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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Women With Migraine At Increased Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Prof. Dr. Dr. Tobias Kurth Professor of Public Health and Epidemiology and Director of the Institut of Public Health, Charité – Universitätsmedizin Berlin, Germany. Co-director, Centre Virchow-Villermé, for Public Health Paris – Berlin, Campus Berlin. Adjunct Associate Epidemiologist, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Dr. Tobias Kurth

Prof. Dr. Dr. Tobias Kurth
Professor of Public Health and Epidemiology and Director of the Institut of Public Health, Charité – Universitätsmedizin Berlin, Germany.
Co-director, Centre Virchow-Villermé, for Public Health Paris – Berlin, Campus Berlin.
Adjunct Associate Epidemiologist, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

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

Dr. Kurth: Migraine has been consistently associated with increased risk of stroke. Associations with other (non-stroke) Cardiovascular Disease (CVD) was less clear.

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

Dr. Kurth: Women with migraine are at increased risk of any CVD event, including Myocardial infarction, stroke and cardivoascular death.

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

Dr. Kurth:  We do not yet understand the mechanism of this association and strong efforts are needed to find solution to reduce the increased risk.

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

Dr. Kurth: I am aware of the importance of the finding but we hope to not scare patients with migraine. Nevertheless, women with migraine should be evaluated for their vascular risk.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Kurth Tobias, Winter Anke C, Eliassen A Heather,Dushkes Rimma, Mukamal Kenneth J, Rimm Eric Bet al. Migraine and risk of cardiovascular disease in women: prospective cohort study

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Inflammatory Biomarkers Predictive of Coronary Artery Calcium in Women at Midlife

MedicalResearch.com Interview with:
Norman C. Wang, M.D., M.S., Assistant professor
University of Pittsburgh School of Medicine
Samar R. El Khoudary, Ph.D., M.P.H.,
Assistant professor 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: We studied 252 middle-aged women with no known cardiovascular disease from the Study of Women’s Health Across the Nation [SWAN] Heart Study to determine if 5 blood biomarkers associated with abnormal inflammation/hemostasis were associated with increasing amounts of calcium detected in coronary arteries on computed tomography scans, or coronary artery calcium progression. Only higher blood levels of plasminogen activator inhibitor-1 was associated with coronary artery calcium progression.

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Inflammatory Biomarker CRP Linked To Heart Disease Risk in African American Women

MedicalResearch.com Interview with:
Norman C. Wang, M.D., M.S., Assistant professor
University of Pittsburgh School of Medicine
Samar R. El Khoudary, Ph.D., M.P.H.,
Assistant professor 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: We examined medical records, blood samples and heart CT scans for 372 black and white women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged just over 51 years old, were not on hormone replacement therapy and had no known heart disease when enrolled. We then looked at blood levels of five biomarkers linked to inflammation. All of the biomarkers were associated with coronary artery calcification, a predictor of heart disease that is measured with a heart CT scan.

Taking into account the participants’ body mass index (BMI), a measure of overall body fat, we found that obesity was a key factor linking most of the elevated inflammation biomarkers and coronary artery calcification. Regardless of BMI, black women with higher levels of one particular biomarker, C-reactive protein, were more likely to have coronary artery calcification than whites. In fact, black women with coronary artery calcification had an average level of C-reactive protein in their blood that was almost double that of their white counterparts.

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Women May Overestimate Breast Cancer Risk, Underestimate Obesity, Heart Disease Risks

MedicalResearch.com Interview with:

Julie M. Kapp, MPH, PhD Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212

Dr. Kapp

Julie M. Kapp, MPH, PhD
Associate Professor
2014 Baldrige Executive Fellow
University of Missouri School of Medicine
Department of Health Management and Informatics
Columbia, MO 65212

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

Dr. Kapp: For the past several decades the U.S. has had the highest obesity rate compared to high-income peer countries, and for many years people in the U.S. have had a shorter life expectancy. For female life expectancy at birth, the U.S. ranked second to last. At the same time, the U.S. has the third highest rate of mammography screening among peer countries, and the pink ribbon is one of the most widely recognized symbols in the U.S. While the death rate in females for coronary heart disease is significantly higher than that for breast cancer, at 1 in 7.2 deaths compared to 1 in 30, respectively, women have higher levels of worry for getting breast cancer.

