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Abusnina W, Elhouderi E, Walters RW, Al-Abdouh A, Mostafa MR, Liu JL, Mazozy R, Mhanna M, Ben-Dor I, Dufani J, Kabach A, Michos ED, Aboeata A, Mamas MA. Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy: A Meta-Analysis of Observational Studies. Am J Cardiol 2024; 211:316-325. [PMID: 37923154 DOI: 10.1016/j.amjcard.2023.10.066] [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: 12/13/2022] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA; Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC.
| | - Eiman Elhouderi
- Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mostafa R Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | - John L Liu
- Creighton University School of Medicine, Omaha, NE, USA
| | - Ruqayah Mazozy
- Department of Cardiology, Zliten Medical Center, Zliten, Libya
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, IA, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC
| | - Jalal Dufani
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Amjad Kabach
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahemd Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Kim HM, Kim HL, Kim MA, Lee HY, Park JJ, Choi DJ. Sex differences in clinical characteristics and long-term outcome in patients with heart failure: data from the KorAHF registry. Korean J Intern Med 2024; 39:95-109. [PMID: 38092557 PMCID: PMC10790043 DOI: 10.3904/kjim.2023.288] [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: 07/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND/AIMS Sex differences in the prognosis of heart failure (HF) have yielded inconsistent results, and data from Asian populations are even rare. This study aimed to investigate sex differences in clinical characteristics and long-term prognosis among Korean patients with HF. METHODS A total of 5,625 Korean patients hospitalized for acute HF were analyzed using a prospective multi-center registry database. Baseline clinical characteristics and long-term outcomes including HF readmission and death were compared between sexes. RESULTS Women were older than men and had worse symptoms with higher N-terminal pro B-type natriuretic peptide levels. Women had a significantly higher proportion of HF with preserved ejection fraction (HFpEF). There were no significant differences in in-hospital mortality and rate of guideline-directed medical therapies in men and women. During median follow- up of 3.4 years, cardiovascular death (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.07-1.78; p = 0.014), and composite outcomes of death and HF readmission (adjusted HR, 1.13; 95% CI, 1.01-1.27; p = 0.030) were significantly higher in men than women. When evaluating heart failure with reduced ejection fraction (HFrEF) and HFpEF separately, men were an independent risk factor of cardiovascular death in patients with HFrEF. Clinical outcome was not different between sexes in HFpEF. CONCLUSION In the Korean multi-center registry, despite having better clinical characteristics, men exhibited a higher risk of all-cause mortality and readmission for HF. The main cause of these disparities was the higher cardiovascular mortality rate observed in men compared to women with HFrEF.
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Affiliation(s)
- Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul,
Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul,
Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jin Joo Park
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Dong-Ju Choi
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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Hioki H, Watanabe Y, Kataoka A, Kozuma K, Shirai S, Naganuma T, Yamawaki M, Enta Y, Mizuno S, Ueno H, Ohno Y, Nakajima Y, Izumo M, Bouta H, Kodama K, Yamaguchi J, Kubo S, Amaki M, Asami M, Saji M, Mizutani K, Okazaki S, Hachinohe D, Otsuka T, Adachi Y, Yamamoto M, Hayashida K. Impact of Gender on Mortality After Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation. Am J Cardiol 2023; 205:12-19. [PMID: 37579655 DOI: 10.1016/j.amjcard.2023.07.143] [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: 04/02/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/16/2023]
Abstract
Recent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between men and women. However, the gender-specific prognostic difference in the long-term follow-up after TEER is still unknown. To evaluate the impact of gender on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. We retrospectively analyzed 1,233 patients (male 60.3%) who underwent TEER for FMR at 24 centers. The impact of gender on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. During the 2-year follow-up, 207 all-cause death and 263 hospitalizations for HF were observed after TEER for FMR. Men had a significantly higher incidence of all-cause death than women (18.6% vs 14.1%, log-rank p = 0.03). After adjustment by multivariate Cox regression and PS matching, the male gender was significantly associated with a higher incidence of all-cause mortality after TEER than the female gender (hazard ratio 2.11, 95% confidence interval 1.42 to 3.14 in multivariate Cox regression; hazard ratio 1.89, 95% confidence interval 1.03 to 3.48 in PS matching). The gender-specific prognostic difference was even more pronounced after 1-year of TEER. On the contrary, there was no gender-related difference in hospitalization for HF after TEER. In conclusion, women with FMR had a better prognosis after TEER than men, whereas this was not observed in hospitalization for HF. This result might indicate that women with FMR are more likely to benefit from TEER.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan.
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yusuke Enta
- Department of Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
| | - Shingo Mizuno
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanmakura, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St, Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Bouta
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuhisa Kodama
- Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Keshvani N, Shah S, Ayodele I, Chiswell K, Alhanti B, Allen L, Greene SJ, Yancy C, Alonso W, Van Spall H, Fonarow GC, Heidenreich PA, Pandey A. Sex differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get With The Guidelines-Heart Failure registry. Eur J Heart Fail 2023; 25:1544-1554. [PMID: 37632339 PMCID: PMC11069419 DOI: 10.1002/ejhf.3003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Abstract
AIMS Sex differences in long-term outcomes following hospitalization for heart failure (HF) across ejection fraction (EF) subtypes are not well described. In this study, we evaluated the risk of mortality and rehospitalization among males and females across the spectrum of EF over 5 years of follow-up following an index HF hospitalization event. METHODS AND RESULTS Patients hospitalized with HF between 1 January 2006 and 31 December 2014 from the American Heart Association's Get With The Guidelines-Heart Failure registry with available 5-year follow-up using Medicare Part A claims data were included. The association between sex and risk of mortality and readmission over a 5-year follow-up period for each HF subtype (HF with reduced EF [HFrEF, EF ≤40%], HF with mildly reduced EF [HFmrEF, EF 41-49%], and HF with preserved EF [HFpEF, EF >50%]) was assessed using adjusted Cox models. The effect modification by the HF subtype for the association between sex and outcomes was assessed by including multiplicative interaction terms in the models. A total of 155 670 patients (median age: 81 years, 53.4% female) were included. Over 5-year follow-up, males and females had comparably poor survival post-discharge; however, females (vs. males) had greater years of survival lost to HF compared with the median age- and sex-matched US population (HFpEF: 17.0 vs. 14.6 years; HFrEF: 17.3 vs. 15.1 years; HFmrEF: 17.7 vs. 14.6 years for age group 65-69 years). In adjusted analysis, females (vs. males) had a lower risk of 5-year mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.87-0.90, p < 0.0001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85-0.89; pinteraction [sex*HF subtype] = 0.04). Females (vs. males) had a higher adjusted risk of HF readmission over 5-year follow-up (aHR 1.06, 95% CI 1.04-1.08, p < 0.0001), with the risk difference most pronounced among patients with HFpEF (aHR 1.11, 95% CI 1.07-1.14; pinteraction [sex*HF subtype] = 0.001). CONCLUSIONS While females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age- and sex-matched US population and had a greater risk of rehospitalization over 5 years following HF hospitalization.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Sonia Shah
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | | | - Larry Allen
- Division of Cardiology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Stephen J. Greene
- Duke Clinical Research Institute, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical School, Durham, NC
| | - Clyde Yancy
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Windy Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | | | - Gregg C Fonarow
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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5
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Saleh ZT, Alraoush AT, Aqel AA, Shawashi TO, Chung M, Lennie TA. Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:386-393. [PMID: 37707972 PMCID: PMC8733054 DOI: 10.1097/jcn.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined. AIM The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables. METHOD This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF. RESULTS There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation. CONCLUSION These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.
