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Ebong IA, Quesada O, Fonkoue IT, Mattina D, Sullivan S, Oliveira GMMD, Spikes T, Sharma J, Commodore Y, Ogunniyi MO, Aggarwal NR, Vaccarino V. The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:298-314. [PMID: 38986672 DOI: 10.1016/j.jacc.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 07/12/2024]
Abstract
Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.
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Affiliation(s)
- Imo A Ebong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California, USA.
| | - Odayme Quesada
- Women's Heart Center, Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; Carl and Edyth Lindner Center for Research and Education, Christ Hospital, Cincinnati, Ohio, USA
| | - Ida T Fonkoue
- Divisions of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Deirdre Mattina
- Division of Regional Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samaah Sullivan
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center-Houston, Houston, Texas, USA
| | | | - Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Yvonne Commodore
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Angarita-Fonseca A, Peebles A, Pilote L. Gender-Related Factors Associated With Outcomes of Acute Coronary Syndrome in Young Female Patients. CJC Open 2024; 6:370-379. [PMID: 38487050 PMCID: PMC10935682 DOI: 10.1016/j.cjco.2023.11.019] [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: 09/01/2023] [Accepted: 11/28/2023] [Indexed: 03/17/2024] Open
Abstract
Acute coronary syndrome (ACS) remains a significant global health concern, with a growing recognition of its impact on young adults, particularly young female adults. Although gender-related factors, defined as a social construct that encompasses 4 distinct dimensions (gender roles, gender identity, gender relations, and institutionalized gender) are undoubtedly relevant across age groups, young female patients with ACS face specific challenges and disparities in outcomes, compared to other populations. This narrative review examines the role of gender-related factors-specifically, gender roles, gender identity, gender relations, and institutionalized gender-in influencing objective and subjective ACS outcomes in young female patients. In the 5 articles identified, the objective outcomes included hospital readmission, "door-to-electrocardiography" time, and coronary atherosclerosis progression. Subjective outcomes, such as physical and mental functional status, quality of life, physical limitations, and vital exhaustion, were also examined. Being employed, which is a gender role, emerged as a protective factor against hospital readmission. Gender identity factors such as depression and stress were correlated with negative outcomes, and anxiety influenced "door-to-electrocardiography" times. Institutional factors, including income disparities, affected readmission likelihood. Strong social support decreased physical limitations post-ACS, whereas financial challenges and lower education negatively impacted quality of life and vital exhaustion. These findings underscore the intricate interplay of gender dimensions in shaping ACS outcomes among young female patients. Integrating these insights into clinical practice and research can enhance care, mitigate disparities, and foster improved cardiovascular health in this vulnerable population.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra Peebles
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Pilote
- Research Institute of the McGill University Health Centre and Department of Medicine, McGill University, Montreal, Quebec, Canada
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Siagian SN, Christianto C. A young woman with acute coronary syndrome and antiphospholipid syndrome. Is it the antiphospholipid syndrome or COVID-19 vaccination or classical risk as the risk factor? a case report. J Med Case Rep 2024; 18:47. [PMID: 38238833 PMCID: PMC10797992 DOI: 10.1186/s13256-023-04314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) in young women is poorly understood due to underdiagnosis and undertreatment. One of the possible risk factors for ACS in young women is antiphospholipid syndrome (APS). Coronavirus disease 2019 (COVID-19) vaccination also emerged as one of the possible risk factors for ACS during the COVID-19 pandemic. CASE PRESENTATION Our patient, a 39-year-old Batak woman with dyslipidemia and family history of cardiovascular disease, experienced chest pain slightly improved at rest accompanied by autonomic symptoms. She was diagnosed with non-ST-elevation myocardial infarction (NSTEMI) based on her clinical features, dynamic electrocardiogram changes, troponin elevation, and multislice computed tomography angiography confirmed with diagnostic catheterization. The patient was managed by percutaneous coronary intervention with implantation of drug-eluting stents. On follow-up, the patient was diagnosed with APS based on history of preeclampsia with severe features in the first and third pregnancy, spontaneous abortion in the second pregnancy, history of transient ischemic attack, moderately positive lupus anticoagulant on two occasions with an interval of 12 weeks, and ACS. Further investigation revealed a history of COVID-19 vaccination with Sinovac four and six weeks before presentation. The patient was recommended for lifelong warfarin and short-term dual antiplatelet (aspirin and ticagrelor). CONCLUSIONS Young women are not completely immune to ACS as evident in this case of ACS in a young woman with classical risk factors (dyslipidemia and family history of cardiovascular disease) and APS. Further studies are required to fill the knowledge gap on whether COVID-19 vaccination had any contribution to the ACS in the young woman.
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Affiliation(s)
- Sisca Natalia Siagian
- Pediatric Cardiology and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Zhang X, Wang X, Xu L, Liu J, Ren P, Wu H. The predictive value of machine learning for mortality risk in patients with acute coronary syndromes: a systematic review and meta-analysis. Eur J Med Res 2023; 28:451. [PMID: 37864271 PMCID: PMC10588162 DOI: 10.1186/s40001-023-01027-4] [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: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Acute coronary syndromes (ACS) are the leading cause of global death. Optimizing mortality risk prediction and early identification of high-risk patients is essential for developing targeted prevention strategies. Many researchers have built machine learning (ML) models to predict the mortality risk in ACS patients. Our meta-analysis aimed to evaluate the predictive value of various ML models in predicting death in ACS patients at different times. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database establishment to March 12, 2022 for studies developing or validating at least one ML predictive model for death in ACS patients. We used PROBAST to assess the risk of bias in the reported predictive models and a random-effects model to assess the pooled C-index and accuracy of these models. RESULTS Fifty papers were included, involving 216 ML prediction models, 119 of which were externally validated. The combined C-index of the ML models in the validation cohort predicting the in-hospital mortality, 30-day mortality, 3- or 6-month mortality, and 1 year or above mortality in ACS patients were 0.8633 (95% CI 0.8467-0.8802), 0.8296 (95% CI 0.8134-0.8462), 0.8205 (95% CI 0.7881-0.8541), and 0.8197 (95% CI 0.8042-0.8354), respectively, with the corresponding combined accuracy of 0.8569 (95% CI 0.8411-0.8715), 0.8282 (95% CI 0.7922-0.8591), 0.7303 (95% CI 0.7184-0.7418), and 0.7837 (95% CI 0.7455-0.8175), indicating that the ML models were relatively excellent in predicting ACS mortality at different times. Furthermore, common predictors of death in ML models included age, sex, systolic blood pressure, serum creatinine, Killip class, heart rate, diastolic blood pressure, blood glucose, and hemoglobin. CONCLUSIONS The ML models had excellent predictive power for mortality in ACS, and the methodologies may need to be addressed before they can be used in clinical practice.
