Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies

Statins for secondary prevention in women with atherosclerotic vascular disease: A nation-wide analysis of 24,665 women hospitalized for coronary, cerebrovascular or peripheral artery disease

Background

Statin therapy is recommended for secondary prevention of atherosclerotic vascular disease (ASCVD) based on randomized trials, which enrolled mostly men with coronary artery disease (CAD), whereas women and patients with cerebrovascular (CVD) and peripheral artery disease (PAD) were under-represented. We analyzed the effectiveness of statin therapy uptake in a nation-wide cohort of women hospitalized for ASCVD.

Methods

Women hospitalized for CAD, CVD, or PAD, including aortic disease, between 2015 and 2021 were retrospectively identified by linking the national hospital database, medicines reimbursement claims, and national mortality registry. The association of statin uptake within 30 days post-discharge with clinical outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed by Kaplan-Meier curves and Cox proportional hazards regression model with propensity score-derived inverse probability of treatment weights and a 30-day landmark period.

Results

We included 24,665 women with ASCVD - 14,419 with CAD, 5,427 with CVD, and 4,819 with PAD. Overall, the median age was 73 (64-81) years. The rates of statin uptake were 50 % for women with CAD, 60 % for CVD and 28 % for PAD. Statin therapy uptake was associated with a reduction in all-cause mortality and cardiovascular hospitalizations across all three major types of ASCVD: hazard ratio (HR) 0.88, 95 % confidence interval (CI) 0.83-0.93, p = 0.001 for CAD, HR 0.87, 95 % CI 0.80-0.94, p = 0.006 for PAD, and HR 0.72, 95 % CI 0.66-0.78, p < 0.001 for CVD.

Conclusion

Statin therapy is associated with reduced all-cause mortality and cardiovascular hospital readmissions in women with all major types of ASCVD.

Heart matters: the unique landscape of cardiovascular health in women

Cardiovascular disease (CVD) remains the leading cause of death globally, despite significant public health efforts. The identification and targeting of modifiable risk factors - including hypertension, dyslipidemia, diabetes mellitus, smoking and obesity - have led to significant improvements in patient outcomes over the past 60 years. However, current strategies based on this model have been shown to underestimate CVD risk in women and they are less frequently targeted compared to men. In addition, female-specific biological differences known to contribute to CVD are frequently understudied or excluded from risk stratification efforts. This review explores the unique epidemiological burden, pathobiology and outcomes of CVD in women; the influence of traditional and sex-specific risk factors; and both diagnostic and therapeutic strategies that may improve clinical outcomes in the future.

Sex-Specific Risk of Smoking for Abdominal Aortic Aneurysm and Exploration of Potential Mechanism: Meta-Analysis and Prospective Cohort Study

BACKGROUND

Smoking is the strongest modifiable risk factor for the development of abdominal aortic aneurysm (AAA). This study aims to confirm whether smoking is a stronger risk factor in women than men and identify contributory reasons, including inflammation, for any sex-specific difference observed.

METHODS

Systematic review and meta-analysis, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Data sources were Medline, Embase, and Cochrane Central Register of Controlled Trials. Population-based studies reporting the risk of AAA, adjusted for age and cardiovascular risk factors, for women versus men, were included. These were complemented by data from UK Biobank, which also were assessed for sex-specific effects of smoking on incident atherosclerotic cardiovascular disease.

RESULTS

Meta-analysis of 6 studies (including UK Biobank, 2001-2024) showed that the relative risk ratio of current versus never smokers for incident AAA in women versus men was 1.78 (95% CI, 1.32-2.38). In the UK Biobank cohort, the sex-specific relative risks of current smoking risks were higher for AAA than for atherosclerotic cardiovascular disease; hazard ratio, 1.74 and 1.29, respectively: analysis by cigarettes per day echoed these findings, but pack-year history had lesser association. The proportionately lower AAA incidence rate in exsmokers (versus current smokers) was more marked in women. Sex-specific risks of current smoking for incident AAA were not significantly modified by CRP (C-reactive protein), white blood cell count, or other inflammatory markers.

CONCLUSIONS

The relative risk of developing AAA by current smokers is almost twice as high in women versus men, but no strong association with inflammation was observed. Other reasons, including smoking intensity, must be sought.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD2024586609.

Sex differences in guideline adherence for coronary angiography in patients with suspected chronic coronary syndrome in Germany: insights from the ENLIGHT-KHK trial

BACKGROUND

For the management of acute coronary syndrome, literature shows lower healthcare providers' guideline adherence for women than for men. Since less is known about the management of chronic coronary syndrome (CCS), this study investigated patient-related sex differences in providers' guideline adherence for invasive coronary angiography (CA) performed in patients with suspected CCS.

METHODS

Using data from the German ENLIGHT-KHK trial, patients with suspected CCS who underwent a CA were analysed. To assess the association between patient sex and physicians' adherence to the German National Disease Management Guideline "Chronic coronary artery disease" of 2019, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, comorbidities, and non-invasive testing and its results. To examine sex differences in predictors of guideline adherence, models were run separately for women and men.

RESULTS

Two hundred seventy-three women and three hundred eighty-six men were included (aged 67 ± 10 years). Physicians' guideline adherence for CA was lower for women than for men (19.4% vs. 30.1%, p = 0.002). CAs were less likely to be guideline-adherent for women with suspected CCS than men (OR 0.4, p < 0.05). Guideline adherence predictors differed between women and men. For example, men's predictors included non-invasive testing and its results, age, typical angina and smoking; of these, only a positive non-invasive test result had an impact for women.

CONCLUSION

Our results indicate a less guideline-adherent diagnostic workup of CA for women with suspected CCS than men. This might reflect a limited awareness of CCS in women and insufficiently sex-specific guideline recommendations.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00015638, Registered February 19, 2019; Universal Trial Number (UTN): U1111-1227-8055.

Hearts apart: exploring sex disparity in the global and regional burden of ischemic heart disease; a systematic analysis from the global burden of disease study 1990-2021

BACKGROUND

Worldwide, ischemic heart disease is less prevalent in women than in men, but this gap has narrowed in recent decades. This study aims to evaluate trends and gender differences in the global burden of ischemic heart disease (IHD) across demographics and regions from 1990 to 2021.

METHODS

We utilized the data of the Global Burden of Disease Study from 1990 to 2021. The standard epidemiological measurements, including incidence, prevalence, mortality rates, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were obtained to estimate the burden of IHD concerning age, sex, and the sociodemographic index, allowing for comparisons over time.

RESULTS

The sex parity ratio (SPR), defined as the ratio of females to males, has increased globally. The SPR of age-standardized prevalence (ASPR) and age-standardized incidence (ASIR) rose from 0.610 to 0.631 in 1990 to 0.653 and 0.670 in 2021, respectively. From 1990 to 2021, the SPRs for ASPR and ASIR of IHD increased across all age groups. However, the SPRs for the age-standardized mortality rate (ASMR) and the age-standardized DALY rates (ASDR) of IHD declined. This decrease in the SPR for both ASMR and ASDR of IHD was observed in most regions of this study.

CONCLUSIONS

While progress has been made in reducing the burden of IHD, the increasing sex disparities in specific regions and age groups emphasize the need for continuous monitoring, adaptive health policies, and sex-specific healthcare practices to ensure equitable health outcomes for all populations.

CLINICAL TRIAL NUMBER

not applicable.

