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Kałużna-Oleksy M, Krysztofiak H, Sawczak F, Kukfisz A, Szczechla M, Soloch A, Cierzniak M, Szubarga A, Przytarska K, Dudek M, Uchmanowicz I, Straburzyńska-Migaj E. Sex differences in the nutritional status and its association with long-term prognosis in patients with heart failure with reduced ejection fraction: a prospective cohort study. Eur J Cardiovasc Nurs 2024; 23:458-469. [PMID: 38170824 DOI: 10.1093/eurjcn/zvad105] [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: 12/11/2022] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
AIMS Many studies show the association between malnutrition and poor prognosis in heart failure (HF) patients. Our research aimed to analyse sex differences in patients with HF with reduced ejection fraction (HFrEF), emphasizing nutritional status and the influence of selected parameters on the prognosis. METHODS AND RESULTS We enrolled 276 consecutive patients diagnosed with HFrEF. Nutritional status was assessed using Mini Nutritional Assessment (MNA), geriatric nutritional risk index (GNRI), and body mass index (BMI). The mean follow-up period was 564.4 ± 346.3 days. The analysed group included 81.2% of men. The median age was 58, interquartile range (IQR) 49-64 years. Among all patients, almost 60% were classified as NYHA III or IV. Half of the participants were at risk of malnutrition, and 2.9% were malnourished. During follow-up, 72 (26.1%) patients died. The female sex was not associated with a higher occurrence of malnutrition (P = 0.99) or nutritional risk (P = 0.85), according to MNA. Coherently, GNRI scores did not differ significantly between the sexes (P = 0.29). In contrast, BMI was significantly higher in males (29.4 ± 5.3 vs. 25.9 ± 4.7; P < 0.001). Impaired nutritional status assessed with any method (MNA, GNRI, BMI) was not significantly associated with a worse prognosis. In multivariable analysis, NYHA class, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP), higher N-terminal fragment of proBNP, and higher uric acid were independent of sex and age predictors of all-cause mortality. CONCLUSION There were no sex differences in the nutritional status in the HFrEF patients, apart from lower BMI in females. Impaired nutritional status was not associated with mortality in both men and women.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Agata Kukfisz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Curie-Sklodowska 9, 41-800 Zabrze, Poland
| | - Magdalena Szczechla
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Aleksandra Soloch
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Maria Cierzniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Alicja Szubarga
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Katarzyna Przytarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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Chen C, Chen X, Chen S, Wu Y, He X, Zhao J, Li B, He J, Dong Y, Liu C, Wei FF. Prognostic Implication of Admission Mean and Pulse Pressure in Acute Decompensated Heart Failure With Different Phenotypes. Am J Hypertens 2023; 36:217-225. [PMID: 36520093 DOI: 10.1093/ajh/hpac130] [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: 09/28/2022] [Revised: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It remains unknown whether admission mean (MAP) and pulse pressure (PP) pressure are associated with short- and long-term mortality in Chinese patients with heart failure with preserved (HFpEF), mid-range (HFmrEF), and reduced (HFrEF) ejection fraction. METHODS In 2,706 acute decompensated heart failure (HF) patients, we assessed the risk of 30-day, 1-year, and long-term (>1 year) mortality with 1-SD increment in MAP and PP, using multivariable logistic and Cox regression, respectively. RESULTS During a median follow-up of 4.1 years, 1,341 patients died. The 30-day, 1-year, and long-term mortality were 3.5%, 16.7%, and 39.4%, respectively. A lower MAP was associated with a higher risk of 30-day mortality in women (P = 0.023) and a higher risk of 30-day and 1-year mortality in men (P ≤ 0.006), while higher PP predicted long-term mortality in men (P ≤ 0.014) with no relationship observed in women. In adjusted analyses additionally accounted for PP, 1-SD increment in MAP was associated with 30-day mortality in HFpEF (odds ratio [OR], 0.63; 95% CI, 0.43 to 0.92; P = 0.018), with 1-year mortality in HFmrEF (OR, 0.46; 95% CI, 0.32 to 0.66; P < 0.001) and HFrEF (OR, 0.54; 95% CI, 0.40 to 0.72; P < 0.001). In the adjusted model additionally accounted for MAP, 1-SD increment in PP was associated with long-term mortality in HFpEF (hazard ratio, 1.16; 95% CI, 1.05 to 1.28; P = 0.003). CONCLUSIONS A lower MAP was associated with a higher risk of short-term mortality in all HF subtypes, while a higher PP predicted a higher risk of long-term mortality in men and in HFpEF. Our observations highlight the clinical importance of admission blood pressure for risk stratification in HF subtypes.
