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Lima Dos Santos CC, Matharoo AS, Pinzón Cueva E, Amin U, Perez Ramos AA, Mann NK, Maheen S, Butchireddy J, Falki VB, Itrat A, Rajkumar N, Zia Ul Haq M. The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review. Cureus 2023; 15:e47799. [PMID: 38021526 PMCID: PMC10676710 DOI: 10.7759/cureus.47799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiovascular disease has remained one of the leading causes of mortality in the world. The basic pathophysiology of coronary artery disease (CAD) is a reduction of the blood flow in coronary vessels, leading to restricted blood flow to the heart muscle. Both modifiable and non-modifiable risk factors contribute to its multifactorial etiology. The clinical presentation ranges from asymptomatic to typical symptoms like chest pain, shortness of breath, and left arm or jaw pain. The purpose of this review is to investigate and analyze the variation of CAD depending on the biological sex, age, race, or ethnicity and how it might differ in the studied population while comparing the symptoms and prognosis of CAD. For this research, PubMed's database was used. A total of 926 articles were selected using pre-determined inclusion and exclusion criteria, with 74 articles eligible to be included in the narrative review. Studies were selected from the general population of patients with CAD, regardless of their severity, stage of diagnosis, and treatment plan. The scale for the assessment of non-systematic review articles (SANRA) was used to assess the quality of the study. As humans age, the incidence of CAD increases, and people over 75 are more likely to have multiple-vessel CAD. It has been observed that South Asians have the highest rate of CAD at 24%, while the White population has the lowest at 8%. The prevalence of CAD also depends on race, with the White population having the lowest rate at 3.2%, followed by Hispanics at 5%, Black women at 5.2%, and Black men at 5.7%. Younger Black women tend to have more chest pain. Men with CAD commonly experience chest pain, and women are more likely to present with atypical symptoms. Modifiable risk factors such as smoking and alcoholism are more commonly observed in young men than in young women. Coronary artery disease in the elderly, female, minority, and Black patients is associated with a higher mortality rate. Acknowledging the prevalence of certain risk factors, signs, results, and responses to treatment in certain socio-demographic groups, as well as the provision and accessibility of diagnosis and treatment, would lead to a better outcome for all individuals. The impact of this shift can range from an earlier diagnosis of CAD to a faster and more customized treatment plan tailored to each patient's individual requirements.
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Affiliation(s)
| | | | | | - Uzma Amin
- Pathology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Navpreet K Mann
- Cardiology, Government Medical College and Rajindra Hospital, Patiala, IND
| | - Sara Maheen
- General Medicine, Odessa National Medical University, Odessa, UKR
| | - Jyothsna Butchireddy
- Cardiology, Government Medical College, Omandurar Government Estate, Chennai, IND
| | | | - Abeeha Itrat
- Cardiology, Lutheran General Hospital, Illinois, USA
| | | | - Muhammad Zia Ul Haq
- Epidemiology and Public Health, Emory University Rollins School of Public Health, Atlanta, USA
- Noncommunicable Diseases and Mental Health, World Health Organization, Cairo, EGY
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Rakhshan M, Toufigh A, Dehghani-firouzabadi A, Yektatalab S. Effect of Cardiac Rehabilitation on Hope Among Cardiac Patients After Coronary Artery Bypass Graft Surgery. Risk Manag Healthc Policy 2020; 13:1319-1326. [PMID: 32922100 PMCID: PMC7457873 DOI: 10.2147/rmhp.s262656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Following coronary artery bypass graft (CABG) surgery, some patients experience psycho-mental problems such as hopelessness. The Phase 2 cardiac rehabilitation (CR) program is an important element of the secondary prevention program in treating patients with cardiovascular disease (CVD). The present study aimed to determine the effect of the Phase 2 CR program on the level of hope in cardiac patients after CABG surgery. PATIENTS AND METHODS A clinical trial was conducted from July 2017 to late January 2018 at the Heart Surgery Centre, Al-Zahra Hospital, Shiraz, Iran. The target population was patients who sought CR therapy after CABG surgery. A total of 104 cardiac patients were recruited and equally divided into control and intervention groups. The intervention group received 20 sessions of Phase 2 CR program combined with education and counselling during 8 weeks. The control group only received routine observations and education. The data were collected pre- and post-intervention using a demographic form and the Miller Hope Scale (MHS). Descriptive statistics were expressed as percentages, frequency distribution, mean and standard deviation. Paired t-test and independent t-test were used for statistical inference. Data were analyzed using the SPSS statistical software (version 23.0) and P values <0.05 were considered statistically significant. RESULTS There was no significant difference in the mean score of hope between the control and intervention groups before the intervention. However, a significant difference between the groups was observed post-intervention (P<0.001). The results showed a significant difference in the mean score of hope between pre-intervention (182.36±23.07) and post-intervention (216.94±23.05) in the intervention group (P<0.001), whereas the difference in the control group was not significant (P=0.095). The measured post-intervention effect size was high (1.05). CONCLUSION The Phase 2 CR program combined with education and counseling increased hope in CVD patients after CABG surgery.
