Cardiovascular Disease In Women Research Articles

Abstract 4116692: Cardiovascular Safety of Fertility Therapy: A Systematic Review and Meta-Analysis

Background and Aims: The increasing use of assisted reproductive technology (ART) has raised concerns regarding its long-term cardiovascular safety due to potential hormonal imbalances and pro-thrombotic states. This study aimed to assess the long-term cardiovascular risk associated with fertility treatments in women. Methods: Following PRISMA guidelines, a systematic review and meta-analysis was conducted via MEDLINE (Pubmed) from inception to January 2024. Randomized, cohort or case-control studies were included if fulfilling the following criteria: the association between fertility therapy and the subsequent cardiovascular outcome was reported and conditioned on confounding factors (at least age); the presence of a control group; minimum one-year follow-up. Effect size (ES) estimates of the association between fertility therapy and subsequent cardiovascular disease were pooled using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with the I 2 index. This study is registered with PROSPERO (CRD42024505605). Results: Of 7,298 articles screened, eleven studies were included, encompassing 606,912 women undergoing ART and 70,562,486 controls. The analysis found no increase in the long-term risk of major adverse cardiovascular events (ES=0.97, 95% CI=0.81-1.16, I 2 =89.55%, p=0.73), coronary heart disease (ES=0.88, 95% CI=0.71-1.10, I 2 =24.36%, p=0.26), stroke (ES=1.20, 95% CI=0.96-1.49, I 2 =48.33%, p=0.11), heart failure (ES=0.74, 95% CI=0.60-0.94, I 2 =0.00%, p=0.01), venous thromboembolism (ES=1.03, 95% CI=0.78-1.34, I 2 =54.41%, p=0.85), hypertension (ES=1.08, 95% CI=0.88-1.326, I 2 =94.63%, p=0.46), or diabetes (ES=1.03, 95% CI=0.86-1.22, I 2 =78.44%, p=0.77). Conclusions: ART does not increase the long-term risk of cardiovascular diseases in women. These results support the cardiovascular safety of fertility treatments, though further research into specific ART techniques and extended follow-up is recommended.

Sustained Reduction of Subclinical Inflammation in the years after Breastfeeding.

Lactation is associated with lower future risk of cardiovascular disease in women but the mechanism(s) underlying this relationship remain unclear. We sought to characterize the relationship between duration of exclusive breastfeeding and cardiovascular risk factors over the first 5-years postpartum. In this prospective cohort study, 328 women underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, fasting glucose, adiponectin, C-reactive protein (CRP)) at 1-year, 3-years, and 5-years postpartum. Cardiovascular risk factors in 3 groups defined by duration of exclusive breastfeeding, as follows: <3 months (n=107), 3-6 months (n=101), and ≥6 months (n=120). The prevalence of metabolic syndrome did not differ between the groups at 3-years but, by 5-years postpartum, was higher in women who had exclusively breastfed <3 months than in those who did so for 3-6 and ≥6 months, respectively (14.0% vs 6.9% vs 4.2%; p=0.02). However, after adjustment for covariates (including BMI), there were no significant differences between groups in blood pressure, glucose, LDL cholesterol, HDL cholesterol, triglycerides or adiponectin. Indeed, the only cardiovascular risk factor difference that persisted after covariate adjustment was that women who had exclusively breastfed <3 months had higher CRP at both 3-years (p=0.04) and 5-years (p=0.01). Moreover, generalized estimating equation analyses with adjustment for covariates (including time-dependent BMI) showed that CRP remained higher over time in these women, as compared to their peers, from 1-year to 3-years to 5-years postpartum (p=0.03). Sustained reduction of subclinical inflammation may contribute to the cardioprotective effect of lactation in women.

