Sex Differences in Imaging for Structural Heart Disease: What is Normal for Women?

Background Sex differences in premature mortality is well documented, but we have less knowledge about sex differences in disability, how this varies across the life course, and what risk factors attribute to these differences. Using data from the Global Burden of Disease Study (GBD) 2019, we examined sex differences in diseases burden in Norway. Methods Data for years of life lost (YLLs), years lived with disability (YLDs) and the sum of these two; disability-adjusted life-years (DALYs), were extracted from GBD 2019 by sex and age groups, in addition to data on risk factors (data will be updated upon the release of GBD 2021). Results In 2019, the age-standardized DALY rate was similar in males (18 901, 95% CI 16 338-21 823) and females (18 165, 95% CI 14 875 - 21 791) in Norway. However, in women, a larger proportion of the disease burden was due to causes leading to years lived with disability (YLD), compared to in men. This was found across all age groups, starting in adolescence. A larger proportion of the disease burden among males could be attributed to known and preventable risk factors (41.0%, 95% CI 38.3-43.7) compared to in females (32.4%, 95% CI 29.3-35.6%). Conclusions The total burden of disease is equally shared by men and women in Norway. However, women have a larger share of the total burden of years lived with disability. As we know much less about what contributes to disability compared to premature mortality, we also have less knowledge about the causes of disease burden in women. This in turn, affects our ability to develop targeted and effective health policies to address sex differences in disease burden. Key messages • Women carry a larger share of the total number of years lived with disability, while men have higher premature mortality. • We know less about how to prevent disease burden in women than in men.

BackgroundRecent influenza surveillance data from Africa suggest an important burden of influenza-associated morbidity and mortality. In tropical countries where influenza virus transmission may not be confined to a single season alternative strategies for vaccine distribution via antenatal care (ANC) or semiannual campaigns should be considered.MethodsUsing data on monthly influenza disease burden in women of child-bearing age and infants aged 0–5 months in Kenya from 2010–2014, we estimated the number of outcomes (illnesses, medical visits, hospitalizations, and deaths) that occurred and that may have been averted through influenza vaccination of pregnant women using: 1) a year-round immunization strategy through ANC, 2) annual vaccination campaigns, and 3) semiannual vaccination campaigns.ResultsDuring 2010–2014, influenza resulted in an estimated 279,047 illnesses, 36,276 medical visits, 1612 hospitalizations and 243 deaths in pregnant women and 157,053 illnesses, 65,177 medical visits, 4197 hospitalizations, and 755 deaths in infants aged 0–5 months in Kenya. Depending on the mode of distribution and the vaccine coverage achieved, 12.8–31.4% of influenza-associated disease in pregnant women and 11.6–22.1% in infants aged 0–5 months might have been prevented through maternal influenza immunization. In this model, point estimates for influenza-associated disease averted through maternal vaccination delivered year-round in ANC or semiannually in campaigns were higher than vaccination delivered in a single annual campaign, but confidence intervals overlapped.ConclusionsVaccinating pregnant women against influenza can reduce the burden of influenza-associated illness, hospitalization and death in both pregnant women and their young infants. Alternative immunization strategies may avert more influenza-associated disease in countries where influenza virus transmission occurs throughout the year.

Time for sex specific atherosclerosis risk prediction

BackgroundThere is increasing evidence revealing sex differences in the manifestations of axial spondyloarthritis (axSpA). However, the results in this regard are heterogeneous and studies that analyze the influence of sex...

Atrial fibrillation (AF) significantly increases the risk of stroke and disease burden and is an established predictor of poor outcomes after stroke. However, data regarding sex differences in long-term outcomes following stroke in patients with AF are scarce. We thus aimed to assess these differences. We recruited 951 consecutive patients with acute ischemic stroke and non-valvular atrial fibrillation (NVAF) treated at three hospitals in Tianjin, China, from January 2006 to September 2014. Information regarding stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence) at 3, 12, and 36 months after stroke was recorded. The prevalence of NVAF was 8.4% overall, with a higher frequency in women than in men (11.3 vs. 6.9%, P < 0.001). Among patients with NVAF, women were older than men. Women were more likely than men to have severe stroke (38.8 vs. 29.5%, P < 0.001), high levels of total cholesterol and high- and low-density lipoprotein cholesterol (all P < 0.001), hypertension (69.1 vs. 61.2%, P = 0.012), dyslipidemia (29.8 vs. 20.7%, P = 0.001), and obesity (18.5 vs. 11.6%, P = 0.003); they were less likely than men to be current smokers (12.2 vs. 33.6%, P < 0.001) and to consume alcohol (0.9 vs. 13.9%, P < 0.001). There were greater risks of dependency and recurrence at 36 months after stroke in women than in men [odds ratios (95% confidence intervals), 1.64 (1.02–2.64) for dependency, P = 0.043; and 2.03 (1.28–3.20) for recurrence, P = 0.002] after adjustment for stroke subtype, severity, and risk factors. These findings suggest that it is crucial to emphasize the need for individualized stroke prevention education and promotion of healthy lifestyles in order to improve NVAF-related stroke outcomes and reduce disease burden in women.

