Comorbidity In Women Research Articles

Filling gaps in female gout: a cross-sectional study of comorbidities in 192 037 hospitalised patients

ObjectiveThere is room for improvement in the knowledge of female gout, often noted at risk of gender blindness. This study aims to compare the prevalence of comorbidities in women versus...

Gender differences in prognosis and treatment in acute coronary syndrome at the coronary care unit

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Women who suffer Acute Coronary Syndrome (ACS) have worse prognosis, with higher mortality and more complications. These results might be partially influenced by an older age and a higher number of comorbidities in women. Purpose The aim of the study is to analyse gender differences among patients with ACS admitted to our Coronary Care Unit (CCU). Methods Retrospective cohort of all patients with ACS admitted to a CCU between July 2011 and August 2022. Univariate analyses to assess gender influence in intrahospital mortality and complications were carried out. We also performed a multivariate analysis to identify predictive factors of intrahospital mortality. Results 3161 patients were included, with a mean age of 63 years old. Women accounted for 26.4% of patients. Women were older than men (68.9 vs. 61.71 years old), had a higher prevalence of hypertension (72.52% vs. 55.92%), diabetes mellitus (37.5% vs. 32.31%), heart failure and chronic kidney disease. On the other hand, smoking and chronic obstructive pulmonary disease were more frequent in men. In-hospital mortality was higher in women (OR 2.18, IC95% 1.63-2.92; p<0.001). In respect of complications, women showed a higher rate of bleeding (OR 1.35, IC95% 1.05-1.73; p<0.017) and cardiogenic shock (OR 1.43, IC95% 1.1-1.84; p<0.006). There were no significant gender-differences regarding ischemic complications (reinfarction, stent thrombosis, ischemic stroke…), atrial fibrillation or ventricular arrhythmias during hospital admission. Treatment differences were observed in the study. Prasugrel, statins, beta-blockers and IECAS were less prescribed in women, while clopidogrel was prescribed more frequently for them. Ticagrelor was prescribed less for women at hospital discharge but no gender differences in in-hospital prescription were identified. Multivariate analysis adjusting for age, comorbidities and complications demonstrated that diabetes mellitus, age, previous chronic kidney disease, severe bleeding and Killip-Kimball category were predictors of mortality. Female sex however did not reach significance in multivariate analysis (OR 1.28, IC95% 0.89-1.84; p=0.169). Conclusion In our sample, women had higher intrahospital mortality and bleeding rates, although mortality differences disappeared after adjusting by age, complications and comorbidities. Pharmacological treatment was lower and less intensive in them. It is crucial to know these differences in order to guarantee a more equitable medical assistance.

A Review of Cardiovascular Risk Factors in Women with Psychosis

The presence of medical comorbidities in women with psychotic disorders can lead to poor medical and psychiatric outcomes. Of all comorbidities, cardiovascular disease is the most frequent, and the one most likely to cause early death. We set out to review the evidence for cardiovascular risk factors (CRFs) in women with schizophrenia-related disorders and for interventions commonly used to reduce CRFs. Electronic searches were conducted on PubMed and Scopus databases (2017–2022) to identify papers relevant to our aims. A total of 17 studies fulfilled our inclusion criteria. We found that CRFs were prevalent in psychotic disorders, the majority attributable to patient lifestyle behaviors. We found some inconsistencies across studies with regard to gender differences in metabolic disturbances in first episode psychosis, but general agreement that CRFs increase at the time of menopause in women with psychotic disorders. Primary care services emerge as the best settings in which to detect CRFs and plan successive intervention strategies as women age. Negative symptoms (apathy, avolition, social withdrawal) need to be targeted and smoking cessation, a heart-healthy diet, physical activity, and regular sleep routines need to be actively promoted. The goal of healthier hearts for women with psychotic disorders may be difficult, but it is achievable.