Extreme LDL-C concentration is associated with increased cardiovascular disease in women with homozygous familial hypercholesterolemia

Extreme LDL-C concentration is associated with increased cardiovascular disease in women with homozygous familial hypercholesterolemia

Preventing ischemic heart disease in women: a systematic review of global directives and policies

Cardiovascular disease is the leading cause of mortality in women worldwide. Yet cardiovascular disease in women remains underdiagnosed and undertreated, especially among vulnerable populations such as older women, low-income populations, and ethnic minorities. Resultantly, reduction in cardiovascular mortality among women has stagnated. To examine, consolidate current research findings and policies to identify gaps in women’s heart health practice, this review screened 21476 records and synthesized results from 124 English language publications worldwide. Using a life course approach, we assessed the connection between clinical recommendations and policy, and documented global recommendations and policies addressing prevention of cardiovascular disease in women. Key recommendations include fostering environments that encourage sustainable health behaviors for young women, advocating for national surveillance systems and guidelines for monitoring and increasing the understanding of cardiovascular health in high-risk pregnancy/postpartum groups, developing community prevention programs for midlife/menopause, and implementing direct population health management initiatives for elderly women, with an emphasis on higher risk groups. Inequalities still exist among women with varying socioeconomic status and race between countries, and even within countries.

Combined mammographic breast density and breast arterial calcification is incrementally predictive of coronary artery disease beyond traditional risk factors

Abstract Background Coronary artery disease (CAD) risk is underestimated in women using current risk stratification tools. The mammographic finding of breast arterial calcification (BAC) associates with CAD. Furthermore, breast adipose tissue, measured through breast density (BD) on mammography (low breast density indicates high adiposity) has shown potential to act as a pro-inflammatory, pro-atherogenic fat deposit. Given its uptake in screening programs, mammography may therefore represent a novel risk stratification tool for cardiovascular disease in women. Purpose To evaluate the association between the combined mammographic features of BD and BAC, with CAD. Methods Single-centre, retrospective, cross-sectional study, including 153 women, mean age 62±10, who had both clinically indicated mammography, and coronary computed tomography angiogram (CCTA) for suspected CAD. CAD risk was identified by the CAD Consortium Score, with a 15% threshold for low and high risk. BD was visually assessed and categorised by 4-level BI-RADS grade with grade A-B representing low density, and C-D representing high density (Figure 1). BAC was visually assessed and categorised as present/absent (Figure 1). CAD was categorised as presence/absence of coronary artery plaque on CCTA. Logistic regression was performed with results presented as Odds Ratio (OR) and [95% Confidence Intervals]. Receiver operator characteristic area under the curve (AUC) was used for model discrimination. Results Low BD (n=103 (67%)) was associated with CAD (OR 3.20 [1.58-6.53], p=0.001, as was BAC presence (n=37 (24%), OR 4.36 [1.58-12], p=0.004). There were 51 (33%) with elevated CAD risk. Participants were categorised into 4 subgroups based on low/high BD and presence/absence of BAC: 29 (19%) had low BD and BAC, 74 (48%) had low BD and no BAC, 8 (5%) had high BD and BAC and 42 (27%) had high BD and no BAC. Significantly higher proportions of CAD were noted with low BD and BAC alone, as well as combined low BD and BAC (Figure 2). Compared with high BD/BAC negative, the presence of low BD and BAC independently associated with CAD (OR 5.27 [1.19-23.3], p=0.03). Significant incremental benefit was seen after adding BD/BAC status to CAD Consortium Score (AUC 0.65 vs. 0.72, p=0.004). Conclusions Combined, and individual mammographic features of low BD and BAC presence are associated with CAD and improve risk prediction beyond standard coronary risk probabilities. Standardised reporting of these features to inform risk identification may be of further benefit and should be tested in prospective screening studies.

