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Tegg NL, Myburgh C, O'Donnell E, Kennedy M, Norris CM. Impact of Secondary Amenorrhea on Cardiovascular Disease Risk in Physically Active Women: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e033154. [PMID: 38497482 PMCID: PMC11010010 DOI: 10.1161/jaha.123.033154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Exercise-associated secondary amenorrhea results in estrogen deficiency, which may lead to dysfunction in estrogen's normal cardioprotective pathways. Estrogen may be essential in a woman's endothelial adaptations to exercise. The objective of this review was to assess the association between secondary amenorrhea in physically active women and cardiovascular disease (CVD) risk. METHODS AND RESULTS A literature search was performed in January 2023 and updated in August 2023 of the Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations. Citation chaining was done to screen for additional studies. Eight sources were searched for gray literature. Studies that compared physically active women with amenorrhea to physically active women with eumenorrhea aged 18 to 35 years with evidence of CVD, alterations to cardiovascular physiology, or CVD risks were included. Eighteen observational studies from 3 countries were included. Overall, the quality of evidence was good. A meta-analysis was performed. Physically active women with secondary amenorrhea had significantly lower estradiol, flow-mediated dilation, resting heart rate, systolic blood pressure, and diastolic blood pressure and higher total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein cholesterol. CONCLUSIONS Estrogen deficiency resulting from exercise-associated secondary amenorrhea in physically active women may impact cardiovascular physiology and certain CVD risk factors. The research in this area is observational; therefore, findings should be interpreted cautiously. However, as exercise-associated secondary amenorrhea is reversible and the primary prevention of CVD is important for public health, it may be important to treat secondary amenorrhea and restore estrogen levels.
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Affiliation(s)
- Nicole L. Tegg
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Caitlynd Myburgh
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
- Faculty of Natural SciencesThe Kings UniversityEdmontonAlbertaCanada
| | | | | | - Colleen M. Norris
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
- Cavarzan Chair in Mature Women’s Research, WCHRIEdmontonAlbertaCanada
- Faculty of Medicine, School of Public Health SciencesUniversity of AlbertaEdmontonAlbertaCanada
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Fazzini L, Casati M, Martis A, Perra F, Rubiolo P, Deidda M, Mercuro G, Cadeddu Dessalvi C. Gender Effect on Clinical Profiles, Pharmacological Treatments and Prognosis in Patients Hospitalized for Heart Failure. J Clin Med 2024; 13:881. [PMID: 38337574 PMCID: PMC10856570 DOI: 10.3390/jcm13030881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Heart failure (HF) is a significant disease affecting 1-2% of the general population. Despite its general aspects, HF, like other cardiovascular diseases, presents various gender-specific aspects in terms of etiology, hemodynamics, clinical characteristics, therapy, and outcomes. As is well known, HF with preserved ejection fraction more frequently affects females, with diabetes and arterial hypertension representing the most critical determinants of HF. On the other hand, women are traditionally underrepresented in clinical trials and are often considered undertreated. However, it is not clear whether such differences reflect cultural behaviors and clinical inertia or if they indicate different clinical profiles and the impact of sex on hard clinical outcomes. We aimed to review the sex-related differences in patients affected by HF.
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Affiliation(s)
- Luca Fazzini
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Mattia Casati
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Alessandro Martis
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Ferdinando Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Paolo Rubiolo
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
- Sassu Cardiologic Center, Cittadella Universitaria, 09033 Sardinia, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Christian Cadeddu Dessalvi
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
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Tegg NL, Myburgh C, Kennedy M, Norris CM. Impact of secondary amenorrhea on cardiovascular disease risk in physically active women: a systematic review protocol. JBI Evid Synth 2024; 22:343-350. [PMID: 37529977 DOI: 10.11124/jbies-23-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The objective of this review is to assess the association between secondary amenorrhea in physically active women and cardiovascular disease risk. INTRODUCTION It is well established that a woman's risk of cardiovascular disease greatly increases after menopause. The sharp decline in estrogen is seen as a causal factor. Exercise-induced secondary amenorrhea results in estrogen deficiency, which may lead to dysfunction in estrogen's cardioprotective pathways. Further, estrogen may be essential in a woman's endothelial adaptations to exercise. The impact of secondary amenorrhea on cardiovascular disease risk in premenopausal women is not well established. INCLUSION CRITERIA This review will consider studies that include physically active women experiencing amenorrhea in any country. Only studies that present evidence of cardiovascular disease, alterations to cardiovascular physiology, or data on cardiovascular risk factors (eg, lipid profile changes) will be considered. The review will consider experimental or observational epidemiological study designs. METHODS Searches will be conducted in CINAHL (EBSCOhost), the Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations. Two independent reviewers will screen titles, abstracts, and full texts, appraise methodological quality, and extract data from studies. Where possible, studies will be pooled in a statistical meta-analysis in addition to subgroup analyses. Where pooling is not possible, the findings will be presented in narrative format. Certainty of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION PROSPERO CRD42023360781.
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Affiliation(s)
- Nicole L Tegg
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Caitlynd Myburgh
- Faculty of Natural Sciences, The Kings University, Edmonton, AB, Canada
| | | | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Cavarzan Chair in Mature Women's Research, Women's and Children's Health Research Institute, Edmonton, AB, Canada
- Faculty of Medicine, School of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
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Chen JY, Ardissino M, Reddy RK, Mason AM, Raisi‐Estabragh Z, Di Angelantonio E, Burgess S, Ng FS. Genetically predicted androgenic profiles and adverse cardiac markers: a sex-specific Mendelian randomization study. ESC Heart Fail 2023; 10:3525-3537. [PMID: 37736873 PMCID: PMC10682908 DOI: 10.1002/ehf2.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
AIMS Observational evidence suggests associations between sex hormone levels and heart failure (HF). We used sex-specific genetic variants associated with androgenic sex hormone profiles to investigate the causal relevance of androgenic sex hormone profiles on cardiac structure and function and HF using Mendelian randomization (MR). METHODS AND RESULTS Sex-specific uncorrelated genome-wide significant (P < 5 × 10-8 ) variants predicting sex hormone-binding globulin (SHBG), total testosterone, and bioavailable testosterone were extracted from summary statistics of genome-wide association study (GWAS) on 425 097 participants in the UK Biobank. Sex-specific gene-outcome association estimates were computed for left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV, respectively), left ventricular stroke volume (LVSV), cardiac index, and cardiac output in 11 528 female and 14 356 male UK Biobank Imaging Study participants and for incident or prevalent HF in an external cohort of 47 309 cases and 930 014 controls. Inverse-variance weighted MR was the primary analysis method. In females, higher genetically predicted bioavailable testosterone was associated with lower LVEDV [β per nmol/L = -0.11 (-0.19 to -0.03), P = 0.006], lower LVESV [β = -0.09 (-0.17 to -0.01), P = 0.022], lower LVSV [β = -0.11 (-0.18 to -0.03), P = 0.005], lower cardiac output [β = -0.08 (-0.16 to 0.00), P = 0.046], and lower cardiac index [β = -0.08 (-0.16 to -0.01), P = 0.034] and a higher risk of HF [odds ratio 1.10 (1.01-1.19), P = 0.026] on external validation analysis in larger scale, sex-adjusted GWAS data. Higher genetically predicted SHBG was associated with higher LVEDV [β per nmol/L = 0.17 (0.08-0.25), P = 2 × 10-4 ], higher LVESV [β = 0.13 (0.05-0.22), P = 0.003], and higher LVSV [β = 0.18 (0.08-0.28), P = 2 × 10-4 ]. In males, higher genetically predicted total and bioavailable testosterone was associated with lower LVESV [β = -0.07 (-0.12 to -0.02), P = 0.007] and LVEF [β = -0.11 (-0.18 to -0.04), P = 0.003], respectively. CONCLUSIONS This study supports a causal effect of pro-androgenic sex hormone profiles in females on adverse markers of left ventricular structure and function typically associated with HF with preserved ejection fraction and with HF. There was weaker evidence of association in males.