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Affiliation(s)
- Chen Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuwei Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shilan Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuzhong Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingjing Zhao
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bin Li
- Biostatistics Team, Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiangui He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, Guangdong, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, Guangdong, China
| | - Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
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Mo R, Yang YM, Yu LT, Tan HQ, Zhu J. Sex-related prognostic value of systolic blood pressure on admission in critically ill patients with acute decompensated heart failure. Heart Vessels 2022; 37:2039-2048. [PMID: 35778638 DOI: 10.1007/s00380-022-02121-z] [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: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
The present study aimed to evaluate sex-specific association between admission systolic blood pressure (SBP) and in-hospital prognosis in patients with acute decompensated heart failure (ADHF) admitted to intensive care unit (ICU). In this retrospective, observational study, 1268 ADHF patients requiring intensive care were consecutively enrolled and divided by sex. Patients were divided into three subgroups according to SBP tertiles: high (≥ 122 mmHg), moderate (104-121 mmHg) and low (< 104 mmHg). The primary endpoint was either all-cause mortality, cardiac arrest or utilization of mechanical support devices during hospitalization. Female patients were more likely to be older, have poorer renal function and higher ejection fractions (p < 0.001). The C statistics of SBP was 0.665 (95%CI 0.611-0.719, p < 0.001) for men and 0.548 (95% CI 0.461-0.634, p = 0.237) for women, respectively. Multivariate analysis demonstrated that admission SBP as either a continuous (OR = 0.984, 95% CI 0.973-0.996) or a categorical (low vs. high, OR = 3.293, 95% CI 1.610-6.732) variable was an independent predictor in male but the risk did not statistically differ between the moderate and high SBP strata (OR = 1.557, 95% CI 0.729-3.328). In female, neither low (OR = 1.135, 95% CI 0.328-3.924) nor moderate (OR = 0.989, 95% CI 0.277-3.531) SBP had a significant effect on primary endpoint compared with high SBP strata. No interaction was detected between left ventricular ejection fraction (LVEF) and SBP (p for interaction = 0.805). In ADHF patients admitted to ICU, SBP showed a sex-related prognostic effect on primary endpoint. In male, lower SBP was independently associated with an increased risk of primary endpoint. Conversely, in female, no relationship was observed.
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Affiliation(s)
- Ran Mo
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Yan-Min Yang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China. .,National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Li-Tian Yu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Hui-Qiong Tan
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Jun Zhu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
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Nakatani D, Dohi T, Takeda T, Okada K, Sunaga A, Oeun B, Kida H, Sotomi Y, Sato T, Kitamura T, Suna S, Mizuno H, Hikoso S, Matsumura Y, Sakata Y. Relationships of Atrial Fibrillation at Diagnosis and Type of Atrial Fibrillation During Follow-up With Long-Term Outcomes for Heart Failure With Preserved Ejection Fraction. Circ Rep 2022; 4:255-263. [PMID: 35774079 PMCID: PMC9168735 DOI: 10.1253/circrep.cr-22-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Few data are available regarding the impact of atrial fibrillation (AF) at diagnosis and type of AF during the follow-up period on long-term outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results: In all, 1,697 patients diagnosed as HFpEF between March 2010 and December 2017 were included in this study. At enrollment, 698 (41.1%) patients had AF. Over a median follow-up of 1,017 days, there were no significant differences between patients with and without AF in the adjusted hazard ratio (HR) for all-cause death or admission for heart failure. However, those with AF had a higher risk of stroke (HR 1.831; P=0.003). Of 998 patients with sinus rhythm at enrollment, 139 (13.9%) developed new-onset AF. Predictors of new-onset AF were pulse, hemoglobin, left ventricular end-diastolic dimension, and B-type natriuretic peptide. Compared with sinus rhythm, paroxysmal AF had a similar risk for all-cause death, admission for HF, and stroke; persistent AF had a lower risk of all-cause death (HR 0.701; P=0.015), but a higher risk for admission for HF (HR 1.608; P=0.002); and new-onset AF had a lower risk for all-cause death (HR 0.654; P=0.040), but a higher risk of admission for HF (HR 2.475; P<0.001). Conclusions: In patients with HFpEF, long-term outcome may differ by type of AF. Physicians need to consider individual risk with regard to AF type.
