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Wester ML, Olsthoorn JR, A Soliman-Hamad M, Houterman S, Roefs MM, Maas AHEM, ter Woorst JFJ. Sex-differences in outcome after off-pump coronary artery bypass grafting is age-dependent; data from the Netherlands Heart Registration. Heliyon 2024; 10:e23899. [PMID: 38205323 PMCID: PMC10776995 DOI: 10.1016/j.heliyon.2023.e23899] [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: 07/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Background Women are known to have worse outcome after coronary artery bypass grafting (CABG) than men. Studies have shown that off-pump coronary artery bypass grafting (OPCAB) might benefit higher-risk patients, and therefore might also benefit women. We aimed to determine differences in early and late outcomes between sexes after OPCAB. Methods Data from all patients undergoing OPCAB, between 2013 through 2021 was retrieved from the Netherlands Heart Registration (NHR) database. Primary outcomes were early mortality, morbidity and late survival. We divided the population into subgroups based on age (aged ≥70 years or < 70 years) and sex. Results This study included 8,487 men and 2,170 women (total = 10,657). Female patients received fewer anastomoses (mean (SD)) women 2.38 (1.17) vs men 2.68 (1.23), p < 0.001) and total arterial revascularization was performed less frequently in women than in men (21.3 % versus 29.5 % respectively, p < 0.001).In the subgroup of patients <70 years, early mortality was 1.7 % in women and 0.6 % in men (p < 0.001). Survival rate at 5 years was 88.4 % in women and 91.1 % in men (p < 0.001). Female sex was associated with worse late survival in the subgroup <70 years (HR (95 % CI) 1.42 (1.10-1.83) p = 0.008). Conclusions Sex-differences in outcome after CABG persists in OPCAB surgery. However, these differences are solely present in the younger subgroup. In our data, women undergoing OPCAB surgery seem to be treated differently during surgery as compared to their male counter parts, further research is needed to analyze this finding.
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Affiliation(s)
- Mara-Louise Wester
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Jules R. Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | - Saskia Houterman
- Department of Education and Research, Catharina Hospital Eindhoven, the Netherlands
- Netherlands Heart Registration, Utrecht, the Netherlands
| | | | - Angela HEM. Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost FJ. ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
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Brown RM, Weinberg C, Ong C, Mieres JH. Underrepresentation of women in cardiac imaging trials: A review. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100102. [PMID: 38560054 PMCID: PMC10978205 DOI: 10.1016/j.ahjo.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 04/04/2024]
Abstract
Inclusion and equal representation of women in cardiovascular imaging trials are essential to provide insight into the factors impacting women's heart health and outcomes. Despite heart disease being the leading cause of mortality for women in the United States, women have been underrepresented in cardiovascular clinical trials, including imaging trials. Research demonstrates that women have key sex-specific differences in the pathophysiology of cardiovascular disease, the evolution of disease state, and disease manifestation (Solimene, 2010; Nevsky et al., 2011 [1,2]). This understanding and acknowledgment come decades after clinical providers have extrapolated data from cardiovascular disease clinical trials conducted primarily on Caucasian men, assuming the data were generalizable to sex, race, and ethnicity. The current cardiology society guidelines, which recommend optimal medical therapies for various cardiovascular diseases, are based on trials predominantly focused on men rather than women. Sex-based research, governmental and institutional task forces, and policies on gender equity have made inroads into the disproportionate number of women's enrollment in clinical research. The National Institutes of Health in the 1990s set forth requirements on incorporating women and minorities in research, including clinical trials (Mastroianni et al., 1994; Mieres et al., 2014 [3,4]). Continued progress is imperative to improve the gap in the number of women enrolled in clinical research trials.
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Affiliation(s)
- Rachel-Maria Brown
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
| | - Catherine Weinberg
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
| | - Caroline Ong
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
| | - Jennifer H. Mieres
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
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3
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Tobb K, Kocher M, Bullock-Palmer RP. Underrepresentation of women in cardiovascular trials- it is time to shatter this glass ceiling. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100109. [PMID: 38560055 PMCID: PMC10978176 DOI: 10.1016/j.ahjo.2022.100109] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 04/04/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, with underrepresented minority (URM) women experiencing the highest mortality rate. For decades, there has been an underrepresentation of women in CVD trials. Although more recent studies have increased the number of women enrolled in these trials, systematic reviews have demonstrated that this enrollment is still low. The National Institute of Health along with other agencies have boosted their efforts to increase enrollment of women and URM populations in CVD trials. Despite these efforts, there still remains a gap. This paper reviews the magnitude, implications and causes of the underrepresentation of women in CVD trials. A proposed multifaceted approach to solving this issue is also outlined in this commentary. Hopefully, implementation of these proposed solutions may facilitate the increase of women, including URM women, enrolled in CVD trials. It is anticipated that this will improve CVD outcomes in these patients.
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Affiliation(s)
- Kardie Tobb
- Cone Health Medical Group HeartCare, Greensboro, NC, United States of America
| | - Madison Kocher
- Department of Radiology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Renée P. Bullock-Palmer
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ, United States of America
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4
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Attia RQ, Katumalla E, Cyclewala S, Rochon M, Marczin N, Raja SG. Do in-hospital outcomes of isolated coronary artery bypass grafting vary between male and female octogenarians? Interact Cardiovasc Thorac Surg 2021; 34:958-965. [PMID: 34718583 PMCID: PMC9159460 DOI: 10.1093/icvts/ivab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort. METHODS All octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived. RESULTS Five hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30-49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts. CONCLUSIONS No gender difference in outcomes was seen in octogenarians undergoing isolated CABG.
