Assessment of Cardiac Risk in Women with Autoimmune Disease

Emerging risk factors for heart failure in younger populations: A growing public health concern

Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.

Assessment of myocardial dysfunction of patients with systemic lupus erythematosus based on myocardial perfusion imaging and analysis of potential influencing factors

The incidence and prevalence of systemic lupus erythematosus (SLE) have increased annually over the past decade. The involvement of myocardium is one of the main reasons for the poor prognosis of patients with SLE. Identifying myocardial involvement in patients with autoimmune diseases and providing early targeted treatment can improve patient outcomes. The aim of this study is to evaluate myocardial dysfunction in patients with SLE using 99mTc-MIBI rest gated myocardial perfusion imaging (rGMPI) and to investigate factors associated with myocardial dysfunction. 76 patients with SLE were prospectively enrolled in the study and 46 patients without autoimmune diseases or other inflammatory diseases who had undergone 99mTc-MIBI rGMPI were selected as a control group. Results of relevant blood test indicators, echocardiography and rGMPI were recorded, and comparison was made between the two groups. Meanwhile, based on diagnostic results of rGMPI, SLE patients were divided into myocardial dysfunction group and normal myocardial function group and to analyze the influencing factors of myocardial dysfunction in SLE patients. The incidence of myocardial dysfunction was significantly higher in SLE patients than in controls (30.3% vs 0%, 2= 16.131, p < .001). Moderate/severe disease activity, decreased myocardial perfusion and positive anti-SSA/Ro52kDa antibody were associated with impaired myocardial function in SLE patients (OR = 2.753, 5.359, 3.646; p = .049, 0.015, 0.014). Positive anti-SSA/Ro52kDa antibody was is independently correlated with myocardial dysfunction in SLE patients [OR (95% CI) = 3.159 (1.071-9.316), p = .037]. In conclusion, 99mTc-MIBI rGMPI can noninvasively evaluate myocardial dysfunction in patients with SLE and provide evidence for clinical treatment decisions. Positive anti-SSA/Ro52kDa antibody was an independent risk factor for myocardial dysfunction in SLE patients.

Sex-Based Utilization of Guideline Recommended Statin Therapy and Cardiovascular Disease Outcomes: A Primary Prevention Healthcare Network Registry

Background

In the US, women have similar cardiovascular death rates than men. Less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes.

Methods

Statin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between 2013-2019. Guideline-directed statin intensity (GDSI) at index and follow-up visits were compared among sexes across ASCVD risk groups, defined by pooled-cohort equation. Cox regression hazard ratios (HR) [95% CI] were calculated for statin use and outcomes (myocardial infarction, stroke/transient ischemic attack (TIA), and all-cause mortality) stratified by sex. Interaction terms (statin and sex) were applied.

Results

Among 282,298 patients, (mean age ∼ 50 years) 17.1% women and 19.5% men were prescribed any statin at index visit. Time to GDSI was similar between sexes, but the proportion of high-risk women on GDSI at follow-ups was lower compared to high-risk men (2-years: 27.7 vs 32.0%, and 5-years: 47.2 vs 55.2%, p<0.05). When compared to GDSI, no statin use was associated with higher risk of MI and ischemic stroke/TIA amongst both sexes. High-risk women on GDSI had a lower risk of mortality (HR=1.39 [1.22-1.59]) versus men (HR=1.67 [1.50-1.86]) of similar risk (p value interaction=0.004).

Conclusion

In a large contemporary healthcare system, there was underutilization of statins across both sexes in primary prevention. High-risk women were less likely to be initiated on GDSI compared with high-risk men. GDSI significantly improved the survival in both sexes regardless of ASCVD risk group. Future strategies to ensure continued use of GDSI, specifically among women, should be explored.