1
|
Kumar D, Bardooli F, Chen WJ, Huang D, Sankardas MA, Ahmed WH, Liew HB, Gwon HC, Van Dorn B, Holmes T, Thompson A, Zhang S. Risk factors for mortality in post-myocardial infarction patients: insights from the improve SCA bridge study. Egypt Heart J 2024; 76:72. [PMID: 38849606 PMCID: PMC11161447 DOI: 10.1186/s43044-024-00505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/01/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Underutilization of implantable cardioverter defibrillators (ICD) to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients remains an issue across several geographies. A better understanding of risk factors for SCD in post-MI patients from regions with low ICD adoption rates will help identify those who will benefit from an ICD. This analysis assessed risk factors for all-cause and cardiovascular-related mortality in post-MI patients from the Improve Sudden Cardiac Arrest (SCA) Bridge Trial. RESULTS For the entire cohort, the overall 1-year mortality rate was 5.9% (88/1491) and 3.4% (51/1491) for all-cause and cardiovascular mortality, respectively, with 76.5% of all cardiac deaths being from SCD. A multivariate model determined increased age, reduced left ventricular ejection fraction (LVEF), increased time from myocardial infarction to hospital admission, being female, being from Southeast Asia (SEA), and having coronary artery disease to be significant risk factors for all-cause mortality. The risk factors for cardiovascular-related mortality revealed increased age, reduced LVEF, and being from SEA as significant risk factors. CONCLUSIONS We show several characteristics as being predictors of cardiovascular-related mortality in post-MI patients from the Improve SCA Bridge study. Patients who experience an MI and present with these characteristics would benefit from a referral to an electrophysiologist for further SCD risk stratification and management and possible subsequent ICD implantation to reduce unnecessary death.
Collapse
Affiliation(s)
- Dileep Kumar
- Mohammed Bin Khalifa Specialist Cardiac Centre, Awali, Bahrain.
- Phoenix Hospital, Abu Dhabi, United Arab Emirates.
| | - Fawaz Bardooli
- Mohammed Bin Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | | | - Dejia Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Houng-Bang Liew
- Queen Elizabeth Hospital II Clinical Research Centre, Sabah, Malaysia
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Shu Zhang
- Fu Wai Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Mainland, China
| |
Collapse
|
2
|
Yildiz I, Rencüzoğulları I, Karabağ Y, Karakayali M, Artac I, Gurevin MS. Predictors of left ventricular ejection function decline in young patients with ST-segment elevation myocardial infarction. Rev Assoc Med Bras (1992) 2022; 68:802-807. [PMID: 35766695 PMCID: PMC9575903 DOI: 10.1590/1806-9282.20220033] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/20/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: A decrease in the left ventricular ejection fraction (≤40%) in the setting of
ST-segment elevation myocardial infarction is a significant predictor of
mortality in the young ST-segment elevation myocardial infarction
population. In this study, we aimed to investigate the predictors of left
ventricular ejection fraction reduction and evaluate the long-term mortality
rates in young ST-segment elevation myocardial infarction patients with or
without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial
infarction patients aged 45 years or below who underwent primary
percutaneous coronary intervention. Young ST-segment elevation myocardial
infarction patients were divided into two groups according to their left
ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were
compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine
kinase-MB, prolonged ischemia time, left anterior descending artery-related
infarction, proximally/ostial located lesion, and no-reflow were
independently associated with low left ventricular ejection fraction.
Additionally, long-term mortality was considerably higher in the left
ventricular ejection fraction ≤40% group than those in the left ventricular
ejection fraction>40% group (18.1% versus 2.4%; p<0.001). CONCLUSIONS: In young ST-segment elevation myocardial infarction patients, lesion
properties (left anterior descending lesion, proximally located lesion),
no-reflow, and prolonged ischemia time appeared to be important determinants
for the left ventricular ejection fraction decline, rather than coronary
disease severity or demographic and hematological parameters. Statin use may
be preventive in the development of left ventricular ejection fraction
decline in young ST-segment elevation myocardial infarction patients.