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Affiliation(s)
- Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Eve Katumalla
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | | | - Melissa Rochon
- Department of Quality & Safety (Surveillance section), Harefield Hospital, London, UK
| | - Nandor Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthesia, Harefield Hospital, London, UK
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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Made F, Nonterah EA, Tlotleng N, Ntlebi V, Naicker N. Ten-year risk of fatal cardiovascular disease and its association with metabolic risk factors among waste pickers in South Africa. BMC Cardiovasc Disord 2021; 21:336. [PMID: 34246223 PMCID: PMC8272349 DOI: 10.1186/s12872-021-02150-y] [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: 01/12/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death among non-communicable diseases in South Africa. Several metabolic risk factors contribute to the development of CVD. Informal workers such as waste pickers could be unhealthy lifestyle naive, and most public health research on CVD does not include this understudied population. This study estimated the 10-year risk of fatal CVD and its association with metabolic risk factors in an understudied study population of waste pickers in Johannesburg, South Africa. Methods A cross-sectional survey was conducted among waste pickers in two landfill sites in Johannesburg. We used the Systematic Coronary Risk Evaluation (SCORE) risk charts to estimate the 10-year risk of fatal CVD. We then employed ordinary least squares regression to assess the association between the 10-year risk of fatal CVD with metabolic risk factors. Other variables adjusted in the regression model were HIV status, education, income, injuries from work, clinic visits in the previous 12 months, and alcohol consumption. Results A total of 370 waste pickers were included in this analysis, 265 (73.41%) were males. The mean age of the participants was 34 years. The majority were between the age of 20 and 39 years. More than 55% of the waste pickers did not visit a clinic in the previous 12 months, and 68.57% were smoking. The 10-year survival probability from CVD was more than 99% for both males and females. In the multivariable regression model, elevated blood glucose showed a non-significant increase in the mean percentage of 10-year risk of fatal CVD. Waste pickers who were overweight/obese, and hypertensive had high statistically significant mean percentages of the 10-year risk of fatal CVD compared to those who did not have the metabolic risk factors. Conclusions Prevention of 10-year risk of fatal CVD in this understudied population of waste pickers should target the control of obesity, hypertension, and diabetes. Health awareness and education for waste pickers will be an important step in reducing the burden of these metabolic risk factors. We further recommend that health systems should recognize waste pickers as a high-risk group and consider extensive CVDs surveillance. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02150-y.
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Affiliation(s)
- Felix Made
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, 2000, South Africa. .,Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, 2000, South Africa.
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Nonhlanhla Tlotleng
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, 2000, South Africa
| | - Vusi Ntlebi
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, 2000, South Africa
| | - Nisha Naicker
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, 2000, South Africa.,Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2000, South Africa
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Greco A, Capodanno D. Differences in coronary artery disease and outcomes of percutaneous coronary intervention with drug-eluting stents in women and men. Expert Rev Cardiovasc Ther 2021; 19:301-312. [PMID: 33706641 DOI: 10.1080/14779072.2021.1902806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite common perceptions, coronary artery disease (CAD) is not a male-specific condition, and sex-based differences do occur in many aspects, including clinical outcomes after percutaneous coronary intervention (PCI) with stent implantation. New-generation drug-eluting stents (DES) significantly improved post-PCI outcomes. However, no sex-specific guidelines on PCI and the use of DES are available as current evidence was derived from clinical trials enrolling predominantly male patients. AREAS COVERED This review aims at exploring sex-based disparities in CAD characteristics and manifestations, and comparing PCI outcomes and the efficacy and safety profiles of DES according to sex. In addition, a critical approach to trials' interpretation with an analysis of sources of bias is provided to inform future research and clinical practice. EXPERT OPINION Sex gap in clinical outcomes after PCI with DES implantation is narrowing due to improved performances of new-generation DES. However, scientific research and biomedical engineering are striving to optimize DES profiles and generate new iterations of devices. At the same time, gender initiatives and sex-specific trials are accruing to overcome current issues in the field. Advances in these areas will foster improvements in early and long-term clinical outcomes of both women and men.
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Affiliation(s)
- Antonio Greco
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
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Higher Mortality in Women after Coronary Artery Bypass: Meta-analysis & Bias Analysis of Confounding. Ann Thorac Surg 2020; 113:674-680. [PMID: 33373588 DOI: 10.1016/j.athoracsur.2020.11.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Some studies suggest the observed higher mortality in women than men after coronary artery bypass grafting (CABG) is due to confounding. Our meta-analysis aimed to 1) summarize the effect of sex on mortality following CABG and 2) identify whether unmeasured confounding likely explains the apparent higher mortality in women. METHODS MEDLINE, Embase, and CENTRAL databases were searched for studies examining sex and 30-day mortality following CABG. We used random-effects meta-analysis to estimate the summary odds ratio (OR) of mortality in women versus men using 1) unadjusted study results and 2) adjusted study results. Available confounders data from included studies was identified. Using the OR of measured confounders and the risk of death to inform unmeasured confounding effects, we performed bias analysis simulation to correct potential unmeasured confounding in our summary OR. RESULTS From 7138 retrieved studies, 112 were included (N=5,008,262 patients), 25 studies reported adjusted OR (N=770,450 patients). The overall 30-day mortality was 4.9% in women vs. 3.3% in men. The unadjusted summary OR (1.81, 95% CI 1.72 to 1.91) and adjusted summary OR (1.40, 95% CI 1.35 to 1.45) demonstrated that women had an increased risk of 30-day mortality compared to men. Simulations correcting for unmeasured confounding that mostly ranged from 1.05 to 1.80, supporting a higher risk of death in women after CABG. CONCLUSIONS The findings of this review suggest confounding is unlikely to account for the increased risk of mortality in women after CABG and that biological factors have a casual effect.
