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Volleberg RHJA, Mol JQ, Belkacemi A, Hermanides RS, Meuwissen M, Protopopov AV, Laanmets P, Krestyaninov OV, Dennert R, Oemrawsingh RM, van Kuijk JP, Arkenbout K, van der Heijden DJ, Rasoul S, Lipsic E, Rodwell L, Camaro C, Damman P, Roleder T, Kedhi E, van Leeuwen MAH, van Geuns RJM, van Royen N. Sex differences in plaque characteristics of fractional flow reserve-negative non-culprit lesions after myocardial infarction. Atherosclerosis 2024; 397:118568. [PMID: 39241345 DOI: 10.1016/j.atherosclerosis.2024.118568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/12/2024] [Accepted: 08/21/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND AIMS Recurrent events after myocardial infarction (MI) are common and often originate from native non-culprit (NC) lesions that are non-flow limiting. These lesions consequently pose as targets to improve long-term outcome. It is, however, largely unknown whether these lesions differ between sexes. The aim of this study was to assess such potential differences. METHODS From the PECTUS-obs study, we assessed sex-related differences in plaque characteristics of fractional flow reserve (FFR)-negative intermediate NC lesions in 420 MI-patients. RESULTS Among the included patients, 80 (19.1 %) were female and 340 (80.9 %) male. Women were older and more frequently had hypertension and diabetes. In total, 494 NC lesions were analyzed. After adjustment for clinical characteristics and accounting for within-patients clustering, lesion length was longer in female patients (20.8 ± 10.0 vs 18.3 ± 8.5 mm, p = 0.048) and minimum lumen area (2.30 ± 1.42 vs 2.78 ± 1.54 mm2, p < 0.001) and minimum lumen diameter (1.39 ± 0.45 vs 1.54 ± 0.44 mm, p < 0.001) were smaller. The minimum fibrous cap thickness was smaller among females (96 ± 53 vs 112 ± 72 μm, p = 0.025), with more lesions harboring a thin cap fibroatheroma (39.3 % vs 24.9 %, p < 0.001). Major adverse cardiovascular events at two years occurred in 6.3 % of female patients and 11.8 % of male patients (p = 0.15). CONCLUSIONS FFR-negative NC lesions after MI harbored more high-risk plaque features in female patients. Although this did not translate into an excess of recurrent events in female patients in this modestly sized cohort, it remains to be investigated whether this difference affects clinical outcome.
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Affiliation(s)
- Rick H J A Volleberg
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan-Quinten Mol
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Alexey V Protopopov
- Cardiovascular Center of Regional State Hospital, Krasnoyarsk, Russia; Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Peep Laanmets
- Cardiology Center, North Estonia Medical Center, Tallinn, Estonia
| | | | - Robert Dennert
- Department of Cardiology, Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba
| | - Rohit M Oemrawsingh
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands; Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Karin Arkenbout
- Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
| | - Dirk J van der Heijden
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands; Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Saman Rasoul
- Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Cardiology, MUMC+, Maastricht, the Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura Rodwell
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tomasz Roleder
- Faculty of Medicine Wrocław University of Science and Technology, Department of Cardiology, Regional Specialist Hospital, Wrocław, Poland
| | - Elvin Kedhi
- Department of Cardiology, McGill University Health Center, Royal Victoria Hospital, Montreal, Canada
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Mattioli AV, Bucciarelli V, Gallina S. Teaching gender medicine can enhance the quality of healthcare. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 44:100418. [PMID: 39036011 PMCID: PMC11259991 DOI: 10.1016/j.ahjo.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/18/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
Teaching gender and sex differences is fundamental in medical classes because it has a strong impact in reducing disparity in treatment, in defining effective and personalized therapies that respect the different physiology and pathophysiology of women. Furthermore, it is the prerequisite for the pharmacoequity.
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Affiliation(s)
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
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Wentzel JJ, Bos D, White SJ, van der Heiden K, Kavousi M, Evans PC. Sex-related differences in coronary and carotid vessel geometry, plaque composition and shear stress obtained from imaging. Atherosclerosis 2024; 395:117616. [PMID: 38944895 DOI: 10.1016/j.atherosclerosis.2024.117616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Atherosclerosis manifests itself differently in men and women with respect to plaque initiation, progression and plaque composition. The observed delay in plaque progression in women is thought to be related to the hormonal status of women. Also features associated with the vulnerability of plaques to rupture seem to be less frequently present in women compared to men. Current invasive and non-invasive imaging modalities allow for visualization of plaque size, composition and high risk vulnerable plaque features. Moreover, image based modeling gives access to local shear stress and shear stress-related plaque growth. In this review, current knowledge on sex-related differences in plaque size, composition, high risk plaque features and shear stress related plaque growth in carotid and coronary arteries obtained from imaging are summarized.