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Affiliation(s)
- Xiaoxiao Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xi Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luxin Xu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peng Ren
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Huanlin Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Liu R, Xu F, Zhou Y, Liu T, Wu X. Effect of diabetes mellitus on young female patients with acute coronary syndrome. Diabetes Res Clin Pract 2023; 204:110904. [PMID: 37708978 DOI: 10.1016/j.diabres.2023.110904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the most important risk factors of acute coronary syndrome (ACS). There have been many studies on the relationship between DM and ACS. However, the effect of DM on young females with ACS is still unclear. OBJECTIVE To explore the effect of DM on coronary arteries lesions in young females with ACS. METHODS 1278 young females (age ≤ 44 years) undergoing coronary angiography were divided into DM group (n = 197) and control group (n = 1081) according to whether they had diabetes. Based on whether the patient has ACS, each group was further divided into DM-ACS subgroup and Non-DM-ACS subgroup to compare the characteristics and severity of coronary artery lesions and follow-up outcomes. RESULTS The prevalence of diabetes was 15.41% (197/1278). Overweight (58.88%) and depression or anxiety (11.17%) in the DM group was significantly higher than those (32.22% and 6.20%) in the control group (P < 0.05). The prevalence of ACS (85.28%) in the DM group was significantly higher than that (25.35%) in the control group (P < 0.05). The proportion of type A lesions in the DM-ACS subgroup was lesser than that in the Non-DM-ACS subgroup (P < 0.05). The type C lesions in the DM-ACS subgroup were significantly higher than that in the Non-DM-ACS subgroup (P < 0.01). The number of stents implantation in the DM-ACS subgroup was no significant difference compared with the Non-DM-subgroup (P > 0.05). The length of stent implantation in the DM-ACS subgroup was significantly longer than that in the Non-DM-ACS subgroup (P < 0.05). The rate of MACE was not statistically significant between the two subgroups (P > 0.05), but the rate of all-cause death (2.98%) in the DM-ACS subgroup was significantly higher than that (0.36%) in the Non-DM-ACS subgroup (P < 0.05). CONCLUSIONS DM is an important risk factor in young females with ACS. Young women with diabetes are prone to coronary heart disease. The coronary artery lesions in DM patients were more severe than those in Non-DM patients, despite the protective effect of estrogen on the cardiovascular system. Therefore, young women with DM should be treated to prevent ACS and future events activelyandpurposefully.
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Affiliation(s)
- Ruifang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fangxing Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tongku Liu
- The Center of Cardiology, Affiliated Hospital of Beihua University, Jilin, Jilin 132011, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
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Yim S, Ahn JH, Jeong MH, Ahn Y, Kim JH, Hong YJ, Sim DS, Kim MC, Cho KH, Lee SH, Hyun DY. Impact of sex difference on clinical outcomes in acute myocardial infarction patients with single-vessel and multi-vessel disease: based on Korea Acute Myocardial Infarction Registry-National Institute of Health. Cardiovasc Diagn Ther 2023; 13:660-672. [PMID: 37675088 PMCID: PMC10478015 DOI: 10.21037/cdt-22-536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/17/2023] [Indexed: 09/08/2023]
Abstract
Background Several studies have compared clinical outcomes according to sex in patients with acute myocardial infarction (AMI). However, studies evaluating sex differences in clinical outcomes of single-vessel disease (SVD) and multi-vessel disease (MVD) in Korean patients with AMI are lacking. Therefore, this study aimed to analyze sex differences in the clinical characteristics of patients with AMI with SVD and MVD and to evaluate the impact of sex differences on the clinical outcomes in patients with AMI with SVD and MVD. Methods A total of 11,002 AMI patients from November 2011 to June 2015 in the Korea AMI Registry, National Institute of Health, were enrolled. The current study was retrospective observational study. Patients were divided into SVD (n=5,644) and MVD (n=5,358) groups, and clinical impact of sex difference were analyzed by propensity score matching analysis and Cox proportional hazard regression model. Results Women were older and had poor baseline clinical characteristics than men. Propensity score-matched analysis of men and women with SVD and MVD revealed that the adjusted 3-year risk of major adverse cardiac event (MACE) (15.0% vs. 9.4%; hazard ratio, 1.86; 95% confidence interval, 1.10-3.13; P=0.020) was higher in women with SVD aged <65 years. However, the incidence and risk of MACE were similar for men and women with MVD, and those with SVD aged ≥65 years. Conclusions In the present study of Korean patients with AMI, women were older and exhibited a higher prevalence of comorbidities than men. Women with SVD aged <65 years had a significantly higher risk of MACE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Seung Hun Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | | | - other KAMIR-NIH Investigator
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Weizman O, Tea V, Marijon E, Eltchaninoff H, Manzo-Silberman S, Leclercq F, Albert F, Bataille V, Drouet E, Naccache N, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Very long-term outcomes after acute myocardial infarction in young men and women: Insights from the FAST-MI program. Arch Cardiovasc Dis 2023; 116:324-334. [PMID: 37391340 DOI: 10.1016/j.acvd.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
AIMS Conflicting data exists about long-term outcomes in young women and men experiencing acute myocardial infarction (AMI). METHODS The FAST-MI program consists of three nationwide French surveys carried out 5years apart from 2005 to 2015, including consecutive patients with AMI over a 1-month period with up to 10-year follow-up. The present analysis focused on adults≤50 yo according to their gender. RESULTS Women accounted for 17.5% (335) of the 1912 patients under 50 yo and had a similar age as men (43.9±5.1 vs. 43.9±5.5years, P=0.92). They received less percutaneous coronary interventions (PCI) than men (85.9% vs. 91.3%, P=0.005), even in ST-elevation myocardial infarction (83.6% vs. 93.5%, P<0.001). Recommended secondary prevention medications were less frequently prescribed at discharge in women (40.6% vs. 52.8%, P<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, P<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.3%) (crude HR: 0.86 [95% CI: 0.55-1.35], P=0.52, adjusted HR: 0.63 [95% CI: 0.38-1.07], P=0.09); similar results were found for ten-year survival among hospital survivors (91.2% in men vs. 93.7% in women, adjusted HR: 0.87 [95% CI: 0.45-1.66], P=0.66). Of the 1684 patients alive at hospital discharge with morbidity follow-up≥6months available, death, AMI or stroke at 8years occurred in 12.9% men and 11.2% in women (adjusted HR: 0.90 [95% CI: 0.60-1.33], P=0.59). CONCLUSIONS Young women with AMI undergo less cardiac interventions and are less often prescribed secondary prevention treatment than men, even when significant coronary artery disease is present, but keep a similar long-term prognosis after AMI. Optimal management of these young patients, regardless of gender, is necessary to ensure best outcomes after this major cardiovascular event.