Collapse
Affiliation(s)
- Ibrahim Yildiz
- Adana Çukurova State Hospital, Department of Cardiology - Adana, Turkey
| | | | - Yavuz Karabağ
- Kafkas University Faculty of Medicine, Department of Cardiology - Kars, Turkey
| | - Muammer Karakayali
- Kafkas University Faculty of Medicine, Department of Cardiology - Kars, Turkey
| | - Inanc Artac
- Kafkas University Faculty of Medicine, Department of Cardiology - Kars, Turkey
| | | |
Collapse
|
3
|
Gili S, Giuliani M, Santagostino Baldi G, Teruzzi G, Pravettoni G, Montorsi P, Trabattoni D. Early Detection of Cardiovascular Risk Factors and Definition of Psychosocial Profile in Women Through a Systematic Approach: The Monzino Women Heart Center's Experience. Front Cardiovasc Med 2022; 9:844563. [PMID: 35345485 PMCID: PMC8957226 DOI: 10.3389/fcvm.2022.844563] [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: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiovascular (CV) disease is the leading mortality cause among women, yet an alarming misrepresentation of women in CV studies and a low awareness of the impact of CV among women still persist to date. The Monzino Women Heart Center has been established as a clinical and research program dedicated to primary prevention of CV disease in women. Methods Patients aged between 35 and 60 years and with no history of CV disease underwent a comprehensive evaluation including a cardiologic outpatient visit with electrocardiogram, individual CV risk calculation, first-level cardiovascular examinations and a psychological assessment. Results A total of 635 women, with a mean age of 52.2 ± 6.4 participated to the project on a voluntary basis during the period January 2017–August 2021. Included patients had a high level of education (40.4% with a graduate or postgraduate university degree), the majority of them, in a stable couple and with children, were actively working. More than half of the patients performed physical activity on a regular basis. Prevalence of traditional CV risk factors were family history (70.2%), hypertension (46%), hypercholesterolemia (22%) and diabetes (14%). Early or premature menopause was reported by 17.7% of the patients, gestational hypertension and diabetes by 4.96 and 1.7%, respectively. Symptoms of depression were reported by 27%; nearly 36% of the participants rated high score of state anxiety and 41% of trait anxiety. Nearly 69% of the participants showed moderate-to-high perceived stress. The mean value of perceived general self-efficacy was moderate (mean = 28.78, SD = 4.69). Conclusion A CV prevention program dedicated to women can help identifying a considerable number of patients with risk factors for whom early interventions can help reducing the risk of developing CV disease. Psychological assessment might unmask depression or anxiety disorders, which might have a potential long-terme detrimental effect on CV health.
Collapse
Affiliation(s)
- Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Giuliani
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia (IEO), European Institute of Oncology IRCCS, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Daniela Trabattoni
| |
Collapse
|
4
|
Ngiam JN, Thong EHE, Loh PH, Chan KH, Chan MY, Lee CH, Low AF, Tan HC, Loh JP, Sim HW. An Asian Perspective on Gender Differences in In-Hospital and Long-Term Outcome of Cardiac Mortality and Ischemic Stroke after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. J Stroke Cerebrovasc Dis 2021; 31:106215. [PMID: 34814003 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Gender differences historically exist in cardiovascular disease, with women experiencing higher rates of major adverse cardiovascular events. We investigated these trends in a contemporary Asian cohort, examining the impact of gender differences on cardiac mortality and ischemic stroke after primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). MATERIALS AND METHODS We analysed 3971 consecutive patients who underwent primary PCI for STEMI retrospectively. The primary outcome was cardiac mortality and ischemic stroke in-hospital, at one year and on longer-term follow up (median follow up 3.62 years, interquartile range 1.03-6.03 years). RESULTS There were 580 (14.6%) female patients and 3391 (85.4%) male patients. Female patients were older and had higher prevalence of hypertension, diabetes, previous strokes, and chronic kidney disease. Cardiac mortality was higher in female patients during in-hospital (15.5% vs. 6.2%), 1-year (17.4% vs. 7.0%) and longer term follow up (19.9% vs. 8.1%, log-rank test: p < 0.001). Similarly, females had higher incidence of ischemic stroke at in-hospital (2.6% vs. 1.0%), 1-year (3.6% vs. 1.4%) and in the longer-term (6.7% vs. 3.1%) as well (log-rank test: p < 0.001). Female gender remained an independent predictor of in-hospital cardiac mortality (HR 1.395, 95%CI 1.061-1.833, p=0.017) and on longer-term follow-up (HR 1.932 95%CI 1.212-3.080, p=0.006) even after adjusting for confounders. CONCLUSIONS Females were at higher risk of in-hospital and long-term cardiac mortality and ischemic stroke after PPCI for STEMI. Future studies are warranted to investigate the role of aggressive management of cardiovascular risk factors and follow-up to improve outcomes in the females with STEMI.