Obesity and risk for its comorbidities diabetes, hypertension, and dyslipidemia in Japanese individuals aged 65 years

Diabetes, hypertension, and dyslipidemia are obesity-related comorbidities that contribute to the development of cardiovascular disease, one of the leading causes of death. In addition to obesity, the underweight condition is a concern because it can give rise to sarcopenia, particularly after the age of 65 years. We examined the risk for diabetes, hypertension, and dyslipidemia due to obesity in individuals of this age. We retrospectively investigated the relation between obesity and its three major comorbidities in 10,852 individuals aged 65 years who underwent health checkups implemented by Kobe City between April 2017 and March 2021. The prevalence of diabetes, hypertension, and dyslipidemia with and without hyper-low-density lipoprotein-cholesterolemia was 9.7%, 41.0%, 63.8%, and 19.5%, respectively, and the prevalence of these conditions increased with increasing obesity. The risk for diabetes and hypertension was increased markedly (odds ratios of 12.95 and 19.44, respectively), and that for dyslipidemia with and without hyper-low-density lipoprotein-cholesterolemia was modestly increased (odds ratios of 2.59 and 3.65, respectively) at a BMI of ≥ 35 kg/m2 compared with normal weight. Analysis by gender revealed that the obesity-related risk for dyslipidemia with hyper-low-density lipoprotein-cholesterolemia was small compared with other comorbidities in women, while the risk for all comorbidities elevated similarly in men. Our results suggest the importance of public health intervention for obesity to suppress its comorbidities, especially diabetes and hypertension, at this age.

Relationship between adipocytes and androgens — the cause of comorbidities in women with polycystic ovary syndrome

Relationship between adipocytes and androgens — the cause of comorbidities in women with polycystic ovary syndrome

Abstract 11063: Inequities in Modifiable Cardiovascular Risk Factors Among Women of Childbearing Age With Hypertension Using Life's Simple 7

Introduction: Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality. The American Heart Association’s “Life’s Simple 7” (LS7) highlights seven modifiable factors for promoting cardiovascular health - managing blood pressure (BP), controlling cholesterol, reducing blood sugar, getting active, eating better, maintaining a healthy weight, and not smoking. Hypothesis: We hypothesized there would be racial differences in LS7 factors among women of childbearing age with hypertension (HTN). Methods: Using National Health and Nutrition Examination Surveys from 2001-18, we evaluated LS7 factors among women aged 20-50 years with HTN. HTN was defined as BP ≥140/90 mmHg or anti-hypertensive medication use. LS7 scores reflect one point per guideline met. DASH adherence was calculated from 24-hour dietary recalls, with one point per nine nutrient goals. Results: In 1293 women, the mean (SE) age was 36.4 (0.25) years. Black and Hispanic women with HTN were less likely than White women to have total cholesterol <200 mg/dL (39% and 38% vs 47%, both p <0.05), hemoglobin A1c <6.5% (83% and 84% vs 92%, both p <0.05), and BMI <25 (13% and 16% vs 25%, p <0.001 and p <0.05), while Asian women had higher DASH adherence than White women (16% vs 6.5%, p <0.05) (Table). The mean LS7 score was higher in Asian women (3.89 (0.09), p <0.05), lower in Black women (3.16 (0.05), p <0.05), and similar in Hispanic women (3.34 (0.05)) compared to White women (3.40 (0.06)). Conclusions: We found frequent comorbidities in women of childbearing age with HTN along with racial/ethnic differences in LS7 scores. Interventions to increase LS7 scores may promote health equity and reduce pregnancy-related complications.

Impact of co-morbidities on survival after heart transplant in females of childbearing age: analysis of the International Society for Heart and Lung Transplantation (ISHLT) Registry

