women and is the leading cause of death amongst women globally; however, cardiovascular disease in women remains understudied, under-recognized, underdiagnosed, and undertreated. The aim of this descriptive review is to summarize the existing problem and to identify the knowledge gaps in cardiovascular disease research, prevention, treatment, and access to care for women. MATERIAL AND METHODS This is a descriptive review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century related to the spectrum of cardiovascular disease in women. RESULTS There are several obstacles to improve cardiovascular disease outcomes in women. One of them is the lack of reliable, effective screening modalities since her participation in clinical trial is quite low. Other concern is the complexity of the female organism with several hormonal changes during her life and the hemodynamics stress during pregnancy. Moreover, in the last stage of their life several cardiometabolic risk factor may appear, most of them not recognized by the health team in primary care attention. DISCUSSION Effective strategies are required to address inequalities in the diagnosis, treatment and prevention of heart disease in women; to advance innovative solutions for early detection and oriented management; to clarify the underlying biological mechanisms that contribute to sex-specific differences in outcomes; and finally, reduce the global burden of cardiovascular disease in women.
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Affiliation(s)
| | - Gestne Aure Fariñez
- Servicio de Endocrinología, Centro Médico Docente La Trinidad, Caracas, Venezuela
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18
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Hossin MZ, Kazamia K, Faxén J, Rudolph A, Johansson K, Sandström A, Razaz N. Pre-existing maternal cardiovascular disease and the risk of offspring cardiovascular disease from infancy to early adulthood. Eur Heart J 2024; 45:4111-4123. [PMID: 39228375 PMCID: PMC11458151 DOI: 10.1093/eurheartj/ehae547] [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: 02/02/2024] [Revised: 06/10/2024] [Accepted: 08/12/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND AND AIMS A variety of maternal heart conditions are associated with abnormal placentation and reduced foetal growth. However, their impact on offspring's long-term cardiovascular health is poorly studied. This study aims to investigate the association between intrauterine exposure to pre-existing maternal cardiovascular disease (CVD) and offspring CVD occurring from infancy to early adulthood, using paternal CVD as a negative control. METHODS This nationwide cohort study used register data of live singletons without major malformations or congenital heart disease born between 1992 and 2019 in Sweden. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusted for essential maternal characteristics. Paternal CVD served as a negative control for assessment of unmeasured genetic and environmental confounding. RESULTS Of the 2 597 786 offspring analysed (49.1% female), 26 471 (1.0%) were born to mothers with pre-existing CVD. During a median follow-up of 14 years (range 1-29 years), 17 382 offspring were diagnosed with CVD. Offspring of mothers with CVD had 2.09 times higher adjusted HR of CVD (95% CI 1.83, 2.39) compared with offspring of mothers without CVD. Compared with maternal CVD, paternal CVD showed an association of smaller magnitude (HR 1.49, 95% CI 1.32, 1.68). Increased hazards of offspring CVD were also found when stratifying maternal CVD into maternal arrhythmia (HR 2.94, 95% CI 2.41, 3.58), vascular (HR 1.59, 95% CI 1.21, 2.10), and structural heart diseases (HR 1.48, 95% CI 1.08, 2.02). CONCLUSIONS Maternal CVD was associated with an increased risk of CVD in offspring during childhood and young adulthood. Paternal comparison suggests that genetic or shared familial factors may not fully explain this association.
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Affiliation(s)
- Muhammad Zakir Hossin
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Karolinska University Hospital, D1: 04, Stockholm SE-171 76, Sweden
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver BC V6T 1Z3, Canada
| | - Kalliopi Kazamia
- Department of Pediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Faxén
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - André Rudolph
- Department of Pediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Karolinska University Hospital, D1: 04, Stockholm SE-171 76, Sweden
- Division of Obstetrics, Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Karolinska University Hospital, D1: 04, Stockholm SE-171 76, Sweden
- Division of Obstetrics, Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Neda Razaz
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Karolinska University Hospital, D1: 04, Stockholm SE-171 76, Sweden
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19
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Peters SAE, Van Spall HGC. Advancing women's cardiovascular health: an international lens on the Joint British Cardiovascular Societies' consensus statement. Heart 2024:heartjnl-2024-324907. [PMID: 39375026 DOI: 10.1136/heartjnl-2024-324907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/09/2024] Open
Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- The Baim Institute for Clinical Research, Boston, Massachusetts, USA
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20
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Pebole MM, Beck BM, Mahoney CT, Iverson KM. Improvements in Safety Outcomes Following Brief Healthcare-Based Intimate Partner Violence Interventions among Women Who Screen Positive for Intimate Partner Violence-Related Traumatic Brain Injuries. Brain Sci 2024; 14:1008. [PMID: 39452022 PMCID: PMC11506633 DOI: 10.3390/brainsci14101008] [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: 08/23/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Traumatic brain injuries (TBIs) are a common consequence of experiencing intimate partner violence (IPV). IPV-related TBI contributes to adverse health outcomes among women, but it is unknown whether a history of IPV-related TBI negatively impacts safety outcomes following healthcare-based interventions for IPV. Methods: Using data from a larger randomized clinical trial, we explored the impact of IPV-related TBI status on safety-related outcomes in two healthcare-based IPV interventions. At baseline, 35% (n = 21) of the sample screened positive for IPV-related TBI history. We used repeated measures ANOVAs to examine differences in safety outcomes at post-treatment and 1-month follow-up based on treatment condition and IPV-related TBI status. Results: Significant interaction effects were found for safety outcomes, such that women with IPV-related TBI history experienced larger reductions in the frequency of physical IPV and similar reductions in sexual IPV across both treatment conditions compared to women without IPV-TBI (F(2, 102) = 10.88, p < 0.001; F(2, 98) = 3.93, p = 0.036). Conclusions: Findings suggest that brief healthcare-based IPV interventions may result in improvements in safety outcomes for women with a history of IPV-TBI. This highlights the continued need for implementation of promising IPV-focused interventions to promote safety and protect women from experiencing further IPV.
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Affiliation(s)
- Michelle M. Pebole
- The Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Brigitta M. Beck
- Department of Psychology, University of Colorado, Colorado Springs, CO 80918, USA
| | - Colin T. Mahoney
- Department of Psychology, University of Colorado, Colorado Springs, CO 80918, USA
- Lyda Hill Institute for Human Resilience, Colorado Springs, CO 80918, USA
| | - Katherine M. Iverson
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
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21
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Campbell G, Doherty C, D'Silva A, Carr-White G, Webb J, Ismail TF. Implementation and evaluation of specialist heart failure pharmacist prescribing clinics. Int J Clin Pharm 2024:10.1007/s11096-024-01808-9. [PMID: 39368042 DOI: 10.1007/s11096-024-01808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/17/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Medications form the basis of treatment for heart failure (HF) and adherence is crucial as untreated HF has a mortality of greater than 30%. As such, specialist HF pharmacists with expertise in prescribing and promoting adherence have become an integral part of the wider HF multidisciplinary team (MDT). AIM To implement specialist HF pharmacist prescribing clinics and evaluate their impact. SETTING An integrated HF team at a tertiary London hospital. DEVELOPMENT The clinic was initially developed to facilitate the introduction of sacubitril-valsartan evolving to 6 dedicated clinics/week. IMPLEMENTATION A dedicated electronic referral pathway was created to channel referrals to the specialist clinic, and referral criteria expanded to all patients requiring optimisation of medical therapy. EVALUATION Data were retrospectively collected for patients with heart failure with reduced ejection fraction seen in the HF pharmacist clinic between September 2021 and July 2022. Overall, 114 patients were seen (mean age 66 years, 78 male). The mean time to medication optimisation was 3 months (averaging 1 appointment/month). The number on optimised doses of guideline-directed medical therapy, increased significantly from 8% at first appointment to 76% on discharge (p < 0.001). The HF pharmacists reviewed all medications and optimised non-HF medications for 17.5% (n = 20) of patients. CONCLUSION HF pharmacists can optimise patients' HF and non-HF medical therapy typically within 3 months. By reviewing all prescribed medications, HF pharmacists provide a holistic review of all medications. They can play a vital role in addressing the underutilisation of HF medical therapy and thereby improving patient outcomes.
