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Nasr N, Soltész B, Sándor J, Ádány R, Fiatal S. Comparison of Genetic Susceptibility to Coronary Heart Disease in the Hungarian Populations: Risk Prediction Models for Coronary Heart Disease. Genes (Basel) 2023; 14:1033. [PMID: 37239393 PMCID: PMC10218435 DOI: 10.3390/genes14051033] [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: 03/15/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Background and Aim: It was evaluated whether the integration of genetic risk scores (GRS-unweighted, wGRS-weighted) into conventional risk factor (CRF) models for coronary heart disease or acute myocardial infarction (CHD/AMI) could improve the predictive ability of the models. Methods: Subjects and data collected in a previous survey were used to perform regression and ROC curve analyses as well as to examine the role of genetic components. Thirty SNPs were selected, and genotype and phenotype data were available for 558 participants (general: N = 279 and Roma: N = 279). Results: The mean GRS (27.27 ± 3.43 vs. 26.68 ± 3.51, p = 0.046) and wGRS (3.52 ± 0.68 vs. 3.33 ± 0.62, p = 0.001) were significantly higher in the general population. The addition of the wGRS to the CRF model yielded the strongest improvement in discrimination among Roma (from 0.8616 to 0.8674), while the addition of GRS to the CRF model yielded the strongest improvement in discrimination in the general population (from 0.8149 to 0.8160). In addition to that, the Roma individuals were likely to develop CHD/AMI at a younger age than subjects in the general population. Conclusions: The combination of the CRFs and genetic components improved the model's performance and predicted AMI/CHD better than CRFs alone.
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Affiliation(s)
- Nayla Nasr
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Beáta Soltész
- Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Szilvia Fiatal
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Zheng PF, Yin RX, Deng GX, Guan YZ, Wei BL, Liu CX. Association between the XKR6 rs7819412 SNP and serum lipid levels and the risk of coronary artery disease and ischemic stroke. BMC Cardiovasc Disord 2019; 19:202. [PMID: 31429711 PMCID: PMC6700994 DOI: 10.1186/s12872-019-1179-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background The present study aimed to expound the association between the XK related 6 gene (XKR6) rs7819412 single nucleotide polymorphism (SNP) and serum lipid profiles and the risk of coronary artery disease (CAD) and ischemic stroke. Methods The genetic makeup of the XKR6 rs7819412 SNP in 1783 unrelated participants (controls, 643; CAD, 588 and ischemic stroke, 552) of Han Chinese was obtained by the Snapshot technology. Results The genotypic frequencies of the SNP were disparate between CAD (GG, 81.0%; GA/AA, 19.0%) or ischemic stroke (GG, 81.2%; GA/AA, 18.8%) patients and healthy controls (GG, 85.7%, GA/AA, 14.3%; P < 0.05 vs. CAD or ischemic stroke; respectively). The A allele frequency was also diverse between CAD (10.1%) or ischemic stroke (10.0%) and control groups (7.5%; P < 0.05 vs. CAD or ischemic stroke; respectively). The GA/AA genotypes and A allele were associated with high risk of CAD and ischemic stroke (CAD: P = 0.026 for GA/AA vs. GG, P = 0.024 for A vs. G; Ischemic stroke: P = 0.029 for GA/AA vs. GG, P = 0.036 for A vs. G). The GA/AA genotypes were also associated with increased serum triglyceride (TG) concentration in CAD and total cholesterol (TC) concentration in ischemic stroke patients. Conclusions These data revealed that the XKR6 rs7819412 A allele was related to increased serum TG levels in CAD, TC levels in ischemic stroke patients and high risk of CAD and ischemic stroke.
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Affiliation(s)
- Peng-Fei Zheng
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China. .,Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Disease Control and Prevention, Nanning, 530021, Guangxi, People's Republic of China. .,Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, 530021, Guangxi, People's Republic of China.
| | - Guo-Xiong Deng
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Yao-Zong Guan
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Bi-Liu Wei
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Chun-Xiao Liu
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
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Liu W, Wang T, Sun P, Zhou Y. Expression of Hcy and blood lipid levels in serum of CHD patients and analysis of risk factors for CHD. Exp Ther Med 2018; 17:1756-1760. [PMID: 30783445 PMCID: PMC6364198 DOI: 10.3892/etm.2018.7111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Abstract
Expression of homocysteine (Hcy) and blood lipid levels in serum of atherosclerotic coronary heart disease (CHD) patients was investigated and the related risk factors were analyzed. A total of 148 CHD patients were selected as study group and another 120 healthy people attending Weifang People's Hospital for physical examination in the same period as control group. Hcy and blood lipid levels in serum were measured in the two groups, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). At the same time, analysis of risk factors for CHD was performed. The levels of Hcy, TC, TG and LDL-C in patients in the study group were significantly higher than that in control group, while the HDL-C level was significantly lower than that in control group, and the differences were statistically significant (P<0.001). The difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between acute and old myocardial infarction and angina pectoris group (P<0.05), and the difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between old and acute myocardial infarction group (P<0.05). Analysis of risk factors for the disease was performed using logistic regression. The results of univariate analysis showed that CHD was associated with Hcy, hyperlipidemia, smoking, hypertension and diabetes (P<0.05), but had no relationship with drinking and obesity (P>0.05). The results of multivariate analysis showed that Hcy, hyperlipidemia, hypertension and diabetes were independent risk factors for CHD, and the difference was statistically significant (P<0.05). The Hcy level increased and the HDL-C level decreased in serum of CHD patients. Hcy, hyperlipidemia, hypertension and diabetes are independent risk factors for CHD, which can provide practical basis for the diagnosis, treatment and prevention.
