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Garatti L, Tavecchia G, Milani M, Rizzi I, Tondelli D, Bernasconi D, Maloberti A, Oliva F, Sacco A. Unveiling the gender gap in ST-elevation myocardial infarction: a retrospective analysis of a single Italian center gender disparities in STEMI-ACS. J Cardiovasc Med (Hagerstown) 2024; 25:239-242. [PMID: 38305123 DOI: 10.2459/jcm.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Laura Garatti
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giovanni Tavecchia
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Martina Milani
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Ilaria Rizzi
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Daniele Tondelli
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Fabrizio Oliva
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Alice Sacco
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
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Bender U, Norris CM, Dreyer RP, Krumholz HM, Raparelli V, Pilote L. Impact of Sex- and Gender-Related Factors on Length of Stay Following Non-ST-Segment-Elevation Myocardial Infarction: A Multicountry Analysis. J Am Heart Assoc 2023; 12:e028553. [PMID: 37489737 PMCID: PMC10492965 DOI: 10.1161/jaha.122.028553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 07/26/2023]
Abstract
Background Gender-related factors are psycho-socio-cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex- and gender-related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non-ST-segment-elevation myocardial infarction remains unknown. Methods and Results This observational cohort study combined and analyzed data from the GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non-ST-segment-elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixty-three patients were excluded for missing LOS, and 2938 were excluded because of no non-ST-segment-elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; P<0.001), unemployment (0.63 days; P=0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, -1.0 days; all P<0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12-month all-cause mortality. Conclusions Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non-ST-segment-elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.
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Affiliation(s)
- Uri Bender
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
| | - Colleen M. Norris
- Faculties of Nursing, Medicine and School of Public HealthUniversity of AlbertaEdmontonCanada
| | - Rachel P. Dreyer
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCTUSA
- Department of BiostatisticsYale School of Public HealthNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraItaly
- University Center for Studies on Gender MedicineUniversity of FerraraItaly
| | - Louise Pilote
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
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Ngaruiya C. When women win, we all win-Call for a gendered global NCD agenda. FASEB Bioadv 2022; 4:741-757. [PMID: 36479209 PMCID: PMC9721093 DOI: 10.1096/fba.2021-00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Gender is a social determinant of health, interacting with other factors such as income, education, and housing and affects health care access and health care outcomes. This paper reviews key literature and policies on health disparities and gender disparities within health. It examines noncommunicable disease (NCD) health outcomes through a gender lens and challenges existing prevailing measures of success for NCD outcomes that focus primarily on mortality. Chronic respiratory disease, one of the four leading contributors to NCD mortality, is highlighted as a case study to demonstrate the gender gap. Women have different risk factors and higher morbidity for chronic respiratory disease compared to men but morbidity is shadowed by a penultimate research focus on mortality, which results in less attention to the gap in women's NCD outcomes. This, in turn, affects how resources, programs, and interventions are implemented. It will likely slow progress in reducing overall NCD burden if we do not address risk factors in an equitable fashion. The article closes with recommendations to address these gender gaps in NCD outcomes. At the policy level, increasing representation and inclusion in global public health leadership, prioritizing NCDs among marginalized populations by global health societies and political organizations, aligning the gendered global NCD agenda with other well-established movements will each catalyze change for gender-based disparities in global NCDs specifically. Lastly, incorporating gender-based indicators and targets in major NCD-related goals and advancing gender-based NCD research will strengthen the evidence base for women's unique NCD risks and health outcomes.
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Affiliation(s)
- Christine Ngaruiya
- Section of Global Health and International Emergency Medicine, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Yale Network for Global Noncommunicable Diseases (NGN)Yale School of MedicineNew HavenConnecticutUSA
- Women Lift Health Women Leaders in Global Health (2020)https://www.womenlifthealth.org/profile/christine‐ngaruiya/
- Kenyan Doctors USAhttps://www.kedusa.org
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Jariwala P, Padmavathi A, Patil R, Chawla KD, Jadhav K. The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A gender-based multi-center study. Indian Heart J 2022; 74:282-288. [PMID: 35843268 PMCID: PMC9453019 DOI: 10.1016/j.ihj.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n = 113), while 6.9% were young men (n = 254). Traditional risk factors such as hypertension (p = 0.73), diabetes (p = 0.61), and family history of premature CAD (p = 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p = 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women.
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Affiliation(s)
- Pankaj Jariwala
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India.
| | | | - Rahul Patil
- Ruby Hall Clinic, Sangamvadi, Pune, Maharashtra 411001, India
| | - Kamal Deep Chawla
- Sterling Hospitals, Race Course Road, Opposite Inox Cinema Hari Nagar, Circle West, Vadodara, Gujarat 390007, India
| | - Kartik Jadhav
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India
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Plakht Y, Elkis Hirsch Y, Shiyovich A, Abu Tailakh M, Liberty IF, Gilutz H. Heterogenicity of diabetes as a risk factor for all-cause mortality after acute myocardial infarction: Age and sex impact. Diabetes Res Clin Pract 2021; 182:109117. [PMID: 34756959 DOI: 10.1016/j.diabres.2021.109117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality. METHODS A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex. OUTCOME up-to-10 years post-discharge all-cause mortality. RESULTS 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR = 1.622 (p < 0.001). Females (adjHR = 1.085, p = 0.052) and increased age (adjHR = 1.056 for one-year increase, p < 0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at < 50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups. CONCLUSIONS The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI.
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Affiliation(s)
- Ygal Plakht
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Department of Emergency Medicine, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel.
| | - Yuval Elkis Hirsch
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Cardiothoracic Intensive Care Unit, Rabin Medical Center, Zeev Jabotinsky St., 39, Petah Tikva 49100, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Zeev Jabotinsky St., 39, Petah Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, 69978, Israel
| | - Muhammad Abu Tailakh
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Nursing Research Unit, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel
| | - Idit F Liberty
- Diabetes Clinic, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel
| | - Harel Gilutz
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel
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Engelbertz C, Pinnschmidt HO, Freisinger E, Reinecke H, Schmitz B, Fobker M, Schmieder RE, Wegscheider K, Breithardt G, Pavenstädt H, Brand E. Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry. Clin Res Cardiol 2021; 110:1625-1636. [PMID: 34036426 PMCID: PMC8484247 DOI: 10.1007/s00392-021-01864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiovascular morbidity and mortality are closely linked to chronic kidney disease (CKD). Sex-specific long-term outcome data of patients with coronary artery disease (CAD) and CKD are scarce. METHODS In the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Long-term outcome was evaluated using survival analysis and multivariable Cox-regression models. RESULTS At enrollment, women were significantly older than men, and suffered from more comorbidities like CKD, hypertension, diabetes mellitus, and multivessel coronary disease. Regarding long-term mortality, no sex-specific differences were observed (Kaplan-Meier survival estimates: 69% in women vs. 69% in men, plog-rank = 0.7). Survival rates decreased from 89% for patients without CKD at enrollment to 72% for patients with CKD stages 1-2 at enrollment and 49% for patients with CKD stages 3-5 at enrollment (plog-rank < 0.001). Cox-regression analysis revealed that sex or multivessel coronary disease were no independent predictors of long-term mortality, while age, CKD stages 3-5, albumin/creatinine ratio, diabetes, valvular heart disease, peripheral artery disease, and left-ventricular ejection fraction were predictors of long-term mortality. CONCLUSIONS Sex differences in CAD patients mainly exist in the cardiovascular risk profile and the extent of CAD. Long-term mortality was not depended on sex or multivessel disease. More attention should be given to treatment of comorbidities such as CKD and peripheral artery disease being independent predictors of death. Clinical Trail Registration ClinicalTrials.gov Identifier: NCT00679419.
