1
|
Wang Y, Tian A, Wu C, Lu J, Chen B, Yang Y, Zhang X, Zhang X, Cui J, Xu W, Song L, Guo W, Wang R, Li X, Hu S. Influence of Socioeconomic Gender Inequality on Sex Disparities in Prevention and Outcome of Cardiovascular Disease: Data From a Nationwide Population Cohort in China. J Am Heart Assoc 2023; 12:e030203. [PMID: 37804201 PMCID: PMC10757514 DOI: 10.1161/jaha.123.030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Abstract
Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or β blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, r=-0.57, P=0.0013), hypertension control (r=-0.62, P=0.0007), and CVD mortality (r=0.45, P=0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.
Collapse
Affiliation(s)
- Yunfeng Wang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Shenzhen Clinical Research Center for Cardiovascular DiseasesFuwai Hospital Chinese Academy of Medical Sciences, ShenzhenShenzhenChina
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chaoqun Wu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Bowang Chen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yang Yang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaoyan Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xingyi Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianlan Cui
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wei Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lijuan Song
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Weihong Guo
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Runsi Wang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Shenzhen Clinical Research Center for Cardiovascular DiseasesFuwai Hospital Chinese Academy of Medical Sciences, ShenzhenShenzhenChina
- Central China Subcenter of the National Center for Cardiovascular DiseasesZhengzhouChina
| | - Shengshou Hu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai HospitalNational Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
2
|
Kouvari M, Tsiampalis T, Chrysohoou C, Georgousopoulou E, Notara V, Souliotis K, Psaltopoulou T, Yannakoulia M, Pitsavos C, Panagiotakos DB. A Mediterranean diet microsimulation modeling in relation to cardiovascular disease burden: the ATTICA and GREECS epidemiological studies. Eur J Clin Nutr 2021; 76:434-441. [PMID: 34230628 DOI: 10.1038/s41430-021-00967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. SUBJECTS/METHODS An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. RESULTS Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). CONCLUSIONS This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,School of Medicine, The University of Notre Dame, Sydney, Australia.,Medical School, Australian National University, Canberra, Australia
| | - Venetia Notara
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. .,Faculty of Health, University of Canberra, Canberra, Australia.
| |
Collapse
|
3
|
Jepma P, Snaterse M, Du Puy S, Peters RJG, op Reimer WJMS. Older patients' perspectives toward lifestyle-related secondary cardiovascular prevention after a hospital admission-a qualitative study. Age Ageing 2021; 50:936-943. [PMID: 33480979 DOI: 10.1093/ageing/afaa283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND lifestyle-related secondary prevention reduces cardiac events and is recommended irrespective of age. However, motivation may be influenced by age and disease progression. OBJECTIVE to explore older cardiac patients' perspectives toward lifestyle-related secondary prevention after a hospital admission. METHODS a generic qualitative design was used. Semi-structured interviews were performed with cardiac patients ≥ 70 years within 3 months after a hospital admission. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model. All interviews were analysed using thematic analysis. RESULTS eight themes emerged which were linked to the determinants of the ASE-model. The three themes (i) Perspectives are determined by general health and habits, (ii) feeling the threat as a motivator and (iii) balancing between health benefits and quality of life (QoL), were linked to attitude. Regarding social influence, the themes (iv) feeling both encouraged and hindered by family members, and (v) the healthcare professional says so, were identified. For the self-efficacy determinant, (vi) experiences from previous lifestyle changes, (vii) integrating advice in daily life and (viii) feeling limited by functional impairments, emerged as themes. CONCLUSION most older cardiac patients made no lifestyle modifications after the last hospital admission and balanced possible benefits against their QoL. Functional impairments frequently limit implementation, in particular of physical activity. Patients' preferences and patient-centred outcomes focusing on QoL and functional independence may be the starting point when healthcare professionals discuss lifestyle modification in older patients. The involvement of family members may help patients to integrate lifestyle-related secondary prevention in daily life.
Collapse
Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Simone Du Puy
- Nursing Sciences, Programme of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Xie C, Hang Y, Zhu J, Li C, Jiang B, Zhang Y, Miao L. Benefit and risk of adding rivaroxaban in patients with coronary artery disease: A systematic review and meta-analysis. Clin Cardiol 2020; 44:20-26. [PMID: 33219708 PMCID: PMC7803358 DOI: 10.1002/clc.23514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 01/25/2023] Open
Abstract
Background Although the European Medicines Agency and the US Food and Drug Administration have, respectively, approved rivaroxaban for the prevention of recurrent major adverse cardiovascular events in patients with myocardial infarction and stable coronary artery disease, its efficacy and safety is unclear. This meta‐analysis aimed to evaluate the benefit and risk of adding rivaroxaban in coronary artery disease (CAD) patients, focusing on treatment effects stratified by different baseline clinical presentations. Hypothesis There are differences in treatment effects of adding rivaroxaban among CAD patients with different baseline clinical presentations. Methods Medline, EMBASE, and Cochrane Databases were systematically searched from inception to 21 July 2020 for randomized controlled trials (RCTs) comparing rivaroxaban in CAD patients. The primary efficacy endpoint and safety endpoint were assessed by using Mantel–Haenszel pooled risk ratios (RRs) and 95% confidence intervals (CIs). Results Five RCTs that included 43 650 patients were identified. Patients receiving rivaroxaban had a significantly lower risk of the primary efficacy endpoint (RR, 0.86; 95% CI, 0.76–0.97, p = .01) accompanied by increased risk of the primary safety endpoint (RR, 1.83; 95% CI, 1.10–3.05, p = .02). Subgroup analyses showed that in males the risk–benefit appears to be more favorable while in patients ≥65 years, in females, in patients with diabetes, those with mild to moderate impaired renal function, and region of Asia/other seems unfavorable. Conclusion Rivaroxaban may provide an additional choice for secondary prevention in CAD patients. However, careful estimation of the risk of ischemic and bleeding events using patient characteristics are critical to achieving net benefit.