Collapse
Affiliation(s)
- Jinghao Nicholas Ngiam
- Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9 119228, Singapore.
| | - Elizabeth Hui-En Thong
- Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9 119228, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Koo Hui Chan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Hui Wen Sim
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| |
Collapse
|
5
|
Pascual I, Avanzas P, Almendárez M, Lorca R, Vigil-Escalera M, Arboine L, Alperi A, Adeba A, Díaz R, Silva J, Morís C, Hernández-Vaquero D. IAMCEST, angioplastia primaria y recuperación de la esperanza de vida: ideas procedentes del estudio SurviSTEMI. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2021; 41:1328-1336. [PMID: 31876924 DOI: 10.1093/eurheartj/ehz898] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.
Collapse
Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Judy Luu
- Division of Cardiology, Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg MB R3A, Manitoba, Canada
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Centre for Preclinical Research and Technology, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| |
Collapse
|
7
|
STEMI, primary percutaneous coronary intervention and recovering of life expectancy: insights from the SurviSTEMI study. ACTA ACUST UNITED AC 2020; 74:829-837. [PMID: 32978098 DOI: 10.1016/j.rec.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES In the last few decades, there has been a continuous process of improvement in medical treatment and secondary prevention measures after ST-segment elevation myocardial infarction (STEMI). Patients older than 65 years are at increased risk of death due to this event. Our aim was to determine whether patients aged less than 65 years and 65 years and older experiencing a STEMI can recover a life expectancy similar to that of the general population of the same age, sex, and geographical region. METHODS We included all patients experiencing a STEMI at our institution during a 6-year period in an observational-study (SurviSTEMI: survival in STEMI). We calculated their observed survival, expected survival, and excess mortality. We repeated all analyses for survivors of the acute event stratifying by 65 years. RESULTS For patients aged <65 years who survived the STEMI, observed survival at 3 and 5 years of follow-up was 97.68% (95%CI, 96.05%-98.64%) and 94.14% (95%CI, 90.89%-96.25%), respectively. Expected survival at 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52% (95%CI, 82.23%-88.24%) and 75.43% (95%CI, 70.26%-79.83%), respectively. Expected survival at 3 and 5 years was 86.48% and 76.56%, respectively. CONCLUSIONS For survivors of the acute event, life expectancy is fairly similar to that of the general population of the same age, sex, and geographical region.
Collapse
|
8
|
Lee MK, Hsu PC, Tsai WC, Chen YC, Lee HH, Lee WH, Chu CY, Lee CS, Yen HW, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Gender differences in major adverse cardiovascular outcomes among aged over 60 year-old patients with atherosclerotic cardiovascular disease: A population-based longitudinal study in Taiwan. Medicine (Baltimore) 2020; 99:e19912. [PMID: 32384435 PMCID: PMC7220184 DOI: 10.1097/md.0000000000019912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) including cerebrovascular disease (CVD), coronary artery disease (CAD), and peripheral arterial disease (PAD), contributes to the major causes of death in the world. Although several studies have evaluated the association between gender and major adverse cardiovascular outcomes in old ASCVD patients, the result is not consistent. Hence, we need a large-scale study to address this issue.This retrospective cohort study included aged over 60 year-old patients with a diagnosis of ASCVD, including CVD, CAD, or PAD, from the database contained in the Taiwan National Health Insurance Bureau during 2001 to 2004. The matched cohort was matched by age, comorbidities, and medical therapies at a 1:1 ratio. A total of 9696 patients were enrolled in this study, that is, there were 4848 and 4848 patients in the matched male and female groups, respectively. The study endpoints included acute myocardial infarction, hemorrhagic stroke, ischemic stroke, vascular procedures, in-hospital mortality, and so on. In multivariate Cox regression analysis in matched cohort, the adjusted hazard ratios (HRs) for female group in predicting acute myocardial infarction, hemorrhagic stroke, ischemic stroke, vascular procedures, and in-hospital mortality were 0.67 (P < .001), 0.73 (P = .0015), 0.78 (P < .001), 0.59 (P < .001), and 0.77 (P = .0007), respectively.In this population-based propensity matched cohort study, age over 60 year-old female patients with ASCVD were associated with lower rates of acute myocardial infarction, hemorrhagic stroke, ischemic stroke, vascular procedures, and in-hospital mortality than male patients. Further prospective studies may be investigated in Taiwan.