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Affiliation(s)
- J J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, the Netherlands.
| | - D Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J White
- Biosciences Institute, Newcastle University, UK
| | - K van der Heiden
- Department of Cardiology, Biomedical Engineering, Erasmus MC, the Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - P C Evans
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London, Faculty of Medicine and Dentistry, Queen Mary University of London, UK
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Zimodro JM, Mucha M, Berthold HK, Gouni-Berthold I. Lipoprotein Metabolism, Dyslipidemia, and Lipid-Lowering Therapy in Women: A Comprehensive Review. Pharmaceuticals (Basel) 2024; 17:913. [PMID: 39065763 PMCID: PMC11279947 DOI: 10.3390/ph17070913] [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: 06/20/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Lipid-lowering therapy (LLT) is a cornerstone of atherosclerotic cardiovascular disease prevention. Although LLT might lead to different reductions in low-density lipoprotein cholesterol (LDL-C) levels in women and men, LLT diminishes cardiovascular risk equally effectively in both sexes. Despite similar LLT efficacy, the use of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors is lower in women compared to men. Women achieve the guideline-recommended LDL-C levels less often than men. Greater cholesterol burden is particularly prominent in women with familial hypercholesterolemia. In clinical practice, women and men with dyslipidemia present with different cardiovascular risk profiles and disease manifestations. The concentrations of LDL-C, lipoprotein(a), and other blood lipids differ between women and men over a lifetime. Dissimilar levels of LLT target molecules partially result from sex-specific hormonal and genetic determinants of lipoprotein metabolism. Hence, to evaluate a potential need for sex-specific LLT, this comprehensive review (i) describes the impact of sex on lipoprotein metabolism and lipid profile, (ii) highlights sex differences in cardiovascular risk among patients with dyslipidemia, (iii) presents recent, up-to-date clinical trial and real-world data on LLT efficacy and safety in women, and (iv) discusses the diverse medical needs of women and men with dyslipidemia and increased cardiovascular risk.
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Affiliation(s)
- Jakub Michal Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Magda Mucha
- Faculty of Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Heiner K. Berthold
- Department of Internal Medicine and Geriatrics, Bethel Clinic (EvKB), 33611 Bielefeld, Germany
| | - Ioanna Gouni-Berthold
- Center for Endocrinology, Diabetes and Preventive Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Abstract
Antiplatelet therapy is a cornerstone of secondary prevention of cardiovascular diseases (CVDs). However, current guidelines are based on data derived primarily from men, as women are generally underrepresented in trials. Consequently, there are insufficient and inconsistent data on the effect of antiplatelet drugs in women. Sex differences were reported in platelet reactivity, patient management, and clinical outcomes after treatment with aspirin, P2Y12 inhibitor, or dual antiplatelet therapy. To evaluate whether sex-specific antiplatelet therapy is needed, in this review we discuss (i) how sex affects platelet biology and response to antiplatelet agents, (ii) how sex and gender differences translate into clinical challenges and (iii) how the cardiological care in women might be improved. Finally, we highlight the challenges faced in clinical practice regarding the different needs and characteristics of female and male patients with CVD and address issues requiring further investigation.
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Affiliation(s)
- Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Independent Public Central Teaching Hospital, Warsaw, Poland
| | - Jakub M Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Independent Public Central Teaching Hospital, Warsaw, Poland
| | - Yolande Appelman
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Gurgoglione FL, Solinas E, Pfleiderer B, Vezzani A, Niccoli G. Coronary atherosclerotic plaque phenotype and physiopathologic mechanisms: Is there an influence of sex? Insights from intracoronary imaging. Atherosclerosis 2023; 384:117273. [PMID: 37730456 DOI: 10.1016/j.atherosclerosis.2023.117273] [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: 02/27/2023] [Revised: 06/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of disability and death in both women and men; considerable differences in clinical presentation, natural history and prognosis are reported between sexes. Different pathophysiological mechanisms play a major role, including sex-related and gender-related features or a combination of both. Reports from intracoronary imaging studies pointed towards morphological plaque features, which seemed to differ between men and women, albeit results reported so far were not conclusive. The purpose of this review is to shed light on differences in the pathophysiology underlying CAD in women vs men including the description of coronary plaque phenotype and mechanisms of plaque instability, as assessed by intracoronary imaging. We will also discuss potential clinical implications with the aim to move towards a sex and gender-based personalized approach in CAD patients.
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Affiliation(s)
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy.
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Kwapong YA, Sharma G, Valero-Elizondo J, Achirica MC, Ali SS, Blaha MJ, Blankstein R, Shapiro MD, Arias L, Budoff MJ, Feldman T, Cury RC, Mehta L, Fialkow J, Nasir K. The association of sex-specific hormones with coronary artery plaque characteristics from Miami Heart (MiHeart) study. Am J Prev Cardiol 2023; 14:100479. [PMID: 36950675 PMCID: PMC10025130 DOI: 10.1016/j.ajpc.2023.100479] [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: 11/15/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The association of sex-specific hormones with coronary computed tomography angiography(CCTA)-based plaque characteristics in women without cardiovascular disease is not well understood. We investigated the association of sex-specific hormones with coronary artery plaque characteristics in a contemporary multiracial cohort with no clinical coronary artery disease (CAD). Methods In this cross-sectional analysis, we utilized data from 2,325 individuals with no clinical CAD from the Miami Heart (MiHeart) study. Multivariable logistic regression models were used to investigate the association of sex hormones: sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), free and total testosterone, estradiol, with plaque characteristics among women and men. Results Of the 1,155 women, 34.2% had any plaque and 3.4% had any high-risk plaque features (HRP) while among men (n = 1170), 63.1% had any plaque and 10.4% had HRP. Among women, estradiol and SHBG were associated with lower odds of any plaque after adjusting for age and race-ethnicity (estradiol OR per SD increase: 0.87, 95%CI: 0.76-0.98; SHBG OR per SD increase: 0.82, 95%CI: 0.72-0.93) but the significance did not persist after adjustment of cardiovascular risk factors. High free testosterone was associated with higher odds of HRP (aOR:3.48, 95%CI:1.07-11.26) but null associations for the other sex hormones with HRP, in the context of limited sample size. Among men, there were no significant associations between sex-specific hormones and plaque or HRP. Conclusion Among young to middle-aged women with no clinical CAD, increasing estradiol and SHBG were associated with lower odds of any plaque and higher free testosterone was associated with HRP. Larger cohorts may be needed to validate this.