Lipid changes across menopause status point to increased cardiovascular risk

Abstract Background While women develop cardiovascular disease (CVD) approximately ten years later than men, risk of CVD in women rises precipitously following menopause. The mechanisms underlying this acceleration in CVD risk are not well elucidated, but adverse changes in lipid measures are known to occur during the perimenopause period. Previous investigations have been largely restricted to traditional lipid measures and have not examined changes in lipoprotein particles including lipid subfractions and particle number. Purpose We sought to examine longitudinal changes in lipoprotein particles that occur during the menopause transition. Methods A total of 1305 participants in the Dallas Heart Study with known menopause status underwent measurement of LDL-P, HDL-P, sd-LDL, and ld-HDL by NMR LipoProfile LP4 algorithm (LabCorp, Raleigh Durham, NC, U.S.A.) at 2 examinations (between 7-8 years between DHS studies). We compared longitudinal changes in lipoprotein measures between pre-, peri-, post-menopausal women and men using multivariable adjusted linear regression models. For our analysis peri- is the group that was pre-menopause at DHS I and post-menopause at DHS 2, not to mean the period before menopause. Results There 1346 men (referent group) included in the study with a mean age of 43 ± 9.4 years. There was a total of 1246 women with a mean age of 42 ± 5.6 for peri-group, 54 ± 6.2 for post-group, and 34 ± 3.08 for the pre-group. Of the women 440 (35.3%) were pre-menopausal, 298 (23.9%) were peri-menopausal, and 508 (40.8%) were post-menopausal. Over a median follow-up time of 7 years. All three groups had an increase in LDL-P but the greatest percent change is between peri and post, 18.30 (SE 3.05, P&amp;lt;0.001). When compared to men the post-group has the greatest percent change of HDL-P with a negative change of 4.77 (SE 0.948 P&amp;lt;0.0001). Small-dense LDL had the highest percent change in the peri- group when compared to men with a change of 578.62 (SE 288.45, P&amp;lt;0.045). Large-dense HDL had greatest percent change in the post- group when compared to men with negative change of 37.84 (SE 12.83, P&amp;lt;0.0032). Conclusions We found that menopause is associated with adverse changes in lipoprotein profiles, with the most pronounced changes in LDL-particles and subfractions observed for peri-menopausal women. By contrast, post-menopausal women demonstrated the greatest reductions in HDL-particles and subfractions. Taken together, these changes suggest that menopause is associated with a transition to a more atherogenic lipoprotein profile. Further research is needed to investigate whether these adverse changes in lipoproteins translate to greater CV risk.

Unveiling the determinants of women's cardiovascular disease awareness in northern Italy: insights from the Call for Women project

Abstract Background Despite strides in prevention, diagnosis, and treatment of cardiovascular disease (CVD), CVD remains the leading cause of death (LCOD) in women. While global initiatives aim to enhance awareness, recent studies reveal deficiencies, particularly in Europe where misconceptions prevail, hindering women’s understanding of CVD severity. Purpose To describe determinants affecting awareness of CVD as LCOD among women in the Lombardy region, Italy. Methods A web-based survey (the ‘Call for Women’ Project) was conducted from Sep 2022 to Nov 2023, including women aged 18 and above. The primary focus was awareness of CVD as the LCOD (scaled 1 [adequate] to 2 [inadequate]). The individual predictors (i.e., determinants) of adequate awareness were assessed through a logistic regression (LR) model. Variables exhibiting a point biserial correlation coefficient (rpb) with a p-value ≤ 0.1 were included in the LR model as independent variables. The goodness-of-fit for the LR model was determined using the Hosmer-Lemeshow test and Nagelkerke’s pseudo-R2. Independent variables were entered simultaneously into the model to examine each variable’s relatively unique contribution. Results Out of 3,487 women who completed the survey, only 35.6% (n = 1,240) showed adequate awareness. The Hosmer-Lemeshow test indicated a good model fit (p-value = 0.692), suggesting that the model adequately captures the relationships between the variables and the outcome. Figure 1 shows the contribution of each individual characteristic in modulating cardiovascular risk awareness. The odds of being aware of CVD as the LCOD were significantly influenced by age, decreasing by approximately 1.3% for each additional year of age (Adj. OR = 0.987; 95% CI = 0.981–0.993; p-value &amp;lt; 0.001). Individuals with a lower secondary school diploma exhibited a substantial increase in the odds of awareness, with an Adj. OR of 4.999 (95% CI = 3.074–8.128; p-value &amp;lt; 0.001). Similarly, those with an upper secondary school diploma, a bachelor’s degree, or a master’s degree also demonstrated higher odds of awareness (Adj. OR = 2.427, 1.673, and 1.429, respectively; all p-values &amp;lt; 0.001). Regarding lifestyle, higher number of children was associated with increased odds of awareness, with an Adj. OR of 1.109 (95% CI = 1.027–1.197; p-value = 0.008). Consumption of dry fruits and fruits showed a positive association with an Adj. OR of 1.014 (95% CI = 1.005–1.024; p-value = 0.004), indicating a potential role of dietary habits in influencing awareness. BMI and physical activity did not exhibit statistically significant associations with awareness of CVD risk. Conclusions This pilot study, limited to one region only, reveals key determinants of awareness of CVD as the LCOD among women in northern Italy. Tailoring interventions to address these determinants has the potential to narrow the gaps in CVD awareness among women.