Abstract Background Data on life expectancy specific to female heart transplant (HT) recipients of reproductive age are lacking, but are needed to inform shared decision making at the time of pre-conception counseling. We analyzed the ISHLT registry for post-transplant survival and studied the impact of co-morbidities in women of childbearing age. Methods Female HT recipients reported to the ISHLT registry who were aged 15–45 yrs at time of HT were included in this retrospective analysis. Primary outcome was post-transplant survival. Secondary outcomes included the impact of co-morbidities on conditional survival at 5, 10 and 15 years. Results Of 121,501 HT recipients (Jan 1992–June 2018), 30,179 (24.8%) were women. 9,229 (7.6%) were 15–45 yrs at time of HT. Overall median post-transplant survival was 15.2 yrs. Diabetes mellitus (DM) and/or severe chronic kidney disease (CKD) at HT adversely impacted long-term survival (Figure 1). Co-morbidities including cardiac allograft vasculopathy (CAV), DM and CKD negatively impacted 5yr and 10yr conditional survival, individually as well as a combination (Figure 2). 15yr conditional survival confirmed the negative impact of DM and CKD, while CAV did not reach statistical significance. Conclusion Female HT recipients of childbearing age have favorable survival post-HT. Conditional survival at 5 and 10 yrs is negatively impacted by CAV, DM and CKD. The quantification of survival outcomes after heart transplant in women of childbearing age may improve counseling as part of pre-conception informed decision making. Funding Acknowledgement Type of funding sources: None.

Abnormal Endometrial Receptivity and Oxidative Stress in Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder in women of childbearing age. Individual heterogeneity is evident, and the prevalence rate ranges between 6 and 15% globally. The prevalence rate of PCOS in Chinese women of childbearing age is 5.6%. The main manifestations are infertility, sparse menstruation, irregular vaginal bleeding, long-term endometrial hyperplasia, and endometrial cancer. PCOS is often associated with hyperandrogenemia, insulin resistance, hyperinsulinemia, obesity, metabolic syndrome, and intestinal flora disorder. Although there have been many studies in the past, the underlying pathophysiological mechanism of the disease is still unclear. Studies have shown that PCOS diseases and related complications are closely related to local oxidative stress imbalance in the endometrium, leading to poor endometrial receptivity and effects on pregnancy. Previous reviews have mainly focused on the abnormal mechanism of ovarian oxidative stress in women with PCOS, while reviews on endometrial receptivity and oxidative stress are relatively insufficient. This study reviews the abnormal cellular and molecular mechanisms of oxidative stress due to comorbidities in women with PCOS, leading to a downregulation of endometrial receptivity.

Sex Differences in Comorbidity Combinations in the Swedish Population.

High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.

Endometriosis and irritable bowel syndrome: similarities and differences in the spectrum of comorbidities.

Do the spectrum and prevalence of comorbidities of endometriosis and irritable bowel syndrome (IBS) overlap? Despite several overlapping symptoms, the most significantly associated comorbidities of endometriosis and IBS are different and are rather related to the organ systems primarily involved in the index diagnosis. Endometriosis and IBS both have several similar unspecific symptoms, such as recurrent abdominal pain, cramping and anxiety, and both diseases affect young women and are associated with a number of comorbidities causing a poor quality of life. However, a detailed study, revealing the full spectrum of endometriosis and IBS comorbidities in the same study population, is lacking. This article presents a retrospective in silico analysis of the data from a large nationwide biobank-based cohort consisting of 121 773 women. After excluding all first- and second-degree relatives, the data of up to 65 421 women were analyzed. International Classification of Disease-10 diagnosis main codes associated with endometriosis (N80) and IBS (K58) diagnoses were identified from the Estonian Biobank dataset by linking with the Estonian Health Insurance Fund and other relevant registries. The associations between N80 and K58 and other diagnosis codes were tested using logistic regression, adjusting for age at recruitment and 10 genetic principal components to account for potential population stratification. Bonferroni correction was applied to account for multiple testing. Both women with endometriosis and IBS suffered from more conditions compared to the control group, with 226 and 428 diagnosis codes statistically significantly more frequent in women with respective diagnosis compared to controls. Women suffering from both conditions had 275 significantly associated comorbidities. A remarkable proportion of women with IBS or endometriosis suffered also from endometriosis (9.0%) or IBS (13.6%), respectively. In endometriosis, the most prevalent diagnoses were related to diseases of the genitourinary system (33 N-category codes) and in women with IBS, the most associated diagnoses were related to digestive disorders and gastrointestinal tract (52 codes from K-category). Among the most significant diagnoses in endometriosis were uterine leiomyomas (D25), menstrual disorders (N92) and infertility (N97) (P < 1 × 10-315 for all), and in IBS, lactose intolerance (E73), gastritis and duodenitis (K29) and functional dyspepsia (K30) were in the top list of most significant comorbidities (P < 1 × 10-315 for all). The information about the severity stages of endometriosis and subtypes of IBS was not available for analysis. The findings may not be fully extrapolated to all female populations, because all participants were from one geographic area and had good access to health services. These findings support previous studies that have found a high prevalence of pre-selected comorbidities in women with endometriosis and IBS. However, taking into account the differences in the full spectrum of comorbidities of endometriosis and IBS may aid in diagnosing these disorders. Women and healthcare providers need to be aware that women with endometriosis are at high risks of complications during pregnancy and should be carefully monitored. This research was funded by the Estonian Research Council (grant PRG1076), Horizon 2020 innovation grant (ERIN, grant no. EU952516), Enterprise Estonia (grant no. EU48695), MSCA-RISE-2020 project TRENDO (grant no. 101008193) and by the European Union through the European Regional Development Fund (Projects no. 2014-2020.4.01.15-0012 and no. 2014-2020.4.01.16-0125). The authors have no conflicts of interest to declare. N/A.