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Affiliation(s)
- Orianne Weizman
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Victoria Tea
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Hélène Eltchaninoff
- Normandie Université, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - Stéphane Manzo-Silberman
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne Université, ACTION Study Group, Paris, France
| | - Florence Leclercq
- Centre Hospitalier Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | | | - Vincent Bataille
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | | | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Jean Ferrières
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - François Schiele
- University Hospital Jean-Minjoz, Department of Cardiology, Besançon, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France.
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Dreyer RP, Arakaki A, Raparelli V, Murphy TE, Tsang SW, D’Onofrio G, Wood M, Wright CX, Pilote L. Young Women With Acute Myocardial Infarction: Risk Prediction Model for 1-Year Hospital Readmission. CJC Open 2023; 5:335-344. [PMID: 37377522 PMCID: PMC10290947 DOI: 10.1016/j.cjco.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background Although young women ( aged ≤ 55 years) are at higher risk than similarly aged men for hospital readmission within 1 year after an acute myocardial infarction (AMI), no risk prediction models have been developed for them. The present study developed and internally validated a risk prediction model of 1-year post-AMI hospital readmission among young women that considered demographic, clinical, and gender-related variables. Methods We used data from the US Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study (n = 2007 women), a prospective observational study of young patients hospitalized with AMI. Bayesian model averaging was used for model selection and bootstrapping for internal validation. Model calibration and discrimination were respectively assessed with calibration plots and area under the curve. Results Within 1-year post-AMI, 684 women (34.1%) were readmitted to the hospital at least once. The final model predictors included: any in-hospital complication, baseline perceived physical health, obstructive coronary artery disease, diabetes, history of congestive heart failure, low income ( < $30,000 US), depressive symptoms, length of hospital stay, and race (White vs Black). Of the 9 retained predictors, 3 were gender-related. The model was well calibrated and exhibited modest discrimination (area under the curve = 0.66). Conclusions Our female-specific risk model was developed and internally validated in a cohort of young female patients hospitalized with AMI and can be used to predict risk of readmission. Whereas clinical factors were the strongest predictors, the model included several gender-related variables (ie, perceived physical health, depression, income level). However, discrimination was modest, indicating that other unmeasured factors contribute to variability in hospital readmission risk among younger women.
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Affiliation(s)
- Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Health Informatics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Andrew Arakaki
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Nursing, University of Alberta, Edmonton, Alberta, Canada
- University Centre for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Terrence E. Murphy
- Program on Aging, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sui W. Tsang
- Program on Aging, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Malissa Wood
- Massachusetts General Hospital Heart Centre, Boston, Massachusetts, USA
- Harvard School of Medicine, Boston, Massachusetts, USA
| | - Catherine X. Wright
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of Clinical Epidemiology McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Gulanski BI, Butera NM, Krause-Steinrauf H, Lichtman JH, Harindhanavudhi T, Green JB, Suratt CE, AbouAssi H, Desouza C, Ahmann AJ, Wexler DJ, Aroda VR. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 2023; 11:e003159. [PMID: 37094945 PMCID: PMC10151943 DOI: 10.1136/bmjdrc-2022-003159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. RESULTS Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. CONCLUSIONS This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01794143).
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Section of Endocrinology, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nicole M Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Health, Minneapolis, Minnesota, USA
| | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Colleen E Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew J Ahmann
- Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
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Chen Y, Weng C, Wu J, Tang Y, Li Z, Wen Q, Sun X, Wu M, Peng Z, Luo X, Yuan H, Lu Y, Huang W, Cai J. Clinical characteristics and prognosis differences between isolated right and left ventricular myocardial infarction in the Chinese population: a retrospective study. PeerJ 2023; 11:e14959. [PMID: 36874976 PMCID: PMC9983429 DOI: 10.7717/peerj.14959] [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] [Received: 12/13/2022] [Accepted: 02/05/2023] [Indexed: 03/04/2023] Open
Abstract
Background and aims Acute myocardial infarction (AMI) is divided into left ventricular myocardial infarction (LVMI) and right ventricular myocardial infarction (RVMI) according to the regions of myocardial ischemic necrosis. Clinical characteristics, treatment strategies, and prognosis differences between isolated RVMI and LVMI have not been well characterized. This study aimed to explore this difference of patients with isolated RVMI and LVMI. Methods This retrospective cohort study included 3,506 patients hospitalized with coronary angiography diagnosed type 1 myocardial infarction (MI). Characteristics of admission and treatment strategies were compared in patients with isolated RVMI and LVMI. COX proportional hazards models with and without inverse probability of treatment weighting (IPTW) adjustment were performed to estimate the difference in all-cause and cardiovascular mortality between the two groups. Results In this retrospective study, we found the frequency of isolated RVMI was significantly lower in the population than that of isolated LVMI (406 (11.6%) vs 3,100 (88.4%)). Patients with isolated RVMI have similar age, sex, and comorbidities to the patients with isolated LVMI. However, patients with isolated RVMI have lower heart rate and blood pressure, but higher rates of cardiogenic shock and atrioventricular block. It is noteworthy that patients with isolated RVMI are more likely to be complicated with the multivessel lesion. Patients with isolated RVMI have lower risk of all-cause mortality (HR 0.36; 95% CI [0.24-0.54], p < 0.001) and cardiovascular mortality (HR 0.37; 95% CI [0.22-0.62], p < 0.001) than patients with isolated LVMI. Conclusions This study showed that patients with isolated RVMI and LVMI have similar baseline characteristics. However, the clinical manifestations were different in the isolated RVMI and LVMI patients. This study revealed a better prognosis of isolated RVMI patients compared to isolated LVMI, which indicates the ischemic region could be considered in AMI risk stratification models for better assessment of risk for adverse clinical events.