The women's cardiovascular disease risk perception after hypertensive disorders of pregnancy: A qualitative meta-synthesis

BackgroundHypertensive disorders of pregnancy is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous hypertensive disorders of pregnancy are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks. ObjectivesThis study aims to examine and synthesize qualitative evidence on the perceptions and awareness of women with hypertensive disorders of pregnancy following perceived cardiovascular disease risk. MethodsComputer searches of Pub Med, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang database, Vip and SinoMed for all qualitative studies that met the inclusion criteria. The time frame for the search was from the establishment of the database to April 2024. Literature quality was assessed using the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Qualitative Research quality assessment criteria, and results were summarised and integrated using a pooled integration approach. ResultsEleven studies that fulfilled the inclusion criteria and quality assessment were included in the meta synthesis. Three themes were identified during the analysis: (1)Factors affecting perceived cardiovascular risk in women with hypertensive disorders of pregnancy; (2)Women with hypertensive disorders of pregnancy use different strategies to cope with cardiovascular risk; (3)Needs and expectations for coping with cardiovascular disease risk. ConclusionsBoth women with hypertensive disorders of pregnancy and healthcare providers lack knowledge of the link between hypertensive disorders of pregnancy and cardiovascular risk. Healthcare professionals should establish a multidimensional support model, pay timely attention to postpartum women's psycho-emotional and risk awareness, and give individualised health education to promote health behaviour change. At the same time, professionals should be given standardised training and personalised follow-up services to reduce the incidence of cardiovascular disease in the future.

Cardiovascular Disease in Women and the Role of Hormone Replacement Therapy.

Cardiovascular disease (CVD) is the leading cause of death in women and manifests more severely and at a later stage in life compared to men. The low estrogen levels during menopause are linked to an increased CVD risk. This association has promoted research regarding the role of hormone replacement therapy (HRT) in reducing the symptoms and diseases related to menopause, including CVD. This review article aims to discuss the biological changes associated with menopause and their impact on CVD. It also examines the effects of HRT in women with comorbidities related to CVD,its indications, risks, and contraindications.

Mammographic breast density and cardiovascular disease in women. A literature review

The world is searching for new simple and economically available gender-specific markers to improve cardiovascular risk stratification in women. The aim of this review was to analyze the association of mammographic density (MD) with cardiovascular disease (CVD). In low MD, i.e., high relative mammary gland fat content, there is a higher incidence of the main risk factors for CVD: hypertension, hyperlipidemia, hyperglycemia, excess body weight, as well as an increase in the volume of fat depots, visceral and ectopic fat. Low MD is associated with a higher 10-year risk of adverse cardiovascular events such as coronary artery disease, stroke, peripheral arterial disease, revascularization, and heart failure, and may serve as a predictor of their development. Including MD in the Framingham Risk Score model improves its accuracy. Identification of low MD, as a marker of high cardiovascular risk, allows the use of mammography for early detection and prevention of the two most dangerous diseases among the female population — breast cancer and CVD.

Risk factors for cardiovascular disease in women with preeclampsia and intrauterine growth restriction.