Collapse
Affiliation(s)
- Meng-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
| | - Hung-Hao Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| |
Collapse
|
9
|
Ajam T, Devaraj S, Fudim M, Ajam S, Soleimani T, Kamalesh M. Lower Post Myocardial Infarction Mortality Among Women Treated at Veterans Affairs Hospitals Compared to Men. Am J Med Sci 2020; 360:537-542. [PMID: 31982101 DOI: 10.1016/j.amjms.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is conflicting evidence about whether mortality after myocardial infarction is higher among women than among men. This study aimed to compare sex differences in post myocardial infarction mortality in the Veterans Affairs system, a setting where the predominant subjects are men. MATERIALS AND METHODS The Veterans Affairs Corporate Data Warehouse inpatient and laboratory chemistry databases were used to identify patients diagnosed with acute myocardial infarction from inpatient records from January 1st, 2005 to April 25th, 2015. Mortality data was obtained through the Veterans Affairs death registry. RESULTS A total of 130,241 patients were identified; 127,711 men (98%) and 2,530 women (2%). Men typically had more comorbidities including congestive heart failure (54% vs. 46%, P value < 0.001), diabetes mellitus (54% vs. 48%, P value < 0.001), and chronic kidney disease (39% vs. 28%, P value < 0.001). The peak troponin-I was significantly higher among men (16.0 vs. 10.7 ng/mL, P value = 0.03). The mean follow-up time was 1490.67 ± 8 days. After adjusting for differences in demographics and comorbidities, women had a significantly lower risk of mortality (hazard ration [HR]: 0.747, P value < 0.0001) as compared to men. CONCLUSIONS In a health care system where the predominant subjects are men, women had better short- and long-term survival than men after an acute myocardial infarction. Further investigation is warranted to determine the reasons behind the improved outcomes in women post myocardial infarction in the veteran population.
Collapse
Affiliation(s)
- Tarek Ajam
- Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri
| | - Srikant Devaraj
- Center of Business and Economics, Ball State University, Muncie, Indiana
| | - Marat Fudim
- Department of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
| | - Samer Ajam
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Tahereh Soleimani
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Masoor Kamalesh
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana; Department of Cardiovascular Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
| |
Collapse
|
10
|
Baji P, Bíró A. Adaptation or recovery after health shocks? Evidence using subjective and objective health measures. HEALTH ECONOMICS 2018; 27:850-864. [PMID: 29479772 DOI: 10.1002/hec.3644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 12/17/2017] [Accepted: 01/10/2018] [Indexed: 06/08/2023]
Abstract
In this paper, we analyse the effect of an onset of a health shock on subjective survival probability and compare it with objective survival probability and self-reported health measures. In particular, we are interested in whether expectations of people respond to health shocks and whether these follow the evolution of objective life expectations and self-reported health measures over time. Using longitudinal data from the Health and Retirement Study, we estimate fixed effects models of adaptation for the objective and subjective survival probabilities and for some self-reported health measures. The results show that after cancer diagnosis, conditional on surviving, both the objective and subjective longevity and self-reported health measures drift back to the before diagnosis trajectories. For stroke and heart attack, in spite of their persistent negative effect on survival, subjective life expectations and self-reported health measures seem to indicate only a transient effect of the health shock. The differences between the objective and subjective measures are in line with the concept of adaptation. We discuss the policy implications of our results.