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Affiliation(s)
- Yuanyuan Chen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunyan Weng
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junru Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhengxin Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Wen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Zhiliu Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Xiying Luo
- Department of Cardiology, The First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Hong Yuan
- The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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11
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Sommer OJ, Hergan K. Cardiovascular Disease in Women: What the Radiologist Needs to Know. ROFO-FORTSCHR RONTG 2022; 195:309-318. [PMID: 36577431 DOI: 10.1055/a-1966-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sex-specific disparities are well documented for cardiovascular disease (CVD). There are differences in physiology and pathophysiology, pain perception, spectrum of disease, risk, therapeutic aspects, prognosis, and outcome. CVD represents a broad spectrum of disorders. This review focuses on cardiovascular and cardiac pathology. METHOD This review summarizes the current state of the literature on cardiovascular disease in women from a radiological viewpoint. It aims to provide a deeper understanding of these differences and thereby alerts the reader to the potential of CT and MRI for diagnosing CVD in women. Special attention is paid to disparities in the underlying physiological and pathophysiological processes, clinical presentation, and the quality of care to provide a deep understanding of the topic. Cardiovascular and cardiac pathologies with a sex-specific pattern of disease are presented and typical CT and MRI findings are arranged and illustrated with imaging findings. RESULTS AND CONCLUSION Sex-specific differences are not only sex hormonal in nature but are rooted in the epigenome and encompass a multitude of physiological systems. In fact, cardiovascular disease shows sex-specific characteristics spanning from incidence to clinical presentation, course of disease, and prognosis. This is of significance regarding pretest probabilities, the power of tests, imaging strategies, and interpretation of imaging results. Key sex-specific issues encompass obstructive and non-obstructive coronary artery disease (CAD), microvascular angina, myocardial infarction with non-obstructive CAD, and coronary artery dissection. Sex-specific patterns are also noted in myocardial disease and heart failure such as pregnancy-related heart disease, Takotsubo syndrome, and anthracycline-induced cardiotoxicity. KEY POINTS · Cardiovascular diseases have sex-specific characteristics.. · Imaging strategies and interpretation of imaging results should be adjusted for women.. · Imaging helps in the improvement of the sex-specific management of cardiovascular disease..
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Affiliation(s)
- Oliver Josef Sommer
- Institute of Radiology, Kardinal Schwarzenberg Hospital, Schwarzach im Pongau, Austria
| | - Klaus Hergan
- University Institute of Radiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria
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12
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Dhruva SS, Dziura J, Bathulapalli H, Rosman L, Gaffey AE, Davis MB, Brandt CA, Haskell SG. Gender Differences in Guideline-Directed Medical Therapy for Cardiovascular Disease Among Young Veterans. J Gen Intern Med 2022; 37:806-815. [PMID: 36042086 PMCID: PMC9481764 DOI: 10.1007/s11606-022-07595-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is an increasing burden of cardiovascular disease, including coronary artery disease (CAD) and heart failure (HF), among women Veterans. Clinical practice guidelines recommend multiple pharmacotherapies that can reduce risk of mortality and adverse cardiovascular outcomes. OBJECTIVE To determine if there are disparities in the use of guideline-directed medical therapy by gender among Veterans with incident CAD and HF. DESIGN Retrospective. PARTICIPANTS Veterans (934,504; 87.8% men and 129,469; 12.2% women) returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn. MAIN MEASURES Differences by gender in the prescription of Class 1, Level of Evidence A guideline-directed medical therapy among patients who developed incident CAD and HF at 30 days, 90 days, and 12 months after diagnosis. For CAD, medications included statins and antiplatelet therapy. For HF, medications included beta-blockers and renin-angiotensin-aldosterone system inhibitors. KEY RESULTS Overall, women developed CAD and HF at a younger average age than men (mean 45.8 vs. 47.7 years, p<0.001; and 43.7 vs. 45.4 years, p<0.02, respectively). In the 12 months following a diagnosis of incident CAD, the odds of a woman receiving a prescription for at least one CAD drug was 0.85 (95% confidence interval [CI], 0.68-1.08) compared to men. In the 12 months following a diagnosis of incident HF, the odds of a woman receiving at least one HF medication was 0.54 (95% CI, 0.37-0.79) compared to men. CONCLUSIONS Despite guideline recommendations, young women Veterans have approximately half the odds of being prescribed guideline-directed medical therapy within 1-year after a diagnosis of HF. These results highlight the need to develop targeted strategies to minimize gender disparities in CVD care to prevent adverse outcomes in this young and growing population.
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Affiliation(s)
- Sanket S Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. .,Section of Cardiology, Department of Medicine, UCSF School of Medicine, 4150 Clement St., Building 203, 111C, San Francisco, CA, 94121, USA.
| | - James Dziura
- Veterans Affairs Connecticut Healthcare System, West Haven, West Haven, USA.,Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harini Bathulapalli
- Veterans Affairs Connecticut Healthcare System, West Haven, West Haven, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lindsey Rosman
- Department of Medicine, Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Allison E Gaffey
- Veterans Affairs Connecticut Healthcare System, West Haven, West Haven, USA.,Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT, USA
| | - Melinda B Davis
- Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia A Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, West Haven, USA.,Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sally G Haskell
- Veterans Affairs Connecticut Healthcare System, West Haven, West Haven, USA.,Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine (General), Yale School of Medicine, New Haven, CT, USA
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13
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Khraishah H, Karout L, Jeong SY, Alahmad B, AlAshqar A, Belanger MJ, Welty FK, Michos ED, Albaghdadi M. Clinical characteristics and cardiovascular outcomes among young patients with acute myocardial infarction in Kerala, India: A secondary analysis of ACS QUIK trial. ATHEROSCLEROSIS PLUS 2022; 50:25-31. [PMID: 36643797 PMCID: PMC9833239 DOI: 10.1016/j.athplu.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 01/18/2023]
Abstract
Background Limited data exist on the risk profile and outcomes among young patients with acute myocardial infarction(AMI) in low-and middle-income countries(LMICs). This study explored differences in the clinical characteristics, medical care, and outcomes of AMI in young adults in India with a subanalysis focusing on sex disparities amongst the young. Methods Using the Acute Coronary Syndrome Quality Improvement in Kerala trial database, we compared baseline characteristics, management, and outcomes amongst the young patients(≤50 years) and their older counterparts. The primary outcomes were the rates of in-hospital and 30-day composite of in-hospital major adverse cardiovascular events(MACE). Results Of the 21,374 adults enrolled, 4762(22%) were young, of which 614 (12.9%) were females. Young patients with AMI were more likely to be smokers(41.9% vs. 27.8%;P < 0.001) and undergo coronary angiography (66.3%vs.57.3%;P < 0.001) and percutaneous coronary intervention (PCI)(57.5% vs. 47.0%;P < 0.001), compared to older patients. After adjustment for potential confounders, younger patients had a lower likelihood of in-hospital (RR = 0.49; 95%CI 0.40-0.61;P < 0.001) and 30-day MACE (RR = 0.54; 95%CI 0.46-0.64;P < 0.001). Subgroup analysis comparing young males and females revealed worse cardiovascular risk profile among young women except for smoking. In-hospital MACE(RR = 1.60; 95%CI, 1.0-2.45;P = 0.048) were higher for young women compared to men. Conclusion Young AMI patients had higher prevalence of modifiable risk factors, were more likely to receive reperfusion therapy, and had better short and intermediate outcomes, compared to older patients. Compared to young men with AMI, young women had worse cardiovascular risk profile, were less likely to be treated with diagnostic angiography or PCI and experienced higher in-hospital death and MACE.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Corresponding author. Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Lina Karout
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Barrak Alahmad
- Department of Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew J. Belanger
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francine K. Welty
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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14
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Blocking the Aryl Hydrocarbon Receptor Alleviates Myocardial Ischemia/Reperfusion Injury in Rats. Curr Med Sci 2022; 42:966-973. [DOI: 10.1007/s11596-022-2601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
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15
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Lucà F, Colivicchi F, Rossini R, Riccio C, Gelsomino S, Gulizia MM. Reply to Kielb et al. Untapped Potential for Female Patients? Comment on "Lucà et al. Update on Management of Cardiovascular Diseases in Women. J. Clin. Med. 2022, 11, 1176". J Clin Med 2022; 11:jcm11113086. [PMID: 35683475 PMCID: PMC9181007 DOI: 10.3390/jcm11113086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
We would like to thank the authors of this letter for their comments [...].
