CVD In Women Research Articles

Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study).

The prevalence and mortality of CVD in women increase over time. We conducted this research to evaluate the severity of coronary artery disease with the number of live births and breastfeeding duration. Patients aged 30-50 years old with positive exercise tests or evidence of cardiac ischemia who were candidates for coronary angiography were included. All the participants had at least one child. Syntax score was used to evaluate the severity of coronary arteries. Mean number of children was 3.72±1.85, in those patients with <2 live births no one had a syntax score≥1, but in the>5 live births group most patients had a syntax score≥1. In patients with zero syntax score, it was estimated as 4.91±39.7; in patients with 1≤ syntax score, it was 4.48±7.29 (P =0.76). Among patients with > 5 birth lives, those with higher syntax scores had older ages (P=0.497). After adjusting age, the association between live births and syntax score became non-significant (P=0.850). By increasing the number of live births >5, the severity of coronary artery disease, increases. However, this association was not significant after adjusting the age of patients.

International Registry of Cardiovascular diseases in Women (IROCW): Assessing the feasibility of large data registry in absence of funding and electronic database; initial data from Iraq

Abstract Funding Acknowledgements Type of funding sources: None. Background There is unmet need of sex focused registries to be the first step towards sex focused trials and guidelines. In Iraq due to absent electronic database and research funding, it is challenging to initiate long term cardiovascular registries. Also, for women patients follow up, it is challenging to contact them by male doctors due to cultural causes. Purpose IROCW aims to portrait the demographics focusing on sex-specific risk factors, presentation, in-hospital and 1-month outcomes of women admitted to cardiac centers or cardiology wards in general hospitals. Patients with any of the following diagnoses were included in the registry: IHD (ACS admitted to CCU or chronic coronary syndromes admitted for elective catheterization), arrhythmia, heart failure and valvular heart disease. Methods Under the Umbrella of Iraqi Scientific Council of Cardiology, a female interventional cardiologist was among leaders of the study, so, she enhanced the recruitment of female trainees besides male doctors to participate in data collection and patients follow up to bridge the cultural barriers. IROCW is a prospective, multicentre, cross-sectional study. Data collection using paper forms was done by investigators then data entry started and stopped after seven weeks to assess feasibility and reliability of data entry into google form that was designed for the registry. If the registry is feasible using paper forms and google form, then the next phase will be international and assessing 12-month cardiovascular outcomes (target number=10,000 patients; total number in all four arms of registry). Results n=150, mean age=60 years, 89.3% of patients reside in urban areas. Women were mostly married (67.8%) or widowed (25.5%). They were illiterate (47.3%) or having primary education (34.7%). 60% of women's family total income&amp;lt;500 USD. Most common risk factor was hypertension while menopause and gestational hypertension were most common sex-specific risk factors. In-hospital echocardiography was done in 26%. In-hospital heart failure was reported in 20% of patients. Aspirin, P2Y12 inhibitors, heparin, and statin were used in: 85.8%, 60.4%, 35.4% and 87.9% respectively. B-blockers, ACEI/ARBs and MRA were used in 71.1%, 62.8%, and 7.2% respectively. Dietary instructions as indicated on discharge was done properly in 96.6%, while smoking cessation counseling and referral for cardiac rehabilitation were not done properly. At 1-month follow up, patients were reachable in 91.5%. Conclusion Illiteracy and poor socio-economic status in women raise the importance of dedicated approach required for health education and care. Despite absent electronic data base and lack of research funding in Iraq, this study is feasible. The next international phase (Iraq and Sudan) will be initiated, so, data from LMIC from both Asia and Africa will be available to bridge knowledge gaps in CVD in women from these countries.