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Affiliation(s)
- Gayle Campbell
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Ciara Doherty
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Andrew D'Silva
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerald Carr-White
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Jessica Webb
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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22
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Lailler G, Gabet A, Grave C, Boudet-Berquier J, El Rafei R, Regnault N, Acar P, Thomas-Chabaneix J, Tuppin P, Béjot Y, Blacher J, Olié V. Cardiovascular hospitalizations and deaths in adults, children and pregnant women. Arch Cardiovasc Dis 2024:S1875-2136(24)00324-3. [PMID: 39414462 DOI: 10.1016/j.acvd.2024.08.007] [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: 07/09/2024] [Revised: 08/14/2024] [Accepted: 08/19/2024] [Indexed: 10/18/2024]
Abstract
Cardiovascular diseases (CVDs) and strokes are the leading cause of death worldwide. To estimate the number and incidence of cardiovascular hospitalizations and deaths in adults and children and strokes and acute coronary syndromes (ACS) among pregnant women in France. Using National Health Data, we identified all hospitalizations for CVD in 2022 and cardiovascular deaths in 2021. We also identified all women in the general health insurance scheme who gave birth in France during 2010-2018 after 22 weeks' gestation and all strokes and ACS that occurred during pregnancy and postpartum. In adults in 2022, there were 1,229,003 hospitalizations for CVD among 925,936 adults (59.2% men) for a standardized rate of 1614 per 100,000. This was twice as high in men versus women and increased with age and social deprivation. In 2021, 138,137 adults died of CVD (47.4% men), i.e. 216 per 100,000 adults. Among children born during the first 6 months of 2022, a congenital heart defect (CHD) was identified in 3876 (1068 cases per 100,000 live births). In 2021, 193 children died of a CHD (1.4 per 100,000) and 100 of another CVD (0.7 per 100,000). In the women accounting for the 6.3 million deliveries during 2010-2018, 1261 strokes and 225 ACS were identified during pregnancy and the postpartum period, i.e. respective incidence rates of 24.0 and 4.3 per 100,000 person-years. The burden of CVD calls for large-scale action to improve the prevention, screening and management of CVD in these different populations.
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Affiliation(s)
- Grégory Lailler
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France.
| | - Amélie Gabet
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France
| | - Clémence Grave
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France
| | | | - Rym El Rafei
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France
| | - Nolwenn Regnault
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France
| | - Philippe Acar
- Paediatric Cardiology Department, Toulouse University Hospital, 31059 Toulouse, France
| | - Julie Thomas-Chabaneix
- Paediatric and Congenital Cardiology Unit, Bordeaux University Hospital, 33000 Bordeaux, France
| | | | - Yannick Béjot
- Neurology Department, Dijon University Hospital, Dijon Stroke Registry, 21000 Dijon, France
| | - Jacques Blacher
- Diagnostic and Therapeutic Centre, Hôtel-Dieu de Paris, Paris Public Hospitals (AP-HP), 75004 Paris, France
| | - Valérie Olié
- Santé publique France, 12, rue du Val d'Osne, 94410 Saint-Maurice, France
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23
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Zahiriharsini A, Gilbert-Ouimet M, Hervieux V, Trudel X, Matteau L, Jalbert L, Svyntozelska O, Demers J, LeBlanc A, Smith P. Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies. Neurosci Biobehav Rev 2024; 167:105916. [PMID: 39374679 DOI: 10.1016/j.neubiorev.2024.105916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/24/2024] [Accepted: 10/02/2024] [Indexed: 10/09/2024]
Abstract
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, with disparities observed between males and females. Psychosocial work exposures (PWE), including workload, job control, reward and long working hours, are associated with CVD development. Despite higher prevalence among females, the association with CVD is consistently observed in males, with limited explanations for these differences. This study aimed to examine the consideration of sex and gender in prospective studies within systematic reviews on PWE - specifically, the demand-control model, the effort-reward imbalance model, and long working hours - and CVD. Conducting a systematic review, we assessed sex and gender considerations using criteria from the Sex and Gender Equity in Research (SAGER) guidelines. While most studies recognized potential sex and gender differences in the associations between PWE and CVD, only about half of the 28 studies that included both sexes (15 studies) analyzed females and males separately. Moreover, few studies included criteria for sex- and gender-based analyses. Less than half of the studies (23 studies) incorporated a sex and/or gender perspective to discuss observed differences and similarities between men and women. Although there is a rising trend in integrating sex and gender considerations, significant gaps persist in methodologies and reporting, highlighting the need for comprehensive incorporation of sex and gender considerations to bolster CVD prevention strategies and policies.
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Affiliation(s)
- Azita Zahiriharsini
- Health Sciences Department, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada; CHU de Québec - Laval University Research Center, Population health and optimal health practices axis, Québec, Québec, Canada.
| | - Mahée Gilbert-Ouimet
- Health Sciences Department, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada; CHU de Québec - Laval University Research Center, Population health and optimal health practices axis, Québec, Québec, Canada; Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada.
| | - Valérie Hervieux
- CHU de Québec - Laval University Research Center, Population health and optimal health practices axis, Québec, Québec, Canada; Department of Management, Laval University, Québec, Québec, Canada; VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Xavier Trudel
- CHU de Québec - Laval University Research Center, Population health and optimal health practices axis, Québec, Québec, Canada; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Health Sciences Department, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada; CHU de Québec - Laval University Research Center, Population health and optimal health practices axis, Québec, Québec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Peter Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Work and Health, Toronto, Ontario, Canada
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Rosa WE, Weiss Goitiandia S, Braybrook D, Metheny N, Roberts KE, McDarby M, Behrens M, Berkman C, Stein GL, Adedimeji A, Wakefield D, Harding R, Spence D, Bristowe K. LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive. PLoS One 2024; 19:e0311506. [PMID: 39365801 PMCID: PMC11452035 DOI: 10.1371/journal.pone.0311506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/18/2024] [Indexed: 10/06/2024] Open
Abstract
CONTEXT LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. METHODS Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). FINDINGS 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary," "Recommendations," and/or "Key Messages" sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. CONCLUSIONS LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Sofia Weiss Goitiandia
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England, United Kingdom
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England, United Kingdom
| | - Nicholas Metheny
- School of Nursing and Health Studies University of Miami, Coral Gables, FL, United States of America
| | - Kailey E. Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States of America
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Mia Behrens
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY, United States of America
| | - Gary L. Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, NY, United States of America
| | - Adebola Adedimeji
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, NC, United States of America
| | - Donna Wakefield
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England, United Kingdom
| | | | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England, United Kingdom
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25
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Xu XY, Wu HY, Wei Q. Obesity-related indices as predictors of lower extremity arterial disease in type 2 diabetes mellitus. Endocrine 2024:10.1007/s12020-024-04039-0. [PMID: 39365387 DOI: 10.1007/s12020-024-04039-0] [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: 05/12/2024] [Accepted: 09/09/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE The aim of this study was to investigate the relationship between obesity and lower extremity arterial disease (LEAD) in patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective study included 1821 patients with type 2 diabetes: 364 patients with LEAD and 1457 patients without LEAD. The patients were divided into training and internal test cohorts in a 7:3 ratio. LASSO regression analysis was used in the training cohort to filter relevant variables. Univariate and multivariate regression analyses were conducted to assess independent risk factors. A diagnostic nomogram was constructed and its discrimination was evaluated using the area under the ROC curve (AUC). The consistency was assessed using a calibration plot. The clinical application of the nomogram was evaluated by performing a decision curve analysis (DCA) and validated by an internal test cohort of the training cohorts. RESULTS The LEAD group exhibited significantly higher values in obesity-related indices compared to the non-LEAD group, including waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI), body adiposity index (BAI), and abdominal volume index (AVI). Multivariate analysis identified BMI, CI, BAI, and other parameters as independent risk factors for LEAD. A nomogram was constructed, and the AUC value of the nomogram was 0.746 in the training cohort and 0.663 in the internal test cohort. CONCLUSION Obesity-related indices are associated with LEAD in patients with T2DM. Therefore, it is important to manage waist circumference and weight to reduce the risk of LEAD in patients with T2DM.