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Affiliation(s)
- Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiro Takeda
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Bei Y, Wang L, Ding R, Che L, Fan Z, Gao W, Liang Q, Lin S, Liu S, Lu X, Shen Y, Wu G, Yang J, Zhang G, Zhao W, Guo L, Xiao J. Animal exercise studies in cardiovascular research: Current knowledge and optimal design-A position paper of the Committee on Cardiac Rehabilitation, Chinese Medical Doctors' Association. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:660-674. [PMID: 34454088 PMCID: PMC8724626 DOI: 10.1016/j.jshs.2021.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/09/2021] [Accepted: 07/11/2021] [Indexed: 05/02/2023]
Abstract
Growing evidence has demonstrated exercise as an effective way to promote cardiovascular health and protect against cardiovascular diseases However, the underlying mechanisms of the beneficial effects of exercise have yet to be elucidated. Animal exercise studies are widely used to investigate the key mechanisms of exercise-induced cardiovascular protection. However, standardized procedures and well-established evaluation indicators for animal exercise models are needed to guide researchers in carrying out effective, high-quality animal studies using exercise to prevent and treat cardiovascular diseases. In our review, we present the commonly used animal exercise models in cardiovascular research and propose a set of standard procedures for exercise training, emphasizing the appropriate measurements and analysis in these chronic exercise models. We also provide recommendations for optimal design of animal exercise studies in cardiovascular research, including the choice of exercise models, control of exercise protocols, exercise at different stages of disease, and other considerations, such as age, sex, and genetic background. We hope that this position paper will promote basic research on exercise-induced cardiovascular protection and pave the way for successful translation of exercise studies from bench to bedside in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
- Yihua Bei
- Institute of Geriatrics, Affiliated Nantong Hospital of Shanghai University, Sixth People's Hospital of Nantong, School of Medicine, Shanghai University, Nantong 226011, China; Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai 200444, China
| | - Lei Wang
- Department of Rehabilitation Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Rongjing Ding
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - Lin Che
- Department of Cardiology, Tongji Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai 200065, China
| | - Zhiqing Fan
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing 163000, China
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - Qi Liang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Shenghui Lin
- School of Medicine, Huaqiao University, Quanzhou 362021, China
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha 410008, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuqin Shen
- Department of Cardiology, Tongji Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai 200065, China
| | - Guifu Wu
- Department of Cardiology, Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-Sen University, Shenzhen 518033, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou 510080, China
| | - Jian Yang
- Department of Rehabilitation Medicine, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Guolin Zhang
- Cardiac Rehabilitation Department, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Zhao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - Lan Guo
- Cardiac Rehabilitation Department, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
| | - Junjie Xiao
- Institute of Geriatrics, Affiliated Nantong Hospital of Shanghai University, Sixth People's Hospital of Nantong, School of Medicine, Shanghai University, Nantong 226011, China; Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai 200444, China.
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Sex Differences in Clinical Characteristics and 1- and 10-Year Mortality Among Patients Hospitalized With Acute Heart Failure. Am J Med Sci 2020; 360:392-401. [DOI: 10.1016/j.amjms.2020.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/20/2023]
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Incidence, predictors and prognostic implications of dyspnea at admission among acute coronary syndrome patients without heart failure. Int J Cardiol 2020; 301:29-33. [DOI: 10.1016/j.ijcard.2019.11.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/29/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
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Gender disparities in heart failure with mid-range and preserved ejection fraction: Results from APOLLON study. Anatol J Cardiol 2019; 21:242-252. [PMID: 31062760 PMCID: PMC6528519 DOI: 10.14744/anatoljcardiol.2019.71954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: This study aimed to examine gender-based differences in epidemiology, clinical characteristics, and management of consecutive patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter, cross-sectional, and observational study. Consecutive patients with HFmrEF or HFpEF who were admitted to the cardiology clinics were included (NCT03026114). Herein, we performed a post-hoc analysis of data from the APOLLON trial. Results: The study population included 1065 (mean age of 67.1±10.6 years, 54% women) patients from 11 sites in Turkey. Compared with men, women were older (68 years vs. 67 years, p<0.001), had higher body mass index (29 kg/m2 vs. 27 kg/m2, p<0.001), and had higher heart rate (80 bpm vs. 77.5 bpm, p<0.001). Women were more likely to have HFpEF (82% vs. 70.9%, p<0.001), and they differ from men having a higher prevalence of hypertension (78.7% vs. 73.2%, p=0.035) and atrial fibrillation (40.7% vs. 29.9%, p<0.001) but lower prevalence of coronary artery disease (29.5% vs. 54.9%, p<0.001). Women had higher N-terminal pro-B-type natriuretic peptide (691 pg/mL vs. 541 pg/mL, p=0.004), lower hemoglobin (12.7 g/dL vs. 13.8 g/dL, p<0.001), and serum ferritin (51 ng/mL vs. 64 ng/mL, p=0.001) levels, and they had worse diastolic function (E/e’=10 vs. 9, p<0.001). The main cause of heart failure (HF) in women was atrial fibrillation, while it was ischemic heart disease in men. Conclusion: Clinical characteristics, laboratory findings, and etiological factors are significantly different in female and male patients with HFmrEF and HFpEF. This study offers a broad perspective for increased awareness about this patient profile in Turkey.