Collapse
Affiliation(s)
- Cheng Xie
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongfu Hang
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianguo Zhu
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Caiyun Li
- Department of Pharmacy, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Bin Jiang
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuzhen Zhang
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liyan Miao
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
5
|
Chrysohoou C, Kouvari M, Lazaros G, Varlas J, Dimitriadis K, Zaromytidou M, Masoura C, Skoumas J, Kambaxis M, Galiatsatos N, Papanikolaou A, Xydis P, Konstantinou K, Pitsavos C, Tsioufis K, Stefanadis C. Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors. Nutrients 2020; 12:nu12113293. [PMID: 33121164 PMCID: PMC7693172 DOI: 10.3390/nu12113293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
The sex-specific effect of skeletal muscle mass (SMM) index (SMI) on 4-year first fatal/non-fatal cardiovascular disease (CVD) event in free-of-disease individuals was examined. In 2009, n = 1411 inhabitants (mean age = 64(12)) from Ikaria were selected. Follow-up was performed in 2013. SMI was created to reflect SMM through appendicular skeletal muscle mass (indirectly calculated through formulas) divided by body mass index (BMI). Fifteen and six tenths percent of participants exhibited CVD (19.8% in men/12% in women, p = 0.002). Significant U-shape trends were observed in participants >65 years old and women irrespective to age confirmed through multi-adjusted Cox regression analysis; in age >65 years, Hazard Ratio (HR)(2nd vs. 1st SMI tertile) = 0.80, 95% Confidence Interval (95%CI) (0.45, 0.96) and in women HR(2nd vs. 1st SMI tertile) = 0.71, 95% CI (0.33, 0.95), while, as for the 3rd SMI tertile, no significant trends were observed. Mediation analysis revealed that mediators of the aforementioned associations in men were the arterial distensibility and total testosterone, while, in women, inflammation, insulin resistance, and arterial distensibility. High SMM accompanied by obesity may not guarantee lower CVD risk. Specific cardiometabolic factors seem to explain this need for balance between lean and fat mass.
Collapse
Affiliation(s)
- Christina Chrysohoou
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
- Correspondence: ; Tel.: +3-0210-960-3116
| | - Matina Kouvari
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
- Department of Nutrition and Dietetics, Harokopio University of Athens, 17676 Athens, Greece
| | - George Lazaros
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - John Varlas
- Immunology, Scientific Support Department, MEDICON Hellas S.A., Gerakas, 15344 Attica, Greece;
| | - Kyriakos Dimitriadis
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Marina Zaromytidou
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Constantina Masoura
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - John Skoumas
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Manolis Kambaxis
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Nikos Galiatsatos
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Aggelos Papanikolaou
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Panagiotis Xydis
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Konstantinos Konstantinou
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Christos Pitsavos
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Konstantinos Tsioufis
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| | - Christodoulos Stefanadis
- Cardiology Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece; (M.K.); (G.L.); (K.D.); (M.Z.); (C.M.); (J.S.); (M.K.); (N.G.); (A.P.); (P.X.); (K.K.); (C.P.); (K.T.); (C.S.)