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Affiliation(s)
- Xin-Yue Xu
- Department of Endocrinology, Shanghai Public Health Clinical Center, Shanghai, China
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hong-Yan Wu
- Department of Endocrinology, People's Hospital of Xuyi, Jiangsu, China
| | - Qiong Wei
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Manzo-Silberman S, Chabbert-Buffet N, Roux E, Parisi M, Regidor PA, Mounier-Vehier C. Prevalence of cumulative cardiovascular risk factors among women of childbearing age in France: Results of the GYNRISK® survey. J Gynecol Obstet Hum Reprod 2024; 54:102859. [PMID: 39368653 DOI: 10.1016/j.jogoh.2024.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/12/2024] [Accepted: 09/29/2024] [Indexed: 10/07/2024]
Abstract
Global burden of cardiovascular disease is growing worldwide among women, particularly in younger women. Corresponding increases in the number and severity of cardiovascular risk factors (CVRF) associated with a greater impact in women could explain this increase in incidence. The prevalence of CVRF remains poorly known within young women, especially their cumulative prevalence. This study aimed to determine the prevalence of traditional and emerging CVRF, including female-specific CVRF, in young French women of childbearing age (16-45 years). The GYNRISK® survey aimed to analyse the magnitude and cumulation of CVRF. Two thousand women, representative of the general population, completed a self-administered, computer-assisted web interviewing survey. Results highlighted the high prevalence of traditional CVRF (73.8 % with at least one CVRF). Modifiable CVRF were also particularly high, especially overweight/obesity (31.3 %), tobacco/cannabis consumption (24.0 %), sedentary lifestyle (55.4 %), low fruit and vegetable intake (83.6 %), and poor health literacy (87.2 %). Additionally, a high prevalence of accumulated CVRF was reported, with 37.8 % of young French women having ≥2 traditional CVRF, 69.6 % having ≥1 traditional and ≥1 emergent CVRF, and 73.3 % having ≥1 traditional in addition to ≥1 lifestyle associated CVRF. Among women receiving combined hormonal contraception (CHC), 34.0 % had a contraindication for CHC due of the presence of CVRF (single or cumulative) according to recommendations. GYNRISK® survey highlighted the need for more data in this understudied population of young women. Increasing knowledge, screening, prevention, and information, with targeting on modifiable CVRF must be a priority to reduce women cardiovascular burden.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France.
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27
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Maurina M, Pivato CA, Kunadian V, Testa L, Briguori C, Pacchioni A, Latini AC, Cesani N, Piccolo R, Musto C, Sardella G, Indolfi C, Regazzoli D, Paradies V, Stefanini G. One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in women at high-bleeding risk: Insights from the POEM trial. Catheter Cardiovasc Interv 2024. [PMID: 39359172 DOI: 10.1002/ccd.31255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/27/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
AIMS We conducted a prespecified subanalysis of the POEM trial to assess the association between sex and clinical outcomes following a short 1-month dual-antiplatelet-therapy (DAPT) period after percutaneous coronary intervention (PCI) with bioresorbable polymer everolimus-eluting stent (BP-EES) among patients at high bleeding risk (HBR). BACKGROUND Shortening the DAPT period after PCI is an effective bleeding avoidance strategy with contemporary drug-eluting stents. Whether sex affects the risk of adverse events following PCI is still debated. METHODS Patients at HBR undergoing PCI with BP-EES were enrolled and treated with 1-month DAPT. If anticoagulation was needed, study participants received an oral anticoagulant (OAC) in addition to a P2Y12 inhibitor for 1 month, followed by OAC only thereafter. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. We report sex-based outcomes of patients included in the POEM study. RESULTS We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with lower hemoglobin levels, and worse renal function. Accordingly, they had a trend for a greater number of HBR criteria fulfilled and a higher PARIS bleeding score. However, they were not at a significantly higher risk for the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI: 0.48-3.54, p = 0.61), or any of the hemorrhagic and ischemic secondary endpoints. CONCLUSIONS This prespecified subanalysis of the POEM trial suggests that 1-month DAPT following PCI with BP-EES may be a safe and effective therapeutic strategy for women at HBR.
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Affiliation(s)
- Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Luca Testa
- IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Alessia Chiara Latini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy
| | - Nicola Cesani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy
| | - Raffale Piccolo
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Carmine Musto
- Department of Cardiosciences A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy
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28
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Huang S, Zou S, Hee J, Gongye R, Xu S, Tang K. Pregnancy loss and risk of cardiometabolic multimorbidity in Chinese women: the China Kadoorie Biobank study. BMC Public Health 2024; 24:2694. [PMID: 39358758 PMCID: PMC11448432 DOI: 10.1186/s12889-024-20199-0] [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: 07/05/2023] [Accepted: 09/26/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND While the association between pregnancy loss and individual cardiometabolic diseases (CMDs) is well-established, its impact on the risk of coexisting CMDs remains unclear. Therefore, the aim of this study is to investigate the association between pregnancy loss with the risk of cardiometabolic multimorbidity in Chinese women. METHOD We analyzed the cross-sectional data of 299,582 female participants aged 30-79 years old from the China Kadoorie biobank. Cardiometabolic multimorbidity was defined as the coexistence of two or more CMDs, including coronary heart disease, stroke, hypertension, and diabetes. Multivariable logistic regression was used to evaluate the odds ratios (ORs) between the number and type of pregnancy loss with the risk of cardiometabolic multimorbidity, characterized by the number and type of CMD. RESULTS After adjusting for confounding factors, pregnancy loss was found to be significantly associated with increased cardiometabolic multimorbidity risk (OR, 1.13 95% CI 1.08-1.19). Specifically, pregnancy loss due to spontaneous and induced abortion (OR 1.10, 95% CI 1.03-1.18 and OR 1.13, 95% CI 1.08-1.19, respectively). In contrast, no significant association was found between stillbirth and cardiometabolic multimorbidity (OR 1.03, 95% CI 0.95-1.11). The risk of cardiometabolic multimorbidity increases as the number of pregnancy loss increases (one pregnancy loss: OR 1.10, 95% CI 1.05-1.16, two or more pregnancy loss: OR 1.16, 95% CI 1.10-1.22). Similarly, the diagnosis of multiple CMDs increases with increasing number of pregnancy loss. Pregnancy loss was related to higher risk of cardiometabolic multimorbidity across most CMD combinations of CMDs. CONCLUSION Pregnancy loss, in particular, spontaneous and induced abortion was significantly associated with greater risk of cardiometabolic multimorbidity. The associations were stronger among those with recurrent pregnancy loss.
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Affiliation(s)
- Sha Huang
- School of Environmental Science and Engineering, Hainan University, Haikou, Hainan, 570228, China.
| | - Siyu Zou
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
| | - Jiayi Hee
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
| | - Ruofan Gongye
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
| | - Shunqing Xu
- School of Environmental Science and Engineering, Hainan University, Haikou, Hainan, 570228, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China.
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Bastian-Pétrel K, Rohmann JL, Oertelt-Prigione S, Piccininni M, Gayraud K, Kelly-Irving M, Bajos N. Sex and gender bias in chronic coronary syndromes research: analysis of studies used to inform the 2019 European Society of Cardiology guidelines. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101041. [PMID: 39279866 PMCID: PMC11402417 DOI: 10.1016/j.lanepe.2024.101041] [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: 05/03/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024]
Abstract
Background Sex and gender inequalities in ischemic heart diseases persist. Although ischemic heart disease is less common in women, they experience worse clinical outcomes and are less likely to receive guideline-recommended treatments. The primary scientific literature from which clinical guideline recommendations are derived may not have considered potential sex- and gender biases. This study aims to determine whether the literature cited in recent cardiovascular guidelines' clinical recommendations contain sex and gender biases. Methods We analysed publications cited in the 2019 European Society of Cardiology (ESC) guideline recommendations on chronic coronary syndromes, using a checklist to guide data extraction and evaluate the individual studies for sex- and gender-related aspects, such as inclusion/exclusion criteria, outcome measures, and demographic data reporting. To assess representation over time, the proportion of women participants in each study was computed and analysed using a beta regression model. We also examined the associations between women's representation, journal impact factor and author gender. Findings Among the 20 ESC recommendations on chronic coronary syndromes, four contained sex-related statements; we did not identify any gender-specific suggestions. The referenced literature upon which these recommendations were based consisted of 108 articles published between 1991 and 2019, encompassing more than 1.6 million study participants (26.8%; 432,284 women). Only three studies incorporated sex-sensitive designs; none were gender-specific. The term "gender" did not occur in 84% (n = 91/108) of the publications; when used, it was exclusively to denote biological sex. The proportion of women (assumed by investigators) among study participants fluctuated over time. Having a woman as first (odds ratio (OR) = 1.68, 95% CI: 1.19-2.39) or last author (OR = 2.28, 95% CI: 1.31-3.97), was significantly associated with having more women participants in the study. Interpretation The data underlying ESC guideline recommendations largely lack reporting of possible sex- and gender-specific aspects, and women are distinctly underrepresented. To what extent these recommendations apply to members of specific population groups who are not well-represented in the underlying evidence base remains unknown. Funding This study is part of the Gender and Health Inequalities (GENDHI) project, ERC-2019-SyG. This project has received funding from the European Research Council (ERC).