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8
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Dar M, Sharma A, Iqbal M, Tramboo N. Gender-based differences in coronary artery disease: A prospective observational study from a North Indian state. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_13_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Becker ER, Granzotti AM. Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain? J Natl Med Assoc 2019; 111:527-539. [DOI: 10.1016/j.jnma.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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Ares Blanco J, Valdés Hernández S, Botas P, Rodríguez-Rodero S, Morales Sánchez P, Díaz Naya L, Menéndez-Torre E, Delgado E. [Gender differences in the mortality of people with type 2 diabetes: Asturias Study 2018]. GACETA SANITARIA 2019; 34:442-448. [PMID: 31029461 DOI: 10.1016/j.gaceta.2019.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the influence of gender on mortality according to the presence or absence of type 2 diabetes mellitus (DM2) and other cardiovascular risk factors in the Asturias Study cohort. METHOD The Asturias Study (started in 1998) is an observational, prospective cohort study of a representative sample of a population of Asturias aged 30-75 years. The population was divided into groups according to the presence or absence of DM2 and according to gender to assess control of cardiovascular risk factors. In addition, aware of the vital status of the cohort 18 years after the beginning of the study, we analyzed differences in causes of mortality according to the previous categories. RESULTS In 1998, 1034 people started the study, 561 women (54.25%) and 473 men (45.75%). Of these, 131 (12.66%) had diabetes (75 men and 56 women). The women with T2D presented a hazard ratio (HR) for total mortality of 1.64 (95% confidence interval [95%CI]: .97-2.77), which was 1.63 (95%CI: 1.07-2.50) for the men and, for cardiovascular mortality, 3.06 (95%CI: 1.44-6.47) for the females, versus 1.49 (95%CI: 0.64-3.46) for the males. The mortality rate for people with T2D of both sexes was higher than for people without T2D. CONCLUSIONS Women with T2D have a risk more than three times higher than women without diabetes of dying from cardiovascular causes. We should implement treatment strategies in women with this condition.
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Affiliation(s)
- Jessica Ares Blanco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Sergio Valdés Hernández
- Instituto de Investigación Biomédica de Málaga, Málaga, España; Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, Málaga, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), España
| | - Patricia Botas
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Sección de Endocrinología y Nutrición, Hospital San Agustín, Avilés, Asturias, España
| | - Sandra Rodríguez-Rodero
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - Paula Morales Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - Lucía Díaz Naya
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Sección de Endocrinología y Nutrición, Hospital de Cabueñes, Gijón, Asturias, España
| | - Edelmiro Menéndez-Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Elías Delgado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
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Boczar KE, Coutinho T. Sex Considerations in Aneurysm Formation, Progression, and Outcomes. Can J Cardiol 2018; 34:362-370. [DOI: 10.1016/j.cjca.2017.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 01/11/2023] Open
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Yüksel A, Kan II, Yolgösteren A, Velioğlu Y, Çayır MÇ, Gürbüz O, Kumtepe G, Akarsu S, Biçer M, Tok M, Şenkaya I. Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's? Braz J Cardiovasc Surg 2017; 32:191-196. [PMID: 28832797 PMCID: PMC5570389 DOI: 10.21470/1678-9741-2016-0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the impact of gender difference in early postoperative
outcomes in elderly patients (aged 70 or older) undergoing coronary artery
bypass grafting surgery. Methods Between October 2009 and December 2013, a total of 223 elderly patients (aged
70 or older) undergoing isolated primary coronary artery bypass grafting
surgery were included in this retrospective observational cohort study.
Patients were divided into two groups according to their gender. The
patients' medical records were collected, their baseline preoperative
characteristics, operative data, and postoperative outcomes were
retrospectively reviewed, and the effect of gender difference in the early
postoperative outcomes was analyzed. Results Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152
patients, respectively. Mean age of patients was 74.4±3.6 years
(range: 70-84 years). The level of EuroSCORE I, the incidence of
hypertension and hyperlipidemia were significantly higher in Group 1, while
the rate of smoking was significantly higher in Group 2. Mean postoperative
intubation time, length of intensive care unit and hospital stay were longer
in female patients than in male patients, but these differences were not
statistically significant. No statistically significant difference between
two groups in terms of the transfusion of blood products was observed. The
rates of in-hospital mortality and major postoperative complications were
statistically similar between the two groups. Conclusion In conclusion, the female gender was not associated with worse early
postoperative outcomes in elderly patients undergoing coronary artery bypass
grafting surgery.
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Affiliation(s)
- Ahmet Yüksel
- Department of Cardiovascular Surgery of Bursa State Hospital, Bursa, Turkey
| | - Irem Iris Kan
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Atıf Yolgösteren
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Yusuf Velioğlu
- Department of Cardiovascular Surgery of Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | | | - Orçun Gürbüz
- Department of Cardiovascular Surgery of Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Gencehan Kumtepe
- Department of Cardiovascular Surgery of Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Serkan Akarsu
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Biçer
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mustafa Tok
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Işık Şenkaya
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
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Tailor TD, Kicska GA, Jacobs JE, Pampaloni MH, Litmanovich DE, Reddy GP. Imaging of Heart Disease in Women. Radiology 2017; 282:34-53. [DOI: 10.1148/radiol.2016151643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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14
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Yihua L, Yun J, Dongshen Z. Coronary Artery Disease in Premenopausal and Postmenopausal Women. Int Heart J 2017; 58:174-179. [DOI: 10.1536/ihj.16-095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lu Yihua
- Department of Epidemiology, School of Public Health, Nantong University
| | - Jiang Yun
- Department of Cardiothoracic Medicine, Nantong Rich Hospital
| | - Zhao Dongshen
- Department of Cardiovascular Medicine, Nantong First People’s Hospital
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Loley C, Alver M, Assimes TL, Bjonnes A, Goel A, Gustafsson S, Hernesniemi J, Hopewell JC, Kanoni S, Kleber ME, Lau KW, Lu Y, Lyytikäinen LP, Nelson CP, Nikpay M, Qu L, Salfati E, Scholz M, Tukiainen T, Willenborg C, Won HH, Zeng L, Zhang W, Anand SS, Beutner F, Bottinger EP, Clarke R, Dedoussis G, Do R, Esko T, Eskola M, Farrall M, Gauguier D, Giedraitis V, Granger CB, Hall AS, Hamsten A, Hazen SL, Huang J, Kähönen M, Kyriakou T, Laaksonen R, Lind L, Lindgren C, Magnusson PKE, Marouli E, Mihailov E, Morris AP, Nikus K, Pedersen N, Rallidis L, Salomaa V, Shah SH, Stewart AFR, Thompson JR, Zalloua PA, Chambers JC, Collins R, Ingelsson E, Iribarren C, Karhunen PJ, Kooner JS, Lehtimäki T, Loos RJF, März W, McPherson R, Metspalu A, Reilly MP, Ripatti S, Sanghera DK, Thiery J, Watkins H, Deloukas P, Kathiresan S, Samani NJ, Schunkert H, Erdmann J, König IR. No Association of Coronary Artery Disease with X-Chromosomal Variants in Comprehensive International Meta-Analysis. Sci Rep 2016; 6:35278. [PMID: 27731410 PMCID: PMC5059659 DOI: 10.1038/srep35278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/26/2016] [Indexed: 11/09/2022] Open
Abstract
In recent years, genome-wide association studies have identified 58 independent risk loci for coronary artery disease (CAD) on the autosome. However, due to the sex-specific data structure of the X chromosome, it has been excluded from most of these analyses. While females have 2 copies of chromosome X, males have only one. Also, one of the female X chromosomes may be inactivated. Therefore, special test statistics and quality control procedures are required. Thus, little is known about the role of X-chromosomal variants in CAD. To fill this gap, we conducted a comprehensive X-chromosome-wide meta-analysis including more than 43,000 CAD cases and 58,000 controls from 35 international study cohorts. For quality control, sex-specific filters were used to adequately take the special structure of X-chromosomal data into account. For single study analyses, several logistic regression models were calculated allowing for inactivation of one female X-chromosome, adjusting for sex and investigating interactions between sex and genetic variants. Then, meta-analyses including all 35 studies were conducted using random effects models. None of the investigated models revealed genome-wide significant associations for any variant. Although we analyzed the largest-to-date sample, currently available methods were not able to detect any associations of X-chromosomal variants with CAD.
