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Tegg NL, Myburgh C, O'Donnell E, Kennedy M, Norris CM. Impact of Secondary Amenorrhea on Cardiovascular Disease Risk in Physically Active Women: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e033154. [PMID: 38497482 PMCID: PMC11010010 DOI: 10.1161/jaha.123.033154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Exercise-associated secondary amenorrhea results in estrogen deficiency, which may lead to dysfunction in estrogen's normal cardioprotective pathways. Estrogen may be essential in a woman's endothelial adaptations to exercise. The objective of this review was to assess the association between secondary amenorrhea in physically active women and cardiovascular disease (CVD) risk. METHODS AND RESULTS A literature search was performed in January 2023 and updated in August 2023 of the Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations. Citation chaining was done to screen for additional studies. Eight sources were searched for gray literature. Studies that compared physically active women with amenorrhea to physically active women with eumenorrhea aged 18 to 35 years with evidence of CVD, alterations to cardiovascular physiology, or CVD risks were included. Eighteen observational studies from 3 countries were included. Overall, the quality of evidence was good. A meta-analysis was performed. Physically active women with secondary amenorrhea had significantly lower estradiol, flow-mediated dilation, resting heart rate, systolic blood pressure, and diastolic blood pressure and higher total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein cholesterol. CONCLUSIONS Estrogen deficiency resulting from exercise-associated secondary amenorrhea in physically active women may impact cardiovascular physiology and certain CVD risk factors. The research in this area is observational; therefore, findings should be interpreted cautiously. However, as exercise-associated secondary amenorrhea is reversible and the primary prevention of CVD is important for public health, it may be important to treat secondary amenorrhea and restore estrogen levels.
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Affiliation(s)
- Nicole L. Tegg
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Caitlynd Myburgh
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
- Faculty of Natural SciencesThe Kings UniversityEdmontonAlbertaCanada
| | | | | | - Colleen M. Norris
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
- Cavarzan Chair in Mature Women’s Research, WCHRIEdmontonAlbertaCanada
- Faculty of Medicine, School of Public Health SciencesUniversity of AlbertaEdmontonAlbertaCanada
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Norris CM, Tegg NL, Ahmed SB, Gingara S, Green BJ, Gresiuk C, Henriquez M, Mulvagh SL, Van Damme A, Myburgh C, Graham MM. Women's Heart Health and the Menopausal Transition: Two Faces of the Same Coin. CJC Open 2024; 6:327-333. [PMID: 38487041 PMCID: PMC10935676 DOI: 10.1016/j.cjco.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/23/2023] [Indexed: 03/17/2024] Open
Abstract
The impact of the presence or absence of sex hormones on women's health is woefully underresearched. Fundamentally, women's bodies are now understood to spend considerable time under widely fluctuating hormonal influences, including puberty, pregnancy, peripartum, and menopause, and a woman's vessels are therefore preset for functional and physiological alterations based on levels of sex hormones. However, our understanding of the influences of sex hormones on the regulation of a multitude of biological and physiological processes has not translated into the development and/or collection or analyses of data on therapeutic treatments and/or outcomes in the context of women's disease management.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cavarzan Chair in Mature Women’s Research, WCHRI, AWHF, Edmonton, Alberta, Canada
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nicole L. Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sofia B. Ahmed
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Gingara
- Member of Canadian Women's Heart Health Alliance with lived experience, Edmonton, Alberta, Canada
| | - Bobbi-Jo Green
- Member of Canadian Women's Heart Health Alliance with lived experience, Edmonton, Alberta, Canada
| | | | - Maya Henriquez
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andrea Van Damme
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Caitlynd Myburgh
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Natural Sciences, The Kings University, Edmonton, Alberta, Canada
| | - Michelle M. Graham
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Tegg NL, Ahmed SB, Southern DA, Shlakhter O, Norris CM. Myocardial Infarction Within 30 Days of Discharge From an Emergency Department: A Descriptive Study of Albertan Women. CJC Open 2024; 6:355-361. [PMID: 38487066 PMCID: PMC10935690 DOI: 10.1016/j.cjco.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of premature death for Canadian women, which may be due partly to a lack of awareness of the presentation of acute coronary events in emergency departments (EDs). To address an identified gap in women's cardiovascular care, we sought to describe the clinical and comorbid factors of women who, following discharge from an ED, suffered a myocardial infarction (MI). Methods Descriptive analyses were completed on a cohort of women who presented to an ED in Alberta, Canada, between January 1, 2010 and December 31, 2020, were discharged, and within 30 days of their index ED visit, were admitted to the hospital with an MI. The cohort was explored for clinical and comorbid data, ED visits pre-MI, type of MI, and presenting complaint/ primary diagnosis for the index ED visit. Results 1380 women were included in this analysis with a mean age of 67 (standard deviation ±13) years. The frequencies of hypertension, diabetes, and dyslipidemia among the youngest women, aged 18-45 years, were 47.5%, 31.3%, and 48.8%, respectively. Women across all ages demonstrated a high prevalence of traditional CVD risk factors, and 22% of women presented to an ED 2 or more times within the 30 days pre-MI. Conclusions Regardless of their age, the women in this cohort had notable CVD risk factors. Future research is required to better understand the phenomenon of women presenting multiple times to an ED pre-MI. Research is needed on life-stage-specific factors of women presenting to EDs pre-MI, to help reduce MI incidence.