Collapse
Affiliation(s)
- Petra Baji
- Corvinus University of Budapest, Budapest, Hungary
- CERGE-EI Fellow, Prague, Czech Republic
| | - Anikó Bíró
- The University of Edinburgh, Edinburgh, UK
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| |
Collapse
|
11
|
Vaccarino V, Sullivan S, Hammadah M, Wilmot K, Al Mheid I, Ramadan R, Elon L, Pimple PM, Garcia EV, Nye J, Shah AJ, Alkhoder A, Levantsevych O, Gay H, Obideen M, Huang M, Lewis TT, Bremner JD, Quyyumi AA, Raggi P. Mental Stress-Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms. Circulation 2018; 137:794-805. [PMID: 29459465 PMCID: PMC5822741 DOI: 10.1161/circulationaha.117.030849] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/19/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is frequent in patients with coronary artery disease and is associated with worse prognosis. Young women with a previous myocardial infarction (MI), a group with unexplained higher mortality than men of comparable age, have shown elevated rates of MSIMI, but the mechanisms are unknown. METHODS We studied 306 patients (150 women and 156 men) ≤61 years of age who were hospitalized for MI in the previous 8 months and 112 community controls (58 women and 54 men) frequency matched for sex and age to the patients with MI. Endothelium-dependent flow-mediated dilation and microvascular reactivity (reactive hyperemia index) were measured at rest and 30 minutes after mental stress. The digital vasomotor response to mental stress was assessed using peripheral arterial tonometry. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental (speech task) and conventional (exercise/pharmacological) stress. RESULTS The mean age of the sample was 50 years (range, 22-61). In the MI group but not among controls, women had a more adverse socioeconomic and psychosocial profile than men. There were no sex differences in cardiovascular risk factors, and among patients with MI, clinical severity tended to be lower in women. Women in both groups showed a higher peripheral arterial tonometry ratio during mental stress but a lower reactive hyperemia index after mental stress, indicating enhanced microvascular dysfunction after stress. There were no sex differences in flow-mediated dilation changes with mental stress. The rate of MSIMI was twice as high in women as in men (22% versus 11%, P=0.009), and ischemia with conventional stress was similarly elevated (31% versus 16%, P=0.002). Psychosocial and clinical risk factors did not explain sex differences in inducible ischemia. Although vascular responses to mental stress (peripheral arterial tonometry ratio and reactive hyperemia index) also did not explain sex differences in MSIMI, they were predictive of MSIMI in women only. CONCLUSIONS Young women after MI have a 2-fold likelihood of developing MSIMI compared with men and a similar increase in conventional stress ischemia. Microvascular dysfunction and peripheral vasoconstriction with mental stress are implicated in MSIMI among women but not among men, perhaps reflecting women's proclivity toward ischemia because of microcirculatory abnormalities.
Collapse
Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Samaah Sullivan
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
| | - Muhammad Hammadah
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Ibhar Al Mheid
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics (L.E.), Rollins School of Public, Emory University, Atlanta, GA
| | - Pratik M Pimple
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
| | | | | | - Amit J Shah
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
- Atlanta VA Medical Center, Decatur (A.J.S., J.D.B.)
| | - Ayman Alkhoder
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Oleksiy Levantsevych
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Hawkins Gay
- Northwestern University Medical Center, Chicago, IL (H.G.)
| | - Malik Obideen
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
| | - Minxuan Huang
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
| | - Tené T Lewis
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur (A.J.S., J.D.B.)
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology (V.V., M.H., K.W., I.A.M., R.R., A.J.S., A.A., O.L., A.A.Q.)
| | - Paolo Raggi
- Department of Epidemiology (V.V., S.S., P.M.P., A.J.S., M.O., M.H., T.T.L., P.R.)
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| |
Collapse
|
12
|
Abstract
Women live longer than men in nearly all populations today. Some research focuses on the biological origins of the female advantage; other research stresses the significance of social factors. We studied male–female survival differences in populations of slaves and populations exposed to severe famines and epidemics. We find that even when mortality was very high, women lived longer on average than men. Most of the female advantage was due to differences in mortality among infants: baby girls were able to survive harsh conditions better than baby boys. These results support the view that the female survival advantage is modulated by a complex interaction of biological environmental and social factors. Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors.
