Heart Attacks Less Common in Women, But More Likely To Be Fatal

MedicalResearch.com Interview with:
Dr. Edina Cenko  MD, PhD first author  and
Dr. Raffaele Bugiardini M.D. FESC, FAHA,
Professor of Cardiovascular Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

MedicalResearch.com: What is the background for this study?

Response: Recent studies have identified younger women as “at-higher risk of mortality” after acute myocardial infarction. However, There are few studies looking at sex differences in mortality of patients with ST-Elevation Myocardial Infarction (STEMI). None of these studies have adjusted outcomes for treatment and delay to primary PCI, which may largely contribute to variations in clinical decision making and sex differences in outcomes. We used a large data set with fully risk and medications-adjusted models to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age in this excess of risk.

MedicalResearch.com: What are the main findings? 

Response: The different twist to this manuscript is to demonstrate that even when women have the same aggressive interventional and medical therapy as men, they die more than men and much more if women are younger , less than 60 years

MedicalResearch.com: What should readers take away from your report?

Response: Younger women are less likely to have a STEMI, but when they do so they show an excess of 30-day death than men, even in primary PCI treated patients. One strategy does not fit all in terms of women and men and mortality after STEMI. We need a more personalized approach to cardiovascular care. Behind sex disparities, sex is a biological variable in myocardial infarction. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The study supports the new NIH initiative requiring researchers to factor sex into the design, analysis, and reporting of studies. Severe adverse effects in women were not recognized by clinical trials as there was not a sufficient sample of women. Studying (balancing or randomizing) both sexes may inform appropriate medical care for women.  

MedicalResearch.com: Is there anything else you would like to add? 

Response: The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment. This holds true even in patients undergoing primary PCI. However, more studies are needed. Findings from men could not necessarily be applied to women. It is central considering the effects of sex as a biological variable at all stages and in any type of research on ischemic heart disease.

Any disclosures? Nothing to disclose 

Citations:

Cenko E, Yoon J, Kedev S, et al. Sex Differences in Outcomes After STEMIEffect Modification by Treatment Strategy and Age. JAMA Intern Med. Published online April 09, 2018. doi:10.1001/jamainternmed.2018.0514 

 

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Women Who Walk Briskly At Least Twice Per Week Have Lower Risk of Heart Failure

MedicalResearch.com Interview with:
Dr. Somwail Rasla, MD

Primary Care Center
Brown University, Pawtucket, RI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart failure (HF) is a major global epidemic. The risk of heart failure rises with age, It triples for women above age 60.
Studies have found an inverse relationship between the risk of heart failure hospitalization and midlife fitness.Walking is the most common form of physical activity reported in women
and older adults. T
his study aims at exploring the association of walking pace (speed), walking frequency and duration with the risk of incident acute hospitalized HF (HHF).

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Menopausal Hormone Therapy Linked To Favorable Cardiac Profile

MedicalResearch.com Interview with:

Mihir Sanghvi Academic Junior Doctor Barts Health NHS Trust

Dr. Sanghvi

Mihir Sanghvi
Academic Junior Doctor
Barts Health NHS Trust

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The effect of menopausal hormone therapy (MHT), previously known as hormone replacement therapy, on cardiovascular health in post-menopausal women remains controversial and unclear. Extensive observational data had suggested MHT to be cardioprotective, leading to MHT being routinely prescribed for both primary and secondary prevention of coronary heart disease (CHD). However, subsequent data from the Women’s Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) studies cast doubt on the beneficial cardiovascular effects of MHT; this was reflected in learned societies’ clinical guidance concerning MHT’s role in CHD prevention. The most recent randomised trial data on the subject arose from the Danish Osteoporosis Prevention Study, which indicated that women taking menopausal hormone therapy had a reduced risk of the composite endpoint of mortality, heart failure and myocardial infarction but the study has been subject to criticism [10]. In more recent work, again from the WHI, there was no difference in cardiovascular mortality in MHT users compared to placebo, although the authors themselves state that cause-specific mortality data should be interpreted “cautiously”.