Left ventricular diastolic function in the fifth decade of life in women with a history of spontaneous preterm birth

ObjectiveCardiovascular disease (CVD) is the number one cause of death in women and defining its risk factors is necessary to reduce its prevalence. A history of preeclampsia is shown to be associated with hypertension and alterations in left ventricular (LV) diastolic function parameters. Because of overlapping mechanisms between preeclampsia and spontaneous preterm birth (SPTB), our most recent study investigated the association between SPTB and hypertension, and found an almost 2 times higher prevalence of hypertension after SPTB. No previous studies have focused on the association between SPTB and LV diastolic function. The aim of this study is to investigate LV diastolic function as potential early parameter of CVD in women with a history of SPTB. Study designWe included cases with a history of SPTB between 22 and 37 weeks and controls who had a term birth. Women with hypertensive disorders or gestational diabetes in any of their pregnancies, were excluded. Both groups underwent cardiovascular risk assessment and transthoracic echocardiography 9 to 16 years after pregnancy. Echocardiographic measures were adjusted using a linear regression analysis accounting for hypertension and other risk factors known to be associated with CVD. A subgroup analysis was performed based on hypertension at follow-up. ResultsA total of 94 cases and 94 controls were included, on average 13 years after pregnancy. There were no significant differences in LV diastolic function parameters. Women with a history of SPTB and diagnosed hypertension at follow-up, showed significant higher late diastolic mitral flow velocity, lower e’septal velocity and higher E/e’ratio, compared to women with a history of SPTB without hypertension, although within normal ranges. ConclusionsWhen a history of SPTB is accompanied by hypertension at follow-up, significant changes in LV diastolic function were seen. Therefore, hypertension is the central factor in preventive screening methods, and transthoracic echocardiography has no additional value at this follow-up duration.

The Role of Imaging in Preventive Cardiology in Women.

The prevalence of CVD in women is increasing and is due to the increased prevalence of CV risk factors. Traditional CV risk assessment tools for prevention have failed to accurately determine CVD risk in women. CAC has shown to more precisely determine CV risk and is a better predictor of CV outcomes. Coronary CTA provides an opportunity to determine the presence of CAD and initiate prevention in women presenting with angina. Identifying women with INOCA due to CMD with use of cPET or cMRI with MBFR is vital in managing these patients. This review article outlines the role of imaging in preventive cardiology for women and will include the latest evidence supporting the use of these imaging tests for this purpose. CV mortality is higher in women who have more extensive CAC burden. Women have a greater prevalence of INOCA which is associated with higher MACE. INOCA is due to CMD in most cases which is associated with traditional CVD risk factors. Over half of these women are untreated or undertreated. Recent study showed that stratified medical therapy, tailored to the specific INOCA endotype, is feasible and improves angina in women. Coronary CTA is useful in the setting of women presenting with acute chest pain to identify CAD and initiate preventive therapy. CAC confers greater relative risk for CV mortality in women versus (vs.) men. cMRI or cPET is useful to assess MBFR to diagnose CMD and is another useful imaging tool in women for CV prevention.

Sex-specific Risk Factors for Cardiovascular Disease in Women

CVD is the leading cause of death for women worldwide. The symptoms of CVD in women may be less specific than in men, so women are less likely to be properly diagnosed and adequately treated. Women experience a proportional increase in cardiovascular risk on risk factors that are common to both genders. In addition, women have endocrine-related factors that increase their susceptibility to CVD. 1 in 3 women die from CVD, and 45% of women over the age of 20 have some form of CVD. [33] We must exploit gender differences to ensure optimal medical care. Detection of CVD risk factors and preventive measures in this regard are essential for proper cardiovascular care among women.