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Affiliation(s)
- Zyad T. Saleh
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Ahmad T. Alraoush
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan 22110
| | - Ahmad A. Aqel
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Tagreed O. Shawashi
- School of Nursing, The University of Jordan, Queen Rania Street, Amman, Jordan 11942
| | - Misook Chung
- College of Nursing, University of Kentucky, 315 College of Nursing Building, 751 Rose Street, Lexington, KY 40536
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, 315 College of Nursing Building, 751 Rose Street, Lexington, KY 40536
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Nakasuka K, Ishibashi K, Hattori Y, Mori K, Nakajima K, Nagayama T, Kamakura T, Wada M, Inoue Y, Miyamoto K, Nagase S, Noda T, Aiba T, Takaya Y, Isobe M, Terasaki F, Ohte N, Kusano K. Sex-related differences in the prognosis of patients with cardiac sarcoidosis treated with cardiac resynchronization therapy. Heart Rhythm 2022; 19:1133-1140. [DOI: 10.1016/j.hrthm.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
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Wang L, Wang LQ, Gu ML, Li L, Wang C, Xia YF. A Simple Clinical Risk Score to Predict Post-Discharge Mortality in Chinese Patients Hospitalized with Heart Failure. Arq Bras Cardiol 2021; 117:615-623. [PMID: 34406318 PMCID: PMC8528360 DOI: 10.36660/abc.20200435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/10/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading causes of death in China. However, present efforts to identify the risk factors for death in patients hospitalized with heart failure (HF) are primarily focused on in-hospital mortality and 30-day mortality in the United States. Thus, a model similar to the model used for predicting the risk in patients considered for cardiovascular surgical procedures is needed to evaluate the risk of the patients admitted with a diagnosis of HF. OBJECTIVE To identify variables that can predict post-discharge one-year HF mortality and develop a risk score to assess the risk of dying within one year. METHODS In the present study, 1,742 Chinese patients with HF were randomly divided into two groups: a derivation sample group and a test sample group. A Markov Chain Monte Carlo simulation method was used to identify variables that can predict the one-year post-discharge mortality. Variables with a frequency of >1% in the bivariate analysis and that were considered clinically meaningful were eligible for further modeling analyses. The posterior probability that a variable was statistically and significantly associated with the outcome was calculated as the total number of times that the variable's 95% CI did not overlap with 1 (i.e., the reference point) divided by the total number of iterations. A variable with a probability of 0.9 or higher was considered a robust risk factor for predicting the outcome, and this was included in the final variable list. The level of statistical significance adopted was 5%. RESULTS Five variables that could robustly predict the one-year post-discharge mortality were identified: age, female gender, New York Heart Association functional classification score >3, left atrial diameter, and body mass index. Both derivation and test models had a receiver operating curve area of 0.79. These selected variables were used to assess the one-year HF mortality risk score, and these were divided into three groups (low, moderate, and high). The high-risk group corresponds to nearly 86% of the deaths, while the moderate group corresponds to 12% of the deaths. CONCLUSION A simple 5-variable risk score can be used to assess the one-year post-discharge mortality of hospitalized Chinese patients with HF.
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Affiliation(s)
- Lei Wang
- Departamento de Medicina Geriátrica, the Fourth Medical Center, Chinese PLA General Hospital, Beijng - China
| | - Li-Qin Wang
- Departamento de Enfermagem, the Eighth Medical Center, Chinese PLA General Hospital, Beijng - China
| | - Mo-Li Gu
- Departamento de Medicina Geriátrica, the Fourth Medical Center, Chinese PLA General Hospital, Beijng - China
| | - Liang Li
- Departamento de Medicina Geriátrica, the Fourth Medical Center, Chinese PLA General Hospital, Beijng - China
| | - Chen Wang
- Departamento de Medicina Geriátrica, the Fourth Medical Center, Chinese PLA General Hospital, Beijng - China
| | - Yun-Feng Xia
- Departamento de Medicina Geriátrica, the Fourth Medical Center, Chinese PLA General Hospital, Beijng - China
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Burghardt J, Riffer F, Sprung M. Gender effects on outcomes of psychosomatic rehabilitation are reduced. PLoS One 2021; 16:e0256916. [PMID: 34449826 PMCID: PMC8396777 DOI: 10.1371/journal.pone.0256916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/19/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men. METHODS We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic. RESULTS Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden. CONCLUSION Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods.
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Affiliation(s)
- Juliane Burghardt
- Division of Clinical Psychology, Department Psychology and Psychodynamics, Karl Landsteiner University of Health Science, Krems an der Donau, Austria
- * E-mail:
| | - Friedrich Riffer
- University Hospital for Psychosomatic Medicine Eggenburg, Psychosomatisches Zentrum Waldviertel, Eggenburg, Austria
- Psychiatric Rehabilitation Clinic Gars am Kamp, Psychosomatisches Zentrum Waldviertel, Gars am Kamp, Austria
| | - Manuel Sprung
- Division of Clinical Psychology, Department Psychology and Psychodynamics, Karl Landsteiner University of Health Science, Krems an der Donau, Austria
- University Hospital for Psychosomatic Medicine Eggenburg, Psychosomatisches Zentrum Waldviertel, Eggenburg, Austria
- Psychiatric Rehabilitation Clinic Gars am Kamp, Psychosomatisches Zentrum Waldviertel, Gars am Kamp, Austria
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9
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Ram E, Sternik L, Moshkovitz Y, Iakobishvili Z, Zuroff E, Peled Y, Herscovici R, Raanani E. Coronary Artery Bypass Grafting Following Acute Coronary Syndrome: Impact of Gender. Semin Thorac Cardiovasc Surg 2021; 34:920-929. [PMID: 34289411 DOI: 10.1053/j.semtcvs.2021.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
The impact of gender on clinical outcomes after coronary artery bypass grafting (CABG) has generated conflicting results. We investigated the impact of gender, on 30 day mortality, complications and late survival in patients with acute coronary syndrome (ACS) undergoing CABG. The study included 1308 patients enrolled from the biennial Acute Coronary Syndrome Israeli Survey between 2000 and 2016, who were hospitalized for ACS and underwent CABG. Of them, 1045 (80%) were men and 263 (20%) women. While women were older and had more hypertension and hyperlipidemia, they demonstrated less diabetes mellitus, previous ischemic heart disease, smoking, and fewer implicated coronary arteries. Women presented with more atypical symptoms as compared to men (26.3% vs 19.4%, p = 0.017). Overall multivariable-adjusted 30 day mortality was higher in women than in men (OR 2.47 95% CI 1.19-5.1, p = 0.015). Among patients with ST-elevation myocardial infarction (STEMI) or non-STEMI, women had a higher 10 year mortality rate than men (42.5% vs 19.2%, log-rank p < 0.001 and 31.5% vs 20.7%, log-rank, p = 0.012). However, in patients with unstable angina pectoris on admission, these differences were not seen (16.9% vs 13.4%, log-rank p = 0.540). Multivariable analysis demonstrated that female gender was a significant predictor for 10 year mortality (HR 1.39, 95% CI 1.02-1.9, p = 0.038). In a real-life setting, women constitute an independent predictor for short- and long-term mortality following ACS treated by CABG surgery. The reasons for a higher mortality in women should be further investigated as well as specific and/or more intensive therapies after CABG in this high-risk group of patients.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
| | - Leonid Sternik
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yaron Moshkovitz
- Department of Cardiothoracic Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel; Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Zuroff
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yael Peled
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Romana Herscovici
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
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10
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Whitelaw S, Sullivan K, Eliya Y, Alruwayeh M, Thabane L, Yancy CW, Mehran R, Mamas MA, Van Spall HGC. Trial characteristics associated with under-enrolment of females in randomized controlled trials of heart failure with reduced ejection fraction: a systematic review. Eur J Heart Fail 2020; 23:15-24. [PMID: 33118664 DOI: 10.1002/ejhf.2034] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS To evaluate temporal trends in the enrolment of females in randomized controlled trials (RCTs) of heart failure with reduced ejection fraction (HFrEF) published in high-impact journals, and assess RCT characteristics associated with under-enrolment. METHODS AND RESULTS We searched MEDLINE, EMBASE and CINAHL for studies published from January 2000 to May 2019 in journals with impact factor ≥10. We included RCTs that recruited adults with HFrEF. We used a 20% threshold below the sex distribution of HFrEF to define under-enrolment. We used multivariable logistic regression to assess trial characteristics independently associated with under-enrolment. We included 317 RCTs. Among the 183 097 participants, mean (standard deviation) age was 63.0 (7.0) years and 25.5% were female. Females were under-enrolled in 71.6% [95% confidence interval (CI) 66.6-76.6%] of the RCTs; enrolment did not increase significantly between 2000-2019. Sex-related eligibility criteria [odds ratio (OR) 2.05, 95% CI 1.01-4.16; P = 0.046]; recruitment in ambulatory settings (OR 2.56, 95% CI 1.37-4.81; P = 0.003); trial coordination in North America (OR 4.44, 95% CI 1.09-18.07; P = 0.037), Europe (OR 6.79, 95% CI 1.63-27.39; P = 0.018) and Asia (OR 9.33, 95% CI 1.40-12.40; P = 0.033); drug (OR 1.76, 95% CI 1.96-7.36; P < 0.001) and device/surgical interventions (OR 1.69, 95% CI 1.16-9.43; P = 0.002); and men in first and last authorship position (OR 1.32, 95% CI 1.12-3.54; P = 0.047) were associated with under-enrolment of females. CONCLUSIONS Females were under-enrolled relative to disease distribution in a majority of high-impact HFrEF RCTs, with no change in temporal trends between 2000 and 2019. Trial characteristics and gender of trial leaders were associated with under-enrolment.