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Affiliation(s)
- Jun Yu Chen
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Maddalena Ardissino
- National Heart and Lung InstituteImperial College LondonLondonUK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Amy Marie Mason
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| | - Zahra Raisi‐Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research CentreQueen Mary University of LondonLondonUK
- Barts Heart Centre, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUK
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Bertomeu-Gonzalez V, Cordero A, Ruiz-Nodar JM, Sánchez-Ferrer F, López-Pineda A, Quesada JA. Risk factors for major adverse cardiovascular events in postmenopausal women: UK Biobank prospective cohort study. Atherosclerosis 2023; 386:117372. [PMID: 37976635 DOI: 10.1016/j.atherosclerosis.2023.117372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular risk increases during menopause, so the medical and scientific community should consider women's specific risk factors to prevent cardiovascular disease. This study aims to assess the risk factors for the incidence of major adverse cardiovascular events (MACE) exclusive to postmenopausal women. METHODS We conducted a prospective cohort study in postmenopausal women aged 40 years and older, who were included in the UK Biobank cohort between 2006 and 2010 and followed to 2021 (12 years). A total of 156,787 women were followed for a median of 12.5 years (nearly 2 million person-years), and MACE risk was assessed using Fine-Gray competing risk models. RESULTS The cumulative incidence of cardiovascular morbidity and mortality was 1.2% (0.97 cases per 1000 women-years). Not having taken birth control pills, not having children, and early menarche (≤12 years) were independently associated with cardiovascular morbidity and mortality. CONCLUSIONS Risk factors for cardiovascular disease that are specific to women include early menarche, not having taken oral contraceptives, and reproductive history, and this relationship is independent of classic cardiovascular risk factors.
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Affiliation(s)
- Vicente Bertomeu-Gonzalez
- Cardiology Department, Benidorm Clinical Hospital, Benidorm, Spain; GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain
| | - Alberto Cordero
- GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain; Cardiology Department, Hospital IMED, Alicante, Spain; Cardiovascular CIBER, Madrid, Spain
| | - Juan Miguel Ruiz-Nodar
- GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain; Cardiology Department, University Hospital Dr. Balmis de Alicante, Alicante, Spain
| | - Francisco Sánchez-Ferrer
- GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain; Pediatrics Department, University Hospital San Juan de Alicante, Alicante, Spain
| | - Adriana López-Pineda
- GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain; Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain.
| | - José Antonio Quesada
- GRINCAVA Research Group, Clinical Medicine Department, University Miguel Hernández de Elche, Alicante, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Alicante, Spain
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Niu Z, Mu L, Buka SL, Loucks EB, Wang M, Tian L, Wen X. Involuntary tobacco smoke exposures from conception to 18 years increase midlife cardiometabolic disease risk: a 40-year longitudinal study. J Dev Orig Health Dis 2023; 14:689-698. [PMID: 38186328 PMCID: PMC10984799 DOI: 10.1017/s2040174423000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Few population studies have sufficient follow-up period to examine early-life exposures with later life diseases. A critical question is whether involuntary exposure to tobacco smoke from conception to adulthood increases the risk of cardiometabolic diseases (CMD) in midlife. In the Collaborative Perinatal Project, serum-validated maternal smoking during pregnancy (MSP) was assessed in the 1960s. At a mean age of 39 years, 1623 offspring were followed-up for the age at first physician-diagnoses of any CMDs, including diabetes, heart disease, hypertension, or hyperlipidemia. Detailed information on their exposure to environmental tobacco smoke (ETS) in childhood and adolescence was collected with a validated questionnaire. Cox regression was used to examine associations of in utero exposure to MSP and exposure to ETS from birth to 18 years with lifetime incidence of CMD, adjusting for potential confounders. We calculated midlife cumulative incidences of hyperlipidemia (25.2%), hypertension (14.9%), diabetes (3.9%), and heart disease (1.5%). Lifetime risk of hypertension increased by the 2nd -trimester exposure to MSP (adjusted hazard ratio: 1.29, 95% confidence interval: 1.01-1.65), ETS in childhood (1.11, 0.99-1.23) and adolescence (1.22, 1.04-1.44). Lifetime risk of diabetes increased by joint exposures to MSP and ETS in childhood (1.23, 1.01-1.50) or adolescence (1.47, 1.02-2.10). These associations were stronger in males than females, in never-daily smokers than lifetime ever smokers. In conclusion, early-life involuntary exposure to tobacco smoke increases midlife risk of hypertension and diabetes in midlife.
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Affiliation(s)
- Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Eric B. Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
- RENEW Institute, The State University of New York at Buffalo, Buffalo, NY
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Lili Tian
- Department of Biostatistics, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, NY
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Mattioli AV, Coppi F, Bucciarelli V, Gallina S. Cardiovascular risk stratification in young women: the pivotal role of pregnancy. J Cardiovasc Med (Hagerstown) 2023; 24:793-797. [PMID: 37773880 DOI: 10.2459/jcm.0000000000001557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Kvandova M, Puzserova A, Balis P. Sexual Dimorphism in Cardiometabolic Diseases: The Role of AMPK. Int J Mol Sci 2023; 24:11986. [PMID: 37569362 PMCID: PMC10418890 DOI: 10.3390/ijms241511986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality and disability among both males and females. The risk of cardiovascular diseases is heightened by the presence of a risk factor cluster of metabolic syndrome, covering obesity and obesity-related cardiometabolic risk factors such as hypertension, glucose, and lipid metabolism dysregulation primarily. Sex hormones contribute to metabolic regulation and make women and men susceptible to obesity development in a different manner, which necessitates sex-specific management. Identifying crucial factors that protect the cardiovascular system is essential to enhance primary and secondary prevention of cardiovascular diseases and should be explicitly studied from the perspective of sex differences. It seems that AMP-dependent protein kinase (AMPK) may be such a factor since it has the protective role of AMPK in the cardiovascular system, has anti-diabetic properties, and is regulated by sex hormones. Those findings highlight the potential cardiometabolic benefits of AMPK, making it an essential factor to consider. Here, we review information about the cross-talk between AMPK and sex hormones as a critical point in cardiometabolic disease development and progression and a target for therapeutic intervention in human disease.
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Affiliation(s)
- Miroslava Kvandova
- Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (A.P.); (P.B.)
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Coppi F, Bucciarelli V, Sinigaglia G, Zanini G, Selleri V, Nasi M, Pinti M, Gallina S, Mattioli AV. Sex Related Differences in the Complex Relationship between Coffee, Caffeine and Atrial Fibrillation. Nutrients 2023; 15:3299. [PMID: 37571236 PMCID: PMC10420923 DOI: 10.3390/nu15153299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
This literature review aims to explore the data of articles published on the association between coffee, caffeine and atrial fibrillation and to analyze any differences between the two sexes. Several factors influence this complex relationship; genetic, environmental and psychosocial factors come into play in the pathophysiology of atrial fibrillation. These factors are expressed differently in women and men. However, the analysis of the literature has shown that comparison works between the two sexes are extremely rare. Most population-based and prospective studies either analyze aggregated data or focus on exclusively male or female populations. This results in a lack of information that could be useful in the prevention of and treatment approach to atrial fibrillation. It is necessary to deepen this issue with dedicated studies.