| |
Collapse
|
6
|
Kouvari M, Souliotis K, Yannakoulia M, Panagiotakos DB. Cardiovascular Diseases in Women: Policies and Practices Around the Globe to Achieve Gender Equity in Cardiac Health. Risk Manag Healthc Policy 2020; 13:2079-2094. [PMID: 33116988 PMCID: PMC7567535 DOI: 10.2147/rmhp.s264672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
The women's global health agenda has recently been reformulated to address more accurately cardiovascular disease (CVD) prevention, diagnosis, and treatment. The aim of the present work was to review the global and national policies and practices that address sex equality in health with a focus on CVDs in women. Scientific databases and health organizations' websites that presented/discussed policies and initiative targeting to enhance a sex-centered approach regarding general health and/or specifically cardiac health care were reviewed in a systematic way. In total, 61 relevant documents were selected. The selected policies and initiatives included position statements, national action plans, evidence-based guidelines, guidance/recommendations, awareness campaigns, regulations/legislation, and state-of-the art reports by national/international projects and conferences. The target audiences of large stakeholders (eg, American Heart Association, European Society of Cardiology, Centers for Disease Control and Prevention) were female citizens, health professionals, and researchers. Much as policy-makers have recognized the sex/gender gap in the CVD field, there is still much to be done. Thereby, tailor-made strategies should be designed, evaluated, and delivered on a global and most importantly a national basis to achieve gender equity with regard to CVDs.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Bruce, Canberra, Australia
| |
Collapse
|
7
|
Mueller KAL, Hanna DB, Ehinger E, Xue X, Baas L, Gawaz MP, Geisler T, Anastos K, Cohen MH, Gange SJ, Heath SL, Lazar JM, Liu C, Mack WJ, Ofotokun I, Tien PC, Hodis HN, Landay AL, Kaplan RC, Ley K. Loss of CXCR4 on non-classical monocytes in participants of the Women's Interagency HIV Study (WIHS) with subclinical atherosclerosis. Cardiovasc Res 2020; 115:1029-1040. [PMID: 30520941 DOI: 10.1093/cvr/cvy292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/07/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS To test whether human immunodeficiency virus (HIV) infection and subclinical cardiovascular disease (sCVD) are associated with expression of CXCR4 and other surface markers on classical, intermediate, and non-classical monocytes in women. METHODS AND RESULTS sCVD was defined as presence of atherosclerotic lesions in the carotid artery in 92 participants of the Women's Interagency HIV Study (WIHS). Participants were stratified into four sets (n = 23 each) by HIV and sCVD status (HIV-/sCVD-, HIV-/sCVD+, HIV+/sCVD-, and HIV+/sCVD+) matched by age, race/ethnicity, and smoking status. Three subsets of monocytes were determined from archived peripheral blood mononuclear cells. Flow cytometry was used to count and phenotype surface markers. We tested for differences by HIV and sCVD status accounting for multiple comparisons. We found no differences in monocyte subset size among the four groups. Expression of seven surface markers differed significantly across the three monocyte subsets. CXCR4 expression [median fluorescence intensity (MFI)] in non-classical monocytes was highest among HIV-/CVD- [628, interquartile range (IQR) (295-1389)], followed by HIV+/CVD- [486, IQR (248-699)], HIV-/CVD+ (398, IQR (89-901)), and lowest in HIV+/CVD+ women [226, IQR (73-519)), P = 0.006 in ANOVA. After accounting for multiple comparison (Tukey) the difference between HIV-/CVD- vs. HIV+/CVD+ remained significant with P = 0.005 (HIV-/CVD- vs. HIV+/CVD- P = 0.04, HIV-/CVD- vs. HIV-/CVD+ P = 0.06, HIV+/CVD+ vs. HIV+/CVD- P = 0.88, HIV+/CVD+ vs. HIV-/CVD+ P = 0.81, HIV+/CVD- vs. HIV-/CVD+, P = 0.99). All pairwise comparisons with HIV-/CVD- were individually significant (P = 0.050 vs. HIV-/CVD+, P = 0.028 vs. HIV+/CVD-, P = 0.009 vs. HIV+/CVD+). CXCR4 expression on non-classical monocytes was significantly higher in CVD- (501.5, IQR (249.5-887.3)) vs. CVD+ (297, IQR (81.75-626.8) individuals (P = 0.028, n = 46 per group). CXCR4 expression on non-classical monocytes significantly correlated with cardiovascular and HIV-related risk factors including systolic blood pressure, platelet and T cell counts along with duration of antiretroviral therapy (P < 0.05). In regression analyses, adjusted for education level, study site, and injection drug use, presence of HIV infection and sCVD remained significantly associated with lower CXCR4 expression on non-classical monocytes (P = 0.003), but did not differ in classical or intermediate monocytes. CONCLUSION CXCR4 expression in non-classical monocytes was significantly lower among women with both HIV infection and sCVD, suggesting a potential atheroprotective role of CXCR4 in non-classical monocytes.