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Affiliation(s)
- Sera Whitelaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Yousif Eliya
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Clyde W Yancy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Roxana Mehran
- Ican School of Medicine, Mount Sinai Hospital, NY, New York, USA
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK.,Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,ICES, McMaster University, Hamilton, Canada
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11
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Yamamoto E, Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Himura Y, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Kawato M, Seko Y, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Kimura T. Sex differences in patients with acute decompensated heart failure in Japan: observation from the KCHF registry. ESC Heart Fail 2020; 7:2485-2493. [PMID: 32705815 PMCID: PMC7524241 DOI: 10.1002/ehf2.12815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
Aims The association between sex and long‐term outcome in patients hospitalized for acute decompensated heart failure (ADHF) has not been fully studied yet in Japanese population. The aim of this study was to determine differences in baseline characteristics and management of patients with ADHF between women and men and to compare 1‐year outcomes between the sexes in a large‐scale database representing the current real‐world clinical practice in Japan. Methods and results Kyoto Congestive Heart Failure registry is a prospective cohort study enrolling consecutive patients hospitalized for ADHF in Japan among 19 centres. Baseline characteristics, clinical presentation, management, and 1‐year outcomes were compared between men and women. A total of 3728 patients who were alive at discharge constituted the current study population. There were 1671 women (44.8%) and 2057 men. Women were older than men [median (IQR): 83 (76–88) years vs. 77 (68–84) years, P < 0.0001]. Hypertensive and valvular heart diseases were more prevalent in women than in men (28.0% vs. 22.5%, P = 0.0001; and 26.9% vs. 14.0%, P < 0.0001, respectively), whereas ischaemic aetiology was less prevalent in women than in men (20.0% vs. 32.5%, P < 0.0001). Women less often had reduced left ventricular ejection fraction (<40%) than men (27.5% vs. 45.1%, P < 0.0001). The cumulative incidence of all‐cause death or hospitalization for heart failure was not significantly different between women and men (33.6% vs. 34.3%, P = 0.71), although women were substantially older than men. After multivariable adjustment, the risk of all‐cause death or hospitalization for heart failure was significantly lower among women (adjusted hazard ratio: 0.84, 95% confidence interval: 0.74–0.96, P = 0.01). Conclusions Women with heart failure were older and more often presented with preserved EF with a non‐ischaemic aetiology and were associated with a reduced adjusted risk of 1‐year mortality compared with men in the Japanese population.
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Affiliation(s)
- Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Kyoto, Japan
| | - Mamoru Takahashi
- Department of Cardiology, Shimabara Hospital, Kyoto, Kyoto, Japan
| | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Shiga, Japan
| | - Yoshihiro Himura
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Shiga, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Osaka, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Osaka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Fukuoka, Japan
| | - Mitsunori Kawato
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Wakayama, Japan
| | - Yuta Seko
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | | | - Yutaka Furukawa
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Fukuoka, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Yukihito Sato
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
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12
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Fukuma N, Takimoto E, Ueda K, Liu P, Tajima M, Otsu Y, Kariya T, Harada M, Toko H, Koga K, Blanton RM, Karas RH, Komuro I. Estrogen Receptor-α Non-Nuclear Signaling Confers Cardioprotection and Is Essential to cGMP-PDE5 Inhibition Efficacy. JACC Basic Transl Sci 2020; 5:282-295. [PMID: 32215350 PMCID: PMC7091505 DOI: 10.1016/j.jacbts.2019.12.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023]
Abstract
Using genetically engineered mice lacking estrogen receptor-α non-nuclear signaling, this study demonstrated that estrogen receptor-α non-nuclear signaling activated myocardial cyclic guanosine monophosphate-dependent protein kinase G and conferred protection against cardiac remodeling induced by pressure overload. This pathway was indispensable to the therapeutic efficacy of cyclic guanosine monophosphate-phosphodiesterase 5 inhibition but not to that of soluble guanylate cyclase stimulation. These results might partially explain the equivocal results of phosphodiesterase 5 inhibitor efficacy and also provide the molecular basis for the advantage of using a soluble guanylate cyclase simulator as a new therapeutic option in post-menopausal women. This study also highlighted the need for female-specific therapeutic strategies for heart failure.
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Key Words
- E2, estradiol
- ECs, endothelial cells
- EDC, estrogen dendrimer conjugate
- ER, estrogen receptor
- LV, left ventricular
- NO, nitric oxide
- PDE5i, phosphodiesterase 5 inhibitor
- PKG, cGMP-dependent protein kinase G
- PaPE, pathway-preferential estrogen
- TAC, transverse aortic constriction
- VO2, oxygen consumption rate
- cGMP, cyclic guanosine monophosphate
- cyclic GMP
- eNOS, endothelial nitric oxide synthase
- estradiol
- heart failure
- non-nuclear signaling
- sGC stimulator
- sGC, soluble guanylate cyclase
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Affiliation(s)
- Nobuaki Fukuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eiki Takimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kazutaka Ueda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Pangyen Liu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyu Tajima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Otsu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kariya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mutsuo Harada
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruhiro Toko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Richard H Karas
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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14
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Diamant MJ, Toma M. Should We Be Using Sex-Specific Heart Failure Risk Scores? Can J Cardiol 2019; 36:11-12. [PMID: 31787437 DOI: 10.1016/j.cjca.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Michael J Diamant
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mustafa Toma
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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15
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Sex differences in excess and reservoir arterial blood pressures as markers of phenotype. J Hypertens 2019; 37:2159-2167. [DOI: 10.1097/hjh.0000000000002135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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16
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Gutman SJ, Costello BT, Papapostolou S, Iles L, Ja J, Hare JL, Ellims A, Marwick TH, Taylor AJ. Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure. ESC Heart Fail 2019; 6:944-952. [PMID: 31618531 PMCID: PMC6816230 DOI: 10.1002/ehf2.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio‐economic status (SES), and remoteness] are associated with lower prescription of evidence‐based therapy and higher mortality among patients with moderate–severe heart failure with reduced ejection fraction. Methods and results We recruited 452 consecutive class II–III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence‐based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow‐up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74–1.92, 0.48). There was no difference in prescription of beta‐blockers [χ2(1) = 0.91, 0.66], angiotensin‐converting enzyme inhibitors [χ2(1) = 0.001, 0.97], nor aldosterone antagonists [χ2(1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter‐defibrillator implantation in men compared with women [χ2(1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.
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Affiliation(s)
- Sarah J Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Ben T Costello
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stavroula Papapostolou
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Leah Iles
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Johnson Ja
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - James L Hare
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andris Ellims
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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17
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Kim HL, Kim MA, Park KT, Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Shin MS, Kang SM, Chae SC, Ryu KH. Gender difference in the impact of coexisting diabetes mellitus on long-term clinical outcome in people with heart failure: a report from the Korean Heart Failure Registry. Diabet Med 2019; 36:1312-1318. [PMID: 31254366 DOI: 10.1111/dme.14059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 01/14/2023]
Abstract
AIM Few data are available on the gender-related differences in the prognostic impact of diabetes in people with heart failure. This study was performed to investigate whether there is a gender difference in the association between diabetes and long-term clinical outcomes in people hospitalized for heart failure. METHODS A total of 3162 people hospitalized with heart failure (aged 67.4 ± 14.1 years, 50.4% females) from the data set of the nationwide registry were analysed. The primary endpoint was a composite of all-cause mortality and heart failure readmission. RESULTS People with diabetes (30.5% for males vs. 31.1% for females, P = 0.740) were older and had more unfavourable risk factors and laboratory findings than those without diabetes in both genders. During a median follow-up period of 549 days, there were 1418 cases of composite events (44.8%). In univariable analysis, the coexistence of diabetes was significantly associated with a higher incidence of composite events in both genders (P < 0.05 each for males and females). In multivariable analysis, the prognostic impact of diabetes on the development of composite events remained significant in females even after controlling for potential confounders (hazard ratio 1.43, 95% confidence intervals 1.12-1.84; P = 0.004). However, an independent association between diabetes and composite events was not seen in males in the same multivariable analysis (P > 0.05). CONCLUSIONS In people with heart failure, the impact of diabetes on long-term mortality and heart failure readmission seems to be stronger in females than in males. More careful and intensive management is needed especially in females with heart failure and diabetes.
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Affiliation(s)
- H-L Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Centre, Seoul, Korea
| | - M-A Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Centre, Seoul, Korea
| | - K-T Park
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Centre, Seoul, Korea
| | - D-J Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
| | - S Han
- Department of Cardiovascular Medicine, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwasung, Korea
| | - E-S Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Centre, Seoul, Korea
| | - M-C Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - J-J Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea
| | - B-S Yoo
- Department of Internal Medicine, Yonsei University Wonju Christian Hospital, Wonju, Korea
| | - M-S Shin
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - S-M Kang
- Department of Internal Medicine, Yonsei University Severance Hospital, Seoul, Korea
| | - S C Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - K-H Ryu
- Department of Cardiovascular Medicine, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwasung, Korea
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18
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Chung J, Kim HL, Kim MA, Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Shin MS, Kang SM, Chae SC, Ryu KH. Sex Differences in Long-Term Clinical Outcomes in Patients Hospitalized for Acute Heart Failure: A Report from the Korean Heart Failure Registry. J Womens Health (Larchmt) 2019; 28:1606-1613. [PMID: 31216207 DOI: 10.1089/jwh.2018.7404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Although a better survival rate in women than in men has been reported in heart failure (HF) with reduced ejection fraction (HFrEF), the sex-specific prognosis has scarcely been addressed in HF with preserved EF (HFpEF). Thus, this study investigated the sex difference in clinical outcomes in patients with HFpEF, as well as in those with HFrEF. Materials and Methods: We studied clinical outcomes of 2,572 hospitalized patients due to HF (66.8 ± 14.4 years, 49.7% women) in the Korean Heart Failure Registry. Patients were divided into two groups by left ventricular EF (LVEF): HFpEF (LVEF ≥50%, n = 764) and HFrEF (LVEF <40%, n = 1,808) groups. Results: During a median follow-up of 1,121 days, there were 693 (28.7%) deaths and 1,073 (44.5%) composite events (death and HF readmission). There were no sex differences in the incidence of death or composite events during follow-up in both HFrEF and HFpEF groups (p > 0.05 for each). In 1:1 age-matched population (n = 1,005 in each sex), the long-term mortality was significantly lower in women than men in HFrEF group (p = 0.005), but not in HFpEF group (p = 0.786), while the incidences of composite events were similar between sex irrespective of LVEF (p > 0.05). However, there were no significant associations between sex and clinical outcomes in multivariable analysis (p > 0.05 for each). Conclusions: Sex per se was not the significant factor determining long-term clinical outcomes in HF patients regardless of the LVEF.