The UK Biobank is an ongoing, large-scale, population-based study designed to examine determinants of health in middle and old age. Besides extensive collection of health questionnaire data, biological samples and physical measurements, it has incorporated cardiovascular magnetic resonance (CMR) imaging – the gold standard for analysis of cardiac structure and function – to provide detailed imaging phenotypes. At present, there is a paucity of data on the effects of  menopausal hormone therapy on left ventricular (LV) and left atrial (LA) volumes and function, alterations in which are markers of subclinical cardiovascular disease and have prognostic implications.

We found that in a large, population-based cohort of post-menopausal women free of cardiovascular disease, use of menopausal hormone therapy is not associated with adverse, subclinical changes in cardiac structure and function.

Indeed, we demonstrate significantly smaller LV and LA chamber volumes which have been linked to favorable cardiovascular outcomes in other settings.

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Does Gender Bias Play A Role in Cardiovascular Surgery in Women?

MedicalResearch.com Interview with:

Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa

Dr.  Jabagi

Habib Jabagi B.Sc., M.Sc., M.D.
Department of Surgery
University of Ottawa , Ottawa

MedicalResearch.com: What is the background for this study? What are the main findings

Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes.

The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG).

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Cardiovascular Disease Not a Top Concern For Women or Their Physicians

MedicalResearch.com Interview with:

C. Noel Bairey Merz, MD, FACC  Director, Barbra Streisand Women's Heart Center Director, Linda Joy Pollin Women's Heart Health Program Director, Erika Glazer Family Foundation Women's Heart Disease Initiative Director, Preventive Cardiac Center  Professor of Medicine  Cedars-Sinai Medical Center

Dr. Merz

C. Noel Bairey Merz, MD, FACC 
Director, Barbra Streisand Women’s Heart Center
Director, Linda Joy Pollin Women’s Heart Health Program
Director, Erika Glazer Family Foundation Women’s Heart Disease Initiative
Director, Preventive Cardiac Center
Professor of Medicine
Cedars-Sinai Medical Center

MedicalResearch.com: What is the background for this study?

Response: Cardiovascular disease (CVD) is the number 1 killer of women in the U.S.A., yet few younger women personalize awareness. CVD campaigns focus little attention on physicians and their role assessing risk.

MedicalResearch.com: What are the main findings?

Response: Overall, 45% of women were unaware that CVD is the #1 killer of women, only 11% knew a woman who has died from it.  Overall, 45% of women reported it is common to cancel or postpone a physician appointment until losing weight. Cardiovascular disease was a top concern for only 39% of PCPs, after weight and breast health. A minority of physicians (22% of PCPs and 42% of cardiologists) felt well prepared to assess women’s CVD risk, and infrequently use guidelines.

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Failed Fertility Therapy Linked To Increased Risk of Heart Disease

MedicalResearch.com Interview with:

Jacob A. Udell MD MPH FRCPC Cardiovascular Division Women's College Hospital Toronto General Hospital University of Toronto

Dr. Jacob Udell

Jacob A. Udell MD MPH FRCPC
Cardiovascular Division
Women’s College Hospital
Toronto General Hospital
University of Toronto 

MedicalResearch.com: What is the background for this study?

Response: We’ve noticed for a long time that fertility drug treatment can cause short-term complications such as high blood pressure or diabetes in pregnancy. We recently started wondering whether there may be long term consequences for these women years after a baby was or was not born.  To do this, we looked at all women who were treated with fertility therapy in Ontario for the last 20 years, from what we could determine this amounted to more than 28,000 women. We then followed up years later to examine every woman’s cardiovascular health.

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Paracardial Fat Linked To Postmenopausal Coronary Artery Calcification

MedicalResearch.com Interview with:

Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Department of Epidemiology University of Pittsburgh Graduate School of Public Health

Dr. El Khoudary,

Samar R. El Khoudary, Ph.D., M.P.H.
Assistant professor
Department of Epidemiology
University of Pittsburgh Graduate School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study revealed a previously unknown, menopause-specific indicator of heart disease risk. For the first time, we’ve pinpointed the type of heart fat, linked it to a risk factor for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women.

