Cardiovascular Disease In Women Research Articles

Principles of cardiovascular risk management in perimenopausal women with type 2 diabetes

Cardiovascular disease is the leading cause of death in patients with diabetes mellitus. It has been established that the period of menopause, associated with an increase in age and a change in the metabolic background, increases the risk of developing cardiovascular diseases in women with diabetes mellitus. Despite tentative expectations, a number of studies have shown conflicting evidence regarding the beneficial effects of menopausal hormone therapy on CV risk markers in diabetes mellitus. In this connection, therapy with hormonal preparations containing estrogen is currently not recommended for the prevention of cardiovascular diseases in the absence of specific indications. At the same time, estrogen therapy can be used in this group to minimize menopausal symptoms. At the same time, the risk of adverse events associated with the use of menopausal hormone therapy can be estimated using calculation methods for determining cardiovascular risk and breast cancer risk using specific calculators, especially in the group of women with type 2 diabetes.The main principles of cardiovascular risk management continue to focus on lifestyle modification and achieving target levels of cardiovascular risk parameters such as lipid levels, glycemia, and blood pressure. The use of pharmacological therapy to address these risk factors, especially some pleiotropic antihyperglycemic drugs, may provide additional options for the prevention of cardiovascular disease.

Cardiovascular Disease in Women: A Qualitative Study of Quebec Coroner's Reports from 2002 to 2017

Cardiovascular Disease in Women: A Qualitative Study of Quebec Coroner's Reports from 2002 to 2017

Sex-specific effects of mild to moderate renal dysfunction on vascular endothelial function and large elastic artery stiffness

BACKGROUND: Cardiovascular disease (CVD) risk is elevated in patients with advanced chronic kidney disease (CKD). Vascular dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, is a key contributor to increased CVD risk in advanced CKD. Individuals with mild to moderately reduced renal function may also be at increased risk for CVD, but endothelial function and arterial stiffness are not well characterized in this group. Further, women with CKD have lower risk for CVD than men. Whether women are protected from renal dysfunction-related decreases in vascular function is unknown. PURPOSE: We sought to determine: i) whether individuals with mild to moderate renal dysfunction (MRD) have lower endothelial function and greater arterial (aortic) stiffness compared to healthy controls (HC) and ii) if the presence of vascular dysfunction in individuals with MRD is influenced by sex. METHODS & RESULTS: Fifty-nine adults were split into two groups based on renal function. Thirty-two adults (mean±SEM: 66±2 years; 16 women) were identified with MRD, characterized as an estimated glomerular filtration rate (eGFR) of 45-89 (CKD-EPI; 75.0±2.0 mL/min/1.73m2) and/or the presence of microalbuminuria (albumin: creatinine ratio between 30-300 mg/g). Twenty-seven adults (63±2 years; 13 women) were identified as HC with an eGFR >90 (CKD-EPI; 98.7±0.9 mL/min/1.73m2). Subject characteristics known to influence vascular function (e.g., blood pressure, cholesterol, blood glucose, etc.) were not different between groups (all p>0.05). Endothelial function, assessed by brachial artery flow mediated dilation, was not different between groups (MRD: 4.4±0.5%, HC: 4.6±0.5%, p=0.75). Aortic stiffness, assessed via carotid-femoral pulse wave velocity, also was not different (MRD: 950.7±50.6 cm/s, HC: 864.3±33.1 cm/s, p=0.18). When analyzed by sex, men with MRD had lower endothelial function (MRD: 2.8±0.4%, HC: 4.4±0.6%, p=0.04) and tended to have stiffer arteries (MRD: 879.0±42.7 cm/s, HC: 787.7±35.5 cm/s, p=0.11) compared to HC men. In women with MRD, there were no differences in endothelial function (MRD: 5.9±0.8%, HC: 4.8±0.8%, p=0.36) or aortic stiffness (MRD: 1022.3±89.9 cm/s, HC: 953.6±49.4 cm/s, p=0.55) versus HC women. CONCLUSIONS: Men with MRD exhibit vascular dysfunction, while women appear to be protected from MRD-related vascular dysfunction. The lower risk of CVD in women versus men with CKD may, in part, be due to resistance against renal dysfunction-related vascular dysfunction. NIH K01DK115524 to MJR; 5T32DK007135-46 to KOM; K01HL153326 to DHC This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both genders equally. However, in comparison to men, in women it often is underrecognized and undertreated in both the primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between woman and men and this may impact how both groups present when they become ill. Therefore, there are some diseases that affect more frequently in women than in men such us myocardial ischemia or infarction without obstructive coronary disease, Tako-subo syndrome, some atrial arrhythmias or the appearance of heart failure with preserved ejection fraction. Therefore, the diagnostic and therapeutic strategies that have been established based largely on clinical studies with a predominant male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique, when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes of woman with the most frequent cardiovascular pathologies including coronary artery disease, arrythmias, heart failure and valvopathies. In addition, we will describe diseases that exclusively affect to women related with the pregnancy some of them are life treating. Although the lack of research in women plays a role in the poorer outcomes in women specially in ischemic heart disease the results of some techniques such as transcathether aortic valve implantation and transcatheter edge to edge therapy seem to have better outcome in women.