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Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Boris Schmitz
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Manfred Fobker
- Center of Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Günter Breithardt
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Hermann Pavenstädt
- Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany.
- Allg. Innere Medizin sowie Nieren- und Hochdruckkrankheiten und Rheumatologie, Medizinische Klinik D, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
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De Bacquer D, Ueda P, Reiner Ž, De Sutter J, De Smedt D, Lovic D, Gotcheva N, Fras Z, Pogosova N, Mirrakhimov E, Lehto S, Jernberg T, Kotseva K, Rydén L, Wood D, De Backer G. Prediction of recurrent event in patients with coronary heart disease: the EUROASPIRE Risk Model. Eur J Prev Cardiol 2020; 29:328-339. [PMID: 33623999 DOI: 10.1093/eurjpc/zwaa128] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with established atherosclerotic cardiovascular disease (CVD) are at very high risk for developing recurrent events. Since this risk varies a lot between patients there is a need to identify those in whom an even more intensive secondary prevention strategy should be envisaged. Using data from the EUROASPIRE IV and V cohorts of coronary heart disease (CHD) patients from 27 European countries, we aimed at developing and internally and externally validating a risk model predicting recurrent CVD events in patients aged < 75 years. METHODS AND RESULTS Prospective data were available for 12 484 patients after a median follow-up time of 1.7 years. The primary endpoint, a composite of fatal CVD or new hospitalizations for non-fatal myocardial infarction (MI), stroke, heart failure, coronary artery bypass graft, or percutaneous coronary intervention (PCI), occurred in 1424 patients. The model was developed based on data from 8000 randomly selected patients in whom the association between potential risk factors and the incidence of the primary endpoint was investigated. This model was then validated in the remaining 4484 patients. The final multivariate model revealed a higher risk for the primary endpoint with increasing age, a previous hospitalization for stroke, heart failure or PCI, a previous diagnosis of peripheral artery disease, self-reported diabetes and its glycaemic control, higher non-high-density lipoprotein cholesterol, reduced renal function, symptoms of depression and anxiety and living in a higher risk country. The model demonstrated excellent internal validity and proved very adequate in the validation cohort. Regarding external validity, the model demonstrated good discriminative ability in 20 148 MI patients participating in the SWEDEHEART register. Finally, we developed a risk calculator to estimate risks at 1 and 2 years for patients with stable CHD. CONCLUSION In patients with CHD, fatal and non-fatal rates of recurrent CVD events are high. However, there are still opportunities to optimize their management in order to prevent further disease or death. The EUROASPIRE Risk Calculator may be of help to reach this goal.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Peter Ueda
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Johan De Sutter
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Dragan Lovic
- Cardiology Department, School of Medicine, Clinic for Internal Disease Intermedica, Hypertensive Centre, Singidunum University, Nis, Serbia
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Zlatko Fras
- Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nana Pogosova
- National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.,National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, London, UK.,National University of Ireland, Galway, Ireland
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Heart and Lung Institute, Imperial College London, London, UK.,National University of Ireland, Galway, Ireland
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
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O'Neil A, Thompson K, Russell JD, Norton R. Inequalities and Deteriorations in Cardiovascular Health in Premenopausal US Women, 1990-2016. Am J Public Health 2020; 110:1175-1181. [PMID: 32552022 PMCID: PMC7349459 DOI: 10.2105/ajph.2020.305702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
Coronary heart disease (CHD) mortality rates in the United States have declined by up to two thirds in recent decades. Closer examination of these trends reveals substantial inequities in the distribution of mortality benefits. It is worrying that the uneven distribution of CHD that exists from lowest to highest social class-the social gradient-has become more pronounced in the United States since 1990 and is most pronounced for women.Here we consider ways in which this trend disproportionately affects premenopausal women aged 35 to 54 years. We apply a social determinants of health framework focusing on intersecting axes of inequalities-notably gender, class, ethnicity, geographical location, access to wealth, and class-among other power relations to which young and middle-aged women are especially vulnerable, and we argue that increasing inequalities may be driving these unprecedented deteriorations. We conclude by discussing interventions and policies to target and alleviate inequality axes that have potential to promote greater equity in the distribution of CHD mortality and morbidity gains.The application of this framework in the context of women's cardiovascular health can help shed light regarding why we are seeing persistently poorer outcomes for premenopausal US women.
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Affiliation(s)
- Adrienne O'Neil
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Kelly Thompson
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Josephine D Russell
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention. J Cardiovasc Nurs 2019; 34:410-417. [PMID: 31365439 DOI: 10.1097/jcn.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients. OBJECTIVE The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention. METHODS A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model. RESULTS Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it. CONCLUSIONS Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
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Schmidt KES, Quadros ASD, Moura MR, Gottschall CAM, Schmidt MM. Anger and Coronary Artery Disease in Women Submitted to Coronary Angiography: A 48-Month Follow-Up. Arq Bras Cardiol 2018; 111:410-416. [PMID: 30281687 PMCID: PMC6173346 DOI: 10.5935/abc.20180165] [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: 08/11/2017] [Accepted: 04/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Anger control was significantly lower in patients with coronary artery
disease (CAD), regardless of traditionally known risk factors, occurrence of
prior events or other anger aspects in a previous study of our research
group. Objective To assess the association between anger and CAD, its clinical course and
predictors of low anger control in women submitted to coronary
angiography. Methods This is a cohort prospective study. Anger was assessed by use of
Spielberger’s State-Trait Anger Expression Inventory (STAXI). Women were
consecutively scheduled to undergo coronary angiography, considering CAD
definition as ≥ 50% stenosis of one epicardial coronary artery. Results During the study, 255 women were included, being divided into two groups
according to their anger control average (26.99). Those with anger control
below average were younger and had a family history of CAD. Patients were
followed up for 48 months to verify the occurrence of major cardiovascular
events. Conclusion Women with CAD undergoing coronary angiography had lower anger control, which
was associated with age and CAD family history. On clinical follow-up,
event-free survival did not significantly differ between patients with anger
control above or below average.