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Affiliation(s)
- Weijing Liu
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Tao Wang
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Pengfei Sun
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Yanju Zhou
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
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Miao L, Yin RX, Yang S, Huang F, Chen WX, Cao XL. Association between single nucleotide polymorphism rs9534275 and the risk of coronary artery disease and ischemic stroke. Lipids Health Dis 2017; 16:193. [PMID: 28982360 PMCID: PMC5629769 DOI: 10.1186/s12944-017-0584-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The present study was to detect the association of single nucleotide polymorphism (SNP) in the breast susceptibility gene 2 (BRCA2) and the risk of coronary artery disease (CAD) and ischemic stroke (IS). METHODS Genotypes of the BRCA2 rs9534275 in 1822 unrelated subjects (CAD, 606; IS, 569; and healthy controls, 647) were determined by the polymerase chain reaction and restriction fragment length polymorphism and then confirmed by direct sequencing. RESULTS The genotypic and allelic frequencies of rs9534275 were significantly different between the CAD, IS patients and controls (P = 0.033 and P = 0.027; respectively). The GG, GT/GG genotypes and G allele were associated with an increased risk of CAD and IS (CAD: P = 0.005 for GG vs. TT, P = 0.004 for GT/GG vs. TT, P = 0.005 for G vs. T; IS: P = 0.003 for GG vs. TT, P = 0.005 for GT/GG vs. TT; P = 0.002 for G vs. T). The GG, GT and GT/GG genotypes in the CAD, but not in healthy controls and IS patients, were associated with an increased serum total cholesterol (TC) and apolipoprotein B (ApoB) concentration. CONCLUSIONS The present study shows that the G allele carriers of BRCA2 rs9534275 were associated with increased serum TC and ApoB levels in the CAD patients and increased risk of CAD and IS. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Liu Miao
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
| | - Shuo Yang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
| | - Wu-Xian Chen
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
| | - Xiao-Li Cao
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021 Guangxi People’s Republic of China
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Xu Y, Wang Y, Zhi J, Qi L, Zhang T, Li X. Impact of matrix metalloproteinase 9 rs3918242 genetic variant on lipid-lowering efficacy of simvastatin therapy in Chinese patients with coronary heart disease. BMC Pharmacol Toxicol 2017; 18:28. [PMID: 28390432 PMCID: PMC5385050 DOI: 10.1186/s40360-017-0132-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 03/28/2017] [Indexed: 01/05/2023] Open
Abstract
Background Genetic variation of matrix metalloproteinase 9 (MMP-9) gene polymorphism has been suggested to modulate coronary heart diseases (CHD), yet the underlying mechanisms are not well understood. Methods We investigated the association of MMP9 rs3918242 single nucleotide polymorphism with inflammation and lipid-lowering efficacy after simvastatin treatment in Chinese patients with CHD. Fasting serum lipid profile and plasma inflammatory mediators were determined at baseline in 264 patients with CHD and 186 healthy control subjects, and after HMG-CoA reductase inhibitor simvastatin treatment (20 mg/day) for 12 weeks in CHD subjects. Results We found that plasma MMP-9, TNF-α and IL-10 levels were significantly elevated in patients with CHD compared to control subjects before treatment. The plasma MMP9 in CHD patients carrying rs3918242 CC, CT and TT genotypes were comparable. Interestingly, CHD patients carrying TT genotype had significantly higher level of triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) than those carrying CC genotype (P <0.05). Simvastatin treatment significantly reduced LDL-C, TG and plasma inflammatory mediator levels in CHD patients. The reduction of LDL-C upon simvastatin therapy was significantly greater in patients carrying TT genotype than those carrying CC genotype (P <0.05). Conclusions MMP9 rs3918242 TT genotype is associated with elevated serum TG and LDL-C, and enhanced LDL-C-lowering response upon simvastatin treatment in Chinese patients with CHD. Clinical trial registration This study was retrospectively registered at Chinese Clinical Trial Registry (Registration number: ChiCTR-ROC-17010971) on March 23rd 2017.
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Affiliation(s)
- Yuanyuan Xu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China
| | - Yan Wang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China
| | - Jixin Zhi
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China
| | - Lichun Qi
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China
| | - Tong Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China
| | - Xueqi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Rd, Nangang Region, Heilongjiang, Harbin, 150001, China.
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Integrating health education and physical activity programming for cardiovascular health promotion among female inmates: A proof of concept study. Contemp Clin Trials 2016; 48:65-9. [PMID: 27020419 DOI: 10.1016/j.cct.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/11/2016] [Accepted: 03/21/2016] [Indexed: 11/21/2022]
Abstract
Female inmate populations in the United States tend to be overweight, physically inactive, experience high stress, and have a history of nicotine and other drug dependence. Thus, they bear an elevated risk of cardiovascular (CV) disease than the general population. However, few evidence-based health interventions exist for this population. This study will test proof of concept, feasibility, and potential efficacy of a multiple health behavior change intervention that integrates CV-health promotion education delivered during a physical activity (PA) program (indoor cycling) tailored to this population. This study uses a quasi-experimental 2-group design with two measurement time-points: baseline and 8-week end of treatment. N=120 incarcerated women (18-59years of age) who are medically cleared for participation in PA will be enrolled. Indoor cycling instructors will be trained to deliver five health education topics over an 8-week period during twice-weekly cycling classes. Topics match the American Heart Association recommendations for CV health: (a) nutrition, (b) PA promotion, (c) weight management, (d) stress management, and (e) smoking cessation and relapse prevention. Modes of intervention include instructor advice, written materials and audio/video clips reviewed during class. CV-related and mental health measures will be assessed at both time-points. Results will guide a full scale efficacy study. Future research in this area has potential to impact the health of female inmates, a high-risk population. Moreover, this multiple health behavior change intervention model represents a community approach to health promotion that could generalize to other underserved populations who may benefit most from similar intervention efforts.
