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Morandini V, Dugger KM, Schmidt AE, Varsani A, Lescroël A, Ballard G, Lyver PO, Barton K, Ainley DG. Sex-specific recruitment rates contribute to male-biased sex ratio in Adélie penguins. Ecol Evol 2024; 14:e10859. [PMID: 38384831 PMCID: PMC10879839 DOI: 10.1002/ece3.10859] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/23/2024] Open
Abstract
Sex-related differences in vital rates that drive population change reflect the basic life history of a species. However, for visually monomorphic bird species, determining the effect of sex on demographics can be a challenge. In this study, we investigated the effect of sex on apparent survival, recruitment, and breeding propensity in the Adélie penguin (Pygoscelis adeliae), a monochromatic, slightly size dimorphic species with known age, known sex, and known breeding history data collected during 1996-2019 (n = 2127 birds) from three breeding colonies on Ross Island, Antarctica. Using a multistate capture-mark-recapture maximum-likelihood model, we estimated apparent survival (S ^ ), recapture (resighting) probability (p ^ ), and the probability of transitioning among breeding states and moving between colonies (ψ ^ ; colony-specific non-juvenile pre-breeders, breeders, and non-breeders). Survival rate varied by breeding status and colony, but not sex, and pre-breeders had higher survival rates than breeders and non-breeders. Females had a higher probability of recruiting into the breeding population each year and may enter the breeding pool at younger ages. In contrast, both sexes had the same probability of breeding from year to year once they had recruited. Although we detected no direct sex effects on survival, the variation in recruitment probability and age-at-first reproduction, along with lower survival rates of breeders compared to pre-breeders, likely leads to shorter lifespans for females. This is supported by our findings of a male-biased mean adult sex ratio (ASR) of 1.4 males for every female (x ^ proportion of males = 0.57, SD = 0.07) across all colonies and years in this metapopulation. Our study illustrates how important it can be to disentangle sex-related variation in population vital rates, particularly for species with complex life histories and demographic dynamics.
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Affiliation(s)
- Virginia Morandini
- Oregon Cooperative Fish and Wildlife Research Unit, Department of Fisheries and WildlifeOregon State UniversityCorvallisOregonUSA
- Migres FoundationCIMATarifaSpain
| | - Katie M. Dugger
- U.S. Geological Survey, Oregon Cooperative Fish and Wildlife Research Unit, Department of Fisheries and WildlifeOregon State UniversityCorvallisOregonUSA
| | | | - Arvind Varsani
- The Biodesign Center for Fundamental and Applied Microbiomics, Center for Evolution and Medicine, School of Life SciencesArizona State UniversityTempeArizonaUSA
| | | | - Grant Ballard
- Point Blue Conservation SciencePetalumaCaliforniaUSA
| | - Phil O'B. Lyver
- Manaaki Whenua Landcare Research New Zealand Ltd.LincolnNew Zealand
| | - Kerry Barton
- Manaaki Whenua Landcare Research New Zealand Ltd.LincolnNew Zealand
| | - David G. Ainley
- H.T. Harvey & Associates Ecological ConsultantsLos GatosCaliforniaUSA
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2
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Strijker BN, Iwińska K, van der Zalm B, Zub K, Boratyński JS. Is personality and its association with energetics sex-specific in yellow-necked mice Apodemus flavicollis? Ecol Evol 2023; 13:e10233. [PMID: 37408630 PMCID: PMC10318423 DOI: 10.1002/ece3.10233] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
For the last two decades, behavioral physiologists aimed to explain a plausible covariation between energetics and personality, predicted by the "pace-of-life syndrome" (POLS) hypothesis. However, the results of these attempts are mixed with no definitive answer as to which of the two most acknowledged models "performance" or "allocation" predicts covariation between consistent among-individual variation in metabolism and repeatable behavior (animal personality). The general conclusion is that the association between personality and energetics is rather context-dependent. Life-history, behavior, and physiology as well as its plausible covariation can be considered a part of sexual dimorphism. However, up to now, only a few studies demonstrated a sex-specific correlation between metabolism and personality. Therefore, we tested the relationships between physiological and personality traits in a single population of yellow-necked mice Apodemus flavicollis in the context of a plausible between-sexes difference in this covariation. We hypothesized that the performance model will explain proactive behavior in males and the allocation model will apply to females. Behavioral traits were determined using the latency of risk-taking and the open field tests, whereas the basal metabolic rates (BMR) was measured using indirect calorimetry. We have found a positive correlation between body mass-adjusted BMR and repeatable proactive behavior in male mice, which can support the performance model. However, the females were rather consistent mainly in avoidance of risk-taking that did not correlate with BMR, suggesting essential differences in personality between sexes. Most likely, the lack of convincing association between energetics and personality traits at the population level is caused by a different selection acting on the life histories of males and females. This may only result in weak support for the predictions of the POLS hypothesis when assuming that only a single model explaining the link between physiology and behavior operates in males and females. Thus, there is a need to consider the differences between sexes in behavioral studies to evaluate this hypothesis.