Collapse
|
13
|
|
14
|
Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017; 17:53. [PMID: 28173750 PMCID: PMC5297173 DOI: 10.1186/s12872-017-0482-9] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/23/2017] [Indexed: 12/18/2022] Open
Abstract
Background Most studies of outcomes after myocardial infarction (MI) focus on the acute phase after the index event. We assessed mortality and morbidity trends after the first year in survivors of acute MI, by conducting a systematic literature review. Methods Literature searches were conducted in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify epidemiological studies of long-term (>10 years) mortality and morbidity trends in individuals who had experienced an acute MI more than 1 year previously. Results Thirteen articles met the inclusion criteria. Secular trends showed a consistent decrease in mortality and morbidity after acute MI from early to more recent study periods. The relative risk for all-cause death and cardiovascular outcomes (recurrent MI, cardiovascular death) was at least 30% higher than that in a general reference population at both 1–3 years and 3–5 years after MI. Risk factors leading to worse outcomes after MI included comorbid diabetes, hypertension and peripheral artery disease, older age, reduced renal function, and history of stroke. Conclusions There have been consistent improvements in secular trends for long-term survival and cardiovascular outcomes after MI. However, MI survivors remain at higher risk than the general population, particularly when additional risk factors such as diabetes, hypertension, or older age are present.
Collapse
Affiliation(s)
- Saga Johansson
- AstraZeneca Gothenburg, Pepparedsleden 1, S-431 83, Mölndal, Sweden.
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kate Young
- Research Evaluation Unit, Oxford PharmaGenesis, 503 Washington Ave, Newtown, PA, 18940, USA
| | - Em Jennings
- AstraZeneca R&D, 132 Hills Rd, Cambridge, CB2 1PG, UK
| |
Collapse
|
15
|
Tan YC, Sinclair H, Ghoorah K, Teoh X, Mehran R, Kunadian V. Gender differences in outcomes in patients with acute coronary syndrome in the current era: A review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:51-60. [PMID: 26450783 DOI: 10.1177/2048872615610886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Coronary heart disease is the most common cause of death worldwide. In the United Kingdom in 2010, over 80,000 deaths were attributed to coronary heart disease, and one in 10 female deaths were due to coronary heart disease. Acute coronary syndrome, a subset of coronary heart disease, was responsible for 175,000 inpatient admissions in the United Kingdom in 2012. While men have traditionally been considered to be at higher risk of acute coronary syndrome, various studies have demonstrated that women often suffer from poorer outcomes following an adverse cardiovascular event. This gap is gradually narrowing with the introduction of advanced interventional strategies and pharmacotherapy. However, a better understanding of these differences is of crucial importance for the improvement of the pharmacological and interventional management of acute coronary syndrome and for the development of possible new gender-specific diagnostic and therapeutic options. The goals of this review are to evaluate gender differences in outcomes in patients with acute coronary syndrome in the current era and identify potential mechanisms behind these differences in outcomes following percutaneous coronary intervention.
Collapse
Affiliation(s)
- Ying C Tan
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | - Hannah Sinclair
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Kuldeepa Ghoorah
- 2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Xuyan Teoh
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Vijay Kunadian
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| |
Collapse
|
16
|
Schmidt M, Szépligeti S, Horváth-Puhó E, Pedersen L, Bøtker HE, Sørensen HT. Long-Term Survival Among Patients With Myocardial Infarction Before Age 50 Compared With the General Population: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes 2016; 9:523-31. [PMID: 27576336 DOI: 10.1161/circoutcomes.115.002661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/30/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The long-term prognosis for young myocardial infarction (MI) survivors remains poorly understood. METHODS AND RESULTS We conducted a nationwide population-based cohort study using prospectively collected medical data from all hospitals in Denmark during 1980 to 2009. We examined 30-year cause-specific death rates among 21 693 MI patients <50 years versus 216 930 sex- and age-matched people from the general population. We calculated mortality rate ratios (MRRs) based on Cox regression. Between 1980 to 1989 and 2000 to 2009, MI mortality declined from 12.5% to 3.2% within 30 days, 5.1% to 1.6% within 31 to 365 days, and 24.2% to 8.9% within 1 to 10 years. Compared with the general population, the MRR adjusted for sex, age, and cardiovascular and noncardiovascular comorbidity decreased 4.5-fold within 30 days (from 468 to 97), 3-fold within 31 to 365 days (from 11.32 to 3.70), and 2.5-fold within 1 to 10 years (from 4.77 to 1.89). The remaining 1.89-fold increased mortality rate among 1-year survivors in 2000 to 2009 corresponded to 6 additional deaths each year per 1000 patients compared with the general population. Long-term causes of death were primarily because of cardiovascular and chronic pulmonary diseases. The excess 10-year MRR among 1-year survivors was consistent within MI subtypes, did not differ substantially between comorbidity categories, but was higher for women than men (3-fold versus 1.7-fold). CONCLUSIONS The long-term mortality rate after MI before age 50 has decreased remarkably over the last 3 decades, but remains increased relative to the general population, mainly because of deaths from ischemic heart disease and other smoking-related diseases.