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Affiliation(s)
- Christina Loley
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg-Lübeck-Kiel, Lübeck, Germany
| | - Maris Alver
- Estonian Genome Center, University of Tartu, Tartu, Estonia.,Institute of Molecular and Cell Biology, Tartu, Estonia
| | - Themistocles L Assimes
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine Stanford, Standford, California, USA
| | - Andrew Bjonnes
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anuj Goel
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jussi Hernesniemi
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Cardiology, Heart Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Jemma C Hopewell
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - King Wai Lau
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Majid Nikpay
- Ruddy Canadian Cardiovascular Genetics Centre University of Ottawa Heart Institute, Ottawa, Canada
| | - Liming Qu
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elias Salfati
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine Stanford, Standford, California, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology/Medical Faculty/University of Leipzig, Leipzig, Germany.,LIFE Research Center of Civilization Diseases, Leipzig, Germany
| | - Taru Tukiainen
- Analytic and Translation Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Christina Willenborg
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg-Lübeck-Kiel, Lübeck, Germany.,Institut für Integrative und Experimentelle Genomik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and University Heart Center Luebeck, Campus Lübeck, Lübeck, Germany
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
| | - Lingyao Zeng
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Weihua Zhang
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,Department of Cardiology, Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK
| | - Sonia S Anand
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Frank Beutner
- LIFE Research Center of Civilization Diseases, Leipzig, Germany.,Heart Center Leipzig, Cardiology, University of Leipzig, Leipzig, Germany
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Clarke
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.,The Center for Statistical Genetics, Icahn School of Medicine at Mount Sinai, New York, USA.,The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, USA.,The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Markku Eskola
- Department of Cardiology, Heart Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Martin Farrall
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, Uppsala, Sweden
| | | | - Alistair S Hall
- Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, UK
| | - Anders Hamsten
- Cardiovascular Genetics and Genomics Group, Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Jie Huang
- Boston VA Research Institute, Inc., Boston, Massachusetts, USA
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Physiology, University of Tampere School of Medicine, Tampere, Finland
| | - Theodosios Kyriakou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Reijo Laaksonen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland.,Zora Biosciences, Espoo, Finland
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Kjell Nikus
- Department of Cardiology, Heart Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Nancy Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Loukianos Rallidis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Svati H Shah
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre University of Ottawa Heart Institute, Ottawa, Canada
| | - John R Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Pierre A Zalloua
- Lebanese American University, School of Medicine, Beirut, Lebanon.,Harvard School of Public Health, Boston, Massachusetts, USA
| | - John C Chambers
- Department of Cardiology, Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Imperial College Healthcare NHS Trust, London, UK
| | - Rory Collins
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Erik Ingelsson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Carlos Iribarren
- Kaiser Permanente, Division of Research, Oakland, California, USA
| | - Pekka J Karhunen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Forensic Medicine, University of Tampere School of Medicine, Tampere, Finland
| | - Jaspal S Kooner
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.,Imperial College Healthcare NHS Trust, London, UK.,Cardiovascular Science, National Heart and Lung Institute, Imperial College London, London, UK
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Synlab Academy, Synlab Services GmbH, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre University of Ottawa Heart Institute, Ottawa, Canada
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Tartu, Estonia.,Institute of Molecular and Cell Biology, Tartu, Estonia
| | - Muredach P Reilly
- Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuli Ripatti
- Kaiser Permanente, Division of Research, Oakland, California, USA.,Hjelt Institute, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Dharambir K Sanghera
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Oklahoma Center for Neuroscience, Oklahoma City, Oklahoma, USA
| | - Joachim Thiery
- LIFE Research Center of Civilization Diseases, Leipzig, Germany.,Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Medical Faculty, Leipzig, Germany
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.,Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sekar Kathiresan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Heribert Schunkert
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany.,Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Jeanette Erdmann
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg-Lübeck-Kiel, Lübeck, Germany.,Institut für Integrative und Experimentelle Genomik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and University Heart Center Luebeck, Campus Lübeck, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg-Lübeck-Kiel, Lübeck, Germany
