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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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.

More Medical Research Interviews on MedicalResearch.com.

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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Multiple Pregnancies May Raise Metabolic Syndrome Risk in Latina Women

MedicalResearch.com Interview with:

Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC

Dr. Catherine Vladutiu

Catherine J. Vladutiu, PhD, MPH
Research Assistant Professor, Department of Obstetrics & Gynecology
Adjunct Assistant Professor, Department of Epidemiology
Chapel Hill, NC

Medical Research: What is the background for this study?

Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life.  Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women.  Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts.

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CVD Risk in Women Also Raises Risk of Diabetes, Hypertension and High Cholesterol

MedicalResearch.com Interview with:

Mercedes Sotos Prieto, PhD Research Associate, Department of Nutrition Harvard T.H. Chan School of Public Health 665 Huntington Ave Boston, MA, 02115

Dr. Mercedes Sotos Prieto

Mercedes Sotos Prieto, PhD
Research Associate, Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA, 02115

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

Dr. Sotos-Prieto: Given that CVD remains the leading cause of death in the US, the prevention of risk factor development through healthy lifestyle factors, or primordial prevention, is of paramount importance to minimize the long-term risk of CVD. However, the prevalence of these healthy behaviors among US adults remains low.

The Healthy Heart Score is a 20-year CVD risk prediction model based on modifiable lifestyle factors and we have shown previously that this score effectively predicted the 20-year risk of CVD in mid-adulthood. Whether this risk score is associated with clinically-relevant CVD risk factors is unknown. Therefore, in this study we analyzed the association between the Healthy Heart Score and incidence of clinical CVD risk factors, including diabetes, hypertension, and hypercholesterolemia among 69,505 U.S women in the Nurses’ Health Study II during 20 years of follow-up. The Healthy Heart Score is based on the 9 most critical lifestyle factors that best estimate CVD risk including: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits, vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats. The Healthy Heart Score estimates the 20 –year CVD risk, thus a higher score reflected a higher predictive CVD risk. Over 20 years, we documented 3,275 incident cases of diabetes, 17,420 of hypertension, and 24,385 of hypercholesterolemia.

Our main findings showed that women with higher predicted CVD risk based on the Healthy Heart Score (highest quintile vs. lowest) had significantly greater risk of developing each clinical risk factor individually. Specifically, women with a higher predictive CVD risk had an 18-fold higher risk of type 2 diabetes, 5-fold higher risk of hypertension, and 3-fold higher risk of hypercholesterolemia over 20-years. Further, a higher predictive CVD risk was associated with a 53-fold greater risk of developing a high CVD risk profile (defined as the diagnosis of all 3 clinical risk factors) and this association was most pronounced among women who were younger, did not smoke, and had optimal weight

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Young Women With CAD Need Repeat Procedures More Often Than Men

MedicalResearch.com Interview with:

Dr. Robert L. Wilensky MD Director, Interventional Cardiology Research Director, Interventional Cardiology Training Program Professor of Medicine Hospital of the University of Pennsylvania

Dr. Robert Wilensky

Dr. Robert L. Wilensky MD
Director, Interventional Cardiology Research
Director, Interventional Cardiology Training Program
Professor of Medicine Hospital of the University of Pennsylvania

Medical Research: What is the background for this study?

Dr. Wilensky: We wanted to evaluate whether young women, under the age of 50 years, had an increased risk for recurrent ischemic events after percutaneous coronary intervention (PCI) compared to young men or older women.

Medical Research: What are the main findings?

 Dr. Wilensky: Despite having less severe coronary artery disease,  had an increased risk of repeated events, generally need for repeat PCI in either the exact location of the original procedure or within the artery that underwent the procedure. This despite the finding that young women were treated with the same medications as young men.

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Group Urges Focus on Non-Communicable Diseases in Women

MedicalResearch.com Interview with:

Professor Robyn Norton Principal Director of The George Institute for Global Health Board Member, The George Institute for Global Health Professor of Public Health at the University of Sydney Professor of Global Health at the University of OxfordProfessor Robyn Norton
Principal Director of The George Institute for Global Health
Board Member, The George Institute for Global Health
Professor of Public Health at the University of Sydney
Professor of Global Health at the University of Oxford

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

Prof. Norton: The impetus to focus on women’s health, stems from the knowledge that, while noncommunicable diseases (NCDs) are the leading cause of death and disability for women worldwide, this is not sufficiently recognized nor sufficiently resourced. Equally, while there is increasing evidence that we can learn so much more about how to address the burden of disease for women, by collecting and analyzing data on women, separately to that for men, this is not happening.

