1
|
Berbach L, Nelsa Atongfor Nguéfack C, Potter BJ, Pacheco C, Forcillo J. Prevalence of Cardiovascular Risk Factors in Women With Obstructive Coronary Disease Requiring Revascularization: A Meta-analysis. CJC Open 2024; 6:334-346. [PMID: 38487068 PMCID: PMC10935986 DOI: 10.1016/j.cjco.2023.10.016] [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: 08/08/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024] Open
Abstract
Background Cardiovascular disease continues to be the primary cause of premature mortality in women, who previously have been overlooked in clinical trials. Several studies showed that women undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) present more cardiovascular risk factors at baseline, develop more postprocedural complications, and have a higher mortality rate than men. The goal of this review is to analyze the difference between men and women in terms of the prevalence of individual cardiovascular risk factors. Methods A meta-analysis was conducted of original investigations with adult subjects who underwent surgical intervention or PCIs in which cardiovascular risk factors were evaluated, using the MEDLINE, Cochrane, Evidence-Based Medicine Reviews (EBMR), Ovid Embase, Google Scholar, and PubMed databases. Results Of the 4567 identified records found, 18 were retained for qualitative analysis. Prevalence of hypertension (CABG: 71% (95% confidence interval [CI] 64%, 78%]); PCI: (59% [95% CI 48%,70%]), and diabetes (CABG: 48% [95% CI 38%, 57%]); PCI 43% (95% CI 27%, 59%]) was high in women. Women who underwent either CABG or PCI had higher odds of having hypertension (CABG: odds ratio [OR] 1.92 [95% CI 1.47-2.50], P < 0.05); PCI: OR 1.86 [95% CI 1.76-1.97], P < 0.05]), and diabetes (CABG: OR 1.94 [95% CI 1.55-2.42], P < 0.05; PCI: OR 1.97 [95% CI 1.54-2.53], P < 0.05)). However, the prevalence of smoking among women, compared to men, was lower (CABG: 0.17 [95% CI 0.06-0.52], P < 0.05; PCI: 0.22 [95% CI 0.06-0.86], P < 0.03). Conclusion The review shows that women who underwent either surgical or percutaneous revascularization had higher odds of hypertension and diabetes, compared to men.
Collapse
Affiliation(s)
- Léa Berbach
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal Research Center (CRCHUM), Montréal, Québec, Canada
| | - Claudia Nelsa Atongfor Nguéfack
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal Research Center (CRCHUM), Montréal, Québec, Canada
| | - Brian J. Potter
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal Research Center (CRCHUM), Montréal, Québec, Canada
- Department of Medicine, Division of Cardiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Christine Pacheco
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal Research Center (CRCHUM), Montréal, Québec, Canada
- Department of Medicine, Division of Cardiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jessica Forcillo
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal Research Center (CRCHUM), Montréal, Québec, Canada
- Department of Surgery, Division of Cardiac Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
2
|
AlShammeri O, AL Saif S, Al Shehri H, Alasng M, Qaddoura F, Al Shehri M, Turkistani Y, Tash A, Alharbi W, Al Qahtani F, Diaz R, Mahaimeed W, Al habeeb W, Alfaraidy K. Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes. J Saudi Heart Assoc 2022; 34:182-211. [PMID: 36578770 PMCID: PMC9762239 DOI: 10.37616/2212-5043.1320] [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: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.
Collapse
Affiliation(s)
- Owayed AlShammeri
- Dr. Sulaiman Al-Habib Hospital, Riyadh,
Saudi Arabia,Corresponding author at: Dr. Sulaiman Alhabib Hospital, Ar Rayyan Hospital, Riyadh, 14212, Saudi Arabia. E-mail address: (O. AlShammeri)
| | | | - Halia Al Shehri
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Mirvat Alasng
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah,
Saudi Arabia
| | | | | | | | - Adel Tash
- National Heart Center, Saudi Health Council,
Saudi Arabia
| | - Walid Alharbi
- King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | - Fahad Al Qahtani
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Rafael Diaz
- ECLA (Estudios Clínicos Latino América), Instituto Cardiovascular de Rosario, Rosario,
Argentina
| | - Wael Mahaimeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
| | - Waleed Al habeeb
- Saudi Heart Association, Department of Cardiac Sciences, King Saud University Riyadh,
Saudi Arabia
| | | |
Collapse
|
3
|
Almogati JG, Ahmed EO. Glycated Hemoglobin as a Predictor of the Length of Hospital Stay in Patients Following Coronary Bypass Graft Surgery in the Saudi Population. Braz J Cardiovasc Surg 2019; 34:28-32. [PMID: 30810671 PMCID: PMC6385841 DOI: 10.21470/1678-9741-2018-0202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Objective The diabetic population has a high prevalence of coronary artery disease, and
frequently patients with diabetes undergo coronary artery bypass graft
(CABG) surgery. Elevated glycated hemoglobin (HbA1c) in diabetics is shown
to be associated with morbidity and mortality, but the association of HbA1c
with postoperative length of hospital stay (LOS) has conflicting results. In
this study, we aim to identify if elevated HbA1c levels are associated with
prolonged LOS after CABG surgery. Methods A retrospective chart review study was performed, using a total of 305
patients who were referred for CABG surgery. HbA1c levels were measured
before the day of surgery. Patients were classified into two groups
according to HbA1c levels: <7% and ≥7%. A LOS of more than 14 days
was proposed as an extended LOS. HbA1c and the LOS relationship were
assessed using appropriate statistical methods. Results Patients who had diabetes mellitus comprised 81.6% of our studied population.