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Affiliation(s)
| | | | - Mauro Regis Moura
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | | | - Márcia Moura Schmidt
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
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Di Mauro M, Totaro A, Foschi M, Calafiore AM. Gender and surgical revascularization: there is a light at the end of the tunnel? J Thorac Dis 2018; 10:S2202-S2205. [PMID: 30123561 DOI: 10.21037/jtd.2018.06.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Di Mauro
- Department of Cardiovascular Disease, University of L'Aquila, L'Aquila, Italy
| | - Antonio Totaro
- Cardiology and Cardiac Surgery, John Paul II Foundation, Campobasso, Italy
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Gender-Related Particularities in Acute Myocardial Infarction – a Study on a Patient Cohort from North East Romania. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Introduction: Cardiovascular disease is the leading cause of death among women irrespective of race or ethnicity, and about half of these deaths are caused by coronary artery disease. Several studies have reported that cardiovascular diseases manifest themself with a delay of about 7–10 years in women and that they have higher in-hospital mortality. It has not yet been established whether female gender itself, through biological and sociocultural differences, represents a risk factor for early in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI). The aim of our study was to identify the angiographic particularities in women with STEMI from North East Romania.
Material and Methods: For one year, 207 (31.7%) women and 445 (68.3%) men diagnosed with acute myocardial infarction were hospitalized in the Cardiology Clinic of the “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases in Iași, Romania.
Results: The highest incidence of symptom onset was between 6:00 a.m. and 12:00 a.m., this morning polarization being more obvious in women. Within the first two hours of admission to the hospital, coronary angiography was performed in 78.1% of men and only 67.3% of women, the difference being statistically significant (p <0.05). We found that a large number of women had multivascular coronary disease (47.9% vs. 42.3%). At the same time, we found that left main disease and multivascular disease were more frequent in women than in men (3.8% vs. 0.7%, p = 0.001 for left main plus two-vessel disease, and 19.4% vs. 14.8%, p = 0.0005 for three-vessel disease).
Conclusions: In women, coronary events began more frequently in the morning, with atypical symptoms; also, fewer women presented to the hospital within the first 12 hours after the onset of the acute event. Compared to men, women from North East Romania present a higher incidence of multivascular atherosclerotic coronary lessions, indicating a higher severity of STEMI in the female population from this geographical area.
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Szewczyk-Golec K, Grzelakowski P, Ługowski T, Kędziora J. The effects of percutaneous transluminal coronary intervention on biomarkers of oxidative stress in the erythrocytes of elderly male patients. Redox Rep 2017; 22:315-322. [PMID: 27866469 PMCID: PMC6837639 DOI: 10.1080/13510002.2016.1257754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Oxidative stress plays a key role in the pathogenesis of coronary artery disease. The aim of this study was to compare the effects of percutaneous transluminal coronary angioplasty (PTCA) and elective coronary angiography (EC) on erythrocytic antioxidant defense in elderly male patients. METHODS Twenty-three stable angina pectoris (SAP) patients undergoing PTCA and 18 patients with ischemic symptoms scheduled to undergo diagnostic EC were included in the study. The concentrations of malondialdehyde (MDA) and reduced glutathione (GSH) and the activities of Zn,Cu-superoxide dismutase (SOD-1), catalase (CAT), and cytosolic glutathione peroxidase (GSH-Px) were examined in the erythrocytes before, immediately after and 2 weeks following PTCA or EC. RESULTS The MDA concentrations were significantly higher and SOD-1, CAT, and GSH-Px activities were significantly lower in the PTCA group than in the EC group at baseline. Two weeks after treatment, the activities of the enzymes significantly increased in both groups, whereas the MDA concentrations decreased only in the PTCA patients. CONCLUSIONS The results confirm that an advanced state of atherosclerosis is related to greater levels of oxidative stress. The study indicates that both procedures may induce antioxidant defenses; however, PTCA exclusively induces a long-term reduction in lipid peroxidation.
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Affiliation(s)
- Karolina Szewczyk-Golec
- Chair of Medical Biology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Paweł Grzelakowski
- Clinic of Cardiology and Cardiac Surgery, 10. Military Training Hospital, Bydgoszcz, Poland
| | - Tomasz Ługowski
- Clinic of Cardiology and Cardiac Surgery, 10. Military Training Hospital, Bydgoszcz, Poland
| | - Józef Kędziora
- Department of Biochemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Bouriche F, Yvorra S, Hassan A, Paganelli F, Bonello L, Luigi S, Attia F. [Management of NSTEMI in a hospital without interventional cardiology and without use of GRACE score: Does the clinician appreciation match the GRACE score calculated retrospectively for the coronarography delay?]. Ann Cardiol Angeiol (Paris) 2017; 66:288-294. [PMID: 29029775 DOI: 10.1016/j.ancard.2017.09.014] [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: 09/16/2016] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The management of non-ST segment elevation acute coronary syndromes (NSTEACS) remains an issue for mobidity, mortality, and an economic stake. The first aim of the study was to evaluate the additional value of the GRACE score for the compliance with the recommended times to coronary angiography in an hospital without interventional cardiology. We also analysed the in-hospital and 6-month mortality and the predictive factors of compliance for the coronarography delays. METHODS Retrospective monocenter cross-sectional study including consecutive patients with chest pain suggestive of a NSTEACS during 1 year. Data of the delay to coronarography were collected and GRACE score was calculated a posteriori. RESULTS The time to perform coronary angiography was non-compliant in 49% of cases (27 patients out of 55). The calculation of the GRACE score would have allowed correcting the delay for two patients of our cohort. Clinical appreciation, troponin elevation, ECG modifications were associated with the delay compliance. Age <75 years predisposed to recommended delays. Renal failure and history of coronaropathy were significantly associated with non compliant delays. A non-compliant delay was significantly associated with higher mortality. CONCLUSION In our experience, the knowledge of the GRACE score had little impact on the timing of coronary angiography. However, as a predictor of mid and long term mortality, GRACE score remains SCA ST+ useful to intensify surveillance of high-risk patients.
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Affiliation(s)
- F Bouriche
- Centre hospitalier de Martigues, 3, boulevard des Rayettes, 13500 Martigues, France.