Endometriosis and cardiovascular disease: A systematic review and meta-analysis

ObjectivesEndometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is the main cause of death worldwide. Because the relationship between endometriosis and CV disease is not well established, we performed a systematic review of longitudinal studies that assessed the occurrence of cardiovascular events in women with endometriosis compared to those without endometriosis. Study designSystematic review with meta-analysis of longitudinal cohort/nested case-control studies with endometriosis patients and controls. A search was conducted of the MEDLINE, CENTRAL, and Embase databases from inception to November 2022. Random-effects meta-analysis was performed to estimate pooled hazard ratios (HR) and 95 % confidence intervals (95%CI). Main outcome measureCardiovascular outcomes such as ischemic heart disease and cerebrovascular disease. ResultsSix cohort studies were included, with a total of 254,929 participants. Meta-analysis showed that endometriosis was associated with a significantly increased risk of ischemic heart disease (HR 1.50, 95%CI 1.37–1.65; I2 = 0 %) and cerebrovascular disease (HR 1.17, 95%CI 1.07–1.29; I2 = 0 %). The one study that examined the relationship between cardiovascular mortality and endometriosis found a decreased risk in women with endometriosis relative to women without endometriosis (HR 0.55 (95%CI 0.47–0.65)). ConclusionsEndometriosis is associated with a significantly increased risk of cardiovascular disease, namely ischemic heart disease and cerebrovascular disease. Further studies are required to determine if endometriosis and/or its treatments are risk factors (particularly for cardiovascular mortality), and whether preventive measures could reduce the burden of cardiovascular disease in women with endometriosis.Study protocol registered at PROSPERO: CRD42022298830.

TCTAP A-097 International Registry of Cardiovascular Diseases in Women (IROCW): Assessing the Feasibility of Large Data Registry in the Absence of Funding and Electronic Database; Initial Data From Iraq

TCTAP A-097 International Registry of Cardiovascular Diseases in Women (IROCW): Assessing the Feasibility of Large Data Registry in the Absence of Funding and Electronic Database; Initial Data From Iraq

Angiotensin II Increases Oxidative Stress and Inflammation in Female, But Not Male, Endothelial Cells.

Women are at elevated risk for certain cardiovascular diseases, including pulmonary arterial hypertension, Alzheimer's disease, and vascular complications of diabetes. Angiotensin II (AngII), a circulating stress hormone, is elevated in cardiovascular disease; however, our knowledge of sex differences in the vascular effects of AngII are limited. We therefore analyzed sex differences in human endothelial cell response to AngII treatment. Male and female endothelial cells were treated with AngII for 24h and analyzed by RNA sequencing. We then used endothelial and mesenchymal markers, inflammation assays, and oxidative stress indicators to measure female and male endothelial cell functional changes in response to AngII. Our data show that female and male endothelial cells are transcriptomically distinct. Female endothelial cells treated with AngII had widespread gene expression changes related to inflammatory and oxidative stress pathways, while male endothelial cells had few gene expression changes. While both female and male endothelial cells maintained their endothelial phenotype with AngII treatment, female endothelial cells showed increased release of the inflammatory cytokine interleukin-6 and increased white blood cell adhesion following AngII treatment concurrent with a second inflammatory cytokine. Additionally, female endothelial cells had elevated reactive oxygen species production compared to male endothelial cells after AngII treatment, which may be partially due to nicotinamide adenine dinucleotide phosphate oxidase-2 (NOX2) escape from X-chromosome inactivation. These data suggest that endothelial cells have sexually dimorphic responses to AngII, which could contribute to increased prevalence of some cardiovascular diseases in women. The online version contains supplementary material available at 10.1007/s12195-023-00762-2.

