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Gulati M. Heart month: Redesigning the message. Am J Prev Cardiol 2024; 17:100643. [PMID: 38586188 PMCID: PMC10994952 DOI: 10.1016/j.ajpc.2024.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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2
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Zheng J, Chen K, Huang T, Shao C, Li P, Wang J, Wang W, Zhang K, Meng X, Gao J, Wang X, Liu Y, Song J, Dong E, Tang YD. Genetically Determined Lifestyle and Cardiometabolic Risk Factors Mediate the Association of Genetically Predicted Age at Menarche With Genetic Predisposition to Myocardial Infarction: A Two-Step, Two-Sample Mendelian Randomization Study. Front Cardiovasc Med 2022; 9:821068. [PMID: 35548428 PMCID: PMC9081496 DOI: 10.3389/fcvm.2022.821068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies have shown an association between early age at menarche (AAM) and myocardial infarction (MI) with recorded cases. In this Mendelian randomization (MR) study, we used large amounts of summary data from genome-wide association studies (GWASs) to further estimate the association of genetically predicted AAM with genetically predicated risk of MI and investigate to what extent this association is mediated by genetically determined lifestyles, cardiometabolic factors, and estrogen exposure. Methods A two-step, two-sample MR study was performed by mediation analysis. Genetic variants identified by GWAS meta-analysis of reproductive genetics consortium (n = 182,416) were selected for genetically predicted AAM. Genetic variants identified by the Coronary ARtery DIsease Genome-wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics Consortium (n = 184,305) were selected for genetically predicted risk of MI. Genetic variants from other international GWAS summary data were selected for genetically determined mediators. Results This MR study showed that increase in genetically predicted AAM was associated with lower risk of genetically predicted MI (odds ratio 0.91, 95% confidence interval 0.84–0.98). Inverse variance weighted (IVW) MR analysis also showed that decrease in genetically predicted AAM was associated with higher genetically predicted alcohol intake frequency, current smoking behavior, higher waist-to-hip ratio, and higher levels of systolic blood pressure (SBP), fasting blood glucose, hemoglobin A1c (HbA1c), and triglycerides (TGs). Furthermore, increase in genetically predicted AAM was associated with genetically predicted longer sleep duration, higher levels of high-density lipoproteins, and older age at which hormone replacement therapy was started. The most essential mediators identified were genetically predicted current smoking behavior and levels of HbA1c, SBP, and TGs, which were estimated to genetically mediate 13.9, 12.2, 10.5, and 9.2%, respectively, with a combined mediation proportion of 37.5% in the association of genetically predicted AAM with genetically predicted increased risk of MI in an MR framework. Conclusion Our MR analysis showed that increase in genetically predicted AAM was associated with lower genetically predicted risk of MI, which was substantially mediated by genetically determined current smoking behavior and levels of HbA1c, SBP, and TGs. Intervening on the above mediators may reduce the risk of MI.
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Affiliation(s)
- Jilin Zheng
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ken Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Huang
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Epidemiology and Biostatistics, Center for Intelligent Public Health, Academy for Artificial Intelligence, School of Public Health, Ministry of Education, Peking University, Beijing, China
| | - Chunli Shao
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Ping Li
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjia Wang
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Wenyao Wang
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Kuo Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangbin Meng
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Jun Gao
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Xuliang Wang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yupeng Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjing Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Eran Dong
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Institute of Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, China
| | - Yi-Da Tang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Department of Cardiology, Institute of Vascular Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- *Correspondence: Yi-Da Tang,
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Jones HJ, Bakas T, Nared S, Humphries J, Wijesooriya J, Butsch Kovacic M. Co-Designing a Program to Lower Cardiovascular Disease Risk in Midlife Black Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031356. [PMID: 35162379 PMCID: PMC8835512 DOI: 10.3390/ijerph19031356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
Midlife Black women suffer disproportionately from heart disease and stroke in comparison to White women of similar age and demographic. Risk for cardiovascular disease (CVD) and stroke is largely considered to be modifiable yet CVD prevention and awareness campaigns have been less effective among Black women. Decreased awareness of personal CVD risk is associated with delays in the presentation of women to the emergency room or health care providers for symptoms of myocardial infarction. The Midlife Black Women's Stress and Wellness (B-SWELL) program was designed to increase awareness about CVD risk factors, stress, and healthy lifestyle behaviors among midlife Black women. In partnership with an existing Community Research Advisory Board (C-RAB), materials were developed and culturally adapted for the B-SWELL program. Following successful development of the B-SWELL materials, a trial of the B-SWELL program was conducted with a sample of midlife Black women recruited from the community. The program was co-facilitated by members of the C-RAB. We outline the strategies used to successfully co-create and trial the B-SWELL program materials and reflect on the strengths and challenges associated with the development of a culturally tailored heart disease prevention program using community participatory methods.
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Affiliation(s)
- Holly J. Jones
- College of Nursing, University of Cincinnati, Cincinnati, OH 45267, USA;
- Correspondence: ; Tel.: +1-513-558-5285
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Sheila Nared
- West End Community Research Advisory Board, Cincinnati, OH 45214, USA; (S.N.); (J.H.); (M.B.K.)
- Seven Hills Neighborhood Houses, Cincinnati, OH 45214, USA;
| | - Jacqueline Humphries
- West End Community Research Advisory Board, Cincinnati, OH 45214, USA; (S.N.); (J.H.); (M.B.K.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Julie Wijesooriya
- Seven Hills Neighborhood Houses, Cincinnati, OH 45214, USA;
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Melinda Butsch Kovacic
- West End Community Research Advisory Board, Cincinnati, OH 45214, USA; (S.N.); (J.H.); (M.B.K.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
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4
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Kotit S, Yacoub M. Cardiovascular adverse events in pregnancy: A global perspective. Glob Cardiol Sci Pract 2021; 2021:e202105. [PMID: 34036091 PMCID: PMC8133785 DOI: 10.21542/gcsp.2021.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnant women with heart disease are vulnerable to many adverse cardiovascular events (AE). AEs during and after pregnancy continue to be important causes of maternal mortality and morbidity worldwide, with huge variations in burden in different countries and regions. These AEs are classified as having direct or indirect causes, depending on whether they are directly caused by pregnancy or due to some pre-existing disease and/or non-obstetric cause, respectively. The risks continue throughout pregnancy and even after childbirth. Apart from immediate complications during pregnancy, there is increasing evidence of a significant link between several events and the risk of cardiovascular disease (CVD) later in life. A significant number of pregnancy-related deaths caused by cardiovascular disease are preventable. This prevention can be realized through increasing awareness of cardiovascular AE in pregnancy, coupled with the application of strategies for prevention and treatment. Knowledge of the risks associated with CVD and pregnancy is of extreme importance in that regard. We discuss the global distribution of cardiovascular maternal mortality, adverse events during and after pregnancy, their predictors and risk stratification. In addition, we enumerate possible solutions, particularly the role of cardio-obstetric clinics.