Sixty-four percent had HbA1c levels ≥ 7%. There was no significant
difference in the total LOS in HbA1c <7% compared to HbA1c ≥7%
patients (P=0.367). Conclusion Our study results rejected the proposed hypothesis that elevated HbA1c levels
≥7% would be associated with prolonged hospital stay following CABG
surgery in a Saudi population.
Collapse
Affiliation(s)
- Joud G Almogati
- Faculty of Medicine, King Abdulaziz University, Kingdom of Saudi Arabia
| | - Elnazeer O Ahmed
- Cardiac Surgery Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| |
Collapse
|
4
|
Emokpae MA, Nwagbara GONA. Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences. Med Sci (Basel) 2017; 5:E8. [PMID: 29099024 PMCID: PMC5635785 DOI: 10.3390/medsci5020008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/05/2017] [Accepted: 04/21/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertension (high blood pressure) is a major health challenge and more women than men are affected by the condition. Complications as a result of this condition often lead to disabilities and premature death. The objective of this study was to evaluate creatine kinase-MB (CK-MB) activity in uncomplicated hypertension and to know whether sex differences exist in the activity of the enzyme. Serum creatine kinase-MB isoenzyme activity, troponin I, and lipid profile were evaluated in 140 male and 100 female Nigerians with hypertension. The control group was comprised of 100 (50 males and 50 females) normotensive subjects. Measured parameters were assayed using Selectra Pros chemistry analyzer. The means were compared between males and females using Students't-test. The mean CK-MB activity of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Similarly, the mean cardiac troponin I (cTnI) of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Conversely, the mean CK-MB activity of the female normotensive subjects was significantly lower (p < 0.001) than the male counterparts. There was no difference in the levels of cTnI between male and female normotensive subjects. Serum CK-MB activity was higher in female than male hypertensive subjects. In the light of these results, cardiac markers should be routinely done in the evaluation of hypertensive subjects and sex-specific consideration may be recognized in the management of these patients.
Collapse
Affiliation(s)
| | - Goodluck O N A Nwagbara
- Department of Medical Laboratory Science, University of Benin, Benin City 300283, Nigeria.
- Defence Reference Laboratory, Health institution, Abuja-Nigeria, FCT-Abuja 900211, Nigeria.
| |
Collapse
|
5
|
Mirghani HO, Elnour MA, Taha AM, Elbadawi AS. Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan. J Family Community Med 2016; 23:100-4. [PMID: 27186156 PMCID: PMC4859094 DOI: 10.4103/2230-8229.181007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. OBJECTIVES To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. SUBJECTS AND METHODS This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. RESULTS A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). CONCLUSION Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.
Collapse
Affiliation(s)
- Hyder O Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Kingdom of Saudi Arabia
| | - Mohammed A Elnour
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Kingdom of Saudi Arabia
| | - Akasha M Taha
- Department of Internal Medicine, Faculty of Medicine, Omdurman Islamic University, Omdurman, Sudan
| | - Abdulateef S Elbadawi
- Department of Community Medicine, Faculty of Medicine, University of Tabuk, Kingdom of Saudi Arabia
| |
Collapse
|
6
|
Yu TH, Hou YC, Chung KP. Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan? Int J Equity Health 2014; 13:64. [PMID: 25052723 PMCID: PMC4159514 DOI: 10.1186/s12939-014-0064-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equity is an important issue in the healthcare research field. Many studies have focused on the relationship between patient characteristics and outcomes of care. These studies, however, have seldom examined whether patients' characteristics affected their access to quality healthcare, which further affected the care outcome. The purposes of this study were to determine whether low-income coronary artery bypass surgery (CABG) patients receive healthcare services with poorer quality, and if such differences in treatment result in different outcomes. METHODS A retrospective multilevel study design was conducted using claims data from Taiwan's universal health insurance scheme for 2005-2008. Patients who underwent their CABG surgery between 2006 and 2008 were included in this study. CABG patients who were under 18 years of age or had unknown gender or insured classifications were excluded. Hospital and surgeon's performance indicators in the previous one year were used to evaluate the level of quality via k-means clustering algorithm. Baron and Kenny's procedures for mediation effect were conducted to explore the relationship among patient's income, quality of CABG care, and inpatient mortality. RESULTS A total of 10,320 patients were included in the study. The results showed that 5.65% of the low-income patients received excellent quality of care, which was lower than that of patients not in the low-income group (5.65% vs.11.48%). The mortality rate of low-income patients (12.10%) was also higher than patients not in the low-income group (5.25%). Also, the mortality of patients who received excellent care was half as low as patients receiving non-excellent care (2.63% vs. 5.68%). Finally, after the procedure of mediation effect testing, the results showed that the relationship between patient income level and CABG mortality was partially mediated by patterns of quality of care. CONCLUSIONS The results of the current study implied that worse outcome in low-income CABG patients might be associated with poorer quality of received services. Health authorities should pay attention to this issue, and propose appropriate solutions.