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Mattingly AS, Lerman BJ, Popat R, Wren SM. Association of Sex With Postoperative Mortality Among Patients With Heart Failure Who Underwent Elective Noncardiac Operations. JAMA Netw Open 2019; 2:e1914420. [PMID: 31675085 PMCID: PMC6826642 DOI: 10.1001/jamanetworkopen.2019.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Sex differences in postoperative outcomes in patients with heart failure (HF) have not been well characterized. Women generally experience a lower postoperative mortality risk after noncardiac operations. It is unclear if this pattern holds among patients with HF. OBJECTIVES To determine if the risk of postoperative mortality is associated with sex among patients with HF who underwent noncardiac operations and to determine if sex is associated with the relationship between HF and postoperative mortality. DESIGN, SETTING, AND PARTICIPANTS This multisite cohort study used data from the US Department of Veterans Affairs Surgical Quality Improvement Project database for all patients who underwent elective noncardiac operations from October 1, 2009, to September 30, 2016, with a minimum of 1 year follow-up. The data analysis was conducted from May 1, 2018, to August 31, 2018. EXPOSURES Heart failure, left ventricular ejection fraction, and sex. MAIN OUTCOMES AND MEASURES Postoperative mortality at 90 days. RESULTS Among 609 735 patients who underwent elective noncardiac operations from 2009 to 2016, 47 997 patients had HF (7.9%; mean [SD] age, 68.6 [10.1] years; 1391 [2.9%] women) and 561 738 patients did not have HF (92.1%; mean [SD] age, 59.4 [13.4] years; 50 862 [9.1%] women). Among patients with HF, female sex was not independently associated with 90-day postoperative mortality (adjusted odds ratio [aOR], 0.97; 95% CI, 0.71-1.32). Although HF was associated with increased odds of postoperative mortality in both sexes compared with their peers without HF, the odds of postoperative mortality were higher among women with HF (aOR, 2.44; 95% CI, 1.73-3.45) than men with HF (aOR, 1.64; 95% CI, 1.54-1.74), suggesting that HF may negate the general protective association of female sex with postoperative mortality (P for interaction of HF × sex = .03). This pattern was consistent across all levels of left ventricular ejection fraction. CONCLUSIONS AND RELEVANCE Although HF was associated with increased odds of postoperative mortality in both sexes compared with their peers without HF, the odds of postoperative mortality were higher among women with HF than men with HF, suggesting that HF may negate the general protective association of female sex with postoperative mortality risk in noncardiac operations.
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Affiliation(s)
| | - Benjamin J. Lerman
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Rita Popat
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Shih ML, Tsai ST, Chen HM, Chou FH, Liu Y. Gender differences? Factors related to quality of life among patients with Heart failure. Women Health 2019; 60:382-395. [PMID: 31506006 DOI: 10.1080/03630242.2019.1662868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Heart failure (HF) is a chronic, progressive disease that substantially decreases patients' quality of life. Few studies have compared quality of life and its related factors across genders in patients with HF. To explore gender differences in quality of life and related factors among adult patients with HF. A comparative study was conducted with 245 HF patients recruited from a medical center and a regional teaching hospital in Taiwan from February 2009 to February 2011. Descriptive and inferential statistics were used, including stepwise multiple regressions. The mean quality of life scores of males were significantly higher than those of females (87.78 ± 13.99 vs. 84.49 ± 11.85). The factors significantly related to quality of life for the male HF patients, in descending order of strength of association were depressive symptoms, physical symptoms, and monthly family income-less than USD 1,000; for the females, the significantly related factors were physical symptoms, depressive symptoms, and monthly family income-less than USD 1,000. The amount variance for which quality of life accounted for male and female HF patients was similar (60% vs. 64%). The results could be used for health professionals to provide more appropriate assessments and care according to gender in the future.
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Affiliation(s)
- Meng-Ling Shih
- Department of Nursing and Cardiovascular Surgery Intensive Care Unit, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Shian-Ting Tsai
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
| | - Hsing-Mei Chen
- College of Nursing, National Cheng Kung University, Tainan City, Taiwan, R.O.C
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
| | - Yi Liu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
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11
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Perrone V, Veronesi C, Nica M, Colombo D, Degli Esposti L, Castello R. Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital. Ther Clin Risk Manag 2019; 15:847-850. [PMID: 31360063 PMCID: PMC6625643 DOI: 10.2147/tcrm.s203011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Sex-related differences have been shown to deeply affect health-related aspects of patients. However, the lack of gender-specific analysis makes it difficult to advance personalized medicine in terms of a gender-based approach. The aim of the present study was to describe gender-specific features of patients diagnosed with heart failure (HF), with a focus on the clinical presentation. Data were collected from a properly designed database and referred to an Italian hospital. Patients aged ≥18 years with a primary or secondary diagnosis of HF between 1 January 2012 and 31 December 2016 were included, and their demographic and clinical characteristics were analyzed according to gender. Of the 719 HF patients included, 317 (44.1%) were male and 402 (55.9%) were female. Women tended to be older compared to men (82.4±8.8 years and 77.1±10.6 years, respectively). As for clinical presentation, 62.1% of female and 38.3% of male patients had preserved ejection fraction, and 56.1% of men and 58.2% of women suffered from atrial fibrillation. The left atrium was partially compromised in 62.4% of male and 63% of female patients, while right atrium dysfunction tended to be more frequent in male patients compared to female patients (29.1% and 25.5%, respectively). In conclusion, gender-specific features of a cohort of HF patients from a clinical setting were accurately described.