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Affiliation(s)
- Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Shozab S. Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lara Arias
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Harbor UCLA, Medical Center, Torrance, CA, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Laxmi Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, OH, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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Sex-specific features of optical coherence tomography detected plaque vulnerability related to clinical outcomes: insights from the CLIMA study. Int J Cardiovasc Imaging 2022; 39:873-881. [PMID: 36534217 DOI: 10.1007/s10554-022-02775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the different impact of optical coherence tomography (OCT)-derived vulnerable plaque features on future adverse events (AEs) according to the biological sex. METHODS The prospective multicenter CLIMA study (ClinicalTrials.gov: NCT02883088) enrolled 1003 patients with OCT plaque analysis of non-treated coronary plaques located in the proximal left anterior descending artery. Sex-specific differences in plaque composition and vulnerable features were described. We investigated the incidence of AEs, including cardiac death, any myocardial infarction and target vessel revascularization at 1-year. RESULTS Among 1003 patients, 24.6% were women. Women were older and more frequently affected by chronic kidney disease. Dyslipidemia, prior MI and smoking habit were more common in men. At OCT analysis, women had shorter plaque length (p < 0.001), ticker fibrous cap (p = 0.001), smaller maximum lipid arc (p = 0.019), lower macrophage infiltration (p < 0.001) and intra-plaque layered tissue (p = 0.007). During follow-up, 65 AEs were registered. The presence of a thin fibrous cap and a large macrophage infiltration (> 67°) predicted AEs in both sexes. The presence of macrophages (HR 3.38, p = 0.018) and a small minimum lumen area (HR 4.97, p = 0.002) were associated with AEs in women but not in men, while a large lipid arc (> 180°) was associated with AEs in men (HR 2.56, p = 0.003) but not in women. CONCLUSION This subanalysis of the CLIMA study investigated for the first-time sex-specific OCT features of plaque vulnerability associated with AEs. Local inflammation was associated with AEs in women and a large lipid arc was predictive in men. OCT may help develop sex-specific risk stratification strategies.
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Kim CH, Yang S, Zhang J, Lee JM, Hoshino M, Murai T, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen SL, Tanaka N, Matsuo H, Akasaka T, Kakuta T, Koo BK. Differences in Plaque Characteristics and Myocardial Mass. JACC: ASIA 2022; 2:157-167. [PMID: 36339124 PMCID: PMC9627886 DOI: 10.1016/j.jacasi.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022]
Abstract
Background The mechanism of the fractional flow reserve (FFR) difference according to sex has not been clearly understood. Objectives This study sought to evaluate sex differences in coronary stenosis, plaque characteristics, and left ventricular (LV) mass and their implications for physiological significance. Methods This was a post hoc analysis of a pooled population of multicenter, international prospective cohorts. Patients (166 women and 489 men) underwent coronary computed tomography angiography (CCTA) within 90 days before invasive FFR measurements were included. The minimal lumen area, percent of plaque burden, whole vessel plaque volume by composition, high-risk plaque characteristics, and LV mass were analyzed from CCTA images. Results Among 1,188 vessels analyzed, the FFR value was higher in women than that in men (0.85 ± 0.13 vs 0.82 ± 0.14; P = 0.001) despite a similar percentage of diameter stenosis between the sexes (45.9% ± 18.9% vs 46.1% ± 17.7%; P = 0.920). The composition of fibrofatty plaque + necrotic core (13.1% ± 16.9% vs 21.2% ± 19.9%; P < 0.001) and frequencies of low attenuation plaque (12.7% vs 24.5%; P < 0.001) and positive remodeling (33.8% vs 45.5%; P = 0.001) were lower in women than in men. Vessel, plaque, and lumen volumes were significantly smaller in women than that in men (all P < 0.001); however, no sex difference was observed in any of these parameters after adjustment for LV mass (all P > 0.10). Sex was not an independent predictor of the FFR value after adjustment for stenosis severity, plaque characteristics, and LV mass. Conclusions Higher FFR values for the same stenosis severity in women can be explained by fewer high-risk plaque characteristics and smaller myocardial mass in women than that in men. (CCTA-FFR Registry for Risk Prediction; NCT04037163)
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Mensink FB, ten Cate TJ, Damen SA, Roes K, Di Mario C, Singh V, Ali ZA, Skinner W, Artis A, Torguson R, Zhang C, Doros G, Garcia-Garcia HM, Mintz GS, Geuns RJV, Waksman R. Near-infrared spectroscopy predicts events in men and women: Results from the Lipid Rich Plaque study. IJC HEART & VASCULATURE 2022; 39:100985. [PMID: 35281753 PMCID: PMC8914327 DOI: 10.1016/j.ijcha.2022.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022]
Abstract
Background The Lipid Rich Plaque (LRP) study demonstrated that near-infrared spectroscopy imaging of non-obstructive lesions identified patients and segments at higher risk for subsequent non-culprit major adverse cardiac events (NC-MACE). Whether this is true for both men and women is not known. In this post hoc analysis of the LRP study, we sought to investigate whether the maximum 4-mm Lipid Core Burden Index (maxLCBI4mm) was of similar predictive value in men and women for NC-MACE. Methods Patients with an evaluable maxLCBI4mm were stratified on the basis of sex at birth. A Cox proportional-hazards model was used to assess the predictive value of maxLCBI4mm on future NC-MACE at the patient and plaque levels. The primary endpoint was cumulative incidence of NC-MACE at 24 months. Results Among 1271 patients, 388 (30.5%) were women. Women were older and had a higher cardiovascular risk profile. Cumulative incidence of NC-MACE at 24 months was 10.3% for women and 7.6% for men (log-rank p = 0.11). When comparing maxLCBI4mm > 400 to maxLCBI4mm ≤ 400, the hazard ratio (HR) for future NC-MACE was not significantly different between sexes: 2.10 (95% confidence interval [CI]: 1.28–3.44; p = 0.003) for men and 2.24 (95% CI: 1.18–4.28; p = 0.014) for women (p = 0.87). At the plaque level, the HR comparing maxLCBI4mm > 400 to maxLCBI4mm ≤ 400 was 3.49 (95% CI: 1.60–7.60, p = 0.002) for men and 4.79 (95% CI: 2.02–11.38, p < 0.001) for women, which was not significantly different (p = 0.57). Conclusions The maxLCBI4mm was of similar predictive value for NC-MACE within 24 months in men and women.