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitano Hospital, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
- Correspondence:
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy;
| | - Roberta Rossini
- Cardiology Unit, Santa Croce e Carle Hospital, 12100 Cuneo, Italy;
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Fondazione per ilTuocuore-Heart Care Foundation, 50121 Firenze, Italy
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16
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Dreyer RP, Pavlo AJ, Horne A, Dunn R, Danvers K, Brush J, Slade M, Davidson L. Conceptual Framework for Personal Recovery in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e022354. [PMID: 34581198 PMCID: PMC8649153 DOI: 10.1161/jaha.121.022354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although there has been movement in cardiology to advance patient-centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients' experience of AMI and treatment to develop a new conceptual framework of patient-centered recovery in cardiology. Methods and Results We conducted in-depth interviews with people who previously experienced an AMI (2016-2019). The interview focused on participants' experiences of their recovery, which were audio-recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a "different person" after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed. Conclusions Participants experienced the AMI as an unexpected disruption in their lives that had far-reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long-term adherence to secondary prevention and other aspects of self-care.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE) New Haven CT.,Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Anthony J Pavlo
- Department of Psychiatry Yale School of Medicine New Haven CT.,Yale Program for Recovery and Community Health (PRCH) New Haven CT
| | - Anna Horne
- Department of Psychiatry Yale School of Medicine New Haven CT.,Yale Program for Recovery and Community Health (PRCH) New Haven CT
| | - Robert Dunn
- Department of Psychiatry Yale School of Medicine New Haven CT.,Yale Program for Recovery and Community Health (PRCH) New Haven CT
| | - Karina Danvers
- Department of Psychiatry Yale School of Medicine New Haven CT.,Yale Program for Recovery and Community Health (PRCH) New Haven CT
| | - John Brush
- Sentara Healthcare and Eastern Virginia Medical School Norfolk VA
| | - Mike Slade
- School of Health Sciences Institute of Mental Health University of Nottingham United Kingdom
| | - Larry Davidson
- Department of Psychiatry Yale School of Medicine New Haven CT.,Yale Program for Recovery and Community Health (PRCH) New Haven CT
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17
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Raparelli V, Pilote L, Dang B, Behlouli H, Dziura JD, Bueno H, D’Onofrio G, Krumholz HM, Dreyer RP. Variations in Quality of Care by Sex and Social Determinants of Health Among Younger Adults With Acute Myocardial Infarction in the US and Canada. JAMA Netw Open 2021; 4:e2128182. [PMID: 34668947 PMCID: PMC8529414 DOI: 10.1001/jamanetworkopen.2021.28182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Quality of care of young adults with acute myocardial infarction (AMI) may depend on health care systems in addition to individual-level factors such as biological sex and social determinants of health (SDOH). OBJECTIVE To examine whether the quality of in-hospital and postacute care among young adults with AMI differs between the US and Canada and whether female sex and adverse SDOH are associated with a low quality of care. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis used data from 2 large cohorts of young adults (aged ≤55 years) receiving in-hospital and outpatient care for AMI at 127 centers in the US and Canada. Data were collected from August 21, 2008, to April 30, 2013, and analyzed from July 12, 2019, to March 10, 2021. EXPOSURES Sex, SDOH, and health care system. MAIN OUTCOMES AND MEASURES Opportunity-based quality-of-care score (QCS), determined by dividing the total number of quality indicators of care received by the total number for which the patient was eligible, with low quality of care defined as the lowest tertile of the QCS. RESULTS A total of 4048 adults with AMI (2345 women [57.9%]; median age, 49 [interquartile range, 44-52] years; 3004 [74.2%] in the US) were included in the analysis. Of 3416 patients with in-hospital QCS available, 1061 (31.1%) received a low QCS, including more women compared with men (725 of 2007 [36.1%] vs 336 of 1409 [23.8%]; P < .001) and more patients treated in the US vs Canada (962 of 2646 [36.4%] vs 99 of 770 [12.9%]; P < .001). Conversely, low quality of post-AMI care (748 of 2938 [25.5%]) was similarly observed for both sexes, with a higher prevalence in the US (678 of 2346 [28.9%] vs 70 of 592 [11.8%]). In adjusted analyses, female sex was not associated with low QCS for in-hospital (odds ratio [OR], 1.05; 95% CI, 0.87-1.28) and post-AMI (OR, 1.07; 95% CI, 0.88-1.30) care. Conversely, being treated in the US was associated with low in-hospital (OR, 2.93; 95% CI, 2.16-3.99) and post-AMI (OR, 2.67; 95% CI, 1.97-3.63) QCS, regardless of sex. Of all SDOH, only employment was associated with higher quality of in-hospital care (OR, 0.72; 95% CI, 0.59-0.88). Finally, only in the US, low quality of in-hospital care was associated with a higher 1-year cardiac readmissions rate (234 of 962 [24.3%]). CONCLUSIONS AND RELEVANCE These findings suggest that beyond sex, health care systems and SDOH that depict social vulnerability are associated with quality of AMI care. Taking into account SDOH among young adults with AMI may improve quality of care and reduce readmissions, especially in the US.