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Affiliation(s)
- Kristina Orth-Gomér
- Karolinska Institutet, Stockholm, Sweden. Charite Universitätsmedizin, Berlin, Germany
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Pop D, Dădârlat A, Zdrenghea D. Novel cardiovascular risk markers in women with ischaemic heart disease. Cardiovasc J Afr 2015; 25:137-41. [PMID: 25000444 PMCID: PMC4120125 DOI: 10.5830/cvja-2014-014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/14/2014] [Indexed: 11/06/2022] Open
Abstract
Abstract The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However, mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation, both of which play a key role in the pathogenesis of microvascular angina, which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers, markers of haemostasis, and other biomarkers.
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Affiliation(s)
- Dana Pop
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania.
| | - Alexandra Dădârlat
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania
| | - D Zdrenghea
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania
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Crea F, Battipaglia I, Andreotti F. Sex differences in mechanisms, presentation and management of ischaemic heart disease. Atherosclerosis 2015; 241:157-68. [DOI: 10.1016/j.atherosclerosis.2015.04.802] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 01/24/2023]
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Langvik E, Nordahl HM. Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study. Health Psychol Open 2014; 1:2055102914557658. [PMID: 28070344 PMCID: PMC5193285 DOI: 10.1177/2055102914557658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This prospective study examines gender-specific psychological risk factors of myocardial infarction. Out of 41,248 participants free of coronary heart disease at baseline, 822 cases of myocardial infarction were identified in the Nord-Trøndelag Health Study or the mortality register. The participants completed the Hospital Anxiety and Depression Scale. Cholesterol, blood pressure, and waist–hip ratio were measured by medical staff. Smoking, diabetes, non-fatal myocardial infarction, and history of depressive episode were self-reported. Anhedonic depression (Hospital Anxiety and Depression Scale-D ≥8) was a significant predictor of myocardial infarction in women but not in men. Gender difference in risk estimate based on Hospital Anxiety and Depression Scale-D was significant (p < .01). History of depressive episode was a significant predictor of myocardial infarction in men. Symptoms of anxiety (Hospital Anxiety and Depression Scale-A ≥8) reduced the risk of having a myocardial infarction.
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Prevalence of comorbidities and their impact on hospital management and short-term outcomes in Vietnamese patients hospitalized with a first acute myocardial infarction. PLoS One 2014; 9:e108998. [PMID: 25279964 PMCID: PMC4184812 DOI: 10.1371/journal.pone.0108998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with a first acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi for purposes of describing the prevalence of cardiovascular (CVD) and non-CVD comorbidities and their impact on hospital management, in-hospital clinical complications, and short-term mortality in these patients. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. The proportions of patients with none, any 1, and ≥ 2 CVD comorbidities were 34%, 42%, and 24%, respectively. Among the CVD comorbidities, hypertension was the most commonly reported (59%). There were decreasing trends in the proportion of patients who were treated with effective cardiac medications and coronary interventions as the number of CVD comorbidities increased. Patients with multiple CVD comorbidities tended to develop acute clinical complications and die at higher rates during hospitalization compared with patients with no CVD comorbidities (Odds Ratio: 1.40; 95% Confidence Interval: 0.40–4.84). Conclusions Our data suggest that patients with multiple cardiac comorbidities tended to experience high in-hospital death rates in the setting of AMI. Full-scale surveillance of Hanoi residents hospitalized with AMI at all Hanoi hospitals is needed to confirm these findings. Effective strategies to manage Vietnamese patients hospitalized with AMI who have multiple comorbidities are warranted to improve their short-term prognosis.
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Ladwig KH, Waller C. [Gender-specific aspects of coronary heart disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1083-91. [PMID: 25112950 DOI: 10.1007/s00103-014-2020-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The total number of deaths from cardiovascular diseases (CVD) is greater for women than for men, although the mean age at manifestation of CVD is about 10 years older. However, the annual number of cases treated for CVD in acute hospital settings in men exceeds that of women by 50 %. Remarkable gender differences exist in terms of morphological and physiological conditions (e.g. mean coronary vessel diameter; ability to adapt to protective exercise-induced myocardial hypertrophy), as well as of the frequency and clinical significance of somatic risk factors (e.g. smoking). Female body weight increases after menopause and the body shape assumes a more android fat distribution. Women report higher levels of unspecific and affective symptoms. They suffer more from anxiety and depression than men; however, the secondary impact on CVD onset may be less pronounced. The post-acute CVD course is more complicated in women, mainly because they are older and suffer more from multi-morbidity. Whilst male CVD patients aim for a rapid recovery, physical fitness and an increased life expectancy, female patients seek relief from everyday challenges, the maintenance of their independence and emotional support.