Collapse
Affiliation(s)
- Karin A L Mueller
- La Jolla Institute of Immunology, Athena Circle Drive La Jolla, CA, USA.,Eberhard Karls University, Tuebingen University Hospital, Department of Cardiology, Otfried-Mueller-Strasse 10, Tuebingen, Germany
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 13th floor, Bronx, NY, USA
| | - Erik Ehinger
- La Jolla Institute of Immunology, Athena Circle Drive La Jolla, CA, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 13th floor, Bronx, NY, USA
| | - Livia Baas
- La Jolla Institute of Immunology, Athena Circle Drive La Jolla, CA, USA.,Eberhard Karls University, Tuebingen University Hospital, Department of Cardiology, Otfried-Mueller-Strasse 10, Tuebingen, Germany
| | - Meinrad P Gawaz
- Eberhard Karls University, Tuebingen University Hospital, Department of Cardiology, Otfried-Mueller-Strasse 10, Tuebingen, Germany
| | - Tobias Geisler
- Eberhard Karls University, Tuebingen University Hospital, Department of Cardiology, Otfried-Mueller-Strasse 10, Tuebingen, Germany
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 13th floor, Bronx, NY, USA
| | - Mardge H Cohen
- John H. Stroger, Jr. Hospital of Cook County, 1969 Ogden Ave, Chicago, IL, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, 265 Garland Hall, 3400 North Charles Street, Baltimore, MD, USA
| | - Sonya L Heath
- Department of Medicine, University of Alabama at Birmingham, 908 20th Street South, Birmingham, AL, USA
| | - Jason M Lazar
- Department of Medicine, SUNY-Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Chenglong Liu
- Georgetown University Medical Center, Washington, DC, USA
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, USA
| | - Phyllis C Tien
- Department of Medicine, VAMC, Infectious Disease Section, 111W 4150 Clement St., San Francisco, CA, USA
| | - Howard N Hodis
- Department of Preventive Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, 1735 West Harrison St, Chicago, IL, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 13th floor, Bronx, NY, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Klaus Ley
- La Jolla Institute of Immunology, Athena Circle Drive La Jolla, CA, USA
| |
Collapse
|
8
|
Liang Y, Zhu J, Liu L, Anand SS, Connolly SJ, Bosch J, Guzik TJ, O'Donnell M, Dagenais GR, Fox KA, Shestakovska O, Berkowitz SD, Muehlhofer E, Keller L, Yusuf S, Eikelboom JW. Efficacy and safety of rivaroxaban plus aspirin in women and men with chronic coronary or peripheral artery disease. Cardiovasc Res 2020; 117:942-949. [PMID: 32289159 DOI: 10.1093/cvr/cvaa100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS The COMPASS trial demonstrated that the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease or peripheral artery disease by 24% during a mean follow-up of 23 months. We explored whether this effect varies by sex. METHODS AND RESULTS The effects were examined in women and men using log-rank tests and Kaplan-Meier curve. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were obtained from stratified Cox proportional hazards models to explore subgroup effects including subgroup of women and men according to baseline modified REACH risk score. Of 27 395 patients randomized, 18 278 were allocated to receive rivaroxaban plus aspirin (n = 9152) or aspirin alone (n = 9126), and of these, 22.1% were women. Women compared with men had similar incidence rates for MACE and major bleeding but borderline lower rates for myocardial infarction (1.7% vs. 2.2%, P = 0.05). The effect of combination therapy compared with aspirin in women and men was consistent for MACE (women: 3.8% vs. 5.2%, HR 0.72, 95% CI 0.54-0.97; men: 4.2% vs. 5.5%, HR 0.76, 95% CI 0.66-0.89; P interaction 0.75) and major bleeding (women: 3.1% vs. 1.4%, HR 2.22, 95% CI 1.42-3.46; men: 3.2% vs. 2.0%, HR 1.60, 95% CI 1.29-1.97; P interaction 0.19). There was no significant interaction between randomized treatment and baseline modified REACH score above or below the median for MACE or major bleeding. CONCLUSION In patients with stable coronary artery disease or peripheral artery disease, the combination of rivaroxaban (2.5 mg twice daily) and aspirin compared with aspirin alone appears to produce consistent benefits in women and men, independent of baseline cardiovascular risk.
Collapse
Affiliation(s)
- Yan Liang
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jun Zhu
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Lisheng Liu
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Sonia S Anand
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Epidemiology, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Cardiology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tomasz J Guzik
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Martin O'Donnell
- Department of Translational Medicine, NUI Galway and Saolta Hospital Group, HRB-Clinical Research Facility, Galway, Ireland
| | - Gilles R Dagenais
- Department of Medicine, Laval University and Quebec Heart and Lung Institute, Quebec City, Canada
| | - Keith Aa Fox
- Department of Cardiology, University of Edinburgh, Edinburgh, UK.,Department of Medical and Radiological Sciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Olga Shestakovska
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Scott D Berkowitz
- Clinical Development, Group Head Thrombosis, Bayer U.S. LLC, Research & Development, Pharmaceuticals, Thrombosis & Hematology Therapeutic Area, Whippany, NJ, USA
| | - Eva Muehlhofer
- Bayer AG, Research & Development, Pharmaceuticals, TA Thrombosis & Hematology, USA
| | - Lars Keller
- Bayer AG, Research & Development, Pharmaceuticals, Medical Experts Cardio & Coagulant, USA
| | - Salim Yusuf