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Affiliation(s)
- Valeria Raparelli
- Department of Translation Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Brian Dang
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - James D. Dziura
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hector Bueno
- Centro Nactional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigacion Sanitaria Hospital 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale–New Haven Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Health, New Haven, Connecticut
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18
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Murat B, Kivanc E, Dizman R, Ozge Mert G, Murat S. Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40. J Cardiovasc Thorac Res 2021; 13:116-124. [PMID: 34326965 PMCID: PMC8302902 DOI: 10.34172/jcvtr.2021.17] [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: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. Methods: This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. Results: The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; P = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man (P = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Conclusion: Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.
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Affiliation(s)
- Bektas Murat
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Eylem Kivanc
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Rafet Dizman
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Gurbet Ozge Mert
- Eskisehir Yunus Emre State Hospital Department of Cardiology, Eskisehir, Turkey
| | - Selda Murat
- Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir, Turkey
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19
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Ibarra-Lara L, Sánchez-Aguilar M, Del Valle-Mondragón L, Soria-Castro E, Cervantes-Pérez LG, Pastelín-Hernández G, Sánchez-Mendoza A. Clofibrate improves myocardial ischemia-induced damage through regulation of renin-angiotensin system and favours a pro-vasodilator profile in left ventricle. J Pharmacol Sci 2020; 144:218-228. [PMID: 33070841 DOI: 10.1016/j.jphs.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
Myocardial ischemia initiates a chain of pathological conditions leading to cardiomyocyte death. Therefore, pharmacological treatment to stop ischemia-induced damage is necessary. Fibrates, have been reported to decrease inflammatory markers and to modulate the renin-angiotensin system (RAS). Our aim was to explore if clofibrate treatment, administered one week after myocardial event, decreases MI-induced cardiac damage. Wistar rats were assigned to: 1. Sham or 2. Coronary artery ligation (MI). Seven days after, rats were subdivided to receive vehicle (V) or clofibrate [100 mg/kg (C)] daily for 7 days. Blood samples and left ventricle were analyzed. RAS components [angiotensin II, angiotensin converting enzyme (ACE), and AT1-receptor] decreased in MI-C compared to MI-V, while [Ang-(1-7), bradykinin, ACE-2, and AT2-receptor] raised in response to clofibrate treatment. Oxidative stress markers increased in MI-V rats, a profile reverted in MI-C rats. Nitric oxide (NO) pathway (Akt, eNOS, and NO) exhibits a lower participation in MI-V, but clofibrate raised NO-pathway components and its production. MI-induced fibrosis and structural damage was also improved by clofibrate-treatment. In conclusion, clofibrate administration to 7 days MI-rats exerts an antioxidant, pro-vasodilator expression profile, and anti-fibrotic effect suggesting that PPARα activation can be considered a therapeutic target to improve cardiac condition posterior to ischemia.
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Affiliation(s)
- L Ibarra-Lara
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - M Sánchez-Aguilar
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - L Del Valle-Mondragón
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - E Soria-Castro
- Department of Cardiovascular Biomedicine, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - L G Cervantes-Pérez
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - G Pastelín-Hernández
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - A Sánchez-Mendoza
- Department of Pharmacology, National Institute of Cardiology Ignacio Chávez, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
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20
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Zhang Z, Qiao G, Sun Z, Chen X, Liu J, Lu W, Zou G. Expression of miR-223-3p in a rat model of myocardial infarction and the effects of miR-223-3p on cardiomyocytes. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1796827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Zhidong Zhang
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Gang Qiao
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Zhigang Sun
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Xiaosan Chen
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Jianyang Liu
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Wei Lu
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
| | - Gangqiang Zou
- Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital (The Cardiovascular Center of Henan Provincial People’s Hospital), Zhengzhou, People’s Republic of China
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21
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Du BB, Wang XT, Tong YL, Liu K, Li PP, Li XD, Yang P, Wang Y. Optical coherence tomography guided treatment avoids stenting in an antiphospholipid syndrome patient: A case report. World J Clin Cases 2020; 8:2399-2405. [PMID: 32548174 PMCID: PMC7281051 DOI: 10.12998/wjcc.v8.i11.2399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing attention has been paid to acute myocardial infarction (AMI) in young female patients for whom secondary factors should be considered during the diagnostic process. Anti-phospholipid syndrome (APS), a rare autoimmune disease that is most common in young female patients, is reportedly related to AMI. To date, coronary interventions, particularly stenting, remains controversial in this special clinical scenario.
CASE SUMMARY A 26-year-old female patient was admitted to hospital for acute chest pain, palpitations, and dyspnea. She had a past medical history of APS and pulmonary embolism. Coronary angiography showed acute occlusion of the proximal left anterior descending artery. After repeated thrombus aspirations, residual thrombus and mild stenosis were found in the proximal left anterior descending artery. Optical coherence tomography (OCT) was done, which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient. Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen. One week later, coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus. The 3-mo telephone follow-up reported a good prognosis.
CONCLUSION APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients. Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.
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Affiliation(s)
- Bei-Bei Du
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xing-Tong Wang
- Department of Hematology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ya-Liang Tong
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Kun Liu
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Pei-Pei Li
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xiang-Dong Li
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ping Yang
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ying Wang
- Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
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22
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Brush JE, Krumholz HM, Greene EJ, Dreyer RP. Sex Differences in Symptom Phenotypes Among Patients With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 13:e005948. [PMID: 32063049 DOI: 10.1161/circoutcomes.119.005948] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The diagnosis of acute myocardial infarction (AMI) is missed more frequently in young women than men, which may be related to the cognitive psychology of the diagnostic process. Physicians start the diagnostic process by intuitively recognizing familiar symptom phenotypes, but little is known about how symptoms combine in individuals as unique symptom phenotypes. We examined how symptoms of AMI combine as unique symptom phenotypes in individual patients to compare the distribution of symptom phenotypes in women versus men. METHODS AND RESULTS The VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) was a multicenter, observational cohort study of 3501 young adults hospitalized with AMI. Data were collected on presenting symptoms with standardized interviews and from medical record abstraction. The number and distribution of unique symptom phenotypes were compared between women and men. Because of the 2:1 female-to-male enrollment ratio, women and men were compared with permutation testing and repeated subsampling. There were 426 interview-symptom phenotypes in women and 280 in men. The observed difference between women and men of 146 phenotypes was significant, even allowing for the greater enrollment of women (permutation P=0.004, median difference 110 under the null hypothesis of no association between sex and phenotype). The repeated subsample analysis also showed significantly more interview-symptom phenotypes in women than men (206.8±7.3 versus 188.6±6.0, P<0.001). Women were more broadly distributed among symptom phenotype subgroups than men (P<0.001). Similar findings were observed in the analysis of symptoms abstracted from the medical record. CONCLUSIONS Women exhibited substantially more variation in unique symptom phenotypes than men, regardless of whether the symptoms were derived from structured interviews or abstracted from the medical record. These findings may provide an explanation for the higher missed diagnosis rate in young women with AMI and may have important implications for teaching and improving clinicians' ability to recognize the diagnosis of AMI in women.