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Affiliation(s)
- Kathleen Bastian-Pétrel
- CERPOP-UMR1295, Université de Toulouse III, UPS, Inserm, Toulouse, France
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences Sociales, Politique, Santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jessica L Rohmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Gayraud
- Department of Aviation and Space Psychology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Hamburg, Germany
| | | | - Nathalie Bajos
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences Sociales, Politique, Santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
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30
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Manzo-Silberman S, Couturaud F, Bellemain-Appaix A, Vautrin E, Gompel A, Drouet L, Marliere S, Sollier CBD, Uhry S, Eltchaninoff H, Bergot T, Motreff P, Lahlou N, Cottin Y, Mounier-Vehier C, Gilard M, Montalescot G. Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study. J Am Heart Assoc 2024; 13:e034456. [PMID: 39319493 DOI: 10.1161/jaha.124.034456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population. METHODS AND RESULTS This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019). The primary outcome was the composite of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke, or major bleeding occurring during hospitalization with a 12-month follow up. Three hundred fourteen women were included. The mean age was 43.0 (±5.7) years, 60.8% presented with ST-segment-elevation myocardial infarction, 75.5% were current smokers, 31.2% had a history of complicated pregnancy, and 55.1% reported recent emotional stress. Most (91.6%) women presented with typical chest pain. Of patients on an estrogen-containing contraceptive, 86.0% had at least 1 contraindication. Of patients with ST-segment-elevation myocardial infarction, 17.8% had myocardial infarction with nonobstructive coronary arteries and 14.6% had spontaneous coronary artery dissection, whereas 29.3% presented with multivessel vessel disease. During hospitalization, 11 net adverse clinical events occurred in 9 (2.8%) women, but no deaths or stent thromboses occurred. By 12 months, 14 net adverse clinical events occurred in 10 (3.2%) women; 2 (0.6%) died (from progressive cancer) and 25 (7.9%) had an ischemia-driven repeat percutaneous coronary intervention. CONCLUSIONS Most young women with myocardial infarction reported typical chest pain and had modifiable cardiovascular risk factors. History of adverse pregnancy outcomes and prescription of combined oral contraceptive despite a contraindication were prevalent, emphasizing the need for comprehensive cardiological and gynecological evaluation and follow-up. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03073447.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology-Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group Paris France
| | - Francis Couturaud
- Chest Diseases, CHU_Brest, INSERM U1304, Univ_Brest, Brest Brest France
| | - Anne Bellemain-Appaix
- Cardiology Hospital of Antibes Juan Les Pins Antibes France
- ACTION Study Group Paris France
| | | | - Anne Gompel
- Gynecology University Paris Cité Paris France
| | | | | | | | - Sabrina Uhry
- Department of Cardiology Haguenau Hospital Haguenau France
| | - Hélène Eltchaninoff
- Department of Cardiology Normandie University, UNIROUEN, U1096, CHU Rouen Rouen France
| | | | - Pascal Motreff
- Cardiology University Hospital Gabriel Montpied Clermont-Ferrand France
| | - Najiba Lahlou
- Specialized Hormonology and Metabolism Laboratory AP-HP Centre Hôpital Cochin, Paris University Paris France
| | - Yves Cottin
- Cardiology University Hospital of Dijon Dijon France
| | | | - Martine Gilard
- Chest Diseases, CHU_Brest, INSERM U1304, Univ_Brest, Brest Brest France
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Viktorinova A, Brnka R, Pirosova M, Pontuch P, Kinova S. Sex differences in the correlation between lipids related to cardiovascular risk factors and small dense LDL particles in patients with type 2 diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e240069. [PMID: 39420941 PMCID: PMC11460969 DOI: 10.20945/2359-4292-2024-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 10/19/2024]
Abstract
Objective Sex differences in lipid metabolism associated with prevalent small dense (S-) low-density lipoprotein (LDL) cholesterol particles are not elucidated. An LDL to apolipoprotein B (ApoB) ratio < 1.2 can estimate how prevalent S-LDL particles are and, thus, reflect cardiovascular risk. The aim of this study was to evaluate the sex distribution of LDL/ApoB ratio among patients with type 2 diabetes (DM) and to assess, in both sexes, the correlations between key lipid parameters and LDL/ApoB < 1.2. Subjects and methods The study included 190 Caucasian participants (mean age 51.8 ± 6.4 years) with DM (DM group) or without DM (control group) divided into subgroups according to sex. The participants were examined for levels of several lipid parameters, selected lipid-related oxidative stress markers, and estimated S-LDL prevalence. Results An LDL/ApoB < 1.2 (p < 0.05) was observed in 67% of male and female patients with DM. Although triglyceride levels did not differ between men and women, women had higher levels of total cholesterol (p < 0.05) and LDL cholesterol (p < 0.01) than men. Among women with LDL/ApoB < 1.2, strong correlations were observed between values of lipid hydroperoxides (LOOH) and atherogenic index of plasma (p < 0.005) and between levels of triglycerides and LOOH (p < 0.005) and ApoB (p < 0.0001). Conclusions The findings indicate that women with LDL/ApoB < 1.2 tend to have a higher cardiovascular risk than men. Additionally, LDL/ApoB < 1.2 can be a surrogate marker for estimating the S-LDL prevalence in individuals with potentially increased cardiovascular risk.
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Affiliation(s)
- Alena Viktorinova
- Institute of Medical Chemistry, Biochemistry and Clinical BiochemistryFaculty of MedicineComenius University in BratislavaBratislavaSlovakia Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Robert Brnka
- Faculty of MedicineComenius University in BratislavaUniversity HospitalBratislavaSlovakia 1st Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
| | - Margita Pirosova
- Faculty of MedicineComenius University in BratislavaUniversity HospitalBratislavaSlovakia 4th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
| | - Peter Pontuch
- Faculty of MedicineComenius University in BratislavaUniversity HospitalBratislavaSlovakia 4th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
| | - Sona Kinova
- Faculty of MedicineComenius University in BratislavaUniversity HospitalBratislavaSlovakia 1st Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
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Petrova D, Garrido D, Catena A, Ramírez-Hernández JA, Blakoe M, Fernández-Martínez NF, Pérez-Gómez B, Sánchez MJ, Garcia-Retamero R. Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study. Soc Sci Med 2024; 359:117263. [PMID: 39232381 DOI: 10.1016/j.socscimed.2024.117263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Reducing patient decision delay - the time elapsed between symptom onset and the moment the patient decides to seek medical attention - can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. METHODS We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. RESULTS Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DISCUSSION The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Dunia Garrido
- Faculty of Psychology, University of Granada, Spain.
| | | | - José Antonio Ramírez-Hernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Mitti Blakoe
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - María José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Malloy S. Impact of Digital Health Interventions on Birth Equity: A Review. Semin Reprod Med 2024. [PMID: 39348847 DOI: 10.1055/s-0044-1791206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.
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Affiliation(s)
- Shannon Malloy
- Department of Clinical Operations and Evidence, Ovia Health, Boston, Massachusetts
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Yang Y, Li C, Hong Y, Sun J, Chen G, Ji K. Association between functional dependence and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study. Heliyon 2024; 10:e37821. [PMID: 39315220 PMCID: PMC11417238 DOI: 10.1016/j.heliyon.2024.e37821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024] Open
Abstract
Background The effect of different functional dependency types on cardiovascular disease (CVD) is largely unknown. Here, we aimed to investigate the association between functional dependence and CVD among middle-aged and older adults by conducting a cross-sectional and longitudinal study. Methods The study sample comprised 16,459 individuals of ≥40 years (including 10,438 without CVD) who had participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Functional dependence was categorized based on the "interval-of-need" method, while CVD was defined as physician-diagnosed heart disease or stroke. Cox proportional hazard regression was employed to assess the effects of functional dependence on CVD. Moreover, patients were grouped according to the functional status changes, and the impact of these changes on CVD was observed. Heterogeneity, subgroup, and interaction analyses were used to evaluate the consistency of the study findings. Finally, a mediation analysis was performed to estimate the potential mediation effects on the relationship between functional dependence and CVD risk. Results CVD prevalence in the overall study population was 13.73 % (2260/16,459), while its prevalence among individuals with functional independence, low dependency, medium dependency, and high dependency was 9.60 % (1085/11,302), 14.25 % (119/835), 17.72 % (115/649), and 25.01 % (941/3763), respectively. Additionally, medium (odds ratio: 1.33, 95 % confidence interval: 1.06-1.68) and high functional dependency (1.55, 95 % CI: 1.38-1.75) were associated with CVD. A total of 2987 (28.62 %) participants with CVD were identified during the 9-year follow-up, with 4.85 % (145/2987) of the CVD cases being attributed to functional dependence. The individuals with medium (HR: 1.20, 95 % CI: 1.01-1.44) and high functional dependency (1.25, 95 % CI: 1.14-1.37) were more likely to develop CVD than their peers with functional independence. Furthermore, persistent functional dependence (HR: 1.72, 95 % CI: 1.52-1.94) and transition from functional independence to dependence (1.79, 95 % CI: 1.61-1.98) were associated with a higher CVD risk than continuous functional independence. Hypertension and diabetes may partially mediate CVD caused by functional dependence. Conclusion Functional dependence is associated with high CVD risk. Therefore, appropriate healthcare attention must be directed towards functionally dependent populations to protect their cardiovascular health.
