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Vijayalakshmi IB, Nemani L, Kher M, Kumar A. The Gamut of Coronary Artery Disease in Indian Women. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/mm_ijcdw_404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Coronary artery disease is the leading cause of death among women. Majority of women suffering from CAD have one or more risk factors for CAD in their parents. Women are at higher risk for cardiac events with respect to traditional risk factors including dyslipidemia, hypertension, diabetes, and smoking. Menopause, pregnancy complications, inflammation, anemia, migraines, and depression are important sex-specific novel risk factors for CVD, and it is important that clinicians should be aware of these risks to design strategies for prevention. Education, self-awareness in women, and timely recognition of CAD in women with lifestyle modifications and timely intervention result in better outcomes.
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Affiliation(s)
- I. B. Vijayalakshmi
- Department of Pediatric Cardiology, Super Specialty Hospital (Pradhana Mantri Swasthya Suraksha Yojana), Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India,
| | - Lalita Nemani
- Department of Cardiology, Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, India,
| | - Monica Kher
- Department of Cardiology, Aster Hospital, Doha, Qatar,
| | - Achukatla Kumar
- Department of Health Research, ICMR, Port Blair, Andaman and Nicobar Islands, India,
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Deichmann S, Manschikow SG, Petrova E, Bolm L, Honselmann KC, Frohneberg L, Keck T, Wellner UF, Bausch D. Evaluation of Postoperative Quality of Life After Pancreatic Surgery and Determination of Influencing Risk Factors. Pancreas 2021; 50:362-370. [PMID: 33835967 DOI: 10.1097/mpa.0000000000001780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The postoperative quality of life (QoL) after pancreatic surgery is frequently impaired. The aim of this study was to evaluate the QoL after pancreatic surgery and its influencing risk factors. Furthermore, an age-adjusted comparison with the normal population of Germany was performed. METHODS A total of 94 patients were surveyed. The Short Form-36 questionnaire was sent to all patients undergoing pancreatic surgery between 2013 and 2017. All pathologies and types of pancreatic resections were included. Statistical analyses were performed, and an analysis by the Robert Koch-Institute to determine the health-related age-adjusted QoL in Germany served as control group. RESULTS Response rate was 29%. Median time of survey was 28 months. As compared with a normative population, QoL after pancreaticoduodenectomy was significantly impaired. Distal pancreatic resection showed no significant differences. Univariate and Lasso analyses showed that the following factors had a negative impact: coronary artery disease, chronic pancreatitis, and open access. Postoperative enzyme supplementation seemed to have a positive impact. CONCLUSIONS Pancreatic surgery leads to long-lasting negative effect on QoL. Distal pancreatic resections and laparoscopic access seemed to be the best tolerated. Complications seems to have less impact, whereas maintaining exocrine and endocrine function seems to have a positive effect.
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Affiliation(s)
- Steffen Deichmann
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Sanda G Manschikow
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Ekaterina Petrova
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Louisa Bolm
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Kim C Honselmann
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Laura Frohneberg
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Tobias Keck
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
| | - Ulrich F Wellner
- From the Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck
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Dual Effect of IL-6 -174 G/C Polymorphism and Promoter Methylation in the Risk of Coronary Artery Disease Among South Indians. Indian J Clin Biochem 2018; 34:180-187. [PMID: 31092991 DOI: 10.1007/s12291-018-0740-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