My team evaluated clinical data, including blood samples and heart CT scans, on 478 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy.

In a previous study, we showed that a greater volume of paracardial fat, but not epicardial fat, after menopause is associated with a decline in the sex hormone estradiol—the most potent estrogen—in women. The higher volume of epicardial fat was tied to other risk factors, such as obesity.

In the new study, we built on those findings to discover that not only is a greater paracardial fat volume specific to menopause, but—in postmenopausal women and women with lower levels of estradiol—it’s also associated with a greater risk of coronary artery calcification, an early sign of heart disease that is measured with a heart CT scan.

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Increased Risk of Heart Disease in Postmenopausal Women With History of Weight Cycling

MedicalResearch.com Interview with:

Somwail Rasla, MD Internal Medicine Resident Memorial Hospital of Rhode Island Brown University

Dr. Somwail Rasla

Somwail Rasla, MD
Internal Medicine Resident
Memorial Hospital of Rhode Island
Brown University

MedicalResearch.com: What is the background for this study?

Response: Weight cycling has been studied as a possible risk factors for all-cause mortality and was found to be insignificant in some studies and significant in other studies when adjusted to age and timing of when the weight cycling occurred. It was proposed that weight cycling may increase risk of chronic inflammation by which weight cycling was considered to be a risk factor for increased morbidity and all cause mortalities. Other studies have reported that frequent weight cycling was associated with shorter telomere length, which is a risk factor for several comorbidities including CHD. Earlier studies showed that weight cycling has an association with increase in size of adipocytes as well as fluctuation of serum cholesterol, triglycerides, glucose, insulin, and glucagon which may contribute to the increased incidence of diabetes. Alternatively, in the nurses’ health study , weight cycling was not predictive of cardiovascular or total mortality.

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Coronary Artery Calcium Found in 1/3 Women Designated “Low-Risk’

MedicalResearch.com Interview with:

Dr-Maryam-Kavousi

Dr. Maryam Kavousi

Maryam Kavousi MD, PhD, FESC
Assistant Professor
Department of Epidemiology
Erasmus University Medical Center
Rotterdam The Netherlands 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The most recent American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease (CVD) prevention guidelines recommend statins for a larger proportion of populations.

Notably, a large group of women are categorized as low CVD risk by the guidelines and would therefore not typically qualify for intensive management of their standard risk factors. Coronary artery calcium (CAC) scanning allows for the detection of subclinical coronary atherosclerosis and is viewed as the vessel’s memory of lifetime exposure to risk factors. We therefore aimed to address the utility of CAC as a potential tool for refining CVD risk assessment in asymptomatic women at low CVD risk based on the new guidelines.

This study involved data on 6,739 low-risk women from 5 population-based cohort studies across the United States and Europe. We found that CAC was present in 36% of low-risk women and was associated with increased risk of CVD. Continue reading

Breastfeeding Is a Women’s Health Issue

MedicalResearch.com Interview with:

Melissa C. Bartick, M.D. Assistant Professor of Medicine Department of Medicine, Cambridge Health Alliance, Cambridge Harvard Medical School, Boston Massachusetts

Dr. Melissa Bartick

Melissa C. Bartick, M.D.
Assistant Professor of Medicine
Department of Medicine, Cambridge Health Alliance, Cambridge
Harvard Medical School, Boston
Massachusetts

MedicalResearch.com: What is the background for this study?

Response: There has never been a study that combined maternal and pediatric health outcomes and costs into a single model. My colleague Arnold Reinhold and I had published a pediatric study in 2010, which was widely publicized but needed to be updated. My colleagues and I published a maternal study in 2013. But the two studies had different methodologies, and so the total costs could not be simply added together.

Here, we wanted to get a picture of the impact of breastfeeding in the US public health as whole, by creating a single model that combined maternal and pediatric outcomes. That had never been done before.

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