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Wentzel JJ, Papafaklis MI, Antoniadis AP, Takahashi S, Cefalo NV, Cormier M, Saito S, Coskun AU, Stone PH. Sex-related differences in plaque characteristics and endothelial shear stress related plaque-progression in human coronary arteries. Atherosclerosis 2021; 342:9-18. [PMID: 34999306 DOI: 10.1016/j.atherosclerosis.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Clinical atherosclerosis manifestations are different in women compared to men. Since endothelial shear stress (ESS) is known to play a critical role in coronary atherosclerosis development, we investigated differences in anatomical characteristics and endothelial shear stress (ESS)-related plaque growth in human coronary arteries in men compared to women. METHODS 1183 coronary arteries (male/female: 944/239) from the PREDICTION study were studied for differences in artery/plaque and ESS characteristics, and ESS-related plaque progression (6-10 months follow-up) among men and women and after stratification for age. All characteristics were derived from IVUS-based vascular profiling and reported per 3 mm-segments (13,030 3-mm-segments (male/female: 10,465/2,565)). RESULTS Coronary arteries and plaques were significantly smaller in females compared to males; but no important differences were observed in plaque burden, ESS and rate of plaque progression. Change in plaque burden was inversely related to ESS (p<0.001) with no difference between women versus men (β: -0.62 ± 0.13 vs -0.68 ± 0.05, p=0.62). However, stratification for age demonstrated that ESS-related plaque growth was more marked in young women compared to men (<55 years, β: -2.02 ± 0.61 vs -0.33 ± 0.10, p=0.007), reducing in magnitude over the age-categories up till 75 years. CONCLUSIONS Coronary artery and plaque size are smaller in women compared to men, but ESS and ESS- related plaque progression were similar. Sex-related differences in ESS-related plaque growth were evident after stratification for age. These observations suggest that although the fundamental processes of atherosclerosis progression are similar in men versus women, plaque progression may be influenced by age within gender.
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Affiliation(s)
- Jolanda J Wentzel
- Biomedical Engineering, Department of Cardiology, ErasmusMC, University Medical Center Rotterdam, the Netherlands.
| | | | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Nicholas V Cefalo
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Cormier
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Kott KA, Morel-Kopp MC, Vernon ST, Takagi Y, Di Bartolo BA, Peter K, Yang JY, Grieve SM, Ward C, Figtree GA. Association of Global Coagulation Profiles With Cardiovascular Risk Factors and Atherosclerosis: A Sex Disaggregated Analysis From the BioHEART-CT Study. J Am Heart Assoc 2021; 10:e020604. [PMID: 34622670 PMCID: PMC8751896 DOI: 10.1161/jaha.120.020604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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 the association between dysregulated coagulation and atherosclerosis is well recognized, individual assays have been of minimal value in understanding disease susceptibility. Here we investigated the association of global coagulation profiles with coronary artery disease with consideration of sex differences. Methods and Results The study included patients from the BioHEART‐CT (The BioHEART Study: Assessing Patients With Suspected Cardiovascular Disease for New Disease Markers and Risk Factors) biobank who had computed tomography coronary angiograms scored for coronary artery calcium score (CACS) and Gensini score. The cohort included 206 adult patients who were referred for clinically indicated computed tomography coronary angiography and had a median of 2 major cardiac risk factors; 50% were women and the average age was 62.6 years (±9.9 years). The overall hemostatic potential (OHP) and calibrated automated thrombography generation assays were performed on platelet‐poor plasma. CACS and Gensini score in men were significantly correlated in bivariate analysis with measures from the OHP assay, and regression models predicting disease severity by CACS or Gensini score were improved by adding the OHP assay variables in men but not in women. The calibrated automated thrombography generation assay demonstrated a more hypercoagulable profile in women than in men. The OHP assay showed hypercoagulable profiles in women with hyperlipidemia and men with obesity. Conclusions The OHP assay identified hypercoagulable profiles associated with different risk factors for each sex and was associated with CACS and Gensini score severity in men, emphasizing the associations between increased fibrin generation and reduced fibrinolysis with cardiac risk factors and early atherosclerosis. Registration Information www.anzctr.org.au. Identifier: ACTRN12618001322224.