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Affiliation(s)
- K-H Ladwig
- Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-II, Mental Health Research Unit, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland,
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Knowlton AA, Korzick DH. Estrogen and the female heart. Mol Cell Endocrinol 2014; 389:31-9. [PMID: 24462775 PMCID: PMC5709037 DOI: 10.1016/j.mce.2014.01.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/04/2014] [Accepted: 01/05/2014] [Indexed: 12/24/2022]
Abstract
Estrogen has a plethora of effects in the cardiovascular system. Studies of estrogen and the heart span human clinical trials and basic cell and molecular investigations. Greater understanding of cell and molecular responses to estrogens can provide further insights into the findings of clinical studies. Differences in expression and cellular/intracellular distribution of the two main receptors, estrogen receptor (ER) α and β, are thought to account for the specificity and differences in responses to estrogen. Much remains to be learned in this area, but cellular distribution within the cardiovascular system is becoming clearer. Identification of GPER as a third ER has introduced further complexity to the system. 17β-estradiol (E2), the most potent human estrogen, clearly has protective properties activating a signaling cascade leading to cellular protection and also influencing expression of the protective heat shock proteins (HSP). E2 protects the heart from ischemic injury in basic studies, but the picture is more involved in the whole organism and clinical studies. Here the complexity of E2's widespread effects comes into play and makes interpretation of findings more challenging. Estrogen loss occurs primarily with aging, but few studies have used aged models despite clear evidence of differences between the response to estrogen deficiency in adult and aged animals. Thus more work is needed focusing on the effects of aging vs. estrogen loss on the cardiovascular system.
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Affiliation(s)
- A A Knowlton
- The Department of Veteran's Affairs, Northern California VA, Sacramento, CA, USA; Molecular & Cellular Cardiology, Departments of Medicine and Pharmacology, University of California, Davis, USA.
| | - D H Korzick
- Intercollege Program in Physiology and Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
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Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction. PLoS One 2014; 9:e95631. [PMID: 24752383 PMCID: PMC3994106 DOI: 10.1371/journal.pone.0095631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/28/2014] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years) and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%). During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI) compared with men (57% vs. 74%), and women were more likely to have developed heart failure compared with men (19% vs. 10%). Women experienced higher in-hospital case-fatality rates (CFRs) than men (13% vs. 4%) and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89), and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09). Conclusions Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.
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Pop D, Dădârlat A, Zdrenghea M, Zdrenghea DT, Sitar-Tăut AV. Evolution of cardiovascular risk factors and ischemic heart disease in an elderly urban Romanian population over the course of 1 year. Clin Interv Aging 2013; 8:1497-503. [PMID: 24348025 PMCID: PMC3848471 DOI: 10.2147/cia.s53987] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Romania has some of the highest mortality figures in the world attributable to ischemic heart disease and stroke among both men and women. OBJECTIVES To assess the changes in cardiovascular risk factors and ischemic heart disease in a group of subjects over 65 years of age during 1 year in an urban community of Romania. MATERIALS AND METHODS We studied 515 subjects (264 women and 251 men) with a mean age of 73.41±6.44 years, followed up over the course of 1 year in order to determine the changes that occurred in cardiovascular risk factors and in the evolution of ischemic heart disease. At the beginning and after 1 year, we determined the following parameters: anthropometric measurements, blood pressure, smoking status, lipid profile (total cholesterol, triglycerides, high-density lipid cholesterol, low-density lipid cholesterol), fasting plasma glucose, and the presence of ischemic heart disease. RESULTS There were no differences between the first and second assessments concerning the incidence of smoking (12.3% versus (vs) 12.5%), obesity (25% vs 26%), diabetes mellitus (19% vs 22.9%), or hypertension (88.2% vs 92.2%). Statistically significant differences were recorded regarding dyslipidemia (40.6% vs 30.3%, P<0.001). Cholesterol median values decreased (204 mg/dL vs 194 mg/dL, P=0.003), while median concentrations of plasma glucose increased (101 mg/dL vs 105 mg/dL, P<0.05). At the same time, we noted a higher incidence of ischemic heart disease (51.65% vs 63%). CONCLUSION Our data show that in subjects over 65 years of age, cardiovascular disease occurs more often in women, but with certain features that should be taken into account. In addition, we point out the importance of reducing cardiovascular risk factors. However, we should not expect a major decrease or improvement in cardiovascular risk factors with such a short follow-up. Such results will be achieved only through long-term interventions.
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Affiliation(s)
- Dana Pop
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Dădârlat
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru Tudor Zdrenghea
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Manfrini O, Koller A, Pries A, Cenko E, Bugiardini R. Presentation, management, and outcomes of ischaemic heart disease in women. Nat Rev Cardiol 2013; 10:508-18. [PMID: 23817188 PMCID: PMC10878732 DOI: 10.1038/nrcardio.2013.93] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Scientific interest in ischaemic heart disease (IHD) in women has grown considerably over the past 2 decades. A substantial amount of the literature on this subject is centred on sex differences in clinical aspects of IHD. Many reports have documented sex-related differences in presentation, risk profiles, and outcomes among patients with IHD, particularly acute myocardial infarction. Such differences have often been attributed to inequalities between men and women in the referral and treatment of IHD, but data are insufficient to support this assessment. The determinants of sex differences in presentation are unclear, and few clues are available as to why young, premenopausal women paradoxically have a greater incidence of adverse outcomes after acute myocardial infarction than men, despite having less-severe coronary artery disease. Although differential treatment on the basis of patient sex continues to be described, the extent to which such inequalities persist and whether they reflect true disparity is unclear. Additionally, much uncertainty surrounds possible sex-related differences in response to cardiovascular therapies, partly because of a persistent lack of female-specific data from cardiovascular clinical trials. In this Review, we assess the evidence for sex-related differences in the clinical presentation, treatment, and outcome of IHD, and identify gaps in the literature that need to be addressed in future research efforts.