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Affiliation(s)
- Nicole L. Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sofia B. Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A. Southern
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Heart Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Tegg NL, Myburgh C, Kennedy M, Norris CM. Impact of secondary amenorrhea on cardiovascular disease risk in physically active women: a systematic review protocol. JBI Evid Synth 2024; 22:343-350. [PMID: 37529977 DOI: 10.11124/jbies-23-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The objective of this review is to assess the association between secondary amenorrhea in physically active women and cardiovascular disease risk. INTRODUCTION It is well established that a woman's risk of cardiovascular disease greatly increases after menopause. The sharp decline in estrogen is seen as a causal factor. Exercise-induced secondary amenorrhea results in estrogen deficiency, which may lead to dysfunction in estrogen's cardioprotective pathways. Further, estrogen may be essential in a woman's endothelial adaptations to exercise. The impact of secondary amenorrhea on cardiovascular disease risk in premenopausal women is not well established. INCLUSION CRITERIA This review will consider studies that include physically active women experiencing amenorrhea in any country. Only studies that present evidence of cardiovascular disease, alterations to cardiovascular physiology, or data on cardiovascular risk factors (eg, lipid profile changes) will be considered. The review will consider experimental or observational epidemiological study designs. METHODS Searches will be conducted in CINAHL (EBSCOhost), the Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations. Two independent reviewers will screen titles, abstracts, and full texts, appraise methodological quality, and extract data from studies. Where possible, studies will be pooled in a statistical meta-analysis in addition to subgroup analyses. Where pooling is not possible, the findings will be presented in narrative format. Certainty of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION PROSPERO CRD42023360781.
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Affiliation(s)
- Nicole L Tegg
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Caitlynd Myburgh
- Faculty of Natural Sciences, The Kings University, Edmonton, AB, Canada
| | | | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Cavarzan Chair in Mature Women's Research, Women's and Children's Health Research Institute, Edmonton, AB, Canada
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
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Kneller M, Pituskin E, Tegg NL, Norris CM. Rural Prenatal Care by Nurse Practitioners: A Narrative Review. Womens Health Rep (New Rochelle) 2023; 4:262-270. [PMID: 37284485 PMCID: PMC10240310 DOI: 10.1089/whr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
Background Rural Canadian populations face many challenges due to their geographical isolation, including inaccessible and inequitable primary health care. Specifically, pregnant women are at risk of not receiving prenatal care (PNC) due to physical and social barriers. Inadequate PNC can have detrimental effects on both maternal and neonatal health outcomes. Nurse practitioners (NPs) are an essential group of alternative primary care providers who can provide specialized care, including PNC, to these underserved populations. Objective The purpose of this narrative review was to identify existing NP-led rural PNC programs in other health care systems to support maternal and neonatal outcomes. Methods A systematic search was performed to identify articles published between 2002 and 2022 on CINAHL (EBSCO host) and MEDLINE (OVID). Literature was excluded if (1) the context was based in urban centers; (2) the study focused on specialized obstetrical/gynecological-based care; or (3) the study was published in a language other than English. The literature was assessed and synthesized into a narrative review. Results The initial search identified 34 potentially relevant articles. Five broad themes were identified, including (1) barriers to care; (2) mobile health clinics; (3) collaborative or tiered models of care; (4) telemedicine; and (5) NPs as essential primary care providers. Conclusions The introduction of a collaborative NP-led approach to rural Canadian settings has the potential to address barriers to PNC and provide efficient, equitable, and inclusive health care.
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Affiliation(s)
- Monica Kneller
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Nicole L. Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Canada
- Cavarzan Chair in Mature Women's Research, Women and Children's Health Research Institute, Edmonton, Canada
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Canada
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Tegg NL, Desmarais OH, Lindsay MP, McDermott S, Mulvagh SL, Desbiens MM, Norris CM. A Survey of Female-Specific Cardiovascular Protocols in Emergency Departments in Canada. CJC Open 2023; 5:107-111. [PMID: 36880067 PMCID: PMC9984888 DOI: 10.1016/j.cjco.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases (CVD) remain the leading cause of death for women. However, systematic inequalities exist in how women experience clinical cardiovascular (CV) policies, programs, and initiatives. Methods In collaboration with the Heart and Stroke Foundation of Canada, a question regarding female-specific CV protocols in an emergency department (ED), or an inpatient or ambulatory care area of a healthcare site was sent via e-mail to 450 healthcare sites in Canada. Contacts at these sites were established through the larger initiative-the Heart Failure Resources and Services Inventory-conducted by the foundation. Results Responses were received from 282 healthcare sites, with 3 sites confirming the use of a component of a female-specific CV protocol in the ED. Three sites noted using sex-specific troponin levels in the diagnosis of acute coronary syndromes; 2 of the sites are participants in the hs-cTn-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE MI) trial. One site reported the integration of a female-specific CV protocol component into routine use. Conclusions We have identified an absence of female-specific CVD protocols in EDs that may be associated with the identified poorer outcomes in women impacted by CVD. Female-specific CV protocols may serve to increase equity and ensure that women with CV concerns have access to the appropriate care in a timely manner, thereby helping to mitigate some of the current adverse effects experienced by women who present to Canadian EDs with CV symptoms.
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Affiliation(s)
- Nicole L Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanna McDermott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Heart Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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