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Heart and Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John W Eikelboom
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Hamilton General Hospital, Hamilton, Ontario, Canada
| | | |
Collapse
|
9
|
Kouvari M, Panagiotakos DB, Chrysohoou C, Georgousopoulou EN, Tousoulis D, Pitsavos C. Sex-Related Differences of the Effect of Lipoproteins and Apolipoproteins on 10-Year Cardiovascular Disease Risk; Insights from the ATTICA Study (2002-2012). Molecules 2020; 25:E1506. [PMID: 32225033 PMCID: PMC7180686 DOI: 10.3390/molecules25071506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
The sex-specific effect of lipid-related biomarkers on 10-year first fatal/non fatal cardiovascular disease (CVD) incidence was evaluated. ATTICA study was conducted during 2001-2012. n = 1514 men and n = 1528 women (>18 years) from greater Athens area, Greece were recruited. Follow-up (2011-2012) was achieved in n = 2020 participants. Baseline lipid profile was measured. Overall CVD event was 15.5% (n = 317) (19.7% in men and 11.7% in women, p < 0.001). High density lipoprotein cholesterol (HDL-C) and triglycerides (TAG) were independently associated with CVD in women; per 10 mg/dL HDL-C increase, hazard ratio (HR) = 0.73, 95% confidence interval (95% CI) (0.53, 1.00); and per 10 mg/dL TAG increase, HR = 1.10, 95% CI (1.00, 1.21). Apolipoprotein A1 (ApoA1) (per 10 mg/dL increase, HR = 0.90, 95% CI (0.81, 0.99)) was inversely associated with CVD in women, while a positive association with apolipoprotein B100 (ApoB100) was observed only in men (per 10 mg/dL increase, HR = 1.10, 95% CI (1.00, 1.21)). Non-HDL-C was associated with CVD in the total sample (HR = 1.10, 95% CI (1.00, 1.21)) and in women (HR = 1.10, 95% CI (1.00, 1.21)); a steep increase in HR was observed for values >185 mg/dL in the total sample and in men, while in women, a raise in CVD risk was observed from lower values (>145 mg/dL). As for non-HDL-C/HDL-C and TC/HDL-C ratios, similar trends were observed. Beyond the common cholesterol-adjusted risk scores, reclassifying total CVD risk according to other lipid markers may contribute to early CVD prevention. Biomarkers such as HDL-C, non-HDL-C, and TAG should be more closely monitored in women.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece; (M.K.); (E.N.G.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece; (M.K.); (E.N.G.)
- Faculty of Health, University of Canberra, Bruce ACT 2617, Australia
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece; (C.C.); (D.T.); (C.P.)
| | - Ekavi N. Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece; (M.K.); (E.N.G.)
- School of Medicine, Sydney, The University of Notre Dame, 128-140 Broadway, Chippendale NSW 2007, Australia
- Medical School, Australian National University, Canberra, Canberra ACT 0200, Australia
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece; (C.C.); (D.T.); (C.P.)
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece; (C.C.); (D.T.); (C.P.)
| |
Collapse
|
10
|
Patsourakos NG, Kouvari M, Kotidis A, Kalantzi KI, Tsoumani ME, Anastasiadis F, Andronikos P, Aslanidou T, Efraimidis P, Georgiopoulos A, Gerakiou K, Grigoriadou-Skouta E, Grigoropoulos P, Hatzopoulos D, Kartalis A, Lyras A, Markatos G, Mikrogeorgiou A, Myroforou I, Orkopoulos A, Pavlidis P, Petras C, Riga M, Skouloudi M, Smyrnioudis N, Thomaidis K, Tsikouri GE, Tsikouris EI, Zisimos K, Vavoulis P, Vitali MG, Vitsas G, Vogiatzidis C, Chantanis S, Fousas S, Panagiotakos DB, Tselepis AD. The incidence of recurrent cardiovascular events among acute coronary syndrome patients treated with generic or original clopidogrel in relation to their sociodemographic and clinical characteristics. The Aegean study. Arch Med Sci 2020; 16:1013-1021. [PMID: 32863989 PMCID: PMC7444691 DOI: 10.5114/aoms.2020.95878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of generic drugs is continuously growing; however, there are limited epidemiological data regarding the therapeutic equivalence of each original drug formulation with its generic counterparts. We evaluated the 12-month composite endpoint of recurrent acute myocardial infarction, ischaemic stroke, cardiac deaths, or hospitalisation due to a major bleeding in acute coronary syndrome (ACS) patients treated with original clopidogrel or a generic clopidogrel formulation, in relation to sociodemographic and clinical characteristics. MATERIAL AND METHODS Consecutive Greek ACS patients (n = 1194) hospitalised in the Aegean islands and the Attica region were enrolled. Clopidogrel treatment was recorded either as original clopidogrel hydrogen sulphate (Plavix®/Iscover®) or as a generic clopidogrel besylate formulation (Clovelen®). The composite endpoint was recorded at 12-month follow-up. RESULTS The 12-month composite endpoint was 3.9% (4.6% in the Aegean islands and 3.5% in the Attica area, p > 0.05). The respective incidence in men was 4.0% and in women 3.8% (p > 0.05). Overall, generic and original clopidogrel use was 87% and 13% of patients, respectively. No significant differences were observed between original and generic clopidogrel use and 12-month composite endpoint incidence. Subgroup analysis with gender, region of residence, and clinical and lifestyle factors as strata did not reveal any significant outcomes. Haemorrhage incidence did not exceed 1% in the total sample. CONCLUSIONS The use of a generic clopidogrel besylate formulation was quite high in both urban and insular areas of Greece and had similar efficacy and safety profile with the original clopidogrel salt, supporting the routine use of this low-cost generic clopidogrel in the management of cardiovascular disease patients.