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Affiliation(s)
- Yaxi Yang
- College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Chaonian Li
- Department of Clinical Medical Research, Binhai County People's Hospital, Clinical Medical College of Yangzhou University, Yancheng, Jiangsu, 224500, China
| | - Ye Hong
- Department of Clinical Medical Research, Binhai County People's Hospital, Clinical Medical College of Yangzhou University, Yancheng, Jiangsu, 224500, China
| | - Jinqi Sun
- Department of Clinical Medical Research, Binhai County People's Hospital, Clinical Medical College of Yangzhou University, Yancheng, Jiangsu, 224500, China
| | - Guoping Chen
- Department of Clinical Medical Research, Binhai County People's Hospital, Clinical Medical College of Yangzhou University, Yancheng, Jiangsu, 224500, China
- Institute of Translational Medicine, Yangzhou University, Yangzhou, Jiangsu, 225002, China
| | - Kangkang Ji
- College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
- Department of Clinical Medical Research, Binhai County People's Hospital, Clinical Medical College of Yangzhou University, Yancheng, Jiangsu, 224500, China
- College of Biomedicine and Health, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [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] [Indexed: 09/04/2024] Open
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Tayal U, Pompei G, Wilkinson I, Adamson D, Sinha A, Hildick-Smith D, Cubbon R, Garbi M, Ingram TE, Colebourn CL, Camm CF, Guzik TJ, Anderson L, Page SP, Wicks E, Jenkins P, Rosen SD, Eftychiou S, Roberts E, Eftekhari H, Probert H, Cowie A, Thakkar R, Moore J, Berry C, Captur G, Deshpande A, Brown S, Malkin R, Harrison M, Lawson C, Ng GA, Kunadian V. Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies' consensus document. Heart 2024:heartjnl-2024-324625. [PMID: 39317437 DOI: 10.1136/heartjnl-2024-324625] [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] [Indexed: 09/26/2024] Open
Abstract
Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide. Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women's cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD. Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)'s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women. This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex- and gender-based research through collaboration across different affiliated societies within the BCS.
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Affiliation(s)
- Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Graziella Pompei
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | | | - Dawn Adamson
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Richard Cubbon
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | | | - Thomas E Ingram
- Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - C Fielder Camm
- Keble College, University of Oxford, Oxford, UK
- Royal Berkshire Hospital, Oxford University Hospitals NHS Foundation Trust, Reading, UK
| | | | - Lisa Anderson
- Cardivascular Sciences, St George's University of London, London, UK
| | | | | | - Petra Jenkins
- Department of Adult Congenital Heart Disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Stuart D Rosen
- Cardiology, Ealing Hospital, National Heart and Lung Institute, Middlesex, UK
| | | | | | - Helen Eftekhari
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Raj Thakkar
- Primary Care Cardiovascular Society, University of Cardiff, Cardiff, UK
| | - Jim Moore
- Gloucestershire Health and Care NHS Foundation Trust, Brockworth, Gloucestershire, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Gaby Captur
- University College London Institute of Cardiovascular Science, London, UK
- Centre for Inherited Heart Muscle Conditions, Royal Free Hospital, London, UK
| | | | | | | | | | | | - G Andre Ng
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Vijay Kunadian
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Cardiothoracic Directorate, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Liu L, Peng J, Zang D, Zhang Y, Wu Z, Song C, Chen S, Guo D, Lu F, Zheng T, Yang J. The Chinese visceral adiposity index: a novel indicator more closely related to cardiovascular disease than other abdominal obesity indices among postmenopausal women. J Transl Med 2024; 22:855. [PMID: 39313824 PMCID: PMC11421114 DOI: 10.1186/s12967-024-05665-y] [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: 09/06/2023] [Accepted: 09/04/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Several abdominal obesity indices including waist circumference (WC), waist-hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) were considered effective and useful predictive markers for cardiovascular disease (CVD) in general populations or diabetic populations. However, studies investigating the associations between these indices among postmenopausal women are limited. Our study aimed to investigate the associations of the five indices with incident CVD and compare the predictive performance of CVAI with other abdominal obesity indices among postmenopausal women. METHODS A total of 1252 postmenopausal women without CVD at baseline were analyzed in our investigation based on a 10-year follow-up prospective cohort study. Link of each abdominal obesity index with CVD were assessed by the Cox regression analysis and the Kaplan-Meier curve. The receiver operating characteristic (ROC) curves were drawn to compare the predictive ability for CVD. RESULTS During the median follow-up of 120.53 months, 121 participants newly developed CVD. Compared to quartile 1 of LAP and CVAI, quartile 4 had increased risk to develop CVD after fully adjusted among postmenopausal women. When WC, VAI and CVAI considered as continuous variables, significant increased hazard ratios (HRs) for developing CVD were observed. The areas under the curve (AUC) of CVAI (0.632) was greatly higher than other indices (WC: 0.580, WHR: 0.538, LAP: 0.573, VAI: 0.540 respectively). CONCLUSIONS This study suggested that the abdominal obesity indices were associated with the risk of CVD excluded WHR and highlighted that CVAI might be the most valuable abdominal obesity indicator for identifying the high risk of CVD in Chinese postmenopausal women.
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Affiliation(s)
- Li Liu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Jie Peng
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Dejin Zang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Yerui Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Zhenguo Wu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Chunfei Song
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Sha Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Dachuan Guo
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Shandong Academy of Medical Sciences, Jinan, China
| | - Tengfei Zheng
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China.
| | - Jianmin Yang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, No 107, Wenhuaxi Road, Jinan, Shandong, China.
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Castelvecchio S, Nappi RE. When the ovaries speak to your heart…..are we ready to listen? Eur J Prev Cardiol 2024; 31:1655-1657. [PMID: 37930321 DOI: 10.1093/eurjpc/zwad337] [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] [Received: 10/20/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Serenella Castelvecchio
- Department of Cardiovascular Prevention and Gender Medicine, I.R.C.C.S Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, I.R.C.C.S Matteo Foundation, 27100 Pavia, Italy
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Wan Z, Zhao J, Ye Y, Sun Z, Li K, Chen Y, Fang Y, Zhang Y, Lin J, Sun P, Zhang T, Shuai P, Li D, Li P, Zheng H, Li X, Liu Y. Risk and incidence of cardiovascular disease associated with polycystic ovary syndrome. Eur J Prev Cardiol 2024; 31:1560-1570. [PMID: 38373259 DOI: 10.1093/eurjpc/zwae066] [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: 11/15/2023] [Revised: 01/20/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
AIMS We aimed to evaluate the risk of cardiovascular disease (CVD) in women with polycystic ovary syndrome (PCOS) and estimate the global incidence of PCOS-associated CVD. METHODS AND RESULTS We conducted a meta-analysis across five databases to evaluate the risk of CVD among women with PCOS. The global incidence of PCOS-associated CVD was calculated by a population attributable fraction modelling using the pooled risk ratio (RR), PCOS prevalence, CVD incidence number, and age-standardized rate (ASIR), from the Global Burden of Diseases 2019. An estimated annual percentage change (EAPC) was used to assess the temporal trend of PCOS-associated CVD. The risk of CVD was significantly increased in women with PCOS for an all-age group (pooled RR 1.51, 95% confidence interval 1.36-1.69) and 10- to 54-year-olds (1.37, 1.17-1.59). Globally, from 1990 to 2019, the PCOS-associated CVD cases in women across the all-age group has raised from 102 530 to 235 560. The most affected regions were East Asia and the Pacific (108 430, 66 090-166 150) in 2019. South Asia has the highest increase trend of PCOS-associated CVD ASIRs (EAPC 2.61%, 2.49-2.73). The annual increase in ASIR in PCOS-CVD incidence for the 10-54 age group (EAPC 0.49%, 0.41-0.56) is faster than that of the all-age group (0.34, 0.27-0.42). The middle- or low-middle sociodemographic index countries experienced higher increase trend of CVD due to PCOS in the past 30 years. CONCLUSION Women with PCOS have a significantly increased risk of CVD. Efficient measures to enhance its prevention and treatment are important for regions with a high PCOS-associated CVD burden, especially premature CVD in women under 55 years.