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Arif R, Farag M, Gertner V, Szabó G, Weymann A, Veres G, Ruhparwar A, Bekeredjian R, Bruckner T, Karck M, Kallenbach K, Beller CJ. Female Gender and Differences in Outcome after Isolated Coronary Artery Bypass Graft Surgery: Does Age Play a Role? PLoS One 2016; 11:e0145371. [PMID: 26845158 PMCID: PMC4741386 DOI: 10.1371/journal.pone.0145371] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/01/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Female gender is a known risk factor for early and late mortality after coronary artery bypass graft surgery (CABG). Higher age of women at operation may influence outcome, since age per se is also an important risk factor. The purpose of our study was to analyze possible gender differences in outcome after isolated CABG in different age groups to delineate the impact of female gender and age. Methods All patients over 60 years of age undergoing isolated CABG at our department during 2001 and 2011 were included and categorized by age into sexagenarians (2266, 16.6% women), septuagenarians (2332, 25.4% women) and octogenarians (374, 32% women) and assessed by gender for 30-day and 180-day mortality. Results Thirty-day mortality was significantly higher in women only amongst septuagenarians (7.1 vs. 4.7%, p = 0.033). Same differences apply for 180-day mortality (12.3 vs. 8.2%, p = 0.033) and estimated one-year survival (81.6 ± 4.2 vs. 86.9 ± 2.2%, p = 0.001). Predictive factors for 30-day mortality of septuagenarian were logistic EuroSCORE (ES) (p = 0.003), perioperative myocardial infarction (MI) (p<0.001), pneumonia (p<0.001), abnormal LV-function (p<0.04) and use of LIMA graft (p<0.001), but not female gender. However, female gender was found to be an independent predictor for 180-day mortality (HR 1.632, p = 0.001) in addition to ES, use of LIMA graft, perioperative MI, pneumonia and abnormal LV function (HR 1.013, p = 0.004; HR 0.523, p<0.001; HR 2.710, p<0.001; HR 3.238, p<0.001; HR 2.013, p<0.001). Conclusion Women have a higher observed probability of early death after CABG in septuagenarians. However, female gender was not found to be an independent risk factor for 30-day, but for 180-day survival. Therefore, reduction of high impact risk factors such as perioperative MI and enhancement of LIMA use should be future goals. In view of our findings, decision for surgical revascularization should not be based on gender.
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Affiliation(s)
- Rawa Arif
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Mina Farag
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Victor Gertner
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Szabó
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Veres
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Angiology and Pneumology, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tom Bruckner
- Institute of Medical Biometry and Informatics, Heart Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten J. Beller
- Department of Cardiac Surgery, Heart Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
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17
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Aoi S, Miyake T, Iida T, Ikeda H, Ishizaki F, Chikamura C, Tamura N, Nitta Y, Harada T, Miyaguchi H. Association of Changes in Neck Circumference with Cardiometabolic Risk in Postmenopausal Healthy Women. J Atheroscler Thromb 2016; 23:728-36. [PMID: 26797264 DOI: 10.5551/jat.31963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Although neck circumference (NC) is thought to predict obesity-related metabolic abnormality, its causal role in cardiometabolic risk is unclear. The aim of this study was to clarify the impact of changes in NC on cardiometabolic risk in healthy postmenopausal women through a community-based longitudinal study. METHODS From a local community in Japan, 63 generally healthy postmenopausal women were recruited. All participants received an assessment of obesity-related anthropometric markers, biochemical parameters, and hemodynamic measures and were followed on average for 3 years. RESULTS At baseline analysis, larger NC was positively associated with atherosclerosis-related markers, brachial-ankle pulse wave velocity (baPWV) and blood pressure, as well as some lipid parameters. After the follow-up period, change in NC was associated with changes in body mass index (BMI), body fat percentage, and waist circumference (WC). Interestingly, significant correlations of change in NC with changes in baPWV and blood pressure were observed, whereas changes in WC and BMI were only associated with changes in low-density lipoprotein cholesterol and/or total cholesterol. In multivariate linear regression analysis, change in NC was significantly associated with changes in baPWV and systolic blood pressure, independent of changes in BMI, WC, and biochemical parameters. In addition, an increase in NC was associated with a 2.69-fold increased odds ratio of accelerated baPWV. CONCLUSIONS Change in NC was independently associated with changes in atherosclerosis-related markers. These observations suggest that NC is an important predictor of the risk of developing obesity-related atherosclerosis in healthy postmenopausal women.
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Affiliation(s)
- Satomi Aoi
- Faculty of Health and Welfare, Prefectural University of Hiroshima
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18
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Gender-specific differences in outcome of ascending aortic aneurysm surgery. PLoS One 2015; 10:e0124461. [PMID: 25902057 PMCID: PMC4406687 DOI: 10.1371/journal.pone.0124461] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/05/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Gender specific differences receive increasing attention and are known to affect the outcome of cardiovascular diseases. We investigated possible risk-factors for gender-specific differences in ascending aortic aneurysm surgery. METHODS 548 consecutive patients (male: n = 390, age: 58.3 ± 14.4 years; female: n = 158, age: 65.3 ± 12.9 years) with aneurysms of the ascending aorta eligible for cardiac surgery were retrospectively analyzed. RESULTS Women were significantly older when operation was indicated (p < 0.001) and presented with significantly more hypertension (p = 0.04) and chronic obstructive pulmonary disease (COPD; p = 0.017), whereas men had significantly more previous cardiac operations (p = 0.016). Normalized aortic diameters (diameter / body surface area) were significantly larger in women (3.10 ± 0.6 cm) vs. (2.75 ± 0,5 cm, p ≤ 0.001) in men, without differences in absolute values (5.74 ± 1.04 cm vs. 5.86 ± 1.34 cm). The aortic arch was significantly more involved in aneurysm formation in women (p = 0.04). Follow-up was available in 93% of the patients with a mean follow-up time of 3.9 ± 3.9 (0-17.8) years. 30-day mortality was 3.5% in men (n=12) and 7.9% in women (n = 11; p = 0.058). Univariate regression analysis shows gender specific risk factors for 30-day mortality in men to be age: p = 0.028; myocardial infarction: p = 0.0.24 and in women diameter of the ascending aorta: p = 0.014; renal insufficiency: p = 0.007. Long-term survival was significantly reduced in women (log-rank p = 0.0052). CONCLUSIONS The outcome after surgery for ascending aortic aneurysm is less favourable in women with significantly reduced long-term survival and a trend to increased 30-day mortality in this cohort. Larger normalized aortic diameters, higher incidence of involvement of the aortic arch and differences in comorbidities may contribute to gender differences. Women undergo surgery at higher age and more progressed state of aortic disease. Therefore, gender-specific guidelines for ascending replacement may be useful to improve outcome in women.