To identify the risk factors for cardiovascular disease in women with pre-eclampsia and intrauterine growth retardation. This cross sectional study was conducted in Department of Gynecology and Obstetrics, Liaquat University Hospital, Hyderabad, from April 2022 to October 2022. Patients with history of intrauterine growth retardation or preeclampsia after 20 weeks of gestation, age more than 18 years were included in this study. Patients were assessed for cardiovascular risk factors during pregnancy. The average age and gestational age were almost equal in preeclampsia and IUGR patients, (p≤0.050). The primparous were higher in preeclampsia than IUGR, n=286 (73.5%) and n=80 (52.3%), respectively, (p=0.000). The average birth weight of IUGR was lower than preeclampsia patients, 925.19±6.35 gram and 1324.76±10.19 gram, respectively, (p=0.000). The average systolic and diastolic blood pressure of IUGR patients was less than preeclampsia patients, (p=0.000). But, the chronic hypertension was higher in preeclampsia patients n=99 (25.4%) as compare to IUGR n=13 (8.5%) patients, (p=0.000). The average cholesterol level in IUGR was 5.52±0.58(mmol/L) versus preeclampsia 5.34±1.01(mmol/L), (p=0.043). The average triglycerides was almost equal in both the groups, (p=0.924). The mean Lp(a) in preeclampsia patients was 177.15±20.15(mg/L) versus 202.94±24.83 (mg/L), (p=0.000). Findings of this study help conclude that women with known history of IUGR or preeclampsia must be screened for possible cardiovascular risk factors and treated for these risk factors in order to avoid future mortality and morbidity associated with cardiovascular diseases.

Abstract P314: A Community Outreach Program Focused on Hypertension Awareness Reaches 600+ People in Rural Georgia and Works to Build the Next Generation of Biomedical Scientists

The U.S. national average for the prevalence of hypertension in women aged 35-44 is 10.8%. In southeastern states including Georgia, Mississippi, and South Carolina, the prevalence of hypertension in women of this same age group is 13.5%, 17.8%, and 15.5%, respectively. The increase is mostly observed in Black women from non-metro areas. Thus, a need exists to improve awareness of cardiovascular risk in these communities and to support scientific research to improve the understanding of how sex contributes to differences in cardiovascular risk factors like hypertension. Rural Obese At Risk (ROAR) establishes a Specialized Center of Research Excellence on Sex Differences (SCORE) homed at Augusta University, spanning three Southeast universities. The overall goal is to establish ROAR as a national resource and recognized leader in cardiovascular disease in females, and to change perceptions and awareness surrounding cardiovascular risk in women across the Southeast, particularly in high-risk groups. One objective of ROAR Augusta is to establish a community outreach pipeline of trained scientists to increase awareness of sex as a biological variable (SABV), promote optimal cardiovascular healthcare for men and women, and empower the community to self-monitor and identify barriers to improving access to healthcare through the Community Engagement Core (CEC). The CEC aims to develop meaningful relationships among the research, medical, and lay communities promoting the increase of awareness of the importance of blood pressure control in women through community outreach, a Qualitative Needs Assessment, design and dissemination of unique illustrative educational materials related to cardiovascular disease in women, and the launch of a Blood Pressure Checks for Women campaign. In six months (December 2023 – May 2024), ROAR participated in 10 community events providing blood pressure checks and educational materials and reaching more than 600 people in 6 counties; awarded one pre-doctoral career enhancement mini-sabbatical; awarded three early career SABV pilot grants; hosted a SABV symposium reaching 120 biomedical scientists; and hosted a SABV seminar and workshop reaching 142 biomedical scientists. In conclusion, the ROAR CEC is well on its way to positively impacting hypertension perceptions and awareness in women across the Southeast.

Awareness and knowledge of cardiovascular disease and their associations with the lifestyles of 8-16-year-old girls: a perspective from Saudi Arabia