Collapse
Affiliation(s)
| | - Matina Kouvari
- School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | | | | | - Maria E. Tsoumani
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | - Theano Aslanidou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Petros Efraimidis
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | - Kalliopi Gerakiou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | | | - Athanasios Kartalis
- Cardiology Department, ‘Skylitseio’ General Hospital of Chios, Chios, Greece
| | - Anastasios Lyras
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Gerasimos Markatos
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Myroforou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Anestis Orkopoulos
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Pavlos Pavlidis
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Charalampos Petras
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Maria Riga
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Marina Skouloudi
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | - George Vitsas
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | - Stefanos Fousas
- Cardiology Department, Tzaneio Hospital of Piraeus, Piraeus, Greece
| | - Demosthenes B. Panagiotakos
- School of Health Science and Education, Harokopio University of Athens, Athens, Greece
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | |
Collapse
|
11
|
Kouvari M, Panagiotakos DB, Chrysohoou C, Notara V, Georgousopoulou E, Tousoulis D, Pitsavos C. Sex-discrete role of depressive symptomatology on 10-year first and recurrent cardiovascular disease incidence: results from ATTICA and GREECS prospective studies. Hellenic J Cardiol 2019; 61:321-328. [PMID: 31740355 DOI: 10.1016/j.hjc.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The sex-specific effect of depressive symptomatology on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated. METHODS The Greek samples from ATTICA (2002-2012, n = 845 free-of-CVD subjects) and GREECS (2004-2014, n = 2,172 subjects with acute coronary syndrome (ACS)) prospective epidemiological studies with baseline psychological assessments were used for the first and the recurrent event, respectively. Depressive symptomatology was assessed at baseline, through Zung Self-Rating Depression Scale in the ATTICA study, and through the Center for Epidemiological Studies-Depression scale in the GREECS study. RESULTS ACS as well as free-of-CVD women scored significantly higher for depressive symptomatology. Men scored higher than women against first (19.7% vs. 11.7%) and subsequent CVD events (38.8% vs. 32.9%). In participants with depressive symptoms man-to-woman first and recurrent CVD event rate ratio was below 1, confirming that depressive women were more likely to have a CVD event than depressive men. Multiadjusted analysis revealed that depressive symptomatology had an independent aggravating effect on the first (hazard ratio (HR) = 2.72, 95% confidence interval (95% CI) 1.50, 9.12) and recurrent (HR = 1.31, 95% CI 1.01, 1.69) CVD events only in women. Mediation analysis in women revealed that 35% (23%, 44%) of excess first-CVD-event risk of depressive symptoms was attributed to conventional risk factors. The respective number for recurrent CVD events was 46% (23%, 53%); different patterns of ranking regarding the mediating effect corresponding to each adjustment factor were observed. CONCLUSIONS The present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in women, while it gives rise to research toward unidentified paths behind this claim.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia.
| | | | - Venetia Notara
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Department of Public Health & Community Health, Technological Educational Institute of Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; School of Medicine, Sydney, The University of Notre Dame, Sydney, Australia; Medical School, Australian National University, Canberra, Australia
| | | | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | | |
Collapse
|
12
|
Kouvari M, Panagiotakos DB. Vitamin D status, gender and cardiovascular diseases: a systematic review of prospective epidemiological studies. Expert Rev Cardiovasc Ther 2019; 17:545-555. [DOI: 10.1080/14779072.2019.1637255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Matina Kouvari
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| |
Collapse
|
13
|
Kouvari M, Chrysohoou C, Dilaveris P, Georgiopoulos G, Magkas N, Aggelopoulos P, Panagiotakos DB, Tousoulis D. Skeletal muscle mass in acute coronary syndrome prognosis: Gender-based analysis from Hellenic Heart Failure cohort. Nutr Metab Cardiovasc Dis 2019; 29:718-727. [PMID: 31151882 DOI: 10.1016/j.numecd.2019.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. METHODS AND RESULTS In 2006-2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 1st tertile (Hazard Ratio (HR) = 0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p = 0.002) and 3rd tertile (HR = 1.85, 95%CI 1.05, 2.94, p = 0.03). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect. CONCLUSION A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-specific remarks for "obesity-lean paradox" in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis.
Collapse
Affiliation(s)
- M Kouvari
- First Cardiology Clinic, School of Medicine, University of Athens, Greece; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - C Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Greece.
| | - P Dilaveris
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - G Georgiopoulos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - N Magkas
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - P Aggelopoulos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - D B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, NJ, USA; Faculty of Health, University of Canberra, Australia; School of Allied Health, College of Science, Health and Engineering, LA TROBE University, Australia
| | - D Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| |
Collapse
|
14
|
Kouvari M, Panagiotakos DB, Chrysohoou C, Georgousopoulou E, Notara V, Tousoulis D, Pitsavos C, ATTICA & GREECS Studies Investigators. Gender-specific, Lifestyle-related Factors and 10-year Cardiovascular Disease Risk; the ATTICA and GREECS Cohort Studies. Curr Vasc Pharmacol 2019; 17:401-410. [DOI: 10.2174/1570161116666180608121720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/02/2023]
Abstract
Background:
Lifestyle remains a huge driving force of Cardiovascular Diseases (CVD) onset/
progression. Lifestyle-patterns are highly dependent on gender-related attitudes.