Canadian Cardiovascular Society Clinical Practice Update on Contemporary Approaches to Smoking Cessation

Smoking tobacco is the leading cause of preventable disease and death in Canada. Life expectancy of those who smoke is on average 10 years shorter than those who do not smoke. It is the most important modifiable risk factor for cardiovascular disease (CVD), doubling the risk of abdominal aortic aneurysm, coronary artery disease, ischemic stroke, and peripheral arterial disease. Smoking cessation is the single most powerful preventative intervention in clinical practice. Within 1 year of smoking cessation, the risk of CVD events decreases by 50%; after 15 years, the risk is the same as that of someone who has never smoked. Those who quit by age 40 have a life expectancy similar to that of people who have never smoked. Smoking cessation is a fundamental responsibility of every health care provider and must be a priority in all clinical settings. All patients must be systematically identified, treated, and have sufficient follow-up arranged. Advice should be brief, clear, and unambiguous to inform people who smoke about the harms of smoking and the benefits of cessation, in a personalized and nonjudgemental manner. It should be combined with pharmacotherapy because this can increase the likelihood of success by almost threefold. Health care practitioners should be as comfortable managing smoking cessation and initiating pharmacotherapy as they would be managing other CVD risk factors like hypertension or dyslipidemia.

Higher cumulative blood pressure is associated with increased risk of incident stroke but not heart disease among middle-aged and older Chinese adults: A prospective cohort study

OBJECTIVES

To examine the associations of cumulative systolic blood pressure (SBP)/diastolic blood pressure (DBP)/pulse pressure (PP) with the incident heart disease and stroke, as well as the dose-response relationship between them.

STUDY DESIGN

Longitudinal prospective cohort study.

METHODS

The present cohort was drawn from the China Health and Retirement Longitudinal Study during 2011-2018. The Kaplan-Meier method was used to calculate the cumulative incidence of heart disease and stroke by quartiles of cumulative BP among participants, and the hazard ratios (HRs) and 95% confidence intervals (CIs) for heart diseases and stroke risk associated with the cumulative BP were estimated using Cox proportional hazards models. Restricted cubic spline plots were used to elucidate the dose-response relationship.

RESULTS

After adjusting for multiple covariates, higher levels of cumulative SBP/DBP were found to be associated with the increased risk of incident stroke (HR for cumulative SBP: 2.11, 95% CI: 1.31-3.41; HR for cumulative DBP: 1.97, 95% CI: 1.25-3.11), but not heart diseases (HR for cumulative SBP: 1.21, 95% CI: 0.83-1.78; HR for cumulative DBP: 1.17, 95% CI:0.81-1.68). In stratified analyses, we found that age modified the positive association between high cumulative DBP and incident stroke, which more evident in subjects younger than 65 years. Besides, cumulative BP had no nonlinear dose-response relationship with the risk of heart diseases or stroke (P > 0.05).

CONCLUSIONS

These findings suggested that higher levels of cumulative SBP/DBP increased the risk of incident stroke, while no significant association was observed for incident heart disease and cumulative BP level.

An observational study of intergenerational sex differences in mortality in Aotearoa New Zealand

Internationally, there are observable sex differentials in mortality in many countries, most notably in affluent countries, with women living longer than men. To understand if this is also the case in Aotearoa New Zealand (NZ), we visualise the precise nature and evolution of sex differentials in mortality by age over time, within a wider context of increasing life expectancy and falling mortality. This allows us to determine if NZ mirrors other affluent countries in having a male/female inequality in mortality, and how the inequality has evolved over several generations in NZ. We use newly available single-year mortality data by sex in NZ to visualise and analyse the sex differentials in mortality using an observational study design. Sex and age-specific mortality data were obtained from the human mortality database from 1948 to 2021 for NZ. The data were then processed to create a smoothed data series using a geometric mean of those two years older and younger as well as aggregating the single-year age groups over 90 into a single category due to small numbers. The processed data was then visualised using a lexis diagram. There are clear patterns of elevated mortality ratios at younger ages (18-30) for males compared to females. The relative difference in mortality inequality between the sexes grew between 1950 and 1980 in NZ, before converging between 2000 and 2020. There is a consistent gap of at least 3 years in life expectancy across the study period by sex. Particularly striking is the longstanding nature of this inequality in mortality by sex in NZ and the relative lack of focus from policymakers. This focus on one country, NZ, allows examination of this specific context to understand how policy changes may have exacerbated or ameliorated trends in male/female mortality inequality.

Mitigation of nicotine-induced podocyte injury through inhibition of thioredoxin interacting protein

Nicotine has been reported to initiate NLRP3 inflammasome formation and activation in different pathological conditions. The current study assessed whether thioredoxin-interacting protein (TXNIP) mediates nicotine-induced NLRP3 inflammasome activation and consequent podocyte injury. Co-immunoprecipitation analysis demonstrated that nicotine-induced TXNIP/NLRP3 interaction in podocytes relative to control groups. However, pre-treatment with TXNIP inhibitors, verapamil (Vera) or SRI-37330 (SRI) attenuates nicotine-induced TXNIP/NLRP3 interaction. Confocal microscopic analysis showed that nicotine treatment significantly increased the colocalization of Nlrp3 with Asc, Nlrp3 with caspase-1 and Nlrp3 with TXNIP in podocytes compared to control cells. Pretreatment with TXNIP inhibitor Vera or SRI abolished nicotine-induced Nlrp3/Asc, Nlrp3/caspase-1 or Nlrp3/TXNIP colocalization. Correspondingly, nicotine treatment significantly increased the caspase-1 activity and IL-1β production compared to control cells. However, prior treatment with TXNIP inhibiting Vera or SRI significantly attenuated the nicotine-induced caspase-1 activity and IL-1β production. Further immunofluorescence analysis showed that nicotine treatment significantly decreased podocin and nephrin expression compared to control cells. However, pretreatment with TXNIP inhibiting Vera or SRI attenuated the nicotine-induced podocin and nephrin reduction. In addition, confocal, flow cytometry and biochemical analysis showed that nicotine treatment significantly increased desmin expression, apoptosis and cell permeability compared to control cells. However, prior treatment with TXNIP inhibiting Vera or SRI significantly attenuated the nicotine-induced desmin expression, apoptosis and cell permeability. Taken together, our results demonstrate that TXNIP/NLRP3 interaction constitutes a potentially key signalling mechanism driving nicotine-induced NLRP3 inflammasome formation, activation and subsequent podocyte damage.

Estimating the Direct Medical Costs of Smoking-Attributable Non-communicable Diseases in Northeastern Iran From 2015 to 2023

Introduction: Smoking remains a significant public health issue, leading to severe non-communicable diseases (NCDs) and a considerable economic burden, particularly in low- and middle-income countries. In Iran, smoking-attributable diseases account for substantial healthcare costs. This study aims to estimate the direct medical costs of smoking-attributable NCDs in hospitals affiliated with Mashhad University of Medical Sciences from 2015 to 2023. Methods: A descriptive-analytical study was conducted using a cross-sectional design, analyzing hospital records from 2015 to 2023. The study population included all patients aged 35 and older with smoking-attributable NCDs hospitalized during this period. The smoking-attributable fraction (SAF) was calculated using prevalence data for current and former smokers and relative risk estimates for various NCDs. Direct medical costs were extracted from the hospital information system and analyzed using Microsoft Excel 2019 and STATA 14 software. Results: The total direct medical costs of smoking-related NCDs averaged $10.5 million annually, with male patients accounting for 93.4% of these costs. Cardiovascular diseases were the largest cost driver, comprising 74.1% of the total expenses, followed by respiratory diseases (15.2%) and cancers (10.7%). The attributable risk for smoking-related diseases was consistently higher in men, particularly for lung cancer (76.9%) and chronic obstructive pulmonary disease (68.3%). Conclusion: Smoking imposes a significant financial burden on the healthcare system, particularly for male patients. Targeted tobacco control interventions, such as increased taxation and public awareness campaigns, are urgently needed to reduce smoking prevalence and mitigate its economic impact on healthcare systems. Comprehensive policies could alleviate the strain on Iran's healthcare system and improve public health outcomes.

A Stop-Smoking Strategy After Cervical Cancer Screening: Results of a Cluster-Randomized Controlled Trial in Dutch General Practice

INTRODUCTION

This study aimed to assess whether brief stop-smoking advice given to women who smoke and visit their general practice for cervical cancer screening improves smoking cessation outcomes.