Phenotypic differences based on lateralization of intrahippocampal kainic acid injection in female mice

Clinical evidence indicates that patients with temporal lobe epilepsy (TLE) often show differential outcomes of comorbid conditions in relation to the lateralization of the seizure focus. A particularly strong relationship exists between the side of seizure focus and the propensity for distinct reproductive endocrine comorbidities in women with TLE. Therefore, here we evaluated whether targeting of left or right dorsal hippocampus for intrahippocampal kainic acid (IHKA) injection, a model of TLE, produces different outcomes in hippocampal granule cell dispersion, body weight gain, and multiple measures of reproductive endocrine dysfunction in female mice. One, two, and four months after IHKA or saline injection, in vivo measurements of estrous cycles and weight were followed by ex vivo examination of hippocampal dentate granule cell dispersion, circulating ovarian hormone and corticosterone levels, ovarian morphology, and pituitary gene expression. IHKA mice with right-targeted injection (IHKA-R) showed greater granule cell dispersion and pituitary Fshb expression compared to mice with left-targeted injection (IHKA-L). By contrast, pituitary expression of Lhb and Gnrhr were higher in IHKA-L mice compared to IHKA-R, but these values were not different from respective saline-injected controls. IHKA-L mice also showed an increased rate of weight gain compared to IHKA-R mice. Increases in estrous cycle length, however, were similar in both IHKA-L and IHKA-R mice. These findings indicate that although major reproductive endocrine dysfunction phenotypes present similarly after targeting left or right dorsal hippocampus for IHKA injection, distinct underlying mechanisms based on lateralization of epileptogenic insult may contribute to produce similar emergent reproductive endocrine outcomes.

Structure of Gynecological Diseases and Comorbidity in Women with HIV Infection and Reproductive Disorders

Background: The increase in the number of HIV-infected women of fertile age, as well as their reproductive plans to have healthy children, was the reason for studying the features of reproductive health disorders and comorbid conditions in women with HIV infection. Methods and Results: Women meeting the inclusion criteria were divided into two groups: Group 1 included 27 HIV-infected women (average age of 30.8±2.9 years) with reproductive disorders; Group 2 included 23 HIV-infected women (average age of 31.4±7.1 years) without reproductive disorders. In study groups, the main route of HIV transmission was sexual contact. When assigning women to a particular category (fertile or infertile), the WHO classification of fertility was used: fertile, presumably fertile, primarily infertile, secondarily infertile, women with unknown fertility. There was a statistically significant difference in the incidence of medical abortion in the HIV-infected women with secondary infertility [14(60.9%)], compared to Group 2 [8(29.6%)] (P=0.026). There were no statistically significant differences in the incidence of chronic co-morbidities (ENT disorders, gastritis/duodenitis, pancreatitis, cystitis, viral hepatitis (B, C), papillomavirus infection) in Groups 1 and 2 (P&gt;0.05). The incidence of pelvic inflammatory diseases was 2 times higher in Group 1 than in Group 2. No statistically significant differences in the incidence of uterine myoma, chronic cervicitis, chronic endometritis, vulvovaginal candidiasis,, and cervical dysplasia were found. A significant prevalence of chronic salpingo-oophoritis, secondary dysmenorrhea, secondary amenorrhea, opsomenorrhea, and secondary oligomenorrhea was detected significantly more frequently in Group 1 than in Group 2. The syndrome of hyperprolactinemia was also 2.6 times more frequent in Group 1 than in Group 2. Reproductive disorders in HIV-infected women were associated with a high incidence of STI combinations (trichomoniasis, gonorrhea, syphilis, chlamydia). Conclusion: Early detection of menstrual dysfunctions, prevention of abortion and sexually transmitted diseases, and timely treatment of infertility, are essential for women living with HIV.