Objective:
To evaluate the gender-specific association of lifestyle-related factors (adherence to Mediterranean
diet (MedDiet), Physical Activity (PA), smoking) with 10-year first and recurrent CVD events.
Methods:
Two prospective studies, the ATTICA (2002-2012, n=3,042 subjects free-of-CVD) and
GREECS (2004-2014, n=2,172 subjects with Acute Coronary Syndrome (ACS)) were undertaken.
Baseline adherence to MedDiet (MedDietScore <27/≥27, range 0-55), PA (sedentary/physically active)
and smoking (current/never) was tested against 10-year first (ATTICA) and recurrent (GREECS) CVD
events, in men and women.
Results:
The “superiority” of men over women regarding overall CVD events was revealed in both first
(ATTICA, 19.7% men vs. 11.7% women, p<0.001) and recurrent CVD events, but less significantly
(GREECS, 38.8% men vs. 32.9% women, p=0.016). Gender-stratified analysis revealed that: lower
adherence to MedDiet in women (Odds Ratio (OR)=1.22, 95% Confidence Interval (95%CI) 1.03, 1.51)
and PA (OR=1.35, 95%CI 1.01, 1.85) and smoking (OR=1.28, 95%CI 1.04, 1.82) in men, were independent
predictors of 10-year first CVD event; whereas, adherence to MedDiet (OR=1.28, 95%CI 1.01,
1.59), PA (OR=1.25, 95%CI 1.01, 2.50) and smoking (OR=1.15, 95%CI 1.01, 1.30) in women, yet only
adherence to MedDiet (OR=1.27, 95%CI 1.01, 1.35) and PA (OR=1.27, 95%CI 1.02, 1.59) in men,
were independent predictors of 10-year CVD recurrent events.
Conclusion:
Differences between men and women, in the effect-size measures of lifestyle-related factors,
underline different paths for men and women, probably contributing to better designing strategies
for primary and secondary CVD prevention.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Venetia Notara
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | | |
Collapse
|
15
|
Kouvari M, Panagiotakos DB, Chrysohoou C, Georgousopoulou EN, Yannakoulia M, Tousoulis D, Pitsavos C. Lipoprotein (a) and 10-year Cardiovascular Disease Incidence in Apparently Healthy Individuals: A Sex-based Sensitivity Analysis from ATTICA Cohort Study. Angiology 2019; 70:819-829. [DOI: 10.1177/0003319719854872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The association between lipoprotein (a) (Lp(a)) and 10-year first fatal/nonfatal cardiovascular disease (CVD) risk in apparently healthy men and women was evaluated. The ATTICA prospective study was conducted during 2001-2012 and included n = 1514 men and n = 1528 women (age >18 years) from the greater Athens area, Greece. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases); baseline Lp(a) was measured in n = 1890 participants. The recommended threshold of 50 mg/dL was used to define abnormal Lp(a) status. Ten-year CVD-event rate was 14% and 24% in participants with Lp(a) <50 and Lp(a) ≥50 mg/dL, respectively. Multivariate analysis revealed that participants with Lp(a) ≥50 mg/dL versus Lp(a) <50 mg/dL had about 2 times higher CVD risk (hazard ratio (HR) = 2.18, 95% confidence interval (CI) 1.11, 4.28). The sex-based analysis revealed that the independent Lp(a) effect was retained only in men (HR = 2.00, 95% CI 1.19, 2.56); in women, significance was lost after adjusting for lipid markers. Sensitivity analyses revealed that Lp(a) increased CVD risk only in case of abnormal high-density lipoprotein cholesterol, apolipoprotein A1, and triglycerides as well as low adherence to Mediterranean diet. Certain patient characteristics may be relevant when considering Lp(a) as a therapeutic or risk-prediction target.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi N. Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- School of Medicine, The University of Notre Dame, Sydney, Australia
- Medical School, Australian National University, Canberra, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| |
Collapse
|
16
|
Trenaman SC, Rideout M, Andrew MK. Sex and gender differences in polypharmacy in persons with dementia: A scoping review. SAGE Open Med 2019; 7:2050312119845715. [PMID: 31041100 PMCID: PMC6477755 DOI: 10.1177/2050312119845715] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: To date, research studies in most disciplines have not made sex-based
analysis a priority despite increasing evidence of its importance. We now
understand that both sex and gender impact medication prescribing, use, and
effect. This is particularly true for older adults with dementia who have
alterations in drug metabolism, drug response, and the permeability of the
blood–brain barrier. To better understand the influence of sex and gender on
drug use in older adults with dementia, we conducted a scoping review. Methods: This scoping review systematically searched the Medline, Embase, Web of
Science, CINAHL, and ProQuest databases to find published reports on
polypharmacy in populations of older adults with dementia that included a
sex- or gender-based analysis. Results: A total of 12 published reports were identified. Findings were cohort studies
and case-control trials that commented on sex-related differences in
medication use as a secondary analysis to the studies’ primary objective.