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Affiliation(s)
- V Perrone
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - C Veronesi
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - M Nica
- Novartis Pharma, Origgio, VA, Italy
| | | | - L Degli Esposti
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - R Castello
- Division of General Medicine, University Hospital of Verona, Verona, Italy
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12
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The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci 2019; 189:119-131. [DOI: 10.1007/s11845-019-02034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022]
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13
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Gender Differences in Prognostic Markers of All-Cause Death in Patients with Acute Heart Failure: a Prospective 18-Month Follow-Up Study. J Cardiovasc Transl Res 2019; 13:97-109. [PMID: 31119563 DOI: 10.1007/s12265-019-09893-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/06/2019] [Indexed: 12/24/2022]
Abstract
Acute heart failure (AHF) is a life-threatening condition with poor prognosis. Gender differences have been increasingly recognized in diverse cardiovascular diseases. The present study aimed to evaluate gender-specific prognostic markers of all-cause death in AHF patients based on a prospective 18-month follow-up study. Data were collected from 419 patients with AHF hospitalization who were followed up for 18 months using all-cause death as primary endpoint. The mean age of all patients was 60.9 ± 15.7 years old, 277 were males, and 142 were females. Females had higher rate of valvular heart disease (37.3%) and atrial fibrillation (45.8%) but lower rate of cardiomyopathy (30.3%) than males in this cohort. Based on multiple COX stepwise regression and ROC curve analysis, diastolic blood pressure (DBP), serum sodium, serum creatinine, and pulmonary artery systolic pressure (PASP) were identified as independent predictors of all-cause death in male AHF patients, while systolic blood pressure (SBP), serum aspartate transaminase (AST), serum creatinine, and serum D-dimer as independent predictors in females. Kaplan-Meier analysis showed a higher probability of all-cause death over time in male AHF patients with DBP ≤ 77 mmHg, serum sodium ≤ 138.5 mM, serum creatinine ≥ 126.2 μM, or PASP ≥ 52 mmHg, and in female AHF patients with SBP ≤ 129 mmHg, serum AST > 29.3 U/L, serum creatinine ≥ 102.7 μM, or serum D-dimer ≥ 1.76 mg/L. In conclusion, these data provide novel insights into gender differences in prognostic markers of outcomes of AHF patients.
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14
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Formiga F, Moreno-Gonzalez R, Chivite D, Yun S, Franco J, Ariza-Solé A, Corbella X. Sex differences in 1-year mortality risks in older patients experiencing a first acute heart failure hospitalization. Geriatr Gerontol Int 2018; 19:184-188. [PMID: 30548748 DOI: 10.1111/ggi.13580] [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: 08/07/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
AIM To assess whether 1-year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex. METHODS We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3-year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis. RESULTS There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1-year all-cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio [HR] 0.35, 95% confidence interval [95% CI] 0.21-0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16-3.40), systolic blood pressure (HR 0.98, 95% CI 0.97-0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12-3.85), number of chronic therapies (HR 1.12, 95% CI 1.05-1.19) and 1-year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97-0.98) and higher potassium values (HR 1.42, 95% CI 1.01-2.00). CONCLUSIONS Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184-188.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jonathan Franco
- Internal Medicine Department, Hospital Universitari Quiron Dexeus Universitary Hospital, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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15
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Scrutinio D, Guida P, Passantino A, Lagioia R, Raimondo R, Venezia M, Ammirati E, Oliva F, Stucchi M, Frigerio M. Female gender and mortality risk in decompensated heart failure. Eur J Intern Med 2018; 51:34-40. [PMID: 29317139 DOI: 10.1016/j.ejim.2018.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). METHODS We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups. RESULTS The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90-1.59; p=.202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95-1.43; p=.127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction. CONCLUSIONS Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Tradate, Varese, Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri SPA SB, Institute of Ginosa Marina, Taranto, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Miriam Stucchi
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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16
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Kosmidou I, Redfors B, Selker HP, Thiele H, Patel MR, Udelson JE, Magnus Ohman E, Eitel I, Granger CB, Maehara A, Kirtane A, Généreux P, Jenkins PL, Ben-Yehuda O, Mintz GS, Stone GW. Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials. Eur Heart J 2018; 38:1656-1663. [PMID: 28407050 DOI: 10.1093/eurheartj/ehx159] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/13/2017] [Indexed: 11/14/2022] Open
Abstract
Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P < 0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.