Collapse
Affiliation(s)
- Morten Schmidt
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.).
| | - Szimonetta Szépligeti
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Erzsébet Horváth-Puhó
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Lars Pedersen
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Hans Erik Bøtker
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Henrik Toft Sørensen
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| |
Collapse
|
17
|
|
18
|
Gjesdal K. Hjerteinfarkt før og nå – et 50 års perspektiv. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:833-6. [DOI: 10.4045/tidsskr.15.0852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
19
|
Chen Y, Zhang Y, Zhao G, Chen C, Yang P, Ye S, Tan X. Difference in Leukocyte Composition between Women before and after Menopausal Age, and Distinct Sexual Dimorphism. PLoS One 2016; 11:e0162953. [PMID: 27657912 PMCID: PMC5033487 DOI: 10.1371/journal.pone.0162953] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/31/2016] [Indexed: 02/05/2023] Open
Abstract
There are sex differences in many inflammatory and immune diseases, and the differences tend to diminish after menopause. The underlying reasons are unclear, but sex hormone levels are likely to be an important factor. Blood leukocyte count and composition provide an indicator of the inflammatory and immune status of an individual. We performed a cross-sectional analysis of blood leukocyte data from 46,879 individuals (26,212 men and 20,667 women, aged 18 to 93 years) who underwent a routine health checkup. In women aged around 50 years, neutrophil percentage (NE%) dropped whilst lymphocyte percentage (LY%) rose. Accordingly, women before age 50 had significantly higher NE%, lower LY%, and higher neutrophil-to-lymphocyte ratio (NLR) than women of 51-70 years of age (p = 1.35×10-82, p = 5.32×10-100, and p = 1.25×10-26, respectively). In age groups of <50 years, women had higher NE%, lower LY% and higher NLR than men (p = 1.82×10-206, p = 1.46×10-69, and p = 2.30×10-118, respectively), whereas in age groups of >51 years, it was the reverse (p = 1.92×10-15, p = 1.43×10-84, and p = 1.51×10-48, respectively). These results show that blood leukocyte composition differs between women before and after menopausal age, with distinct sexual dimorphism.
Collapse
Affiliation(s)
- Yequn Chen
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | | | - Guojun Zhao
- Shantou University Medical College, Shantou, China
| | - Chang Chen
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peixuan Yang
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shu Ye
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, China
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Biomedical Research Centre in Cardiovascular Disease, Leicester, United Kingdom
- * E-mail: (XT); (SY)
| | - Xuerui Tan
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
- * E-mail: (XT); (SY)
| |
Collapse
|
20
|
Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2015; 108:428-36. [DOI: 10.1016/j.acvd.2015.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 12/19/2022]
|
21
|
Redfors B, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Dworeck C, Odenstedt J, Ioaness D, Ravn-Fischer A, Wellin P, Sjöland H, Tokgozoglu L, Tygesen H, Frick E, Roupe R, Albertsson P, Omerovic E. Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). J Am Heart Assoc 2015; 4:JAHA.115.001995. [PMID: 26175358 PMCID: PMC4608084 DOI: 10.1161/jaha.115.001995] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender-specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. METHODS AND RESULTS We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web-System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age-adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST-segment elevation MI. Compared with men, younger women and women with ST-segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P<0.001) and were less likely to be prescribed evidence-based treatment at discharge (P<0.001 for β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y12 antagonists). Differences in treatment between the genders did not decrease over the study period (P>0.1 for all treatments). CONCLUSIONS Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment.
Collapse
Affiliation(s)
- Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Dan Ioaness
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Annika Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Peder Wellin
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Helen Sjöland
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Hospital, Ankara, Turkey (L.T.)
| | - Hans Tygesen
- Department of Cardiology, Södra Älvsborgs Sjukhus, Borås, Sweden (H.T.)
| | - Erik Frick
- Department of Cardiology, Skaraborg Hospital, Skövde, Sweden (E.F.)
| | - Rickard Roupe
- Department of Cardiology, Allingsås Hospital, Allingsås, Sweden (R.R.)