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Affiliation(s)
- John E Brush
- Sentara Healthcare and Eastern Virginia Medical School, Norfolk, VA (J.E.B)
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K), Yale School of Medicine.,Department of Health Policy and Management (H.M.K), Yale School of Public Health.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K, R.P.D)
| | - Erich J Greene
- Department of Biostatistics (E.J.G), Yale School of Public Health
| | - Rachel P Dreyer
- Department of Emergency Medicine (R.P.D), Yale School of Medicine.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K, R.P.D)
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23
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Vautrin E, Jean ABP, Fourny M, Marlière S, Vanzetto G, Bouvaist H, Debaty G, Belle L, Danchin N, Labarère J. Sex differences in coronary artery lesions and in‐hospital outcomes for patients with ST‐segment elevation myocardial infarction under the age of 45. Catheter Cardiovasc Interv 2019; 96:1222-1230. [DOI: 10.1002/ccd.28627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Estelle Vautrin
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | | | - Magali Fourny
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Stéphanie Marlière
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Gérald Vanzetto
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Hélène Bouvaist
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Guillaume Debaty
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- Department of Emergency Medicine Grenoble Alpes University Hospital Grenoble France
| | - Loïc Belle
- Department of Cardiology Annecy‐Genevois Hospital, Réseau nord alpin des urgences (RENAU) Annecy France
| | - Nicolas Danchin
- Department of Cardiology Hôpital Européen Georges Pompidou, Assistance Publique‐Hôpitaux de Paris Paris France
| | - José Labarère
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- CIC 1406, INSERM Grenoble Alpes University Hospital Grenoble France
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24
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Smolderen KG, Brush A, Dreyer RP. Psychosocial Factors and Recovery After Acute Myocardial Infarction in Younger Women. Curr Cardiol Rep 2019; 21:50. [PMID: 31020453 DOI: 10.1007/s11886-019-1140-x] [Citation(s) in RCA: 5] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To explain sex and gender approaches to studying acute myocardial infarction (AMI) risk and outcomes in younger women (18-55 years). More specifically, by looking at the AMI care pathway-from AMI risk to receiving acute and follow-up outpatient care to longer term AMI outcomes-we will examine where potential psychosocial factors may be associated with inequalities in AMI care and outcomes in younger women. RECENT FINDINGS Despite recent declines in AMI incidence, morbidity, and mortality rates, younger women stand out as a group whose incidence has risen and who face worse outcomes following AMI, as compared with other groups. A focus on gender, rather than the binary, biological sex construct, allowed researchers to better understand potential pathways as to why younger women are facing this risk. Feminine traits and disproportionate exposures to psychosocial stressors in society at large may be correlated with inequalities in AMI care and further AMI outcomes in younger women. Psychosocial interventions in women with AMI that have proven to be successful have embraced this wider gender concept. Adopting a wider gender-concept to understand roles and demands that are placed on individuals that make them more at risk to experience psychosocial stressors and make it more challenging to organize self-care, get access to care, and equitable care may be needed.
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Affiliation(s)
- Kim G Smolderen
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO, 64111, USA.
- UMKC School of Medicine - Biomedical & Health Informatics, Kansas City, MO, 64108, USA.
| | - Anna Brush
- University of Virginia, Charlottesville, VA, USA
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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25
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Shader RI. Women and Heart Disease. Clin Ther 2019; 41:191-194. [DOI: 10.1016/j.clinthera.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
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26
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Raparelli V, Proietti M, Lenzi A, Basili S. Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design. J Cardiovasc Transl Res 2018; 13:14-25. [PMID: 30511337 PMCID: PMC7010648 DOI: 10.1007/s12265-018-9846-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/13/2018] [Indexed: 12/18/2022]
Abstract
Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study (Clinicaltrial.gov NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sex- and gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes. The integration of sex and gender in this translational project on IHD will contribute to the identification of new targets for further innovative clinical interventions.
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Affiliation(s)
- Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. .,Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada.
| | - Marco Proietti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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27
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Dreyer RP, Zheng X, Xu X, Liu S, Li J, Ding Q, Du X, Li X, Zhang H, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:273-282. [PMID: 30270637 DOI: 10.1177/2048872618803726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). METHODS A total of 3415 acute myocardial infarction patients (23.2% women) aged ⩾18 years were enrolled across 10 geographic regions in China (2012-2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. RESULTS At one year, women with acute myocardial infarction had a higher risk of death from all causes ( p<0.001), but had similar rates of major adverse cardiac events ( p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90±0.13 vs 0.94±0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3±11.4 vs 78.4±9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score ⩽60 vs >60: 9.1% vs 4.7%; all p<0.001). In multivariable analysis, there was a significant association between female sex and mortality (β=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (β=-0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (β=-0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (β=-0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88-2.21). CONCLUSION Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.