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Affiliation(s)
- Viola Vaccarino
- Emory University Rollins School of Public Health and School of Medicine, USA
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17
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Korzick DH, Lancaster TS. Age-related differences in cardiac ischemia-reperfusion injury: effects of estrogen deficiency. Pflugers Arch 2013; 465:669-85. [PMID: 23525672 DOI: 10.1007/s00424-013-1255-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 02/23/2013] [Accepted: 02/25/2013] [Indexed: 01/17/2023]
Abstract
Despite conflicting evidence for the efficacy of hormone replacement therapy in cardioprotection of postmenopausal women, numerous studies have demonstrated reductions in ischemia/reperfusion (I/R) injury following chronic or acute exogenous estradiol (E2) administration in adult male and female, gonad-intact and gonadectomized animals. It has become clear that ovariectomized adult animals may not accurately represent the combined effects of age and E2 deficiency on reductions in ischemic tolerance seen in the postmenopausal female. E2 is known to regulate the transcription of several cardioprotective genes. Acute, non-genomic E2 signaling can also activate many of the same signaling pathways recruited in cardioprotection. Alterations in cardioprotective gene expression or cardioprotective signal transduction are therefore likely to result within the context of aging and E2 deficiency and may help explain the reduced ischemic tolerance and loss of cardioprotection in the senescent female heart. Quantification of the mitochondrial proteome as it adapts to advancing age and E2 deficiency may also represent a key experimental approach to uncover proteins associated with disruptions in cardiac signaling contributing to age-associated declines in ischemic tolerance. These alterations have important ramifications for understanding the increased morbidity and mortality due to ischemic cardiovascular disease seen in postmenopausal females. Functional perturbations that occur in mitochondrial respiration and Ca(2+) sensitivity with age-associated E2 deficiency may also allow for the identification of alternative therapeutic targets for reducing I/R injury and treatment of the leading cause of death in postmenopausal women.
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Affiliation(s)
- Donna H Korzick
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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18
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Coventry LL, Bremner AP, Jacobs IG, Finn J. Myocardial infarction: sex differences in symptoms reported to emergency dispatch. PREHOSP EMERG CARE 2012; 17:193-202. [PMID: 23078145 DOI: 10.3109/10903127.2012.722175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emergency management of myocardial infarction (MI) is time-critical, because improved patient outcomes are associated with reduced time from symptom onset to definitive care. Previous studies have identified that women are less likely to present with chest pain. OBJECTIVE We sought to measure the effect of sex on symptoms reported to the ambulance dispatch and ambulance times for MI patients. METHODS The Western Australia Emergency Department Information System (EDIS) was used to identify patients with emergency department (ED) diagnoses of MI (ST-segment elevation MI and non-ST-segment elevation MI) who arrived by ambulance between January 1, 2008, and October 31, 2009. Their emergency telephone calls to the ambulance service were transcribed to identify presenting symptoms. Ambulance data were used to examine ambulance times. Sex differences were analyzed using descriptive and age-adjusted regression analysis. RESULTS Of 3,329 MI patients who presented to Perth EDs, 2,100 (63.1%) arrived by ambulance. After predefined exclusions, 1,681 emergency calls were analyzed. The women (n = 621; 36.9%) were older than the men (p < 0.001) and, even after age adjustment, were less likely to report chest pain (odds ratio [OR] = 0.70; 95% confidence interval [CI] 0.57, 0.88). After age adjustment, ambulance times did not differ between the male and female patients with chest pain. The women with chest pain were less likely than the men with chest pain to be allocated a "priority 1" (lights and sirens) ambulance response (men 98.3% vs. women 95.5%; OR = 0.39; 95% CI 0.18, 0.87). CONCLUSION Ambulance dispatch officers (and paramedics) need to be aware of potential sex differences in MI presentation in order to ensure appropriate ambulance response.
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Affiliation(s)
- Linda L Coventry
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
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19
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TERRILL ALEXANDRAL, GAROFALO JOHNP, SOLIDAY ELIZABETH, CRAFT REBECCA. Multiple Roles and Stress Burden in Women: A Conceptual Model of Heart Disease Risk. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1751-9861.2011.00071.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Lawton JS. Sex and gender differences in coronary artery disease. Semin Thorac Cardiovasc Surg 2012; 23:126-30. [PMID: 22041042 DOI: 10.1053/j.semtcvs.2011.07.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 01/10/2023]
Abstract
Significant sex differences exist between men and women with regard to coronary artery disease. Most notably, this lethal disease kills more women than men each year and remains the leading cause of death for both men and women. Women and men clearly have different risk profiles when diagnosed with coronary artery disease and fare much differently after myocardial infarction and coronary artery bypass grafting. This review summarizes the sex differences in clinical presentation, diagnosis, and the surgical treatment of coronary artery disease between men and women; and potential multifactorial reasons for sex disparities are suggested.