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Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ. Ten-Year Differences in Women's Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation 2020; 143:e239-e248. [PMID: 32954796 DOI: 10.1161/cir.0000000000000907] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND High awareness that cardiovascular disease is the leading cause of death (LCOD) among women is critical to prevention. This study evaluated longitudinal trends in this awareness among women. METHODS AND RESULTS Online surveys of US women (≥25 years of age) were conducted in January 2009 and January 2019. Data were weighted to the US population distribution of sociodemographic characteristics. Multivariable logistic regression was used to evaluate knowledge of the LCOD. In 2009, awareness of heart disease as the LCOD was 65%, decreasing to 44% in 2019. In 2019, awareness was greater with older age and increasing education and lower among non-White women and women with hypertension. The 10-year awareness decline was observed in all races/ethnicities and ages except women ≥65 years of age. The greatest declines were among Hispanic women (odds ratio of awareness comparing 2019 to 2009, 0.14 [95% CI, 0.07-0.28]), non-Hispanic Black women (odds ratio, 0.31 [95% CI, 0.19-0.49]), and 25- to 34-year-olds (odds ratio, 0.19 [95% CI, 0.10-0.34]). In 2019, women were more likely than in 2009 to incorrectly identify breast cancer as the LCOD (odds ratio, 2.59 [95% CI, 1.86-3.67]), an association that was greater in younger women. Awareness of heart attack symptoms also declined. CONCLUSIONS Awareness that heart disease is the LCOD among women declined from 2009 to 2019, particularly among Hispanic and non-Hispanic Black women and in younger women (in whom primordial/primary prevention may be most effective). An urgent redoubling of efforts by organizations interested in women's health is required to reverse these trends.
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Boardman H, Lamata P, Lazdam M, Verburg A, Siepmann T, Upton R, Bilderbeck A, Dore R, Smedley C, Kenworthy Y, Sverrisdottir Y, Aye CY, Williamson W, Huckstep O, Francis JM, Neubauer S, Lewandowski AJ, Leeson P. Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy. Hypertension 2020; 75:1542-1550. [PMID: 32306767 PMCID: PMC7682801 DOI: 10.1161/hypertensionaha.119.14530] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m2; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (−18.31±4.46% versus −19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m2; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm2; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.
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Affiliation(s)
- Henry Boardman
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Pablo Lamata
- Department of Biomedical Engineering, King’s College London, United Kingdom (P. Lamata)
| | - Merzaka Lazdam
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Ashley Verburg
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany (T.S.)
| | - Ross Upton
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Amy Bilderbeck
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Rhys Dore
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Clare Smedley
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Yvonne Kenworthy
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Yrsa Sverrisdottir
- Nuffield Department of Surgical Sciences (Y.S.), University of Oxford, United Kingdom
- Mohammed Bin Rashid University of Medicine, Dubai, UAE (Y.S.)
| | - Christina Y.L. Aye
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health (C.Y.L.A.), University of Oxford, United Kingdom
| | - Wilby Williamson
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Odaro Huckstep
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Jane M. Francis
- Oxford Centre for Clinical Magnetic Resonance Research (J.M.F., S.N.), University of Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (J.M.F., S.N.), University of Oxford, United Kingdom
| | - Adam J. Lewandowski
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
| | - Paul Leeson
- From the Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.B., M.L., A.V., R.U., A.B., R.D., C.S., Y.K., C.Y.L.A., W.W., O.H., A.J.L., P. Leeson), University of Oxford, United Kingdom
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Abstract
Patients with a current diagnosis of breast cancer are enjoying dramatic cure rates and survivorship secondary to an increase in awareness, earlier detection, and more effective therapies. Although strategies such as Breast Cancer Awareness Month in October focus on early detection, lifestyle changes are seldom discussed other than dietary concerns and physical activity. Lifestyle modifications centered on diet and exercise have been demonstrated to affect overall disease-free survival in breast cancer. Since the early 2000s, the role of the human gut microbiota and its relation to breast cancer has become a major area of interest in the scientific and medical community. We live and survive owing to the symbiotic relationship with the microorganisms within us: the human microbiota. Scientific advances have identified a subset of the gut microbiota: the estrobolome, those bacteria that have the genetic capability to metabolize estrogen, which plays a key role in most breast cancers. Recent research provides evidence that the gut microbiome plays a substantial role in estrogen regulation. Gut microbiota diversity appears to be an essential component of overall health, including breast health. Future research attention should include a more extensive focus on the role of the human gut microbiota in breast cancer.
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Affiliation(s)
- Balazs I Bodai
- The Breast Cancer Survivorship Institute, Kaiser Permanente, Sacramento, CA
| | - Therese E Nakata
- The Breast Cancer Survivorship Institute, Kaiser Permanente, Sacramento, CA
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Lee JJ, Cook-Wiens G, Johnson BD, Braunstein GD, Berga SL, Stanczyk FZ, Pepine CJ, Bairey Merz CN, Shufelt CL. Age at Menarche and Risk of Cardiovascular Disease Outcomes: Findings From the National Heart Lung and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation. J Am Heart Assoc 2019; 8:e012406. [PMID: 31165670 PMCID: PMC6645646 DOI: 10.1161/jaha.119.012406] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Previous studies have reported an association between the timing of menarche and cardiovascular disease (CVD). However, emerging studies have not examined the timing of menarche in relation to role of estrogen over a lifetime and major adverse cardiac events (MACE). Methods and Results A total of 648 women without surgical menopause undergoing coronary angiography for suspected ischemia in the WISE (Women's Ischemia Syndrome Evaluation) study were evaluated at baseline and followed for 6 years (median) to assess major adverse CVD outcomes. MACE was defined as the first occurrence of all‐cause death, nonfatal myocardial infarction, nonfatal stroke, or heart failure hospitalization. Age at menarche was self‐reported and categorized (≤10, 11, 12, 13, 14, ≥15 years) with age 12 as reference. Total estrogen time and supra–total estrogen time were calculated. Cox regression analysis was performed adjusting for CVD risk factors. Baseline age was 57.9 ± 12 years (mean ± SD), body mass index was 29.5 ± 6.5 kg/m2, total estrogen time was 32.2 ± 8.9 years, and supra–total estrogen time was 41.4 ± 8.8 years. MACE occurred in 172 (27%), and its adjusted regression model was J‐shaped. Compared with women with menarche at age 12 years, the adjusted MACE hazard ratio for menarche at ≤10 years was 4.53 (95% CI 2.13‐9.63); and at ≥15 years risk for MACE was 2.58 (95% CI, 1.28‐5.21). Conclusions History of early or late menarche was associated with a higher risk for adverse CVD outcomes. These findings highlight age at menarche as a potential screening tool for women at risk of adverse CVD events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000554.