The Influence of Early-Life Health Conditions on Life Course Health.

We expand on previous studies investigating the links between early health and later health by examining four distinct dimensions of early-life health and multiple life course outcomes, including the age of onset of serious cardiovascular diseases (CVDs) and several job-related health outcomes. The four dimensions of childhood health are mental, physical, self-reported general health, and severe headaches or migraines. The data set we use includes men and women in 21 countries from the Survey of Health, Ageing and Retirement in Europe. We find that the different dimensions of childhood health have unique ties to later outcomes. For men, early mental health problems play a stronger role for life course job-related health outcomes, but early poor/fair general health is more strongly linked to the spike in onset of CVDs in their late 40s. For women, these links between childhood health dimensions and life course outcomes are similar but are less clear-cut than for men. The spike in onset of CVDs in women's late 40s is driven by those with severe headaches or migraines, while those with early poor/fair general health or mental health problems do worse as captured by job-related outcomes. We also delve into and control for possible mediating factors. Exploring the links between several dimensions of childhood health and multiple health-related life course outcomes will enable a better understanding of how health inequalities originate and are shaped over the course of people's lives.

Factors Affecting the Risk of Cardiovascular Disease in Postmenopausal Women: A Postmenopausal Period-Stratified Analysis

Purpose: This study aimed to investigate the factors affecting the risk of cardiovascular disease among postmenopausal Korean women. Methods: This postmenopausal period-stratified analysis used secondary data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018. We selected 1,465 participants with all the relevant data for analysis. The Chi-square test and multiple logistic regression analysis were used to analyze the data. Results: Age, subjective health status, body mass index, and triglyceride level were the factors that influenced the risk of cardiovascular disease for women with a postmenopausal period ≤5 years, whereas age, subjective health status, household income, body mass index, and triglyceride level were the factors that influenced the risk of cardiovascular disease for women with a postmenopausal period >5 years and ≤10 years. Conclusion: Planning health promotion strategies to lower the risk of cardiovascular disease in women must consider the differences among women according to the menopausal status and postmenopausal period.

World Heart Day: Clinical case to raise awareness on cardiovascular disease in women

AbstractThe World Heart Federation highlights that cardiovascular disease (CVD) is the leading cause of death in women worldwide. Indeed, women have unique female-specific risk factors for stroke, which include pregnancy, history of preeclampsia/eclampsia or gestational diabetes, duration of reproductive life, oral contraceptive use, and postmenopausal hormone therapy. In light of the female-specific risk factors and/or predisposing conditions, there is need to sensitize health professionals and the public in general on CVD in women. This clinical case is being shared with the written consent of the patient so as to avoid misdiagnosis or underdiagnosis of CVD among women.

Meet the First Authors.