1080-P: Sex-Specific Associations between Risk-Factor Control and Incident CVD in Diabetic Patients

Background: Women with diabetes are at higher risk of CVDs than men. We investigated the associations between the degree of risk factor control and CVD in women and men with diabetes. Methods: A total of 16,760 diabetes patients from UK Biobank were included. The exposure was the number of optimized risk factors including HbA1c level &amp;lt;53 mol/mol (7%) , blood pressure &amp;lt;140/90 mm/Hg, and non-HDL-cholesterol &amp;lt;130 mg/dl. Results: During a mean follow-up of 8.4 years, 2000 incident CVD were documented, including 1685 IHD and 412 stroke. Number of risk-factor control was inversely associated with the risks of IHD, stroke and total CVD, and such associations were stronger in women than men (P for interaction with sex=0.012, 0.018 and 0.017, respectively) . The two most important risk factors for men were blood pressure and non-HDL-cholesterol, while for women were HbA1c and non-HDL-cholesterol. In addition, as compared with non-diabetic controls, the diabetes-related risk of CVD was theoretically eliminated when 2 or more risk-factors were under control in women, and 3 risk-factors were under control in men. Conclusion: Among diabetes patients, to control the risk factors within the target range benefit more in women than men in preventing subsequent risk of CVD. Our findings highlight the importance of raising awareness of control of risk factors and provide evidence for the sex-specific priority of control strategies. Disclosure X.Wang: None. H.Ma: None. V.Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. L.Qi: None. Funding National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024) , the National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616)

NewsCAP: New evidence that breastfeeding reduces the risk of CVD in women.

NewsCAP: New evidence that breastfeeding reduces the risk of CVD in women.

Consumption of &lt;I&gt;Allium sativum&lt;/i&gt; (Functional Food) and Lipid Profile of Postmenopausal Women with Dyslipidemia: A Correlational Study

CVD is the leading cause of death in women around the world. Estrogen deficiency has been linked to the rapid increase in CVD in women who have undergone natural or surgical menopause. Garlic (Allium sativum) has played an important dietary as well as medicinal role in human history. The study was conducted to assess correlation of garlic consumption on lipid level among postmenopausal women with dyslipidemia. In this clinical trial 180 respondents willing to participate in intervention program, who met inclusion criteria, were divided into three groups, control (n=60), Exp-I (garlic eaters n=60) and Exp-II (non-garlic eaters n=60). Dry garlic powder was prepared using standard procedure and analyzed for its active phytonutrients. A 500 mg of dry garlic powder capsules two per day were given to the respondents for 12 weeks. Biochemical analysis for cholesterol levels were measured in the standard laboratory before and after the study. Questionnaire-cum- interview method was used to obtain relevant information. Pearson correlation and one-way analysis of variance tests were conducted to analyze the data. Mean age of the respondents was found to be (53.6 ± 0.89) years. Pretest cholesterol levels in control (211.2 ± 6.24), Exp-I (212.2 ± 6.41) and Exp-II (212.4 ± 6.74) was observed. The results indicate that all the groups exhibit negative correlation with total cholesterol, LDL, triglycerides but the values of control group are non-significant and the relationship is weak, whereas values of experimental groups (Exp-I and Exp-II) shows strong negative correlation which is significant at 1 % level. Strong positive correlation observed with HDL among experimental groups and weak positive non-significant correlation was seen with control group. It can be concluded that functional property of garlic has positive correlation in managing dyslipidemia among postmenopausal women. Significant improvement in the lipid level was observed with garlic intervention.

RISK FACTORS FOR WOMEN’S CARDIOVASCULAR DISEASE

Risk factors specific to women such as hypertension in pregnancy, premature births, gestational diabetes and menopause are among the unique aspects of cardiovascular health in women.Objective: Women of childbearing age were considered protected and CVD were considered male diseases. A report from the European Heart Health Strategy (EuroHeart) finds that women are less likely to receive the same preventive advice as men and that women are still underrepresented in cardiovascular researchRisk factors are important for both men and women, but differ their impact was stronger in men and women. Especially in women, the presence of diabetes, hypertension and smoking is associated with a higher risk than in men. Female sex-specific risk factors related to hormonal and reproductive status that affect the risk of cardiovascular disease in women. These risk factors are related to hormonal status, pregnancy, some non-cardiac diseases with a higher prevalence in women and their treatment.Conclusions. To improve the care of women with cardiovascular disease, it is necessary to realize that the diagnosis of acute coronary syndromes can be problematic in women due to differences in symptoms. and presenting symptoms. At the same time, it is necessary to understand the importance of specific approaches in the diagnosis, treatment and prevention of CVD in women.