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Affiliation(s)
- Mahnaz Rakhshan
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsoon Toufigh
- Student Research Commitee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shahrzad Yektatalab
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Feng TR, Hoyler MM, Ma X, Rong LQ, White RS. Insurance Status and Socioeconomic Markers Affect Readmission Rates After Cardiac Valve Surgery. J Cardiothorac Vasc Anesth 2020; 34:668-678. [DOI: 10.1053/j.jvca.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 11/11/2022]
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Racial Disparities in Clinical Characteristics and Outcomes of Women Undergoing Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1039-1042. [PMID: 31678115 DOI: 10.1016/j.carrev.2019.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Women are underrepresented in cardiovascular clinical studies. Black women have a higher ischemic heart disease mortality risk than their white counterparts. However, there exist limited outcome data comparing black women and white women after percutaneous coronary intervention (PCI). The aim of this retrospective analysis was to evaluate for racial disparities in 1-year major adverse cardiovascular events (MACE) in women undergoing PCI. METHODS/MATERIALS Within our PCI database, we identified 4776 female patients who underwent PCI between 2003 and 2016. Of those, 1916 were black and 2860 were white. Endpoints included MACE, death, myocardial infarction, target vessel revascularization (TVR) and stent thrombosis (ST) at 30 days and 1 year. A proportional Cox hazard model analysis was performed to assess outcomes after adjustment for confounding factors. RESULTS Black women presented at a younger age and had a significantly higher prevalence of risk factors. Periprocedural and in-hospital outcomes were similar in the 2 groups. At 30 days and 1 year, the rates of myocardial infarction, TVR and ST were significantly higher in black women. After adjustment for baseline differences, only ST appears to be more likely to occur in black women than in white women. CONCLUSIONS In this large cohort of women with coronary artery disease undergoing PCI, we observed racial disparities primarily in baseline characteristics indicative of need for interventions to achieve early diagnosis and better prevention in black women. Future directions should include efforts to identify and better characterize the factors underlying and contributing to cardiovascular outcomes in women after PCI. SUMMARY In this real-world analysis from a large cohort of women with coronary artery disease undergoing percutaneous coronary intervention at a US tertiary-care center, racial disparities were observed, especially in baseline characteristics, indicating late presentation.
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5
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Effect of Cardiac Rehabilitation on Sexual Satisfaction Among Patients After Coronary Artery Bypass Graft Surgery. J Cardiopulm Rehabil Prev 2019; 39:E26-E30. [DOI: 10.1097/hcr.0000000000000434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis. J Thorac Cardiovasc Surg 2019; 157:2216-2225.e4. [DOI: 10.1016/j.jtcvs.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 01/13/2023]
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Efird JT, Jindal C, Kiser AC, Akhter SA, Crane PB, Kypson AP, Sverdlov AL, Davies SW, Kindell LC, Anderson EJ. Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents. J Int Med Res 2018; 46:3183-3194. [PMID: 29808744 PMCID: PMC6134635 DOI: 10.1177/0300060518773934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents. Methods Clinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors. Results POAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results. Conclusions Administration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.
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Affiliation(s)
- Jimmy T Efird
- 1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Charulata Jindal
- 1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Andy C Kiser
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Shahab A Akhter
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Patricia B Crane
- 3 Office of the Dean, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Alan P Kypson
- 4 Cardiac Surgical Specialists, REX Health Care, University of North Carolina, Raleigh, NC, USA
| | - Aaron L Sverdlov
- 5 Priority Clinical Centre for Cardiovascular Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Stephen W Davies
- 6 Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Linda C Kindell
- 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA
| | - Ethan J Anderson
- 7 Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
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Efird JT, Kiser AC, Crane PB, Landrine H, Kindell LC, Nelson MA, Jindal C, Sarpong DF, Griffin WF, Ferguson TB, Chitwood WR, Davies SW, Kypson AP, Gudimella P, Anderson EJ. Perioperative Inotrope Therapy and Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery: Evidence of a Racial Disparity. Pharmacotherapy 2017; 37:297-304. [PMID: 28052357 DOI: 10.1002/phar.1894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Following coronary artery bypass graft (CABG) surgery, mortality rates are significantly higher among black patients who experience postoperative atrial fibrillation (POAF). Perioperative inotropic therapy (PINOT) was associated with POAF in previous reports, but the extent to which race influences this association is unknown. In the present study, the relationship between PINOT, race, and POAF was examined in patients undergoing CABG surgery. METHODS AND SETTING Clinical records were examined from a prospectively maintained cohort of 11,855 patients (median age 64 yrs; 70% male; 16% black) undergoing primary isolated CABG at a large cardiovascular institute in the southeastern region of the United States. Relative risk (RR) and 95% confidence intervals (CIs) were computed using log-binomial regression. MAIN RESULTS The association between PINOT and POAF was significantly increased among black patients (adjusted RR 1.7, CI 1.4-2.0) compared with white patients (adjusted RR 1.3, CI 1.2-1.4) (pinteraction = 0.013). CONCLUSIONS These findings suggest that PINOT may be disproportionately associated with POAF among black patients undergoing CABG surgery. Additional studies are needed to examine further the potential underlying mechanisms of this association.