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Affiliation(s)
- Beau N. Strijker
- Van Hall LarensteinUniversity of Applied SciencesLeeuwardenThe Netherlands
| | - Karolina Iwińska
- University of Białystok Doctoral School in Exact and Natural SciencesBiałystokPoland
- Mammal Research InstitutePolish Academy of SciencesBiałowieżaPoland
| | - Bram van der Zalm
- Van Hall LarensteinUniversity of Applied SciencesLeeuwardenThe Netherlands
| | - Karol Zub
- Mammal Research InstitutePolish Academy of SciencesBiałowieżaPoland
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Abstract
Background Studies on intact abdominal aortic aneurysms mainly focus on treated patients, and data on untreated patients are sparse. The objective was to investigate sex differences among untreated patients regarding rupture and mortality rates and to determine predictors for these events. Sex‐specific causes of death were evaluated. Methods and Results All patients ≥40 years diagnosed from 2001 to 2015 (n=32 393) with intact abdominal aortic aneurysms were identified in national registries; 60% (n=19 569) were untreated. Comorbid loads, crude rupture, and mortality rates were assessed. Predictors of 5‐year rupture and mortality were analyzed in Cox models (sex, age, comorbidities, income, and marital status). The proportion of men and women with multiple comorbidities was similar. Within 5 years, 798 ruptures occurred (9.7% women versus 6.9% men, P<0.001). Ruptures were independently predicted by female sex (hazard ratio [HR], 1.23; 95% CI, 1.07–1.42; P=0.004), chronic obstructive pulmonary disease (HR, 1.36; 95% CI, 1.15–1.62; P<0.001), age (HR, 11.49; 95% CI, 5.68–23.25 for ≥80 years; P<0.001), and income (HR, 0.63; 95% CI, 0.53–0.75 for highest tertile; P<0.001). After 5 years, 56.5% women and 50.4% men were deceased. Mortality was not independently predicted by female sex. Rupture was the third most common cause of death (11.9% women versus 8.7% men; P<0.001). The median time‐to‐events was 2.8 years. Conclusions A considerable proportion of patients with intact abdominal aortic aneurysms in surveillance remain untreated. Despite surveillance algorithms, the healthcare system fails to prevent a high number of ruptures, especially among women. The time‐to‐event data highlight the urgency to develop more individualized surveillance.
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Affiliation(s)
- Mareia Talvitie
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Perioperative Medicine and Intensive Care Function Karolinska University Hospital Stockholm Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
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4
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Iglesias-Carrasco M, Brookes S, Kruuk LEB, Head ML. The effects of competition on fitness depend on the sex of both competitors. Ecol Evol 2020; 10:9808-9826. [PMID: 33005346 PMCID: PMC7520201 DOI: 10.1002/ece3.6620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/05/2022] Open
Abstract
In intraspecific competition, the sex of competing individuals is likely to be important in determining the outcome of competitive interactions and the way exposure to conspecifics during development influences adult fitness traits. Previous studies have explored differences between males and females in their response to intraspecific competition. However, few have tested how the sex of the competitors, or any interactions between focal and competitor sex, influences the nature and intensity of competition. We set up larval seed beetles Callosobruchus maculatus to develop either alone or in the presence of a male or female competitor and measured a suite of traits: development time, emergence weight; male ejaculate mass, copulation duration, and lifespan; and female lifetime fecundity, offspring egg-adult survival, and lifespan. We found effects of competition and competitor sex on the development time and emergence weight of both males and females, and also of an interaction between focal and competitor sex: Females emerged lighter when competing with another female, while males did not. There was little effect of larval competition on male and female adult fitness traits, with the exception of the effect of a female competitor on a focal female's offspring survival rate. Our results highlight the importance of directly measuring the effects of competition on fitness traits, rather than distant proxies for fitness, and suggest that competition with the sex with the greater resource requirements (here females) might play a role in driving trait evolution. We also found that male-male competition during development resulted in shorter copulation times than male-female competition, a result that remained when controlling for the weight of competitors. Although it is difficult to definitively tease apart the effects of social environment and access to resources, this result suggests that something about the sex of competitors other than their size is driving this pattern.