Inflammation plays an important role in the pathogenesis of atherosclerosis and coronary syndromes; moreover, various lines of evidence suggest that genetic factors do contribute to the risk of coronary artery disease (CAD). The proinflammatory cytokine IL-6 is a central mediator of inflammation associated with CAD. The present study is aimed to investigate the association of single nucleotide polymorphism in the promoter region of the IL-6 gene (-174 G > C) and methylation with the susceptibility of CAD. Genotyping of IL-6 -174 G/C polymorphism was performed by PCR-RFLP. Methylation-specific PCR method was used to study the IL-6 gene promoter methylation. Analysis of 470 subjects (265 CAD patients and 205 controls) showed association of the -174 G/C variant with the CAD risk in dominant model (OR 1.58, 95% CI, 1.024-2.23, P = 0.04). Further, the analysis of the distribution of genotypes and alleles of -174 G > C polymorphism according to clinical features of CAD, revealed significant association of genotype and allele (OR 1.86, 95% CI 1.18-2.84 P = 0.01, and OR 1.71, 95% CI 1.09-2.23 P = 0.02 respectively) with diabetes, and we found no association with hypertension (OR 0.95, 95% CI 0.57-1.59, P = 0.8). We also analyzed the methylation status of IL-6 promoter region between cases and controls showed significant hypo methylation in CAD subjects (OR 2.36, 95% CI 1.51-4.259, P = 0.006). Additionally, GC, CC genotypes and C allele carriers show hypomethylation in CAD cases compared to controls (54.58 vs. 76.85%, 29.83 vs. 40% respectively). In conclusion, the promoter polymorphism -174 G/C is associated with CAD risk and further carriers of 'C' allele at -174 locus showed significant hypo methylation which could contribute to increased risk of CAD. The present study highlights the association of allele and genotypes with differential DNA methylation of CpG islands in the IL-6 promoter region which may affect IL-6 gene regulation.
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Pathak LA, Shirodkar S, Ruparelia R, Rajebahadur J. Coronary artery disease in women. Indian Heart J 2017; 69:532-538. [PMID: 28822527 PMCID: PMC5560902 DOI: 10.1016/j.ihj.2017.05.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 05/04/2017] [Accepted: 05/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the importance of CAD for women, there is persistent perception that CAD is a man's disease. Contributing to this notion is the observation of differences in incidence rates according to age; the incidence of CAD in women is lower than men, but rises steadily after fifth decade. The distribution of CAD risk factors varies between men and women across age ranges and failure to consider these differences may have contributed to the belief that women are at lower risk of CAD compared with men. In addition, women are more likely to have symptoms considered atypical compared with men. There is an urgent need to better understand the presentation of cardiac symptoms in women, in order to facilitate diagnosis and treatment, to initiate aggressive risk factor intervention and to improve the quality of life. METHODS We studied clinical and angiographic profile of women undergoing coronary angiogram over a period of 6 years at Nanavati Hospital, Mumbai. The objectives were to examine the distribution of risk factor and coronary angiographic patterns of CAD in women. RESULTS It was observed that coronary artery disease is most commonly involving females between the age 60 to 80 years. Raised LDL-C was found to be most common risk factor involved in development of coronary artery disease in females. Most common presentation of CAD in women is unstable angina or non-ST segment elevation MI. Most common coronary angiography finding was single vessel disease. CONCLUSION Though coronary artery disease is late to present in women it significantly hamper quality of life. The clinical presentation of coronary artery disease in women varies from asymptomatic to severe unstable angina to myocardial infarction. Stress testing and 2D-ECHO helps to some extent for prediction of coronary artery disease but false positive as well as false negative test results are not negligible. Coronary angiography is the conclusive test to determine spectrum and characterization of coronary artery anatomy in women. As this study is based on experience at single center, various biases may be possible. Widespread data collection involving multiple center and multiple operators will be helpful.
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Affiliation(s)
- Lekha Adik Pathak
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India.