| | - S Yvorra
- Centre hospitalier de Martigues, 3, boulevard des Rayettes, 13500 Martigues, France
| | - A Hassan
- Centre hospitalier de Martigues, 3, boulevard des Rayettes, 13500 Martigues, France
| | - F Paganelli
- Centre hospitalo-universitaire Nord, chemin des Bourrely, 13015 Marseille, France
| | - L Bonello
- Centre hospitalo-universitaire Nord, chemin des Bourrely, 13015 Marseille, France
| | - S Luigi
- Centre hospitalier de Martigues, 3, boulevard des Rayettes, 13500 Martigues, France
| | - F Attia
- Centre hospitalier de Martigues, 3, boulevard des Rayettes, 13500 Martigues, France
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Dong X, Cai R, Sun J, Huang R, Wang P, Sun H, Tian S, Wang S. Diabetes as a risk factor for acute coronary syndrome in women compared with men: a meta-analysis, including 10 856 279 individuals and 106 703 acute coronary syndrome events. Diabetes Metab Res Rev 2017; 33. [PMID: 28103417 DOI: 10.1002/dmrr.2887] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 09/17/2016] [Accepted: 01/16/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diabetes mellitus is a significant cause of death and disability worldwide and is a strong risk factor for acute coronary syndrome (ACS). Whether diabetes confers the same excess risk of ACS in both sexes is unknown. Therefore, we undertook a meta-analysis to estimate the relative risk (RR) for ACS associated with diabetes in men and women. METHODS We systematically searched PubMed, Embase, and Cochrane Library databases for both case-control and cohort studies published between January 1, 1966, and January 1, 2015. Studies were included if they reported sex-specific estimates of the RR, hazard ratio, or odds ratio for the association between diabetes and ACS. We pooled the sex-specific RR and the ratio between women and men using a random-effect model with inverse-variance weighting. RESULTS We included 9 case-control and 10 cohort studies with data for 10 856 279 individuals and at least 106 703 fatal and nonfatal ACS events. The pooled maximum-adjusted RR of ACS associated with diabetes was 2.46 (95% CI, 1.92-3.17) in women and 1.68 (95% CI, 1.39-2.04) in men. In patients with diabetes compared with those without diabetes, women had a significantly greater risk of ACS-the pooled women-to-men RR and the ratio of relative risks was 1.38 (95% CI, 1.25-1.52; P < .001), with no evidence of publication bias. CONCLUSIONS The excess risk of ACS associated with diabetes is significantly higher in women than in men. This finding may be explained by more adverse cardiovascular risk profiles and suggests that further work is needed to clarify the relevant biological, behavioural, and social mechanisms.
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Affiliation(s)
- Xue Dong
- Department of Endocrinology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Rongrong Cai
- Medical School of Southeast University, Nanjing, China
| | - Jie Sun
- Medical School of Southeast University, Nanjing, China
| | - Rong Huang
- Medical School of Southeast University, Nanjing, China
| | - Pin Wang
- Medical School of Southeast University, Nanjing, China
| | - Haixia Sun
- Medical School of Southeast University, Nanjing, China
| | - Sai Tian
- Medical School of Southeast University, Nanjing, China
| | - Shaohua Wang
- Department of Endocrinology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
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Worrall-Carter L, MacIsaac A, Scruth E, Rahman MA. Gender difference in the use of coronary interventions for patients with acute coronary syndrome: Experience from a major metropolitan hospital in Melbourne, Australia. Aust Crit Care 2017; 30:3-10. [DOI: 10.1016/j.aucc.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/20/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
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de Andrade CRM, Silva ELC, da Matta MDFB, Castier MB, Rosa MLG, Gomes MB. Vascular or chronological age: which is the better marker to estimate the cardiovascular risk in patients with type 1 diabetes? Acta Diabetol 2016; 53:925-933. [PMID: 27528365 DOI: 10.1007/s00592-016-0891-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate whether using vascular age (VA) instead of chronological age (CA) in the Framingham score would enhance the cardiovascular disease (CVD) risk estimation in patients with type 1 diabetes (T1D). METHODS This was a cross-sectional study comprising 58 T1D patients and 38 control subjects matched by age, gender and body mass index. To estimate the VA, we used carotid intima-media thickness normality estimation tables that took into account age, gender and ethnic group. RESULTS Compared to the control group, T1D patients had an older VA with an 8.8-year difference (p < 0.001), a higher CVD risk stratification comparing CA and VA (p < 0.001). In the group of T1D patients, there was a 9.4-year difference between VA and CA (p < 0.001), mainly due to a greater increase in women compared to men (11.2 vs 6.4 years, respectively) and 29.3 % of the patients with T1D increased their CVD risk stratification using VA as a parameter. Still, in the group of T1D patients, women had a higher increase in VA for each 1-year increase in CA than men (1.2 years vs 0.8 years, respectively, p < 0.001). This difference persisted as we compared women with T1D with women in the control group (0.4 years), p = 0.006. CONCLUSIONS T1D patients have an increased VA, a marker of subclinical atherosclerosis. The use of VA age may contribute to the identification of high CVD risk in T1D. In patients with T1D, a younger chronological age, particularly in women, might not be a protective factor for CVD.
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Affiliation(s)
- Carlos Roberto Moraes de Andrade
- Endocrinology Department, University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil.
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil.
- , Avenida Prof. Florestan Fernandes 1036 Bl.16 ap.503, Camboinhas, Niterói, Rio de Janeiro, CEP 24358-580, Brazil.
| | - Eliete Leão Clemente Silva
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil
| | - Maria de Fátima Bevilaqua da Matta
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil
| | - Marcia Bueno Castier
- Department of Internal Medicine, Cardiology Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Luiza Garcia Rosa
- Epidemiology and Biomaths, University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil
| | - Marília Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil
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Heart failure in women and men during acute coronary syndrome and long-term cardiovascular mortality (the ABC-3* Study on Heart Disease) (*Adria, Bassano, Conegliano, and Padova Hospitals). Int J Cardiol 2016; 220:538-43. [DOI: 10.1016/j.ijcard.2016.06.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022]
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Bjørnnes AK, Parry M, Lie I, Fagerland MW, Watt-Watson J, Rustøen T, Stubhaug A, Leegaard M. Pain experiences of men and women after cardiac surgery. J Clin Nurs 2016; 25:3058-68. [PMID: 27301786 DOI: 10.1111/jocn.13329] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To compare the prevalence and severity of pain in men and women during the first year following cardiac surgery and to examine the predictors of persistent postoperative pain 12 months post surgery. BACKGROUND Persistent pain has been documented after cardiac surgery, with limited evidence for differences between men and women. DESIGN Prospective cohort study of patients in a randomised controlled trial (N = 416, 23% women) following cardiac surgery. METHODS Secondary data analysis of data collected prior to surgery, across postoperative days 1-4, at two weeks, and at one, three, six and 12 months post surgery. The main outcome was worst pain intensity (Brief Pain Inventory-Short Form). RESULTS Twenty-nine percent (97/339) of patients reported persistent postoperative pain at rest at 12 months that was worse in intensity and interference for women than for men. For both sexes, a more severe co-morbidity profile, lower education and postoperative pain at rest at one month post surgery were associated with an increased probability for persistent postoperative pain at 12 months. Women with more concerns about communicating pain and a lower intake of analgesics in the hospital had an increased probability of pain at 12 months. CONCLUSION Sex differences in pain are present up to one year following cardiac surgery. Strategies for sex-targeted pain education and management pre- and post-surgery may lead to better pain outcomes. RELEVANCE TO CLINICAL PRACTICE These results suggest that informing patients (particularly women) about the benefits of analgesic use following cardiac surgery may result in less pain over the first year post discharge.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Monica Parry
- Nurse Practitioner Programs, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Irene Lie
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.,Ullevål/Center for Patient Centered Heart- and Lung Research, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Leegaard
- Faculty of Health Sciences, Institute of Nursing, Oslo, Norway.,Akershus University College of Applied Sciences, Oslo, Norway
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Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, Lavoie KL, Daskupta K, Rabi D, Humphries KH, Norris CM, Thanassoulis G, Behlouli H, Pilote L. Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young? J Am Coll Cardiol 2016; 67:127-135. [PMID: 26791057 DOI: 10.1016/j.jacc.2015.10.067] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND "Gender" reflects social norms for women and men, whereas "sex" defines biological characteristics. Gender-related characteristics explain some differences in access to care for premature acute coronary syndrome (ACS); whether they are associated with cardiovascular outcomes is unknown. OBJECTIVES This study estimated associations between gender and sex with recurrent ACS and major adverse cardiac events (MACE) (e.g., ACS, cardiac mortality, revascularization) over 12 months in patients with ACS. METHODS We studied 273 women and 636 men age 18 to 55 years from GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome), a prospective observational cohort study, who were hospitalized for ACS between January 2009 and April 2013. Gender-related characteristics (e.g., social roles) were assessed using a self-administered questionnaire, and a composite measure of gender was derived. Outcomes included recurrent ACS and MACE over 12 months. RESULTS Feminine roles and personality traits were associated with higher rates of recurrent ACS and MACE compared with masculine characteristics. This difference persisted for recurrent ACS, after multivariable adjustment (hazard ratio from score 0 to 100: 4.50; 95% confidence interval: 1.05 to 19.27), and was a nonstatistically significant trend for MACE (hazard ratio: 1.54; 95% confidence interval: 0.90 to 2.66). A possible explanation is increased anxiety, the only condition that was more prevalent in patients with feminine characteristics and that rendered the association between gender and recurrent ACS nonstatistically significant (hazard ratio: 3.56; 95% confidence interval: 0.81 to 15.61). Female sex was not associated with outcomes post-ACS. CONCLUSIONS Younger adults with ACS with feminine gender are at an increased risk of recurrent ACS over 12 months, independent of female sex.