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Affiliation(s)
- Maider Iglesias-Carrasco
- Division of Ecology and Evolution Research School of Biology Australian National University Canberra ACT Australia
| | - Samuel Brookes
- Division of Ecology and Evolution Research School of Biology Australian National University Canberra ACT Australia
| | - Loeske E B Kruuk
- Division of Ecology and Evolution Research School of Biology Australian National University Canberra ACT Australia
| | - Megan L Head
- Division of Ecology and Evolution Research School of Biology Australian National University Canberra ACT Australia
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5
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Schreuder MM, Badal R, Boersma E, Kavousi M, Roos-Hesselink J, Versmissen J, Visser LE, Roeters van Lennep JE. Efficacy and Safety of High Potent P2Y 12 Inhibitors Prasugrel and Ticagrelor in Patients With Coronary Heart Disease Treated With Dual Antiplatelet Therapy: A Sex-Specific Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e014457. [PMID: 32063118 PMCID: PMC7070195 DOI: 10.1161/jaha.119.014457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Sex differences in efficacy and safety of dual antiplatelet therapy remain uncertain because of the underrepresentation of women in cardiovascular trials. The aim of this study was to perform a sex‐specific analysis of the pooled efficacy and safety data of clinical trials comparing a high potent P2Y12 inhibitor+aspirin with clopidogrel+aspirin in patients with acute coronary syndrome. Methods and Results A systematic literature search was performed. Randomized clinical trials that compared patients following percutaneous coronary intervention/acute coronary syndrome who were taking high potent P2Y12 inhibitors+aspirin versus clopidogrel+aspirin were selected. Random effects estimates were calculated and relative risks with 95% CIs on efficacy and safety end points were determined per sex. We included 6 randomized clinical trials comparing prasugrel/ticagrelor versus clopidogrel in 43 990 patients (13 030 women), with a median follow‐up time of 1.06 years. Women and men had similar relative risk (RR) reduction for major cardiovascular events (women: RR, 0.89 [95% CI, 0.80–1.00; men: RR, 0.84 [95% CI, 0.79–0.91) (P for interaction=0.39). Regarding safety, women and men had similar risk of major bleeding by high‐potency dual antiplatelet therapy (RR, 1.18 [95% CI, 0.98–1.41] versus RR, 1.03 [95% CI, 0.93–1.14]) (P for interaction=0.20). Conclusions The small and statistically insignificant difference in efficacy and safety estimates of high‐potency dual antiplatelet therapy between women and men following percutaneous coronary intervention/acute coronary syndrome do not justify differential dual antiplatelet therapy treatment for both sexes.
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Affiliation(s)
- Michelle M Schreuder
- Department of Internal Medicine Erasmus Medical Centre Rotterdam The Netherlands
| | - Ricardo Badal
- Department of Internal Medicine Erasmus Medical Centre Rotterdam The Netherlands
| | - Eric Boersma
- Department of Epidemiology Erasmus Medical Centre Rotterdam The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology Erasmus Medical Centre Rotterdam The Netherlands
| | | | - Jorie Versmissen
- Department of Internal Medicine Erasmus Medical Centre Rotterdam The Netherlands
| | - Loes E Visser
- Department of Epidemiology Erasmus Medical Centre Rotterdam The Netherlands
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6
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Prins KW, Rose L, Archer SL, Pritzker M, Weir EK, Olson MD, Thenappan T. Clinical Determinants and Prognostic Implications of Right Ventricular Dysfunction in Pulmonary Hypertension Caused by Chronic Lung Disease. J Am Heart Assoc 2020; 8:e011464. [PMID: 30646788 PMCID: PMC6497344 DOI: 10.1161/jaha.118.011464] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Patients with pulmonary hypertension caused by chronic lung disease (Group 3 PH) have disproportionate right ventricle (RV) dysfunction, but the correlates and clinical implications of RV dysfunction in Group 3 PH are not well defined. Methods and Results We performed a cohort study of 147 Group 3 PH patients evaluated at the University of Minnesota. RV systolic function was quantified using right ventricular fractional area change (RVFAC) and +dP/dtmax/instantaneous pressure. Tau and RV diastolic stiffness characterized RV diastolic function. Multivariate linear regression was used to define correlates of RVFAC. Kaplan‐Meier and Cox proportional hazards analyses were used to examine freedom from heart failure hospitalization and death. Positive correlates of RVFAC on univariate analysis were pulmonary arterial compliance, cardiac index, and left ventricular diastolic dimension. Conversely, male sex, N‐terminal pro‐brain natriuretic peptide, heart rate, right atrial enlargement, mean pulmonary arterial pressure, and pulmonary vascular resistance were negative correlates. Male sex was the strongest predictor of lower RVFAC, after adjusting for pulmonary vascular resistance and pulmonary arterial compliance. When comparing sexes, males had lower RVFAC (26% versus 31%, P=0.03) both overall and for any given mean pulmonary arterial pressure and pulmonary vascular resistance value. Males exhibited a reduction in +dP/dtmax/instantaneous pressure as pulmonary vascular resistance increased, whereas females did not. There were no sex differences in RV diastolic function. RV dysfunction (RVFAC <28%) was associated with increased risk of heart failure hospitalization or death (hazard ratio: 1.84, 95% CI: 1.04–3.10, P=0.035). Conclusions Male sex is associated with RV dysfunction in Group 3 PH, even after adjusting for RV afterload. RV dysfunction (RVFAC <28%) identifies Group 3 PH patients at risk for poor outcomes.