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| |
Collapse
|
22
|
Shigematsu K, Watanabe Y, Nakano H. Lower hazard ratio for death in women with cerebral hemorrhage. Acta Neurol Scand 2015; 132:59-64. [PMID: 25643895 DOI: 10.1111/ane.12359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to clarify the hazard ratio for death within 30 days after stroke comparing women to men. MATERIAL AND METHODS We reviewed all stroke patients registered in the Kyoto Stroke Registry (from January 1999 to December 2009) in Japan. Hazard ratio (HR) for death and 95% confidence interval were calculated by the Cox regression in stroke and in each stroke subtype: cerebral infarction (CI), cerebral hemorrhage, (CH) and subarachnoid hemorrhage (SAH). We also evaluated HR for death in women in each consciousness level at the onset of stroke: the Japan Coma Scale (JCS) 0 (alert), JCS 1-digit code (disoriented but awake), JCS 2-digit code (arousable with stimulation), and JCS 3-digit code (unarousable). RESULTS A total of 13,788 patients were analyzed. HR for death comparing women to men were 1.04 (0.88-1.23, P = 0.66 in stroke as a whole), 0.91 (0.69-1.21, P = 0.51 in CI), 0.53 (0.41-0.71, P < 0.01 in CH), and 0.89 (0.60-1.30, P = 0.535 in SAH) after adjustment for age and histories of hypertension, arrhythmia, diabetes mellitus and hyperlipemia and uses of tobacco and alcohol. Stratified by JCS, HR for death in women with CH were 0.32 (0.11-0.94 in JCS0), 0.48 (0.28-0.82 in JCS1), 0.49 (0.28-0.83 in JCS2), and 0.79 (0.65-0.97 in JCS3), respectively. HR for death in women with CI in JCS3 was significantly lower than in men (0.71; 0.52-0.98). CONCLUSION We evaluated HR for death comparing men to women in stroke and in each stroke subtype. Women with CH had lower HR for death within 30 days after stroke than men.
Collapse
Affiliation(s)
- K. Shigematsu
- Department of Neurology; National Hospital Organization; Minami Kyoto Hospital; Kyoto Japan
| | - Y. Watanabe
- Department of Epidemiology for Community Health and Medicine; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - H. Nakano
- Department of Neurosurgery; Kyoto Kidugawa Hospital; Kyoto Japan
| | | |
Collapse
|
23
|
Nedkoff L, Atkins E, Knuiman M, Sanfilippo FM, Rankin J, Hung J. Age-specific gender differences in long-term recurrence and mortality following incident myocardial infarction: a population-based study. Heart Lung Circ 2015; 24:442-9. [PMID: 25618449 DOI: 10.1016/j.hlc.2014.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/23/2014] [Accepted: 11/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Higher mortality following myocardial infarction (MI) is reported in women compared with men with short-term follow-up. Our study aim was to compare long-term gender- and age-specific outcomes following incident MI. METHODS 30-day survivors of incident MI from 2003-2009 were identified from linked administrative data in Western Australia. Outcomes identified were recurrent MI, and cardiovascular and all-cause mortality. Follow-up data was available until 30(th) June 2011. Unadjusted risk out to eight-years was estimated from Kaplan-Meier survival curves, and multivariate Cox regression models were used to estimate relative risk in women compared with men by age group. RESULTS There were 12,420 30-day survivors of incident MI from 2003-2009 (males 71.2%). Women had higher levels of comorbidities across all age groups compared with men. Unadjusted event risks were higher in women than men overall, underpinned by higher risk of recurrent MI in 55-69 year-old women and of cardiovascular mortality across all age groups in women. Gender differences were generally attenuated after adjustment for demographic factors and comorbidities. CONCLUSIONS This study highlights the elevated risk of cardiovascular events in women compared with men with long-term follow-up, and demonstrates the need for improved long-term secondary prevention in this patient group.
Collapse
Affiliation(s)
- Lee Nedkoff
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009.
| | - Emily Atkins
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Jamie Rankin
- Cardiology Department, Royal Perth Hospital, Perth, Western Australia, 6000
| | - Joseph Hung
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009; School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, 6009
| |
Collapse
|