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Affiliation(s)
- Roxanne Pelletier
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia A Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jafna Cox
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Kaberi Daskupta
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - George Thanassoulis
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011. PLoS One 2016; 11:e0153326. [PMID: 27078262 PMCID: PMC4831744 DOI: 10.1371/journal.pone.0153326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 03/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. AIMS To examine all hospitalizations in Switzerland from 2010-2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. DATA AND METHODS We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. RESULTS Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. CONCLUSION Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data.
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 752] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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Worrall-Carter L, McEvedy S, Wilson A, Rahman MA. Gender Differences in Presentation, Coronary Intervention, and Outcomes of 28,985 Acute Coronary Syndrome Patients in Victoria, Australia. Womens Health Issues 2016; 26:14-20. [DOI: 10.1016/j.whi.2015.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 01/08/2023]
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Clemmensen P, Roe MT, Hochman JS, Cyr DD, Neely ML, McGuire DK, Cornel JH, Huber K, Zamoryakhin D, White HD, Armstrong PW, Fox KA, Prabhakaran D, Ohman EM. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial. Am Heart J 2015; 170:695-705.e5. [PMID: 26386793 DOI: 10.1016/j.ahj.2015.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy. RESULTS Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P = .56), all-cause mortality (12.2% vs 11.7%; P = .88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P = .74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity. CONCLUSIONS Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.
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Simonsen SE, Digre KB, Ralls B, Mukundente V, Davis FA, Rickard S, Tavake-Pasi F, Napia EE, Aiono H, Chirpich M, Stark LA, Sunada G, Keen K, Johnston L, Frost CJ, Varner MW, Alder SC. A gender-based approach to developing a healthy lifestyle and healthy weight intervention for diverse Utah women. EVALUATION AND PROGRAM PLANNING 2015; 51:8-16. [PMID: 25559947 DOI: 10.1016/j.evalprogplan.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants.
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Affiliation(s)
- Sara E Simonsen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Kathleen B Digre
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Brenda Ralls
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Valentine Mukundente
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Best of Africa, 6379 Thor Way, West Valley City, UT 84128, United States.
| | - France A Davis
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Calvary Baptist Church, 1090 South State Street, Salt Lake City, UT 84111, United States.
| | - Sylvia Rickard
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Hispanic Health Care Task Force, PO Box 58654, Salt Lake City, UT 84158, United States.
| | - Fahina Tavake-Pasi
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; National Tongan American Society, 3007 South West Temple, Building H, Salt Lake City, UT 84115, United States.
| | - Eru Ed Napia
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Urban Indian Center, 120 West 1300 South, Salt Lake City, UT 84115, United States.
| | - Heather Aiono
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Meghan Chirpich
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Louisa A Stark
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Grant Sunada
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Kassy Keen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Leanne Johnston
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Caren J Frost
- University of Utah College of Social Work, 395 South 1500 East, Room 101, Salt Lake City, UT 84112, United States.
| | - Michael W Varner
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Stephen C Alder
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
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Lanaro E, Caixeta A, Soares JA, Alves CMR, Barbosa AHP, Souza JAM, Sousa JMA, Amaral A, Ferreira GM, Moreno AC, Júnior IG, Stefanini E, Carvalho AC. Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy. J Thromb Thrombolysis 2015; 38:510-6. [PMID: 24671733 DOI: 10.1007/s11239-014-1072-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pharmacoinvasive treatment is an acceptable alternative for patients with ST-segment elevation myocardial infarction (STEMI) in developing countries. The present study evaluated the influence of gender on the risks of death and major adverse cardiovascular events (MACE) in this population. Seven municipal emergency rooms and the Emergency Mobile Healthcare Service in São Paulo treated STEMI patients with tenecteplase. The patients were subsequently transferred to a tertiary teaching hospital for early (<24 h) coronary angiography. A total of 469 patients were evaluated [329 men (70.1%)]. Compared to men, women had more advanced age (60.2 ± 12.3 vs. 56.5 ± 11 years; p = 0.002); lower body mass index (BMI; 25.85 ± 5.07 vs. 27.04 ± 4.26 kg/m2; p = 0.009); higher rates of hypertension (70.7 vs. 59.3%, p = 0.02); higher incidence of hypothyroidism (20.0 vs. 5.5%; p < 0.001), chronic renal failure (10.0 vs. 8.8%; p = 0.68), peripheral vascular disease (PVD; 19.3 vs. 4.3%; p = 0.03), and previous history of stroke (6.4 vs. 1.3%; p = 0.13); and higher thrombolysis in myocardial infarction risk scores (40.0 vs. 23.7%; p < 0.001). The overall in-hospital mortality and MACE rates for women versus men were 9.3 versus 4.9% (p = 0.07) and 12.9 versus 7.9% (p = 0.09), respectively. By multivariate analysis, diabetes (OR 4.15; 95% CI 1.86-9.25; p = 0.001), previous stroke (OR 4.81; 95% CI 1.49-15.52; p = 0.009), and hypothyroidism (OR 3.75; 95% CI 1.44-9.81; p = 0.007), were independent predictors of mortality, whereas diabetes (OR 2.05; 95% CI 1.03-4.06; p = 0.04), PVD (OR 2.38; 95% CI 0.88-6.43; p = 0.08), were predictors of MACE. In STEMI patients undergoing pharmacoinvasive strategy, mortality and MACE rates were twice as high in women; however, this was due to a higher prevalence of risk factors and not gender itself.