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Affiliation(s)
- Jaehoon Chung
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Myung-A Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Republic of Korea
| | - Seongwoo Han
- Department of Cardiovascular Medicine, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwasung, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju Christian Hospital, Wonju, Republic of Korea
| | - Mi-Seung Shin
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Kyu-Hyung Ryu
- Department of Cardiovascular Medicine, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwasung, Republic of Korea
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19
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Merrill M, Sweitzer NK, Lindenfeld J, Kao DP. Sex Differences in Outcomes and Responses to Spironolactone in Heart Failure With Preserved Ejection Fraction: A Secondary Analysis of TOPCAT Trial. JACC. HEART FAILURE 2019; 7:228-238. [PMID: 30819379 PMCID: PMC6817333 DOI: 10.1016/j.jchf.2019.01.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to investigate sex differences in outcomes and responses to spironolactone in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND HFpEF affects women more frequently than men. Sex differences in responses to effects of mineralocorticoid antagonists have not been reported. METHODS This was an exploratory, post hoc, non-pre-specified analysis of the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial. Subjects with symptomatic HF and a left ventricular ejection fraction ≥45% were randomized to spironolactone or placebo therapy. Subjects enrolled from the Americas were analyzed. The primary outcome was a composite of cardiovascular (CV) death, cardiac arrest, or HF hospitalization. Secondary outcomes included all-cause mortality, CV, and non-CV mortality and CV, HF, and non-CV hospitalization. Sex differences in outcomes and treatment effects were determined using time-to-event analysis. RESULTS In total, 882 of 1,767 subjects (49.9%) were women. Women were older with fewer comorbidities but worse patient-reported outcomes. There were no sex differences in outcomes in the placebo arm or in response to spironolactone for the primary outcome or its components. Spironolactone therapy was associated with reduced all-cause mortality in women (hazard ratio: 0.66; p = 0.01) but not in men (pinteraction = 0.02). CONCLUSIONS In TOPCAT, women and men presented with different clinical profiles and similar clinical outcomes. The interaction between spironolactone and sex in TOPCAT overall and in the present analysis was nonsignificant for the primary outcome, but there was a reduction in all-cause mortality associated with spironolactone therapy in women, with a significant interaction between sex and treatment arm. Prospective evaluation is needed to determine whether spironolactone therapy may be effective for treatment of HFpEF in women. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302).
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Affiliation(s)
- Miranda Merrill
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Nancy K Sweitzer
- Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - David P Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
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20
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Zahid FM, Ramzan S, Faisal S, Hussain I. Gender based survival prediction models for heart failure patients: A case study in Pakistan. PLoS One 2019; 14:e0210602. [PMID: 30779736 PMCID: PMC6380566 DOI: 10.1371/journal.pone.0210602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objective of this study was to build and assess the performance of survival prediction models using the gender-specific informative risk factors for patients with left ventricular systolic dysfunction. METHODS A lasso approach was used to decide the informative predictors for building semi-parametric proportional hazards Cox model. Separate models were built for all patients [N = 299], male patients [Nmale = 194 (64.88%)], and female patients [Nfemale = 105 (35.12%)], to observe the risk factors associated with the individual's risk of death. The likelihood- ratio test was used to test the goodness of fit of the selected model, and the C-index was used to assess the predictive performance of the selected model(s) with respect to the overall model with all observed risk factors. RESULTS The survival prediction model for females is notably different from that for males. For males, smoking, diabetes, and anaemia, whereas for females, ejection fraction, sodium, and platelets count are non-informative with zero regression coefficients. The goodness of fit of the selected models with respect to the general model with all observed risk factors is tested using the likelihood-ratio test. The results are in favor of the selected models with p-values 0.51,0.61, and 0.70 for all patients, male patients, and female patients, respectively. The same values of C-index for the full model and the selected models for overall data, for males, and for females (0.72, 0.73, and 0.77 for overall data, male data, and female data, respectively) indicate that the selected models are as good as the corresponding overall models regarding their predictive performance. CONCLUSION There is a substantial difference in the survival prediction models for heart failure (HF) of male and female patients in this study. More studies are needed in Pakistan for confirming this striking male-female difference regarding the potential risk factors to predict survival with heart failure.
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Affiliation(s)
| | - Shakeela Ramzan
- Faisalabad Medical University, Allied Hospital, Faisalabad, Pakistan
| | - Shahla Faisal
- Department of Statistics / Government College University, Faisalabad, Pakistan
| | - Ijaz Hussain
- Department of Statistics / Quaid-i-Azam University, Islamabad, Pakistan
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21
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Stubnova V, Os I, Høieggen A, Solbu MD, Grundtvig M, Westheim AS, Atar D, Waldum-Grevbo B. Gender differences in association between uric acid and all-cause mortality in patients with chronic heart failure. BMC Cardiovasc Disord 2019; 19:4. [PMID: 30611196 PMCID: PMC6321661 DOI: 10.1186/s12872-018-0989-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background Elevated serum uric acid (SUA) is associated with poor prognosis in patients with cardiovascular disease, yet it is still not decided whether the role of SUA is causal or only reflects an underlying disease. The purpose of the study was to investigate if SUA was an independent predictor of 5-year all-cause mortality in a propensity score matched cohort of chronic heart failure (HF) outpatients. Furthermore, to assess whether gender or renal function modified the effect of SUA. Methods Patients (n = 4684) from the Norwegian Heart Failure Registry with baseline SUA were included in the study. Individuals in the highest gender-specific SUA quartile were propensity score matched 1:1 with patients in the lowest three SUA quartiles. The propensity score matching procedure created 928 pairs of patients (73.4% males, mean age 71.4 ± 11.5 years) with comparable baseline characteristics. Kaplan Meier and Cox regression analyses were used to investigate the independent effect of SUA on all-cause mortality. Results SUA in the highest quartile was an independent predictor of all-cause mortality in HF outpatients (hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.03–1.37, p-value 0.021). Gender was found to interact the relationship between SUA and all-cause mortality (p-value for interaction 0.007). High SUA was an independent predictor of all-cause mortality in women (HR 1.65, 95% CI 1.24–2.20, p-value 0.001), but not in men (HR 1.06, 95% CI 0.89–1.25, p-value 0.527). Renal function did not influence the relationship between SUA and all-cause mortality (p-value for interaction 0.539). Conclusions High SUA was independently associated with inferior 5-year survival in Norwegian HF outpatients. The finding was modified by gender and high SUA was only an independent predictor of 5-year all-cause mortality in women, not in men.
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Affiliation(s)
- Viera Stubnova
- Finnmark Hospital Trust, Kirkenes, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ingrid Os
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Aud Høieggen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Morten Grundtvig
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - Arne S Westheim
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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22
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23
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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24
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Iorga A, Umar S, Ruffenach G, Aryan L, Li J, Sharma S, Motayagheni N, Nadadur RD, Bopassa JC, Eghbali M. Estrogen rescues heart failure through estrogen receptor Beta activation. Biol Sex Differ 2018; 9:48. [PMID: 30376877 PMCID: PMC6208048 DOI: 10.1186/s13293-018-0206-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/11/2018] [Indexed: 01/11/2023] Open
Abstract
Background Recently, we showed that exogenous treatment with estrogen (E2) rescues pre-existing advanced heart failure (HF) in mice. Since most of the biological actions of E2 are mediated through the classical estrogen receptors alpha (ERα) and/or beta (ERβ), and both these receptors are present in the heart, we examined the role of ERα and ERβ in the rescue action of E2 against HF. Methods Severe HF was induced in male mice by transverse aortic constriction-induced pressure overload. Once the ejection fraction (EF) reached ~ 35%, mice were treated with selective agonists for ERα (PPT, 850 μg/kg/day), ERβ (DPN, 850 μg/kg/day), or E2 (30 μg/kg/day) together with an ERβ-antagonist (PHTPP, 850 μg/kg/day) for 10 days. Results EF of HF mice was significantly improved to 45.3 ± 2.1% with diarylpropionitrile (DPN) treatment, but not with PPT (31.1 ± 2.3%). E2 failed to rescue HF in the presence of PHTPP, as there was no significant improvement in the EF at the end of the 10-day treatment (32.5 ± 5.2%). The improvement of heart function in HF mice treated with ERβ agonist DPN was also associated with reduced cardiac fibrosis and increased cardiac angiogenesis, while the ERα agonist PPT had no significant effect on either cardiac fibrosis or angiogenesis. Furthermore, DPN improved hemodynamic parameters in HF mice, whereas PPT had no significant effect. Conclusions E2 treatment rescues pre-existing severe HF mainly through ERβ. Rescue of HF by ERβ activation is also associated with stimulation of cardiac angiogenesis, suppression of fibrosis, and restoration of hemodynamic parameters.