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Affiliation(s)
- Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero—Universitaria delle Marche, 60126 Ancona, Italy
| | - Giorgia Sinigaglia
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (G.Z.); (V.S.); (M.P.)
| | - Giada Zanini
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (G.Z.); (V.S.); (M.P.)
| | - Valentina Selleri
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (G.Z.); (V.S.); (M.P.)
| | - Milena Nasi
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (G.Z.); (V.S.); (M.P.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy;
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Bucciarelli V, Bianco F, Di Blasio A, Morano T, Tuosto D, Mucedola F, Di Santo S, Cimini A, Napolitano G, Bucci I, Di Baldassarre A, Cianchetti E, Gallina S. Cardiometabolic Profile, Physical Activity, and Quality of Life in Breast Cancer Survivors after Different Physical Exercise Protocols: A 34-Month Follow-Up Study. J Clin Med 2023; 12:4795. [PMID: 37510910 PMCID: PMC10381308 DOI: 10.3390/jcm12144795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Breast cancer (BC) and cardiovascular (CV) disease share many risk factors associated with worse outcomes, in terms of cancer relapse, CV events, and quality of life (QoL), that could be counteracted by physical exercise (PE). We aimed to assess the impact of a 12-week differential PE protocol on cardiometabolic profile, QoL, CV- and BC-related long-term outcomes, and physical activity (PA) in a cohort of BC survivors (BCS) not treated with chemotherapy. METHODS 57 BCS participated in a 12-week PE protocol [aerobic exercise training (AET) or resistance exercise training (RET)]. Anthropometric and CV evaluation, health-related (HR)-QoL, daily PA, cortisol, and dehydroepiandrosterone sulfate (DHEA-S) levels were assessed before (T0) and after (T1) PE. We assessed BC and CV outcomes, HR-QoL, CV-QoL, and PA at the follow-up. RESULTS RET improved waist circumference, DHEA-S, cortisol/DHEA-S, systolic and mean blood pressure, and ventricular/arterial coupling; AET ameliorated sagittal abdomen diameter and pulse wave velocity. Regarding HR-QoL, physical function improved only in AET group. At a mean 34 ± 3.6-month follow-up, we documented no significant differences in CV-QoL, HR-QoL, and PA or CV and BC outcomes. CONCLUSIONS AET and RET determine specific, positive adaptations on many parameters strongly related to CV risk, CV and BC outcomes, and QoL, and should be included in any cardio-oncology rehabilitation program.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Teresa Morano
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Desiree Tuosto
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Francesco Mucedola
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Serena Di Santo
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Alessandra Cimini
- Eusoma Breast Centre, "G. Bernabeo" Hospital, ASL02 Lanciano-Vasto-Chieti, 66026 Ortona, Italy
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Ines Bucci
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
| | - Ettore Cianchetti
- Eusoma Breast Centre, "G. Bernabeo" Hospital, ASL02 Lanciano-Vasto-Chieti, 66026 Ortona, Italy
| | - Sabina Gallina
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University, 66100 Chieti, Italy
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11
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Arata A, Ricci F, Khanji MY, Mantini C, Angeli F, Aquilani R, Di Baldassarre A, Renda G, Mattioli AV, Nodari S, Gallina S. Sex Differences in Heart Failure: What Do We Know? J Cardiovasc Dev Dis 2023; 10:277. [PMID: 37504533 PMCID: PMC10380698 DOI: 10.3390/jcdd10070277] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Heart failure (HF) remains an important global health issue, substantially contributing to morbidity and mortality. According to epidemiological studies, men and women face nearly equivalent lifetime risks for HF. However, their experiences diverge significantly when it comes to HF subtypes: men tend to develop HF with reduced ejection fraction more frequently, whereas women are predominantly affected by HF with preserved ejection fraction. This divergence underlines the presence of numerous sex-based disparities across various facets of HF, encompassing aspects such as risk factors, clinical presentation, underlying pathophysiology, and response to therapy. Despite these apparent discrepancies, our understanding of them is far from complete, with key knowledge gaps still existing. Current guidelines from various professional societies acknowledge the existence of sex-based differences in HF management, yet they are lacking in providing explicit, actionable recommendations tailored to these differences. In this comprehensive review, we delve deeper into these sex-specific differences within the context of HF, critically examining associated definitions, risk factors, and therapeutic strategies. We provide a specific emphasis on aspects exclusive to women, such as the impact of pregnancy-induced hypertension and premature menopause, as these unique factors warrant greater attention in the broader HF discussion. Additionally, we aim to clarify ongoing controversies and knowledge gaps pertaining to the pharmacological treatment of HF and the sex-specific indications for cardiac implantable electronic devices. By shining a light on these issues, we hope to stimulate a more nuanced understanding and promote the development of more sex-responsive approaches in HF management.
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Affiliation(s)
- Allegra Arata
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Angeli
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33-40126 Bologna, Italy
| | - Roberta Aquilani
- Cardiac Surgery Intensive Care Unit, Heart Department, SS Annunziata University Hospital, Via dei Vestini 5, 66100 Chieti, Italy
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, and Reprogramming and Cell Differentiation Lab, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST "Spedali Civili" Hospital, 25123 Brescia, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
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12
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Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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13
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Mattioli AV, Moscucci F, Sciomer S, Maffei S, Nasi M, Pinti M, Bucciarelli V, Dei Cas A, Parati G, Ciccone MM, Palmiero P, Maiello M, Pedrinelli R, Pizzi C, Barillà F, Gallina S. Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on 'Prevention, hypertension and peripheral disease'. J Cardiovasc Med (Hagerstown) 2023; 24:e147-e155. [PMID: 37186565 DOI: 10.2459/jcm.0000000000001423] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The recent pandemic has substantially changed the approach to the prevention of cardiovascular diseases in women. Women have been significantly impacted by the changes that occurred during the pandemic and the quarantine adopted to prevent the spread of the disease. Changes involved prevention both through the reduction of visits and preventive screening and through social and economic changes. It is necessary to adopt new cardiovascular prevention approaches focused on returning to healthy lifestyles, reducing stress and depression also using modern tools such as telemedicine, mobile phone applications and the web. These tools convey messages in a persuasive way especially in young and adult women. There is less impact of these new tools on older women towards whom it is important to adopt a more traditional approach. This review focuses on the new approach to cardiovascular prevention in women in light of the lifestyle changes recorded during the pandemic and which led to an increase in obesity examines the effects on the cardiovascular system induced by stress and depression and analyses the new high blood pressure guidelines and indications that are specific to women.
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Affiliation(s)
- Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome
| | | | - Milena Nasi
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena
| | - Marcello Pinti
- Department of Life Science, University of Modena and Reggio Emilia, Modena
| | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
| | - Alessandra Dei Cas
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan & Department of Medicine and Surgery, University of Milano-Bicocca, Milan
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University 'A. Moro' of Bari, Bari
| | | | - Maria Maiello
- ASL Brindisi, Cardiology Equipe, District of Brindisi, Brindsi
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University of Pisa, Pisa
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | | | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
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14
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Moscucci F, Gallina S, Bucciarelli V, Aimo A, Pelà G, Cadeddu-Dessalvi C, Nodari S, Maffei S, Meloni A, Deidda M, Mercuro G, Pedrinelli R, Penco M, Sciomer S, Mattioli AV. Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on 'gender cardiovascular diseases'. J Cardiovasc Med (Hagerstown) 2023; 24:e15-e23. [PMID: 36729627 PMCID: PMC10100638 DOI: 10.2459/jcm.0000000000001398] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023]
Abstract
The coronavirus disease 19 (COVID-19), due to coronavirus 2 (SARS-CoV-2) infection, presents with an extremely heterogeneous spectrum of symptoms and signs. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality than women. In particular, cardiovascular diseases (preexistent or arising upon infection) play a central role in COVID-19 outcomes, differently in men and women. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Such variability can be ascribed to both sex-related biological factors and sex-related behavioural traits. Sex differences in cardiovascular disease and COVID-19 involve the endothelial dysfunction, the innate immune system and the renin-angiotensin system (RAS). Furthermore, the angiotensin-converting enzyme 2 (ACE2) is involved in disease pathogenesis in cardiovascular disease and COVID-19 and it shows hormone-dependent actions. The incidence of myocardial injury during COVID-19 is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders among men. Its pathogenesis is not fully elucidated, but the main theories foresee a direct role for the ACE2 receptor, the hyperimmune response and the RAS imbalance, which may also lead to isolated presentation of COVID-19-mediated myopericarditis. Moreover, the latest evidence on cardiovascular diseases and their relationship with COVID-19 during pregnancy will be discussed. Finally, authors will analyse the prevalence of the long-covid syndrome between the two sexes and its impact on the quality of life and cardiovascular health.