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Affiliation(s)
- Katharine A Kott
- Cardiovascular Discovery Group Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia.,Department of Cardiology Royal North Shore Hospital Sydney Australia.,Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia
| | - Marie-Christine Morel-Kopp
- Department of Haematology and Transfusion Medicine Royal North Shore Hospital Sydney Australia.,Northern Blood Research Centre Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia
| | - Stephen T Vernon
- Cardiovascular Discovery Group Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia.,Department of Cardiology Royal North Shore Hospital Sydney Australia.,Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia
| | - Yuki Takagi
- Northern Blood Research Centre Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia
| | - Belinda A Di Bartolo
- Cardiovascular Discovery Group Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute Melbourne Australia
| | - Jean Y Yang
- Charles Perkins Centre University of Sydney Sydney Australia.,School of Mathematics and Statistics University of Sydney Sydney Australia
| | - Stuart M Grieve
- Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia.,Department of Radiology Royal Price Alfred Hospital Sydney Australia.,Imaging and Phenotyping Laboratory Charles Perkins Centre Faculty of Medicine and Health University of Sydney Australia
| | - Christopher Ward
- Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia.,Department of Haematology and Transfusion Medicine Royal North Shore Hospital Sydney Australia.,Northern Blood Research Centre Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia
| | - Gemma A Figtree
- Cardiovascular Discovery Group Kolling Institute of Medical ResearchUniversity of Sydney Sydney Australia.,Department of Cardiology Royal North Shore Hospital Sydney Australia.,Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney Australia.,Charles Perkins Centre University of Sydney Sydney Australia
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13
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Park S, Ahn JM, Park H, Kang DY, Lee PH, Kim TO, Lee J, Kim JH, Yang Y, Jeong YJ, Hyun J, Kim AR, Kim T, Oh HJ, Lee YJ, Lee JH, Jang M, Park DW, Park SJ. Comparison of Long-Term Outcomes Following Coronary Revascularization in Men-vs-Women with Unprotected Left Main Disease. Am J Cardiol 2021; 153:9-19. [PMID: 34233836 DOI: 10.1016/j.amjcard.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Abstract
Gender differences have been recognized in several aspects of coronary artery disease (CAD). However, evidence for gender differences in long-term outcomes after left main coronary artery (LMCA) revascularization is limited. We sought to evaluate the impact of gender on outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected LMCA disease. We evaluated 4,320 patients with LMCA disease who underwent CABG (n = 1,456) or PCI (n = 2,864) from the Interventional Research Incorporation Society-Left MAIN Revascularization registry. The primary outcome was a composite of death, myocardial infarction (MI), or stroke. Among 4,320 patients, 968 (22.4%) were females and 3,352 (77.6%) were males. Compared to males, females were older, had a higher prevalence of hypertension and insulin-requiring diabetes, more frequently presented with acute coronary syndrome, but had less extensive CAD and less frequent left main bifurcation involvement. The adjusted risk for the primary outcome was not different after PCI or CABG in females and males (hazard ratio [HR] 1.09; 95% confidence interval [CI]: 0.73-1.63 and HR 0.97; 95% CI: 0.80-1.19, respectively); there was no significant interaction between gender and the revascularization strategy (P for interaction = 0.775). In multivariable analysis, gender did not appear to be an independent predictor for the primary outcome. In revascularization for LMCA disease, females and males had a comparable primary composite outcome of death, MI, or stroke with either CABG or PCI without a significant interaction of gender with the revascularization strategy.
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Affiliation(s)
- Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hanbit Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Tae Oh Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Junghoon Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Ju Hyeon Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Yujin Yang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Yeong Jin Jeong
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Junho Hyun
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Ah-Ram Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Taesun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyeon Jeong Oh
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Yeon Jeong Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jeen Hwa Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Mihee Jang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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14
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Simonetto C, Rospleszcz S, Heier M, Meisinger C, Peters A, Kaiser JC. Simulating the dynamics of atherosclerosis to the incidence of myocardial infarction, applied to the KORA population. Stat Med 2021; 40:3299-3312. [PMID: 34008245 DOI: 10.1002/sim.8951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022]
Abstract
Analyzing epidemiological data with simplified mathematical models of disease development provides a link between the time-course of incidence and the underlying biological processes. Here we point out that considerable modeling flexibility is gained if the model is solved by simulation only. To this aim, a model of atherosclerosis is proposed: a Markov Chain with continuous state space which represents the coronary artery intimal surface area involved with atherosclerotic lesions of increasing severity. Myocardial infarction rates are assumed to be proportional to the area of most severe lesions. The model can be fitted simultaneously to infarction incidence rates observed in the KORA registry, and to the age-dependent prevalence and extent of atherosclerotic lesions in the PDAY study. Moreover, the simulation approach allows for non-linear transition rates, and to consider at the same time randomness and inter-individual heterogeneity. Interestingly, the fit revealed significant age dependence of parameters in females around the age of menopause, qualitatively reproducing the known vascular effects of female sex hormones. For males, the incidence curve flattens for higher ages. According to the model, frailty explains this flattening only partially, and saturation of the disease process plays also an important role. This study shows the feasibility of simulating subclinical and epidemiological data with the same mathematical model. The approach is very general and may be extended to investigate the effects of risk factors or interventions. Moreover, it offers an interface to integrate quantitative individual health data as assessed, for example, by imaging.