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Affiliation(s)
- Eduardo Lanaro
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Slagman A, Searle J, Vollert JO, Storchmann H, Büschenfelde DMZ, von Recum J, Vlasny D, Ale-Abaei A, Koch M, Müller C, Müller R, Somasundaram R, Möckel M. Sex differences of troponin test performance in chest pain patients. Int J Cardiol 2015; 187:246-51. [DOI: 10.1016/j.ijcard.2015.03.261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 03/04/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
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Duan JG, Chen XY, Wang L, Lau A, Wong A, Thomas GN, Tomlinson B, Liu R, Chan JCN, Leung TW, Mok V, Wong KS. Sex differences in epidemiology and risk factors of acute coronary syndrome in Chinese patients with type 2 diabetes: a long-term prospective cohort study. PLoS One 2015; 10:e0122031. [PMID: 25830291 PMCID: PMC4382276 DOI: 10.1371/journal.pone.0122031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/11/2015] [Indexed: 01/14/2023] Open
Abstract
Objective Diabetic patients with acute coronary syndrome (ACS) are at higher risk of poor outcome than are non-diabetic patients with ACS. Few studies have focused on sex-related ACS incidence, ACS-related mortality or risk factors to affects sex specific ACS in Chinese with Type 2 diabetes mellitus (T2DM). Based on a hospital-based cohort of Chinese patients with T2DM, we aimed to investigate whether there was sex difference in ACS or ACS-related mortality or risk factors of ACS. Methods Totally 2,135 Hong Kong Chinese with T2DM were recruited during 1994-1996 and followed up until August 2012. We systematically analyzed sex-related ACS incidence and ACS-related mortality and risk factors with χ2-squared test, descriptive statistics and survival analysis. Results Regular follow-up was completed in 2,105 subjects (98.6%), with a median period of 14.53 years. The occurrence of ACS was recorded among 414 patients (19.7%) and ACS-related death among 104 patients (4.9%). ACS incidences increased with age in both men and women, and men had a higher prevalence of ACS than women across different age categories and different follow-up periods (log rank χ2=20.32, P<0.001). The transition of ACS incidences from slow to rapid increase were about 5 years earlier in men (at 51-55 years) than in women (55-60 years). Among ACS patients, cumulative ACS-related mortalities was similar between men and women (log rank χ2=0.063, P=0.802). Besides age and albuminuria, different profiles of risk factors accounted for the occurrence of ACS between men and women. Conclusions Our findings demonstrated sex differences in ACS incidence and risk factors, but not in ACS-related mortality in Chinese patients withT2DM. These findings suggest that screening and prevention campaigns should be optimized for men and women, which may help to identify diabetic patients at higher risk of coronary heart disease.
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Affiliation(s)
- Jian Gang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Li Wang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Alex Lau
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Adrian Wong
- Department of Psychological Studies and Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong Special Administrative Region
| | - G. Neil Thomas
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Roxanna Liu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Thomas W. Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Vincent Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
- * E-mail:
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den Ruijter HM, Haitjema S, van der Meer MG, van der Harst P, Rouleau JL, Asselbergs FW, van Gilst WH. Long-term outcome in men and women after CABG; results from the IMAGINE trial. Atherosclerosis 2015; 241:284-8. [PMID: 25731671 DOI: 10.1016/j.atherosclerosis.2015.02.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/05/2015] [Accepted: 02/18/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to determine sex differences in long-term outcome after coronary artery bypass grafting (CABG). METHODS The international randomized controlled IMAGINE study included 2553 consecutive patients with a left ventricular ejection fraction of >40% who underwent isolated CABG. Median follow-up was 32 months (IQR 17-42 months). The composite endpoint comprised of death, myocardial infarction (MI), cerebrovascular event, angina, revascularization and congestive heart failure. Cox regression analysis was used to examine sex differences in outcome post-CABG. RESULTS Of the 2553 patients, 2229 were men and 324 (13%) were women. Women were older and more often reported diabetes and hypertension. Smoking and impaired renal function were more prevalent in men. Women experienced a higher event rate during follow-up (composite endpoint 18% vs 12%; P = 0.007). Cox regression showed an increased risk of the composite endpoint in women after adjustment for age (HR 1.48 (95% CI: 1.11-1.97)) which was non-significant after additional adjustment for other confounders (HR 1.26 (95% CI: 0.92-1.72)). CONCLUSION Women have a worse long-term outcome after CABG than men in univariate analysis. However, after adjusting for potential confounders female sex became a non-significant predictor for prognosis, possibly due to the small sample size of women. Definite answers regarding sex-differences in long-term outcome after CABG should come from future pooling of studies comprising a larger number of women.
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Affiliation(s)
- Hester M den Ruijter
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Haitjema
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Manon G van der Meer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jean L Rouleau
- Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research, University of Montreal, Montreal, Canada
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Wiek H van Gilst
- Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands
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Singh S, Kullo IJ, Pardi DS, Loftus EV. Epidemiology, risk factors and management of cardiovascular diseases in IBD. Nat Rev Gastroenterol Hepatol 2015; 12:26-35. [PMID: 25446727 DOI: 10.1038/nrgastro.2014.202] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IBD is an established risk factor for venous thromboembolism. In the past few years, studies have suggested that patients with IBD might also be at an increased risk of coronary heart disease and stroke. The increased risk is thought to be similar to the level of risk seen in patients with other chronic systemic inflammatory diseases such as rheumatoid arthritis. The risk of developing these conditions is particularly increased in young adults with IBD, and more so in women than in men. Conventional cardiovascular risk factors are not over-represented in patients with IBD, so the increased risk could be attributable to inflammation-mediated atherosclerosis. Patients with IBD often have premature atherosclerosis and have biochemical and genetic markers similar to those seen in patients with atherosclerotic cardiovascular disease. The role of chronic inflammation in IBD-associated cardiovascular disease merits further evaluation. Particular attention should be given to the increased risk observed during periods of increased disease activity and potential modification of the risk by immunosuppressive and biologic therapies for IBD that can modify the disease activity. In addition, preclinical studies suggest that cardiovascular medications such as statins and angiotensin-converting enzyme inhibitors might also favourably modify IBD disease activity, which warrants further evaluation.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Leurent G, Garlantézec R, Auffret V, Hacot JP, Coudert I, Filippi E, Rialan A, Moquet B, Rouault G, Gilard M, Castellant P, Druelles P, Boulanger B, Treuil J, Avez B, Bedossa M, Boulmier D, Le Guellec M, Le Breton H. Gender differences in presentation, management and inhospital outcome in patients with ST-segment elevation myocardial infarction: data from 5000 patients included in the ORBI prospective French regional registry. Arch Cardiovasc Dis 2014; 107:291-8. [PMID: 24910083 DOI: 10.1016/j.acvd.2014.04.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/17/2014] [Accepted: 04/10/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. AIM To determine whether female gender is associated with higher inhospital mortality. METHODS Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). RESULTS The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). CONCLUSIONS One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality.