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Affiliation(s)
- Jennifer S Lawton
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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21
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Ginty CT, Chang AM, Matsuura AC, Decker C, Le J, Green M, Litt HI, Hollander JE. Lack of sex disparity in cardiovascular testing after coronary computerized tomographic angiography. Acad Emerg Med 2012; 19:147-52. [PMID: 22320365 DOI: 10.1111/j.1553-2712.2011.01286.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors assessed whether there was a sex disparity in testing of patients after coronary computerized tomographic angiography (CTA) was performed for emergency department (ED) patients with potential acute coronary syndromes (ACS). In theory, once coronary anatomy has been determined, any disparity in subsequent workup should not be the result of differences in presentation. METHODS This was a prospective cohort study of ED patients who presented with potential ACS and received coronary CTAs at a university hospital. Demographics, history, cardiac risk factors, follow-up testing, and procedures were recorded. Follow-up at 30 days was obtained by structured record review and telephone contact. Patients were stratified by sex and coronary CTA results (max stenosis: none, 1% to 24%, 25% to 49%, 50% to 69%, and ≥70%). Main outcome was the relative risk (RR) of a male receiving a stress test or catheterization within 30 days, stratified by categories of percent maximal stenosis. RESULTS A total of 1,144 patients received coronary CTAs (mean ± SD age = 47.8 ± 8.7 years), 55% were female, and 64% were black or African American. Overall, 161 patients received follow-up testing within 30 days, 113 during their index visit. Men were more likely to receive further testing (RR = 1.51; 95% confidence interval [CI] = 1.14 to 1.99) compared to women. However, when stratified by percentage of stenosis, men were not more likely to receive further testing within 30 days after coronary CTA compared to women (RR = 1.14; 95% CI = 0.68 to 1.91). In multivariable modeling for risk of further testing, stenosis remained significant (adjusted relative risk [aRR] = 1.51; 95% CI = 1.19 to 1.91), while male sex, age, race, and Thrombolysis in Myocardial Infarction (TIMI) risk score were not. CONCLUSIONS Male patients with potential ACS who receive a coronary CTA as a part of their ED evaluation were no more likely than female patients to receive further testing within 30 days.
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Affiliation(s)
- Catherine T Ginty
- Department of Emergency Medicine, Cooper University Hospital, Camden, NJ, USA
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22
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Brown TT, Dela Cruz E, Brown SS. The effect of dental care on cardiovascular disease outcomes: an application of instrumental variables in the presence of heterogeneity and self-selection. HEALTH ECONOMICS 2011; 20:1241-1256. [PMID: 20882577 DOI: 10.1002/hec.1667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 06/22/2010] [Accepted: 08/06/2010] [Indexed: 05/29/2023]
Abstract
Studies show a relationship between oral inflammatory processes and cardiovascular risk factors, suggesting that dental care may reduce the risk of cardiovascular disease (CVD) events. However, due to the differences between men and women in the development and presentation of CVD, such effects may vary by sex. We use a valid set of instrumental variables to evaluate these issues and include a test of essential heterogeneity. CVD events include new occurrences of heart attack (including death from heart attack), stroke (including death from stroke), angina, and congestive heart failure. Controls include age, race, education, marital status, foreign birthplace, and cardiovascular risk factors (health status, body mass index, alcohol use, smoking status, diabetes status, high-blood-pressure status, physical activity, and depression). Our analysis finds no evidence of essential heterogeneity. We find the minimum average treatment effect for women to be -0.01, but find no treatment effect for men. This suggests that women who receive dental care may reduce their risk of future CVD events by at least one-third. The findings may only apply to married middle-aged and older individuals as the data set is only representative for this group.
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Affiliation(s)
- Timothy Tyler Brown
- Nicholas C. Petris Center, School of Public Health, University of California at Berkeley, Berkeley, CA 94720, USA.
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23
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Lawton JS, Cupps BP, Knutsen AK, Ma N, Brady BD, Reynolds LM, Pasque MK. Magnetic resonance imaging detects significant sex differences in human myocardial strain. Biomed Eng Online 2011; 10:76. [PMID: 21859466 PMCID: PMC3180436 DOI: 10.1186/1475-925x-10-76] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 08/22/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The pathophysiology responsible for the significant outcome disparities between men and women with cardiac disease is largely unknown. Further investigation into basic cardiac physiological differences between the sexes is needed. This study utilized magnetic resonance imaging (MRI)-based multiparametric strain analysis to search for sex-based differences in regional myocardial contractile function. METHODS End-systolic strain (circumferential, longitudinal, and radial) was interpolated from MRI-based radiofrequency tissue tagging grid point displacements in each of 60 normal adult volunteers (32 females). RESULTS The average global left ventricular (LV) strain among normal female volunteers (n = 32) was significantly larger in absolute value (functionally better) than in normal male volunteers (n = 28) in both the circumferential direction (Male/Female = -0.19 ± 0.02 vs. -0.21 ± 0.02; p = 0.025) and longitudinal direction (Male/Female = -0.14 ± 0.03 vs. -0.16 ± 0.02; p = 0.007). CONCLUSIONS The finding of significantly larger circumferential and longitudinal LV strain among normal female volunteers suggests that baseline contractile differences between the sexes may contribute to the well-recognized divergence in cardiovascular disease outcomes. Further work is needed in order to determine the pathologic changes that occur in LV strain between women and men with the onset of cardiovascular disease.
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Affiliation(s)
- Jennifer S Lawton
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, Missouri 63110, USA.