We are calling for a refocus of the women’s health agenda on NCDs – given that globally and in many countries the focus of women’s health almost exclusively is still on women’s sexual and reproductive health. The fact is that in all but the poorest countries, the greatest health burden, for women, is  noncommunicable diseases and so that if we are to make significant gains in improving women’s health then we must focus on addressing NCDs. The current global burden of disease for women reflects both the significant gains that have been made as a result of addressing maternal mortality and changes that have affected both women and men equally – namely, that populations are living longer, as a consequence of reductions in both infant mortality and communicable diseases, as well as the fact that populations are becoming wealthier and, as a result, are engaging in behaviors that increase the risk of noncommunicable diseases.

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Women Adhere Poorly to Cardiac Rehabilitation Programs, Regardless of Type

Sherry L. Grace, PhD Senior Scientist, Toronto Rehabilitation Institute (TRI) Affiliate Scientist, Toronto General Research Institute (TGRI)

Dr. Sherry Grace

MedicalResearch.com Interview with:
Sherry L. Grace, PhD
Professor, York University
Senior Scientist, University Health Network
University of Toronto

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

Dr. Grace: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for women world-wide. Cardiac rehabilitation (CR) is an outpatient secondary prevention program composed of structured exercise and comprehensive education and counseling.Cardiac rehabilitation participation results in lower morbidity and mortality, among other benefits. Unfortunately, women are significantly less likely to adhere to these programs than men.

While the traditional model of Cardiac rehabilitation care is a hospital-based mixed-sex program, women are the minority in such programs, and state that these programs do not meet their care preferences. Two other models of CR care have been developed: hospital-based women-only (sex-specific) and monitored home-based programs. Women’s adherence to these program models is not well known.

Cardiac Rehabilitation for her Heart Event Recovery (CR4HER) was a 3 parallel arm pragmatic randomized controlled trial‎ (RCT) designed to compare women’s program adherence to traditional hospital-based CR with males and females attending (mixed-sex), home-based CR (bi-weekly phone calls), and women-only hospital-based CR. The primary outcome was program adherence operationalized as  Cardiac rehabilitation site-reported percentage of prescribed sessions completed by phone or on-site, as reported by a staff member who was blind to study objectives. The secondary outcomes included functional capacity. It was hoped that by identifying the CR program model which resulted in the greatest adherence for women, their participation and potentially their cardiac outcomes could be optimized.

MedicalResearch: What are the main findings?

Dr. Grace: Similar to previous research, we found that women did not adhere very highly to the  Cardiac rehabilitation programs. Half of the women dropped out of CR, and this occurred regardless of the type of program they went to. Some women did not even start Cardiac rehabilitation at all, even though we had referred them.

On average, the women went to just over half the sessions (at the CR centre or on the phone; they were prescribed a median of 24 sessions). If we consider only the women who actually started CR, they attended almost 2/3rds of prescribed CR sessions.

Women experienced gains in their exercise capacity over the course of CR participation. Attending the traditional co-ed program was associated with the greatest exercise capacity. This could be due to the fact that the staff push them to exercise at their target levels when they are in a supervised program.

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Young Women Receive Fewer Medications After Heart Attack

MedicalResearch.com Interview with:
Kate Smolina, PhD
Banting Postdoctoral Fellow
Centre for Health Services and Policy Research
School of Population and Public Health
The University of British Columbia
Vancouver, BC  Canada 

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

Dr. Smolina: Women take fewer cardiovascular medications than men in an outpatient setting and there is limited information in the literature as to why. There are two possible explanations: this is either a consequence of prescribing behaviour by physicians or adherence behaviour by patients – or a combination of the two. This study showed that younger women are less likely to be prescribed or to fill their first prescription after a heart attack compared to younger men. But once the therapy is actually started, we found no sex differences in adherence. This is very helpful because it identifies the point on the continuum of care at which the disparity occurs and where we need to focus interventions.