Background Post-COVID-19 Syndrome (PCS) involves multiple lead symptoms, including reduced physical performance, fatigue, dyspnea, cognitive impairment, and psychological distress. While it has been shown that exercise-based rehabilitation in PCS is effective, sex-specific differences are underreported. Purpose To compare the effects of exercise-based rehabilitation on pulmonary function, cardiopulmonary exercise capacity, and health-related outcomes in long-term female and male PCS patients. Methods A prospective cohort study was performed with PCS patients attending center-based rehabilitation. Cardiopulmonary exercise testing (CPET) and spirometry were conducted at admission and before discharge. Questionnaires were used to assess health-related quality of life, fatigue, wellbeing, and workability for up to 6 months. Results 145 patients (women, n=52 [36%]) with a mean age of 50.2 ± 10.7 years (women, 47.1 ± 12.7 years; men, 52.0 ± 9.1 years; p=0.018) were referred to rehabilitation 262.0 ± 128.8 days (women, 285.5 ± 140.6 days; men, 248.8 ± 112.0 days; p=0.110) after acute infection. Diagnosed lead symptoms were fatigue/exercise intolerance (81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%). Men presented with lower relative baseline exercise capacity (68.8 ± 13.3%) compared to women (82.0 ± 14.3%, p&amp;lt;0.001), but female PCS patients showed greater improvement in submaximal workload (p=0.026). By contrast, men exhibited higher values for FEV1/VC, MEF, and PEF and lower VC at baseline (p≤0.038), while FEV1/VC showed greater improvements in women (p=0.027). Higher fatigue and lower wellbeing were detected in women at baseline which correlated with impaired pulmonary function (p&amp;lt;0.05). Disease perception including fatigue, health-related quality of life, wellbeing and workability improved for up to six-month after rehabilitation. Conclusions Exercise-based rehabilitation improves pulmonary function, cardiopulmonary fitness, and disease burden in women and men with long-term PCS. While women with PCS may benefit from intensified respiratory muscle training, rehabilitation in men with PCS should set a strong focus on physical exercise training. Clinical assessment for all PCS patients should include CPET and pulmonary function tests and assessments of fatigue to document limitations and tailor therapeutical strategies.

Coronary artery disease burden in women poorly explained by traditional risk factors: Sex disaggregated analyses from the BioHEART-CT study

.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

BackgroundThyroid cancer has increased globally, particularly among young women, highlighting the need for research on its epidemiological characteristics and disease burden in women of child-bearing age. This study aimed to analyze the global and regional burden of thyroid cancer from 1990 to 2021, focusing on women of child-bearing age, and to predict trends up to 2035.MethodsThis study analyzed the global and regional burden of thyroid cancer from 1990 to 2021, focusing on women of child-bearing age, using data from the Global Burden of Disease Study. Key indicators assessed included incidence, mortality, and disability-adjusted life years (DALYs) of thyroid cancer in different regions. Statistical analysis techniques were employed to compare the burden across regions and countries, examining the effects of age, sex, and socio-demographic index (SDI) on disease burden. The Bayesian Age-Period-Cohort model was used to predict the incidence, mortality, and DALYs of thyroid cancer from 2022 to 2035.ResultsGlobally, in 2021, there were 67,558 new cases of thyroid cancer among women of child-bearing age, with 3,260 deaths and 206,508 DALYs. Compared to 1990, new cases increased by 156.86%, deaths increased by 52.33%, and DALYs increased by 61.72%. The age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALYs rate (ASDR) per 100,000 population were 3.37, 0.16, and 10.38, respectively. The Estimated Annual Percentage Change (EAPC) for ASIR was 1.47, indicating an increasing trend, whereas the EAPCs for ASMR and ASDR were -0.35 and -0.05, showing decreasing trends. The burden of thyroid cancer among patients with women of child-bearing age exhibited a significant age-related trend, peaking in the 45–49 age group. There were significant regional and national variations in thyroid cancer burden, which are closely related to the SDI. By 2035, a notable increase in the incidence, mortality, and DALYs associated with thyroid cancer among women of child-bearing age has been predicted globally.ConclusionOver the past 30 years, thyroid cancer incidence among women has significantly increased globally, with slightly declining mortality and DALYs rates. Significant regional and national variations are closely linked to the SDI. As the population ages and incidence continues to rise, targeted prevention and treatment strategies, particularly in low SDI regions, are crucial to effectively reduce mortality and DALYs.