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Affiliation(s)
- Cristoforo Simonetto
- Institute of Radiation Medicine, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Augsburg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Munich, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
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15
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El Mahdiui M, Smit JM, van Rosendael AR, Neglia D, Knuuti J, Saraste A, Buechel RR, Teresinska A, Pizzi MN, Roque A, Magnacca M, Mertens BJ, Caselli C, Rocchiccioli S, Parodi O, Pelosi G, Scholte AJ. Sex differences in coronary plaque changes assessed by serial computed tomography angiography. Int J Cardiovasc Imaging 2021; 37:2311-2321. [PMID: 33694122 PMCID: PMC8286938 DOI: 10.1007/s10554-021-02204-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Long-term data on sex-differences in coronary plaque changes over time is lacking in a low-to-intermediate risk population of stable coronary artery disease (CAD). The aim of this study was to evaluate the role of sex on long-term plaque progression and evolution of plaque composition. Furthermore, the influence of menopause on plaque progression and composition was also evaluated. Patients that underwent a coronary computed tomography angiography (CTA) were prospectively included to undergo a follow-up coronary CTA. Total and compositional plaque volumes were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). To investigate the influence of menopause on plaque progression, patients were divided into two groups, under and over 55 years of age. In total, 211 patients were included in this analysis, 146 (69%) men. The mean interscan period between baseline and follow-up coronary CTA was 6.2 ± 1.4 years. Women were older, had higher HDL levels and presented more often with atypical chest pain. Men had 434 plaque sites and women 156. On a per-lesion analysis, women had less fibro-fatty PAV compared to men (β -1.3 ± 0.4%; p < 0.001), with no other significant differences. When stratifying patients by 55 years age threshold, fibro-fatty PAV remained higher in men in both age groups (p < 0.05) whilst women younger than 55 years demonstrated more regression of fibrous (β -0.8 ± 0.3% per year; p = 0.002) and non-calcified PAV (β -0.7 ± 0.3% per year; p = 0.027). In a low-to-intermediate risk population of stable CAD patients, no significant sex differences in total PAV increase over time were observed. Fibro-fatty PAV was lower in women at any age and women under 55 years demonstrated significantly greater reduction in fibrous and non-calcified PAV over time compared to age-matched men. (ClinicalTrials.gov number, NCT04448691.)
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Juhani Knuuti
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Maria N Pizzi
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Chiara Caselli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Oberdan Parodi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy.,Institute of Information Science and Technologies CNR, Pisa, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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16
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Hara H, Takahashi K, van Klaveren D, Wang R, Garg S, Ono M, Kawashima H, Gao C, Mack M, Holmes DR, Morice MC, Head SJ, Kappetein AP, Thuijs DJFM, Onuma Y, Noack T, Mohr FW, Davierwala PM, Serruys PW. Sex Differences in All-Cause Mortality in the Decade Following Complex Coronary Revascularization. J Am Coll Cardiol 2021; 76:889-899. [PMID: 32819461 DOI: 10.1016/j.jacc.2020.06.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated. OBJECTIVES The aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years. METHODS The SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease. RESULTS Of 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952). CONCLUSIONS Female sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).
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Affiliation(s)
- Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands; Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Masafumi Ono
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Michael Mack
- Department of Cardiothoracic Surgery, Baylor Scott and White Healthcare, Dallas, Texas
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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17
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A sex paradox in clinical outcomes following complex percutaneous coronary intervention. Int J Cardiol 2020; 329:67-73. [PMID: 33278415 DOI: 10.1016/j.ijcard.2020.11.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the number of complex percutaneous coronary intervention (CPCI) procedures is increasing, data regarding sex-related outcomes following CPCI are scarce. METHODS We retrospectively analyzed data of patients enrolled in a single-center registry between 2009 and 2017. Patients were divided into two groups (CPCI and non-CPCI) stratified by sex. CPCI was defined as any PCI procedure with ≥1 of the following characteristics: ≥3 target vessels/lesions, ≥3 stents implanted, bifurcation with ≥2 stents, stent length > 60 mm, or chronic total occlusion. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization, at oneon-year follow-up. RESULTS Among 20,419 patients, 5004 (24.5%) underwent CPCI of whom 25.6% (n = 1281) women and 74.4% (n = 3723) men. Women presented with more comorbidities yet less complex coronary anatomy than men (syntax score: 19.5 ± 10.3 vs. 20.6 ± 10.7, p = 0.009). Moreover, women were more likely to fulfill a single rather than multiple CPCI criteria. At one year, a higher rate of MACE occurred in women (14.0% vs. 11.6%, p = 0.02). After multivariable adjustment for confounders, the risk of MACE at one year was similar among both sexes (HR:1.04, 95% CI [0.85-1.26], p = 0.71), without significant interaction between the complexity of the procedure and sex (p-interaction = 0.96). Nonetheless, the risk of MI was significantly higher in women than men undergoing CPCI (HR:1.63, 95% CI [1.12-2.38], p = 0.01). CONCLUSIONS Despite presenting with less challenging lesions than men, women had a higher rate of MI at one year following CPCI, even after adjusting for potential confounders.