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Affiliation(s)
- Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
| | - Jianhui Zhao
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongju Ye
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Zhaochen Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Kangning Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yuan Fang
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Yixuan Zhang
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Lin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
| | - Tingting Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
| | - Dongyu Li
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
| | - Pan Li
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, Australia
| | - Huimin Zheng
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Chancheng District, Foshan City, Guangdong Province 528000, China
| | - Xue Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Rd., Qingyang Dist., Chengdu 610072, China
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Weight N, Moledina S, Lawson CA, Van Spall HGC, Wijeysundera HC, Rashid M, Kontopantelis E, Mamas MA. The Intersection of Socioeconomic Differences and Sex in the Management and Outcomes of Acute Myocardial Infarction: A Nationwide Cohort Study. Angiology 2024:33197241273433. [PMID: 39295517 DOI: 10.1177/00033197241273433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Patients with lower socioeconomic status (SES) have poorer outcomes following acute myocardial infarction (AMI) than patients with higher SES; however, how sex modifies socioeconomic differences is unclear. Using the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) registry, alongside Office of National Statistics (ONS) mortality data, we analyzed 736,420 AMI patients between 2005 and 2018, stratified by Index of Multiple Deprivation (IMD) score Quintiles (most affluent [Q1] to most deprived [Q5]). There was no significant difference in probability of in-hospital mortality in our adjusted model according to sex. The probability of 30-day mortality in our adjusted model was similar between men and women throughout Quintiles, ((Q5; Men 7.6%; 95% CI 7.3-7.8% (P < .001), Women; 7.0%; 95% CI 6.8-7.3%, P < .001)) ((Q1; Men 7.1%; 95% CI 6.8-7.4%, P < .001, Women; 6.9%; 95% CI 6.6-7.1%, P < .001)). The probability of one-year mortality in our adjusted model was higher in men throughout all Quintiles (Q1; Men 15.0%; 95% CI 14.8-15.6%), P < .001, Women; 14.5%; 95% CI 14.2-14.9%, P < .001) (Q5; Men 16.9%; 95% CI 16.5-17.3%, P < .001, Women; 15.5%; 95% CI 15.1-15.9 by %, P < .001). Overall, female sex did not significantly influence the effect of deprivation on AMI processes of care and outcomes.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Research Institute of St Joe's, Hamilton, ON, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
- Department of Cardiovascular Sciences, Glenfield Hospital, University Hospitals of Leicester NHS Trust Leicester United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK
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Ortega E, Genua I, Mata-Cases M, Roqué M, Vlacho B, Real Gatius J, Franch-Nadal J, Mauricio D. First manifestation of cardiovascular disease according to age and sex in a Mediterranean country. Front Cardiovasc Med 2024; 11:1403363. [PMID: 39355347 PMCID: PMC11443696 DOI: 10.3389/fcvm.2024.1403363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 09/03/2024] [Indexed: 10/03/2024] Open
Abstract
Background Cardiovascular (CV) diseases are the most common cause of death worldwide. This study aimed to investigate the incidence and type of first CV event in a broad cohort of Spaniards, focusing on age and sex differences. Methods This was a retrospective study using the SIDIAP database. Subjects aged 30-89 years in 2010 were included. Individuals with prevalent CV disease or atrial fibrillation were excluded. Subjects were followed until the occurrence of a CV event, death, or the study end (December 2016). CV outcomes (coronary heart disease [CHD], cerebrovascular or peripheral artery disease and heart failure [HF]) during follow-up were analyzed. Clinical, anthropometrical, and laboratory data were retrieved from clinical records. Results Overall, 3,769,563 at-risk individuals (51.2 ± 15.2 years) were followed for a median of 7 years. The cumulative incidence of a first CV event was 6.66% (men vs. women, 7.48% vs. 5.90%), with the highest incidence (25.97%) among individuals >75 years. HF (29%) and CHD (28.8%) were the most common first events overall; in men it was CHD (33.6%), while in women it was HF and cerebrovascular disease (37.4% and 27.4%). In younger age groups, CHD was more prevalent, with HF in older age groups. Baseline CV risks factors conferred more risk in younger ages and differed between men and women. Conclusions The incidence and type of the first CV event in this Mediterranean region were significantly influenced by age and sex. This information is relevant for tailoring primary prevention strategies including the treatment of risk factors.
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Affiliation(s)
- Emilio Ortega
- Department of Endocrinology & Nutrition, Hospital Clinic Barcelona, Barcelona, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Idoia Genua
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center La Mina, Gerència D'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Mercè Roqué
- Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Cardiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Real Gatius
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center Raval Sud, Gerènciad’Atenció Primaria, InstitutCatalà de la Salut, Barcelona, Spain
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, University of Vic—Central University of Catalonia, Vic, Spain
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Younis JS, Taylor HS. Is There an Association Between Endometriosis, Early Menopause, and Cardiovascular Disease? J Clin Endocrinol Metab 2024; 109:e1946-e1949. [PMID: 39083665 DOI: 10.1210/clinem/dgae508] [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: 05/17/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
Large-scale studies show endometriosis linked to earlier menopause onset. Recent research targeting women with laparoscopically diagnosed endometriosis found an increase in cases of early natural menopause. Furthermore, recent large-scale cohort studies have found a correlation between endometriosis and an increased risk of cardiovascular disease (CVD). Understanding the causality of early menopause, particularly natural menopause, and cardiovascular risks in women with endometriosis could help medical professionals develop effective strategies for early prevention and new therapies. Endometriosis, early menopause, and cardiovascular risks may be linked by primary or secondary mechanisms. Primary mechanisms involve shared pathways that can lead to all morbidities, while secondary occur due to delayed consequences of management strategies. In these large-scale cohort studies, relevant risk and confounding factors, such as oophorectomy, were considered to refine estimates of associations. However, none of the studies considered endometriotic cystectomy, a globally accepted treatment for endometriosis-associated pelvic pain and infertility, as a mediating factor. There is substantial evidence to indicate that endometriotic cystectomy harms ovarian reserve and may lead to early menopause in cases of multiple surgeries or bilateral cases. Early menopause is a well-established risk factor for CVD. To thoroughly examine the link between endometriosis and early menopause, particularly natural menopause, and their connection with cardiovascular risks, it is imperative to consider all the possible factors that may affect the results, such as endometriotic cystectomy. This will enable us to obtain the most accurate and adjusted hazard ratio.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics & Gynecology, Tzafon Medical Center, Poriya 15208001, Israel
- Azrieili Faculty of Medicine in Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
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Santos RD. Familial hypercholesterolaemia: need for equitable treatment in women and men. Eur Heart J 2024; 45:3251-3253. [PMID: 39082699 DOI: 10.1093/eurheartj/ehae464] [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] [Indexed: 09/15/2024] Open
Affiliation(s)
- Raul D Santos
- Academic Research Organization, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701-Morumbi, Sao Paulo, SP 05652-900, Brazil
- Lipid Clinic Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
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Ciolac EG, Babjakova J, de Abreu RM, Mao SJ, Qian G, Teixeira do Amaral V, Wrzesinski B, Ferron AJT, Ossowski Z, Francisqueti-Ferron FV, Yeniğün SC, Fernandes B, Rodrigues LM, Gabulova R. Role of sex and training characteristics on exercise effects on cardiovascular aging: protocol for a systematic review with meta-analysis of randomized trials. Syst Rev 2024; 13:234. [PMID: 39277764 PMCID: PMC11401294 DOI: 10.1186/s13643-024-02644-8] [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: 08/24/2023] [Accepted: 08/22/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Cardiovascular diseases remain a leading global cause of mortality worldwide especially in older adults. Although it is known that regular exercise reduces cardiovascular diseases incidence, its effects on specific cardiovascular aging parameters considering the influence of sex and different exercise designs are still not fully understood. Therefore, this systematic review and meta-analysis aims to evaluate the effects of different physical exercise protocols on age-related cardiovascular outcomes in older adults. METHODS This systematic review and meta-analysis will be reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles will be eligible if they are randomized controlled trials with a primary objective of evaluating the chronic effects of exercise interventions on cardiovascular aging parameters. Search strategy will be performed from the inception to September 30th, 2023, in the following electronic databases: MEDLINE (Ovid), SCOPUS (Elsevier), Embase, Sport Discus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection (Clarivate Analytics). Data will be extracted and managed through Research Electronic Data Capture (REDCap) software. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) will be used to assess the methodological quality of included studies. Additionally, the quality of the findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler. Meta-analysis based on the random-effects model will be performed (if deemed suitable, considering the methodological and clinical heterogeneity of the studies) to estimate the effects of exercise training on cardiovascular aging variables (i.e., cardiac output; arterial stiffness; stroke volume; endothelial function; and carotid intima-media thickness). Heterogeneity will be assessed with the I2 statistics, while the publication bias will be assessed based on Egger's test. DISCUSSION To the best of our knowledge, this will be the first systematic review and meta-analysis to investigate the impact of sex and training protocols on the cardiovascular aging parameters. Moreover, the findings of this systematic review and meta-analysis will provide evidence for health professionals in the management of elderly patients in order to optimize the exercise prescription to face the cardiovascular alterations related to the aging process, considering the effects of different protocols according to sex. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023441015 .