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Affiliation(s)
- Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome ‘Sapienza’, Policlinico Umberto I, Rome
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti
| | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona ‘Umberto I, G. M. Lancisi, G. Salesi’, Ancona
| | - Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio
- Scuola Superiore Sant’Anna, Pisa
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma
- Department of General and Specialistic Medicine, University-Hospital of Parma, Parma
| | | | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Silvia Maffei
- Cardiovascular and Gynaecological Endocrinology Unit, Fondazione G Monasterio CNR-Regione Toscana
| | - Antonella Meloni
- Department of Radiology, Fondazione G Monasterio CNR-Regione Toscana, Pisa
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome ‘Sapienza’, Policlinico Umberto I, Rome
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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15
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Xing W, Gu W, Liang M, Wang Z, Fan D, Zhang B, Wang L. Association between aldehyde exposure and sex steroid hormones among adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:30444-30461. [PMID: 36434445 DOI: 10.1007/s11356-022-24362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Exogenous and endogenous exposure to aldehydes is seen worldwide. Aldehydes are closely associated with human diseases, especially reproductive toxicity. However, the effect of aldehyde exposure on sex steroid hormones among adults remains uninvestigated. A total of 851 participants aged over 18 years were included in this cross-sectional analysis based on data from National Health and Nutrition Examination Survey (NHANES) 2013-2014. Serum aldehyde concentrations were quantified following an automated analytical method. Sex steroid hormones including total testosterone, estradiol, and sex hormone binding globulin (SHBG) were detected. Multivariate linear regression models, forest plots, generalized additive model (GAM), and smooth curve fitting analysis were used to assess the associations between quartiles of aldehydes and sex steroid hormones levels after adjusting for potential confounders. Butyraldehyde and propanaldehyde were found to be negatively associated with estradiol and SHBG in females and males, respectively. β values with 95% confidence intervals (95% CIs) were - 20.59 (- 38.30 to - 2.88) for Q2 vs. Q1 of butyraldehyde and - 8.13 (- 14.92 to - 1.33) and - 7.79 (- 14.91 to - 0.67) for Q2 vs. Q1 and Q4 vs. Q1 of propanaldehyde. No significant associations were observed between other aldehydes and sex hormones. In premenopausal women, isopentanaldehyde was inversely associated with serum total testosterone levels (Q4 vs. Q1: OR = - 7.95, 95% CI: - 15.62 to - 0.27), whereas propanaldehyde was positively associated with serum estradiol concentration (Q3 vs. Q1: β = 28.88, 95% CI: 0.83 to 56.94). Compared with Q1, Q3 of isopentanaldehyde was associated with 3.53 pg/mL higher concentration of estradiol in postmenopausal women (β = 3.53, 95% CI: 0.08 to 6.97). Moreover, in males under 40 years, butyraldehyde and heptanaldehyde were inversely proportional to total testosterone levels and heptanaldehyde and butyraldehyde were negatively associated with estradiol and SHBG. Decreased total testosterone, elevated estradiol, and decreased SHBG levels were found in higher quartiles of benzaldehyde, hexanaldehyde and isopentanaldehyde, and propanaldehyde, respectively, in males aged over 60 years. In male participants aged 40-60 years, only hexanaldehyde was observed to be correlated with higher serum estradiol levels. In conclusion, our current research presented the association between six serum aldehydes and sex hormones. Of note, stratification analyses were conducted in participants with different menopausal statuses and age among males and females. Sex- and age-specific effect of aldehyde exposure on alterations in sex hormone levels were observed. Further studies are warranted to confirm the causal relationship and explore the underlying mechanisms.
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Affiliation(s)
- Weilong Xing
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China.
| | - Wen Gu
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
| | - Mengyuan Liang
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
| | - Zhen Wang
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
| | - Deling Fan
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
| | - Bing Zhang
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
| | - Lei Wang
- Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment (MEE), Nanjing, 210042, People's Republic of China
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16
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Żuchowski B, Błaszyk K, Piskorski J, Wykrętowicz A, Guzik P. Dependence of the Atrioventricular Conduction Time on the Conduction through the Atrioventricular Node and His-Purkinje System. J Clin Med 2023; 12:jcm12041330. [PMID: 36835864 PMCID: PMC9958776 DOI: 10.3390/jcm12041330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/06/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The electrical depolarization of the heart passes through various structures of the cardiac conduction system, which modify its conduction to different extents. In this study, we investigated the relationship between the atrioventricular conduction time (AV interval) and its contributors, the atrioventricular node (AVN) and the His-Purkinje system (HPS), as represented by the AH and HV intervals, respectively. We also compared sex differences in these intervals and their relations. Resting intracardiac tracings lasting 5 min were obtained from 64 patients (33 women) during an invasive electrophysiological study. The aforementioned intervals were measured for all consecutive beats. The mean AH interval was 85.9 ms, HV 43.7 ms, and AV 129.6 ms. Men had longer AH (80.0 vs. 65.9 ms), HV (38.4 vs. 35.3 ms), and AV intervals (124.7 vs. 108.5 ms) than women. The AV intervals were linearly correlated with AH intervals in all patients (r2 = 0.65). No significant correlation was found between AV and HV intervals in all patients (r2 = 0.05). There were no sex differences in these associations. Our results suggest that the atrioventricular conduction time depends mainly on the conduction through the AVN and less on the HPS. These relations are similar in both sexes, although men had longer conduction times through the AVN, HPS, and total atrioventricular conduction time.
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Affiliation(s)
- Bartosz Żuchowski
- Department of Cardiology Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
- Correspondence: ; Tel.: +48-618691391
| | - Krzysztof Błaszyk
- I Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, Z. Szafrana 4a, 65-516 Zielona Gora, Poland
| | - Andrzej Wykrętowicz
- Department of Cardiology Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
| | - Przemysław Guzik
- Department of Cardiology Intensive Therapy, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
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17
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Kajimoto M, Nuri M, Sleasman JR, Charette KA, Kajimoto H, Portman MA. Right ventricular energy metabolism in a porcine model of acute right ventricular pressure overload after weaning from cardiopulmonary bypass. Physiol Rep 2022; 10:e15421. [PMID: 36394073 PMCID: PMC9669618 DOI: 10.14814/phy2.15421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 06/16/2023] Open
Abstract
Acute right ventricular pressure overload (RVPO) occurs following congenital heart surgery and often results in low cardiac output syndrome. We tested the hypothesis that the RV exhibits limited ability to modify substrate utilization in response to increasing energy requirements during acute RVPO after cardiopulmonary bypass (CPB). We assessed the RV fractional contributions (Fc) of substrates to the citric acid cycle in juvenile pigs exposed to acute RVPO by pulmonary artery banding (PAB) and CPB. Sixteen Yorkshire male pigs (median 38 days old, 12.2 kg of body weight) were randomized to SHAM (Ctrl, n = 5), 2-h CPB (CPB, n = 5) or CPB with PAB (PAB-CPB, n = 6). Carbon-13 (13 C)-labeled lactate, medium-chain, and mixed long-chain fatty acids (MCFA and LCFAs) were infused as metabolic tracers for energy substrates. After weaning from CPB, RV systolic pressure (RVSP) doubled baseline in PAB-CPB while piglets in CPB group maintained normal RVSP. Fc-LCFAs decreased significantly in order PAB-CPB > CPB > Ctrl groups by 13 C-NMR. Fc-lactate and Fc-MCFA were similar among the three groups. Intragroup analysis for PAB-CPB showed that the limited Fc-LCFAs appeared prominently in piglets exposed to high RVSP-to-left ventricular systolic pressure ratio and high RV rate-pressure product, an indicator of myocardial oxygen demand. Acute RVPO after CPB strongly inhibits LCFA oxidation without compensation by lactate oxidation, resulting in energy deficiency as determined by lower (phosphocreatine)/(adenosine triphosphate) in PAB-CPB. Adequate energy supply but also metabolic interventions may be required to circumvent these RV energy metabolic abnormalities during RVPO after CPB.