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Affiliation(s)
- Guillaume Leurent
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
| | | | - Vincent Auffret
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France
| | | | | | | | - Antoine Rialan
- Centre Hospitalier de Saint-Malo, Service de Cardiologie, Saint-Malo, France
| | - Benoît Moquet
- Centre Hospitalier de Saint-Brieuc, Service de Cardiologie, Saint-Brieuc, France
| | - Gilles Rouault
- Centre Hospitalier de Quimper, Service de Cardiologie, Quimper, France
| | - Martine Gilard
- CHU de Brest, Service de Cardiologie, Brest, France; EA 4324 - Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France
| | - Philippe Castellant
- CHU de Brest, Service de Cardiologie, Brest, France; EA 4324 - Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France
| | | | | | | | - Bertrand Avez
- Centre Hospitalier de Saint-Brieuc, SAMU, Saint-Brieuc, France
| | - Marc Bedossa
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France
| | - Dominique Boulmier
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France
| | - Marielle Le Guellec
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France
| | - Hervé Le Breton
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France
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Pelletier R, Humphries KH, Shimony A, Bacon SL, Lavoie KL, Rabi D, Karp I, Tsadok MA, Pilote L. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ 2014; 186:497-504. [PMID: 24638026 DOI: 10.1503/cmaj.131450] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care. METHODS We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures. RESULTS Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework. INTERPRETATION Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.
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Characteristics, treatment and one-year outcomes of patients with acute coronary syndrome in a tertiary hospital in India. Indian Heart J 2013; 66:156-63. [PMID: 24814108 DOI: 10.1016/j.ihj.2013.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 09/26/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a major cause of death in India. Data on outcome of CAD is scarce in the Indian population. This study determined the characteristics, treatment and one-year outcomes of acute coronary syndrome (ACS) in an Indian Cardiac Centre. METHODS We carried out a cross sectional retrospective analysis of 1468 ACS patients hospitalized between January 2008 and December 2010 and followed up for 1 year in the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai. Mortality at 1 year, its determinants and 1 year major adverse cardiac events (MACE) were determined. RESULTS The patients were aged 62.2 ± 11.2 years; males (75.2%) and had ST segment elevation myocardial infarction (STEMI) (33.9%), non ST segment elevation myocardial infarction (44.2%) and unstable angina (21.9%). Key pharmacotherapy included aspirin (98.2%), clopidogrel (95.1%), statins (95.6%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (50.6%) and beta blocker (83.1%). Angiography rate was 80.6%. In the STEMI group, 53.3% had primary angioplasty, 20.3% were thrombolysed and 16.1% received sole medical therapy. Overall coronary artery bypass graft rate was 12.4%. At one year, all-cause mortality and composite MACE were 2.5% and 9.7%, respectively. MACE included death (2.5%), reinfarction (4.0%), resuscitated cardiac arrest (1.8%), stroke (1.1%) and bleeding (0.4%). Main factors associated with mortality were combined left ventricular systolic and diastolic dysfunction (OR = 20.0, 95% CI = 6.63-69.4) and positive troponin I (OR = 12.56, 95% CI = 1.78-25.23). Troponin I independently predicted mortality. CONCLUSIONS ACS population was older than previously described in India. Evidence-based pharmacotherapy and interventions, and outcomes were comparable to the developed nations.
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Magalhães P, Capingana DP, Silva ABT, Ferreira AVL, de Sá Cunha R, Rodrigues SL, Mill JG. Age- and gender-specific reference values of pulse wave velocity for African adults: preliminary results. AGE (DORDRECHT, NETHERLANDS) 2013; 35:2345-2355. [PMID: 23319362 PMCID: PMC3824996 DOI: 10.1007/s11357-012-9504-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/27/2012] [Indexed: 06/01/2023]
Abstract
Pulse wave velocity (PWV) is an independent predictor of cardiovascular (CV) risk. Higher PWV values have been observed in Africans; however, there are no established age- and gender-adjusted reference values for this population. Therefore, PWV was measured using a validated device (Complior SP) in 544 subjects recruited from an occupational cohort of employees of a public university in Angola. Since high blood pressure (BP) is an important factor influencing PWV, a subsample of 301 normotensive subjects (aged 22-72 years) was selected for this study. A subset of 131 individuals without CV risk factors was considered the healthy group (HG), while the entire group (n = 301) comprised the less healthy group (LHG). Predictors of PWV were evaluated using multiple regression analyses and age- and gender-specific percentile tables and curves were constructed. Age and PWV means were 36 ± 9.7 years and 6.6 ± 1.0 m/s in the HG, respectively, and 39.9 ± 10.2 years and 7.3 ± 1.3 m/s in the LHG. Age and plasma uric acid (UA) were the only significant PWV predictors in the HG, while age, mean BP (MBP), and gender showed significant prediction of PWV in the multiple regression analysis in the LHG. Age- and gender-adjusted reference values of PWV were provided for healthy and less healthy normotensive Africans. Considering the small sample size of our cohort, these preliminary results should be used cautiously until data on robust sample of the general population can be obtained.
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Actualización en cardiopatía isquémica y cuidados críticos cardiológicos. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shehab A, Al-Dabbagh B, AlHabib KF, Alsheikh-Ali AA, Almahmeed W, Sulaiman K, Al-Motarreb A, Nagelkerke N, Al Suwaidi J, Hersi A, Al Faleh H, Asaad N, Al Saif S, Amin H. Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). PLoS One 2013; 8:e55508. [PMID: 23405162 PMCID: PMC3566183 DOI: 10.1371/journal.pone.0055508] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/27/2012] [Indexed: 11/19/2022] Open
Abstract
Background Gender-related differences in mortality of acute coronary syndrome (ACS) have been reported. The extent and causes of these differences in the Middle-East are poorly understood. We studied to what extent difference in outcome, specifically 1-year mortality are attributable to demographic, baseline clinical differences at presentation, and management differences between female and male patients. Methodology/Principal Findings Baseline characteristics, treatment patterns, and 1-year mortality of 7390 ACS patients in 65 hospitals in 6 Arabian Gulf countries were evaluated during 2008–2009, as part of the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). Women were older (61.3±11.8 vs. 55.6±12.4; P<0.001), more overweight (BMI: 28.1±6.6 vs. 26.7±5.1; P<0.001), and more likely to have a history of hypertension, hyperlipidemia or diabetes. Fewer women than men received angiotensin-converting enzyme inhibitors (ACE), aspirin, clopidogrel, beta blockers or statins at discharge. They also underwent fewer invasive procedures including angiography (27.0% vs. 34.0%; P<0.001), percutaneous coronary intervention (PCI) (10.5% vs. 15.6%; P<0.001) and reperfusion therapy (6.9% vs. 20.2%; P<0.001) than men. Women were at higher unadjusted risk for in-hospital death (6.8% vs. 4.0%, P<0.001) and heart failure (HF) (18% vs. 11.8%, P<0.001). Both 1-month and 1-year mortality rates were higher in women than men (11% vs. 7.4% and 17.3% vs. 11.4%, respectively, P<0.001). Both baseline and management differences contributed to a worse outcome in women. Together these variables explained almost all mortality disparities. Conclusions/Significance Differences between genders in mortality appeared to be largely explained by differences in prognostic variables and management patterns. However, the origin of the latter differences need further study.