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Affiliation(s)
- Julie J Lee
- 1 Jacobs School of Medicine and Biomedical Sciences University at Buffalo NY
| | - Galen Cook-Wiens
- 2 Biostatistics & Bioinformatics Center Cedars-Sinai Medical Center Los Angeles CA
| | - B Delia Johnson
- 4 Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | | | - Sarah L Berga
- 5 Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology University of Utah Salt Lake City UT
| | - Frank Z Stanczyk
- 6 Department of Obstetrics and Gynecology Keck School of Medicine of University of Southern California Los Angeles CA
| | - Carl J Pepine
- 7 Division of Cardiology Department of Medicine University of Florida Gainesville FL
| | - C Noel Bairey Merz
- 8 Barbra Streisand Women's Heart Center Cedars-Sinai Smidt Heart Institute Los Angeles CA
| | - Chrisandra L Shufelt
- 8 Barbra Streisand Women's Heart Center Cedars-Sinai Smidt Heart Institute Los Angeles CA
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Maffei S, Cugusi L, Meloni A, Deidda M, Colasante E, Marchioli R, Surico N, Mercuro G. IGENDA protocol. J Cardiovasc Med (Hagerstown) 2019; 20:278-283. [DOI: 10.2459/jcm.0000000000000761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Bodai BI, Nakata TE, Wong WT, Clark DR, Lawenda S, Tsou C, Liu R, Shiue L, Cooper N, Rehbein M, Ha BP, Mckeirnan A, Misquitta R, Vij P, Klonecke A, Mejia CS, Dionysian E, Hashmi S, Greger M, Stoll S, Campbell TM. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. Perm J 2018; 22:17-025. [PMID: 29035175 DOI: 10.7812/tpp/17-025] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity.In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold ("First do no harm"), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.
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Affiliation(s)
- Balazs I Bodai
- Director of The Breast Cancer Survivorship Institute in Sacramento, CA.
| | - Therese E Nakata
- Program Manager of The Breast Cancer Survivorship Institute in Sacramento, CA.
| | | | - Dawn R Clark
- Chief Facilitator of the Physician Wellness Program and an Obstetrician/Gynecologist at the San Dimas-Baldwin Park Medical Center in San Dimas, CA.
| | - Steven Lawenda
- Internist at the Antelope Valley Medical Center in Lancaster, CA.
| | | | - Raymond Liu
- Chief of Hematology-Oncology at the San Francisco Medical Center in CA.
| | - Linda Shiue
- Internist and the Director of Culinary Medicine at the San Francisco Medical Center in CA.
| | - Neil Cooper
- Radiologist at the Glenlake Medical Center in Atlanta, GA.
| | - Michael Rehbein
- Pediatrician and Assistant Physician-in-Charge for Outpatient Service at the Stockton Medical Office in CA.
| | - Benjamin P Ha
- Associate Area Medical Director for Family Medicine at the Bakersfield Medical Center in CA.
| | - Anne Mckeirnan
- Obstetrician/Gynecologist at the San Diego Medical Center in CA.
| | - Rajiv Misquitta
- Primary Care Physician at the South Sacramento Medical Center in CA. He is also an Elected Representative on The Permanente Medical Group Board of Directors.
| | - Pankaj Vij
- Medical Director of the Kaiser Permanente Weight Management Program in Pleasanton, CA.
| | - Andrew Klonecke
- Nuclear Medicine Specialist at the Sacramento Medical Center and at the Roseville Medical Center in CA.
| | | | - Emil Dionysian
- Orthopedic Surgeon at the Lakeview Medical Offices and at the Orange County Medical Center in Anaheim, CA.
| | - Sean Hashmi
- Internist at the Woodland Hills Medical Center in CA.
| | - Michael Greger
- Physician and Founder of NutritionFacts.org in Kensington, MD.
| | - Scott Stoll
- Co-Founder and Chairman of the Plantrician Project in Rieglesville, PA.
| | - Thomas M Campbell
- Instructor of Clinical Family Medicine at the University of Rochester School of Medicine and Dentistry and the Co-Founder and Clinical Director of the University of Rochester Program for Nutrition in Medicine in NY.
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Elmahi E, Leeson P. Cardiometabolic and reproductive health in young women: Making the right choices. Eur J Prev Cardiol 2018; 25:1040-1041. [PMID: 29846120 DOI: 10.1177/2047487318780061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Einas Elmahi
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Cardiovascular Disease Risk Assessment in the United States and Low- and Middle-Income Countries Using Predicted Heart/Vascular Age. Sci Rep 2017; 7:16673. [PMID: 29192146 PMCID: PMC5709399 DOI: 10.1038/s41598-017-16901-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/15/2017] [Indexed: 12/27/2022] Open
Abstract
Almost 80% of the global burden of cardiovascular disease (CVD) occurs in low- and middle-income countries (LMICs). However, LMICs do not have well-established, low-technology ways to quantify and communicate CVD risk at population or individual levels. We examined predicted heart/vascular age (PHA) in six LMICs and the United States. Data were from CVD-free adults in World Health Organization Study on Global Aging and Adult Health (n = 29094) and US National Health and Nutritional Examination Survey (n = 6726). PHA was calculated using the non-laboratory Framingham CVD risk equation. High excess PHA (HEPHA) was defined as the differences between PHA and chronological age >5 years. Logistic regression models were used to identify factors associated with HEPHA. Age-standardized prevalence of HEPHA was higher in Russia 52%; China 56%; Mexico 59%; and South Africa 65% compared to the US 45%, Ghana 36%; and India 38%. In LMICs, higher income, being divorced/widowed, alcohol intake and abdominal obesity had higher odds of HEPHA; higher education, fruit intake and physical activity had lower odds of HEPHA. The use of PHA may offer a useful avenue to communicate CVD risk. Interventions tailored at socioeconomic and cultural factors that influence CVD risk factors may be necessary to prevent CVD in LMICs.