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24
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Hsieh BT, Chang CY, Chang YC, Cheng KY. Relationship between the level of essential metal elements in human hair and coronary heart disease. J Radioanal Nucl Chem 2011. [DOI: 10.1007/s10967-011-1174-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Maas AHEM, van der Schouw YT, Regitz-Zagrosek V, Swahn E, Appelman YE, Pasterkamp G, ten Cate H, Nilsson PM, Huisman MV, Stam HCG, Eizema K, Stramba-Badiale M. Red alert for women's heart: the urgent need for more research and knowledge on cardiovascular disease in women: Proceedings of the Workshop held in Brussels on Gender Differences in Cardiovascular disease, 29 September 2010. Eur Heart J 2011; 32:1362-8. [DOI: 10.1093/eurheartj/ehr048] [Citation(s) in RCA: 219] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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26
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Differences in management and outcomes between male and female patients with atherothrombotic disease: results from the REACH Registry in Europe. ACTA ACUST UNITED AC 2011; 18:270-7. [DOI: 10.1097/hjr.0b013e32833cca34] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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27
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Li J, Sun YM, Wang LF, Li ZQ, Pan W, Cao HY. Comparison of effects of simvastatin versus atorvastatin on oxidative stress in patients with coronary heart disease. Clin Cardiol 2010; 33:222-7. [PMID: 20394043 DOI: 10.1002/clc.20724] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND HMG-CoA reductase inhibitors (statins) have antiatherogenic effects beyond their cholesterol-lowing effect. Whether atorvastatin has a stronger antioxidant effect than other statins is uncertain. HYPOTHESIS To determine the effects of simvastatin and atorvastatin on markers of oxidative stress in patients with coronary heart disease (CHD). METHODS This study was comprised of 164 patients with CHD and a control population of 122 healthy subjects. The patients with CHD were divided into 2 groups and treated with either simvastatin 20 mg/day or atorvastatin 10 mg/day. The markers of oxidative stress were measured before and after 12 weeks of treatment. RESULTS The effects of atorvastatin on reducing oxidative stress were significantly greater compared with those of simvastatin (P < 0.05). The changes in the markers of oxidative stress did not correlate with the changes in the plasma lipid profile (P > 0.05). CONCLUSIONS This study suggests that atorvastatin reduces oxidative stress more effectively than simvastatin.
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Affiliation(s)
- Jia Li
- Department of Cardiac Care Unit, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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28
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Matsuzawa Y, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Konishi M, Matsubara J, Sumida H, Kaikita K, Kojima S, Nagayoshi Y, Yamamuro M, Izumiya Y, Iwashita S, Matsui K, Jinnouchi H, Kimura K, Umemura S, Ogawa H. Digital Assessment of Endothelial Function and Ischemic Heart Disease in Women. J Am Coll Cardiol 2010; 55:1688-96. [DOI: 10.1016/j.jacc.2009.10.073] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 09/24/2009] [Accepted: 10/12/2009] [Indexed: 11/26/2022]
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Abstract
Coronary heart disease (CHD) remains the leading cause of death in women. However, there are multiple challenges to the diagnosis of CHD in women, including: 1) women perceive their risk of CHD to be lower than it truly is, 2) women frequently present with atypical cardiac symptoms, 3) traditional stress tests have lower accuracy in women than in men, 4) women have a lower frequency of obstructive CHD detected at angiography than do men, and 5) a high percentage of women without obstructive CHD by invasive angiography have recurrent chest pain. Given the increasing number of options and complexity of noninvasive testing for CHD, it is important for women's health care providers to select the best test for a given patient. Newer imaging modalities such as cardiac computed tomography and magnetic resonance imaging offer speed, convenience, and high diagnostic accuracy in women. The goal of this article is to provide practitioners with an overview of the conventional diagnostic tests and to compare these with the newer imaging modalities. The appropriate application of diagnostic tests should allow practitioners to identify accurately and reassure those patients who are at low risk while targeting those who have preclinical or symptomatic atherosclerosis so that they can receive aggressive medical therapy, referral to cardiovascular specialists, or both.
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30
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Vaccarino V, Parsons L, Peterson ED, Rogers WJ, Kiefe CI, Canto J. Sex differences in mortality after acute myocardial infarction: changes from 1994 to 2006. ACTA ACUST UNITED AC 2009; 169:1767-74. [PMID: 19858434 DOI: 10.1001/archinternmed.2009.332] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Previous studies have shown that women younger than 55 years have higher hospital mortality rates after acute myocardial infarction (MI) than age-matched men. We examined whether such mortality differences have decreased in recent years. METHODS We investigated temporal trends in the hospital case-fatality rates of MI by sex and age from June 1, 1994, through December 31, 2006. The study population included 916,380 patients from the National Registry of Myocardial Infarction with a confirmed diagnosis of MI. RESULTS In-hospital mortality decreased markedly between 1994 and 2006 in all patients but more so in women than men. The mortality reduction in 2006 relative to 1994 was largest in women younger than 55 years (52.9%) and lowest in men younger than 55 years (33.3%). In patients younger than 55 years, the absolute decrease in mortality was 3 times larger in women than men (2.7% vs 0.9%). As a result, the excess mortality in younger women (<55 years) compared with men was less pronounced in 2004-2006 (unadjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.67) than it was in 1994-1995 (unadjusted odds ratio, 1.93; 95% confidence interval, 1.67-2.24). The sex difference in mortality decrease was lower in older patients (P = .004 for the interaction among sex, age, and year). Changes in comorbidity and clinical severity features at admission accounted for more than 90% of these mortality trends. CONCLUSIONS In recent years, women, particularly younger ones, experienced larger improvements in hospital mortality after MI than men. The narrowing of the mortality gap between younger women and men is largely attributable to temporal changes in risk profiles.
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Affiliation(s)
- Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30306, USA.