Comorbidities in women living with HIV: A systematic review.

ObjectivesEffective antiretroviral therapy (ART) has improved the life expectancy of women living with HIV (WLWH). This population is now experiencing age‐related comorbidities. This systematic review presents the current understanding of the prevalence and impact of comorbidities in WLWH in the modern ART era.MethodsMEDLINE and Embase were searched for studies (1 January 2010 to 1 September 2020) reporting the prevalence of cardiovascular, bone, renal and neurocognitive disease in WLWH aged > 18 years. Studies were included if at least 100 participants (or > 50%) were female and data analysis included prevalence by sex.ResultsIn all, 3050 articles were identified and screened; 153 full‐text articles were assessed for eligibility and 38 were included in the final review. Significant gaps in the literature were identified, notably a lack of data on WLWH aged > 50 years. The data suggest a high burden of cardiovascular, bone, renal and neurocognitive disease in WLWH compared with HIV negative women. Traditional risk factors, such as hypertension, diabetes and dyslipidaemia, were common and often poorly managed. Generalizability of the results was limited, as many studies were conducted in the USA. Comparisons between WLWH and men with HIV were limited by marked differences in demographic and socioeconomic factors.ConclusionsWomen living with HIV experience a high burden of comorbid disease. Traditional risk factors are common and often poorly managed. This review also highlights the magnitude of differences between women and men living with HIV beyond the pathophysiological. Future research must unpick the complex drivers of morbidity in WLWH, to improve the holistic management of this population.

Risk stratification for endometrial hyperplasia and malignancy in women age ≤ 45 with abnormal uterine bleeding

Quality improvement initiative to identify risk factors for endometrial hyperplasia and carcinoma in a South Texas Hispanic patient population younger than 45 years old. This is a retrospective case control study of women age ≤45 with abnormal uterine bleeding (AUB) at a single academic institution. The study is IRB approved and includes all women ≤45 who had endometrial sampling performed between 2010 - 2020. Exclusion criteria are age >45 or <18 at the time of initial biopsy, known cancer diagnosis, or known cancer-related syndrome. Several covariates including demographics, BMI, parity, menstrual history, endometrial stripe thickness, smoking status, medical comorbidities, previous and current treatment were analyzed to identify trends in patients with endometrial hyperplasia and malignancy. There are 1,618 women included in the study. Of these 26 (1.6%) had endometrial malignancy, 114 (7%) had EIN, 114 (7%) had benign endometrial hyperplasia, and 1,364 (84.3%) had normal endometrium. The demographic distribution of our study population included 50% Hispanic, 38% Caucasian, 8% African American, 4% unspecified, and <1% Asian. The average age was 37 with normal endometrium, 38 with benign hyperplasia, 36 with EIN, and 35 with malignancy. The median BMI for the entire population was 48. Median BMI for women with normal endometrium, benign hyperplasia, EIN, and malignancy was 35, 33, 39, and 43 respectively. Among the 114 women with EIN, 55% were Hispanic and 41% were Caucasian, and of the 26 women with malignancy, 65% were Hispanic and 31% were Caucasian. Women with EIN and malignancy had an average endometrial stripe (ES) of 14.5mm and 20mm. Women with normal biopsies had an average ES of 12mm. Heavy menstrual bleeding (63%) followed by oligomenorrhea (24%) were the most common patterns of AUB across all pathologies. The most common comorbidities in women with EIN and malignancy were hypertension (31% and 42%, respectively) and diabetes (30% and 46%, respectively). Prior to diagnosis, 49% of women with EIN and 54% of women with malignancy had failed previous medical management of AUB. In a South Texas patient population, women ≤45 with AUB are at risk of EIN and malignancy. The characteristics most associated with malignancy and hyperplasia were Hispanic ethnicity, increased BMI, thickened ES, heavy menstrual bleeding pattern, and previous treatment failure. A risk stratification tool may be beneficial to help further clarify which patients are at highest risk and need endometrial sampling vs those patients in whom inappropriate sampling can be avoided.