AIMS AND METHODS

This two-arm cluster-randomized controlled trial was conducted in 75 Dutch general practices. Participants in the intervention group received brief stop-smoking advice based on the Ask-Advise-Connect method, delivered by a practice assistant. Patient-reported outcomes were measured at 6 months: undertaking a serious quit attempt of at least 24 hours during follow-up (primary outcome), 7-day point prevalence abstinence at 6 months, reduction in number of cigarettes smoked, increase in motivation to quit smoking, exposure to advice or support, and other psychological and behavioral measurements.

RESULTS

There was no significant difference in undertaking a serious quit attempt between the intervention (39.8% of n = 266) and control group (36.0% of n = 214), odds ratio 1.18 (95% confidence intervals: 0.80-1.72, p = .41). Neither did the point prevalence abstinence significantly differ between groups: 21.1% versus 16.3%, odds ratio 1.38 (95% confidence interval: 0.83-2.29, p = .21). Although nonsignificant, the direction of effects for the aforementioned outcomes was in favor of the intervention group. The reduction in the number of cigarettes smoked and increase in motivation to quit did not differ between groups. The uptake of cessation counseling was higher in the intervention (14.7%) than in the control group (2.8%).

CONCLUSIONS

A brief stop-smoking strategy after the smear test for cervical screening might encourage women who smoke to attempt quitting and seek cessation counseling, but a significant effect could not be demonstrated in this trial.

IMPLICATIONS

The results of this cluster-randomized trial suggest that brief advice to stop-smoking delivered by a practice assistant after routine cervical screening in general practice might encourage women who smoke to attempt quitting, but a significant effect could not be proven. Also, women who receive advice show a higher uptake of professional cessation counseling compared to their controls. Providing brief advice after the cervical smear might therefore be a useful opportunistic approach to stimulate cessation in women who smoke.

Outcomes of hospitalized black patients with atrial fibrillation based on sex

INTRODUCTION

Despite oral anticoagulation (AC), male patients with atrial fibrillation (AF) have worse inpatient outcomes versus females. This disparity is not well studied in Black Americans. Our objective was to evaluate in-patient outcomes of Black males hospitalized with AF versus Black females for whom AC was utilized.

METHODS

We conducted a retrospective analysis of the National Inpatient Sample and identified hospitalizations of Black Americans with AF prescribed AC between 4th quarter 2015 to 2020 using ICD-10 codes. Males were compared to females with the primary endpoint of major cardiovascular events (MACE) (acute myocardial infarction, cardiogenic shock, ischemic stroke, cardiac arrest, or in-patient mortality). Secondary endpoints included any major bleeding event, length-of-stay (LOS), and adjusted hospital charges. A logistic regression model was used to control potential confounders including age, Charlson Comorbidity Index, and in-hospital mortality.

RESULTS

A total of 180,650 Black patient hospitalizations were identified with AF prescribed AC, among which, 83,135 (46 %) were male. Males had more baseline comorbidities. After adjusting for selected confounders, Black males had higher odds of MACE (adjusted odds ratio [aOR] 1.16), major bleeding event (aOR 1.34), longer LOS (5.7 vs. 5.5 days), and higher adjusted hospital charges ($68,227 vs. $63,027); all p < 0.05.

CONCLUSION

In this "real life" inpatient cohort, compared with Black females, Black males with AF prescribed AC exhibit higher rates of MACE and major bleeding.

The Pathophysiology of Sex Differences in Stroke Risk and Prevention in Atrial Fibrillation: A Comprehensive Review

Atrial fibrillation (AF) is the most common chronic arrhythmia and is a leading cause of stroke, with well-documented differences in pathophysiology, clinical manifestations, and prognosis according to the sex of the patient. This review provides an overview of known or hypothesized sex differences in physiology and stroke risk for patients with AF. Women are reported to have more extensive fibrosis of the left atrium, different functional properties of the atria, and higher sensitivity to prothrombotic stimuli, especially after menopause. Variations in stroke risk with AF are linked to age, hypertension, diabetes, and chronic kidney disease; overall, women have worse outcomes. The widely clinically implemented CHA2DS2-VASc score no longer considers sex as a variable, and its propriety for women is still debated. However, women are usually under prescribed anticoagulation despite having a higher long-term risk of stroke compared to men, suggesting a lack of equity of treatment for certain patient groups. New AI-based risk stratification models and precision medicine approaches are potentially useful in reducing these gaps. Future work should also aim to improve sex-based predictive models, considering different gender categories, and understanding the part played by hormonal alterations, atrial structural alterations, and thromboembolic risk in the treatment of AF.

Epidemiology of Ischemic Heart Disease Burden Attributable to High Temperature in Asia From GBD 2021

BACKGROUND

Ischemic heart disease (IHD) posed the highest global disease burden in 2021, with regional disparities in Asia. Moreover, climate change is exacerbating population exposure to high temperatures (Hi-Tem).

OBJECTIVES

This study aimed to systematically assess the burden of IHD attributed to Hi-Tem in Asia, considering geographic and demographic factors.

METHODS

The Global Burden of Disease Study 2021 tools evaluated the IHD burden from Hi-Tem in Asia, and decomposition analysis was conducted to further explore the potential burden drivers.

RESULTS

Asia witnessed a significant increase in IHD burden caused by Hi-Tem, with 88,450 (95% UI: 15,815-188,816) deaths and 2,112,025.42 (95% UI: 456,758.65-4,325,643.47) disability-adjusted life years in 2021. Over the past 3 decades, the burden increased annually by 1.63% (95% CI: 1.25%-2.01%) in age-standardized mortality rate and by 1.60% (95% CI: 1.21%-1.99%) in age-standardized rate of disability-adjusted life years. Notably, South Asia bore the heaviest burden, whereas high-income Asia Pacific had the lightest. Men and older persons consistently faced a higher IHD burden from Hi-Tem. Despite generally balanced contributions from population growth, aging, and epidemiological changes, regional disparities may persist.

CONCLUSIONS

Our study provides a comprehensive overview of the demographic and geographic characteristics of the IHD burden attributable to Hi-Tem in Asia from 1990 to 2021. In summary, Asia's IHD burden caused by Hi-Tem rose significantly, with the greater impact on men and older populations.

Risk factors for cardiovascular diseases: the focus on primary prevention

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.

Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander

PURPOSE OF REVIEW

The aim of this review was to discuss cardiometabolic risk factors that affect women.

RECENT FINDINGS

Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women.

SUMMARY

Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

Associations of Blood Lipid-Related Polygenic Scores, Lifestyle Factors and Their Combined Effects with Risk of Coronary Artery Disease in the UK Biobank Cohort

Circulating lipids play a crucial role in the development of coronary artery disease (CAD). However, it is unclear whether the genetic susceptibility to hyperlipidemia may interact with lifestyle factors in CAD risk. Using UK Biobank data from 328,606 participants, we evaluated combined effects of genetic susceptibility to hyperlipidemia and lifestyle factors with risk of CAD. We found that both blood lipid-related polygenic score (PGS) and healthy lifestyle score (HLS) are independently associated with CAD risk, and individuals with the highest-risk lipid-related PGS and the least healthy HLS had the highest CAD risk. This association was stronger in younger (< 60 years, hazard ratio: 4.46, 95% confidence interval: 3.44-5.78) than older adults (2.54, 2.13-3.03). Our study suggests that individuals, particularly younger adults, with higher-risk PGSs of blood lipid traits would benefit more substantially by adherence to a healthy lifestyle than those with lower PGSs.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

Global, regional, and national burdens of ischemic heart disease in the older adults aged 60-89 years: a systematic analysis for the Global Burden of Disease Study 2019

Background

Ischemic heart disease (IHD) places a heavy burden on individual and public health. Nevertheless, comprehensive assessments of the burden of IHD in the elderly are absent. It is imperative to update the burden of IHD in older adults and predict the trends.