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Sex, Ethnicity, and CVD Among Women of African Descent: An Approach for the New Era of Genomic Research. Glob Heart 2017; 12:69-71. [PMID: 28351700 DOI: 10.1016/j.gheart.2017.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 01/13/2023] Open
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Santalucia P, Franchi C, Djade CD, Tettamanti M, Pasina L, Corrao S, Salerno F, Marengoni A, Marcucci M, Nobili A, Mannucci PM. Gender difference in drug use in hospitalized elderly patients. Eur J Intern Med 2015. [PMID: 26209883 DOI: 10.1016/j.ejim.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aims of this study were to evaluate whether or not there are gender differences in drug use at hospital admission and prescription at discharge and to evaluate the effect of hospitalization on medication patterns in the elderly. METHOD In-patients aged >65years included in the REPOSI registry during a recruitment period of 3years (2008-2010-2012) were analyzed in order to evaluate drug use at hospital admission and prescription at discharge according to gender. RESULTS A total of 3473 patients, 52% women and 48% men, were considered. Polypharmacy (>5 drugs) is more frequent in men both at hospital admission and discharge. At hospital discharge, the number of prescriptions increased in both sexes at all age groups. Neuropsychiatric drugs were significantly more prescribed in women (p<0.0001). At admission men were more likely to be on antiplatelets (41.7% vs 36.7%; p=0.0029), ACE-inhibitors (28.7% vs 24.7%; p=0.0072) and statins (22.9% vs 18.3%; p=0.0008). At discharge, antiplatelets (43.7% vs 37.3%; p=0.0003) and statins (25,2% vs 19.6%; p<0.0001) continued to be prescribed more often in men, while women were given beta-blockers more often than men (21.8% vs 18.9%; p=0.0340). Proton pump inhibitors were the most prescribed drugs regardless of gender. At discharge, the medication pattern did not change according to gender. CONCLUSION Our study showed a gender difference in overall medications pattern in the hospitalized elderly. Hospitalization, while increasing the number of prescriptions, did not change drug distribution by sex.
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Affiliation(s)
- Paola Santalucia
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Codjo D Djade
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Salvatore Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Francesco Salerno
- Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Milan, Italy
| | - Alessandra Marengoni
- Geriatric Unit Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - Maura Marcucci
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Geriatrics, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lopez-Gonzalez AA, Aguilo A, Frontera M, Bennasar-Veny M, Campos I, Vicente-Herrero T, Tomas-Salva M, De Pedro-Gomez J, Tauler P. Effectiveness of the Heart Age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial. Eur J Prev Cardiol 2014; 22:389-96. [DOI: 10.1177/2047487313518479] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Angel A Lopez-Gonzalez
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Palma de Mallorca, Spain
| | - Antoni Aguilo
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Margalida Frontera
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Miquel Bennasar-Veny
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Irene Campos
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Palma de Mallorca, Spain
| | | | - Matias Tomas-Salva
- Prevention of Occupational Risks, Balearic Islands Government, Palma de Mallorca, Spain
| | - Joan De Pedro-Gomez
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Tauler
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
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Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey. Circulation 2013; 127:1254-63, e1-29. [PMID: 23429926 DOI: 10.1161/cir.0b013e318287cf2f] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate trends in awareness of cardiovascular disease (CVD) risk among women between 1997 and 2012 by racial/ethnic and age groups, as well as knowledge of CVD symptoms and preventive behaviors/barriers. METHODS AND RESULTS A study of awareness of CVD was conducted by the American Heart Association in 2012 among US women >25 years of age identified through random-digit dialing (n=1205) and Harris Poll Online (n=1227), similar to prior American Heart Association national surveys. Standardized questions on awareness were given to all women; additional questions about preventive behaviors/barriers were given online. Data were weighted, and results were compared with triennial surveys since 1997. Between 1997 and 2012, the rate of awareness of CVD as the leading cause of death nearly doubled (56% versus 30%; P<0.001). The rate of awareness among black and Hispanic women in 2012 (36% and 34%, respectively) was similar to that of white women in 1997 (33%). In 1997, women were more likely to cite cancer than CVD as the leading killer (35% versus 30%), but in 2012, the trend reversed (24% versus 56%). Awareness of atypical symptoms of CVD has improved since 1997 but remains low. The most common reasons why women took preventive action were to improve health and to feel better, not to live longer. CONCLUSIONS Awareness of CVD among women has improved in the past 15 years, but a significant racial/ethnic minority gap persists. Continued effort is needed to reach at-risk populations. These data should inform public health campaigns to focus on evidenced-based strategies to prevent CVD and to help target messages that resonate and motivate women to take action.
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Moran B, Walsh T. Cardiovascular disease in women: how nurses can promote awareness and prevention. Nurs Womens Health 2013; 17:63-68. [PMID: 23399015 DOI: 10.1111/1751-486x.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death of women in the U.S. and Canada. Experts estimate that one in two U.S. women will die of heart disease or stroke compared with one in 25 women who will die of breast cancer. Risk factors for CVD include hypertension, high cholesterol, obesity and sedentary lifestyle.
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Affiliation(s)
- Barbara Moran
- The Catholic University of America, Washington, DC, USA.
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Mochari-Greenberger H, Miller KL, Mosca L. Racial/ethnic and age differences in women's awareness of heart disease. J Womens Health (Larchmt) 2012; 21:476-80. [PMID: 22512853 DOI: 10.1089/jwh.2011.3428] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine differences in awareness of heart disease among women according to race/ethnicity by age group, adjusted for confounders. METHODS American Heart Association (AHA) National Surveys conducted in 2006 (n=1005) and 2009 (n=1142) were pooled using common variables (n=2147) and reweighted to reflect the 2010 United States Census. Surveys comprised standardized, interviewer-assisted demographic and awareness questions. Associations between racial/ethnic group and heart disease awareness stratified by age were assessed by weighted chi-square statistics; logistic regression was used for multivariable adjustment. RESULTS Black and Hispanic women were 66% less likely than white women to be aware that heart disease is the leading cause of death in women (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.23-0.50) after multivariable adjustment for significant confounders. The percent aware among white women was 65%; awareness did not differ between black and Hispanic women (37% vs. 38%). Other significant multivariable predictors included <high school education (OR 0.37, 95% CI 0.22-0.62) and income <$35,000/year (OR 0.56, 95% CI 0.41-0.77). Younger women (age<55 years) were less likely to be aware that heart disease is the leading cause of death in women (OR 0.66, 95% CI 0.50-0.87) and were less likely to report being very well/well informed about heart disease (OR 0.53, 95% CI 0.41-0.68) compared to older women (age≥55 years). Awareness of heart attack signs, such as shortness of breath (34%), nausea (15%), and fatigue (7%), was low among all women. CONCLUSIONS Racial/ethnic minority status and age<55 years were significant risk factors for lower heart disease awareness among women, suggesting these groups should be targeted for educational programs. Awareness of heart attack signs was low among all subgroups of women.