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Abstract
AIMS Elderly women with myocardial infarction (MI) show poorer outcomes than men. In patients with MI, reduced heart rate variability (HRV) is associated with an increased risk of mortality. Thus, we aimed to investigate HRV in elderly women with MI. METHODS HRV indexes in women 50 years of age or older were compared to those in age-adjusted men with MI: geometric (triangular index), linear (low frequency [LF, ms(2)], high frequency [HF, ms(2)], standard deviation (SD) of normal R-R wave intervals [SDNN], square root of the mean of the sum of the squares of differences between adjacent normal R wave intervals [RMSSD]) and nonlinear Poincaré analysis [SD1 and SD2, ms]. RESULTS Women had higher MI recurrence than men (11% vs. 5% with two MIs; 6% vs. 1% with three MIs). Overall HRV, the triangular index and SDNN were considerably lower in women than men (3.1 [2.5-4.4] vs. 4.5 [3.2-5.9] and 9.3 [6.9-15.8] vs. 19.2 [11.4-26.4] respectively; p < 0.001). Moreover, HRV indexes (HF, LF/HF, RMSSD, and SD1) were significantly lower in women (62.2%, 55.6%, 37.1%, and 37.2% respectively; p < 0.01). CONCLUSION This study suggests that elderly women with MI may have a worse prognosis than men, indicated by cardiac autonomic dysfunction. Since our study is cross-sectional and cannot infer causality, causation should be confirmed in further longitudinal studies.
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Affiliation(s)
- Andreia de Oliveira Pinheiro
- a Center of Innovation, Technology and Education - (CITE), Camilo Castelo Branco University , Sao Jose dos Campos , Brazil
| | - Valter Luis Pereira
- a Center of Innovation, Technology and Education - (CITE), Camilo Castelo Branco University , Sao Jose dos Campos , Brazil
| | - Ovidiu Constantin Baltatu
- a Center of Innovation, Technology and Education - (CITE), Camilo Castelo Branco University , Sao Jose dos Campos , Brazil
| | - Luciana Aparecida Campos
- a Center of Innovation, Technology and Education - (CITE), Camilo Castelo Branco University , Sao Jose dos Campos , Brazil
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20
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Effects of treatment with zofenopril in men and women with acute myocardial infarction: gender analysis of the SMILE Program. PLoS One 2014; 9:e111558. [PMID: 25364906 PMCID: PMC4218766 DOI: 10.1371/journal.pone.0111558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/05/2014] [Indexed: 12/28/2022] Open
Abstract
Background the SMILE studies proved the prognostic benefit of zofenopril vs. placebo or other ACE-inhibitors (ACEIs) in post-acute myocardial infarction (AMI). In this retrospective pooled analysis of these studies we assessed whether the zofenopril effect is influenced by gender. Methods the four double-blind, randomized, parallel-group SMILE studies, compared the efficacy and safety of 6–48 week treatment with zofenopril 60 mg/day with that of placebo, lisinopril 10 mg/day or ramipril 10 mg/day in 3630 AMI patients. This pooled analysis compared treatment efficacy (1-year combined occurrence of death or hospitalization for CV causes) in 2733 men and 897 women. Results women were older than men, had a higher prevalence of diabetes and of other major CV risk factors. The risk of a major CV event was significantly larger for women (23% vs. 17% men, p<0.001). Between-gender risk difference was more marked for people living in Southern (+54%) than in Northern Europe (+12%). In both genders zofenopril similarly reduced the 1-year risk of CV morbidity and mortality vs. placebo (−39% men, p = 0.0001; −40% women, p = 0.005). The risk reduction was more marked with zofenopril than with the other ACEIs, particularly in men (−27%, p = 0.012; women: −14%, p = 0.479). The drug safety profile was similar between genders in zofenopril-treated patients, while it was worse in women treated with other ACEIs. Conclusions post-AMI women are at higher risk of CV complications than men, particularly when living in Mediterranean countries. Their response to ACE-inhibition varies according to the type of drug and is usually better in men.
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21
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Catalase influence in the regulation of coronary resistance by estrogen: joint action of nitric oxide and hydrogen peroxide. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:159852. [PMID: 24669281 PMCID: PMC3941593 DOI: 10.1155/2014/159852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/25/2013] [Indexed: 01/24/2023]
Abstract
We tested the influence of estrogen on coronary resistance regulation by modulating nitric oxide (NO) and hydrogen peroxide (H2O2) levels in female rats. For this, estrogen levels were manipulated and the hearts were immediately excised and perfused at a constant flow using a Langendorff's apparatus. Higher estrogen levels were associated with a lower coronary resistance, increased nitric oxide bioavailability, and higher levels of H2O2. When oxide nitric synthase blockade by L-NAME was performed, no significant changes were found in coronary resistance of ovariectomized rats. Additionally, we found an inverse association between NO levels and catalase activity. Taken together, our data suggest that, in the absence of estrogen influence and, therefore, reduced NO bioavailability, coronary resistance regulation seems to be more dependent on the H2O2 that is maintained at low levels by increased catalase activity.