Collapse
Affiliation(s)
| | | | - Kuo-Piao Chung
- Institute of Healthcare Policy and Management, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
7
|
Mahfouz AA, Shatoor AS, Hassanein MA, Mohamed A, Farheen A. Gender differences in cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia. J Saudi Heart Assoc 2011; 24:61-7. [PMID: 23960673 DOI: 10.1016/j.jsha.2011.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 08/10/2011] [Accepted: 09/06/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore gender differences in the prevalence of silent and clinical apparent cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia. MATERIALS AND METHODS A cross-sectional study on a stratified sample of 1869 adolescents was carried out. They were interviewed and examined for weight and height, systolic and diastolic blood pressure using standardized techniques. RESULTS The study revealed high prevalence of some potential behavioral and biological cardiovascular diseases (CVD) risk factors among adolescent males and females in the study area. Behavioral risk factors included inadequate low consumption of fruits and vegetables, physical inactivity, and smoking. Physical inactivity was significantly more prevalent among females than males (42.9% and 25.7%, respectively). Smoking was significantly more among females than males (11.8% and 1.3%, respectively). Biological risk factors found were family history of CVD, obesity and high blood pressure. Obesity was significantly prevalent among females (29.4%) compared to males (20.6%). Males had significantly more high blood pressure than females. In logistic regression analysis, being male (aOR = 2.992, 95% CI = 1.933-4.742) and obesity (aOR = 2.995, 95% CI = 2.342-3.991) were found to be significant risk factors in developing high blood pressure among adolescents in the region. CONCLUSIONS Presence of cardiovascular risk factors among adolescents is a public health problem in the region. There is a need for a national program in the country to prevent and control cardiovascular risk factors among adolescents.
Collapse
Affiliation(s)
- Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha
| | | | | | | | | |
Collapse
|
8
|
Assiri AS. Gender differences in clinical presentation and management of patients with acute coronary syndrome in Southwest of Saudi Arabia. J Saudi Heart Assoc 2011; 23:135-41. [PMID: 24146527 DOI: 10.1016/j.jsha.2011.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/02/2011] [Accepted: 01/03/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gender differences in the clinical presentation and management of patients with acute coronary syndrome (ACS) have been reported in different parts of the world with contradicting results. We aimed at investigating the presence of gender bias in patients admitted with ACS to Aseer Central Hospital (ACH). METHODS A retrospective cohort of all consecutive patients admitted to ACH with the diagnosis of ACS, during the period between the 1st of June 2007 and the 31st of May 2009 was studied. Data on demographic and clinical profiles, management and outcomes of ACS patients were collected and compared for both genders. RESULTS The present study included 148 females and 397 males. Females were significantly older than males (62.9 ± 14.2 vs. 60 ± 13.4, respectively, P < 0.03), were less likely ever to have smoked (0.7% vs. 26.2%, respectively, P < 0.001), less likely to have had a history of hyperlipidemia (10.8% vs. 22.2%, respectively, P < 0.003) or family history of ischemic heart disease (10.1% vs. 18.9%, respectively, P < 0.014). Female patients presented more with atypical presentation (42.6% vs. 28.9%, respectively, P < 0.003), more with unstable angina (72.3% vs. 50.4%, respectively, P < 0.001), and less with ST-elevation myocardial infarction (18.9% vs. 40.8%, respectively, P < 0.001). Furthermore, they had significantly lower levels of hemoglobin compared to males (12.9 ± 2.3 vs. 14.5 ± 2.2 g/L, respectively, P < 0.001), and higher levels of high density lipoprotein (1.1 ± 0.4 vs. 0.98 ± 0.4 mmol/L, respectively, P < 0.008). Left ventricular ejection fraction was significantly higher in female patients compared to males (50.9 ± 14 vs. 45.8 ± 14, respectively, P < 0.003). Coronary angiography showed a higher rate of normal findings (29.3% vs. 8.9%, respectively, P < 0.001) and less severe disease (46.7% vs. 60.3%, respectively, P < 0.027) in women, however, they were less likely to undergo invasive revascularization procedures (31% vs. 42.8%, respectively, P < 0.013). No significant differences were found between both sexes regarding in-hospital mortality or re-infarction rates. CONCLUSION We documented gender differences in both clinical presentation as well as management of patients admitted with ACS to ACH. However, there were no significant differences between both genders regarding the clinical in-hospital outcomes. Emphasis should be made to avoid such bias in the future.
Collapse
Affiliation(s)
- Abdullah S Assiri
- King Khalid University, Interventional Cardiology Consultant, College of Medicine, P.O. Box 641, 61421 Abha, Saudi Arabia
| |
Collapse
|