HomeCirculation ResearchVol. 132, No. 6Meet the First Authors Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBMeet the First Authors Originally published16 Mar 2023https://doi.org/10.1161/RES.0000000000000603Circulation Research. 2023;132:672–673is related toGJA1-20k Rescues Cx43 Localization and Arrhythmias in Arrhythmogenic CardiomyopathySmooth Muscle MR in Post-Preeclampsia Hypertension (p 674)Download figureDownload PowerPointDr Lauren Biwer is a postdoctoral researcher in Dr Iris Jaffe’s lab at Tufts Medical Center. She became passionate about research in Dr Taben Hale’s lab at the University of Arizona and completed her PhD in Molecular Physiology at the University of Virginia with Dr Brant Isakson. When her sister developed preeclampsia, she became interested in mitigating future cardiovascular disease in women with complicated pregnancies. Lauren received a K99 grant to pursue this work and is thrilled to start her independent laboratory in the Yale Vascular Biology and Therapeutics program in November 2023. She enjoys traveling, outdoor activities, college sports and reading non-fiction. She can be found on Twitter @DrLaurenBiwer.Endosomal PI3Kγ Regulates Hypoxia Sensing (p 690)Download figureDownload PowerPointDr Yu Sun (Cynthia) earned her MD in Pathology from Shanghai Medical College at Fudan University in 2014. Following her clinical training, Cynthia joined the lab of Dr Naga Prasad in 2017 as a postdoctoral fellow to understand the mechanisms regulating βAR function in hypoxia. Unexpectedly, she found that hypoxia regulates endosomal βAR function by inhibition of resensitization through PI3K. Her current work focuses on dissecting the agonist-independent endosomal regulation of βARs, as acute hypoxia is the initial stress following ischemia. During her free time Cynthia enjoys reading and watching movies.Download figureDownload PowerPointKate Stenson is currently Senior Laboratory Technologist in the Department of Cardiovascular and Metabolic Sciences at Lerner Research Institute, Cleveland Clinic. She earned her undergraduate degrees in Marine Biology and Psychobiology from the University of New England in Maine. She joined Cleveland Clinic to further extend her hands-on approach from her undergraduate education to the mouse models of pathology, specifically heart failure. She is passionate about unraveling scientific discoveries through the use of animal models and during her spare time, when she is not imaging mice, she likes to play with her kids and take them to musicals.Dectin-1 Mediates Ang II Action in Heart (p 707)Download figureDownload PowerPointDr Shiju Ye earned his MS in Cardiovascular Disease at the Wenzhou Medical University, China, in 2019, and is now pursing his Cardiovascular Disease PhD at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China. Dr Ye’s recent research interests include Ang II related cardiac inflammation, heart failure, and the crosstalk between the cardiomyocytes and macrophages. Outside of the laboratory, he not only maintains an active social life and studies, but also focuses on learning clinical knowledge of cardiovascular disease.GJA1-20k Reduces Arrhythmias in ACM (p 744)Download figureDownload PowerPointDr Joseph Palatinus is an Assistant Professor of Medicine at the Nora Eccles Harrison Cardiovascular Research and Training Institute at the University of Utah and Critical Care Cardiologist at Intermountain Medical Center. He completed his residency at Beth Israel Deaconess Medical Center and cardiology and critical care medicine fellowships at Cedars Sinai Medical Center. His postdoctoral work focused on gap junction trafficking in the laboratory of Dr Robin Shaw. The Palatinus Lab is focused on mechanisms contributing to disease progression in arrhythmogenic cardiomyopathy. Dr Palatinus’s clinical interests are focused on the care of patients with cardiogenic shock in the CCU. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesGJA1-20k Rescues Cx43 Localization and Arrhythmias in Arrhythmogenic CardiomyopathyJoseph A. Palatinus, et al. Circulation Research. 2023;132:744-746 March 17, 2023Vol 132, Issue 6 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/RES.0000000000000603PMID: 36927179 Originally publishedMarch 16, 2023 PDF download Advertisement

Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis

BackgroundDietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic reviews have evaluated this relationship...

Sex-Specific Reproductive Factors Augment Cardiovascular Disease Risk in Women: A Mendelian Randomization Study.

Background Observational studies suggest that reproductive factors are associated with cardiovascular disease, but these are liable to influence by residual confounding. This study explores the causal relevance of reproductive factors on cardiovascular disease in women using Mendelian randomization. Methods and Results Uncorrelated (r2<0.001), genome-wide significant (P<5×10-8) single-nucleotide polymorphisms were extracted from sex-specific genome-wide association studies of age at first birth, number of live births, age at menarche, and age at menopause. Inverse-variance weighted Mendelian randomization was used for primary analyses on outcomes of atrial fibrillation, coronary artery disease, heart failure, ischemic stroke, and stroke. Earlier genetically predicted age at first birth increased risk of coronary artery disease (odds ratio [OR] per year, 1.49 [95% CI, 1.28-1.74], P=3.72×10-7) heart failure (OR, 1.27 [95% CI, 1.06-1.53], P=0.009), and stroke (OR, 1.25 [95% CI, 1.00-1.56], P=0.048), with partial mediation through body mass index, type 2 diabetes, blood pressure, and cholesterol traits. Higher genetically predicted number of live births increased risk of atrial fibrillation (OR for <2, versus 2, versus >2 live births, 2.91 [95% CI, 1.16-7.29], P=0.023), heart failure (OR, 1.90 [95% CI, 1.28-2.82], P=0.001), ischemic stroke (OR, 1.86 [95% CI, 1.03-3.37], P=0.039), and stroke (OR, 2.07 [95% CI, 1.22-3.52], P=0.007). Earlier genetically predicted age at menarche increased risk of coronary artery disease (OR per year, 1.10 [95% CI, 1.06-1.14], P=1.68×10-6) and heart failure (OR, 1.12 [95% CI, 1.07-1.17], P=5.06×10-7); both associations were at least partly mediated by body mass index. Conclusions These results support a causal role of a number of reproductive factors on cardiovascular disease in women and identify multiple modifiable mediators amenable to clinical intervention.