Sex Differences in Causes of Death After Stroke: Evidence from a National, Prospective Registry

Background: We examined sex differences in cause of death and cause-specific excess mortality after stroke. Materials and Methods: First-ever strokes (2010–2013; 35 hospitals) participating in the Australian Stroke Clinical Registry were linked to national death registrations and other administrative datasets. One-year cause-specific mortality was categorized as stroke, ischemic heart disease, other cardiovascular disease (CVD; e.g., hypertension), cancer, and other. Specific hazard ratios (sHRs) of death for women compared to men were estimated using competing risk models, with adjustment for factors differing by sex (e.g., age and stroke severity). Age- and sex-specific mortality rates expected in the general population were derived from national data. Standardized mortality ratios (SMRs; observed/expected deaths) were estimated for cause-specific mortality by sex after age standardization. Results: Among 9,441 cases (46% women), women were 7 years older than men, had more severe strokes, and received similar patterns of suboptimal secondary prevention medications at discharge. Women had greater mortality associated with stroke (sHRunadjusted 1.65) and other CVD (sHRunadjusted 1.65), which was related to age and stroke severity rather than other factors. Compared to population norms, those surviving to 30 days had eight-fold increased mortality from stroke (primary/recurrent) events irrespective of sex (SMRage-standardised women 8.8; men 8.3). Excess mortality from other CVD was greater in women (SMRage-standardised 3.6 vs. men 2.8; p = 0.026). Conclusions: Cause-specific mortality after first-ever stroke differs by sex. The greater death rate attributed to stroke/other CVD in women was mostly explained by age and stroke severity. Greater implementation of secondary stroke prevention is relevant to both sexes.

Missed opportunities to prevent cardiovascular disease in women with prior preeclampsia

BackgroundCardiovascular disease (CVD) is the leading cause of death in women in every major developed country and in most emerging nations. Complications of pregnancy, including preeclampsia, indicate a subsequent increase in cardiovascular risk. There may be a primary care provider knowledge gap regarding preeclampsia as a risk factor for CVD. The objective of our study is to determine how often internists at an academic institution inquire about a history of preeclampsia, as compared to a history of smoking, hypertension and diabetes, when assessing CVD risk factors at well-woman visits. Additional aims were (1) to educate internal medicine primary care providers on the significance of preeclampsia as a risk factor for CVD disease and (2) to assess the impact of education interventions on obstetric history documentation and screening for CVD in women with prior preeclampsia.MethodsA retrospective chart review was performed to identify women ages 18–48 with at least one prior obstetric delivery. We evaluated the frequency of documentation of preeclampsia compared to traditional risk factors for CVD (smoking, diabetes, and chronic hypertension) by reviewing the well-woman visit notes, past medical history, obstetric history, and the problem list in the electronic medical record. For intervention, educational teaching sessions (presentation with Q&A session) and education slide presentations were given to internal medicine physicians at clinic sites. Changes in documentation were evaluated post-intervention.ResultsWhen assessment of relevant pregnancy history was obtained, 23.6% of women were asked about a history preeclampsia while 98.9% were asked about diabetes or smoking and 100% were asked about chronic hypertension (p < 0.001). Education interventions did not significantly change rates of screening documentation (p = 0.36).ConclusionOur study adds to the growing body of literature that women with a history of preeclampsia might not be identified as having increased CVD risk in the outpatient primary care setting. Novel educational programming may be required to increase provider documentation of preeclampsia history in screening.

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

Background and aimsReproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women. MethodsWe included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011–2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors. ResultsMean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index. ConclusionsPregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.