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Affiliation(s)
- Andrea Iorga
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.,Present address: Department of Medicine, Division of Gastroenterology/Liver, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90033, USA
| | - Soban Umar
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Gregoire Ruffenach
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Laila Aryan
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jingyuan Li
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Salil Sharma
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Negar Motayagheni
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.,Present Address: Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Rangarajan D Nadadur
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jean C Bopassa
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.,Present address: Department of Physiology, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Mansoureh Eghbali
- Department of Anesthesiology, Division of Molecular Medicine, Cardiovascular Research Laboratories, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, 90095, USA.
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25
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Hassanein M, Abdelhamid M, Ibrahim B, Sobhy M, Nasr G, Aboleineen MW, Reda A, Farag N, Elshazly A, Abdeldayem TK, Elmesseiry F, Boshra H, Sobhy H, Elbahry A, Youssef A, Ashmawy M, Abdelmoneim A, Saleh A, Elrakshy Y, Ebeid H. Gender differences in Egyptian patients hospitalized with heart failure: insights from the European Society of Cardiology Heart Failure Long-Term Registry. ESC Heart Fail 2018; 5:1159-1164. [PMID: 30175905 PMCID: PMC6300819 DOI: 10.1002/ehf2.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
Aims This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long‐Term Registry. Methods and results From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate. Compared with men, women had a higher body mass index (32.5 ± 9.0 vs. 29.3 ± 4.9, P < 0.001), more frequent atrial fibrillation (34.7% vs. 22.4%, P < 0.001), and anaemia defined by haemoglobin < 12 g/dL (83.1% vs. 58.4%, P < 0.001). Women were more likely to present with heart failure with preserved ejection fraction (29.7% vs. 10.6%, P < 0.001). Women had more frequent diabetes mellitus (48.1% vs. 41.6%, P < 0.05) and hypertension (48.7% vs. 39.3%, P < 0.001) than had men, whereas smoking was rare among them (8.8% vs. 82.9%, P < 0.005). There was no significant difference in the primary aetiology of heart failure between both sexes. ACE inhibitors, beta‐blockers, mineralocorticoid receptor antagonists, antiplatelets, statins, and nitrates were less frequently prescribed to women, whereas they more often received digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was no significant difference in in‐hospital (5.7% vs. 4.6%, P = 0.39) and 1 year mortality (27.9% vs. 25.9%, P = 0.48) between women and men, respectively. Conclusions Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. These findings emphasize the importance of individualized management and need for more comprehensive recruitment of women in clinical trials.
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Affiliation(s)
- Mahmoud Hassanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Champillion Street, Azarita, Alexandria, Egypt
| | | | | | | | - Gamela Nasr
- Ismaileya Insurance Hospital, Ismaileya, Egypt
| | | | | | | | - Ahmed Elshazly
- Gamal Abdel Nasser Insurance Hospital, Alexandria, Egypt
| | | | | | | | | | | | | | | | | | | | | | - Hamdy Ebeid
- Damanhour General Hospital, Damanhour, Egypt
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26
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Sakata Y, Miyata S, Nochioka K, Miura M, Shiroto T, Shimokawa H. Sex Differences in Patients With Chronic Heart Failure With Reference to Left Ventricular Ejection Fraction. GENDER AND THE GENOME 2018. [DOI: 10.1177/2470289718787115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Data on sex differences in heart failure (HF) with reference to left ventricular ejection fraction (LVEF) are limited. Methods and Materials: We examined 4683 consecutive patients (mean 69 years) with HF in the CHART-2 study. Results: Compared to men (N = 3188), women with HF (N = 1495) were older and had a lower prevalence of ischemic heart disease and cancer, received less implementation of evidence-based treatment, and were characterized by more severe HF in terms of higher New York Heart Association (NYHA) functional class and increased brain natriuretic peptide (BNP) levels, despite greater preservation of LVEF. During the median 6.3-year follow-up, all-cause mortality was comparable between women and men (32.8% vs 33.2%, P = .816), while women had higher cardiovascular mortality, particularly among those with LVEF ≥50%. Although no sex differences existed in cause of death among patients with LVEF ≤ 40% and 41% to 49%, women had a higher proportion of cardiovascular death and lower proportion of noncardiovascular death than men among those with LVEF ≥ 50%. Multivariable Cox regression models showed that women with HF had reduced risk of both cardiovascular and noncardiovascular death, regardless of LVEF category. Beta-blockers were associated with improved mortality in women but not men with LVEF ≤ 40%, while renin–angiotensin system inhibitors were not associated with improved mortality in women with LVEF ≥ 50% but were in men. Conclusion: In addition to sex-specific differences in the age of onset, etiology and response to treatment, women with heart failure and preserved left ventricular ejection fraction (LVEF ≥ 50%) have higher cardiovascular mortality than men. Sex-related management of congestive heart failure should include a consideration of LVEF.
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Affiliation(s)
- Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Heart failure (HF) represents a global pandemic health problem with a high impact on health-care costs, affecting about 26 million adults worldwide. The overall HF prevalence and incidence are ~2% and ~0.2% per year, respectively, in Western countries, with half of the HF population with reduced ejection fraction (HFpEF) and half with preserved (HFpEF) or mid-range ejection fraction (HFmrEF). Sex differences may exist in HF. More males have HFrEF or HFmrEF and an ischemic etiology, whereas more females have HFpEF and hypertension, diastolic dysfunction, and valvular pathologies as HF etiologies. Females are generally older, have a higher EF, higher frequency of HF-related symptoms, and lower NYHA functional status. Generally, it is observed that female HF patients tend to have more comorbidities such as atrial fibrillation, diabetes, hypertension, anemia, iron deficiency, renal disease, arthritis, frailty, depression, and thyroid abnormalities. However, overall, females have better prognosis in terms of mortality and hospitalization risk compared with men, regardless of EF. Potential sex differences in HF characteristics may be underestimated because of the underrepresentation of females in cardiovascular research and, in particular, the sex imbalance in clinical trial enrollment may avoid to identify sex-specific differences in treatments' benefit.
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28
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Abstract
Heart failure is an important cause of morbidity and mortality in women, and they tend to develop it at an older age compared to men. Heart failure with preserved ejection fraction is more common in women than in men and accounts for at least half the cases of heart failure in women. When comparing men and women who have heart failure and a low left ventricular ejection fraction, the women are more symptomatic and have a similarly poor outcome. Overall recommendations for guideline-directed medical therapies show no differences in treatment approaches between men and women. Overall, women are generally underrepresented in clinical trials for heart failure. Further studies are needed to shed light into different mechanisms, causes, and targeted therapies of heart failure in women.