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Affiliation(s)
- Kurt W Prins
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Lauren Rose
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Stephen L Archer
- 2 Department of Medicine Queen's University Kingston Ontario Canada
| | - Marc Pritzker
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - E Kenneth Weir
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Matthew D Olson
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Thenappan Thenappan
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
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7
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Mitchell RN, Ashar FN, Jarvelin MR, Froguel P, Sotoodehnia N, Brody JA, Sebert S, Huikuri H, Rioux J, Goyette P, Newcomb CE, Junttila MJ, Arking DE. Effect of Sex and Underlying Disease on the Genetic Association of QT Interval and Sudden Cardiac Death. J Am Heart Assoc 2019; 8:e013751. [PMID: 31747862 PMCID: PMC6912973 DOI: 10.1161/jaha.119.013751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Sudden cardiac death (SCD) accounts for ≈300 000 deaths annually in the United States. Men have a higher risk of SCD and are more likely to have underlying coronary artery disease, while women are more likely to have arrhythmic events in the setting of inherited or acquired QT prolongation. Moreover, there is evidence of sex differences in the genetics of QT interval duration. Using sex- and coronary artery disease-stratified analyses, we assess differences in genetic association between longer QT interval and SCD risk. Methods and Results We examined 2282 SCD subjects and 3561 Finnish controls. The SCD subjects were stratified by underlying disease (ischemic versus nonischemic) and by sex. We used logistic regression to test for association between the top QT interval-associated single-nucleotide polymorphism, rs12143842 (in the NOS1AP locus), and SCD risk. We also performed Mendelian randomization to test for causal association of QT interval in the various subgroups. No statistically significant differences were observed between the sexes for associations with rs12143842, despite the odds ratio being higher in females across all subgroup analyses. Consistent with our hypothesis, female non-ischemics had the highest odds ratio point estimate for association between rs12143842 and SCD risk and male ischemics the lowest odds ratio point estimate (P=0.036 for difference). Similar trends were observed for the Mendelian randomization analysis. Conclusions While individual subgroup comparisons did not achieve traditional criteria for statistical significance, this study is consistent with the hypothesis that the causal association of longer QT interval on SCD risk is stronger in women and nonischemic individuals.
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Affiliation(s)
- Rebecca N Mitchell
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - Foram N Ashar
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - Marjo-Riitta Jarvelin
- Center for Life Course Health Research Faculty of Medicine University of Oulu Finland.,Biocenter Oulu University of Oulu Finland.,Unit of Primary Health Care Oulu University Hospital Oulu Finland.,Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom.,Department of Life Sciences College of Health and Life Sciences Brunel University London London United Kingdom
| | - Philippe Froguel
- Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit Division of Cardiology Departments of Medicine and Epidemiology University of Washington Seattle WA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit University of Washington Seattle WA
| | - Sylvain Sebert
- Center for Life Course Health Research Faculty of Medicine University of Oulu Finland.,Biocenter Oulu University of Oulu Finland.,Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom
| | - Heikki Huikuri
- Research Unit of Internal Medicine Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
| | - John Rioux
- Montreal Heart Institute University of Montreal Canada
| | | | - Charles E Newcomb
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - M Juhani Junttila
- Research Unit of Internal Medicine Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
| | - Dan E Arking
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
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8
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Holder SM, Brislane Á, Dawson EA, Hopkins ND, Hopman MTE, Cable NT, Jones H, Schreuder THA, Sprung VS, Naylor L, Maiorana A, Thompson A, Thijssen DHJ, Green DJ. Relationship Between Endothelial Function and the Eliciting Shear Stress Stimulus in Women: Changes Across the Lifespan Differ to Men. J Am Heart Assoc 2019; 8:e010994. [PMID: 30764688 PMCID: PMC6405684 DOI: 10.1161/jaha.118.010994] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 01/26/2023]
Abstract
Background Premenopausal women have a lower incidence of cardiovascular disease, which may partly be due to a protective effect of estrogen on endothelial function. Animal studies suggest that estrogen may also improve the relationship between shear rate ( SR ) and endothelial function. We aimed to explore the relationship between endothelial function (ie, flow-mediated dilation [ FMD ]) and SR (ie, SR area under the curve [ SRAUC ]) in women versus men, and between pre- versus postmenopausal women. Methods and Results Brachial artery FMD and SRAUC were measured in accordance with expert-consensus guidelines in 932 healthy participants who were stratified into young adults (18-40 years, 389 men, 144 women) and older adults (>40 years, 260 men, 139 women). Second, we compared premenopausal (n=173) and postmenopausal women (n=110). There was evidence of a weak correlation between SRAUC and FMD in all groups but older men, although there was variation in strength of outcomes. Further exploration using interaction terms (age-sex× SRAUC ) in linear regression revealed differential relationships with FMD (young women versus young men [β=-5.8-4, P=0.017] and older women [β=-5.9-4, P=0.049]). The correlation between SRAUC and FMD in premenopausal women ( r2=0.097) was not statistically different from that in postmenopausal women ( r2=0.025; Fisher P=0.30). Subgroup analysis using stringent inclusion criteria for health markers (n=505) confirmed a stronger FMD - SRAUC correlation in young women compared with young men and older women. Conclusions Evidence for a stronger relationship between endothelial function and the eliciting SR stimulus is present in young women compared with men. Estrogen may contribute to this finding, but larger healthy cohorts are required for conclusive outcomes.