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König IR, Loley C, Erdmann J, Ziegler A. How to Include Chromosome X in Your Genome‐Wide Association Study. Genet Epidemiol 2014; 38:97-103. [DOI: 10.1002/gepi.21782] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/29/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Inke R. König
- Institut für Medizinische Biometrie und Statistik Universität zu Lübeck, Universitätsklinikum Schleswig‐Holstein Campus Lübeck Lübeck Germany
- DZHK (German Centre for Cardiovascular Research) Lübeck Germany
| | - Christina Loley
- Institut für Medizinische Biometrie und Statistik Universität zu Lübeck, Universitätsklinikum Schleswig‐Holstein Campus Lübeck Lübeck Germany
- Institut für Integrative und Experimentelle Genomik Universitätsklinikum Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Jeanette Erdmann
- DZHK (German Centre for Cardiovascular Research) Lübeck Germany
- Institut für Integrative und Experimentelle Genomik Universitätsklinikum Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Andreas Ziegler
- Institut für Medizinische Biometrie und Statistik Universität zu Lübeck, Universitätsklinikum Schleswig‐Holstein Campus Lübeck Lübeck Germany
- DZHK (German Centre for Cardiovascular Research) Lübeck Germany
- Zentrum für Klinische Studien Lübeck Lübeck Germany
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Papakonstantinou NA, Stamou MI, Baikoussis NG, Goudevenos J, Apostolakis E. Sex differentiation with regard to coronary artery disease. J Cardiol 2013; 62:4-11. [PMID: 23642501 DOI: 10.1016/j.jjcc.2013.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/06/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
Abstract
Coronary artery disease was considered a male disease for many years. However, nowadays, coronary artery disease constitutes the leading cause of death in women, although there are a lot of gender-related differences regarding the presentation of acute myocardial infarction, its diagnosis, its treatment, short- and long-term mortality rates, and post-acute myocardial infarction complications. Generally, women have smaller and stiffer hearts and cardiac vessels, suffering a greater extent of atherosclerosis and endothelial and smooth muscle dysfunction. They are usually older than men and they have more comorbidities such as hypertension, renal impairment, and diabetes mellitus. Moreover, female coronary artery disease, the diagnosis of which is more complicated due to more false negative results of some diagnostic methods in women, is more often presented with atypical symptoms and women's symptoms of typical or atypical angina are more severe. Furthermore, women delay significantly more in seeking care and they are more frequently undertreated. Finally, women are associated with generally poorer in-hospital and long-term prognosis having almost two-fold higher early mortality and they are more prone to complications such as bleeding complications, shock, and heart failure, as well as to post-myocardial infarction depression and poorer physical function and mental health. In this review, we discuss these sex-related differences according to current literature.
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Balta S, Demırkol S, Cakar M, Unlu M, Kucuk U, Dinc M. It is important to control for confounders when examining the role of diet in cardiovascular disease prevention. Clinics (Sao Paulo) 2013; 68:575. [PMID: 23778352 PMCID: PMC3634965 DOI: 10.6061/clinics/2013(04)22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lima R, Yanes LL, Davis DD, Reckelhoff JF. Roles played by 20-HETE, angiotensin II and endothelin in mediating the hypertension in aging female spontaneously hypertensive rats. Am J Physiol Regul Integr Comp Physiol 2012; 304:R248-51. [PMID: 23220478 DOI: 10.1152/ajpregu.00380.2012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prevalence of hypertension (HT) increases in women after menopause, and there is evidence that HT is not as well controlled in postmenopausal women as men. The reasons for this are not clear but may be related to the lack of adequate blockade of the systems contributing to HT in women. This study aimed to determine the roles of three of the systems known to contribute to HT in animal studies: angiotensin II (ANG II; enalapril inhibitor), eicosanoids [1-aminobenzotriazole (1-ABT) inhibitor], and endothelin (ET(A) receptor antagonist), on blood pressure (BP) in three groups of female spontaneously hypertensive rats (SHR), aged 18 mos (postmenopausal rat, PMR). After baseline telemetry BP, three drug periods were performed for 5 days each: single blockade (ABT or enalapril), double blockade (ABT+enalapril or enalapril+ABT), and triple blockade (all 3 drugs). Controls received no treatment until the third period when they received ET(A) receptor antagonist alone. Single drug blockade reduced BP in PMR to similar levels. Double blockade reduced mean arterial pressure more in ABT+enalapril rats than in the other group (enalapril+ABT). Triple drug blockade reduced BP to similar levels in both groups, but the BP remained ∼110 mmHg. The data suggest that these three systems, ANG II, eicosanoids, and endothelin, contribute together and independently to BP control in old female SHR. However, other systems also contribute to the HT since the BP was not normalized, supporting the notion that HT in postmenopausal women may require complex multidrug therapy to be better controlled and that may require the development of additional drugs.
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Affiliation(s)
- Roberta Lima
- Women's Health Research Center, Departments of Physiology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA
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26
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Weber B, Galante AP, Bersch-Ferreira AC, Torreglosa CR, Carvalho VO, Victor EDS, Espírito-Santo JAD, Ross-Fernandes MB, Soares RM, Costa RP, Lara EDS, Buehler AM, Berwanger O. Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial. Clinics (Sao Paulo) 2012; 67:1407-14. [PMID: 23295594 PMCID: PMC3521803 DOI: 10.6061/clinics/2012(12)10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/10/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.
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Affiliation(s)
- Bernardete Weber
- Hospital do Coração (IEP-HCor), Research Institute, São Paulo/SP, Brazil.