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Banner D, Miers M, Clarke B, Albarran J. Women’s experiences of undergoing coronary artery bypass graft surgery. J Adv Nurs 2011; 68:919-30. [DOI: 10.1111/j.1365-2648.2011.05799.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Banner D. Becoming a coronary artery bypass graft surgery patient: a grounded theory study of women's experiences. J Clin Nurs 2011; 19:3123-33. [PMID: 21040017 DOI: 10.1111/j.1365-2702.2010.03424.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To explore women's experiences of becoming a coronary artery bypass graft surgery patient. BACKGROUND Coronary heart disease is a leading cause of morbidity and mortality for both sexes worldwide and is associated with significant human, fiscal and personal burden. There are growing numbers of women undergoing coronary artery bypass graft surgery; however, little is known about their experiences of being diagnosed, referred and waiting for surgery. DESIGN Grounded theory. METHODS A grounded theory study of 30 UK women with coronary heart disease waiting to undergo coronary artery bypass graft surgery. Data were collected using semi-structured interviews and were contextualised through informal observation of the main clinical areas. RESULTS Coronary heart disease and associated symptoms had extensive physical, social and emotional ramifications for the women. A substantive theory of the public-private dialogue around maintaining and renegotiating normality emerged and demonstrated that women faced significant disruption to their lives as they attempted to normalise and make sense of their illness experiences. Six categories emerged from the data: help seeking, diagnosis and referral, conceptualising surgery, living with coronary heart disease and waiting for surgery. CONCLUSION This study has uncovered women's experiences of becoming a coronary artery bypass graft patient. It has highlighted the extensive ramifications of heart disease and the need for more gender-sensitive information and support. RELEVANCE TO CLINICAL PRACTICE The findings of this study provide health care professionals with a greater understanding of the experiences and needs of women through their journey to becoming a coronary artery bypass graft surgery. The study demonstrates that women need meaningful information particularly in relation to domestic and physical functioning. Nurses are in an important position to contribute to the care and support of women undergoing this process by providing appropriate and gender-sensitive information that can improve health outcomes and quality of life.
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Affiliation(s)
- Davina Banner
- University of Northern British Columbia, Prince George, Canada.
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Dunkel A, Kendel F, Lehmkuhl E, Hetzer R, Regitz-Zagrosek V. Causal attributions among patients undergoing coronary artery bypass surgery: gender aspects and relation to depressive symptomatology. J Behav Med 2011; 34:351-9. [PMID: 21305349 DOI: 10.1007/s10865-011-9324-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/27/2011] [Indexed: 11/30/2022]
Abstract
Causal attributions made by patients for their coronary heart disease may contribute to gender differences in emotional adjustment. The purpose of this study was to determine gender differences in causal attributions and to analyze the associations between causal attributions and depressive symptomatology in patients undergoing coronary artery bypass graft (CABG) surgery. Nine hundred and seventy-nine patients (mean age 66.8 years, 19.9% women) completed a modified version of the Illness Perception Questionnaire (IPQ) and the depression module of the Patient Health Questionnaire (PHQ-9) 1-3 days before CABG-surgery and 1 year after surgery. Men were more likely to name their health behavior (men: 40.2%, women: 26.9%, P < .001) as a cause of disease, whereas women were more likely to cite destiny (women: 34.7%, men: 25.7%, P = .012). Regression analyses showed cross-sectional and longitudinal associations of attributions with depressive symptomatology which were independent of gender, sociodemographic and clinical variables. Attribution to personality and stress were associated with an increase in depressive symptomatology. Causal attributions may present a valuable approach for identifying patients at risk for depression and the implementation of targeted interventions.
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Affiliation(s)
- Anne Dunkel
- Berlin Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Luisenstr. 65, 10117 Berlin, Germany.
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Gleeson D, Crabbe DL. Emerging concepts in cardiovascular disease risk assessment: where do women fit in? ACTA ACUST UNITED AC 2011; 21:480-7. [PMID: 19845805 DOI: 10.1111/j.1745-7599.2009.00434.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To highlight the current limitations in the assessment of cardiovascular disease (CVD) risk for women. This article will offer the reader information on the current process for assessing CVD risk in women, the pitfalls associated with this current strategy, and the role of novel risk factors. DATA SOURCES Extensive review of the medical literature in the area of women's cardiovascular health. CONCLUSIONS The assessment of CVD risk for women is currently an evolving science. Limitations in the ability of the Framingham score to accurately estimate risk in women from diverse populations are increasingly recognized. Vastly different treatment goals between the genders for similar levels of risk factors have led to a re-evaluation of this strategy in women. While the Framingham score is still useful for guiding cholesterol treatment goals, the current preventive guidelines for women emphasize assessing a woman's risk throughout her lifetime. The future development of tools for improved risk stratification that incorporate novel risk factors may in fact improve our ability to appropriately risk stratify women to evidence-based therapies. IMPLICATIONS FOR PRACTICE Utilizing the Framingham Risk Assessment Tool and further CVD risk stratification using novel markers such as high sensitivity C-reactive protein, family history, and functional capacity may identify unique subsets of women at higher risk for CVD. Nurse practitioners can be instrumental in this assessment, education, and treatment of women at risk for CVD.
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Affiliation(s)
- Deborah Gleeson
- Department of Nursing, College of Health Professions, Temple University Hospital, Temple University, Philadelphia, PA 19140, USA.
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Stroebele N, Müller-Riemenschneider F, Nolte CH, Müller-Nordhorn J, Bockelbrink A, Willich SN. Knowledge of Risk Factors, and Warning Signs of Stroke: A Systematic Review from a Gender Perspective. Int J Stroke 2011; 6:60-6. [DOI: 10.1111/j.1747-4949.2010.00540.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Stroke is one of the leading causes of death globally. Awareness of stroke risk factors and warning signs are important for stroke prevention and seeking care. The purpose of this systematic review was to review existing literature that assessed the knowledge of stroke risk factors and warning signs and allowed separate gender analysis. We conducted a systematic review of all published studies (to August 2008) examining knowledge of stroke risk factors and warning signs that included women and provided results separated by gender. Two reviewers selected studies for inclusion, assessed quality, and extracted data. The database search identified 2158 references for screening and 158 were selected for possible inclusion. Twenty-two studies were reviewed including 20 cross-sectional and two pretest–posttest design surveys. Overall, better stroke knowledge was observed in women compared with men in the majority of the studies although there is a general lack of knowledge in both genders. Four out of 18 studies reported better risk factor knowledge and eight out of 15 studies reported better knowledge in stroke warning signs in women compared with men. Women tended to know more evidence-based stroke risk factors than men. Stroke knowledge also appeared to be related to country of study origin, age, education, and medical history. Stroke knowledge among different populations and both in men and women is suboptimal. More research is necessary to further investigate gender differences in stroke knowledge with specific focus on how to use these differences to improve public health campaigns.