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Affiliation(s)
- Rachel P Dreyer
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,2 Department of Emergency Medicine, Yale School of Medicine, USA
| | - Xin Zheng
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xiao Xu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,4 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, USA
| | - Shuling Liu
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Jing Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Qinglan Ding
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA
| | - Xue Du
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Xi Li
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Haibo Zhang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
| | - Fredrick A Masoudi
- 5 Department of Medicine, University of Colorado Anschutz Medical Campus, USA
| | - John A Spertus
- 6 Saint Luke's Mid America Heart Institute, USA.,7 University of Missouri - Kansas City, USA
| | - Harlan M Krumholz
- 1 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.,8 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA.,9 Department of Health Policy and Management, Yale School of Public Health, USA
| | - Lixin Jiang
- 3 NHC Key Laboratory of Clinical Research for Cardiovascular Medications, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, People's Republic of China
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von Beckerath O, Santosa F, Waldhausen R, Moerchel C, Kröger K. Thromboembolic disease in females and males aged 10 to 39 years in Germany. VASA 2018; 47:483-489. [PMID: 30200845 DOI: 10.1024/0301-1526/a000729] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND We analysed differences in hospitalization rates for venous diseases such as pulmonary embolism (PE), deep vein thrombosis (DVT), sinus vein thrombosis (SVT), portal vein thrombosis (PVT), and Budd-Chiari syndrome (BCS) as well as for arterial diseases such as myocardial infarction (MI) and embolic stroke (ES) in females and males aged 10 to 39 years. PATIENTS AND METHODS Detailed lists of hospitalizations with the principal and additional diagnoses for PE (ICD-code I26.0 + I26.9), DVT (I80.0-I80.9), SVT (I67.6), PVT (I81), BCS (I82.0), MI (I21.0-I21.9), and ES (I63.1 + I63.4) in males and females aged 10 to 39 years in the years 2006 to 2015 were provided by the Federal Statistical Office in Germany. RESULTS Considering the 10-year period there were more female than male cases hospitalized with the principal diagnoses for PE, DVT, SVT, and BCS. Looking at the principal diagnosis of the year 2015, one can see a steep increase in numbers of hospitalization for PE, DVT, and SVT in females ranging from the ages 12 to 13 and 14 to 15 years compared to males. The curves of PE and DVT meet again in the age group between 32 and 33 years, but not for SVT. The greatest differences are seen at the end of the second and at the beginning of the third decade of life. In contrast, MI was more frequent in young males beginning at the age of 18 to 19 years. The number of female and male cases with ES and PVT were almost similar in the different age groups. CONCLUSIONS The presented data show higher hospitalization rates for females in the age group 10 to 39 years for different venous thrombosis but not for MI and ES.
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Affiliation(s)
| | - Frans Santosa
- 2 Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
| | | | - Christian Moerchel
- 3 General Practitioner, Mainz, Germany.,4 Thrombose Initiative e. V., Mainz, Germany
| | - Knut Kröger
- 1 Department of Angiology, Helios Klinikum Krefeld, Germany.,4 Thrombose Initiative e. V., Mainz, Germany
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30
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Vicent L, Ariza-Solé A, Alegre O, Sanchís J, López-Palop R, Formiga F, González-Salvado V, Bueno H, Vidán MT, Díez-Villanueva P, Abu-Assi E, Martínez-Sellés M. Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:252-263. [PMID: 30168725 DOI: 10.1177/2048872618798226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. METHODS A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. RESULTS Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1-2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04-2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22-9.89) and frailty (HR 3.19, 95% CI 1.08-9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91-16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79-6.22) but not in women. CONCLUSIONS In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.
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Affiliation(s)
- Lourdes Vicent
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain
| | | | - Oriol Alegre
- 3 Cardiology Department, Hospital Universitari Germans Trias i Pujol, Spain
| | - Juan Sanchís
- 4 Cardiology Department, Hospital San Juan, Spain
| | - Ramón López-Palop
- 5 Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Francesc Formiga
- 2 Servei de Cardiologia, Hospital Universitari de Bellvitge, Spain
| | | | - Héctor Bueno
- 6 Cardiology Department, Hospital Doce de Octubre, Spain
| | - María T Vidán
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain
| | | | - Emad Abu-Assi
- 8 Cardiology Department, Hospital Alvaro Cunqueiro, Spain
| | - Manuel Martínez-Sellés
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain.,9 Cardiology Department, Universidad Complutense, Universidad Europea, Spain
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Myocardial Infarction With No Obstructive Coronary Artery Disease: Angiographic and Clinical Insights in Patients With Premature Presentation. Can J Cardiol 2018; 34:468-476. [DOI: 10.1016/j.cjca.2018.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/16/2017] [Accepted: 01/01/2018] [Indexed: 12/13/2022] Open
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Nallamothu BK, Ho PM. Frontiers in Cardiovascular Outcomes Research. Circ Cardiovasc Qual Outcomes 2018; 11:e004612. [PMID: 29449444 DOI: 10.1161/circoutcomes.118.004612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brahmajee K Nallamothu
- From the Michigan Integrated Center for Health Analytics and Medical Prediction, Ann Arbor (B.K.N.); Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N.); the Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI (B.K.N.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Aurora (P.M.H.).
| | - P Michael Ho
- From the Michigan Integrated Center for Health Analytics and Medical Prediction, Ann Arbor (B.K.N.); Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N.); the Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI (B.K.N.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Aurora (P.M.H.)
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Cook NL. Bridging the Sex Gap in Early Myocardial Infarction Mortality. Circ Cardiovasc Qual Outcomes 2017; 10:e004334. [DOI: 10.1161/circoutcomes.117.004334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nakela L. Cook
- From the Immediate Office of the Director, National Heart, Lung, and Blood Institute, Bethesda, MD
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Kuller LH, Catov J. Invited Commentary: Gestational Hypertension and Diabetes-A Major Public Health Concern. Am J Epidemiol 2017; 186:1125-1128. [PMID: 29149254 DOI: 10.1093/aje/kwx265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/11/2017] [Indexed: 12/19/2022] Open
Abstract
The obesity epidemic in the United States and other countries has contributed to an increase in the rates of gestational diabetes and hypertension. In the past, it was thought that most cases of gestational diabetes and hypertension would resolve after completion of pregnancy. In this issue of the Journal, Pace et al. (Am J Epidemiol. 2017;186(10):1115-1124) clearly documented that both gestational diabetes and hypertension lead to diabetes and hypertension and that the combination of both during pregnancy leads to very high rates of subsequent diabetes and hypertension. A new generation of epidemiology studies using the evolving new technologies and genetics (host susceptibility studies) are needed to improve our understanding of the etiology of gestational diabetes and hypertension. Early identification of women at risk of gestational diabetes and hypertension, better treatment during pregnancy, and preventive and clinical therapies for treatment of diabetes and hypertension after pregnancy are very important for improving women's health and reducing risk of cardiovascular disease later in life.
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Affiliation(s)
- Elizabeth A Jackson
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (E.A.J.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.).
| | - Brahmajee K Nallamothu
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (E.A.J.); VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (B.K.N.); and Michigan Center for Health Analytics and Medical Prediction (M-CHAMP), Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.)
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