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Lambrinoudaki I, Papadimitriou D, Kaparos G, Rizos D, Panoulis C, Deligeoroglou E, Alexandrou A, Auguolea A, Apostolakis M, Creatsa M, Kouskouni E. MTHFR C677T polymorphism modifies the effect of HRT on metabolic parameters in postmenopausal women. Climacteric 2012; 16:568-75. [PMID: 23145891 DOI: 10.3109/13697137.2012.738722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the interaction of the MTHFR C677T polymorphism with changes in lipid and glucose metabolism effected by oral hormone replacement therapy (HRT) in postmenopausal women. METHODS In this open-label, prospective, interventional study, parameters of lipid and glucose metabolism, as well as homocysteine, were assessed in 97 postmenopausal women at baseline and 1 year after the initiation of HRT. Participants were stratified into three subgroups, according to the MTHFR C677T polymorphism (wild-type: CC genotype; heterozygous: CT genotype; homozygous for the mutant variable: TT genotype). RESULTS The TT genotype was associated with an elevation of total and low density lipoprotein (LDL) cholesterol, while CT and CC genotypes were associated with a reduction of total cholesterol and LDL cholesterol after 1 year of HRT (p = 0.032 for total cholesterol and p = 0.002 for LDL cholesterol). Women with the TT genotype had higher glucose levels in contrast to women with the CC genotype who had lower glucose levels after 1 year of HRT (p = 0.011). Additionally, CC carriers under HRT had a significant elevation of apolipoprotein A1 levels (p = 0.018), contrarily to CT and TT genotypes. CONCLUSION While HRT was associated with favorable changes in lipid and metabolic parameters in carriers of the CC genotype, this effect was not evident in carriers of the T allele. The MTHFR C677T polymorphism may modify the effect of HRT on lipid and metabolic parameters in postmenopausal women.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens , Aretaieio Hospital, Athens
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Ostadal P, Ostadal B. Women and the management of acute coronary syndrome. Can J Physiol Pharmacol 2012; 90:1151-9. [PMID: 22888799 DOI: 10.1139/y2012-033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronary heart disease (CHD) is the leading cause of morbidity and mortality in both men and women in the developed countries. Despite this fact, females are still under-represented in the majority of clinical trials. At the present time, only limited evidence is available with respect to the female-specific aspects of pathogenesis, management, and outcomes in acute coronary syndrome (ACS). Women less frequently undergo coronary intervention, and a lower proportion of women receive evidence-based pharmacotherapy, compared with men. It has been shown that women benefit from an invasive approach and coronary intervention in ACS as much as men, despite their advanced age and higher rate of bleeding complications. Also, administration of beta-blockers, ACE-inhibitors, and intensive statin therapy is associated with a comparable reduction of cardiovascular event rates in women and men. On the other hand, women may profit less than men from fibrinolytic or glycoprotein IIb/IIIa inhibitor therapy. Both sexes benefit equally from aspirin therapy, whereas contradictory data are available on the efficacy of clopidogrel in women. There is an urgent need for intensive research in the development of female-specific therapeutic strategy in ACS, even though the detailed mechanisms of sex differences are still unknown.
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Affiliation(s)
- Petr Ostadal
- Cardiovascular Center, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.
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Pradeepa R, Nazir A, Mohan V. Type 2 diabetes and cardiovascular diseases: do they share a common soil? The Asian Indian experience. HEART ASIA 2012; 4:69-76. [PMID: 27326035 DOI: 10.1136/heartasia-2011-010081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2012] [Indexed: 12/18/2022]
Abstract
In India, diabetes and cardiovascular disease (CVD) are growing health problems. CVD accounts for much of the increased morbidity and premature mortality associated with type 2 diabetes. Moreover, CVD also occurs 2-3 decades earlier among diabetic subjects and runs a more aggressive course and has a worse prognosis. The pathophysiology of the link between diabetes and CVD is complex and multifactorial and understanding the mechanisms of the disease can help identify and treat CVD in patients with diabetes and vice versa. The current article reviews the common antecedents between type 2 diabetes and CVD including non-modifiable and modifiable risk factors and suggests that future research on diabetes and CVD should focus on searching for risk factors for CVD that may be more specific to diabetes, such as hypoglycaemia or medication related comorbidities. Also, the authors recommend research on common genetic variants which might have stronger effects and hence have a potential role in diabetes and CVD risk prediction. Finally, primary prevention trials trying to prevent both diabetes and CVD are the urgent need of the hour!
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Affiliation(s)
- Rajendra Pradeepa
- Dr Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Gopalapuram, Chennai, India
| | - Adamsha Nazir
- Dr Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Gopalapuram, Chennai, India
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Ciolac EG, Greve JMD. Exercise-induced improvements in cardiorespiratory fitness and heart rate response to exercise are impaired in overweight/obese postmenopausal women. Clinics (Sao Paulo) 2011; 66:583-9. [PMID: 21655751 PMCID: PMC3093788 DOI: 10.1590/s1807-59322011000400011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/25/2010] [Accepted: 01/10/2011] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare the heart rate response to exercise and the exercise-induced improvements in muscle strength, cardiorespiratory fitness and heart rate response between normal-weight and overweight/obese postmenopausal women. METHODS Sedentary women (n = 155) were divided into normal-weight (n = 79; BMI <25 kg/m(2); 58.3 ± 8.6 years) and overweight/obese (n = 76; BMI >25 kg/m(2); 58.3 ± 8.6 years) groups, and have their 1-repetition maximum strength (adjusted for body mass), cardiorespiratory fitness and heart rate response to a graded exercise test compared before and after 12 months of a three times-per-week exercise-training program. RESULTS Overweight/obese women displayed decreased upper and lower extremity muscle strengths, decreased cardiorespiratory fitness, and lower peak and reserve heart rates compared to normal-weight women. After follow-up, both groups improved their upper (32.9% and 41.5% in normal-weight and overweight/obese women, respectively) and lower extremity(49.5% and 47.8% in normal-weight and overweight/obese women, respectively) muscle strength. However, only normal-weight women improved their cardiorespiratory fitness (6.6%) and recovery heart rate (5 bpm). Resting, reserve and peak heart rates did not change in either group. CONCLUSIONS Overweight/obese women displayed impaired heart rate response to exercise. Both groups improved muscle strength, but only normal-weight women improved cardiorespiratory fitness and heart rate response to exercise. These results suggest that exercise-induced improvements in cardiorespiratory fitness and heart rate response to exercise may be impaired in overweight/obese postmenopausal women.
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Affiliation(s)
- Emmanuel Gomes Ciolac
- Laboratory of Kinesiology, Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Brazil.
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Alonso Saenz de Miera M, Balanza Galindo S, Leal Hernández M, Hernández Menarguez F, García-Galbis Marín J, Gómez Jara P, Abellán Alemán J. Análisis de potenciales factores protectores del riesgo cardiovascular en una población mediterránea. HIPERTENSION Y RIESGO VASCULAR 2010. [DOI: 10.1016/j.hipert.2010.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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