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Affiliation(s)
- Nanette Stroebele
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | - Falk Müller-Riemenschneider
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | - Christian H. Nolte
- Department of Neurology, Charité University Medical Center, Berlin, Germany
| | | | - Angelina Bockelbrink
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | - Stefan N. Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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Abstract
Cardiovascular disease (CVD) is still the leading cause of death and disability worldwide despite the availability of well-established and effective preventive options. Accurate perception of a patient’s risk by both the patient and the doctors is important as this is one of the components that determine health-related behavior. Doctors tend to not use cardiovascular (CV) risk calculators and underestimate the absolute CV risk of their patients. Patients show optimistic bias when considering their own risk and consistently underestimate it. Poor patient health literacy and numeracy must be considered when thinking about this problem. Patients must possess a reasonably high level of understanding of numerical processes when doctors discuss risk, a level that is not possessed by large numbers of the population. In order to overcome this barrier, doctors need to utilize various tools including the appropriate use of visual aids to accurately communicate risk with their patients. Any intervention has been shown to be better than nothing in improving health understanding. The simple process of repeatedly conveying risk information to a patient has been shown to improve accuracy of risk perception. Doctors need to take responsibility for the accurate assessment and effective communication of CV risk in their patients in order to improve patient uptake of cardioprotective lifestyle choices and preventive medications.
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Affiliation(s)
- Ruth Webster
- Cardiovascular Division, The George Institute for International Health, Camperdown, NSW, Australia
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Thanavaro JL, Thanavaro S, Delicath T. Health promotion behaviors in women with chest pain. Heart Lung 2010; 39:394-403. [DOI: 10.1016/j.hrtlng.2009.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 10/25/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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Abstract
PURPOSE To develop a tool that measures coronary heart disease (CHD) knowledge specifically for women. DATA SOURCES The new CHD knowledge tool, based on previous surveys of women's CHD knowledge, has 25 multiple-choice questions. An expert panel evaluated content and face validity. The tool was pilot tested in women without CHD, who were admitted to a Chest Pain Center. The tool was subsequently administered to laywomen and female cardiovascular nurses to evaluate its validity and reliability. The sample included 49 women as the control group (Group 1), 23 cardiovascular nurses as a known group (Group 2), and 22 women with an educational program as the treatment group (Group 3). Knowledge of women in Group 1 was compared with Groups 2 and 3 in known group and predictive validity tests. CONCLUSION The new tool demonstrates good validity and reliability to measure CHD knowledge in women. IMPLICATIONS FOR PRACTICE Women continue to have low CHD knowledge, and nurse practitioners should provide education to improve women's CHD knowledge as a strategy to promote healthy lifestyle practices and CHD risk prevention. The new tool can be utilized in future research to measure women's CHD knowledge.
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Mosca L, Mochari-Greenberger H, Dolor RJ, Newby LK, Robb KJ. Twelve-year follow-up of American women's awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes 2010; 3:120-7. [PMID: 20147489 DOI: 10.1161/circoutcomes.109.915538] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Awareness of cardiovascular disease (CVD) risk has been linked to taking preventive action in women. The purpose of this study was to assess contemporary awareness of CVD risk and barriers to prevention in a nationally representative sample of women and to evaluate trends since 1997 from similar triennial surveys. METHODS AND RESULTS A standardized survey about awareness of CVD risk was completed in 2009 by 1142 women >or=25 years of age, contacted through random digit dialing oversampled for racial/ethnic minorities, and by 1158 women contacted online. There was a significant increase in the proportion of women aware that CVD is the leading cause of death since 1997 (P for trend=<0.0001). Awareness among telephone participants was greater in 2009 compared with 1997 (54% versus 30%, P<0.0001) but not different from 2006 (57%). In multivariate analysis, African American and Hispanic women were significantly less aware than white women, although the gap has narrowed since 1997. Only 53% of women said they would call 9-1-1 if they thought they were having symptoms of a heart attack. The majority of women cited therapies to prevent CVD that are not evidence-based. Common barriers to prevention were family/caretaking responsibilities (51%) and confusion in the media (42%). Community-level changes women thought would be helpful were access to healthy foods (91%), public recreation facilities (80%), and nutrition information in restaurants (79%). CONCLUSIONS Awareness of CVD as the leading cause of death among women has nearly doubled since 1997 but is stabilizing and continues to lag in racial/ethnic minorities. Numerous misperceptions and barriers to prevention persist and women strongly favored environmental approaches to facilitate preventive action.
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Affiliation(s)
- Lori Mosca
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA.
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29
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Perception of cardiovascular risk and comparison with actual cardiovascular risk. ACTA ACUST UNITED AC 2009; 16:556-61. [DOI: 10.1097/hjr.0b013e32832d194d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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30
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Qader SS, Shakir YA, Nyberg P, Samsioe G. Sociodemographic risk factors of metabolic syndrome in middle-aged women: results from a population-based study of Swedish women, The Women's Health in the Lund Area (WHILA) Study. Climacteric 2009; 11:475-82. [DOI: 10.1080/13697130802451787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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King KB, Gerich JE, Guzick DS, King KU, McDermott MP. Is a history of gestational diabetes related to risk factors for coronary heart disease? Res Nurs Health 2009; 32:298-306. [DOI: 10.1002/nur.20325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Perceptions and predictions of cardiovascular disease of Alabama women in a rural county. Appl Nurs Res 2009; 23:80-5. [PMID: 20420994 DOI: 10.1016/j.apnr.2008.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 06/19/2008] [Accepted: 06/27/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this project was to gain a better understanding of cardiovascular disease (CVD) as a women's health issue among Alabama women in a rural county. RESEARCH QUESTIONS 1. What are the risks and perceptions of CVD of Alabama women in a rural county? 2. What demographic and study variables predict CVD? METHODS One hundred twelve women participated in this descriptive, prospective study. FINDINGS Thirty percent identified CVD as the greatest health problem facing women and the leading cause of death in women. Ninety percent believed that they had a 41% or greater chance of developing CVD. The variables in the study explained 60% of the participant's coronary heart disease risk prediction scores. CONCLUSIONS The understanding gained in this study will be used to find ways to increase the awareness of CVD and to design interventions that improve the cardiovascular health of women in a rural area of Alabama.
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Grunau GL, Ratner PA, Hossain S. Ethnic and gender differences in perceptions of mortality risk in a Canadian urban centre. Int J Gen Med 2008; 1:41-50. [PMID: 20428405 PMCID: PMC2840537 DOI: 10.2147/ijgm.s3797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Women reportedly do not perceive heart disease (HD) as a major threat to their health; however, men’s perceptions are rarely studied. Purpose: We explored gender and ethnic differences in risk perception of HD mortality. Methods: The survey was completed by 976 people 40+ years of age, in metropolitan Vancouver, Canada. Results: Men, compared with women, were more likely not to know the answer to a question about whether HD is the most common cause of death for women; however, women were more likely not to know the answer to a question about whether HD is the most common cause of death for men. Chinese-Canadian and South Asian-Canadian participants were more likely than participants of other ethnic groups not to know the answer to either question, and the Chinese-Canadian participants were more likely to disagree that HD is the most common cause of death for women. Conclusion: There is a need to educate the Chinese-Canadian and South Asian-Canadian communities about HD as a first step in promoting health behavior change. Men and women must be educated about the other gender’s risk of HD because all adults play integral roles in making decisions about the prevention of and early intervention for HD.