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Four Reasons Why Women Receive Fewer Statins Than Men For Heart Disease

MedicalResearch.com Interview with:

Alexander Turchin, MD, MS Associate Physician, Brigham and Women's Hospital Associate Professor of Medicine, Harvard Medical School Brigham and Women's Hospital Department of Medicine Endocrinology Boston, MA 02115

Dr. Alexander Turchin

Alexander Turchin, MD, MS
Associate Physician, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
Brigham and Women’s Hospital
Department of Medicine
Endocrinology
Boston, MA 02115 

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

Dr. Turchin: It is known that fewer women than men at high risk for cardiovascular disease are treated with statins.

However, the reasons for this sex disparity are not fully understood.

Our study identified 4 factors that accounted for over 90% of the difference in statin therapy between women and men with coronary artery disease:

  • Age (women were older than men),
  • Amoking (men were more likely to smoke),
  • Evaluation by a cardiologist (men were more likely to have been seen by a cardiologist) and
  • History of adverse reactions to statins (women were more likely to have experienced an adverse reaction).

    This is the first time that a near-complete explanation for the sex disparities in statin therapy was found.

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Gender Differences in Stress Test and CT Angiography in Patients with Suspected CAD

MedicalResearch.com Interview with:
Dr. Neha J. Pagidipati
Duke Clinical Research Institute
Duke University School of Medicine
Durham, North Carolina

Medical Research: What is the background for this study? What are the main findings?

Dr. Pagidipati: Women and men experience coronary artery disease differently, and a great deal of literature has shown that these differences extend to the diagnostic performance of various noninvasive testing modalities. However, little is known about the sex-specific prognostic value of computed tomographic angiography (CTA) and functional stress testing.

We used data from the recent PROMISE trial to address this question. The PROMISE trial enrolled 10,003 patients (53% women) with stable symptoms suggestive of coronary artery disease to a diagnostic strategy of CTA vs stress testing, and found no differences in outcomes overall or by sex. We found that in women, a CTA is less likely to be positive, but when it is positive, it appears to have greater predictive value for a future cardiovascular event (all cause death, myocardial infarction, or unstable angina hospitalization) than stress testing. In men, a stress test is less likely to be positive, and though stress testing trended towards being more predictive of future events, there was no statistically significant difference in the prognostic value of either test type.

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Women With Obstructive Coronary Artery Disease Have Higher Mortality Than Men

MedicalResearch.com Interview with:
Nathaniel Smilowitz, MD
Fellow, Cardiovascular Disease
NYU Langone Medical Center

MeicalResearch: What is the background for this study? What are the main findings?

Dr. Smilowitz: Myocardial infarction (MI), commonly known as a heart attack, is a leading cause of death worldwide.  In the majority of patients with MI, examination of the coronary blood vessels by angiography reveals an obstruction that limits blood flow to the heart muscle.  However, some patients develop MI with non-obstructive coronary arteries (MINOCA) at angiography.  This condition is identified more commonly in younger patients and women, and in prior studies, in-hospital death after MINOCA was lower than for MI with obstructive coronary artery disease (MI-CAD).  Despite favorable outcomes associated with MINOCA, young women paradoxically have overall higher in-hospital death after MI in comparison to younger men.  Although sex differences in post-MI mortality are known to vary with age, the interaction between age, sex, and the presence of obstructive coronary artery disease at angiography on death post-MI had not been previously established.