These studies showed that community-dwelling women received more potentially
inappropriate medications and more psychotropic medications, while nursing
home dwelling men received more potentially inappropriate medications,
cholinesterase inhibitors, and antipsychotics. None of the identified
studies explicitly examined gender-related differences in medication
use. Conclusion: This scoping review supports that there is inadequate understanding of both
sex and gender differences in drug use in older men and women with dementia.
To tailor medication-specific interventions to improve drug therapy for
older adults with dementia, it is important that future work includes sex-
or gender-based analysis of drug use.
Collapse
Affiliation(s)
- Shanna C Trenaman
- Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Megan Rideout
- Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Melissa K Andrew
- Nova Scotia Health Authority, Halifax, NS, Canada.,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
17
|
Kouvari M, Panagiotakos DB, Yannakoulia M, Georgousopoulou E, Critselis E, Chrysohoou C, Tousoulis D, Pitsavos C. Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study. Metabolism 2019; 93:18-24. [PMID: 30639450 DOI: 10.1016/j.metabol.2019.01.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Metabolically benign obesity remains a scientific field of considerable debate. The aim of the present work was to evaluate whether metabolically healthy obese (MHO) status is a transient condition which propagates 10-year cardiovascular disease (CVD) onset. METHODS A prospective longitudinal study was conducted during 2001-2012, the ATTICA study studying 1514 (49.8%) men and 1528 (50.2%) women (aged >18 years old) free of CVD and residing in the greater Athens area, Greece. Follow-up assessment of first combined CVD event (2011-2012) was achieved in n = 2020 participants; of them, 317 (15.7%) incident cases were identified. Obesity was defined as body mass index ≥30 kg/m2 and healthy metabolic status as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). RESULTS The MHO prevalence was 4.8% (n = 146) with 28.2% of obese participants presenting metabolically healthy status at baseline. Within this group, 52% developed unhealthy metabolic status during the 10-year follow up. MHO vs. metabolically healthy non-obese participants had a higher likelihood of presenting with 10-year CVD events, yet only the subset of them who lost their baseline status reached the level of significance (Hazard Ratio (HR) = 1.43, 95% Confidence Interval (95% CI) 1.02, 2.01). Sensitivity analyses revealed that MHO status was independently associated with elevated CVD risk in women and participants with low adherence to the Mediterranean diet, low grade inflammation, and insulin resistance. CONCLUSIONS MHO status is a transient condition where weight management is demanded to prevent the establishment of unhealthy cardiometabolic features. The existence of obese persons who remain "longitudinally" resilient to metabolic abnormalities is an emerging area of future research.
Collapse
Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, NJ, USA; Faculty of Health, University of Canberra, Australia; School of Allied Health, College of Science, Health and Engineering, LA TROBE University, Australia.
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Medical School, Australian National University, Australia
| | - Elena Critselis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | | | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Ankylosing spondylitis (AS) was historically seen as a predominantly male disease. However, more recent data showed a more homogenous sex prevalence. Unfortunately, in many studies in axial spondyloarthritis (axSpA), the number of women included is low and the analyses are often not stratified for gender distribution. The purpose of this review is to aggregate the existing data on gender differences in axSpA in order to increase the awareness that female axSpA patients are still under-recognized. RECENT FINDINGS Several studies considering gender differences revealed that female axSpA patients had different disease manifestations due to different immunological, hormonal, and genetic responses. For instance, allelic frequencies of the AHNK-gene and tissue non-specific alkaline phosphatase (TNAP) haplotypes differed between men and women with ankylosing spondylitis (AS). In addition, different levels of tumor necrosis factor (TNF), interleukins IL-6, IL-17, and IL-18, were found between the two sexes. Furthermore, female patients show a higher diagnostic delay compared to males. Several studies indicate a higher frequency of extra-articular manifestations (EAM) in female axSpA patients, such as enthesitis, psoriasis, and inflammatory bowel disease (IBD), whereas acute anterior uveitis is more prevalent in male patients. Male AS patients more frequently show a higher Bath Ankylosing Spondylitis Radiology Index (BASRI) scores and modified Stoke Ankylosing Spondylitis Spine Scores (mSASSS) than females, which indicates that males have higher radiological damage and radiographic progression. However, disease activity (BASDAI) and quality of life (AsQol) scores are significantly higher in women, and more importantly, they have significantly lower response rates to treatment with TNF inhibitors (TNFi) and a significantly lower drug adherence. Despite the fact that men with axial SpA have a worse radiologic prognosis, women have a high disease burden, in part because they have a longer delay in diagnosis, higher disease activity, and significantly less responsiveness to treatment with TNFi.
Collapse
Affiliation(s)
- T Rusman
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | | | | |
Collapse
|