Exploring the Anal Microbiome in HIV Positive and High-Risk HIV Negative Women.

This exploratory study sought to characterize the anal microbiome and explore associations among the anal microbiome, risk factors for anal cancer, and clinical factors. A pilot sample of 50 HIV infected and high-risk HIV negative women were recruited from the former Women's Interagency HIV Study. Microbiome characterization by 16S rRNA gene sequencing and datasets were analyzed using QIIME 2™. Composition of the anal microbiome and its associations with anal cancer risk factors and clinical factors were analyzed using linear decomposition model and permutational multivariate analysis of variance. Composition of the anal microbiome among HIV positive and high-risk negative women was dominated by Bacteroides, Prevotella, and Campylobacter. The overall taxonomic composition and microbial diversity of the anal microbiome did not significantly differ by HIV status. However, the abundance of Ruminococcus 1 belonging to the Rumincoccaceae family was associated with HIV status (q = .05). No anal cancer risk factors were associated with the anal microbiome composition. Clinical factors marginally associated with the anal microbiome composition included body mass index (BMI; p = .05) and hepatitis C virus (HCV; p = .05). Although HIV and risk factors for anal cancer were not associated with the composition of the anal microbiome in this pilot sample, other clinical factors such as BMI and HCV, may be worth further investigation in a larger study. Future research can build on these findings to explore the role of the microbiome and HIV comorbidities in women.

Adiponectin Gene Polymorphism (rs17300539) Has No Influence on the Occurrence of Metabolic Syndrome in Women with Polycystic Ovary Syndrome.

Adiponectin (rs17300539) is implicated in the pathogenesis of metabolic syndrome (MS), a common comorbidity of polycystic ovarian syndrome (PCOS). The aim of this study was to analyze the association between adiponectin gene polymorphism and incidence of MS in patients with PCOS. The study included 201 women (age 18 to 35 years), among them 81 patients with PCOS without concomitant MS, 70 subjects with PCOS and concomitant, and 50 regularly menstruating controls. Adiponectin gene polymorphism (11391 G/A, rs17300539) was determined by means of a real-time PCR. The study groups did not differ significantly in terms of their age and frequencies of various genotypes of the adiponectin gene polymorphism. The largest proportion in the whole group was Caucasian women (n = 178, 88.56%), who carried the GG genotype of the polymorphism; frequencies of GA and AA genotypes in the whole study group were 10.94% (n = 22) and 0.5% (n = 1), respectively. The presence of G or A allele of the rs17300539 adiponectin gene polymorphism was not associated with a greater likelihood of PCOS with/without concomitant MS. The hereby presented findings imply that MS is a common comorbidity in women with PCOS. However, the incidence of concomitant MS does not seem to be associated with adiponectin gene polymorphism.

Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries.

Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population.Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis.Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72–1.44, p = 0.916) and in subgroups of MINOCA patients.Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA.

Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study

BackgroundAlthough women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population.AimsTo assess the burden and impact of cardiovascular comorbidities in women with COVID-19.MethodsAll consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death.ResultsAmong 2878 patients, 1212 (42.1%) were women. Women were older (68.3 ± 18.0 vs. 65.4 ± 16.0 years; P < 0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.53–0.72). Age (adjusted HR: 1.05 per 5-year increase, 95% CI: 1.01–1.10), body mass index (adjusted HR: 1.06 per 2-unit increase, 95% CI: 1.02–1.10), chronic kidney disease (adjusted HR: 1.57, 95% CI: 1.11–2.22) and heart failure (adjusted HR: 1.52, 95% CI: 1.04–2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR: 2.41, 95% CI: 1.70–3.44) and troponin (adjusted HR: 2.00, 95% CI: 1.39–2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure.ConclusionsAlthough female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.