In this study, we confirmed that in-hospital mortality is lower after MINOCA than MI-CAD and that women are more likely to have MINOCA than men.  No sex difference in mortality was observed among patients with MINOCA, but women of all ages had significantly higher mortality after MI-CAD than men.  With advancing age, mortality increased to a greater degree in patients with MI-CAD than MINOCA and in men vs. women.

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Regardless of Ethnicity, Women Have Worse Outcomes From Acute Coronary Syndromes

MedicalResearch.com Interview with:

Karin H Humphries, MBA, DSc | Scientific Director BC Centre for Improved Cardiovascular Health UBC-HSF Professor in Women's Cardiovascular Health Vancouver, BC

Karin Humphries

Karin H Humphries, MBA, DSc | Scientific Director
BC Centre for Improved Cardiovascular Health
UBC-HSF Professor in Women’s Cardiovascular Health
Vancouver, BC

Medical Research: What is the background for this study?

Response: Prior studies have shown that among patients with obstructive coronary artery disease (CAD), women have higher short- and long-term mortality rates as compared to men. Furthermore, a few studies have highlighted the existence of ethnic differences in the incidence of acute myocardial infarction (AMI) and outcomes following an AMI event. However, the joint contribution of sex and ethnicity on outcomes of patients with obstructive  coronary artery disease remains unknown.

Our primary objective was to extend these findings by examining the joint impact of sex and ethnicity on long-term adverse outcomes of all patients with angiographic evidence of obstructive CAD presenting with myocardial ischemia.

Our study included a population-based cohort of patients ≥ 20 years of age who underwent coronary angiography for acute coronary syndromes (ACS) or stable angina in British Columbia, Canada with angiographic evidence of ≥ 50% stenosis in any epicardial artery.

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Symptoms of Anxiety and Heart Disease May Overlap in Women

MedicalResearch.com Interview with:

Dr. Kim Lavoie

Dr.Kim Lavoie

Dr. Kim Lavoie, Ph.D.
CIHR New Investigator, FRQS Chercheur-Boursier Co-Director,
Montreal Behavioural Medicine Centre
Professor, Dept. of Psychology University of Quebec at Montreal Director, Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal Adjunct Professor, Faculty of Medicine, University of Montreal
Associate Researcher, Montreal Heart Institute
Chair, Health Psychology and Behavioral Medicine Section
Canadian Psychological Association
 

Medical Research: What is the background for this study?

Dr. Lavoie: We were interested in looking at whether rates of ischemia in men and women were different as a function of whether or not you had pre-existing heart disease (we would expect those with existing heart disease to have more ischemia because it’s a major marker of disease) or a comorbid anxiety or mood disorder (we expected anx/mood disorders would be associated with higher rates of ischemia because they reflect clinical levels of chronic stress, which has been linked to higher rates of ischemia in previous studies).

Medical Research: What are the main findings?

Dr. Lavoie: Overall, we found that men have higher rates of ischemia than women, and that anxiety or mood disorders overall aren’t associated with higher or lower risk of ischemia (in those with or without previously diagnosed heart disease).

HOWEVER, what we did find that was interesting and perhaps new, was that if you looked within women, those without previously diagnosed heart disease AND anxiety disorders (which including things like panic disorder and generalized anxiety – panickers and worriers) had higher rates of ischemia compared to those without anxiety disorders. This suggests higher rates of ischemia among women without heart disease, which seems counter-intuitive because you would expect those WITH disease to have more ischemia. The fact that anxiety disorders were present in those without previously diagnosed heart disease – and they were the ones with more ischemia, suggests that these women likely HAD heart disease that just hadn’t been diagnosed up yet, and that the reason might have been because of their anxiety disorder, which can mask many symptoms of heart disease because many of them overlap (e.g., fatigue, decreased energy, heart palpitations, sweating, chest discomfort, hyperventilation, and fear/worry). This could lead physicians to misinterpret symptoms of real heart disease as those of anxiety – but this only appears to be the case in women according to our study, suggesting a possible sex/gender bias here.

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