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Affiliation(s)
- Masaki Kajimoto
- Center for Integrative Brain ResearchSeattle Children's Research InstituteSeattleWashingtonUSA
| | - Muhammad Nuri
- Division of Cardiothoracic Surgery at Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Justin R. Sleasman
- Division of Pediatric Cardiac SurgeryLucile Packard Children's HospitalPalo AltoCaliforniaUSA
| | - Kevin A. Charette
- Division of Pediatric Cardiac SurgerySeattle Children's HospitalSeattleWashingtonUSA
| | - Hidemi Kajimoto
- Center for Integrative Brain ResearchSeattle Children's Research InstituteSeattleWashingtonUSA
| | - Michael A. Portman
- Center for Integrative Brain ResearchSeattle Children's Research InstituteSeattleWashingtonUSA
- Division of Cardiology, Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
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18
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Prognostic Value of High-Sensitivity Cardiac Troponin in Women. Biomolecules 2022; 12:biom12101496. [DOI: 10.3390/biom12101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
High-sensitivity cardiac troponin assays have become the gold standard for diagnosing acute and chronic myocardial injury. The detection of troponin levels beyond the 99th percentile is included in the fourth universal definition of myocardial infarction, specifically recommending the use of sex-specific thresholds. Measurable concentrations below the proposed diagnostic thresholds have been shown to inform prognosis in different categories of inpatients and outpatients. However, clinical investigations from the last twenty years have yielded conflicting results regarding the incremental value of using different cut-offs for men and women. While advocates of a sex-specific approach claim it may help reduce gender bias in cardiovascular medicine, particularly in acute coronary syndromes, other groups question the alleged incremental diagnostic and prognostic value of sex-specific thresholds, ultimately asserting that less is more. In the present review, we aimed to synthesize our current understanding of sex-based differences in cardiac troponin levels and to reappraise the available evidence with regard to (i) the prognostic significance of sex-specific diagnostic thresholds of high-sensitivity cardiac troponin assays compared to common cut-offs in both men and women undergoing cardiovascular disease risk assessment, and (ii) the clinical utility of high-sensitivity cardiac troponin assays for cardiovascular disease prevention in women.
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19
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Cardiovascular Function in Different Phases of the Menstrual Cycle in Healthy Women of Reproductive Age. J Clin Med 2022; 11:jcm11195861. [PMID: 36233728 PMCID: PMC9572726 DOI: 10.3390/jcm11195861] [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: 09/08/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Sex hormones influence the cardiovascular (CV) function in women. However, it is uncertain whether their physiological variation related to the regular menstrual cycle affects the CV system. We studied changes in the hemodynamic profile and body’s water content and their relation to sex hormone concentration in healthy women during the menstrual cycle. Material and methods: Forty-five adult women were examined during the early follicular, late follicular, and mid-luteal phases of the same menstrual cycle. The hemodynamic profile was estimated non-invasively by cardiac impedance while water content was estimated by total body impedance. Results were compared with repeated measures ANOVA with post-test, if applicable. Results: There were no significant changes in most hemodynamic and water content parameters between the menstrual cycle phases in healthy women. Left ventricular ejection time differed significantly among phases of the menstrual cycle, with shorter values in the mid-luteal phase (308.4 vs. 313.52 ms, p < 0.05) compared to the late follicular phase. However, the clinical relevance of such small differences is negligible. Conclusions: Changes in sex hormones during the physiological menstrual cycle appear to have no considerable effect on healthy women’s hemodynamic function and water accumulation.
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20
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Ebong IA, DeFilippis EM, Hamad EA, Hsich EM, Randhawa VK, Billia F, Kassi M, Bhardwaj A, Byku M, Munagala MR, Rao RA, Hackmann AE, Gidea CG, DeMarco T, Hall SA. Special Considerations in the Care of Women With Advanced Heart Failure. Front Cardiovasc Med 2022; 9:890108. [PMID: 35898277 PMCID: PMC9309391 DOI: 10.3389/fcvm.2022.890108] [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: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023] Open
Abstract
Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.
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Affiliation(s)
- Imo A. Ebong
- Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, United States
- *Correspondence: Imo A. Ebong
| | - Ersilia M. DeFilippis
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Eman A. Hamad
- Division of Cardiovascular Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Eileen M. Hsich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Filio Billia
- Department of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, United States
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, United States
| | - Mirnela Byku
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mrudala R. Munagala
- Department of Cardiology, Miami Transplant Institute, University of Miami Miller School of Medicine/Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Roopa A. Rao
- Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy E. Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas SouthWestern Medical Center, Dallas, TX, United States
| | - Claudia G. Gidea
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Teresa DeMarco
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Shelley A. Hall
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, United States
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21
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Sex Differences in Cardiovascular Diseases: A Matter of Estrogens, Ceramides, and Sphingosine 1-Phosphate. Int J Mol Sci 2022; 23:ijms23074009. [PMID: 35409368 PMCID: PMC8999971 DOI: 10.3390/ijms23074009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
The medical community recognizes sex-related differences in pathophysiology and cardiovascular disease outcomes (CVD), culminating with heart failure. In general, pre-menopausal women tend to have a better prognosis than men. Explaining why this occurs is not a simple matter. For decades, sex hormones like estrogens (Es) have been identified as one of the leading factors driving these sex differences. Indeed, Es seem protective in women as their decline, during and after menopause, coincides with an increased CV risk and HF development. However, clinical trials demonstrated that E replacement in post-menopause women results in adverse cardiac events and increased risk of breast cancer. Thus, a deeper understanding of E-related mechanisms is needed to provide a vital gateway toward better CVD prevention and treatment in women. Of note, sphingolipids (SLs) and their metabolism are strictly related to E activities. Among the SLs, ceramide and sphingosine 1-phosphate play essential roles in mammalian physiology, particularly in the CV system, and appear differently modulated in males and females. In keeping with this view, here we explore the most recent experimental and clinical observations about the role of E and SL metabolism, emphasizing how these factors impact the CV system.
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22
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Aimo A, Panichella G, Barison A, Maffei S, Cameli M, Coiro S, D'Ascenzi F, Di Mario C, Liga R, Marcucci R, Morrone D, Olivotto I, Tritto I, Emdin M. Sex-related differences in ventricular remodeling after myocardial infarction. Int J Cardiol 2021; 339:62-69. [PMID: 34314766 DOI: 10.1016/j.ijcard.2021.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
The epidemiology, clinical features and outcome of myocardial infarction (MI) display significant differences between men and women. Prominent sex differences have also been suggested in left ventricular (LV) remodeling after MI. Ventricular remodeling refers to a deterioration of LV geometry and function often leading to heart failure (HF) development and an increased risk of adverse cardiovascular events. Women have a lower propensity to the acquisition of a spherical geometry and LV dysfunction. These differences can be attributed at least partially to a lower frequency of transmural infarction and smaller areas of microvascular obstruction in women, as well as to a less prominent activation of neuroendocrine systems and apoptotic, inflammatory and profibrotic pathways in women. Estrogens might play a role in this difference, which could partially persist even after the menopause because of a persisting intramyocardial synthesis of estrogens in women. Conversely, androgens may exert a detrimental influence. Future studies should better clarify sex differences in the predictors, clinical correlates, prognostic impact and disease mechanisms of remodeling, as well as the existence of sex-specific therapeutic targets. This research effort should hopefully allow to optimize the treatment of MI during the acute and post-acute phase, possibly through different therapeutic strategies in men and women, with the goal of reducing the risk of HF development and improving patient outcome.