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Affiliation(s)
- Jimmy T Efird
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina.,Office of the Dean, College of Nursing, East Carolina University, Greenville, North Carolina.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andy C Kiser
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Patricia B Crane
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina.,Office of the Dean, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Hope Landrine
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Center for Health Disparities, Brody School of Medicine, Greenville, North Carolina
| | - Linda C Kindell
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Margaret-Ann Nelson
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina
| | - Charulata Jindal
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, Louisiana
| | - William F Griffin
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - T Bruce Ferguson
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - W Randolph Chitwood
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Alan P Kypson
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, North Carolina
| | - Preeti Gudimella
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina
| | - Ethan J Anderson
- Department of Pharmacology and Toxicology, Brody School of Medicine, Greenville, North Carolina.,Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
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Liou YS, Chen HY, Tien L, Gu YS, Jong GP. Antihypertensive Drug Use and New-Onset Diabetes in Female Patients with Coronary Artery Disease: A Population-based Longitudinal Cohort Study. Medicine (Baltimore) 2015; 94:e1495. [PMID: 26356715 PMCID: PMC4616628 DOI: 10.1097/md.0000000000001495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Antihypertensives have been linked to new-onset diabetes (NOD) and different classes of antihypertensives may alter the risk for the development of NOD; however, the effect of different antihypertensives on the development of NOD in women with hypertension and coronary artery disease (CAD) has not been well studied. The purpose of this study is to investigate the association between usage of different antihypertensive drugs and the development of NOD in female patients with hypertension and CAD.Data in this retrospective cohort study were obtained from claim forms submitted to the Taiwan Bureau of National Health Insurance in central Taiwan during the period 2006-2011. We estimated the odds ratios (OR) to approximate the relative risk of NOD development associated with antihypertensive drug use.Of the 20,108 female patients with CAD at baseline, 2288 patients developed NOD during the 6-year follow-up. Subjects treated with angiotensin-converting enzyme (ACE) inhibitors (OR, 0.92; 95% confidence interval [CI], 0.84-1.00), angiotensin receptor blockers (OR, 0.92; 95% CI, 0.82-0.99), and alpha-blockers (OR, 0.88; 95% CI, 0.79-0.98) in the adjusted analyses had greater reductions of the risk than among nonusers. Patients who took diuretics (OR, 1.10; 95% CI, 1.01-1.20), beta-blockers (OR, 1.12; 95% CI, 1.04-1.21), and calcium channel blockers (OR, 1.10; 95% CI, 1.02-1.18) were at high risk of developing NOD than nonusers. Vasodilators were not associated with risk of NOD.We conclude that women with hypertension who take ACE inhibitors, angiotensin receptor blockers, and alpha-blockers are at lower risk of NOD and that use of diuretics, beta-blockers, and calcium channel blockers was associated with a significantly increased risk of developing NOD during the 6-year follow-up.
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Affiliation(s)
- Yi-Sheng Liou
- From the Department of Family Medicine and Geriatrics, Taichung Veteran General Hospital, and School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC (Y-SL); Department of Pharmacy, China Medical University and China Medical University Beigang Hospital, Taichung, Taiwan, ROC (H-YC); and Department of Pharmacy, China Medical University Hospital and China Medical University Beigang Hospital, Taichung and Beigang Township, Yunlin County, Taiwan, ROC (H-YC, Y-SG); Central Region Branch, Bureau of National Health Insurance, Taichung, Taiwan, ROC (L-T); and Division of Internal Cardiology, Chung Shan Medical University Hospital and Chung Shan Medical University, and Basic Science, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC (G-PJ)
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