| | - Salil Shirodkar
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
| | - Ronak Ruparelia
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
| | - Jaideep Rajebahadur
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
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Kreatsoulas C, Crea-Arsenio M, Shannon HS, Velianou JL, Giacomini M. Interpreting angina: symptoms along a gender continuum. Open Heart 2016; 3:e000376. [PMID: 27158523 PMCID: PMC4854148 DOI: 10.1136/openhrt-2015-000376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/08/2016] [Accepted: 02/23/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND 'Typical' angina is often used to describe symptoms common among men, while 'atypical' angina is used to describe symptoms common among women, despite a higher prevalence of angina among women. This discrepancy is a source of controversy in cardiac care among women. OBJECTIVES To redefine angina by (1) qualitatively comparing angina symptoms and experiences in women and men and (2) to propose a more meaningful construct of angina that integrates a more gender-centred approach. METHODS Patients were recruited between July and December 2010 from a tertiary cardiac care centre and interviewed immediately prior to their first angiogram. Symptoms were explored through in-depth semi-structured interviews, transcribed verbatim and analysed concurrently using a modified grounded theory approach. Angiographically significant disease was assessed at ≥70% stenosis of a major epicardial vessel. RESULTS Among 31 total patients, 13 men and 14 women had angiograpically significant CAD. Patients describe angina symptoms according to 6 symptomatic subthemes that array along a 'gender continuum'. Gender-specific symptoms are anchored at each end of the continuum. At the centre of the continuum, are a remarkably large number of symptoms commonly expressed by both men and women. CONCLUSIONS The 'gender continuum' offers new insights into angina experiences of angiography candidates. Notably, there is more overlap of shared experiences between men and women than conventionally thought. The gender continuum can help researchers and clinicians contextualise patient symptom reports, avoiding the conventional 'typical' versus 'atypical' distinction that can misrepresent gendered angina experiences.
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Affiliation(s)
| | - Mary Crea-Arsenio
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Harry S Shannon
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - James L Velianou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Interventional Cardiology, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Mita Giacomini
- Faculty of Health Sciences, McMaster University, Centre for Health Economics & Policy Analysis, Hamilton, Ontario, Canada
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Fabreau GE, Leung AA, Southern DA, Knudtson ML, McWilliams JM, Ayanian JZ, Ghali WA. Sex, socioeconomic status, access to cardiac catheterization, and outcomes for acute coronary syndromes in the context of universal healthcare coverage. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:540-9. [PMID: 24895450 DOI: 10.1161/circoutcomes.114.001021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sex and neighborhood socioeconomic status (nSES) may independently affect the care and outcomes of acute coronary syndrome, partly through barriers in timely access to cardiac catheterization. We sought to determine whether sex modifies the association between nSES and the receipt of cardiac catheterization and mortality after an acute coronary syndrome in a universal healthcare system. METHODS AND RESULTS We studied 14 012 patients with acute coronary syndrome admitted to cardiology services between April 18, 2004, and December 31, 2011, in Southern Alberta, Canada. We used multivariable logistic regression to compare the odds of cardiac catheterization within 2 and 30 days of admission and the odds of 30-day and 1-year mortality for men and women by quintile of neighborhood median household income. Significant relationships between nSES and the receipt of cardiac catheterization and mortality after acute coronary syndrome were detected for women but not men. When examined by nSES, each incremental decrease in neighborhood income quintile for women was associated with a 6% lower odds of receiving cardiac catheterization within 30 days (P=0.01) and a 14% higher odds of 30-day mortality (P=0.03). For men, each decrease in neighborhood income quintile was associated with a 2% lower odds of receiving catheterization within 30 days (P=0.10) and a 5% higher odds of 30-day mortality (P=0.36). CONCLUSIONS Associations between nSES and receipt of cardiac catheterization and 30-day mortality were noted for women but not men in a universal healthcare system. Care protocols designed to improve equity of access to care and outcomes are required, especially for low-income women.
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Affiliation(s)
- Gabriel E Fabreau
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.).
| | - Alexander A Leung
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
| | - Danielle A Southern
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
| | - Merrill L Knudtson
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
| | - J Michael McWilliams
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
| | - John Z Ayanian
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
| | - William A Ghali
- From the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA (G.E.F., J.M.M.); Institute for Public Health, Department of Medicine (G.E.F., A.A.L., W.A.G.) and Department of Community Health Sciences (D.A.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada; Department of Health Care Policy, Harvard Medical School, Boston, MA (G.E.F., J.M.M., J.Z.A.); Libin Cardiovascular Institute of Alberta, Department of Medicine, Department of Cardiac Sciences, Calgary, Alberta, Canada (M.L.K.); and Institute for Healthcare Policy and Innovation and Department of Medicine, University of Michigan, Ann Arbor (J.Z.A.)
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