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Pregnancy Complications Increase Risk of Heart Disease In Women

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, CaliforniaMedicalResearch.com Interview with:
Barbara A. Cohn, PhD
Director of the Child Health and Development Studies at the Public Health Institute.
Berkeley, California

Medical Research: What is the background for this study?

Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system.

Medical Research: What data were used for this study?

Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study.

Medical Research: Why hasn’t this study already been done?

Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school.   At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience.

Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women.

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Chronic Inflammation May Predict Why Black Women More Prone To Heart Disease

MedicalResearch.com Interview with:
Carmen De Miguel, PhD | Postdoctoral Scholar
Section of Cardio-Renal Physiology and Medicine
Department of Medicine | Division of Nephrology
UAB | The University of Alabama at Birmingham

Medical Research: What is the background for this study?

Dr. De Miguel: It is known that obesity is a major risk for cardiovascular disease and that cardiovascular disease is more prevalent in the African American population. Specifically, female African Americans have an exceptionally high risk of developing cardiovascular disease. Obesity is known to contribute to the development of diabetes, hypertension, heart disease, etc. All these diseases have in common persistent low-grade inflammation, and we also know that signs of inflammation can be observed in patients with cardiovascular disease years before the disease is diagnosed. A better understanding of the differences within ethnicities regarding the development of cardiovascular disease is needed and will lead to the development of better therapies targeted to each population. Based on all of this knowledge, we hypothesized that obesity would lead to different changes in the immune system of male and female, Caucasian and African American teenagers (14-20 year old).

Medical Research: What are the main findings?

Dr. De Miguel: We found differences in the immune cell profile in white and black teenagers, and within gender in the African American subjects. We believe that monitoring these differences could be used to recognize at an earlier stage those individuals that are at-risk of developing cardiovascular disease in the future, and this could allow for preventive therapies that would reduce such risk.

Specifically, we found that obese white teenagers decrease the numbers of T cells (a kind of immune cell) in the circulation (blood) compared to African American teenagers, which indicates that they have less systemic inflammation than the African Americans subjects in response to obesity. Within the African American subjects, we found that obese males had smaller numbers of T cytotoxic cells (CD8+ cells, a specific kind of T cell) and smaller numbers of activated T cytotoxic cells than lean males, what tells us that obese males are trying to decrease their inflammation levels. However, obese African American females do not decrease those levels, so their inflammation remains elevated. We think that the fact that they do not decrease the activation of T cytotoxic cells (CD8+ cells) could be important in explaining the high risk that black females have of developing cardiovascular disease later in life.

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Menopausal Women Accumulate Fat…..Around Their Hearts

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

Assistant professor
Graduate School of Public Health Department of Epidemiology
University of Pittsburgh

Medical Research: What is the background for this study?

Dr. El Khoudary: Cardiovascular disease is the leading cause of death in women, and it increases after age 50 – the average age when a woman is going through menopause. Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.

No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events. My team and I investigated whether there may be a link between menopause and cardiovascular fat using data from 456 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.

Medical Research: What are the main findings?

Dr. El Khoudary: Our study is the first to find that  late- and post-menopausal women have significantly greater volumes of fat around their hearts than their pre-menopausal counterparts. As concentrations of the sex hormone estradiol – the most potent estrogen – declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after my colleagues and I took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases. Continue reading

Women With PTSD At Higher Risk For Heart Disease

Jennifer A. Sumner, Ph.D.MedicalResearch.com Interview with:
Jennifer A. Sumner, Ph.D.
Columbia University Mailman School of Public Health
New York, NY 10032

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

Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men.

My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure.

Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.

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Women On Both Diabetes and Depression Medications Have Increased Risk of Myocardial Infarction

Dr. Karin Rådholm MD Ph.D. Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, SwedenMedicalResearch.com Interview with
Dr. Karin Rådholm MD Ph.D. student
Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University
Department of Local Care West, County Council of Östergötland,
Linköping, Sweden

MedicalResearch: What is the background for this study?