Differences in the Genital Microbiota in Women Who Naturally Clear Chlamydia trachomatis Infection Compared to Women Who Do Not Clear; A Pilot Study.

In vitro studies indicate IFNγ is central to Chlamydia trachomatis (Ct) eradication, but its function may be compromised by anaerobes typically associated with bacterial vaginosis (BV), a frequent co-morbidity in women with Ct. Here we investigated the associations between natural clearance of cervical Ct infection, the vaginal microbiome, and the requirements for IFNγ by evaluating the vaginal microbial and cytokine composition of Ct treatment visit samples from women who cleared Ct infection in the interim between their Ct screening and Ct treatment visit. The pilot cohort was young, predominantly African American, and characterized by a high rate of BV that was treated with metronidazole at the Ct screening visit. The rate of natural Ct clearance was 23.6% by the Ct treatment visit (median 9 days). 16S rRNA gene sequencing revealed that metronidazole-treated women who had a Lactobacillus spp.-dominant vaginal microbiota (CST 2 or 3) at the Ct treatment visit, were more prevalent in the Ct clearing population than the non-clearing population (86% v. 50%). L. iners (CST2) was the major Lactobacillus spp. present in Ct clearers, and 33% still remained anaerobe-dominant (CST1). Vaginal IFNγ levels were not significantly different in Ct clearers and non-clearers and were several logs lower than that required for killing Ct in vitro. An expanded panel of IFNγ-induced and proinflammatory cytokines and chemokines also did not reveal differences between Ct clearers and non-clearers, but, rather, suggested signatures better associated with specific CSTs. Taken together, these findings suggest that BV-associated bacteria may impede Ct clearance, but a Lactobacillus spp.-dominant microbiome is not an absolute requirement to clear. Further, IFNγ may be required at lower concentrations than in vitro modeling indicates, suggesting it may act together with other factors in vivo. Data also revealed that the vaginal bacteria-driven inflammation add complexity to the genital cytokine milieu, but changes in this microbiota may contribute to, or provide cytokine biomarkers, for a shift to Ct clearance.

STRUCTURE AND GENDER DIFFERENCES IN COMORBIDITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract Objective: To determine significant gender differences in the detection of comorbid pathology and to assess the role of comorbidity in the course of patients with myocardial infarction. Design and method: Statistical processing of the results was carried out using SPSS program using the methods of descriptive, parametric and non-parametric statistics. Numeric variables are generalized to their mean, standard deviation. The results are presented by the confidence interval (x ± confidence) for the average population with a normal distribution. Results: We performed a retrospective analysis of 500 patients. There were 325 men (65%); 175 women (35%), whose average age was 64.7 ± 1.03 years. In the analysis, among patients with MI, comorbidity was revealed: in women, 30.6% had an average (2–3 diseases) and 41.1% high (4 or more diseases) comorbidity, while in men a combination of two or three nosological units was in 101 (30.9%), four - five and more in 90 (27.6%). In almost all examined patients, 448 (89.6%) AMI developed against the background of arterial hypertension. Grade I hypertension was detected in 28 (6.3%), grade II hypertension - in 90 (20%), grade III hypertension - in 330 (73.7%). 129 (25.8%) patients had diabetes mellitus, CKD - in 118 (23.6%), COPD - in 97 (19.4%), gastrointestinal diseases - in 92 (18.4%), stroke was found in 58 (11.6%). Anemia was detected in 38 (7.6%), PE - in 7 (1.4%), DVT of the lower extremities - in 7 (1.4%). Conclusions: The vast majority of patients with a history of acute MI had comorbid pathology, more than half of them had 2–3 nosologies. Considering that 89.6% of patients had concomitant arterial hypertension, the influence of this factor on the clinical course of the disease cannot be excluded. Moreover, more than half of the patients with this concomitant pathology had a high degree of hypertension, which undoubtedly indicates an increase in the number of patients with hypertension and requires rational and timely antihypertensive therapy in this category of patients. The prevalence of comorbidity in women compared with men was determined; in women, more comorbidity in the structure was revealed.