BackgroundThere has been an increased focus on children as a target for primordial prevention of cardiovascular disease (CVD). In particular, girls should receive attention to combat the burden of CVD in women, because women have higher CVD mortality and morbidity rates than men do. As health literacy is paramount, the evaluation of awareness, and knowledge of CVD and its risk factors and their associations with the lifestyles of girls forms the basis for planning cardiovascular health promotion programs aiming to improve girls’ immediate health and reduce the future burden of CVD among women.MethodsA prospective cross-sectional study was conducted on a random sample of girls attending elementary and intermediate schools in Riyadh, Saudi Arabia. The girls completed a newly validated 24-item questionnaire that assessed their demographic data, lifestyles, and awareness and knowledge of CVD and its risk factors. Anthropometric and blood pressure measurements were obtained. Knowledge scores were calculated on the basis of correct responses and compared between subgroups via analysis of variance to determine associated factors.ResultsIn total, 469 girls (mean age of 12.5 years) were included. Approximately 41.4% of them did not exercise or only exercised once a week. The dietary intake of important food groups was below or just at the minimal recommended servings for most. Overall, 44.1% were overweight/obese, and almost half were identified as hypertensive on the basis of a single resting measurement. Awareness of CVD as a dangerous disease in adults was 50.3%, whereas, cancer was identified by 61% of participants. Individual risk factors were identified by ≈ 25%, and 16.6% were not aware of any risk factors. The overall knowledge score of the participants was 2.6 (± 1.6) out of a total possible score of 8 representing 32.5% (± 20%). Knowledge levels were positively influenced by increasing school grade (P = 0.001) and family history of CVD (P < 0.001). There was no significant favorable association between improved knowledge level and lifestyle factors.ConclusionThe awareness and knowledge of CVD among girls aged 8–16 years are poor and are largely dissociated from their lifestyle. Improved knowledge scores with increasing school grade and family history of CVD confirm a role for schools and families in improving girls’ knowledge. Our findings mirror those obtained in older women, showing that misinformation among women starts in childhood and should be targeted early in life.

Engaging women in decision-making about their heart health: a literature review with patients' perspective.

Cardiovascular disease (CVD) remains the leading cause of death globally. Although the burden of CVD risk factors tends to be lower in women, they remain at higher risk of developing complications when affected by these risk factors. There is still a lack of awareness surrounding CVD in women, both from a patient's and a clinician's perspective, especially among visible minorities. However, women who are informed about their heart health and who engage in decision-making with their healthcare providers are more likely to modify their lifestyle, and improve their CVD risk. A patient-centered care approach benefits patients' physical and mental health, and is now considered gold-standard for efficient patient care. Engaging women in their heart health will contribute in closing the gap of healthcare disparities between men and women, arising from sociocultural, socioeconomic, and political factors. This comprehensive review of the literature discusses the importance of engaging women in decision-making surrounding their heart health and offers tools for an effective and culturally sensitive patient-provider relationship.

Menopause, Lifestyle Modification, and Cardiovascular Disease in Women: A Prospective Cohort Study

Menopause, Lifestyle Modification, and Cardiovascular Disease in Women: A Prospective Cohort Study

Which chronic diseases contribute the most to healthy life years lost in Algeria?

Chronic diseases contribute significantly to healthy years lost (HYLs). It is critical to investigate which are the most contributing diseases to enable enhancing health programs' effectiveness in improving health expectancy. This paper investigates disease-specific contributions to years lived with chronic diseases in Algeria and examines their recent evolution. We used morbidity data from the last three waves of the Multiple Indicator Cluster Surveys of 2006, 2012-13, and 2018-19. The studied chronic diseases included hypertension, cardiovascular diseases (CVDs), joint diseases, respiratory diseases, and diabetes. We calculated disease-specific contributions using the cause-deleted health expectancy approach. Then, we analyzed time changes and gender-based differences in contributions. The leading cause of HYLs in women is hypertension, followed by diabetes, joint diseases, CVDs, and respiratory diseases. The same ranking applies to men, with joint diseases coming last. The time evolution of relative disease-specific contributions shows an increase in CVDs for women and diabetes for both genders, against a decrease for the other diseases. To improve chronic disease-free life expectancy in Algeria, effective prevention programs must be implemented, with an emphasis on hypertension and diabetes. Further investigation into the risk factors affecting the prevalence and incidence of these diseases is also required.