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Raising awareness of women and heart disease--women's hearts are different. Crit Care Nurs Clin North Am 2008; 20:251-63. [PMID: 18644507 DOI: 10.1016/j.ccell.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Even though a woman has a one in two lifetime risk of dying from a coronary event, women and health care providers do not realize that heart disease is the greatest health risk for women. The purpose of this article is to increase awareness of women and heart disease. The article summarizes the evidence-based literature regarding the epidemiology of heart disease in women, risk factors and risk factor stratification, symptoms, diagnosis, and treatment. The text includes the American Heart Association's 2007 Evidenced Based Guidelines for Cardiovascular Disease Prevention.
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Panagiotakos DB, Pitsavos C, Kourlaba G, Mantas Y, Zombolos S, Kogias Y, Antonoulas A, Stravopodis P, Stefanadis C. Sex-related characteristics in hospitalized patients with acute coronary syndromes – the Greek Study of Acute Coronary Syndromes (GREECS). Heart Vessels 2007; 22:9-15. [PMID: 17285439 DOI: 10.1007/s00380-006-0932-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 06/24/2006] [Indexed: 11/30/2022]
Abstract
We studied the sex-specific distribution of various factors in hospitalized patients who presented with acute coronary syndromes (ACS), as well as the annual incidence and the in-hospital and short-term outcomes in males and females. A sample of six hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all nonfatal admissions with a first event of ACS, from October 2003 to September 2004. Sociodemographic, clinical, dietary, and other lifestyle characteristics were recorded. A total of 2,172 patients were included in the study (1,649, 76% male and 523, 24% female). The annual incidence rate was almost three times higher in males than in females (34 per 10,000 males and 10.9 per 10,000 females). The highest frequency of events was observed in winter, in both sexes. Females had higher in-hospital mortality rate as compared to males (5.7% vs 3.2%, P = 0.007), while the 30-day mortality and rehospitalization rate was 17% in male and 16% in female patients. The most common discharged diagnosis for males was Q-wave myocardial infraction (35%), while females were more likely to suffer from unstable angina (42%). Females were older than males, waited longer between seeking and receiving medical advice, and were more likely to have a history of hypertension, obesity, and diabetes mellitus as compared to males. On the other hand, males were more likely to be smokers, to follow a more typical Mediterranean diet, and to be more physically active (P < 0.05). We revealed a sex-related difference in the profile of clinical characteristics and other cardiovascular risk factors in hospitalized patients for ACS.
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Thanavaro JL, Moore SM, Anthony MK, Narsavage G, Delicath T. Predictors of poor coronary heart disease knowledge level in women without prior coronary heart disease. ACTA ACUST UNITED AC 2006; 18:574-81. [PMID: 17184310 DOI: 10.1111/j.1745-7599.2006.00174.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women. DATA SOURCES The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test. CONCLUSIONS Women lack CHD knowledge. Low educational level, normal serum lipids, high body mass index (BMI), and lack of access to a nurse practitioner (NP) were predictors of poor CHD knowledge levels in women without CHD history. IMPLICATIONS FOR PRACTICE Women who had access to an NP were more likely to have higher CHD knowledge. In an attempt to decrease the morbidity and mortality associated with CHD, NPs may be able to improve CHD knowledge in women, particularly in those with lower educational level, normal serum lipids and higher BMI.
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Affiliation(s)
- Joanne L Thanavaro
- Barnes-Jewish College of Nursing and Allied Health at Washington University, St. Louis, Missouri 63110, USA.
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Thanavaro JL, Moore SM, Anthony M, Narsavage G, Delicath T. Predictors of health promotion behavior in women without prior history of coronary heart disease. Appl Nurs Res 2006; 19:149-55. [PMID: 16877194 DOI: 10.1016/j.apnr.2005.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 07/30/2005] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to determine health promotion behavior (HPB) and the best predictors of HPB in women without prior history of coronary heart disease (CHD). The sample included 119 women aged between 35 and 60 years who had no prior CHD history. The women were asked to complete a self-administered survey regarding their demographic data, personal CHD risk factors, HPB, CHD knowledge, and perceived benefits and barriers to CHD risk factor modification. The women in this study did not practice HPB regularly and had low CHD knowledge levels, a high perception level of benefits, and a moderate level of perceived barriers to CHD risk modification. Backward multiple regression analysis demonstrated that smoking history, family history of CHD, CHD knowledge levels, and perceived barriers to CHD risk modification were the best predictors of HPB in women without CHD. Women with fewer perceived barriers to CHD risk modification, higher CHD knowledge levels, and no smoking history or family history of CHD were more likely to practice HPB.
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Affiliation(s)
- Joanne L Thanavaro
- Barnes-Jewish College of Nursing and Allied Health, Washington University Medical Center, St. Louis, MO 63110, USA.
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Thanavaro JL. Barriers to Coronary Heart Disease Risk Modification in Women without Prior History of Coronary Heart Disease. ACTA ACUST UNITED AC 2005; 17:487-93. [PMID: 16248882 DOI: 10.1111/j.1745-7599.2005.00080.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the extent to which women perceive barriers to coronary heart disease (CHD) risk modification and to determine if access to a nurse practitioner (NP) decreases perceived barriers to CHD risk modification. DATA SOURCES Surveys completed by 120 women between the ages of 35 and 60 years, with no known history of CHD. The barriers scale was used to examine women's perceived barriers to CHD risk modification. CONCLUSIONS Women with access to an NP had less perceived barriers to CHD risk modification. IMPLICATIONS FOR PRACTICE NPs are ideally suited to decrease the mortality and morbidity associated with CHD through education strategies and attention to individual barriers women face when attempting to incorporate CHD risk factor modification into their lifestyles.
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Affiliation(s)
- Joanne L Thanavaro
- Barnes-Jewish College of Nursing and Allied Health, Washington University, St. Louis, MO 63110, USA.
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Abstract
Cardiac patients' beliefs about the causes of their illness may influence their receptivity to psychosocial interventions. The purpose of this study was to determine whether depression or anxiety influence patients' attributions about the causes of their heart disease. The primary hypothesis was that depressed or anxious patients are more likely to endorse negative emotions as among the causes of their heart disease than are patients who are not depressed or anxious. Sixty-nine patients with documented ischemic heart disease recruited from an exercise stress testing laboratory completed the Beck Depression and Anxiety Inventories and a heart disease attribution checklist. Univariate analyses confirmed that patients who are depressed or anxious are more likely than other patients to endorse negative emotions as causes of their heart disease. Anxiety but not depression was retained as an independent predictor of negative emotion attributions in a logistic regression analysis. We conclude that mood state influences cardiac patients' beliefs about the causes of their heart disease.