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Affiliation(s)
- Sophie M. Holder
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Áine Brislane
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Ellen A. Dawson
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Nicola D. Hopkins
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Maria T. E. Hopman
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - N. Timothy Cable
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamUnited Kingdom
| | - Helen Jones
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Tim H. A. Schreuder
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Victoria S. Sprung
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
- Department of Musculoskeletal Biology IIInstitute of Ageing and Chronic DiseaseUniversity of LiverpoolUnited Kingdom
| | - Louise Naylor
- School of Human Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthAustralia
- Allied Health Department & Advanced Heart Failure and Cardiac Transplant ServiceFiona Stanley HospitalPerthAustralia
| | - Andrew Thompson
- Wolfson Centre for Personalised MedicineUniversity of LiverpoolUnited Kingdom
| | - Dick H. J. Thijssen
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Daniel J. Green
- School of Human Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyWestern AustraliaAustralia
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9
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Sörensen NA, Neumann JT, Ojeda F, Schäfer S, Magnussen C, Keller T, Lackner KJ, Zeller T, Karakas M, Münzel T, Blankenberg S, Westermann D, Schnabel RB. Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome. J Am Heart Assoc 2018; 7:e007297. [PMID: 29525782 PMCID: PMC5907542 DOI: 10.1161/jaha.117.007297] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men. METHODS AND RESULTS We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex-specific differences in management of patients with ACS were ascertained and a 2-year follow-up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex-related differences in diagnostic performance in a "first contact" setting (medical history and symptoms) or after "complete triage" (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two-year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men. CONCLUSIONS In a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two-year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).
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Affiliation(s)
- Nils Arne Sörensen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Johannes Tobias Neumann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - Sarina Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christina Magnussen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Till Keller
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- German Center for Cardiovascular Research, Partner Site RheinMain, Hamburg, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research, Partner Site RheinMain, Hamburg, Germany
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research, Partner Site RheinMain, Hamburg, Germany
- Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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10
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Varma N, Mittal S, Prillinger JB, Snell J, Dalal N, Piccini JP. Survival in Women Versus Men Following Implantation of Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy Devices in a Large, Nationwide Cohort. J Am Heart Assoc 2017; 6:JAHA.116.005031. [PMID: 28490521 PMCID: PMC5524072 DOI: 10.1161/jaha.116.005031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Whether outcomes differ between sexes following treatment with pacemakers (PM), implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices is unclear. Methods and Results Consecutive US patients with newly implanted PM, implantable cardioverter defibrillators, and CRT devices from a large remote monitoring database between 2008 and 2011 were included in this observational cohort study. Sex‐specific all‐cause survival postimplant was compared within each device type using a multivariable Cox proportional hazards model, stratified on age and adjusted for remote monitoring utilization and ZIP‐based socioeconomic variables. A total of 269 471 patients were assessed over a median 2.9 [interquartile range, 2.2, 3.6] years. Unadjusted mortality rates (MR; deaths/100 000 patient‐years) were similar between women versus men receiving PMs (n=115 076, 55% male; MR 4193 versus MR 4256, respectively; adjusted hazard ratio, 0.87; 95% CI, 0.84–0.90; P<0.001) and implantable cardioverter defibrillators (n=85 014, 74% male; MR 4417 versus MR 4479, respectively; adjusted hazard ratio, 0.98; 95% CI, 0.93–1.02; P=0.244). In contrast, survival was superior in women receiving CRT defibrillators (n=61 475, 72% male; MR 5270 versus male MR 7175; adjusted hazard ratio, 0.73; 95% CI, 0.70–0.76; P<0.001) and also CRT pacemakers (n=7906, 57% male; MR 5383 versus male MR 7625, adjusted hazard ratio, 0.69; 95% CI, 0.61–0.78; P<0.001). This relative difference increased with time. These results were unaffected by age or remote monitoring utilization. Conclusions Women accounted for less than 30% of high‐voltage implants and fewer than half of low‐voltage implants in a large, nation‐wide cohort. Survival for women and men receiving implantable cardioverter defibrillators and PMs was similar, but dramatically greater for women receiving both defibrillator‐ and PM‐based CRT.