Assessment of Cardiovascular Risk in Women: Progress so Far and Progress to Come.

Cardiovascular disease is the leading cause of death in women worldwide. Nonetheless, there exist several uncertainties in the prediction, diagnosis, and treatment of cardiovascular disease in women. A cornerstone in the prediction of cardiovascular disease is the implementation of risk scores. A variety of pregnancy- and reproductive-factors have been associated with lower or higher risk of cardiovascular disease. Consequently, the question has been raised, whether these female-specific factors also provide added value to cardiovascular risk prediction. In this review, we provide an overview of the existing literature on sex differences in the association of established cardiovascular risk factors with cardiovascular disease and the relation between female-specific factors and cardiovascular risk. Furthermore, we systematically reviewed the literature for studies that assessed the added value of female-specific factors beyond already established cardiovascular risk factors. Adding female-specific factors to models containing established cardiovascular risk factors has led to little or no significant improvement in the prediction of cardiovascular events. However, analyses primarily relied on data from women aged ≥40 years. Future investigations are needed to quantify whether pregnancy-related factors improve cardiovascular risk prediction in young women in order to support adequate treatment of risk factors and enhance prevention of cardiovascular disease in women.

CRT-100.98 International Registry of Cardiovascular Diseases in Women (IROCW): Assessing the Feasibility of Large Data Registry in the Absence of Funding and Electronic Database – Initial Data From Iraq

CRT-100.98 International Registry of Cardiovascular Diseases in Women (IROCW): Assessing the Feasibility of Large Data Registry in the Absence of Funding and Electronic Database – Initial Data From Iraq

Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study.

Pre-eclampsia increases women's lifetime risk of cardiovascular disease (CVD). Little is known about the trajectory of CVD after pre-eclampsia, limiting the usefulness of this knowledge for informing screening, prevention, and interventions. We investigated when the risk of CVD increases after pre-eclampsia and how the risk changes over time since pregnancy. This register-based study included 1 157 666 women with >1 pregnancy between 1978 and 2017. Cumulative incidences of acute myocardial infarction (AMI) and ischaemic stroke were estimated, as well as hazard ratios (HRs) by attained age and time since delivery. Up to 2% [95% confidence interval (CI): 1.46-2.82%] of women with pre-eclampsia in their first pregnancy had an AMI or stroke within two decades of delivery, compared with up to 1.2% (95% CI: 1.08-1.30%) of pre-eclampsia-free women; differences in cumulative incidences were evident 7 years after delivery. Ten years after delivery, women with pre-eclampsia had four- and three-fold higher rates of AMI (HR = 4.16, 95% CI: 3.16-5.49) and stroke (HR = 2.59, 95% CI 2.04-3.28) than women without pre-eclampsia; rates remained doubled >20 years later. Women with pre-eclampsia aged 30-39 years had five-fold and three-fold higher rates of AMI (HR = 4.88, 95% CI 3.55-6.71) and stroke (HR = 2.56, 95% CI 1.95-3.36) than women of similar age without pre-eclampsia. Women with a history of pre-eclampsia have high rates of AMI and stroke at early ages and within a decade after delivery. The findings suggest that pre-eclampsia history could be useful in identifying women at increased risk of CVD and that targeted interventions should be initiated soon after delivery.

The Use of Female Menopausal Hormonal Replacement Therapy To Prevent Cardiovascular Disease in Women and in Men: A Lack of Clinical Benefit and the Potential for Harm.

Department of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY Disclosure: The author has no conflicts of interest to report.