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Affiliation(s)
- Ioanna Kosmidou
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Björn Redfors
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Harry P Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Holger Thiele
- University Heart Center and the German Center for Cardiovascular Research, Lübeck, Germany
| | | | - James E Udelson
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Ingo Eitel
- University Heart Center and the German Center for Cardiovascular Research, Lübeck, Germany
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Ajay Kirtane
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.,Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Morristown Medical Center, Morristown, NJ, USA
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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17
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Khaled S, Matahen R. Obesity paradox in heart failure patients - Female gender characteristics-KAMC-single center experience. Egypt Heart J 2017; 69:209-213. [PMID: 29622978 PMCID: PMC5883486 DOI: 10.1016/j.ehj.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/03/2017] [Indexed: 01/14/2023] Open
Abstract
Background/Introduction The correlation between low body mass index (BMI) and congestive heart failure (obesity paradox) has been described in the literature; However, the association between BMI and clinical outcome measures is not well characterized. Little is known about CHF in the Middle Eastern female population; most of the gender-specific information on heart failure comes from higher income “Western” countries. Objectives We aimed to identify the correlation between heart failure patients especially those with low BMI and clinical/safety outcome measures with focusing on female patients subgroup characteristics. Methods We performed group comparisons of statistically relevant variables using prospectively collected data of HFrEF patients hospitalized over a 12 month period. Results The 167 patients (Group I) enrolled by this study with mean age of 59.64 ± 12.9 years, an EF score of 23.96 ± 10.14, 62.9% had ischemic etiology, 12.5% were smoker, 18% had AF, 31.1% had received ICD/CRT-D and an estimated 8.85 ± 9.5 days length of stay (LOS). The low BMI group of patients (Group II) had means age of 58.7 ± 14.5 years, a significant lower EF score of 20.32 ± 8.58, significantly higher 30, 90 days readmission rates and in-house mortality (22%, 36.6% and 17.1% vs 10.2%, 20.4% and 6.6% respectively) and higher rates of CVA, TIA and unexplained syncope (19.5% vs 7.2%). Similarly, female patients with low BMI (Group IV) had lower EF score of 22.0 ± 53, higher 30,90 days readmission rates and in-house mortality (34.4%,43.8% and 25% vs 13.5%,21.6% and 5.4% respectively) and higher rates of CVA, TIA and unexplained syncope(10% vs 0%). Conclusion Our findings showed that heart failure patients with low BMI had poor adverse clinical outcome measures (poor EF, recurrent readmission, mortality and composite rates of CVA, TIA and unexplained syncope) which reflect the effect of obesity paradox in those patients with HFrEF. Female patient subgroup showed similar characteristic findings which also might reflect the value of gender-specific BMI related clinical outcomes.
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Affiliation(s)
- Sheeren Khaled
- King Abdullah Medical City-Makkah, Muzdallfa Road, Saudi Arabia.,Banha University, Egypt
| | - Rajaa Matahen
- King Abdullah Medical City-Makkah, Muzdallfa Road, Saudi Arabia
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18
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Corrà U, Agostoni P, Giordano A, Cattadori G, Battaia E, La Gioia R, Scardovi AB, Emdin M, Metra M, Sinagra G, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Magrì D, Fiorentini C, Cicoira M, Salvioni E, Giovannardi M, Veglia F, Mezzani A, Scrutinio D, Di Lenarda A, Ricci R, Apostolo A, Iorio AM, Paolillo S, Palermo P, Contini M, Vassanelli C, Passino C, Giannuzzi P, Piepoli MF. Sex Profile and Risk Assessment With Cardiopulmonary Exercise Testing in Heart Failure: Propensity Score Matching for Sex Selection Bias. Can J Cardiol 2016; 32:754-9. [DOI: 10.1016/j.cjca.2015.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 01/20/2023] Open
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19
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Gender-related differences in clinical profile and outcome of patients with heart failure. Results of the RICA Registry. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rceng.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Conde-Martel A, Arkuch M, Formiga F, Manzano-Espinosa L, Aramburu-Bodas O, González-Franco Á, Dávila-Ramos M, Suárez-Pedreira I, Herrero-Domingo A, Montero-Pérez-Barquero M. Diferencias en función del sexo en el perfil clínico y pronóstico de pacientes con insuficiencia cardiaca. Resultados del Registro RICA. Rev Clin Esp 2015; 215:363-70. [DOI: 10.1016/j.rce.2015.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/12/2015] [Accepted: 02/14/2015] [Indexed: 12/11/2022]
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21
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Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG, Walsh MN, Westlake Canary CA, Allen LA, Bonnell MR, Carson PE, Chan MC, Dickinson MG, Dries DL, Ewald GA, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Whellan DJ, Givertz MM. Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. J Card Fail 2015; 21:674-93. [DOI: 10.1016/j.cardfail.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
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22
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Grapsa J, Pereira Nunes MC, Tan TC, Cabrita IZ, Coulter T, Smith BCF, Dawson D, Gibbs JSR, Nihoyannopoulos P. Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension: Seven-Year Follow-Up. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002107. [PMID: 26063743 DOI: 10.1161/circimaging.114.002107] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In this study, we looked at the prognostic value of echocardiographic and hemodynamic measures in a large cohort of patients with precapillary pulmonary hypertension before and after initiation of treatment. METHODS AND RESULTS Data were collected prospectively in a cohort of consecutive patients with precapillary pulmonary hypertension referred between 2002 and 2011. A range of clinical and echocardiographic variables were collected and stored on a database to assess predictors of survival. Invasive hemodynamic data including pulmonary artery pressure, pulmonary vascular resistance, capillary wedge pressure, and cardiac index were also obtained at baseline in all patients. Outcome was defined as mortality because of cardiovascular-related death. The study cohort comprised 777 patients (514 women) with precapillary pulmonary hypertension. A total of 195 (25%) died. In multivariable analysis, moderate or severe tricuspid regurgitation (hazard ratio [HR], 26.537; 95% confidence interval, 11.536-61.044; P<0.001), right ventricular myocardial performance index (HR, 3.421; 95% confidence interval, 1.777-6.584; P<0.001), and the presence of pericardial effusion (HR, 1.38; 95% confidence interval, 1.023-1.862; P=0.035) were independent predictors of mortality. High pulmonary vascular resistance and right atrial pressure by invasive hemodynamic measurements were independent predictors of mortality (HR, 1.084; 95% confidence interval, 1.041-1.130, and 1.079, respectively; 95% confidence interval, 1.049-1.111; P<0.001 for both), whereas patients with a higher cardiac index had better survival overall (HR, 0.384; 95% confidence interval, 0.307-0.481; P<0.001). CONCLUSIONS Right ventricular dysfunction, moderate-severe tricuspid regurgitation, low cardiac index, and raised right atrial pressure were associated with poor survival for both pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertensive disease patients. The severity of tricuspid regurgitation, myocardial performance index, presence of pericardial effusion, pulmonary vascular resistance, cardiac index, and right atrial pressure may be used to stratify risk of death.