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Affiliation(s)
- Biykem Bozkurt
- WINTERS CENTER FOR HEART FAILURE RESEARCH, CARDIOVASCULAR RESEARCH INSTITUTE, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Shaden Khalaf
- WINTERS CENTER FOR HEART FAILURE RESEARCH, CARDIOVASCULAR RESEARCH INSTITUTE, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
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29
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Al-Kindi SG, Koniaris C, Oliveira GH, Robinson MR. Where Patients With Heart Failure Die: Trends in Location of Death of Patients With Heart Failure in the United States. J Card Fail 2017; 23:713-714. [DOI: 10.1016/j.cardfail.2017.07.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
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Drum CL, Tan WKY, Chan SP, Pakkiri LS, Chong JPC, Liew OW, Ng TP, Ling LH, Sim D, Leong KTG, Yeo DPS, Ong HY, Jaufeerally F, Wong RCC, Chai P, Low AF, Davidsson P, Liljeblad M, Söderling AS, Gan LM, Bhat RV, Purnamawati K, Lam CSP, Richards AM. Thymosin Beta-4 Is Elevated in Women With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.117.005586. [PMID: 28611096 PMCID: PMC5669175 DOI: 10.1161/jaha.117.005586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thymosin beta-4 (TB4) is an X-linked gene product with cardioprotective properties. Little is known about plasma concentration of TB4 in heart failure (HF), and its relationship with other cardiovascular biomarkers. We sought to evaluate circulating TB4 in HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared to non-HF controls. METHODS AND RESULTS TB4 was measured using a liquid chromatography and mass spectrometry assay in age- and sex-matched HFpEF (n=219), HFrEF (n=219) patients, and controls (n=219) from a prospective nationwide study. Additionally, a 92-marker multiplex proximity extension assay was measured to identify biomarker covariates. Compared with controls, plasma TB4 was elevated in HFpEF (985 [421-1723] ng/mL versus 1401 [720-2379] ng/mL, P<0.001), but not in HFrEF (1106 [556-1955] ng/mL, P=0.642). Stratifying by sex, only women (1623 [1040-2625] ng/mL versus 942 [386-1891] ng/mL, P<0.001), but not men (1238.5 [586-1967] ng/mL versus 1004 [451-1538] ng/mL, P=1.0), had significantly elevated TB4 in the setting of HFpEF. Adjusted for New York Heart Association class, N-terminal pro B-type natriuretic peptide, age, and myocardial infarction, hazard ratio to all-cause mortality is significantly higher in women with elevated TB4 (1.668, P=0.036), but not in men (0.791, P=0.456) with HF. TB4 is strongly correlated with a cluster of 7 markers from the proximity extension assay panel, which are either X-linked, regulated by sex hormones, or involved with NF-κB signaling. CONCLUSIONS We show that plasma TB4 is elevated in women with HFpEF and has prognostic information. Because TB4 can preserve EF in animal studies of cardiac injury, the relation of endogenous, circulating TB4 to X chromosome biology and differential outcomes in female heart disease warrants further study.
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Affiliation(s)
- Chester L Drum
- Cardiovascular Research Institute, National University Health System, Singapore .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore
| | - Warren K Y Tan
- Cardiovascular Research Institute, National University Health System, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - Siew-Pang Chan
- Cardiovascular Research Institute, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Mathematics & Statistics, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
| | | | - Jenny P C Chong
- Cardiovascular Research Institute, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Oi-Wah Liew
- Cardiovascular Research Institute, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze-Pin Ng
- Cardiovascular Research Institute, National University Health System, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore
| | - Lieng-Hsi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Heart Centre Singapore, Singapore
| | - David Sim
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | | | | | - Hean-Yee Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Fazlur Jaufeerally
- Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | | | - Ping Chai
- National University Heart Centre Singapore, Singapore
| | - Adrian F Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Heart Centre Singapore, Singapore
| | - Pia Davidsson
- Innovative Medicines & Early Development, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, Gothenburg, Sweden
| | - Mathias Liljeblad
- Innovative Medicines & Early Development, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, Gothenburg, Sweden
| | - Ann-Sofi Söderling
- Innovative Medicines & Early Development, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, Gothenburg, Sweden
| | - Li-Ming Gan
- Innovative Medicines & Early Development, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, Gothenburg, Sweden
| | - Ratan V Bhat
- Innovative Medicines & Early Development, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, Gothenburg, Sweden
| | - Kristy Purnamawati
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - A Mark Richards
- Cardiovascular Research Institute, National University Health System, Singapore .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Christchurch Heart Institute, University of Otago, New Zealand
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31
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Kajimoto K, Minami Y, Sato N, Otsubo S, Kasanuki H. Gender Differences in Left Ventricular Ejection Fraction and Outcomes Among Patients Hospitalized for Acute Decompensated Heart Failure. Am J Cardiol 2017; 119:1623-1630. [PMID: 28325570 DOI: 10.1016/j.amjcard.2017.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/19/2022]
Abstract
In patients with acute decompensated heart failure (HF), the association of gender and left ventricular ejection fraction (LVEF) with clinical outcomes has not been fully investigated. The aim of this study was to evaluate gender differences in LVEF and adverse outcomes across the full spectrum of LVEF in patients hospitalized for acute decompensated HF. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 4,231 patients (2,461 men and 1,770 women) discharged alive after hospitalization for acute decompensated HF were investigated to assess the association of gender and LVEF with the primary end point (all-cause death and readmission for HF). Men or women were divided into 5 groups based on the LVEF at hospital discharge (<30%, 30% to <40%, 40% to <50%, 50% to <60%, and ≥60%). The median follow-up period after discharge was 523 (384 to 791) days. The frequency of the primary end point did not differ between men and women (36.5% vs 38.1%, p = 0.291). After adjustment for multiple comorbidities, male patients with an LVEF <30%, 30% to <40%, 40% to <50%, or 50% to <60% had a significantly higher risk of the primary end point than those with an LVEF ≥60%, indicating an inverse association between LVEF and adverse outcomes. In contrast, the adjusted risk of the primary end point was similar for all 5 LVEF groups of female patients. In conclusions, the association between LVEF and outcomes differs markedly between men and women hospitalized for acute decompensated HF, although event-free survival is similar for both genders.
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Affiliation(s)
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Sato
- Department of Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Shigeru Otsubo
- Department of Blood Purification, Tohto Sangenjaya Clinic, Tokyo, Japan
| | - Hiroshi Kasanuki
- Faculty of Science and Engineering, Department of Bioscience and Biotechnology, Waseda University, Tokyo, Japan
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Casós K, Ferrer-Curriu G, Soler-Ferrer P, Pérez ML, Permanyer E, Blasco-Lucas A, Gracia-Baena JM, Castro MA, Sureda C, Barquinero J, Galiñanes M. Response of the human myocardium to ischemic injury and preconditioning: The role of cardiac and comorbid conditions, medical treatment, and basal redox status. PLoS One 2017; 12:e0174588. [PMID: 28380047 PMCID: PMC5381881 DOI: 10.1371/journal.pone.0174588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/02/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The diseased human myocardium is highly susceptible to ischemia/reoxygenation (I/R)-induced injury but its response to protective interventions such as ischemic preconditioning (IPreC) is unclear. Cardiac and other pre-existing clinical conditions as well as previous or ongoing medical treatment may influence the myocardial response to I/R injury and protection. This study investigated the effect of both on myocardial susceptibility to I/R-induced injury and the protective effects of IPreC. METHODS AND RESULTS Atrial myocardium from cardiac surgery patients (n = 300) was assigned to one of three groups: aerobic control, I/R alone, and IPreC. Lactate dehydrogenase leakage, as a marker of cell injury, and cell viability were measured. The basal redox status was determined in samples from 90 patients. The response to I/R varied widely. Myocardium from patients with aortic valve disease was the most susceptible to injury whereas myocardium from dyslipidemia patients was the least susceptible. Tissue from females was better protected than tissue from males. Myocardium from patients with mitral valve disease was the least responsive to IPreC. The basal redox status was altered in the myocardium from patients with mitral and aortic valve disease. CONCLUSIONS The response of the myocardium to I/R and IPreC is highly variable and influenced by the underlying cardiac pathology, dyslipidemia, sex, and the basal redox status. These results should be taken into account in the design of future clinical studies on the prevention of I/R injury and protection.
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Affiliation(s)
- Kelly Casós
- Reparative Therapy of the Heart, Vall d’Hebron Research Institute (VHIR), University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Gemma Ferrer-Curriu
- Reparative Therapy of the Heart, Vall d’Hebron Research Institute (VHIR), University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Paula Soler-Ferrer
- Reparative Therapy of the Heart, Vall d’Hebron Research Institute (VHIR), University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - María L Pérez
- Reparative Therapy of the Heart, Vall d’Hebron Research Institute (VHIR), University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Eduard Permanyer
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Arnau Blasco-Lucas
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Juan Manuel Gracia-Baena
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Miguel A Castro
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Carlos Sureda
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Manuel Galiñanes
- Reparative Therapy of the Heart, Vall d’Hebron Research Institute (VHIR), University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Department of Cardiac Surgery, University Hospital Vall d’Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain
- * E-mail:
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Nozaki A, Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Kusama Y, Asai K, Shimizu W. The prognostic impact of gender in patients with acute heart failure - An evaluation of the age of female patients with severely decompensated acute heart failure. J Cardiol 2016; 70:255-262. [PMID: 28040396 DOI: 10.1016/j.jjcc.2016.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/13/2016] [Accepted: 11/30/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The gender differences in the prognosis of Asian patients with acute heart failure (AHF) remain to be elucidated. METHODS AND RESULTS One thousand fifty AHF patients were enrolled. The patients were assigned to a female group (n=354) and a male group (n=696). A Kaplan-Meier curve showed that the cardiovascular survival rate of the female group was significantly lower than that of the male group (p=0.005). A multivariate Cox regression model identified female gender [hazard ratio (HR): 1.381, 95% CI: 1.018-1.872] as an independent predictor of 730-day cardiovascular death. In subgroup analysis by age, in patients over 79 years, female gender significantly increased the cardiovascular death (HR: 1.715, 95% CI: 1.088-2.074, p<0.001) with a significant interaction (p-value for interaction<0.001). The prognosis, including cardiovascular death, was significantly poorer among elderly female patients (≥79 years) than among elderly male patients (p=0.019). The multivariate Cox regression model identified female gender as an independent predictor of 730-day cardiovascular death in patients who were older than 79 years of age (HR, 1.943; 95% CI, 1.192-3.167). CONCLUSIONS Female gender was associated with poor prognosis in AHF patients. In particular, old age (≥79 years) was associated with adverse outcomes in female patients with AHF.