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11
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Marshall HH, Vitikainen EIK, Mwanguhya F, Businge R, Kyabulima S, Hares MC, Inzani E, Kalema-Zikusoka G, Mwesige K, Nichols HJ, Sanderson JL, Thompson FJ, Cant MA. Lifetime fitness consequences of early-life ecological hardship in a wild mammal population. Ecol Evol 2017; 7:1712-1724. [PMID: 28331582 PMCID: PMC5355200 DOI: 10.1002/ece3.2747] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022] Open
Abstract
Early-life ecological conditions have major effects on survival and reproduction. Numerous studies in wild systems show fitness benefits of good quality early-life ecological conditions ("silver-spoon" effects). Recently, however, some studies have reported that poor-quality early-life ecological conditions are associated with later-life fitness advantages and that the effect of early-life conditions can be sex-specific. Furthermore, few studies have investigated the effect of the variability of early-life ecological conditions on later-life fitness. Here, we test how the mean and variability of early-life ecological conditions affect the longevity and reproduction of males and females using 14 years of data on wild banded mongooses (Mungos mungo). Males that experienced highly variable ecological conditions during development lived longer and had greater lifetime fitness, while those that experienced poor early-life conditions lived longer but at a cost of reduced fertility. In females, there were no such effects. Our study suggests that exposure to more variable environments in early life can result in lifetime fitness benefits, whereas differences in the mean early-life conditions experienced mediate a life-history trade-off between survival and reproduction. It also demonstrates how early-life ecological conditions can produce different selection pressures on males and females.
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Affiliation(s)
- Harry H Marshall
- Centre for Ecology and Conservation University of Exeter Cornwall UK
| | | | - Francis Mwanguhya
- Banded Mongoose Research Project Queen Elizabeth National Park Kasese District Uganda
| | - Robert Businge
- Banded Mongoose Research Project Queen Elizabeth National Park Kasese District Uganda
| | - Solomon Kyabulima
- Banded Mongoose Research Project Queen Elizabeth National Park Kasese District Uganda
| | - Michelle C Hares
- Centre for Ecology and Conservation University of Exeter Cornwall UK
| | - Emma Inzani
- Centre for Ecology and Conservation University of Exeter Cornwall UK
| | | | - Kenneth Mwesige
- Banded Mongoose Research Project Queen Elizabeth National Park Kasese District Uganda
| | - Hazel J Nichols
- School of Natural Science and Psychology Liverpool John Moores University Liverpool UK
| | | | - Faye J Thompson
- Centre for Ecology and Conservation University of Exeter Cornwall UK
| | - Michael A Cant
- Centre for Ecology and Conservation University of Exeter Cornwall UK
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12
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Udell JA, Koh M, Qiu F, Austin PC, Wijeysundera HC, Bagai A, Yan AT, Goodman SG, Tu JV, Ko DT. Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization. J Am Heart Assoc 2017; 6:JAHA.116.004319. [PMID: 28108465 PMCID: PMC5523628 DOI: 10.1161/jaha.116.004319] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Women hospitalized with a non‐ST segment elevation acute coronary syndrome (ACS) have worse clinical outcomes compared with men. An early invasive strategy with prompt coronary revascularization may mitigate sex differences in outcomes. However, few contemporary studies have evaluated whether clinical outcomes differ between women and men presenting with ACS treated with an early invasive strategy. Methods and Results A population‐based cohort of hospitalized ACS patients who received prompt cardiac catheterization from 2008 to 2011 in Ontario, Canada and followed for up to 2 years was studied. Clinical outcomes were compared between men and women, stratified by the use of coronary revascularization. Inverse probability weighting using the propensity score accounted for measured differences in baseline characteristics between men and women. Among the 23 473 ACS patients who received cardiac catheterization during an index hospitalization, 66.1% of men and 51.8% of women received coronary revascularization during the same hospitalization. In the propensity‐weighted cohort of patients who received coronary revascularization, the 1‐year rate of death or recurrent ACS was 10.6% for men (referent) compared with 13.1% for women (hazard ratio 1.24; 95% CI 1.16–1.33). In contrast, outcomes for patients who did not receive coronary revascularization did not differ significantly between women and men at 1 year (17.8% versus 16.9%; hazard ratio 1.06; 95% CI 0.99–1.14) or at longer follow‐up. Conclusions An increased risk of adverse clinical outcomes was observed for women with ACS undergoing an early invasive strategy and coronary revascularization compared with men.