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Affiliation(s)
- Julia Grapsa
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Maria Carmo Pereira Nunes
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Timothy C Tan
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Ines Zimbarra Cabrita
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Taryn Coulter
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Benjamin C F Smith
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - David Dawson
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - J Simon R Gibbs
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Petros Nihoyannopoulos
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
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Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation? J Cardiovasc Nurs 2015; 29:555-64. [PMID: 24165699 DOI: 10.1097/jcn.0000000000000095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF. OBJECTIVES The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF. METHODS Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version. RESULTS Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001). CONCLUSION Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.
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Lam CSP, Chang P, Chia SY, Sim LL, Gao F, Lee FL, Chai P, Wong RCC, Seow SC, Leong GKT, Yeo PSD, Sim D, Chua T, Kwok BWK. Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure. ACTA ACUST UNITED AC 2014; 22:8. [PMID: 26316666 PMCID: PMC4544470 DOI: 10.7603/s40602-014-0008-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: To study sex differences in clinical characteristics and outcomes among multi-ethnic Southeast Asian patients with hospitalized heart failure (HHF). Background: HHF is an important public health problem affecting man and women globally. Reports from Western populations suggest striking sex differences in risk factors and outcomes in HHF. However, this has not been studied in a multi-ethnic Asian population. Methods: Using the population-based resources of the Singapore Cardiac Data Bank, we studied 5,703 consecutive cases of HHF admitted across hospitals in the Southeast Asian nation of Singapore from 1st January, 2008 through 31st December, 2009. Results: Women accounted for 46% of total admissions and were characterized by older age (73 vs. 67 years; p<0.001), higher prevalence of hypertension (78.6 vs. 72.1%; p<0.001) or atrial fibrillation (22.2 vs. 18.1%; p<0.001), and lower prevalence of coronary artery disease (33.8 vs. 41.0%; p<0.001) or prior myocardial infarction (14.9 vs. 19.8%; p<0.001). Women were more likely than men to have HHF with preserved ejection fraction (42.5% versus 20.8%, p < 0.001). Women were less likely than men to receive evidencebased therapies at discharge, both in the overall group and in the sub-group with reduced ejection fraction. Women had longer lengths of stay (5.6 vs. 5.1 days; p<0.001) but similar in-hospital mortality and one-year rehospitalization rates compared to men. Independent predictors of mortality or rehospitalization in both men and women included prior myocardial infarction and reduced ejection fraction. Among women alone, additional independent predictors were renal impairment, atrial fibrillation, and diabetes. Prescription of beta-blockers and ACE-inhibitors at discharge was associated with better outcomes. Conclusion: Among multi-ethnic Asian patients with HHF, there are important sex differences in clinical characteristics and prognostic factors. These data may inform sex-specific strategies to improve outcomes of HHF in Southeast Asians.
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Affiliation(s)
- Carolyn S P Lam
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Peter Chang
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Shaw Yang Chia
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Ling Ling Sim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Fong Ling Lee
- Khoo Teck Puat Hospital, Department of Cardiology, Singapore, Singapore
| | - Ping Chai
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Raymond Ching-Chiew Wong
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Swee Chong Seow
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | | | - Poh Shuan Daniel Yeo
- Tan Tock Seng Hospital, Department of Cardiology, Singapore, Singapore ; Singapore Cardiac Data Bank, Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - David Sim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Bernard W K Kwok
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
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25
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The impact of overweight and obesity on health-related quality of life and blood pressure control in hypertensive patients. J Hypertens 2014; 32:397-407. [PMID: 24366035 DOI: 10.1097/hjh.0000000000000046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Hypertension and obesity deteriorate patient health-related quality-of-life (HRQoL). This study assessed the impact of overweight and obesity on HRQoL and blood pressure (BP) control in hypertensive participants, according to sex. METHODS HRQoL was assessed using the 12-item Short Form Health Survey in 11,498 white patients treated for hypertension for at least 12 months. Nutritional status was diagnosed according to WHO criteria. RESULTS Overweight and obesity were associated with worse BP control, regardless of sex. In women, overweight and especially obesity were inversely associated with all analyzed HRQoL dimensions. Among men, obesity decreased all HRQoL dimensions, and overweight influenced only physical functioning, role physical, bodily pain, vitality, general health, and Physical Component Score (PCS) but not Mental Component Score (MCS). Overweight in men did not influence social functioning, or emotional and mental health. The BMI values associated with optimal PCS and MCS scores were higher for men than for women. Age-adjusted multivariate regression analysis revealed that PCS score was associated with obesity, higher education level, comorbidities, and antihypertensive therapy duration, whereas MCS score was associated with female sex. Polydrug BP control diminished PCS and MCS. CONCLUSION Overweight and obesity deteriorate BP control, regardless of age and polytherapy. BMI values associated with optimal HRQoL are higher for men than women treated for hypertension. Obesity more strongly diminishes the physical versus mental HRQoL component, regardless of sex. Overweight worsens HRQoL physical components in both sexes and mental component-only in women.