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18
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Manzo-Silberman S. Percutaneous coronary intervention in women: is sex still an issue? Minerva Cardioangiol 2020; 68:393-404. [PMID: 32326680 DOI: 10.23736/s0026-4725.20.05203-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease among women presents differences in terms of clinical presentation and pathophysiology. To date, women present worse prognoses with more events and higher mortality rate. One the one hand, they are less likely addressed for invasive therapy. One the other hand, revascularization procedures, whether by bypass or by percutaneous coronary intervention, are associated with higher rates of complications and poorer prognosis. Despite higher risk factor burden and comorbidity, women are less affected by obstructive disease and plaque characteristics are more favorable than among men. Abnormalities of endothelial function and micro vascular flow reserve could explain part of the high prevalence of symptoms of angina observed among women. Due to the worse prognosis of microvascular dysfunction, particularly in women, proper diagnosis is mandatory and deserve invasive management. Outcome following ST elevation myocardial infarction is still more severe among women with higher in-hospital mortality, but sex discrepancies are observed even in elective percutaneous coronary intervention. However, improvement of techniques, drugs and devices benefited to both men and women and tend to decrease gender gap. Especially, changes in the design of newer-generation drug-eluting stents (DES) may be particularly important for women. Female sex remains a potent predictor of higher risk of bleeding and vascular complication; thus important efforts should be promoted to develop bleeding avoidance strategies. Sex-based differences still deserve dedicated investigations in terms of physiopathology, particular hormonal impacts, and specific responses to drugs and devices.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Service of Cardiology, Lariboisière University Hospital, Paris, France - .,UMRS 942, University of Paris, Paris, France -
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19
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Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, Mendelson MA, Wood MJ, Volgman AS, Mieres JH. Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps. Circ Cardiovasc Qual Outcomes 2019; 11:e004437. [PMID: 29449443 DOI: 10.1161/circoutcomes.117.004437] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.
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Affiliation(s)
- Niti R Aggarwal
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.).
| | - Hena N Patel
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Laxmi S Mehta
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Rupa M Sanghani
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Gina P Lundberg
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Sandra J Lewis
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Marla A Mendelson
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Malissa J Wood
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Annabelle S Volgman
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Jennifer H Mieres
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
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20
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Štěchovský C, Hájek P, Horváth M, Veselka J. Effect of stenting on the near-infrared spectroscopy-derived lipid core burden index of carotid artery plaque. EUROINTERVENTION 2019; 15:e289-e296. [PMID: 29957596 DOI: 10.4244/eij-d-17-01054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Catheter-based intravascular near-infrared spectroscopy (NIRS) detects a lipid signal from atherosclerotic plaque. The aim of this study was to describe the effect of carotid artery stenting (CAS) on the lipid signal in a carotid stenosis. METHODS AND RESULTS We performed NIRS combined with intravascular ultrasound (IVUS) during 120 CAS procedures. Minimal luminal area (MLA) and plaque burden (PB) at the site of MLA were measured with IVUS and lipid core burden index (LCBI), maximal LCBI in a 4 mm segment of the artery (LCBImax) and LCBI in a 4 mm segment at the site of MLA (LCBImla) with NIRS-derived chemograms. NIRS-IVUS imaging was performed at baseline, after stent implantation and after balloon post-dilatation. The most common lesion type was the fibrocalcific plaque (76%). Lipid-rich plaque (LCBImax ≥400) was present in 33% of carotid stenoses and in 20% at the site of MLA. Median MLA increased significantly from baseline to stent implantation (3.63 mm2 to 5.56 mm2, p<0.001) and to post-dilatation (5.56 mm2 to 12.03 mm2, p<0.001). Median LCBI, LCBImax and LCBImla significantly decreased from baseline to stent implantation: LCBI (60 to 8, p<0.001), LCBImax (294 to 60, p<0.001) and LCBImla (124 to 0, p<0.001). Post-dilatation of the stent had no further significant effect on median LCBI (8 to 5, p=0.890), LCBImax (60 to 50, p=0.690) and LCBImla (0 to 0, p=0.438). CONCLUSIONS Carotid artery stenting significantly reduced the NIRS-derived lipid core burden index at the stented segment.
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Affiliation(s)
- Cyril Štěchovský
- Department of Cardiology, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
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21
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Ten Haaf ME, Bax M, Ten Berg JM, Brouwer J, Van't Hof AW, van der Schaaf RJ, Stella PR, Tjon Joe Gin RM, Tonino PA, de Vries AG, Zijlstra F, Boersma E, Appelman Y. Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Neth Heart J 2019; 27:263-271. [PMID: 30989470 PMCID: PMC6470244 DOI: 10.1007/s12471-019-1271-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands. METHODS This registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a cardiac catheterisation between 2010-2012. We evaluated sex differences in clinical and procedural characteristics and 1‑year mortality. RESULTS A total of 29,265 ACS patients (8,720 women and 20,545 men) were registered. Women were on average 4.5 years older (68.5 vs 63.0 years, p < 0.001) and had a higher prevalence of hypertension (62.7 vs 49.8%, p < 0.001) and insulin-dependent diabetes mellitus (9.6 vs 6.8%, p < 0.001) than men. Women less often presented with ST-elevation myocardial infarction (43.7% vs 47.6%, p < 0.001) and appeared to have less extensive coronary artery disease than men. Women less often underwent coronary angiography by radial access (52.5 vs 55.9%, p < 0.001). One-year mortality was higher in women than in men (7.3% and 5.6%, p < 0.001). More specific, the relationship between sex and mortality was age-dependent and showed higher mortality in women ≤71 years, but lower mortality in older women compared with men (p-interaction <0.001). CONCLUSION We found differences in clinical and procedural characteristics and outcome between women and men admitted for ACS, which are in line with other Western countries. The limitations of our registry, based on existing local databases, can be overcome by the use of the prospective Netherlands Heart Registry that is currently in development.
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Affiliation(s)
- M E Ten Haaf
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands.