Особливості ліпідного обміну в жінок із гострим коронарним синдромом без підйому сегмента ST залежно від гормонального статусу

Introduction. The role of lipid metabolism disorders in the process of atherogenesis has long been established. It is known little about the effects of dyslipidemia on the development of coronary artery disease in women. There is a perception that the effect of endogenous estrogens during the fertile period of woman's life slows down the manifestation of atherosclerosis in women and before the onset of menopause, the incidence of CVD in women is lower. Hypercholesterolemia or atherogenic dyslipidemia is a particular danger in the development of CVD in women and the risk of macrovascular injury associated with it is due to the long asymptomatic course and significant prevalence in the female population.The aim of the study – toconduct a comparative analysis of lipid metabolism in women with acute coronary syndrome without ST segment elevation(STEMI) and practically healthy women, depending on the hormonal status.Materials and Methods. We examined 157 women aged 35–72 years (average age 56.54±0.87 years). Among them, 112 female patients with STEMI (group 1) aged 39 to 72 years (average age 58.52±0.99 years). The comparison group (group 2) were 45 practically healthy women aged 35 to 71 years (average age 52.58±1.58 years). The levels of female sex hormones were determined. The lipid metabolism indices in women were measured.Depending on the type of hormonal status, women of the 1 and 2 groups were divided into subgroups A and B consisted of 64 patients with STEMI, aged from 39–72 (middle age – 60.77±1.16), 2А – 26 practically healthy women 42–71 years (average age 58.64 ± 2.18 years) with hormonal signs of postmenopause: estradiol level &lt;80 pmol/l (21.79 pg/ml) and LH/FSH &lt;1 ratio index. The subgroup 1Bincluded 48 female patients with non STEMI at the age of 35 to 65 years (mean age 52.29±1.63), IIB-19 practically healthy individuals of the female population aged 35 to 58 years (middle age – 49.84±1.84years) with estradiol levels&gt; 80 pmol/l (21.79 pg/ml) and a ratio of LH/FSH&gt; 1.Resultsand Discussion. Almost all female patients of the IA subgroup had a level of total cholesterol level more than 4 mmol/l, which was 1.3 times significantly greater than that of IB subgroup (95.31±2.64% (IA) vs 75.00±6.25 % (IB)). The mean level of LDL cholesterol is significantly higher in women IA subgroups (4.50±0.21 mmol/l (IA) vs 3.44±0.24 mmol/l (IB)). In 73,43±5,52% of the IA subgroup, hypertriglyceridemia was detected, which was 1.6 times more likely to be registered (45.83±8.19%) than in patients with IB subgroups. The proportion of patients with lowered LDL cholesterol was almost 1.5 times lower in the IA subgroup (37.50±6.05% (IA) vs 52.08±7.21% (IB)). The mean HDL cholesterol level in the IB was significantly lower in comparison with the subgroup 1A (1.04±0.03 mmol/l (1B) versus 1.16±0.05 mmol/l (IA). Diabet (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally hazardous labor (89.58±4.41 %) was significantly higher in patients of the subgroup 1B.Conclusions.In women with STEMI, regardless of the hormonal balance of female sex hormones, there is a greater prevalence and severity of dyslipidemia compared with healthy individuals. Estrogen deficiency in postmenopausal women with STEMI cause severe lipid and lipid metabolism disorders, which contributes to the development of acute coronary syndrome. Lower levels of HDL cholesterol in patients with estrogen retained estrogen compared to estrogen-deficient patients are due to higher prevalence of diabetes (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally harmful work (89.58±4.41 %), along with the presence of traditional risk factors of STEMI in these women.

The pulse-mass index as a predictor of cardiovascular events in women with systemic lupus erythematosus

BackgroundPatients with systemic lupus erythematosus (SLE) have 3times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Indices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE. MethodologyCohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalization records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier. ResultsWe included 238 women with a median age of 31 (18–52) years, with a follow-up of 8years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR=8.1 (95% CI: 1.1–65), metabolic syndrome with 2.4 (95% CI: 1–5.8), cumulative damage with HR=1.5 (95% CI: 1.1–2.2) and body fat percentage HR=2.8 (95% CI: 1.1–6.9). ConclusionsThe PMI is a better predictor factor of CVD in women with SLE.