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Zhao Z, Wang H, Jessup JA, Lindsey SH, Chappell MC, Groban L. Role of estrogen in diastolic dysfunction. Am J Physiol Heart Circ Physiol 2014; 306:H628-40. [PMID: 24414072 DOI: 10.1152/ajpheart.00859.2013] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The prevalence of left ventricular diastolic dysfunction (LVDD) sharply increases in women after menopause and may lead to heart failure. While evidence suggests that estrogens protect the premenopausal heart from hypertension and ventricular remodeling, the specific mechanisms involved remain elusive. Moreover, whether there is a protective role of estrogens against cardiovascular disease, and specifically LVDD, continues to be controversial. Clinical and basic science have implicated activation of the renin-angiotensin-aldosterone system (RAAS), linked to the loss of ovarian estrogens, in the pathogenesis of postmenopausal diastolic dysfunction. As a consequence of increased tissue ANG II and low estrogen, a maladaptive nitric oxide synthase (NOS) system produces ROS that contribute to female sex-specific hypertensive heart disease. Recent insights from rodent models that mimic the cardiac phenotype of an estrogen-insufficient or -deficient woman (e.g., premature ovarian failure or postmenopausal), including the ovariectomized congenic mRen2.Lewis female rat, provide evidence showing that estrogen modulates the tissue RAAS and NOS system and related intracellular signaling pathways, in part via the membrane G protein-coupled receptor 30 (GPR30; also called G protein-coupled estrogen receptor 1). Complementing the cardiovascular research in this field, the echocardiographic correlates of LVDD as well as inherent limitations to its use in preclinical rodent studies will be briefly presented. Understanding the roles of estrogen and GPR30, their interactions with the local RAAS and NOS system, and the relationship of each of these to LVDD is necessary to identify new therapeutic targets and alternative treatments for diastolic heart failure that achieve the cardiovascular benefits of estrogen replacement without its side effects and contraindications.
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Affiliation(s)
- Zhuo Zhao
- Department of Cardiology, Jinan Central Hospital, Affiliated with Shandong University, Jinan, China
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Klempfner R, Koifman E, Goldenberg I, Hamdan A, Tofler GH, Kopel E. The Israel Nationwide Heart Failure Survey: Sex differences in early and late mortality for hospitalized heart failure patients. J Card Fail 2013; 20:193-8. [PMID: 24374113 DOI: 10.1016/j.cardfail.2013.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 12/15/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Current data on the influence of sex on the prognosis of heart failure (HF) are conflicting, possibly owing to the use of different end points and a heterogeneous heart failure population in earlier studies. We sought to evaluate the effect of sex on the risk of early and late mortality outcomes after hospitalization for acute heart failure. METHODS AND RESULTS The prospective cohort study population comprised 2,212 hospitalized patients with acute HF enrolled in a multicenter national survey in Israel. Cox proportional-hazards regression modeling was used to evaluate the effect of sex on the risk of early (≤6 months) and late (>6 months to 4 years) mortality after the index hospitalization. Among the study patients, 998 (45%) were women. Women with HF displayed significantly different clinical characteristics compared with men, including older age, higher frequency of HF with preserved ejection fraction and hypertensive heart disease, and lower percentage of coronary artery disease (all P < .001). The fully adjusted multivariable analyses for mortality outcomes showed that women tended toward an increased risk for early (≤6 months) mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.96-1.41; P = .13), whereas men had significantly increased risk for late (>6 months) mortality (HR 1.25, 95% CI 1.09-1.43; P = .001). CONCLUSIONS There are important differences in the clinical characteristics and the short- and long-term outcomes between men and women hospitalized with acute HF after adjusting for multiple confounding variables.
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Affiliation(s)
- Robert Klempfner
- Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel; Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Edward Koifman
- Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel; Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ilan Goldenberg
- Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel; Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel; Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Geoffrey H Tofler
- University of Sydney, Sydney, Australia; Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Eran Kopel
- Neufeld Cardiac Research Institute, Heart Institute, Tel Hashomer, Ramat Gan, Israel.
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