- The Netherlands Heart Institute, Utrecht, The Netherlands.
| | - M Bax
- Department of Cardiology, HAGA Hospital, The Hague, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Brouwer
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A W Van't Hof
- Department of Cardiology, MUMC, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland MC, Heerlen, The Netherlands
| | - R J van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis location East, Amsterdam, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Tjon Joe Gin
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - P A Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A G de Vries
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - F Zijlstra
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
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22
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Tian J, Wang X, Tian J, Yu B. Gender differences in plaque characteristics of nonculprit lesions in patients with coronary artery disease. BMC Cardiovasc Disord 2019; 19:45. [PMID: 30808307 PMCID: PMC6390304 DOI: 10.1186/s12872-019-1023-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/15/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although numerous reports suggest sex-related differences in atherosclerosis, limited data describing gender-associated differences in plaque morphology and composition are currently available. The aim of the present study was to compare coronary nonculprit plaque characteristics in women and men with coronary artery disease (CAD) by optical coherence tomography (OCT). METHODS This was a retrospective study. A total of 187 nonculprit plaques were identified in 103 patients with CAD who underwent OCT imaging of all 3 coronary arteries. These patients included 77 (74.8%) men and 26 (25.2%) women. RESULTS Female patients were significantly older than males (mean age, 70.8 ± 7.3 vs 60.8 ± 9.8 years; P < 0.001) and less likely to be current smokers (P = 0.007). OCT analysis included the presence of lipid-rich plaque, maximum lipid arc, lipid-core length, lipid index (LI), fibrous cap thickness, and the incidence of thin-cap fibroatheroma (TCFA). Nonculprit plaques in men exhibited greater lipid-core length and LI compared with those of women (9.4 ± 4.5 vs. 7.3 ± 4.3 mm, P = 0.024; 1615.1 ± 893.8 vs. 1237.8 ± 859.8, P = 0.035, respectively). In the univariate linear regression model, sex and current smoker were all associated with a larger LI, whereas only use of statin was independent risk factor for a larger LI in multivariate analysis. CONCLUSIONS Coronary nonculprit plaques in male patients with CAD contain larger lipid cores than those of female patients.
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Affiliation(s)
- Jiangtian Tian
- Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.,Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Xuedong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Bo Yu
- Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. .,Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
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23
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Chieffo A, Buchanan GL, Mehilli J, Capodanno D, Kunadian V, Petronio AS, Mikhail GW, Capranzano P, Gonzal N, Karam N, Manzo-Silberman S, Schüpke S, Byrne RA, Capretti G, Appelman Y, Morice MC, Presbitero P, Radu M, Mauri J. Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee. EUROINTERVENTION 2018; 14:e1227-e1235. [PMID: 29786536 DOI: 10.4244/eij-d-18-00225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.
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24
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Outcomes After Coronary Stenting or Bypass Surgery for Men and Women With Unprotected Left Main Disease. JACC Cardiovasc Interv 2018; 11:1234-1243. [DOI: 10.1016/j.jcin.2018.03.051] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 01/24/2023]
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Chandrasekhar J, Gill A, Mehran R. Acute myocardial infarction in young women: current perspectives. Int J Womens Health 2018; 10:267-284. [PMID: 29922097 PMCID: PMC5995294 DOI: 10.2147/ijwh.s107371] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.
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Affiliation(s)
- Jaya Chandrasekhar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amrita Gill
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY.,Saint Louis University, St Louis, MO, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Kerkhof PLM, Khamaganova I. Sex-Specific Cardiovascular Comorbidities with Associations in Dermatologic and Rheumatic Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:489-509. [DOI: 10.1007/978-3-319-77932-4_30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Li S, Guo YL, Zhao X, Zhang Y, Zhu CG, Wu NQ, Xu RX, Qing P, Gao Y, Li XL, Sun J, Liu G, Dong Q, Li JJ. Novel and traditional lipid-related biomarkers and their combinations in predicting coronary severity. Sci Rep 2017; 7:360. [PMID: 28336922 PMCID: PMC5428477 DOI: 10.1038/s41598-017-00499-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/02/2017] [Indexed: 12/19/2022] Open
Abstract
We investigated simultaneously traditional and novel lipid indices, alone or in combination, in predicting coronary severity assessed by Gensini score (GS) in 1605 non-lipid-lowering-drug-treated patients undergoing coronary angiography. Firstly, levels of triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), non high density lipoprotein cholesterol (non-HDL-C), apolipoprotein (apo) B, lipoprotein (a) [Lp(a)], proprotein convertase subtilisin/kexin type 9 (PCSK9), apoC3, small dense LDL (sdLDL) and large HDL were increased, while HDL-C and apoA1 levels were decreased as GS status (all p for trend <0.05). However, gender stratification analyses showed similar associations between lipids and GS in men but not in women. Secondly, multiple logistic regression analyses indicated that the 12 indices were predictive for high GS (≥24) but not for low GS (1–23) compared with normal coronary (GS = 0) except for TG (neither) and apoB (both). Finally, we found that interactions between two indices with mutually exclusive composition were positively associated with GS status except for couples of TC + apoC3, apoB/PCSK9/apoC3 + sdLDL-C. Concordant elevations in the two showed the highest predictive values for high GS (all p for trend <0.05). Therefore, lipid biomarkers were associated with coronary severity and their adverse changes in combination emerged greater risks in men but not in women.
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Affiliation(s)
- Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Xi Zhao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ping Qing
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ying Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jing Sun
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Geng Liu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Qian Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
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