The need for public education on HPV and cervical cancer prevention in Asia: Opinions of experts at the AOGIN Conference

BackgroundWe aimed to explore the burden of thyroid cancer worldwide from 1990 to 2019 and to project its future trends from 2020 to 2030.MethodsBased on annual data on thyroid cancer cases from 1990 to 2019 available in the Global Burden of Disease (GBD) database, we calculated the age-standardised incidence, death, and disability-adjusted life year (DALY) rates for thyroid cancer. We used the estimated annual percentage change (EPAC) to quantify the temporal trends in these age-standardised rates from 1990 to 2019 and applied generalised additive models to project the disease burden from 2020 to 2030.ResultsThe global age-standardised incidence rate (ASIR) of thyroid cancer increased from 1990 to 2019, with a higher overall disease burden in women than in men at both study time points. The male-to-female ratios for the ASIR increased from 0.41 in 1990 to 0.51 in 2019, while the ratio for the age-standardised death rate (ASDR) increased from 0.60 to 0.82. The models predicted the United Arab Emirates would have the fastest rising trend in both the ASIR (estimated annual percentage changes (EAPC) = 4.19) and age-standardised DALY rate (EAPC = 4.36) in 2020–30, while Saint Kitts and Nevis will have the fastest rising trend in the ASDR (EAPC = 2.29). Meanwhile, the growth trends for the ASDR and age-standardised DALY rate are projected to increase across countries in this period. A correlation analysis of the global burden of thyroid cancer between 1990–2019 and 2020–30 showed a significant positive correlation between the increase in the ASIR and socio-demographic index (SDI) in low-SDI and low-middle-SDI countries.ConclusionsThe global burden of thyroid cancer is increasing, especially in the female population and in low-middle-SDI regions, underscoring a need to target them for effective prevention, diagnosis, and treatment.

The aim of the present review was to highlight gender and sex differences in spondyloarthritis (SpA) to achieve a better awareness of the unmet needs of women with SpA. A literature search of PubMed was performed, including manuscripts in English published in the last twenty years, to select and analyze articles related to SpA and sex and gender differences in epidemiology, genetics, immunology, clinical features, and response to treatment. Women and men with SpA have different disease phenotypes, and this heterogeneity mirrors anatomical, physiological, and hormonal differences, as well as peculiar variability in response to treatment. These underestimated differences, which include several biological factors and intertwined social factors, contribute to diagnostic delay and increased disease burden in women with SpA. This review elucidates gender differences in SpA and raises awareness about the need for gender-related stratification of SpA patients with the concomitant implementation of SpA gender differences in future research and upcoming clinical trials. A deeper knowledge of SpA in women is indispensable to pave the way for real personalized medicine for SpA patients to reduce misdiagnosis and delay in intercepting the disease.

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.

BackgroundPost-COVID-19 Syndrome (PCS) entails a spectrum of symptoms, including fatigue, reduced physical performance, dyspnea, cognitive impairment, and psychological distress. Given the effectiveness of exercise-based rehabilitation for PCS, this study examined the efficacy of rehabilitation for PCS patients, focusing on sex-specific differences.MethodsProspective cohort study during inpatient rehabilitation. Cardiopulmonary exercise testing and spirometry were performed at admission and discharge. Questionnaires were used to assess fatigue, health-related quality of life, wellbeing, and workability for up to 6 months.Results145 patients (36% female, 47.1 ± 12.7 years; 64% male, 52.0 ± 9.1 years; p = 0.018) were referred to rehabilitation 262.0 ± 128.8 days after infection (female, 285.5 ± 140.6 days; male, 248.8 ± 112.0 days; p = 0.110). Lead symptoms included fatigue/exercise intolerance (81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%). Women presented with higher relative baseline exercise capacity (82.0 ± 14.3%) than males (68.8 ± 13.3%, p < 0.001), but showed greater improvement in submaximal workload (p = 0.026). Men exhibited higher values for FEV1, FEV1/VC, PEF, and MEF and lower VC at baseline (p ≤ 0.038), while FEV1/VC improvement more in women (p = 0.027). Higher baseline fatigue and lower wellbeing was detected in women and correlated with impaired pulmonary function (p < 0.05). Disease perception including fatigue, health-related quality of life, wellbeing and workability improved with rehabilitation for up to six-month.ConclusionsRehabilitation improves cardiopulmonary fitness, pulmonary function and disease burden in women and men with long-term PCS. Women with PCS may benefit from intensified respiratory muscle training. Clinical assessment should include cardiopulmonary exercise testing and pulmonary function tests and fatigue assessments for all PCS patients to document limitations and tailor therapeutical strategies.

Myasthenia gravis in women.