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Affiliation(s)
- Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (Unesp), Av. Eng. Luiz Edmundo Carrijo Coube 14-01, Bauru, Sao Paulo, 17033-360, Brazil.
| | - Jana Babjakova
- Faculty of Medicine, Comenius University in Bratislava, Institute of Hygiene, Bratislava, Slovakia
| | - Raphael Martins de Abreu
- Department of Physiotherapy, LUNEX University, International University of Health, Exercise & Sports S.A, Differdange, Luxembourg
- LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg
| | - Su-Jie Mao
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Guoping Qian
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Vanessa Teixeira do Amaral
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (Unesp), Av. Eng. Luiz Edmundo Carrijo Coube 14-01, Bauru, Sao Paulo, 17033-360, Brazil
| | - Bartlomiej Wrzesinski
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Artur Junio Togneri Ferron
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (Unesp), Av. Eng. Luiz Edmundo Carrijo Coube 14-01, Bauru, Sao Paulo, 17033-360, Brazil
| | - Zbigniew Ossowski
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Fabiane Valentini Francisqueti-Ferron
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (Unesp), Av. Eng. Luiz Edmundo Carrijo Coube 14-01, Bauru, Sao Paulo, 17033-360, Brazil
- Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | - Seda Cansu Yeniğün
- Faculty of Health Sciences, Akdeniz University, Kumluca , Antalya, Turkey
| | - Bianca Fernandes
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (Unesp), Av. Eng. Luiz Edmundo Carrijo Coube 14-01, Bauru, Sao Paulo, 17033-360, Brazil
| | - Luis Monteiro Rodrigues
- Research Center for Biosciences & Health Technologies (CBIOS), Universidade Lusófona, Lisbon, Portugal
| | - Rahima Gabulova
- Department of Family Medicine, Azerbaijan Medical University, Baku, Azerbaijan
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Wang B, Xu W, Mei Z, Yang W, Meng X, An G. Association between serum Klotho levels and estimated pulse wave velocity in postmenopausal women: a cross-sectional study of NHANES 2007-2016. Front Endocrinol (Lausanne) 2024; 15:1471548. [PMID: 39329104 PMCID: PMC11424431 DOI: 10.3389/fendo.2024.1471548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 08/26/2024] [Indexed: 09/28/2024] Open
Abstract
Background Postmenopausal women are at an increased risk of arterial stiffness, which can be assessed using estimated pulse wave velocity (ePWV). This study aimed to investigate the relationship between serum klotho levels and ePWV in postmenopausal women. Methods This cross-sectional study used data from postmenopausal women who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Participants were divided into two groups based on the presence of hypertension. Weighted multivariate linear regression was used to analyze the relationship between serum Klotho levels and ePWV in each group. Restricted cubic spline models with multivariable adjustments were employed to examine nonlinear associations within each group. Results Our analysis included 4,468 postmenopausal women from the NHANES database, with 1,671 in the non-hypertensive group and 2,797 in the hypertensive group. In all regression models, serum Klotho (ln-transformed) levels were significantly and independently negatively correlated with ePWV in the non-hypertensive group. After fully adjusting for confounders, a 1-unit increase in ln(Klotho) was associated with a 0.13 m/s decrease in ePWV (β = -0.13, 95% CI -0.23 to -0.03; p = 0.008). Additionally, in the fully adjusted model, participants in the highest quartile of ln(Klotho) had an ePWV value 0.14 m/s lower than those in the lowest quartile (p for trend = 0.017; 95% CI -0.23 to -0.05; p = 0.002). This negative correlation was consistent across subgroups and was particularly significant among women aged < 60 years, nonsmokers, and non-Hispanic Black women. However, no association was observed between serum Klotho levels and ePWV in the hypertensive group. Conclusion Hypertension may affect the relationship between serum Klotho level and ePWV in postmenopausal women. Increased serum Klotho levels may reduce arterial stiffness in postmenopausal women. Further studies are required to confirm these findings.
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Affiliation(s)
- Baiqiang Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqu Xu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zeyuan Mei
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Yang
- Department of Cardiology, People's Hospital of Rizhao, Rizhao, China
| | - Xiao Meng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Guipeng An
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
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Garmany R, Dasari S, Bos JM, Kim ET, Gluscevic M, Martinez KA, Tester DJ, Dos Remedios C, Maleszewski JJ, Dearani JA, Ommen SR, Geske JB, Giudicessi JR, Ackerman MJ. A multi-omics atlas of sex-specific differences in obstructive hypertrophic cardiomyopathy. J Mol Cell Cardiol 2024; 196:26-34. [PMID: 39255898 DOI: 10.1016/j.yjmcc.2024.09.005] [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: 05/08/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a common genetic heart disease. Women with HCM tend to have a later onset but more severe disease course. However, the underlying pathobiological mechanisms for these differences remain unknown. METHODS Myectomy samples from 97 patients (53 males/44 females) with symptomatic obstructive HCM and 23 control cardiac tissues were included in this study. RNA-sequencing was performed on all samples. Mass spectrometry-based proteomics and phosphoproteomics was performed on a representative subset of samples. RESULTS The transcriptome, proteome, and phosphoproteome was similar between sexes and did not separate on PCA plotting. Overall, there were 482 differentially expressed genes (DEGs) between control females and control males while there were only 53 DEGs between HCM females and HCM males. There were 1983 DEGs between HCM females and control females compared to 1064 DEGs between HCM males and control males. Additionally, there was increased transcriptional downregulation of hypertrophy pathways in HCM females and in HCM males. HCM females had 119 differentially expressed proteins compared to control females while HCM males only had 27 compared to control males. Finally, the phosphoproteome showed females had 341 differentially phosphorylated proteins (DPPs) compared to controls while males only had 184. Interestingly, there was hypophosphorylation and inactivation of hypertrophy pathways in females but hyperphosphorylation and activation in males. CONCLUSION There are subtle, but biologically relevant differences in the multi-omics profile of HCM. This study provides the most comprehensive atlas of sex-specific differences in the transcriptome, proteome, and phosphoproteome present at the time of surgical myectomy for obstructive HCM.
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Affiliation(s)
- Ramin Garmany
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Alix School of Medicine, and the Mayo Clinic Medical Scientist Training Program, Rochester, MN, USA; Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences/Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - J Martijn Bos
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Evelyn T Kim
- Mayo Clinic Mentorship Program, Rochester, MN, USA
| | - Martina Gluscevic
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Katherine A Martinez
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - David J Tester
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Cristobal Dos Remedios
- Mechanobiology Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine; Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine; Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - John R Giudicessi
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine; Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics; Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine; Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.
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Williams JS, Wiley E, Cheng JL, Stone JC, Bostad W, Cherubini JM, Gibala MJ, Tang A, MacDonald MJ. Differences in cardiovascular risk factors associated with sex and gender identity, but not gender expression, in young, healthy cisgender adults. Front Cardiovasc Med 2024; 11:1374765. [PMID: 39318832 PMCID: PMC11420989 DOI: 10.3389/fcvm.2024.1374765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/10/2024] [Indexed: 09/26/2024] Open
Abstract
Background Sex differences exist in cardiovascular disease risk factors including elevated blood pressure and arterial stiffness, and decreased endothelial function in males compared to females. Feminine gender expression may be associated with elevated risk of acute coronary syndrome. However, no study has investigated the associations between sex, gender identity, and gender expression and cardiovascular disease risk factors in young adults. Methods One hundred and thirty participants (22 ± 3 years) underwent assessments of hemodynamics, arterial stiffness [pulse wave velocity (PWV)], and brachial artery endothelial function (flow-mediated dilation; %FMD). Participants completed a questionnaire capturing sex category (50 male/80 female), gender identity category (49 men/79 women/2 non-binary), and aspects of gender expression assessed by the Bem Sex Role Inventory-30 (39 androgynous/33 feminine/29 masculine/29 undifferentiated). Sex/gender identity category groups were compared using unpaired t-tests and gender expression groups compared using one-way ANOVAs. Results Resting systolic and mean arterial pressure (p < 0.01) were elevated in males vs. females. Central PWV was elevated in males [median (interquartile range): 6.4 (1.8) vs. 5.8 (2.2) m/s, p = 0.02]; however, leg and arm PWV were not different between sexes. %FMD was elevated in males vs. females, after accounting for a larger baseline artery diameter in males (8.8 ± 3.3% vs. 7.2 ± 3.1%, p = 0.02); since the majority of participants were cisgender, the same results were found examining gender identity (men vs. women). There were no differences across gender expression groups (p > 0.05). Conclusions Sex/gender identity category, but not gender expression, influence cardiovascular risk factors (blood pressure, arterial stiffness, endothelial function) in cisgender adults; further research is needed in gender-diverse populations.