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Affiliation(s)
- Jacob A Udell
- Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada .,Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jack V Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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13
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Roswell RO, Kunkes J, Chen AY, Chiswell K, Iqbal S, Roe MT, Bangalore S. Impact of Sex and Contact-to-Device Time on Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction-Findings From the National Cardiovascular Data Registry. J Am Heart Assoc 2017; 6:JAHA.116.004521. [PMID: 28077385 PMCID: PMC5523636 DOI: 10.1161/jaha.116.004521] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Emergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients. Methods and Results Clinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003). Conclusions To date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.
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Affiliation(s)
- Robert O Roswell
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Jordan Kunkes
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | | | | | - Sohah Iqbal
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | | | - Sripal Bangalore
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
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14
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Michelena HI, Suri RM, Katan O, Eleid MF, Clavel MA, Maurer MJ, Pellikka PA, Mahoney D, Enriquez-Sarano M. Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts. J Am Heart Assoc 2016; 5:JAHA.116.004211. [PMID: 27688238 PMCID: PMC5121517 DOI: 10.1161/jaha.116.004211] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Sex‐related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic‐clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic‐clinical stages remains undetermined. Methods and Results Analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow‐up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow‐up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow‐up 6±5 years). For the community cohort, 20‐year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV‐related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25‐year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05‐1.29) for men versus 1.67 (95% CI 1.38‐2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.34 (95% CI 1.22‐1.47) for men versus 1.63 (95% CI 1.40‐1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04). Conclusions Within evolving echocardiographic‐clinical stages, the long‐term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV‐related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.
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Affiliation(s)
| | - Rakesh M Suri
- Division of Cardiovascular Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ognjen Katan
- Division of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Mathew J Maurer
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Douglas Mahoney
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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15
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Lin GM, Redline S, Klein R, Colangelo LA, Cotch MF, Wong TY, Klein BEK, Patel SR, Shea SJ, Liu K. Sex-Specific Association of Obstructive Sleep Apnea With Retinal Microvascular Signs: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2016; 5:JAHA.116.003598. [PMID: 27451457 PMCID: PMC5015394 DOI: 10.1161/jaha.116.003598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Obstructive sleep apnea (OSA) is a common condition affecting more men than women. The relationship of OSA with microvascular disease is unclear, complicated by possible sex difference. Assessment of the relationship of OSA with retinal microvascular signs in men and women may provide insights into such a relationship. Methods and Results We examined the sex‐specific cross‐sectional association of OSA severity with retinal vascular calibers in 1808 participants, and with specific retinopathy signs in 1831 participants from a sample of 2060 participants aged 54 to 93 years who underwent successful polysomnography in the Multi‐Ethnic Study of Atherosclerosis, 2010–2012. OSA severity was defined by the apnea–hypopnea index (events/h) as none (<5), mild (5–14.9), moderate (15–29.9), and severe (≥30). As compared to no OSA, moderate/severe OSA in men was associated with retinal arteriolar narrowing (odds ratio [OR] and 95% CI for the narrowest quartile: 1.65 [1.00–2.71]) and retinal venular widening (1.80 [1.07–3.04] for the widest quartile), but not in women (odds ratio: 1.10 [0.67–1.81] and 0.91 [0.58–1.43], respectively) after adjusting for age, race/ethnicity, body mass index, pack‐years of cigarette smoking, alcohol intake, hypertension duration, diabetes mellitus duration, HbA1c levels, lipid profile, micro‐/macroalbuminuria, estimated glomerular filtration rate, β‐blockers use, antihypertensive therapy, and lipid‐lowering therapy. In contrast, severe OSA was associated with retinal microaneurysms in women, but not in men (odds ratio: 3.22 [1.16–8.97] and 0.59 [0.27–1.30], respectively). Conclusions The associations of OSA severity with retinal microvascular signs may differ by sex. Whether these findings were related to sex differences in OSA exposure needs further investigation.