El índice pulso-masa como factor pronóstico de eventos cardiovasculares en mujeres con lupus eritematoso sistémico

BackgroundPatients with systemic lupus erythematosus (SLE) have 3times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Índices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE. MethodologyCohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalisation records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier. ResultsWe included 238 women with a median age of 31 (18-52) years, with a follow-up of 8years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR=8.1 (95% CI: 1.1-65), metabolic syndrome with 2.4 (95% CI: 1-5.8), cumulative damage with HR=1.5 (95% CI: 1.1-2.2) and body fat percentage HR=2.8 (95% CI: 1.1-6.9) ConclusionsThe PMI is a better predictor factor of CVD in women with SLE.

Effectiveness and safety of indapamide sustained-release in the treatment of post partial hypertension

Background. Hypertensive disorders in pregnancy have been recognized as an important risk factor for atherosclerotic CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post partial hypertension (HT) yet.Methods. In a case-control, open-label 1-year study, 54 post-partum hypertensive women (aged 22-38 years; body mass index 26.7±3.8 kg/m2; 18 with previous pre-eclampsia, 18 pre-existing HT, 18 pre-existing HT plus superimposed pre-eclampsia) were studied. Nursing mothers (n=27) received adjusted-dose methyldopa (Egis) 500-2000 mg daily, 27 non-feeding women received indapamide SR (Servier) 1.5 mg daily. No significant differences observed between two groups at baseline.Results. After comprehensive follow-up, clinical blood pressure was not found to differ substantially between indapamide and methyldopa groups (124.8±3.2/83.2±2.1 mmHg vs 125.3±3.8/81.5±2.9 mmHg respectively; p =NS), but indapamide significantly better improved diurnal BP patterns. No maternal adverse effects were registered in both groups, except for sleepiness and bad mood in 18.5% of methyldopa patients. There was a significant difference in weight reduction, in favour of indapamide (-11.3 kg vs -2.7 kg; p =0.032), as well as in decrease of microalbuminuria (-189.2 mg/24 h vs -51.4 mg/24 h; p

Assessment of noninvasive risk markers of subclinical atherosclerosis in premenopausal women with previous history of gestational diabetes mellitus.

Introduction:Gestational diabetes mellitus (GDM) is state of carbohydrate intolerance detected first time during pregnancy. GDM represents a significant risk factor for the development of CVD in women. The degree to which women with histories of gestational diabetes are at risk for cardiovascular disease, beyond their predisposition to future diabetes, is still unclear. The aim of our study was to assess the presence of surrogate markers of subclinical atherosclerosis which can be present in them even without developing type 2 diabetes.Subjects and Methods:In this descriptive cross-sectional hospital based study, 50 patients 20-45 yrs of age, premenopausal, at least 1 yr past her most recent pregnancy, and not more than 5 yr past her index pregnancy with GDM. These patients and controls who did not have GDM were assessed for carotid intima media thickness,endothelial dysfunction, epicardial fat thickness and other cardiovascular risk factors.Results:Women with pGDM were found to have unfavourable cardiovascular risk parameters. They also demonstrated more frequent occurrence of metabolic syndrome(64% vs 10%) than control subjects. Individual components of MS increased with increasing BMI in both the groups. As far as markers of subclinical atherosclerosis were concerned women with pGDM had significantly higher CIMT, FMD and epicardial fat thickness than control group.Conclusion:Women with pGDM, even before development of diabetes have significant differences in CVD risk factors when compared to those who do not have such history. Postpartum screening for glucose intolerance and efforts to minimize modifiable cardiovascular risk factors, including hypertension, viscerall adiposity, and dyslipidemia should be the most effective measures for lowering of cardiovascular risk.