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Affiliation(s)
- Jennifer S. Williams
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Jem L. Cheng
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Jenna C. Stone
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - William Bostad
- Human Performance Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Joshua M. Cherubini
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Martin J. Gibala
- Human Performance Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maureen J. MacDonald
- Vascular Dynamics Lab, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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De Cock E, Kautbally S, Timmermans F, Bogaerts K, Hanet C, Desmet W, Gurné O, Vranckx P, Hiltrop N, Dujardin K, Vanduynhoven P, Vermeersch P, Pirlet C, Hermans K, Van Reet B, Ferdinande B, Aminian A, Dewilde W, Guédès A, Simon F, De Roeck F, De Vroey F, Jukema JW, Sinnaeve P, Buysschaert I. Low-dose colchicine for the prevention of cardiovascular events after percutaneous coronary intervention: Rationale and design of the COL BE PCI trial. Am Heart J 2024; 278:61-71. [PMID: 39233210 DOI: 10.1016/j.ahj.2024.08.022] [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: 07/12/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Patients with coronary artery disease (CAD) remain vulnerable to future major atherosclerotic events after revascularization, despite effective secondary prevention strategies. Inflammation plays a central role in the pathogenesis of CAD and recurrent events. To date, there is no specific anti-inflammatory medicine available with proven effective, cost-efficient, and favorable benefit-risk profile, except for colchicine. Initial studies with colchicine have sparked major interest in targeting atherosclerotic events with anti-inflammatory agents, but further studies are warranted to enforce the role of colchicine role as a major treatment pillar in CAD. Given colchicine's low cost and established acceptable long-term safety profile, confirming its efficacy through a pragmatic trial holds the potential to significantly impact the global burden of cardiovascular disease. METHODS The COL BE PCI trial is an investigator-initiated, multicenter, double-blind, event-driven trial. It will enroll 2,770 patients with chronic or acute CAD treated with percutaneous coronary intervention (PCI) at 19 sites in Belgium, applying lenient in- and exclusion criteria and including at least 30% female participants. Patients will be randomized between 2 hours and 5 days post-PCI to receive either colchicine 0.5 mg daily or placebo on top of contemporary optimal medical therapy and without run-in period. All patients will have baseline hsCRP measurements and a Second Manifestations of Arterial Disease (SMART) risk score calculation. The primary endpoint is the time from randomization to the first occurrence of a composite endpoint consisting of all-cause death, spontaneous non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization. The trial is event-driven and will continue until 566 events have been reached, providing 80% power to detect a 21 % reduction in the primary endpoint taking a premature discontinuation of 15% into account. We expect a trial duration of approximately 44 months. CONCLUSION The COL BE PCI Trial aims to assess the effectiveness and safety of administering low-dose colchicine for the secondary prevention in patients with both chronic and acute coronary artery disease undergoing PCI. TRIAL REGISTRATION ClinicalTrials.gov: NCT06095765.
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Affiliation(s)
- Emmanuel De Cock
- Department of Cardiology, AZ Sint-Jan Brugge AV, Bruges, Belgium; Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Shakeel Kautbally
- Department of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium
| | - Claude Hanet
- Department of Cardiology, Université Catholique de Louvain, Mont Godinne, Yvoir, Belgium
| | - Walter Desmet
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Belgium & Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gurné
- Department of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Hasselt, Belgium
| | - Nick Hiltrop
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Karl Dujardin
- Department of Cardiology, AZ Delta, Roeselare, Belgium
| | | | - Paul Vermeersch
- Department of Cardiology, ZNA (Ziekenhuis Netwerk Antwerpen) Middelheim, Antwerp, Belgium
| | - Charles Pirlet
- Department of Cardiology, Citadelle Liège, Liège, Belgium
| | - Kurt Hermans
- Department of Cardiology, AZ Sint-Lucas Ghent, Ghent, Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout, Turnhout, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Antoine Guédès
- Department of Cardiology, Université Catholique de Louvain, Mont Godinne, Yvoir, Belgium
| | - François Simon
- Department of Cardiology, Clinique Saint-Luc Bouge, Namur, Belgium
| | - Frederic De Roeck
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Peter Sinnaeve
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Belgium & Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ian Buysschaert
- Department of Cardiology, AZ Sint-Jan Brugge AV, Bruges, Belgium.
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van Kampen A, Butte S, Paneitz DC, Nagata Y, Langer NB, Borger MA, D'Alessandro DA, Sundt TM, Melnitchouk S. Presentation and outcomes of women and men undergoing surgery for degenerative mitral regurgitation. Eur J Cardiothorac Surg 2024; 66:ezae312. [PMID: 39141430 DOI: 10.1093/ejcts/ezae312] [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: 04/09/2024] [Revised: 05/23/2024] [Accepted: 08/13/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES Degenerative mitral regurgitation is associated with heart failure, arrhythmia and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female degenerative mitral valve regurgitation patients undergoing surgery. METHODS We reviewed our institutional database for all patients undergoing surgery for degenerative mitral regurgitation between 2013 and 2021. Preoperative clinical and echocardiographic variables, surgical characteristics and outcomes were compared, and left atrial strain in available images. RESULTS Of 963 patients, 314 (32.6%) were female. Women were older (67 vs 64 years, P = 0.031) and more often had bileaflet prolapse (19.4% vs 13.8%, P = 0.028), mitral annular calcification (12.1% vs 5.4%, P < 0.001) and tricuspid regurgitation (TR; 31.8% vs 22.5%, P = 0.001). Indexed left ventricular end-diastolic and end-systolic diameters were higher in women, with 29.4 vs 26.7 mm/m2 (P < 0.001) and 18.2 vs 17 mm/m2 (P < 0.001), respectively, and left atrial conduit strain lower (17.6% vs, 21.2%, P = 0.001). Predicted risk of mortality was 0.73% vs 0.54% in men (P = 0.023). Women required mechanical circulatory support more frequently (1.3% vs 0%, P = 0.011), had longer intensive care unit stay (29 vs 26 h, P < 0.001), mechanical ventilation (5.4 vs 5 h, P = 0.036), and overall hospitalization (7 vs 6 days, P < 0.001). There was no difference in long-term reoperation-free survival (P = 0.35). CONCLUSIONS Women undergoing mitral valve repair are older and show indicators of more advanced disease with long-standing left ventricular impairment. Guidelines may need to be adjusted and address this disparity, to improve postoperative recovery times and outcomes.
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Affiliation(s)
- Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sophie Butte
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dane C Paneitz
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasufumi Nagata
- Department of Cardiology, Echocardiography Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathaniel B Langer
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David A D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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50
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Hoel S, Moe K, Sugulle M, Petrovski G, Veiby NCBB, Staff AC. Retinal oximetry and microvascular assessment after hypertensive pregnancy complications. Acta Ophthalmol 2024; 102:653-661. [PMID: 38342958 DOI: 10.1111/aos.16651] [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: 09/19/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE Women with hypertensive disorders of pregnancy (HDP) are at increased risk of developing premature cardiovascular disease (CVD). The mechanisms behind this are not fully understood, but microvascular alterations have been documented in retinal arterioles and venules. The aim of this study was to use non-invasive retinal imaging to investigate the structural and functional properties of arterioles, venules and capillaries in this patient group. METHODS We examined 27 women with previous HDP and 23 controls at 3 years postpartum. The retinal microvasculature was assessed by vessel calibre measurements, retinal oximetry and optical coherence tomography angiography. Differences were analysed using non-parametric tests and multiple regression analyses, adjusted for age and body mass index. RESULTS Median arteriolar oxygen saturation (SaO2; 94.2% vs. 93.0%), venular oxygen saturation (SvO2; 60.1% vs. 62.4%) and arteriovenous saturation difference (AV-difference; 32.8% vs. 32.3%) were similar across groups. Capillary vessel density (VD; 46.2% vs. 46.3%), skeletonised VD (VSD; 21.3 vs. 21.1 mm/mm2) and vessel diameter index (21.65 vs. 21.86) were also comparable. In the HDP group, mean arterial pressure (MAP) was positively correlated with AV-difference (R2 = 0.209) and negatively correlated with arteriolar diameter (CRAE; r2 = 0.382). CONCLUSIONS Structural microvascular alterations appear not to be key biomarkers for CVD risk after HDP as early as 3 years postpartum in otherwise healthy women. Further studies are needed to evaluate whether such changes occur later in life. MAP was associated with AV-difference only in the HDP group, suggesting specific mechanisms affecting functional microvascular properties in these women.
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Affiliation(s)
- Sissel Hoel
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Kjartan Moe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Meryam Sugulle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Goran Petrovski
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Ophthalmology, Center for Eye Research and Innovative Diagnostics, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, Bitola, North Macedonia
| | - Nina Charlotte B B Veiby
- Department of Ophthalmology, Center for Eye Research and Innovative Diagnostics, Oslo University Hospital, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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