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Affiliation(s)
- Gen-Min Lin
- Department of Preventive Medicine, Northwestern University, Chicago, IL Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WS
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, NIH Intramural Research Program, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Tien Y Wong
- National University of Singapore and Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WS
| | | | - Steven J Shea
- Departments of Medicine and Epidemiology, Columbia University, New York, NY
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL
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16
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Kangas P, Tahvanainen A, Tikkakoski A, Koskela J, Uitto M, Viik J, Kähönen M, Kööbi T, Mustonen J, Pörsti I. Increased Cardiac Workload in the Upright Posture in Men: Noninvasive Hemodynamics in Men Versus Women. J Am Heart Assoc 2016; 5:JAHA.115.002883. [PMID: 27329447 PMCID: PMC4937251 DOI: 10.1161/jaha.115.002883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Men and women differ in the risk of cardiovascular disease, but the underlying mechanisms are not completely understood. We examined possible sex‐related differences in supine and upright cardiovascular regulation. Methods and Results Hemodynamics were recorded from 167 men and 167 women of matching age (≈45 years) and body mass index (≈26.5) during passive head‐up tilt. None had diabetes mellitus or cardiovascular disease other than hypertension or used antihypertensive medication. Whole‐body impedance cardiography, tonometric radial blood pressure, and heart rate variability were analyzed. Results were adjusted for height, smoking, alcohol intake, mean arterial pressure, plasma lipids, and glucose. Supine hemodynamic differences were minor: Men had lower heart rate (−4%) and higher stroke index (+7.5%) than women (P<0.05 for both). Upright systemic vascular resistance was lower (−10%), but stroke index (+15%), cardiac index (+16%), and left cardiac work were clearly higher (+20%) in men than in women (P<0.001 for all). Corresponding results were observed in a subgroup of men and postmenopausal women (n=76, aged >55 years). Heart rate variability analyses showed higher low:high frequency ratios in supine (P<0.001) and upright (P=0.003) positions in men. Conclusions The foremost difference in cardiovascular regulation between sexes was higher upright hemodynamic workload for the heart in men, a finding not explained by known cardiovascular risk factors or hormonal differences before menopause. Heart rate variability analyses indicated higher sympathovagal balance in men regardless of body position. The deviations in upright hemodynamics could play a role in the differences in cardiovascular risk between men and women. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01742702.
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Affiliation(s)
| | - Anna Tahvanainen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Mika Kähönen
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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17
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Tibæk M, Dehlendorff C, Jørgensen HS, Forchhammer HB, Johnsen SP, Kammersgaard LP. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry-Based Study. J Am Heart Assoc 2016; 5:JAHA.115.003158. [PMID: 27169547 PMCID: PMC4889186 DOI: 10.1161/jaha.115.003158] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence of hospitalizations for TIA and stroke including sex‐ and subtype‐specific trends in young adults aged 15 to 30 years. Methods and Results From the Danish National Patient Register, we identified all cases of first‐ever stroke and TIA (age 15–30 years) in Denmark, who were hospitalized during the study period of 1994 to 2012. Incidence rates and estimated annual percentage changes (EAPCs) were estimated by using Poisson regression. During the study period, 4156 cases of first‐ever hospitalization for stroke/TIA were identified. The age‐standardized incidence rates of hospitalizations for stroke increased significantly (EAPC 1.83% [95% CI 1.11–2.55%]) from 11.97/100 000 person‐years (PY) in 1994 to 16.77/100 000 PY in 2012. TIA hospitalizations increased from 1.93/100 000 PY in 1994 to 5.81/100 000 PY in 2012 and after 2006 more markedly in men than in women (EAPC 16.61% [95% CI 10.45–23.12%]). The incidence of hospitalizations for ischemic stroke was markedly lower among men, but increased significantly from 2006 (EAPC 14.60% [95% CI 6.22–23.63%]). The incidences of hospitalizations for intracerebral hemorrhage and subarachnoid hemorrhage remained stable during the study period. Conclusions The incidence rates of first‐time hospitalizations for ischemic stroke and TIA in young Danish adults have increased substantially since the mid 1990s. The increase was particularly prominent in the most recent years.
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Affiliation(s)
- Maiken Tibæk
- Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik S Jørgensen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), TBI Unit, Department of Neurorehabilitation, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Lars P Kammersgaard
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), TBI Unit, Department of Neurorehabilitation, Rigshospitalet, University of Copenhagen, Denmark
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