Dietary inflammatory index and cardiovascular disease risk in Hispanic women from the Women’s Health Initiative

BackgroundTo evaluate the association between the dietary inflammatory index (DII®) and incident cardiovascular disease (CVD) in Hispanic women from the Women’s Health Initiative (WHI), and to determine if body mass index (BMI) interacted with the DII scores.MethodsSecondary analysis of baseline dietary data and long-term CVD outcomes among 3,469 postmenopausal women who self-identified as Hispanic enrolled in WHI. DII scores were calculated from self-administered food frequency questionnaires. The CVD outcomes included coronary heart disease (CHD) and stroke. Stratified Cox regression models were used to assess the relationship between DII scores and CVD in women with and without obesity. Models were adjusted for age, lifestyle risk factors, known risk factors, and neighborhood socioeconomic status.ResultsThe incidence of CHD was 3.4 and 2.8% for stroke after a median follow-up of 12.9 years. None of the DIIs were associated with CVD risk in this sample of Hispanic women. BMI interacted with the DII (p < 0.20) and stratified models showed that the associations between the DII and CVD were only significant in women with overweight (p < 0.05). In this group, higher DII scores were associated with a higher risk of CHD (HR 1.27; 95% CI: 1.08, 1.51) and a higher risk of stroke (HR 1.32; 95% CI: 1.07, 1.64).ConclusionAmong postmenopausal Hispanic women with overweight, greater adherence to pro-inflammatory diets was associated with higher risk of CVD. Additional research is needed to understand how to promote long-term heart-healthy dietary habits to reduce inflammation and prevent CVD in at-risk Hispanic women.

Effect of Exercise on Arterial Stiffness in Healthy Young, Middle-Aged and Older Women: A Systematic Review.

Arterial stiffness, an age-dependent phenomenon, is improved with exercise, which in turn may prevent cardiovascular diseases in women. However, there is a lack of consolidated information on the impact of exercise on arterial stiffness among healthy women. The aim of this review was to (i) analyse the effect of exercise on arterial stiffness in healthy young, middle-aged, and older women, and (ii) recommend types, intensity, and frequency for each age group. Database searches on PubMed, ScienceDirect, Web of Science, and Scopus were conducted using PRISMA guidelines until September 2022. The keywords were: exercise, women/female, and arterial stiffness. The inclusion criteria were: healthy women, supervised exercise, and arterial stiffness measures. Study quality and bias were assessed using the PEDro scale. Fifty-one papers were classified into young (n = 15), middle-aged (n = 14), and older (n = 22) women. Improvements in arterial stiffness were observed among: young women (Pulse Wave Velocity, PWV: 4.9-6.6 m/s), following an 8-week high-intensity aerobic (3 days/week) or hypoxic high-intensity interval training; middle-aged women (PWV: 5.1-7.9 m/s), aerobic exercise with moderate intensity or stretching exercise at "moderate to heavy" (Borg Scale), 20-30 s per site, 10 s of rest interval for 30 min; and for older women (PWV: 7.9-15.6 m/s), resistance training at light intensity, aerobic exercise at any intensity, or a combination of the two exercises. This review shows that arterial stiffness increases with age in healthy women and has an inverse relationship with exercise intensity. Therefore, when prescribing exercise to improve arterial stiffness, age and arterial stiffness measures should be accounted for.

The contribution of smoking to differences in cardiovascular disease incidence between men and women across six ethnic groups in Amsterdam, the Netherlands: The HELIUS study

It is unclear to what extent differences in cardiovascular disease (CVD) risk between men and women are explained by differences in smoking, and whether this contribution to risk is consistent across ethnic groups. In this prospective study, we determined the contribution of smoking to differences in CVD incidence between men and women, also in various ethnic groups. We linked baseline data of 18,058 participants of six ethnic groups from the HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands (2013–2019). The contribution of smoking to CVD incidence, as estimated by the population attributable fraction, was higher in men than in women, overall (24.1% versus 15.6%) and across most ethnic groups. Among Dutch participants, however, the contribution of smoking was higher among women (21.0%) than men (16.2%). Using Cox regression analyses, we observed that differences in smoking prevalence explained 22.0% of the overall lower hazard for CVD in women compared to men. Smoking contributed minimally to the lower hazards for CVD in women among participants of Dutch (0%), Ghanaian (4.9%) and Moroccan origin (0%), but explained 28.6% and 48.6% of the lower hazards in women in South-Asian Surinamese and African Surinamese groups, respectively. While smoking prevention and cessation may lead to lower CVD incidence in most groups of men and women, it may not substantially reduce disparities in CVD risk between men and women in most ethnic groups.