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Affiliation(s)
- Alberto Aimo
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Andrea Barison
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Rossella Marcucci
- Experimental and Clinical Medicine, University of Florence, Atherothrombotic Center, AOU Careggi, Florence, Italy
| | - Doralisa Morrone
- Cardio-Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Iacopo Olivotto
- Cardiomiopathy Unit, AOU Careggi, Florence, Italy. Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra
| | | | - Michele Emdin
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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23
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Correlation between physical activity and cardiovascular risk factors in postmenopausal women from Colombia Caribbean. Porto Biomed J 2021; 6:e118. [PMID: 33532659 PMCID: PMC7846413 DOI: 10.1097/j.pbj.0000000000000118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Abstract
Postmenopausal period disturbances are more frequently observed in women with unhealthy lifestyles, insufficient physical activity is related to increased cardiovascular risk (CVR). There is a lack of evidence-based information on physical activity in postmenopausal women and its relationship with CVR factors, including D vitamin serum levels. Objective To determine the physical activity level in postmenopausal women from the Colombia Caribbean and establish relationships between the physical activity and biochemical and anthropometric CVR factors. Methods A correlational descriptive study in which 183 postmenopausal women were linked for convenience sampling. Level of physical activity (International Physical Activity Questionnaire) and their relationships with anthropometric variables, blood pressure, lipid profile, glycemic and serum vitamin D were evaluated. Results According to the physical activity, 82.5% of women were classified as inactive, 9.3% as insufficiently active and only 8.2% as physically active. Physical inactivity was significantly related to higher glucose, triglycerides, and total cholesterol serum levels (P < .05). The prevalence of the women with vitamin D levels less than 30 ng/mL were of 69.9%. The women physically active and with eutrophic nutritional condition had more high levels of vitamin D. Conclusions 82.5% of the postmenopausal women evaluated were physically inactive and this condition was associated with higher serum levels of glycemic, total cholesterol and triglycerides. Serum vitamin D concentrations were higher in traffic and physically active women.
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24
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Bucciarelli V, Bianco F, Mucedola F, Di Blasio A, Izzicupo P, Tuosto D, Ghinassi B, Bucci I, Napolitano G, Di Baldassarre A, Gallina S. Effect of Adherence to Physical Exercise on Cardiometabolic Profile in Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E656. [PMID: 33466649 PMCID: PMC7828719 DOI: 10.3390/ijerph18020656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
Background: Menopause is associated with negative cardiovascular adaptations related to estrogen depletion, which could be counteracted by physical exercise (PhE). However, the impact of total adherence-rate (TA) to PhE and sedentary time (SedT) on cardiometabolic profile in this population has not been elucidated. Methods: For 13-weeks, 43 women (57.1 ± 4.7 years) participated in a 4-days-a-week moderate-intensity walking training. They underwent laboratory, anthropometric and echocardiographic assessment, before and after training (T0-T1). Spontaneous physical activity (PhA) was assessed with a portable multisensory device. The sample was divided according to TA to PhE program: <70% (n = 17) and ≥70% (n = 26). Results: TA ≥ 70% group experienced a significant T1 improvement of relative wall thickness (RWT), diastolic function, VO2max, cortisol, cortisol/dehydroandrostenedione-sulphate ratio and serum glucose. After adjusting for SedT and 10-min bouts of spontaneous moderate-to-vigorous PhA, TA ≥ 70% showed the most significant absolute change of RWT and diastolic function, body mass index, weight and cortisol. TA ≥ 70% was major predictor of RWT and cortisol improvement. Conclusions: In a group of untrained, postmenopausal women, a high TA to a 13-weeks aerobic PhE program confers a better improvement in cardiometabolic profile, regardless of SedT and PhA levels.
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Affiliation(s)
- Valentina Bucciarelli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (F.B.); (F.M.); (D.T.); (S.G.)
| | - Francesco Bianco
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (F.B.); (F.M.); (D.T.); (S.G.)
| | - Francesco Mucedola
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (F.B.); (F.M.); (D.T.); (S.G.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Desiree Tuosto
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (F.B.); (F.M.); (D.T.); (S.G.)
| | - Barbara Ghinassi
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Ines Bucci
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (A.D.B.); (P.I.); (B.G.); (I.B.); (G.N.); (A.D.B.)
| | - Sabina Gallina
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy; (F.B.); (F.M.); (D.T.); (S.G.)
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25
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Hashimoto Y, Okamoto T. Arterial Stiffness and Left Ventricular Diastolic Function in Endurance Athletes. Int J Sports Med 2020; 42:497-505. [PMID: 33176384 DOI: 10.1055/a-1293-8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigated the relationship between arterial stiffness and left ventricular diastolic function in endurance-trained athletes. Sixteen young male endurance-trained athletes and nine sedentary of similar age men participated in this study. Resting measures in carotid-femoral pulse wave velocity were obtained to assess arterial stiffness. Left ventricular diastolic function was assessed using 2-dimensional echocardiography. The athletes tended to have lower arterial stiffness than the controls (P=0.071). Transmitral A-waves in the athletes were significantly lower (P=0.018) than the controls, and left ventricular mass (P=0.034), transmitral E-wave/A-wave (P=0.005) and peak early diastolic mitral annular velocity at the septal site (P=0.005) in the athletes were significantly greater than the controls. A significant correlation was found between arterial stiffness and left ventricular diastolic function (E-wave: r=- 0.682, P=0.003, E-wave/A-wave: r=- 0.712, P=0.002, peak early diastolic mitral annular velocity at the septal site: r=- 0.557, P=0.025) in the athletes, whereas no correlation was found in controls. These results suggest that lower arterial stiffness is associated with higher left ventricular diastolic function in endurance-trained athletes.
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Affiliation(s)
- Yuto Hashimoto
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
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26
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Baroni C, Lionetti V. The impact of sex and gender on heart-brain axis dysfunction: current concepts and novel perspectives. Can J Physiol Pharmacol 2020; 99:151-160. [PMID: 33002366 DOI: 10.1139/cjpp-2020-0391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The heart-brain axis (HBA) recapitulates all the circuits that regulate bidirectional flow of communication between heart and brain. Several mechanisms may underlie the interdependent relationship involving heterogeneous tissues at rest and during specific target organ injury such as myocardial infarction, heart failure, arrhythmia, stroke, mood disorders, or dementia. In-depth translational studies of the HBA dysfunction under single-organ injury should include both male and female animals to develop sex- and gender-oriented prevention, diagnosis, and treatment strategies. Indeed, sex and gender are determining factors as females and males exhibit significant differences in terms of susceptibility to risk factors, age of onset, severity of symptoms, and outcome. Despite most studies having focused on the male population, we have conducted a careful appraisal of the literature investigating HBA in females. In particular, we have (i) analyzed sex-related heart and brain illnesses, (ii) recapitulated the most significant studies simultaneously conducted on cardio- and cerebro-vascular systems in female populations, and (iii) hypothesized future perspectives for the development of a gender-based approach to HBA dysfunction. Although sex- and gender-oriented research is at its infancy, the impact of sex on HBA dysfunction is opening unexpected new avenues for managing the health of female subjects exposed to risk of lifestyle multi-organ disease.