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Affiliation(s)
- Ayaka Nozaki
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
| | - Noritake Hata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yoshiki Kusama
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Significance of animal models of cardiac cachexia and impact of gender on cardiac cachexia. Int J Cardiol 2016; 223:852-853. [DOI: 10.1016/j.ijcard.2016.08.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/23/2022]
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Laufer-Perl M, Havakuk O, Shacham Y, Steinvil A, Letourneau-Shesaf S, Chorin E, Keren G, Arbel Y. Sex-based differences in prevalence and clinical presentation among pericarditis and myopericarditis patients. Am J Emerg Med 2016; 35:201-205. [PMID: 27836311 DOI: 10.1016/j.ajem.2016.10.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/15/2016] [Accepted: 10/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sex differences in heart diseases, including acute coronary syndrome, congestive heart failure, and atrial fibrillation, have been studied extensively. However, data are lacking regarding sex differences in pericarditis and myopericarditis patients. OBJECTIVES The purpose of the study was to evaluate whether there are sex differences in pericarditis and myopericarditis patients as well. METHODS We performed a retrospective, single-center observational study that included 200 consecutive patients hospitalized with idiopathic pericarditis or myopericarditis from January 2012 to April 2014. Patients were evaluated for sex differences in prevalence, clinical presentation, laboratory variables, and outcome. We excluded patients with a known cause for pericarditis. RESULTS Among 200 consecutive patients, 55 (27%) were female. Compared with men, women were significantly older (60±19 years vs 46±19 years, P<.001) and had a higher rate of chronic medical conditions. Myopericarditis was significantly more common among men (51% vs 25%, P=.001). Accordingly, men had significantly higher levels of peak troponin (6.8±17 ng/mL vs 0.9±2.6 ng/mL, P<.001), whereas women presented more frequently with pericardial effusion (68% vs 45%, P=.006). Interestingly, women had a significantly lower rate of hospitalization in the cardiology department (42% vs 63%, P=.015). Overall, there were no significant differences in ejection fraction, type of treatment, complications, or in-hospital mortality. CONCLUSIONS Most patients admitted with acute idiopathic pericarditis are male. In addition, men have a higher prevalence of myocardial involvement. Significant sex differences exist in laboratory variables and in hospital management; however, the outcome is similar and favorable in both sexes.
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Affiliation(s)
- Michal Laufer-Perl
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofer Havakuk
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Letourneau-Shesaf
- Internal Medicine "E," Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Heart failure in women and men during acute coronary syndrome and long-term cardiovascular mortality (the ABC-3* Study on Heart Disease) (*Adria, Bassano, Conegliano, and Padova Hospitals). Int J Cardiol 2016; 220:538-43. [DOI: 10.1016/j.ijcard.2016.06.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022]
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Taveira TH, Ouellette D, Gulum A, Choudhary G, Eaton CB, Liu S, Wu WC. Relation of Magnesium Intake With Cardiac Function and Heart Failure Hospitalizations in Black Adults: The Jackson Heart Study. Circ Heart Fail 2016; 9:e002698. [PMID: 27056880 PMCID: PMC4826717 DOI: 10.1161/circheartfailure.115.002698] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/07/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about magnesium intake and risk of heart failure (HF) hospitalizations, particularly in blacks. We hypothesize that magnesium intake relates to HF hospitalization in blacks. METHODS AND RESULTS From the Jackson Heart Study cohort (n=5301), we studied 4916 blacks recruited during 2000 to 2004 in Jackson (Mississippi), who completed an 158-item Food-Frequency Questionnaire that included dietary supplements. Daily magnesium intake derived from the questionnaire was divided by the body weight to account for body storage and stratified by quartiles (0.522-2.308, 2.309-3.147, 3.148-4.226, and ≥4.227 mg magnesium intake/kg). Cox proportional hazards modeling assessed the association between quartiles of magnesium intake/kg and hospitalizations for HF adjusting for HF risk, energy intake, and dietary factors. The cohort had a mean age=55.3 (SD=12.7 years) and composed of 63.4% women, 21.6% diabetes mellitus, 62.7% hypertension, 7.1% coronary disease, and 2.8% with known HF. When compared with participants in the first quartile of magnesium intake/kg, those with higher magnesium intake (>2.308 mg/kg) had decreased risk of HF admission, with adjusted hazard ratios of 0. 66(95% confidence interval, 0.47-0.94) in the second quartile to 0.47 (95% confidence interval, 0.27-0.82) in the highest quartile. Results were similar when individuals with previously diagnosed HF (2.8%) were excluded or when the analysis was repeated using quartiles of magnesium intake without accounting for body weight. CONCLUSIONS Magnesium intake <2.3 mg/kg was related to increased risk of subsequent HF hospitalizations. Future studies are needed to test whether serum magnesium levels predict risk of HF.
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Affiliation(s)
- Tracey H Taveira
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Danielle Ouellette
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Alev Gulum
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Gaurav Choudhary
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Charles B Eaton
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Simin Liu
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles
| | - Wen-Chih Wu
- From the Department of Medicine, Veterans Affairs Medical Center, Center of Innovation for Long Term Services and Support, Providence, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI (T.H.T., D.O., A.G., G.C., W.-C.W.); Department of Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI (T.H.T., G.C., W.-C.W.); Center for Primary Care and Prevention (C.B.E.) and the Department of Family Medicine (C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI (C.B.E., S.L., W.-C.W.); and The Program on Genomics and Nutrition, Center for Metabolic Disease Prevention, Departments of Epidemiology (S.L.), Medicine (S.L.), and Obstetrics and Gynecology (S.L.), University of California, Los Angeles.
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Torres D, Cuttitta F, Paterna S, Garofano A, Conti G, Pinto A, Parrinello G. Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up. Eur J Intern Med 2016; 28:80-4. [PMID: 26751720 DOI: 10.1016/j.ejim.2015.11.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/16/2015] [Accepted: 11/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF. METHODS One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization. RESULTS At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p=0.0057; HR 0.97, p=0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23 mm) and MAP (93.3 mm Hg). The Kaplan–Meier curve showed that HF patients with both IVC ≥ 23 mm and MAP b93.3 mm Hg on admission had reduced probability of survival free from all-cause death (log rank p = 0.0070 and log rank p = 0.0028, respectively). CONCLUSIONS In patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up.
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Affiliation(s)
- Daniele Torres
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
| | - Francesco Cuttitta
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia.
| | - Salvatore Paterna
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
| | - Alessandro Garofano
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
| | - Giosafat Conti
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
| | - Antonio Pinto
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
| | - Gaspare Parrinello
- Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico (A.O.U.P.) "Paolo Giaccone", Università degli Studi di Palermo, Palermo, Italia
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Hopper I, Kotecha D, Chin KL, Mentz RJ, von Lueder TG. Comorbidities in Heart Failure: Are There Gender Differences? Curr Heart Fail Rep 2016; 13:1-12. [DOI: 10.1007/s11897-016-0280-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zsilinszka R, Shrader P, DeVore AD, Hardy NC, Mentz RJ, Pang PS, Peacock WF, Fonarow GC, Hernandez AF. Sex Differences in the Management and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients Presenting to the Emergency Department With Acute Heart Failure. J Card Fail 2015; 22:781-8. [PMID: 26687985 DOI: 10.1016/j.cardfail.2015.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) with preserved ejection fraction (HFpEF) is more common in women than in men; data characterizing sex differences in the management and outcomes of HFpEF patients presenting to the emergency department (ED) are limited. METHODS AND RESULTS Using Acute Decompensated Heart Failure National Registry Emergency Module data linked to Medicare claims, we conducted a retrospective analysis of acute HF patients in the ED, identifying HFpEF (ejection fraction [EF] ≥40%) patients and stratifying by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and post-discharge outcomes. Of 4161 HFpEF patients, 2808 (67%) were women, who were more likely to be older and hypertensive, but less likely to be diabetic or smokers (all P < .01). Women more often presented with systolic blood pressure >140 mm Hg (62.5% vs 56.4%; P = .0001) and higher EF. There were no sex differences in ED therapies, adjusted 30- and 180-day all-cause mortality, in-hospital mortality, or 30- and 180-day readmissions. After adjustment, women had longer LOS (0.40 days, 95% confidence interval [CI] 0.10-0.70; P = .008). CONCLUSIONS Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to those in men. We observed adjusted differences in hospital LOS, but no differences in 30- and 180-day outcomes.