Dr. Rådholm: Psychosocial risk factors and depressive disorders often co-occur with general medical comorbidities, such as myocardial infarction. Depression is more common in patients with diabetes than in patients without diabetes. About 10-30% of patients with diabetes have a comorbid depressive disorder, which is double the estimated prevalence of depression in individuals without diabetes. There is an association between comorbid depressive symptoms and diabetes complications. This is believed to be mainly due to poor adherence to treatment recommendations and diabetes self-management activities, but could also possibly be due to biological and behavioural causes that could predispose for both metabolic and affective disorders. The general risk of myocardial infarction is strongly dependent on age and sex, where men have an earlier disease onset compared to women. In the general population women are at much lower risk for ischemic heart disease mortality than men are. However, women with diabetes are at especially high risk for coronary heart disease, relatively more so than men with type 2 diabetes, meaning that the impact of diabetes on the risk of coronary death is significantly greater for women than men. The age- and gender-specific risk for myocardial infarction due to diabetes with coexistent depression has not previously been described. Data on all dispensed drug prescriptions in Sweden are available in the Swedish Prescribed Drug Register and all myocardial infarctions are registered in the Myocardial Infarction Statistics. These registers are population-based and have a total national coverage and high validity, which has been previously shown. Prescribed and dispensed antidiabetics and antidepressants were used as markers of disease.

Our objective was to prospectively explore the gender- and age-specific risk of first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared to participants with no pharmaceutical treatment for diabetes or depression in a nationwide register study.

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Women May Be More Susceptible To Toxic Effects Of Alcohol On Heart

Alexandra Gonçalves, MD, PhD Postdoctoral Research Fellow Cardiovascular Department Brigham and Women's Hospital Boston, MA 02115MedicalResearch.com Interview with:
Alexandra Gonçalves, MD, PhD
Postdoctoral Research Fellow
Cardiovascular Department
Brigham and Women’s Hospital
Boston, MA 02115


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

Dr. Gonçalves: Excessive alcohol consumption is associated with alcoholic cardiomyopathy, while light to moderate drinking might have benefits in the risk of heart failure (HF). However, the cardiovascular mechanisms and the alcohol dosage associated with risks or potential benefits are uncertain. Furthermore, the variation in the toxic and protective effects of alcohol by sex remains controversial, as women may be more sensitive than men to the toxic effects of alcohol on cardiac function, developing alcoholic cardiomyopathy at a lower total lifetime dose of alcohol compared to men. In this study we assessed the associations between alcohol intake and cardiac structure and function by echocardiography, in elderly men and women in the large, community-based Atherosclerosis Risk in Communities (ARIC) Study.

MedicalResearch.com: What are the main findings?

Dr. Gonçalves: We studied 4466 participants (76±5 years and 60% women) with alcohol consumption ascertained, who underwent transthoracic echocardiography. Participants were classified into 4 categories based on self-reported alcohol intake: non-drinkers, drinkers of up to 7 drinks per week, ≥7 to 14 and ≥ 14 drinks per week. In both genders, increasing alcohol intake was associated with larger left ventricular (LV) diastolic and systolic diameters and larger left atrial diameter. In men, increasing alcohol intake was associated with greater LV mass and higher E/E’ ratio. In women, increasing alcohol intake was associated with lower LV ejection fraction. Continue reading

Divorce Raises Risk of Heart Attack, Especially For Women

Matthew E. Dupre, PhD Associate Professor of Medicine Department of Community and Family Medicine Department of Sociology Duke Clinical Research InstituteMedicalResearch.com Interview with: 
Matthew E. Dupre, PhD
Associate Professor of Medicine
Department of Community and Family Medicine
Department of Sociology
Duke Clinical Research Institute

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

Dr. Dupre: The negative health consequences of divorce have been known for some time.  However, we showed that lifetime exposure to divorce can have a lasting impact on ones’ cardiovascular health, particularly in women.  Results from our study showed that risks for acute myocardial infarction (AMI) were significantly higher in women who had one divorce, two or more divorces, and among the remarried compared with continuously married women after adjusting for multiple risk factors.  Risks for AMI were elevated only in men with a history of two or more divorces relative to continuously married men. We were especially surprised to find that women who remarried had risks for AMI that were nearly equivalent to that of divorced women.  Men who remarried had no significant risk for acute myocardial infarction.