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Affiliation(s)
- Carlotta Baroni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,UOS Anesthesiology and Intensive Care Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy
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27
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Warda HM, Elshorbagy AK, Habib A, Wagdi A, Mihailidou AS, Warda M. Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population. J Clin Hypertens (Greenwich) 2020; 22:1995-2003. [PMID: 32941678 DOI: 10.1111/jch.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1-3 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1-R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18-87 y) who had 5 unattended automated consecutive BP measurements with one-minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (±SEM) SBP for R1 (136.0 ± 2 mm Hg) was similar to R2 (136.2 ± 2 mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5 mm Hg. The SBP decline was less (4.2 mm Hg) in older (>50 years) vs younger participants (8.1 mm Hg; P < .001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2 > R1, and 24% additionally had R5 > R1. Age was a strong independent predictor of having both R2 > R1 and R5 > R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8 mm Hg from R1 to R5. Females had a 5-fold greater total decline in DBP vs males (P < .001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1-R3 (37%-42%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1-3) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.
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Affiliation(s)
- Hazem M Warda
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Amany K Elshorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amira Habib
- Alhyatt Heart and Vascular Center, Alexandria, Egypt
| | - Ahmed Wagdi
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Institute of Cardiovascular Physiology, University Medical Center Goettingen, Goettingen, Germany
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mamdouh Warda
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
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28
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Menstrual Cycle Changes in Vagally-Mediated Heart Rate Variability are Associated with Progesterone: Evidence from Two Within-Person Studies. J Clin Med 2020; 9:jcm9030617. [PMID: 32106458 PMCID: PMC7141121 DOI: 10.3390/jcm9030617] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
A recent meta-analysis revealed that cardiac vagal activity (mostly indicated by vagally-mediated heart rate variability; HRV) decreases significantly from the follicular to luteal menstrual cycle phase in naturally-cycling participants. However, the question remains as to whether cyclical changes in estradiol (E2), progesterone (P4), or both are responsible for HRV fluctuations. We present the first studies to use repeated measures of E2, P4, and HRV across the cycle to model both the unique and interactive effects of person-centered E2 and P4 on HRV in multilevel models. In study one, 40 naturally-cycling participants were assessed weekly across four weeks, and were blind to the cycle focus of the study. In study two, 50 naturally-cycling participants were examined in three precisely defined cycle phases via ovulation testing. Both studies revealed that only P4 was correlated with HRV, such that higher-than-usual P4 significantly predicted lower-than-usual HRV within a given participant. In line with this, cycle phase comparisons revealed lower HRV in the mid-luteal phase (characterized by elevated P4) than in other phases. No significant main or interactive effects of E2 on HRV were found. Future female health studies should investigate individual differences in these effects and potential consequences of cyclical HRV changes on daily functioning.
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29
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Casin KM, Kohr MJ. An emerging perspective on sex differences: Intersecting S-nitrosothiol and aldehyde signaling in the heart. Redox Biol 2020; 31:101441. [PMID: 32007450 PMCID: PMC7212482 DOI: 10.1016/j.redox.2020.101441] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular disease is the leading cause of the death for both men and women. Although baseline heart physiology and the response to disease are known to differ by sex, little is known about sex differences in baseline molecular signaling, especially with regard to redox biology. In this review, we describe current research on sex differences in cardiac redox biology with a focus on the regulation of nitric oxide and aldehyde signaling. Furthermore, we argue for a new perspective on cardiovascular sex differences research, one that focuses on baseline redox biology without the elimination or disruption of sex hormones.
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Affiliation(s)
- Kevin M Casin
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Mark J Kohr
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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30
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Kokts-Porietis RL, Minichiello NR, Doyle-Baker PK. The Effect of the Menstrual Cycle on Daily Measures of Heart Rate Variability in Athletic Women. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract. Heart rate variability (HRV) is a biomarker used to reflect both healthy and pathological state(s). The effect of the menstrual cycle and menstrual cycle phases (follicular, luteal) on HRV remains unclear. Active eumenorrheic women free from exogenous hormones completed five consecutive weeks of daily, oral basal body temperature (BBT) and HRV measurements upon waking. Descriptive statistics were used to characterize shifts in the HRV measures: standard deviation of NN intervals (SDNN), root mean square of successive difference (rMSSD), high (HF) and low frequency (LF) across the menstrual cycle and between phases. All HRV measures were assessed by medians ( Mdn), median difference of consecutive days ( Mdn∆) and variance. Seven participants ( M ± SD; age: 28.60 ± 8.40 year) completed the study with regular menstrual cycles (28.40 ± 2.30 days; ovulation day 14.57 ± 0.98 day). Median rMSSD displayed a nonlinear decrease across the menstrual cycle and plateau around the day of ovulation. A negative shift before ovulation in Mdn∆, rMSSD, SDNN, and LF as well as peak on luteal phase Day 4 in rMSSD and SDNN was observed. Median variance increased in rMSSD (150.06 ms2) SDNN (271.12 ms2), and LF variance (0.001 sec2/Hz) from follicular to luteal phase. Daily HRV associated with the parasympathetic nervous system was observed to decrease nonlinearly across the menstrual cycle.
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Affiliation(s)
| | | | - Patricia K. Doyle-Baker
- Faculty of Kinesiology, University of Calgary, AB, Canada
- Faculty of Environmental Design, University of Calgary, AB, Canada
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31
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Schmalenberger KM, Eisenlohr-Moul TA, Würth L, Schneider E, Thayer JF, Ditzen B, Jarczok MN. A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies. J Clin Med 2019; 8:jcm8111946. [PMID: 31726666 PMCID: PMC6912442 DOI: 10.3390/jcm8111946] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased exponentially in recent years. However, the understanding of sources of within-person change (i.e., intra-individual variance) in CVA is lagging behind. This systematic review and meta-analysis summarizes and quantifies current empirical evidence of within-person changes in measures of CVA across the menstrual cycle in naturally-cycling premenopausal females. We conducted an extensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in five databases to identify observational studies with repeated measures of CVA in at least two menstrual cycle phases. A broad meta-analysis (nstudies = 37; nindividuals = 1,004) revealed a significant CVA decrease from the follicular to luteal phase (d = −0.39, 95% CI (−0.67, −0.11)). Furthermore, 21 studies allowed for finer-grained comparisons between each of two cycle phases (menstrual, mid-to-late follicular, ovulatory, early-to-mid luteal, and premenstrual). Significant decreases in CVA were observed from the menstrual to premenstrual (nstudies = 5; nindividuals = 200; d = −1.17, 95% CI (−2.18, −0.17)) and from the mid-to-late follicular to premenstrual phases (nstudies = 8; nindividuals = 280; d = −1.32, 95% CI (−2.35, −0.29)). In conclusion, meta-analyses indicate the presence of CVA fluctuations across the menstrual cycle. Future studies involving CVA should control for cycle phase. Recommendations for covarying or selecting cycle phase are provided.
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Affiliation(s)
- Katja M. Schmalenberger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, 69115 Heidelberg, Germany; (L.W.); (E.S.); (B.D.)
- Correspondence: (K.M.S.); (M.N.J.); Tel.: +49-6221-56-8148 (K.M.S.); +49-731-500-61810 (M.N.J.)
| | - Tory A. Eisenlohr-Moul
- Women’s Mental Health Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Lena Würth
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, 69115 Heidelberg, Germany; (L.W.); (E.S.); (B.D.)
| | - Ekaterina Schneider
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, 69115 Heidelberg, Germany; (L.W.); (E.S.); (B.D.)
| | - Julian F. Thayer
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA 92697-7085, USA
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, 69115 Heidelberg, Germany; (L.W.); (E.S.); (B.D.)
| | - Marc N. Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany
- Correspondence: (K.M.S.); (M.N.J.); Tel.: +49-6221-56-8148 (K.M.S.); +49-731-500-61810 (M.N.J.)