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Affiliation(s)
- Ryan C Day
- Department of Psychology, Washington University, St. Louis, Missouri 63108, USA
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Astin F, Jones K. Heart Disease Attributions of Patients Prior to Elective Percutaneous Transluminal Coronary Angioplasty. J Cardiovasc Nurs 2004; 19:41-7. [PMID: 14994781 DOI: 10.1097/00005082-200401000-00008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One hundred forty consecutive subjects attending a clinic prior to undergoing elective percutaneous transluminal coronary angioplasty were asked about what they believed had caused their coronary heart disease (CHD). The aim was to determine gender differences in responses and compare patients' perceived causal attributions for CHD with their own coronary risk factor profile documented by their attending physician. Female subjects most commonly cited stress as the cause of their CHD, followed by family history, cholesterol, and cigarette smoking. Males showed a different pattern of attribution, with poor diet being the most frequently cited factor, followed by cigarette smoking, stress, and family history. A significantly greater proportion of males than females attributed their illness to behavioral causes rather than to biological causes. A positive history for the coronary risk factors cholesterol (84%), family history (43%), and hypertension (55%), as documented by attending physician, was discordant with causal attributions expressed by patients which were 17%, 31%, and 4% respectively. These findings demonstrate the need to improve communication and find a common "platform" of understanding between patient and practitioner when discussing coronary risk factors in order to establish a collaborative action plan for successful and long-term lifestyle change.
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Affiliation(s)
- Felicity Astin
- Faculty of Medicine, Nursing and Health Science, Monash University, Peninsula Campus, Frankston, Victoria, Australia.
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Shedd OL, Limacher MC. Prevention of Cardiovascular Disease in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2003; 5:287-298. [PMID: 12834566 DOI: 10.1007/s11936-003-0028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Appropriate screening and lifestyle modification are the foundations of effective cardiovascular disease (CVD) prevention in women. All adult women should undergo a cardiovascular risk assessment, including family history, smoking, diet, and exercise assessments, and measurement of fasting lipid profile, waist and hip dimensions, and blood pressure. Women should be advised of their 10-year estimated risk of developing a cardiovascular event using the Framingham risk calculator as recommended by the National Cholesterol Education Program. Based on the level of risk, women should receive counseling on dietary modification, physical activity, weight loss, and the need for pharmacologic intervention for blood pressure, lipid, and diabetes management. In addition, women who are overweight, have a history of gestational diabetes, or family history of diabetes should have a fasting glucose measured. Women who smoke should receive advice, encouragement, and assistance for smoking cessation. Postmenopausal hormone therapy should not be considered a treatment option for primary or secondary prevention of CVD. Women and their families should be advised of the possible signs of CVD and the need to seek immediate medical attention in the event of prolonged, new, or severe symptoms. Women with coronary artery disease especially need close attention to their risk factor levels and should receive intensive intervention to achieve optimal control.
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Affiliation(s)
- Omer L. Shedd
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, PO Box 100277, 1600 SW Archer Road, Gainesville, FL 32610-0277, USA.
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Chrysohoou C, Panagiotakos DB, Pitsavos C, Kokkinos P, Marinakis N, Stefanadis C, Toutouzas PK. Gender differences on the risk evaluation of acute coronary syndromes: the CARDIO2000 study. PREVENTIVE CARDIOLOGY 2003; 6:71-7. [PMID: 12732792 DOI: 10.1111/j.1520-037x.2003.01609.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3+/-8 vs. 59.7+/-10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.
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Affiliation(s)
- Christina Chrysohoou
- Section of Preventive Cardiology, Cardiology Department, School of Medicine, University of Athens, Greece
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Johnson PA, Fulp RS. Racial and ethnic disparities in coronary heart disease in women: prevention, treatment, and needed interventions. Womens Health Issues 2002; 12:252-71. [PMID: 12225688 DOI: 10.1016/s1049-3867(02)00148-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paula A Johnson
- Division of Women's Health, Center for Cardiovascular Disease in Women, Brigham and Women's Hospital, Boston, Massachusetts, USA
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King KB, Quinn JR, Delehanty JM, Rizzo S, Eldredge DH, Caufield L, Ling FS. Perception of risk for coronary heart disease in women undergoing coronary angiography. Heart Lung 2002; 31:246-52. [PMID: 12122388 DOI: 10.1067/mhl.2002.126522] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Even though coronary heart disease (CHD) is the leading cause of death among women in the United States, most women underestimate their risk of developing CHD. DESIGN Survey to examine the relationship between women's recollection of being told they were at risk for CHD and the presence of risk factors. SETTING/PARTICIPANTS A convenience sample of 450 women undergoing coronary angiography at 1 university hospital. MAIN OUTCOME MEASURES Self-recollection of being told one was at risk for CHD and presence of CHD risk factors. RESULTS Most women (83.6%) had 3 or more risk factors, 12.2% had 1 or 2 risk factors, and 0.9% had no risk factors. Only 35% of women recalled being told that they were at risk for CHD. Few relationships were found between being told one was at risk for CHD and the presence of individual risk factors. No difference was found in the mean number of risk factors among women who did and did not recall being told they were at risk. In logistic regression analysis, only 5% of the variance in recollection of being told one was at risk was predicted, with only age, education, and having a high cholesterol level significantly contributing to the equation. CONCLUSIONS Even though women may not remember conversations with their health care provider about CHD risk, the possibility that risk factors were not adequately assessed cannot be discounted. Patient-provider conversations about CHD risk factors should be encouraged as the first step toward successful risk reduction.
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Affiliation(s)
- Kathleen B King
- University of Rochester School of Nursing, Rochester, New York 14642, USA
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Abstract
Although cardiovascular disease (CVD) has traditionally been considered a disease that affects middle-aged men, it also has a profound effect on women. By age 65, the number of deaths from CVD in women surpasses deaths in men by 11%. Cardiovascular disease is the leading cause of mortality in women. Despite the impact of CVD, women as a group, as well as healthcare professionals, have not focused on this disease entity. As a result, women may not make adjustments that could reduce their risk for CVD, and healthcare professionals may not adequately counsel women on risk modification, which may include lifestyle changes and pharmaceutical intervention. Although there are many similarities, women differ from men in both disease presentation and prognosis for CVD. Because of the difference in presentation, diagnoses in women may be delayed, potentially causing further harm. Although the number of deaths caused by CVD has been decreasing in men, this trend has yet to be observed in women.
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Affiliation(s)
- Sandra J Lewis
- Portland Cardiovascular Institute, Portland, Oregon 97210, USA
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