Эффективность и безопасность ретардного индапамида в лечении женщин с гипертонией после родов

Background. Hypertensive disorders in pregnancy have been recognized as an important risk factor for atherosclerotic CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post partial hypertension (HT) yet.Methods. In a case-control, open-label 1-year study, 54 post-partum hypertensive women (aged 22-38 years; body mass index 26.7±3.8 kg/m2; 18 with previous pre-eclampsia, 18 pre-existing HT, 18 pre-existing HT plus superimposed pre-eclampsia) were studied. Nursing mothers (n=27) received adjusted-dose methyldopa (Egis) 500-2000 mg daily, 27 non-feeding women received indapamide SR (Servier) 1.5 mg daily. No significant differences observed between two groups at baseline.Results. After comprehensive follow-up, clinical blood pressure was not found to differ substantially between indapamide and methyldopa groups (124.8±3.2/83.2±2.1 mmHg vs 125.3±3.8/81.5±2.9 mmHg respectively; p =NS), but indapamide significantly better improved diurnal BP patterns. No maternal adverse effects were registered in both groups, except for sleepiness and bad mood in 18.5% of methyldopa patients. There was a significant difference in weight reduction, in favour of indapamide (-11.3 kg vs -2.7 kg; p =0.032), as well as in decrease of microalbuminuria (-189.2 mg/24 h vs -51.4 mg/24 h; p <0.001) and left ventricular mass index (-25.3 g/m2 vs -10.5 g/m2; p =0.021). No significant changes in lipid and glucose metabolism were found in both groups. Treatment with indapamide significantly improved endothelial function, non-invasively assessed by flow-mediated dilatation of the brachial artery using high-resolution ultrasound (+9.3% vs +2.9%; p =0.041). Moreover, indapamide demonstrated a good safety profile and led to high adherence to treatment. In the methyldopa group, no reduced milk production and offspring adverse effects were observed.Conclusions. The results provide support for indapamide SR as an effective and safe therapy of hypertension after delivery. Indapamide is superior to methyldopa in women with post partial hypertension.

Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex – Results from two community based cohort studies

AimTo study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off ≥25). Methods and resultsA cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmö Diet and Cancer study – cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35–2.70), WC; 1.81 (95% CI 1.02–3.20), SAD; 1.25 (95% CI 0.74–2.11), and WHHR; 1.97 (95% CI 1.40–2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04–1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04–1.47), WC 1.19 (95% CI 1.00–1.42), SAD 1.21 (95% CI 1.00–1.46), and WHHR; 1.23 (95% CI 1.05–1.44). Only the findings in men with BMI ≥ 25 were verified in MDCC. ConclusionIn normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.

Most Important Outcomes Research Papers on Cardiovascular Disease in Women

Cardiovascular disease (CVD) in women has been historically understudied. For many years, heart disease had been thought to be primarily a “man’s disease.” Consequently, women have been significantly under-represented in longitudinal studies of disease history and in clinical trials. High-quality data from women at the extremes of age, with multiple co-morbidities, and from racial and ethnic minorities have been particularly rare. In order to increase awareness of cardiovascular prevention among women, in 1999 the American Heart Association (AHA) published its first women-specific clinical recommendations for the prevention of CVD.1 In 2004, the AHA and multiple other collaborating organizations subsequently sponsored “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women,” which underwent updates in 2007 and 2011. As a result of these and other related initiatives, the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 CVD-associated death among US women has declined significantly over this time period.3,4 Yet substantial work still needs to be done to improve women’s cardiovascular health. CVD remains the number one killer among women.4 As the obesity epidemic continues, we are actually finding increases in coronary heart disease (CHD) death among young women 35 to 54 years of age.2 Morbidity and mortality from stroke and hypertension remain high.4 In addition, substantial outcomes disparities continue for women from racial and ethnic minorities.4 We have therefore dedicated our topic summaries in this issue of Circulation: Cardiovascular Quality and Outcomes to CVD in women. We have included only those studies where authors provided a convincing a priori reason to study a particular disease process or clinical intervention in women and reported primary endpoints that were sex-specific. We have included articles on the representation of women …