Methods

The absolute numbers and age-standardized rates (ASRs) of prevalence, mortality, and disability-adjusted life-years (DALYs) for IHD among people aged 60-89 years from 1990 to 2019 were analyzed based on the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression analysis was utilized to evaluate the epidemiologic trend of IHD in the elderly from 1990 to 2019. Bayesian age-period-cohort model was used to predict the burden of IHD among the elderly from 2020 to 2034.

Results

Age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR), and age-standardized mortality rate (ASMR) of IHD in older adults have declined slightly over the past 30 years. In 2019, the ASPR, ASIR, ASDR, and ASMR among the elderly with IHD were 14,280.53 (95% UI, 12,301.34-16,610.6), 1,445.21 (1,142-1,793.58), 11,225.74 (10,342.09-11,960.64), and 675.24 (614.21-721.75) per 100,000. The burden of IHD was significantly higher in older men than in women during the study period. In terms of socio-demographic index (SDI), countries and territories with lower SDI bore a more severe burden of IHD. The burden of IHD in the elderly varied considerably across countries. Uzbekistan had the largest increase in rates of prevalence, incidence, DALY, and mortality. The projections show a downward trend in DALY and mortality rates for IHD in older adults from 2020 to 2034, but incidence and prevalence will increase.

Conclusion

From 1990 to 2019, the worldwide burden of IHD among the elderly witnessed a decline. The IHD burden varied significantly across countries and territories. Policymakers should rationalize the allocation of health resources and implement effective prevention and treatment strategies to reduce the burden of IHD among the elderly in economically less developed countries and regions.

Optimism mitigated impacts of pre-operative depression and anxiety on post-operative distress in cardiac patients

Both anxiety and depression are comorbid mortality risks in middle-aged and older patients with heart diseases. Open-heart surgery (OHS), a life-altering procedure, can induce psychological distress that impedes postoperative recovery. Extensive research has shown the health benefit of optimism, an indicator of hope-a Character Strength in positive psychology. It predicts low mortality in cardiovascular disease-the number one killer of all Americans. Few studies, however, have explored whether that optimism mitigates the negative impact of preoperative depression and anxiety on postoperative general psychological distress. This interdisciplinary clinical study evaluated a hypothetical model of these relationships prior to and 1 month following OHS in 311 U.S. patients using a three-wave survey. Structural equation modeling (SEM) was performed to predict post-OHS general psychological distress. Optimism was indicated by two subscales in the Life Orientation Test (LOT). Based on the definition, general psychological distress was indicated by low symptom levels of somatization, depression, and anxiety as measured by the SCL-90 subscales. The final solution demonstrated a good fit. Optimism alleviates the negative effects of preoperative depression and anxiety, as indicators of poor mental health, on postoperative distress. Both older age and female gender were positively and directly associated with higher levels of post-OHS symptoms. The finding supports the beneficial role of optimism in mitigating the damage of poor mental health in the postoperative outcome of cardiac patients. The desirable function of character strength hope suggests that health providers should be attentive to and enhance inner strength for reducing the distress of cardiac patients in the postoperative recovery month.

Smoking Cessation Programs for Women in Non-reproductive Contexts: A Systematic Review

BACKGROUND

Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.

METHODS

We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies' approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.

RESULTS

Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.

CONCLUSIONS

Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment-behavioral counseling and pharmacotherapy-with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Cardiovascular Effects of Smoking and Smoking Cessation: A 2024 Update

Smoking is a significant risk factor for both acute and chronic cardiovascular diseases. These diseases contribute to approximately twenty percent of all-cause mortality. Research indicates that quitting smoking can substantially reduce or even reverse the harmful effects associated with smoking on cardiovascular health. Notably, these benefits can be observed in a relatively short period compared to the duration of smoking history. This article aims to provide data to understand the effects of smoking on the cardiovascular system locally as well as its effects as a pandemic globally and hence provide comprehensive strategies in the management of cardiovascular patients for smoking cessation.

Beyond self-reports: serum cotinine reveals sex-and age-related differences of smoking on all-cause and disease-specific mortality

Background

It is well-known that sex and age play critical roles in smoking-related diseases and mortality. However, quantification of the extent of smoking requires self-reports in these studies, which may yield only partially accurate results. This study investigated sex-and age-related differences in the association between smoking and all-cause, cardiovascular disease, and cancer mortality by measuring serum cotinine levels.

Methods

Participants aged 20-85 years from the US National Health and Nutrition Examination Survey (1999-2018) were included. All-cause and disease-specific mortality data were obtained from publicly available user-linked mortality files. Multivariate Cox regression was performed to identify serum cotinine as an independent risk factor of mortality. Subgroup and interaction analyses were performed to investigate these sex and age differences. Smooth curve fitting was conducted to discover potential nonlinear relationships and threshold saturation effects.

Results

Sex was significantly associated with all-cause and cancer mortality. Threshold saturation effects were observed in all-cause mortality among both males and females, cancer mortality among females, and cardiovascular disease mortality among males. Age markedly associated with all-cause and cardiovascular disease mortality. Threshold saturation effects were found in cardiovascular disease mortality among younger adults and cancer mortality among the all-age population.

Conclusion

These findings suggest that there are threshold saturation effects between smoking and mortality, and sex and age differences in smoking-related mortality are inconsistent in different diseases.

The causal relationship of cigarette smoking to metabolic disease risk and the possible mediating role of gut microbiota

BACKGROUND

Cigarette smoking is a leading cause of preventable death worldwide, with its associated diseases and conditions. Emerging evidence suggests that cigarette smoking contributes to a range of pathological metabolic injuries, including diabetes and nonalcoholic fatty liver disease (NAFLD). The impact of gut microbiota on metabolic health and diseases has been observed, but the causality remains uncertain.

OBJECTIVE

To confirm the causal relationship between cigarette smoking and metabolic diseases, and to investigate the possible mediating effect of gut microbiota on these connections.

METHODS

The relationships among cigarette smoking, metabolic diseases, and the gut microbiome were analyzed by Univariate Mendelian randomization (UVMR). Furthermore, to mitigate the impact of confounding factors, adjusted models were conducted via the multivariate Mendelian randomization (MVMR) method, aiming to improve the accuracy of prediction. Ultimately, the study evaluated the effect of the intermediary factor, gut microbiome, on the relationship between cigarette smoke and metabolic diseases.

RESULTS

The phenomenon that a causal relationship between cigarette smoke (249752 individuals) and gut microbiota (7738 individuals), diabetes (406831 individuals), NAFLD (377998 individuals), hypercholesterolaemia (463010 individuals), and obesity (463010 individuals) was observed using UVMR. In the MVMR model, the genetic connection between cigarette smoking, gut microbiota, and type 2 diabetes remained significant. Of note, paraprevotella_clara served an important mediating role in the type 2 diabetes associated with cigarette smoke.

CONCLUSION

This work offered genetic evidence linking cigarette smoke to metabolic diseases, suggesting that the gut microbiota, particularly paraprevotella_clara, might be a crucial mediator in the development of type 2 diabetes caused by cigarette smoke. Our future studies should consider conducting other ethnic groups MR analyses, particularly with larger sample sizes. Still, more in vivo and in vitro work should be carried out to validate the precise effect and molecular mechanisms of the gut microbiome.

Youthful Choices: A Secondary Analysis of the NFHS-5 Data to Examine Tobacco Use in Indian Adolescent Girls and Young Women

Background and aim

Tobacco use among adolescents and young women is a global health concern. This study investigates the prevalence and determinants of tobacco use among adolescents and young women in India.

Methods

Based on data from the National Family Health Survey-5, this study explored tobacco use among 241,180 young women aged 15-24 in India. The research investigated determinants of current tobacco use, encompassing any tobacco use in any form, smoked and smokeless tobacco (SLT). Independent variables include demographics, religion, caste, region, education, occupation, body mass index, wealth index, alcohol consumption, and media exposure. We used multivariable logistic regression models to estimate the adjusted odds ratio (OR) and 95% confidence intervals (95%CI).