Sex differences in acute myocardial infarction - Preliminary results from an umbrella review

Abstract Background Cardiovascular disease (CVD) is the leading cause of premature death among women, and the negative impact on public health is profound. Women have higher rates of comorbidities, complications such as stroke, in addition to higher mortality compared to men (1-6) and targeting sex-related differences regarding the treatment of CVD in women is of great importance to prevent the number of CVD events. The purpose of this study was to get an overview of the systematic reviews and meta-analyses investigating sex differences in patients with acute myocardial infarction (AMI) the past 10 years. Methods A systematic search was carried out in Epistemonikos, the largest database of systematic reviews that screens PubMed, Cochrane, Embase, CINAHL, PsycInfo and others (i.e., currently nine databases) (7, 8). The search was conducted 12 January 2024, with the general search strings: (1) sex differences OR gender differences AND myocardial infarction, (2) sex differences OR gender differences OR women OR female AND myocardial infarction. The search was restricted to systematic reviews conducted the last 10 years. Results Forty-nine (search 1: 19, search 2: 30) systematic reviews and meta-analyses were identified, and five studies investigating sex differences in relation to AMI were included. Two systematic reviews, Babioakis (2021) and Meer (2015), reported of longer door-to-balloon (D2B) time and/or symptom-to-balloon (S2B) time in female patients presenting with STEMI and referred for PCI, compared to male patients (9). Chaudhary (2022) investigated adverse event of MINOCA (more commonly in women/ younger age (51-59 years) and reported higher risk of MACE among women than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23), in addition to higher incidence of stroke (3.5% vs. 2.2%, OR 1.3, 1.01-1.68), however no significantly differences were observed for all-cause mortality, non-fatal AMI, and cardiovascular readmissions between the groups (10). Three systematic reviews reported of higher risk of mortality after STEMI among women, compared to men (11-13). Xi (2022) reported of higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96)) (adjusted RR, 1.24; 95% CI 1.11 to 1.38) (13), Pancholy (2014) reported of higher risk of in-hospital mortality (RR, 1.93; 95% CI, 1.75-2.14) (adjusted RR, 1.48; 95% CI, 1.07-2.05) (11), and van der Meer (2015) reported of higher crude short- and long-term mortality in women, in addition to less use of GP IIb/IIIa inhibitors in women, compared to men (women 51%, men 57%) (12). Conclusions Our umbrella review revealed that women had longer timeline for treatment in AMI, had less use of medication and higher risk of mortality and MACE compared to men. Clinical practice needs further improvements in management in female patients.

Peripheral arterial disease in women.

Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.

The Impact of Hormonal Contraceptives on the Incidence and Progression of Cardiovascular Diseases in Women: A Systematic Review.

This systematic review examines the impact of hormonal contraceptives on the incidence and progression of cardiovascular diseases in women. We analyzed 14 high-quality studies published between 1998 and 2018, including meta-analyses, cohort studies, case-control studies, and systematic reviews. The aim was to synthesize the current understanding of the relationship between various hormonal contraceptives and cardiovascular risks, focusing on outcomes such as venous thromboembolism, ischemic stroke, and myocardial infarction.The 14 selected studies represent a comprehensive and diverse body of evidence, allowing for a nuanced analysis of the topic. Our findings indicate that combined oral contraceptives are associated with an increased risk of cardiovascular events, with the magnitude of risk varying based on estrogen dose, progestogen type, and individual risk factors. The review of these studies highlights the importance of personalized risk assessment in contraceptive counseling and prescribing practices. By synthesizing data from these key studies, we provide a consolidated view of the current state of knowledge regarding hormonal contraceptives and cardiovascular health, offering valuable insights for both clinicians and researchers in the field.

Female-specific risk factors for cardiovascular disease: an update.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. While it was previously believed that men have greater susceptibility to CVD, recent research suggests that women face an increased risk of CVD after the onset of menopause, primarily due to the loss of the protective effects of estrogens. Premature ovarian insufficiency (POI), polycystic ovarian syndrome (PCOS), and gestational factors, such as gestational diabetes mellitus (GDM), recurrent pregnancy loss, preterm delivery, and preeclampsia, are specific reproductive disorders that may contribute to an elevated risk of CVD at earlier ages, i.e., before the onset of menopause. This suggests that women with these conditions should be closely monitored for CVD risk factors even before reaching menopause. Such early intervention may help reduce the incidence of CVD and improve overall cardiovascular health in this population. The precise pathophysiological mechanism underlying the development of CVD in women with menopause, premature POI, PCOS, and gestational factors remains elusive. This review article seeks to elucidate the latest research on the relationship between these conditions and CVD in women, aiming to explore the underlying pathogenic mechanisms contributing to this association.