Prevention Of Cardiovascular Disease In Men Research Articles

Testosterone to oestradiol ratio reflects systemic and plaque inflammation and predicts future cardiovascular events in men with severe atherosclerosis.

The effects of testosterone on cardiovascular disease (CVD) as reported in literature have been ambiguous. Recently, the interplay between testosterone and oestradiol as assessed by testosterone/oestradiol (T/E2) ratio was suggested to be better informative on the normal physiological balance. Considering the role in CVD, we hypothesized that a low T/E2 ratio in men with CVD is associated with increased inflammation, a more unstable plaque and a worse cardiovascular outcome. Testosterone and oestradiol concentrations were determined in blood samples of 611 male carotid endarterectomy patients included in the Athero-Express Biobank Study. T/E2 ratio was associated with baseline characteristics, atherosclerotic plaque specimens, inflammatory biomarkers, and 3 year follow-up information. Patients with low T/E2 ratio had more unfavourable inflammatory profiles compared with patients with high T/E2 as observed by higher levels of C-reactive protein [2.81 μg/mL vs. 1.22 μg/mL (P < 0.001)] and higher leucocyte counts [8.98*109/L vs. 7.75*109/L (P = 0.001)] in blood. In atherosclerotic plaques, a negative association between T/E2 ratio and number of neutrophils [B = -0.366 (P = 0.012)], plaque calcifications [OR: 0.816 (P = 0.044)], interleukin-6 (IL-6) [B = -0.15 (P = 0.009)], and IL-6 receptor [B = -0.13 (P = 0.024)] was found. Furthermore, in multivariate Cox regression analysis, low T/E2 ratio was independently associated with an increased risk for major cardiovascular events (MACE) during 3 year follow-up [hazard ratio 1.67 (95% confidence interval 1.02-2.76), P = 0.043]. In men with elevated body mass index (BMI), these effects were strongest. In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins, and an increased risk of future MACE as compared to men with normal T/E2 ratio. These effects are strongest in men with elevated BMI and are expected to be affected by aromatase activity in white fat tissues. Normalization of T/E2 ratio may be considered as target for the secondary prevention of CVD in men.

Abstract 267: Testosterone to Estradiol Ratio Reflects Systemic and Plaque Inflammation and Predicts Future Cardiovascular Events in Men With Severe Atherosclerosis

Objective: The effects of testosterone on cardiovascular disease (CVD) as reported in literature have been ambiguous. Recently, the interplay between testosterone and estradiol as assessed by testosterone/estradiol (T/E2) ratio was suggested to be better informative on the normal physiological balance. Considering the role in CVD, we hypothesized that a low T/E2 ratio in men with CVD is associated with increased inflammation, a more unstable plaque and a worse cardiovascular outcome. Approach: Testosterone and estradiol concentrations were determined in blood samples of 709 male carotid endarterectomy patients included in the Athero-Express Biobank Study. T/E2 ratio was associated with baseline characteristics, atherosclerotic plaque specimens, inflammatory biomarkers and three-year follow-up information. Results: Patients with low T/E2 ratio had more unfavorable inflammatory profiles compared to patients with high T/E2 as observed by higher levels of C-reactive protein (CRP) (3.08 μg/mL vs. 1.21 μg/mL (p&lt;0.001)) and higher leukocyte counts (8.95*109/L vs. 7.84*109/L (p&lt;0.001)) in blood. In atherosclerotic plaques, a negative association between T/E2 ratio and number of neutrophils (B=-0.56(p=0.010)), smooth muscle cells (B=-0.049(p=0.046)), interleukin-6 (IL-6) (B=-0.15 p=0.009) and Il-6receptor (B=-0.13 p=0.024) was found. Decreased T/E2 ratio showed an overall trend towards histological features that represent the vulnerability of atherosclerotic lesions. Furthermore, in multivariate cox regression analysis, low T/E2 ratio was independently associated with an increased risk for major cardiovascular events (MACE) during three-year follow-up (HR 1.77 (95%CI: 1.08 - 2.90 p=0.023)). Conclusion: In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins and an increased risk of future major cardiovascular events as compared to men with normal T/E2 ratio. Normalization of T/E2 ratio may be a useful tool for the secondary prevention of CVD in men.

Cost-Effectiveness of Statins for Primary Cardiovascular Prevention in Chronic Kidney Disease

The authors sought to evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD). Patients with CKD have an elevated risk of MI and stroke. Although HMG Co-A reductase inhibitors (“statins”) may prevent cardiovascular events in patients with non–dialysis-requiring CKD, adverse drug effects and competing risks could materially influence net effects and clinical decision-making. We developed a decision-analytic model of CKD and cardiovascular disease (CVD) to determine the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted quality-adjusted life years (QALYs) and lifetime costs (2010 USD), and incremental cost-effectiveness ratios. For 65-year-old men with moderate hypertension and mild-to-moderate CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and increased costs by $1,800 ($18,000 per QALY gained). For patients with lower baseline cardiovascular risks, health and economic benefits were smaller; for 65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and drug costs. Statins are less cost-effective when obtained at average retail prices, particularly in patients at lower CVD risk. Although statins reduce absolute CVD risk in patients with CKD, the increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.

Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation about the use of aspirin for the prevention of coronary heart disease. Review of the literature since 2002, focusing on new evidence on the benefits and harms of aspirin for the primary prevention of cardiovascular disease, including myocardial infarction and stroke. The new evidence was reviewed and synthesized according to sex. Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement) Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation).

Combination Polypharmacy for Cardiovascular Disease Prevention in Men: A Decision Analysis and Cost‐Effectiveness Model

Pharmacotherapies to lower blood pressure and cholesterol are effective in the primary prevention of cardiovascular disease (CVD). The use of fixed-dose medication combinations has not been well studied. The authors created a Markov model to analyze the cost-effectiveness of 4 fixed-dose medications for primary CVD prevention in men. The initial decision node was to treat or not treat men older than 55 years, without CVD, hypertension, or dyslipidemia with a combination of simvastatin, captopril, hydrochlorothiazide, and atenolol. Probability, costs, and effectiveness were derived from the literature. The outcome variable was marginal cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed. The average cost of treatment was $70,000 compared with $93,000 for non-treatment. Treatment resulted in 13.62 QALYs vs 12.96 QALYs without treatment. Primary prevention of CVD with fixed-dose medications dominated "no-treatment." The use of a fixed-dose polypharmacy approach to CVD prevention in men older than 55 years may be cost-effective.

Psychosocial and behavioral aspects of cardiovascular disease prevention in men and women

Cardiovascular disease is a serious threat to population health. The true causes are not fully known, but a number of biological and behavioral risk factors have been identified. In this review we aim at understanding psychosocial, behavioral and lifestyle factors and their role in clinical care of patients with cardiovascular disease. We describe recent scientific evidence of psychosocial and life style risk and behavioral interventions to reduce risk in cardiovascular disease. We also discuss whether intervention programs are effective against cardiovascular disease and its risk factors, and whether they are of benefit to the patients. Gender aspects and ethnic variations are highlighted. In recent European Guidelines of CVD Prevention in Clinical Practice, behavioral factors have become recognized to be true risk factors and identified as important barriers to lifestyle change for patients with cardiovascular disease. Lifestyle changes play a pivotal role in clinical prevention of cardiovascular disease, as they are recommended as the first choice of intervention modalities before pharmacological treatment is initiated. While there is now common agreement about the importance of psychosocial risk factors for cardiovascular disease, a better consensus about intervention methods is needed in order to evaluate and appreciate the future scientific evidence from behavioral cardiovascular preventive efforts.