Results

Findings revealed that 1.3% of the population are current tobacco users, with 1.2% using SLT and 0.14% smoking. Significant determinants included age, urban residence, religion, scheduled tribe status, wealth index, education, alcohol co-use, region, and pregnancy/lactation status. Young women (young women, 3.5% > adolescents, 1.5%; OR 1.78, 95%CI 1.65, 1.92), urban dwellers (OR 1.38, 95%CI 1.32, 1.43), and alcohol users (OR 5.6, 95%CI 4.88, 6.33) exhibited higher odds of tobacco use. In contrast, education (higher education OR 0.15, 95%CI 0.13, 0.18) and higher socioeconomic status (richest OR 0.3, 95%CI 0.22, 0.31) were protective factors.

Conclusion

Our research offered valuable insights into tobacco use among young Indian women. To effectively curb tobacco use in this population, it is imperative to address the identified determinants and vulnerabilities through tailored public health strategies and policies.

Correlation of serum cotinine with fatty liver index in adults: data from the NHANES March 2017 and 2018

BACKGROUND

The correlation between serum cotinine and fatty liver index (FLI) needs further investigation for the early identification, prevention, and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

Data from the NHANES database spanning from March 2017 to 2018 was used to perform the population-based study to assess the relationship between serum cotinine and FLI. A variance estimation strategy was applied to address the data volatility. To examine the correlation between serum cotinine and FLI, a weighted multivariate logistic regression model was used. Initial normality assessment through the Kolmogorov-Smirnov test indicated non-normal distribution. Median and interquartile range were employed for description of non-normally distributed measurement data, and group comparisons were made using the Kruskal-Wallis H test. Proportions were used for ordinal data description and comparisons, with the chi-square test used for categorical data. Smooth curve fittings and generalized additive models were used to explore the non-linear relationship between serum cotinine and FLI.

RESULTS

Finally, 2350 subjects (mean age: 49.83 ± 18.30, 1135 males and 1215 females) were selected for analysis. After adjusting for confounders, serum cotinine showed positive correlation with FLI in adults (β = 0.009, 95% CI: 0.003 to 0.014, P = 0.001). Additionally, individuals in the unexposed and passively exposed groups had lower FLI compared to those in the actively exposed group (β = -3.041, 95% CI: -4.728 to -1.353, P < 0.001; β = -2.159, 95% CI: -4.231 to -0.087, P = 0.041; respectively). Subgroup analyses by gender revealed positive associations between serum cotinine and FLI in both males (β = 0.007, 95% CI: 0.000 to 0.014, P = 0.048) and females (β = 0.012, 95% CI: 0.003 to 0.021, P = 0.007). Additionally, a positive correlation was found in "other races" subgroup (β = 0.017, 95% CI: 0.004 to 0.029, P = 0.008) rather than the subgroups of "Mexican American, Other Hispanic, Non-Hispanic White, and Non-Hispanic Black". The relationship between serum cotinine and FLI exhibited an inverted U-shaped curve with the turning point occurring at 521 ng/mL.

CONCLUSION

This study of a nationally representative sample demonstrates a positive association between serum cotinine and FLI, characterized by an inverted U-shaped curve. Both active and passive smoking emerge as a risk factor for the development and progression of MASLD. Smoking cessation is recommended to manage MASLD and support liver and cardiovascular health.

Exploring sex-specific genetic architecture of coronary artery disease in Tehran: a cardiometabolic genetic study

BACKGROUND

The development of coronary artery disease (CAD) is influenced by sex and genetic factors. Genome-wide association studies (GWAS) have linked genetic loci to CAD, mostly in European populations. The study aims to find sex-related genetic differences in the Iranian population.

RESEARCH DESIGN AND METHODS

We conducted a sex-stratified GWAS with 4519 subjects (1832 males and 2687 females) in the discovery group and 922 subjects (495 males and 427 females) in the confirmation group of an Iranian cohort. We analyzed 9,141,124 variants using a genome-wide complex trait analysis (GCTA) tool.

RESULTS

We detected distinct genetic variants associated with CAD in males: rs34952209 [OR = 1.79; p = 5.216E-8], rs1432687863 [OR = 1.95; p = 8.477E-8], and in females, rs7314741 [OR = 1.67; p = 7.142-8E] positively influenced CAD risk. The CAD-associated SNPs that were obtained have been confirmed using independent samples. Rs3495229 May impact histone mark and Pou2f2 motifs, while rs7314741 in the LEM Domain Containing 3 (LEMD3) promoter may affect a regulatory motif for the STAT transcription factor. According to Roadmap and ENCODE data, Rs1432687863 is a new variant affecting CAD in males, potentially through H3K9me3 in the heart.

CONCLUSIONS

Our findings highlight the role of sex-specific genetic differences in CAD development, providing novel insights into disease pathways which is not appropriate using a sex-combined strategy. [Figure: see text].

Examining the potential causal relationships among smoking behaviors, blood DNA methylation profiles, and the development of coronary heart disease and myocardial infarction

BACKGROUND

Smoking has been identified as a standalone risk factor for coronary heart disease (CHD) and myocardial infarction (MI), but the precise underlying mechanisms remain incompletely elucidated.

RESULTS

In this study, we conducted a two-sample Mendelian randomization analysis to examine the impact of smoking behaviors (including smoking initiation, age of smoking initiation, cigarettes per day, and smoking cessation) and smoking-related DNA methylation at CpG sites on CHD and MI based on the UK Biobank dataset. Additionally, we included the FinnGen and Biobank Japan datasets as replications and performed a meta-analysis to combine the results from different data sources. We further validated our results using genetic colocalization analysis. In genomic analysis, we provided compelling evidence on the association between genetically predicted smoking initiation and increased susceptibility to CHD and MI. In epigenetic analysis, we identified 11 smoking-related CpG sites linked to CHD risk and 10 smoking-related CpG sites associated with the risk of MI based on the UK Biobank dataset. Subsequently, some of these CpG sites were further replicated using the FinnGen or BBJ datasets. Ultimately, a meta-analysis was conducted to integrate findings from various data sources (3 for CHD, and 2 for MI), revealing that 7 of 11 CpG sites were linked to CHD risk; whereas, 7 of 10 CpG sites were associated with MI risk. Furthermore, we performed genetic colocalization analysis and found that cg19744173 (FBLN7), cg00395063 (ARHGEF12), and cg16822035 (MCF2L) exhibited robust evidence of colocalization with coronary heart disease; whereas, cg19529732 (DIABLO), cg26405020 (FES), and cg08940075 (CNN3) demonstrated strong colocalization evidence with the risk of myocardial infarction.

CONCLUSIONS

Our research offers a novel insight into the impact of smoking on the susceptibility to CHD and MI through the lens of epigenetic DNA methylation.

Modeling the determinants of smoking behavior among young adults in Khuzestan province: a two-level count regression approach

Purpose

This study investigates the determinants of smoking behavior among young adults in Khuzestan province, southwest Iran, using two-level count regression models. Given the high prevalence of smoking-related diseases and the social impact of smoking, understanding the factors influencing smoking habits is crucial for effective public health interventions.

Methods

We conducted a cross-sectional analysis of 1,973 individuals aged 18-35 years, using data from the Daily Smoking Consumption Survey (DSCS) in Khuzestan province collected in 2023. A variety of count regression models, including Poisson, Negative Binomial, Conway-Maxwell Poisson, and their zero-inflated counterparts, were evaluated. The best-fitting model was selected based on goodness-of-fit indices.

Results

Approximately 90% of participants were non-smokers. Among smokers, the prevalence of light, moderate, and heavy smoking was 47.7, 19.0, and 33.3%, respectively. The two-level Zero-Inflated Conway-Maxwell Poisson (ZICMP) model provided the appropriate fit for the data. Key determinants of daily cigarette consumption included gender, age, education, and Body Mass Index (BMI). Men consumed 3.24 times more cigarettes per day than women. Higher education levels were inversely related to smoking intensity, with MSc/PhD holders having significantly lower smoking rates. Age and BMI also significantly influenced smoking behavior, with younger and obese individuals showing lower smoking rates.