The results of this study provide strong evidence that cumulative exposure to divorce increases the risk of acute myocardial infarction in older adults.  Also somewhat unexpected was that the associations remained largely unchanged after accounting for a variety socioeconomic, psychosocial, behavioral, and physiological factors.  However, we lacked information on several factors that we suspect may have contributed to the risks related to divorce – such as elevated stress, anxiety, and the loss of social support; as well as possible changes is medication adherence or other prophylactic behaviors.

MedicalResearch: What should clinicians and patients take away from your report? Continue reading

Pre-Hospital Delay Influences Sex Differences in Acute Coronary Care

MedicalResearch.com Interview with:
Raffaele Bugiardini, M.D.
Professor of Cardiology
University of Bologna

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

Dr. Bugiardini: Our analysis differs from previous reports of outcomes following STEMI because prior studies have not looked at sex differences in outcomes adjusted for time from symptom onset to hospital presentation and subsequent utilization of cardiac revascularization procedures, and rates of revascularization are typically significantly lower in women compared with men

Our study is the first to look at the relationship between delays and outcomes. Continue reading

Early Onset, Frequent Hot Flashes Linked To Increased Cardiovascular Disease Risk

Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of PittsburghMedicalResearch.com Interview with:
Dr. Rebecca Clark Thurston Ph.D
Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science
University of Pittsburgh

 

MedicalResearch: What is the background for these studies? What are the main findings?

Dr. Clark Thurston: The understanding of women’s cardiovascular disease and the role that reproductive factors play in women’s cardiovascular health is evolving. There are some studies showing links between menopausal hot flashes and cardiovascular disease risk in women. These studies help further refine this understanding. We showed in two separate studies that women who have hot flashes, particularly frequent hot flashes early in midlife, have poorer vascular health on certain indices.

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IMAGINE Trial: Worse Outcomes For Women Than Men After CABG

Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center UtrechtMedicalResearch.com Interview with:
Saskia Haitjema
MD PhD candidate
Division Heart and Lung, Laboratory of Experimental Cardiology
University Medical Center Utrecht

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

Response: Although cardiovascular diseases are often considered a disease of men, more women than men die each year of cardiovascular diseases. Sex-differences are increasingly being researched and acknowledged. For treatment and prognosis of coronary artery disease, however, many discrepancies exist between studies that investigated sex-differences. For example, it remains unclear whether the observed differences in the outcome after coronary artery bypass grafting (CABG) are due to a different risk burden between men and women or whether female sex is an independent risk factor.

In a group of 2553 patients followed up during a median of 2.5 years after CABG we found an increased risk for worse outcome in women versus men. We found a strong indication for female sex as an independent risk factor, but lacked power to definitively prove th

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Many Patients With Heart Failure Report Impairment of Daily Activities

dr-shannon-dunlayMedicalResearch.com Interview with:
Shannon M. Dunlay, M.D. M.S.
Advanced Heart Failure and Cardiac Transplantation
Assistant Professor of Medicine and Health Care Policy and Research
Mayo Clinic Rochester
MedicalResearch: What is the background for this study?

Dr. Dunlay: Loss of mobility and independence can complicate the care of patients with chronic conditions such as heart failure, and can degrade their quality of life.  However, we have a very poor understanding of the burden of disability in patients with heart failure and how it impacts outcomes.  What are the main findings?  In this study, patients with heart failure were asked whether they had difficulty performing activities of daily living (ADLs)—these include normal activities that most people do in daily life such as eating, bathing, dressing, and walking.  Most patients with heart failure reported having difficulty with at least one ADL at the beginning of the study, and over 1/3 had moderate or severe difficulty with activities of daily living.  Patients who were older, female and had other chronic conditions such as diabetes, dementia and obesity had more difficulty with activities of daily living.  Patients that reported more difficulty with ADLs (worse mobility) were more likely to die and be hospitalized over time.  Some patients had a decline in function over time, and this was also predictive of worse outcomes.

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Research Aims To Understand Heart Failure In Women

Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of PennsylvaniaMedicalResearch.com Interview with:
Dawn Pedrotty, MD, PhD

Cardiovascular Medicine Fellowship
University of Pennsylvania

MedicalResearch: What is the background for this review? What are the main findings?

Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation.
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Women With Atrial Fibrillation At Greater Risk Of Stroke Than Men

Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC Professor of Cardiovascular Medicine, University of Birmingham, UK; Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark; Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK; Visiting Professor of Cardiology, University of Belgrade, Serbia Centre for Cardiovascular Sciences City Hospital Birmingham  England UKMedicalResearch.com Interview with:
Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC
Professor of Cardiovascular Medicine,
Adjunct Professor of Cardiovascular Sciences,
Thrombosis Research Unit, Aalborg University, Denmark;
Aston Centre for Cardiovascular Sciences City Hospital Birmingham
England UK

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

Prof. Lip: Women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation.

The reasons for this elevated risk remain unclear.

The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention.

Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.

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Young Women With Heart Attack May Have Confusing Symptoms

Judith Lichtman, PhD, MPH Associate Professor (with tenure) Chair, Department of Chronic Disease Epidemiology Yale School of Public Health New Haven, CT 06520-803MedicalResearch.com Interview with:
Judith Lichtman, PhD, MPH
Associate Professor (with tenure)
Chair, Department of Chronic Disease Epidemiology
Yale School of Public Health
New Haven, CT 06520-803

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

Dr. Lichtman: Heart disease in younger women (18-55 years of age) is relatively rare, and represents less than 5% of all heart disease in women; however, young women who present with a heart attack are twice as likely to die in the hospital as compared with a similarly aged man, and this excess mortality risk continues beyond the index event. Delays in seeking prompt care has been suggested as one potential cause for the excess mortality in young women. We were interested in learning about the recognition of symptoms, perceived risk of heart disease, decision-making process to seek medical care, and interactions with the healthcare system among young women who recently had a heart attack. We found that even though the majority of young women presented with chest pain, they also experienced many other symptoms such as fatigue, nausea, muscle pain, and weakness. They commonly attributed symptoms to non-cardiac conditions because they felt they did not experience the “Hollywood Heart Attack” that is commonly portrayed in the media. Interestingly, despite reporting a strong family history of cardiac disease, and having multiple risk factors, many of the women we spoke with did not perceive they were at risk for heart disease, and many were not working with their physicians to manage their risk factors. They were also concerned about being seen as a hypochondriac if they reported their symptoms. Finally, women reported that the healthcare system was not consistently responsive when they reported their symptoms.

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Women With Heart Failure Less Likely To Be Referred For Specialty Care

Jennifer L. Cook, MD FAHA Assistant Professor of Medicine | Heart Failure and Transplantation Medical Director Left Ventricular Assist Device Program Medical University of South Carolina Charleston, SC 29425MedicalResearch.com Interview with:
Jennifer L. Cook, MD FAHA
Assistant Professor of Medicine | Heart Failure and Transplantation
Medical Director Left Ventricular Assist Device Program
Medical University of South Carolina
Charleston, SC 29425

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

Dr. Cook: Although the incidence of heart failure is similar in men and women, women are more likely to die from it.  Despite this fact a common misperception persists that men are at greater risk.  Although advanced therapies such as mechanical support are as effective in women as in men, women are less likely to receive mechanical support.  In clinical trials investigating mechanical support as a bridge to transplant less than 30% of patients were women.  In trials investigating mechanical support for patients ineligible for heart transplant even fewer were women, less than 20%.  .

Medical Research: What should clinicians and patients take away from your report?

Dr. Cook: It has been shown that women with heart failure are more likely to remain under the care of a primary physician instead of being referred for specialized cardiovascular care.  The explanation for this pattern is not understood.  It is important to raise awareness and emphasize the high risk of heart failure mortality among women.

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Women Veterans Undergoing Cardiac Catheterization Highlight Link Between Stress and CAD

Claire Duvernoy, MD Chief, Cardiology Section VA Ann Arbor Healthcare System Professor of Medicine University of Michigan Health System Ann Arbor, MI MedicalResearch.com Interview with:
Claire Duvernoy, MD

Chief, Cardiology Section
VA Ann Arbor Healthcare System
Professor of Medicine
University of Michigan Health System Ann Arbor, MI

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

Dr. Duvernoy: We wanted to look at the indications and outcomes for women veterans undergoing cardiac catheterization procedures as compared with men veterans, given that we know that there are significant gender differences in the non-veteran population between women and men undergoing cardiac catheterization.
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