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31
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Barker A, Tsakirides C, Carroll S, Ingle L. Physical self-efficacy, anxiety and depression following a 6-week cardiac rehabilitation programme. ACTA ACUST UNITED AC 2009. [DOI: 10.12968/bjca.2009.4.5.42089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexis Barker
- accident and emergency department, Leeds General Hospital
- Leeds Metropolitan University
| | | | | | - Lee Ingle
- Leeds Metropolitan University, Carnegie Research Institute, 209 Fairfax Hall, Beckett Park, Headingley, Leeds LS6 3QS, UK
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Valdés G, Quezada F, Marchant E, von Schultzendorff A, Morán S, Padilla O, Martínez A. Association of Remote Hypertension in Pregnancy With Coronary Artery Disease. Hypertension 2009; 53:733-8. [DOI: 10.1161/hypertensionaha.108.127068] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because hypertensive pregnancies have been associated with increased cardiovascular disease, we aimed to identify whether angiographically characterized coronary artery disease differed in women with previous normotensive pregnancies or hypertensive pregnancies (HPs). The study group included 217 parous women, aged 60.9±9.2 (SD) years, who required coronary angiography between January 2006 and December 2007, 36.8±9.9 and 28.8±10.5 years after their first and last pregnancy, respectively; 146 had normotensive pregnancies and 71 had ≥1 HP, according to a questionnaire including reproductive history and cardiovascular risks. Body mass index, smoking, and frequency of diabetes were similar in both groups. Chronic hypertension (93% versus 78%;
P
=0.007), hyperlipidemia (82% versus 69%;
P
=0.049), and premature familial cardiovascular disease (42% versus 20%;
P
=0.001) prevailed in HPs. Participants with HPs were younger (58.9±8.3 versus 61.9±9.6 years;
P
=0.025) than participants with normotensive pregnancies. Although 49% of all participants had hemodynamically significant coronary artery disease (≥70% stenosis), no differences were observed between groups in the number of stenotic arteries; however, their number increased by 28% and 22% over a 10-year period in HPs and normotensive pregnancies, respectively (
P
=0.034). Multivariate analysis showed that HPs had a nonsignificant risk of having coronary artery disease (odds ratio: 1.21; 95% CI: 0.64 to 2.28), and being a current smoker (odds ratio: 4.13; 95% CI: 1.85 to 9.25), a diabetic (odds ratio: 2.29; 95% CI: 1.85 to 9.25), or having a family history of premature cardiovascular disease (odds ratio: 2.34; 95% CI: 1.17 to 2.39) significantly increased the risk of coronary artery disease. This study demonstrates that women with HPs have earlier coronary disease, probably related to intermediate cardiovascular risks that have a gestational expression.
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Affiliation(s)
- Gloria Valdés
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Felipe Quezada
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Eugenio Marchant
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Astrid von Schultzendorff
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Sergio Morán
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Oslando Padilla
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Alejandro Martínez
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
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Cortigiani L, Sicari R, Bigi R, Landi P, Bovenzi F, Picano E. Impact of gender on risk stratification by stress echocardiography. Am J Med 2009; 122:301-9. [PMID: 19272491 DOI: 10.1016/j.amjmed.2008.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 11/03/2008] [Accepted: 11/06/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the prognostic value of stress echocardiography results in men and women with known and suspected coronary artery disease. METHODS We analyzed the data of 8737 patients (5529 men and 3208 women) who underwent stress echocardiography (exercise in 523 patients, dipyridamole in 6227 patients, dobutamine in 1987) for evaluating known (n=3857) or suspected (n=4880) coronary artery disease. Patients were followed up for the occurrence of overall mortality or nonfatal myocardial infarction. RESULTS During a median follow-up of 25 months, 1218 cardiac events (693 deaths and 525 infarctions) occurred. Moreover, 2263 patients (1731 men [31%] and 532 women [17%]; P<.0001) underwent coronary revascularization and were censored. Stress echocardiography results added prognostic information to that of clinical findings and resting wall motion score index in men and women with both known and suspected coronary artery disease. In patients with known coronary artery disease, women had a higher (P=.01) event rate than men in the presence of ischemia. The annual event rate was worse for nondiabetic women (P=.007) but not diabetic women; age had a neutral prognostic effect in the 2 sexes. In patients with suspected coronary artery disease, men without ischemia had a higher (P<.0001) event rate than women. The annual event rate was worse in men aged less than 65 years (P<.0001) or more than 65 years (P=.04), and those with (P=.03) or without (P<.0001) diabetes. CONCLUSION Prognosis is at least comparable in men and women with ischemia and in those with coronary artery disease and no ischemia at stress echocardiography. In these clinical settings, availability for major procedures should be similar for both genders.
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Sun YM, Wang LF, Li J, Li ZQ, Pan W. The 223A>G polymorphism of the leptin receptor gene and lipid-lowering efficacy of simvastatin in Chinese patients with coronary heart disease. Eur J Clin Pharmacol 2008; 65:157-61. [DOI: 10.1007/s00228-008-0578-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 09/29/2008] [Indexed: 12/01/2022]
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Uhl K, Marts S. Assessing sex differences: methodological considerations. Expert Rev Clin Pharmacol 2008; 1:585-7. [PMID: 24422730 DOI: 10.1586/17512433.1.5.585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kathleen Uhl
- Assistant Commissioner for Women's Health, US Food and Drug Administration, Office of Women's Health, 5600 Fishers Lane, HF-8, Rockville, MD 20857, USA.
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Uhl K. Advancing Women's Health in the 21st Century: Applying the Tools of Clinical Pharmacology. Clin Pharmacol Ther 2008; 83:3-7. [DOI: 10.1038/sj.clpt.6100463] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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