Conclusion

The use of advanced count models capable of handling numerous zeros and overdispersion is crucial for accurately analyzing trends in cigarette consumption across different population groups. The results indicate that factors such as older age, lower education levels, and gender differences influence smoking behavior. Therefore, prevention strategies aimed at delaying the onset of smoking, particularly among men, and promoting education among adolescents can effectively reduce smoking rates. However, further research should consider additional socioeconomic variables and encompass a broader age range to enhance the understanding of smoking behavior.

Sex differences in prevalence and characteristics of imaging-detected atherosclerosis: a population-based study

AIMS

Men are more likely to suffer a myocardial infarction than women, but population-based studies on sex differences in imaging-detected atherosclerosis are lacking. The aims were to assess sex differences in the prevalence of imaging-detected coronary and carotid atherosclerosis, as well as multivariable adjusted associations between sex and atherosclerosis.

METHODS AND RESULTS

Participants aged 50-65, recruited from the general population to the Swedish Cardiopulmonary bioImage Study (SCAPIS), were included in this population-based cross-sectional study. Comprehensive diagnostics, including coronary computed tomography angiography and carotid ultrasound, were performed. The image findings were any coronary atherosclerosis, coronary stenosis ≥ 50%, segment involvement score (SIS) ≥ 4, coronary artery calcium score (CACS) > 100, and any ultrasound-detected carotid plaque. In 25 580 participants (50% women), men had more hypertension (20.3% vs. 17.0%), hyperlipidaemia (9.0% vs. 5.5%), and diabetes (8.5% vs. 4.7%). The prevalence was 56.2% vs. 29.5% for any coronary atherosclerosis (P < 0.01), 9.0% vs. 2.3% for coronary stenosis ≥ 50% (P < 0.01), 20.2% vs. 5.3% for SIS ≥ 4 (P < 0.01), 18.2% vs. 5.6% for CACS > 100 (P < 0.01), and 60.9% vs. 48.7% for carotid plaque (P < 0.01), in men vs. women, respectively. Multivariable adjustment only marginally changed these associations: odds ratios (ORs) (95% confidence interval): 2.75 (2.53-2.99) for coronary atherosclerosis, 2.88 (2.40-3.45) for coronary stenosis ≥ 50%, 3.99 (3.50-4.55) for SIS ≥ 4, 3.29 (2.88-3.75) for CACS > 100, and 1.57 (1.45-1.70) for carotid plaque.

CONCLUSION

Men had higher prevalence of imaging-detected carotid and coronary atherosclerosis with prevalence in women aged 65 corresponding to men 11-13 years younger. The associations remained after extensive multivariable adjustment.

Prevalence of Elevated Blood Triglycerides and Associated Risk Factors: Findings from a Nationwide Health Screening in Mongolia

BACKGROUND

This study aims to assess the demographic, lifestyle, and clinical characteristics associated with varying levels of triglycerides (TGs) in a large population sample.

METHODS

This cross-sectional study utilized data from a nationwide health screening program in Mongolia. A total of 125,330 participants (mean age: 43.8 ± 15.3 years) were included. TG levels were categorized into normal, borderline high, high, and very high. Due to the small number of participants in the very high TG group, they were combined with the high TG category for analysis. Multivariate logistic regression was performed to identify independent predictors of elevated TG levels.

RESULTS

The majority of participants (80.3%) had normal TG levels, while 10.3% had borderline high, 8.7% had high, and 0.7% had very high TG levels. Significant predictors of elevated TG levels included age (OR 1.013, 95% CI 1.012-1.014), male (OR 2.328, 95% CI 2.251-2.408), obesity (OR 1.920, 95% CI 1.855-1.987), central obesity (OR 1.866, 95% CI 1.801-1.933), smoking (OR 1.399, 95% CI 1.347-1.453), alcohol use (OR 1.233, 95% CI 1.176-1.292), and non-regular exercise (OR 1.144, 95% CI 1.118-1.171). Sex-specific analysis revealed that elevated TG levels were more prevalent among males, regardless of other risk factors such as obesity and smoking.

CONCLUSIONS

Male sex, obesity, and smoking were the strongest predictors of elevated TG levels.

Relationship Between the Risk of Obstructive Sleep Apnea and Cardiovascular Health in Middle-Aged Korean Men and Women: A Nationwide Study

Background/Objectives: Cardiovascular health (CVH) can be conceptualized as encompassing seven health behaviors and metabolic factors that contribute to cardiovascular disease. We explored the relationship between the risk of obstructive sleep apnea (OSA) and CVH among middle-aged Korean adults. Methods: Data from 5909 participants, aged between 40 and 64 years, in the Korea National Health and Nutrition Examination Survey (2019-2021) were analyzed. The risk of OSA was assessed using STOP-Bang questionnaire. CVH metrics, including smoking status, diet, physical activity, body mass index (BMI), blood pressure, total cholesterol level, and fasting glucose concentration, were evaluated using American Heart Association criteria. Multivariate logistic regression analysis was employed to investigate the association between OSA risk and CVH. Results: Among study participants, 78.6% of men and 16.3% of women displayed moderate-to-high risk of OSA, while 45.4% of men and 17.2% of women exhibited poor CVH. The ORs (95% CIs) for poor CVH were 2.69 (2.08-3.49) for men at moderate risk of OSA and 6.54 (4.81-8.90) for those at high risk, compared to men at low risk. For women, the ORs were 3.21 (2.47-4.19) for those with moderate risk and 12.88 (6.29-26.38) for those with high risk of OSA, compared to women at low risk. CVH metrics associated with moderate-to-high OSA risk included high BMI, high blood pressure, elevated fasting glucose, and smoking. Conclusions: The risk of OSA was associated with poor CVH, while various CVH components were linked to moderate-to-high OSA risk. Managing both OSA and components of CVH is essential to minimize poor CVH.

Electronic nicotine delivery systems (ENDS): Frequency of use and smoking-cessation efforts among U.S. women of reproductive age

OBJECTIVE

Reducing harm from combustible cigarette use among women of reproductive age (WRA) is critical given their potential vulnerability to multigenerational adverse impacts of cigarette smoking. Although electronic nicotine delivery systems (ENDS) are not approved smoking cessation aids in the US, many WRA who smoke report using ENDS to help quit smoking. Associations between ENDS use patterns and smoking-cessation efforts among US WRA remain unclear.

METHODS

Using the Population Assessment of Tobacco and Health (PATH) Study, we examined whether baseline (Wave 3 or 4) ENDS use frequency predicted (a) making a cigarette quit attempt (QA) and (b) successful quitting by follow-up (Wave 4 or 5, respectively) among WRA (N = 2834; 72.1% non-Hispanic White).

RESULTS

Daily ENDS use predicted greater adjusted odds of making a QA than non-daily (AOR = 1.63, 95% CI = 1.03, 2.59) and no ENDS use (AOR = 1.97, 95% CI = 1.23, 3.14), and greater odds of successful smoking cessation than non-daily use (AOR = 2.37, 95% CI = 1.31, 4.26). Daily ENDS use did not significantly improve odds of successful smoking cessation compared to no ENDS use (AOR = 1.62, 95% CI = 0.97, 2.69). Non-daily ENDS use did not significantly improve odds of making a QA (AOR = 1.21, 95% CI = 0.94, 1.56) and hindered successful smoking cessation compared to no ENDS use (AOR = 0.68, 95% CI = 0.48, 0.98).

CONCLUSIONS

These findings suggest that benefits of ENDS for smoking cessation in WRA may be greatest among those who use ENDS daily. WRA who choose to use ENDS to help quit would be well-informed by evidence that non-daily ENDS use may impede smoking cessation.

Gender differences between smoking and the risk of hip fracture

OBJECTIVE

This study aimed to estimate the relation between cigarette smoking and hip fracture in men compared with women using a meta-analytic approach.