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Affiliation(s)
| | - Peter Shrader
- Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D DeVore
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Robert J Mentz
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Peter S Pang
- Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Adrian F Hernandez
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
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Li X, Cai C, Luo R, Jiang R, Zeng J, Tang Y, Chen Y, Fu M, He T, Hua W. The usefulness of age and sex to predict all-cause mortality in patients with dilated cardiomyopathy: a single-center cohort study. Clin Interv Aging 2015; 10:1479-86. [PMID: 26396507 PMCID: PMC4577275 DOI: 10.2147/cia.s88565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Recent studies have shown that sex and age are associated with outcomes in patients with cardiomyopathy. The purpose of this study was to determine the all-cause mortality of dilated cardiomyopathy (DCM) by age and sex. Methods and results The patients were divided into non-elderly (age <60 years, n=811) and elderly (age ≥60 years, n=331) groups. No difference in the all-cause mortality rate was observed between elderly and non-elderly patients (27.2% vs 22.2%, log-rank χ2=2.604, P=0.107). Furthermore, no significant difference in mortality was observed between the male and female patients (23.3% vs 24.5%, log-rank χ2=0.707, P=0.400). However, subgroup analysis revealed that elderly male patients exhibited a higher mortality rate than non-elderly male patients (29.4% vs 21.3%, log-rank χ2=5.898, P=0.015), while no difference was observed between the elderly female patients and non-elderly female patients. In the Cox analysis, neither age nor sex was a significant independent predictor of all-cause mortality in patients with DCM. Conclusion In conclusion, no significant difference in mortality between male and female patients or between the elderly and non-elderly patients was observed. Only among males was a difference in mortality observed; elderly male patients experienced greater mortality than that of non-elderly male patients. No effect of age or sex on all-cause mortality was observed in patients with DCM.
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Affiliation(s)
- Xiaoping Li
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China ; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China ; Department of Clinical Electrophysiology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Chi Cai
- Department of Clinical Electrophysiology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Rong Luo
- Key Laboratory of Thermoregulation and Inflammation of Sichuan Higher Education Institutes, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Rongjian Jiang
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Jie Zeng
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Yijia Tang
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Yang Chen
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Tao He
- Department of Cardiology, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Wei Hua
- Department of Clinical Electrophysiology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG, Walsh MN, Westlake Canary CA, Allen LA, Bonnell MR, Carson PE, Chan MC, Dickinson MG, Dries DL, Ewald GA, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Whellan DJ, Givertz MM. Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. J Card Fail 2015; 21:674-93. [DOI: 10.1016/j.cardfail.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
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Lam CSP, McEntegart M, Claggett B, Liu J, Skali H, Lewis E, Køber L, Rouleau J, Velazquez E, Califf R, McMurray JJ, Pfeffer M, Solomon S. Sex differences in clinical characteristics and outcomes after myocardial infarction: insights from the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Eur J Heart Fail 2015; 17:301-12. [DOI: 10.1002/ejhf.238] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/11/2014] [Accepted: 11/14/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Carolyn S. P. Lam
- National University Health System; Tower Block Level 9, 1E Kent Ridge Road Singapore 119228
| | | | | | | | | | | | | | | | | | - Rob Califf
- Duke University Medical Center; Durham NC USA
| | - John J. McMurray
- Department of Cardiology; Western Infirmary; Glasgow Scotland UK
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45
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Gender differences in clinical characteristics and outcome of acute heart failure in sub-Saharan Africa: results of the THESUS-HF study. Clin Res Cardiol 2015; 104:481-90. [DOI: 10.1007/s00392-015-0810-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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Hoeker GS, Hood AR, Katra RP, Poelzing S, Pogwizd SM. Sex differences in β-adrenergic responsiveness of action potentials and intracellular calcium handling in isolated rabbit hearts. PLoS One 2014; 9:e111411. [PMID: 25340795 PMCID: PMC4207827 DOI: 10.1371/journal.pone.0111411] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022] Open
Abstract
Cardioprotection in females, as observed in the setting of heart failure, has been attributed to sex differences in intracellular calcium handling and its modulation by β-adrenergic signaling. However, further studies examining sex differences in β-adrenergic responsiveness have yielded inconsistent results and have mostly been limited to studies of contractility, ion channel function, or calcium handling alone. Given the close interaction of the action potential (AP) and intracellular calcium transient (CaT) through the process of excitation-contraction coupling, the need for studies exploring the relationship between agonist-induced AP and calcium handling changes in female and male hearts is evident. Thus, the aim of this study was to use optical mapping to examine sex differences in ventricular APs and CaTs measured simultaneously from Langendorff-perfused hearts isolated from naïve adult rabbits during β-adrenergic stimulation. The non-selective β-agonist isoproterenol (Iso) decreased AP duration (APD90), CaT duration (CaD80), and the decay constant of the CaT (τ) in a dose-dependent manner (1–316.2 nM), with a plateau at doses ≥31.6 nM. The Iso-induced changes in APD90 and τ (but not CaD80) were significantly smaller in female than male hearts. These sex differences were more significant at faster (5.5 Hz) than resting rates (3 Hz). Treatment with Iso led to the development of spontaneous calcium release (SCR) with a dose threshold of 31.6 nM. While SCR occurrence was similar in female (49%) and male (53%) hearts, the associated ectopic beats had a lower frequency of occurrence (16% versus 40%) and higher threshold (100 nM versus 31.6 nM) in female than male hearts (p<0.05). In conclusion, female hearts had a decreased capacity to respond to β-adrenergic stimulation, particularly under conditions of increased demand (i.e. faster pacing rates and “maximal” levels of Iso effects), however this reduced β-adrenergic responsiveness of female hearts was associated with reduced arrhythmic activity.
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Affiliation(s)
- Gregory S. Hoeker
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ashleigh R. Hood
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rodolphe P. Katra
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Steven Poelzing
- Department of Biomedical Engineering, Virginia Tech Carilion Research Institute, Roanoke, Virginia, United States of America
| | - Steven M. Pogwizd
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Use of the 6-Min Walk Distance to Identify Variations in Treatment Benefits From Implantable Cardioverter-Defibrillator and Amiodarone. J Am Coll Cardiol 2014; 63:2560-2568. [DOI: 10.1016/j.jacc.2014.02.602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/24/2014] [Accepted: 02/25/2014] [Indexed: 11/17/2022]
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48
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Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C, McMurray JJ, Swedberg K, Køber L, Berry C, Squire I. Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis†. Eur J Heart Fail 2014; 14:473-9. [DOI: 10.1093/eurjhf/hfs026] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department; Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 16, 28007 and Universidad Europea de Madrid; Spain
| | - Robert N. Doughty
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | - Katrina Poppe
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | | | - Nikki Earle
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | | | - John J.V. McMurray
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre; Glasgow UK
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Lars Køber
- Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Colin Berry
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre; Glasgow UK
| | - Iain Squire
- University of Leicester and NIHR Biomedical Research Unit, Glenfield Hospital; Leicester UK
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Atrial fibrillation and prognosis in patients 80+ years old with chronic heart failure. Aging Clin Exp Res 2014; 26:53-60. [PMID: 24022323 DOI: 10.1007/s40520-013-0134-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/26/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION It is well known that the prevalence of atrial fibrillation (AF) increases with age. The purpose was to evaluate the impact of AF at the 1-year outcome of patients aged 80? who suffered from chronic heart failure (CHF). MATERIALS AND METHODS The study included 220 consecutive patients at age 80–92 (mean 82.8 years, 45.5 % men) hospitalized for heart failure. The prospective analysis contains demographic and clinical data, basic laboratory tests with hsTnT and NT-proBNP, 12-lead resting electrocardiogram, echocardiography and coronary angiography results and the number of deaths at the 1-year followup. Patients were analyzed depending on AF in the resting electrocardiogram at hospital entry. RESULTS AF was recorded in 52 patients (24 %). The relationship with AF was found for more advanced NYHA class III and IV (p\0.001), higher concentrations of hsCRP (p = 0.0005), hsTnT (p = 0.007) and NT-proBNP (p = 0.0098), higher heart rate in the electrocardiogram (p = 0.000) and longer hospitalization (p = 0.025), older age (p = 0.003) and lower left ventricular ejection fraction (p = 0.006). Annual mortality was 13 % and was higher if AF occurred (17 %). However, there was no association between deaths and AF (p = 0.3297). From the multivariate stepwise analysis, independent risk factors for annual mortality were male gender (OR = 3.432; p = 0.043), left ventricular systolic dimension (OR = 1.871; p = 0.004) and dyslipidemia (OR = 0.252; p = 0.043). CONCLUSIONS In the oldest patients aged 80? who suffered from CHF, the incidence of atrial fibrillation and annual mortality was high. The independent variables, which enhanced the risk of death at the 1-year follow-up, were male sex and left ventricular systolic dimension, but not atrial fibrillation.
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50
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Ghali JK, Lindenfeld J. Sex differences in response to chronic heart failure therapies. Expert Rev Cardiovasc Ther 2014; 6:555-65. [DOI: 10.1586/14779072.6.4.555] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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