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Affiliation(s)
- Abdulla Shehab
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Sigamani A, Kamath D, Xavier D, Pais P. New evidence for gender disparities in cardiac interventions: ‘CREATE’-ing some clarity. Interv Cardiol 2013. [DOI: 10.2217/ica.12.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Update on ischemic heart disease and critical care cardiology. ACTA ACUST UNITED AC 2013; 66:198-204. [PMID: 24775454 DOI: 10.1016/j.rec.2012.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients.
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Affiliation(s)
- Javier Jiménez-Candil
- Servicio de Cardiología, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain.
| | - Óscar Díaz-Castro
- Servicio de Cardiología, Complejo Hospitalario Universitario do Mexoeiro, Vigo, Pontevedra, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Vicente Bodí Peris
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ramón López Palop
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain
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A novel major histocompatibility complex locus confers the risk of premature coronary artery disease in a Chinese Han population. Mol Biol Rep 2012; 40:3649-54. [PMID: 23266671 DOI: 10.1007/s11033-012-2440-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023]
Abstract
Several novel loci have been proved to be associated with coronary artery disease and/or myocardial infarction risk by genome-wide association studies, however, the available coronary artery disease risk variants explain only a small proportion of the predicted genetic heritability of the disease. Recently, a novel coronary artery disease locus on chromosome 6p21.3 in the major histocompatibility complex was identified in an European population. We hereby investigated whether this single nucleotide polymorphisms (rs3869109) confers the risk of premature coronary artery disease in a Chinese Han population. A total of 422 patients were studied including 210 cases with coronary stenosis ≥50% or previous myocardial infarction (male <55 years and female <65 years) and 212 controls without documented coronary artery disease. Ligase detection reaction was performed to detect rs3869109. The 3 genotypes AA, AG, and GG were present in rs3869109. There were significant differences between the control and premature coronary artery disease groups in the frequencies of the rs3869109 variants and alleles (all P < 0.05). The distribution of 3 genotypes and alleles at rs3869109 does not differ between women and men (all P > 0.05). There was a significant association between rs3869109 genotypes and the severity of premature coronary artery disease (P = 0.038). Multivariate logistic regression showed that carriers with AG and GG genotypes at rs3869109 have a higher risk of premature coronary artery disease than carriers of AA genotype (odds ratio [OR] 1.997, 95% CI: 1.166-3.419, P = 0.012; OR 1.695, 95% CI: 1.044-2.752, P = 0.033; respectively). Our results indicate that the rs3869109 variants are associated with premature coronary artery disease in a Chinese Han population, suggesting this genetic risk marker is useful in early coronary artery disease risk prediction.
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Kostapanos MS, Florentin M, Elisaf MS. Gender Differences in the Epidemiology, Clinical Presentation, Prevention, and Prognosis of Acute Coronary Syndromes. Angiology 2012; 64:5-8. [PMID: 23221620 DOI: 10.1177/0003319712446188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Michael S. Kostapanos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Lim SJ, Gombojav B, Jee SH, Nam CM, Ohrr H. Gender-specific combined effects of smoking and hypertension on cardiovascular disease mortality in elderly Koreans: THe Kangwha Cohort Study. Maturitas 2012; 73:331-6. [PMID: 23137791 DOI: 10.1016/j.maturitas.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/27/2012] [Accepted: 09/05/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We examined gender-specific combined effects of smoking and hypertension on risk of mortality from cardiovascular disease in elderly Korean men and women. STUDY DESIGN This study followed a cohort of 6097 residents (2593 men, 3504 women) in the general population of Kangwha County, aged ≥55 years in March 1985 and examined their cause-specific mortality for 20.8 years, up to December 31, 2005. All participants were followed up more than once after the 1985 survey. MAIN OUTCOME MEASURES We calculated hazard ratios for mortality for the combined sets of smoking habits and blood pressure levels using the Cox proportional-hazard model. The set of non-smokers with normal blood pressure served as a reference group. RESULTS During the 20.8 years of follow-up, 759 people died from cardiovascular disease. The risk of mortality from cardiovascular disease and stroke according to smoking or hypertension was not different between men and women. However, the risk among smokers combined with hypertension was higher in men than in women; the multivariable-adjusted hazard ratios (95% CI) for mortality from cardiovascular disease and stroke were 4.52 (1.67-12.21) and 6.37 (1.57-25.85) in men and 2.11 (1.37-3.24) and 2.41 (1.44-4.01) in women, respectively. CONCLUSIONS The magnitude of the joint effects of smoking and hypertension on cardiovascular disease and stroke mortality was different between men and women. This study suggests that combining quitting smoking with lowering blood pressure could contribute to preventing cardiovascular disease and stroke, especially in men.
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Affiliation(s)
- Seung Ji Lim
- Health Insurance Policy Research Institute, Korea National Health Insurance Corporation, Seoul, Republic of Korea.
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Chen Z, Qian Q, Tang C, Ding J, Feng Y, Ma G. Association of two variants in the interleukin-6 receptor gene and premature coronary heart disease in a Chinese Han population. Mol Biol Rep 2012; 40:1021-6. [PMID: 23073775 DOI: 10.1007/s11033-012-2143-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
Two novel single nucleotide polymorphisms (SNPs; rs7529229 and rs2228145) in the interleukin-6 receptor (IL6R) gene have recently been associated with coronary heart disease (CHD) in a European population. We sought to replicate this finding and to investigate associations of these two SNPs with the severity and clinical phenotypes of premature CHD in a Chinese Han population. A total of 418 patients were studied, including 187 cases with coronary stenosis ≥50 % or acute myocardial infarction (males < 55 years and females < 65 years) and 231 controls without documented CHD. A ligase detection reaction was performed to detect rs7529229 and rs2228145. There were no differences between the controls and premature CHD groups in the frequencies for the three genotypes and alleles of rs7529229 and rs2228145 (all P > 0.05), nor did they differ between the two groups when grouped by gender (all P > 0.05). There were also no associations between these two SNPs and the severity of coronary lesions or clinical phenotypes of premature CHD (all P > 0.05). Our results do not support an association between rs7529229 or rs2228145 with premature CHD in the Chinese Han population. Further studies are warranted to elucidate the role of these two SNPs in the development of atherosclerosis and CHD.
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Affiliation(s)
- Zhong Chen
- Department of Cardiology, The Affiliated Zhongda Hospital and School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, People's Republic of China.
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