METHODS

On March 1, 2024, prospective cohort studies were searched from PubMed, Embase and Cochrane library systems. The gender difference in the relationship between smoking and hip fracture risk was evaluated by random effect model.

RESULTS

Eleven prospective cohort studies involving data from 2,689,620 individuals were selected for meta-analysis. The ratio of relative risk (RRR) of hip fractures in current smokers was significantly higher in men than in women (RRR: 1.10; 95%CI: 1.00 - 1.20; P = 0.047), while no evidence of sex differences in former smoking and hip fracture risk (RRR: 0.98; 95%CI: 0.88 - 1.10; P = 0.759).

CONCLUSIONS

The male-to-female RRR of hip fractures increased in current smokers, whereas no sex difference was found in the relationship between former smoking and the risk of hip fractures.

Differential effects of cigarette smoking on cardiovascular disease in females: A narrative review and call to action

OBJECTIVE

Cigarette smoking continues to be a major driver in the incidence and progression of cardiovascular disease (CVD). As females become an increasingly larger fraction of those who smoke it is imperative that the sex-specific effects of smoking be further explored and acted upon.

METHODS

This narrative review describes current evidence on the differential effects of smoking on CVD in females and the need to improve treatment.

RESULTS

Evidence to date suggests that smoking has disproportionately negative effects on the cardiovascular (CV) system in females, especially in those who are younger. Usually, the onset of CVD is later in females than males, but smoking decreases or eliminates this gap. Females are also more likely to develop types of CVD closely tied to smoking, such as ST-elevated myocardial infarctions, with even higher rates among those who are younger. Possible mechanisms for these worse outcomes in females include a complex interplay between nicotine, other products of combusted cigarettes, and hormones. Sex differences also exist in treatment for smoking. In females, Varenicline appears more effective than either Bupropion or nicotine replacement therapy while in males, all three therapies show similar efficacy. Disparities in smoking are also apparent in secondary prevention settings. Females and males are entering secondary prevention with equal rates of smoking, with potentially higher levels of exposure to the byproducts of smoking in females.

CONCLUSIONS

These disproportionately negative outcomes for females who smoke require additional research and these persisting rates of smoking suggest a need for female-specific approaches for treating smoking.

Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies' consensus document

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide. Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women's cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD. Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)'s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women. This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex- and gender-based research through collaboration across different affiliated societies within the BCS.

Perceived Susceptibility to and Severity of Cardiovascular Disease Is Associated With Intent to Change Behavior Among Women 25-55 Years Old

BACKGROUND

Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased, whereas CVD knowledge and awareness remain low.

AIMS

The objective of this study was to describe the relationship between the stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify predictors of the stage of behavior change.

METHODS

A cross-sectional online survey of women ages 25-55 years living in the United States was conducted. Awareness was measured with the question "What is the leading cause of death for women in the United States?" Knowledge, perceptions, and the stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and Precaution Adoption Process Model instruments, respectively. Chi-square and t tests were used to determine differences between awareness, knowledge, and perceptions based on the stage of behavior change. Multiple logistic regression was used to evaluate the relationship between the stage of behavior change and awareness, knowledge, and perceptions.

RESULTS

A total of 149 primarily minority women (n = 105) were included (mean age = 37.15 ± 7.86 years). The perception of CVD susceptibility was associated with increased intention to change behavior (odds ratio, 1.247; 95% confidence interval, 1.101-1.414; P < .001). The perception of CVD severity was associated with reduced intention to change behavior (odds ratio, 0.809; P = .004).

CONCLUSION

Women who believed they were susceptible to CVD and did not perceive CVD as severe were more likely to report intent to change behavior, suggesting perception of CVD risk is more important than awareness or knowledge. Addressing misperceptions may be a strategy for primary risk reduction.

The complexity of cardiovascular risk in women. Descriptive review

OBJECTIVES

Cardiovascular diseases (CVD) are the greatest threat to the health of women and is the leading cause of death amongst women globally; however, cardiovascular disease in women remains understudied, under-recognized, underdiagnosed, and undertreated. The aim of this descriptive review is to summarize the existing problem and to identify the knowledge gaps in cardiovascular disease research, prevention, treatment, and access to care for women.

MATERIAL AND METHODS

This is a descriptive review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century related to the spectrum of cardiovascular disease in women.

RESULTS

There are several obstacles to improve cardiovascular disease outcomes in women. One of them is the lack of reliable, effective screening modalities since her participation in clinical trial is quite low. Other concern is the complexity of the female organism with several hormonal changes during her life and the hemodynamics stress during pregnancy. Moreover, in the last stage of their life several cardiometabolic risk factor may appear, most of them not recognized by the health team in primary care attention.

DISCUSSION

Effective strategies are required to address inequalities in the diagnosis, treatment and prevention of heart disease in women; to advance innovative solutions for early detection and oriented management; to clarify the underlying biological mechanisms that contribute to sex-specific differences in outcomes; and finally, reduce the global burden of cardiovascular disease in women.

Tobacco smoking is associated with sex- and plaque-type specific upregulation of CRLF1 in atherosclerotic lesions

BACKGROUND AND AIMS

Tobacco smoking is a known risk factor for atherosclerotic disease, with more elevated risks in women compared to men. We hypothesized that atherosclerotic plaques from smokers show different gene expression patterns compared to non-smokers, in a sex-specific manner.

METHODS

Gene expression data of 625 carotid plaques (151 females and 474 males) were analyzed for differential gene expression between current smokers (n = 226) and non-smokers (n = 399). All analyses were stratified by sex and by molecular plaque characteristics. Finally, we projected the activity of gene regulatory networks and utilized single-cell transcriptomics from 38 plaques (26 males and 12 females) to interpret the sex- and plaque-type specific signals.

RESULTS

We observed higher expression levels of CRLF1 gene in atherosclerotic plaques from smokers compared to non-smokers (log2FC = 0.48, FDR = 0.012). CRLF1 upregulation was interacting with sex (p = 0.01) and was more pronounced in females (log2FC = 0.93, p = 1.53E-05) compared to males (log2FC = 0.35, p = 0.0018). Through single-cell RNA-seq analysis, we identified the highest CRLF1 expression within the transitioning and synthetic smooth muscle cell populations. CRLF1 expression was increased in fibro-inflammatory and fibro-cellular plaque types. Gene annotations pointed to increased expression of CRLF1 in networks with extracellular matrix related genes.

CONCLUSIONS

Atherosclerotic plaques from current smokers show sex-dependent upregulation of smooth muscle cell gene CRLF1. This may explain the different contributions of smoking to cardiovascular risk in females.

Comparing the Diagnostic Performance of Lung Ultrasonography and Chest Radiography for Detecting Pneumothorax in Patients with Trauma: A Meta-Analysis

INTRODUCTION

The objective of this study was to compare the diagnostic performance of ultrasonography (US) and chest radiography for detecting pneumothorax in patients with trauma using a meta-analytic approach.

METHODS

PubMed, Embase, and the Cochrane Library were systematically searched to identify eligible studies until March 2023. The diagnostic performance of US and chest radiography was assessed using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).

RESULTS

Overall, 21 studies involving 4,087 patients with trauma were included. The overall sensitivity, specificity, PLR, NLR, diagnostic score, DOR, and AUC of US for detecting pneumothorax were 0.83, 0.99, 73.72, 0.17, 6.06, 427.80, and 0.99, respectively. The corresponding values of chest radiography for detecting pneumothorax were 0.37, 1.00, 175.59, 0.63, 5.63, 279.97, and 0.86. US was associated with a higher sensitivity (ratio: 2.24; 95% confidence interval [CI]: 1.70-2.95; p < 0.001) or AUC (ratio: 1.15; 95% CI: 1.11-1.19; p < 0.001) and lower NLR (ratio: 0.27; 95% CI: 0.17-0.43; p < 0.001) compared with chest radiography.