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Ferguson DP, Monroe TO, Heredia CP, Fleischmann R, Rodney GG, Taffet GE, Fiorotto ML. Postnatal undernutrition alters adult female mouse cardiac structure and function leading to limited exercise capacity. J Physiol 2019; 597:1855-1872. [PMID: 30730556 DOI: 10.1113/jp277637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS Impaired growth during fetal life can reprogramme heart development and increase the risk for long-term cardiovascular dysfunction. It is uncertain if the developmental window during which the heart is vulnerable to reprogramming as a result of inadequate nutrition extends into the postnatal period. We found that adult female mice that had been undernourished only from birth to 3 weeks of age had disproportionately smaller hearts compared to males, with thinner ventricle walls and more mononucleated cardiomyocytes. In females, but not males, cardiac diastolic function, and heart rate responsiveness to adrenergic stimulation were limited and maximal exercise capacity was compromised. These data suggest that the developmental window during which the heart is vulnerable to reprogramming by inadequacies in nutrient intake may extend into postnatal life and such individuals could be at increased risk for a cardiac event as a result of strenuous exercise. ABSTRACT Adults who experienced undernutrition during critical windows of development are at increased risk for cardiovascular disease. The contribution of cardiac function to this increased disease risk is uncertain. We evaluated the effect of a short episode of postnatal undernutrition on cardiovascular function in mice at the whole animal, organ, and cellular levels. Pups born to control mouse dams were suckled from birth to postnatal day (PN) 21 on dams fed either a control (20% protein) or a low protein (8% protein) isocaloric diet. After PN21 offspring were fed the same control diet until adulthood. At PN70 V ̇ O 2 , max was measured by treadmill test. At PN80 cardiac function was evaluated by echocardiography and Doppler analysis at rest and following β-adrenergic stimulation. Isolated cardiomyocyte nucleation and Ca2+ transients (with and without β-adrenergic stimulation) were measured at PN90. Female mice that were undernourished and then refed (PUN), unlike male mice, had disproportionately smaller hearts and their exercise capacity, cardiac diastolic function, and heart rate responsiveness to adrenergic stimulation were limited. A reduced left ventricular end diastolic volume, impaired early filling, and decreased stored energy at the beginning of diastole contributed to these impairments. Female PUN mice had more mononucleated cardiomyocytes; under resting conditions binucleated cells had a functional profile suggestive of increased basal adrenergic activation. Thus, a brief episode of early postnatal undernutrition in the mouse can produce persistent changes to cardiac structure and function that limit exercise/functional capacity and thereby increase the risk for the development of a wide variety of cardiovascular morbidities.
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Affiliation(s)
- David P Ferguson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Tanner O Monroe
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Celia Pena Heredia
- Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ryan Fleischmann
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - George G Rodney
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - George E Taffet
- Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Marta L Fiorotto
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
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Boriani G, Lorenzetti S, Cerbai E, Oreto G, Bronzetti G, Malavasi VL, Biffi A, Padeletti L, Botto G, Diemberger I. The effects of gender on electrical therapies for the heart: physiology, epidemiology, and access to therapies. Europace 2018; 19:1418-1426. [PMID: 28525585 DOI: 10.1093/europace/eux068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/18/2017] [Indexed: 12/19/2022] Open
Abstract
The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Stefano Lorenzetti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Gabriele Bronzetti
- Pediatric Cardiology, Cardio-Thoracic-Vascular Department, University Hospital Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Alessandro Biffi
- Institute of Sports Medicine and Science, Italian Olympic Committee, Largo Piero Gabrielli, 00197 Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy and IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Gianluca Botto
- Unit of Electrophysiology, S. Anna Hospital, via Ravona, San Fermo della Battaglia, 22020 Como, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
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Kouvari M, Yannakoulia M, Souliotis K, Panagiotakos DB. Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths. Angiology 2018; 69:843-853. [PMID: 29430964 DOI: 10.1177/0003319718756732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.
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Affiliation(s)
- Matina Kouvari
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kyriakos Souliotis
- 2 Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Demosthenes B Panagiotakos
- 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Vasomotor hot flashes and cardiac repolarization: a randomized placebo-controlled trial of postmenopausal hormone therapy. Menopause 2017; 24:1386-1391. [PMID: 28697043 DOI: 10.1097/gme.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effects of different hormone therapies on cardiac repolarization in recently postmenopausal women with and without hot flashes. METHODS We recruited 150 healthy women: 72 with and 78 without hot flashes. They were randomized and treated for 6 months with transdermal estradiol (1 mg/day), oral estradiol (OE) alone (2 mg/day) or combined with medroxyprogesterone acetate (MPA; 5 mg/day), or placebo. Cardiac repolarization was assessed by measuring QT intervals, rate-dependence of QT-end interval, and T waves from 24-hour electrocardiographic recording before and during hormone therapy, comprising a total of over 20 million QT-interval measurements. RESULTS Hot flashes were accompanied with shortened median T-peak - T-end interval (at RR interval of 700, 800, and 900 ms; P = 0.040, 0.020, and 0.032; η = 0.35, 0.39, and 0.37; respectively) during the use of OE but not transdermal estradiol. In contrast, the addition of MPA to OE lengthened the maximal QT-end (at RR interval of 500 ms, P = 0.016, η = 0.27) and the maximal T-peak - T-end interval (at RR interval of 500 and 600 ms; P = 0.016 and 0.032; η = 0.25 and 0.22, respectively). These effects were not seen in women without hot flashes. CONCLUSIONS Hot flashes predict beneficial shortening in cardiac repolarization during OE, but not if MPA is combined with OE. These data may provide one explanation for MPA-related cardiac hazards in epidemiological studies.
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Effect of chronic estradiol plus progesterone treatment on experimental arterial and venous thrombosis in mouse. PLoS One 2017; 12:e0177043. [PMID: 28486478 PMCID: PMC5423617 DOI: 10.1371/journal.pone.0177043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/23/2017] [Indexed: 11/27/2022] Open
Abstract
Postmenopausal hormone replacement therapy (HRT) with estrogen plus progestogens is the first line therapy to treat menopausal symptoms. The progestogen is added to estrogen to reduce or eliminate the excess risk of endometrial cancer due to the unopposed effect of estrogen. Whereas progestin clearly opposes the proliferative and deleterious long-term actions of estrogen on the endometrium, the interference of progestin on the other estrogen action remains unclear. We previously reported that chronic subcutaneous 17α-estradiol (E2) in mice decreases platelet responsiveness, prolongs the tail-bleeding time and protects against acute thromboembolism. Here, we report the tissue-specific interference of progesterone (P4) on the action of E2 in ovariectomized mice. We first confirm that, in our experimental conditions, P4 attenuates the proliferative action of E2 on the uterus and the effects of E2 on vagina weight and lubrication. We then studied the effect of E2 combined with P4 on hemostasis and thrombosis in vivo in mice and found that P4 did not interfere with the main actions of E2 on platelets, bleeding time and arterial and venous thrombosis. Thus, whereas activation of progesterone receptor interferes with the action of E2 on its classic sex targets, P4 appears to have minimal effect on the hemostasis and thrombosis actions of E2, supporting the prominent role of estrogens and the accessory role of natural progestin on the extra-reproductive cells and tissues involved in thrombosis.
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Cadeddu C, Franconi F, Cassisa L, Campesi I, Pepe A, Cugusi L, Maffei S, Gallina S, Sciomer S, Mercuro G. Arterial hypertension in the female world. J Cardiovasc Med (Hagerstown) 2016; 17:229-36. [DOI: 10.2459/jcm.0000000000000315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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