CONCLUSION

Lung US was associated with better diagnostic performance than chest radiography for detecting pneumothorax in patients with trauma.

INTRODUCTION

The objective of this study was to compare the diagnostic performance of ultrasonography (US) and chest radiography for detecting pneumothorax in patients with trauma using a meta-analytic approach.

METHODS

PubMed, Embase, and the Cochrane Library were systematically searched to identify eligible studies until March 2023. The diagnostic performance of US and chest radiography was assessed using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).

RESULTS

Overall, 21 studies involving 4,087 patients with trauma were included. The overall sensitivity, specificity, PLR, NLR, diagnostic score, DOR, and AUC of US for detecting pneumothorax were 0.83, 0.99, 73.72, 0.17, 6.06, 427.80, and 0.99, respectively. The corresponding values of chest radiography for detecting pneumothorax were 0.37, 1.00, 175.59, 0.63, 5.63, 279.97, and 0.86. US was associated with a higher sensitivity (ratio: 2.24; 95% confidence interval [CI]: 1.70-2.95; p < 0.001) or AUC (ratio: 1.15; 95% CI: 1.11-1.19; p < 0.001) and lower NLR (ratio: 0.27; 95% CI: 0.17-0.43; p < 0.001) compared with chest radiography.

CONCLUSION

Lung US was associated with better diagnostic performance than chest radiography for detecting pneumothorax in patients with trauma.

Urine cotinine versus self-reported smoking and the risk of chronic kidney disease

BACKGROUND AND HYPOTHESIS

Evidence on the role of smoking in the development of chronic kidney disease (CKD) has mostly relied on self-reported smoking status. We aimed to compare the associations of smoking status as assessed by self-reports and urine cotinine with CKD risk.

METHODS

Using the PREVEND prospective study, smoking status was assessed at baseline using self-reports and urine cotinine in 4333 participants (mean age, 52 years) without a history of CKD at baseline. Participants were classified as never, former, light current, and heavy current smokers according to self-reports and comparable cutoffs for urine cotinine. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for CKD.

RESULTS

The percentages of self-reported and cotinine-assessed current smokers were 27.5% and 24.0%, respectively. During a median follow-up of 7.0 years, 593 cases of CKD were recorded. In analyses adjusted for established risk factors, the HRs (95% CI) of CKD for self-reported former, light current, and heavy current smokers compared with never smokers were 1.17 (0.95-1.44), 1.48 (1.10-2.00), and 1.48 (1.14-1.93), respectively. On further adjustment for urinary albumin excretion (UAE), the HRs (95% CI) were 1.07 (0.87-1.32), 1.26 (0.93-1.70), and 1.20 (0.93-1.57), respectively. For urine cotinine-assessed smoking status, the corresponding HRs (95% CI) were 0.81 (0.52-1.25), 1.17 (0.92-1.49), and 1.32 (1.02-1.71), respectively, in analyses adjusted for established risk factors plus UAE.

CONCLUSION

Self-reported current smoking is associated with increased CKD risk, but dependent on UAE. The association between urine cotinine-assessed current smoking and increased CKD risk is independent of UAE. Urine cotinine-assessed smoking status may be a more reliable risk indicator for CKD incidence than self-reported smoking status.

Differential effects of environmental exposures on clinically relevant endophenotypes between sexes

Sex and gender differences play a crucial role in health and disease outcomes. This study used data from the National Health and Nutrition Examination Survey to explore how environmental exposures affect health-related traits differently in males and females. We utilized a sex-stratified phenomic environment-wide association study (PheEWAS), which allowed the identification of associations across a wide range of phenotypes and environmental exposures. We examined associations between 272 environmental exposures, including smoking-related exposures such as cotinine levels and smoking habits, and 58 clinically relevant blood phenotypes, such as serum albumin and homocysteine levels. Our analysis identified 119 sex-specific associations. For example, smoking-related exposures had a stronger impact on increasing homocysteine, hemoglobin, and hematocrit levels in females while reducing serum albumin and bilirubin levels and increasing c-reactive protein levels more significantly in males. These findings suggest mechanisms by which smoking exposure may pose higher cardiovascular risks and greater induced hypoxia for women, and greater inflammatory and immune responses in men. The results highlight the importance of considering sex differences in biomedical research. Understanding these differences can help develop more personalized and effective health interventions and improve clinical outcomes for both men and women.

Perinatal depression and risk of maternal cardiovascular disease: a Swedish nationwide study

BACKGROUND AND AIMS

Increasing evidence suggests that some reproductive factors/hazards are associated with a future risk of cardiovascular disease (CVD) in women. While major (non-perinatal) depression has consistently been associated with CVD, the long-term risk of CVD after perinatal depression (PND) is largely unknown.

METHODS

A nationwide population-based matched cohort study involving 55 539 women diagnosed with PND during 2001-14 in Sweden and 545 567 unaffected women individually matched on age and year of conception/delivery was conducted. All women were followed up to 2020. Perinatal depression and CVD were identified from Swedish national health registers. Using multivariable Cox models, hazard ratios (HR) of any and type-specific CVD according to PND were estimated.

RESULTS

The mean age at the PND diagnosis was 30.8 [standard deviation (SD) 5.6] years. During the follow-up of up to 20 years (mean 10.4, SD 3.6), 3533 (6.4%) women with PND (expected number 2077) and 20 202 (3.7%) unaffected women developed CVD. Compared with matched unaffected women, women with PND had a 36% higher risk of developing CVD [adjusted HR = 1.36, 95% confidence interval (CI): 1.31-1.42], while compared with their sisters, women with PND had a 20% higher risk of CVD (adjusted HR = 1.20, 95% CI 1.07-1.34). The results were most pronounced in women without a history of psychiatric disorder (P for interaction < .001). The association was observed for all CVD subtypes, with the highest HR in the case of hypertensive disease (HR = 1.50, 95% CI: 1.41-1.60), ischaemic heart disease (HR = 1.37, 95% CI: 1.13-1.65), and heart failure (HR 1.36, 95% CI: 1.06-1.74).

CONCLUSIONS

Women with PND are at higher risk of CVD in middle adulthood. Reproductive history, including PND, should be considered in CVD risk assessments of women.

Sex-specific predictive factors of smoking cessation in subjects at high cardiovascular risk

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m2, hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.

The prevalence of the risk factors associated with cardiovascular diseases among Iranian adults: Findings of a cross-sectional study

BACKGROUND

Cardiovascular diseases are among the leading causes of death worldwide. Lack of accurate estimation of the risk factors associated with these diseases can impair the designing of effective interventions in this field; the present study aimed to investigate the risk factors attributable to cardiovascular diseases in males and females visiting comprehensive health service centers in 2018.

MATERIAL AND METHOD

This cross-sectional study is part of the national health transformation plan shaped in response to the emerging epidemic of noncommunicable diseases. In the present study, 6,331 participants aged 30 years and older were randomly and census selected from comprehensive urban and rural health service centers in Naein County, in Isfahan, Iran, respectively. The data were collected using the electronic health record from the IraPEN program in two sections: demographic information and the prevalence of cardiovascular disease risk factors. They were then analyzed with Statistical Package for the Social Sciences (SPSS) 24 software using descriptive statistics, Chi-square test, one-way ANOVA, and logistic regression.

RESULTS

The participants' mean age was 55.09 ± 16.11 years. The main risk factor was insufficient consumption of fruits and vegetables while smoking was a negligible risk factor. Low physical activity, diabetes, hypertension, hypercholesterolemia, and high body mass index were more prevalent in females than in males, whereas smoking was more frequently reported in males (P < 0.001). Risk factors such as age, gender, education level, place of residence, and marital status, played a significant role in determining CVD risk factors.

DISCUSSION

More than half of Iranian adults had one or older cardiovascular disease-related risk factors, and the prevalence of such factors was higher in females than in males. Given the importance of gender differences in cardiovascular disease-related health habits, it is necessary to reduce the majority of these diseases in society, especially in women, by controlling modifiable risk factors.