Differences In Cardiovascular Disease Research Articles

Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology.

Cardiovascular diseases (CVD) represent an important cause of mortality and morbidity in women. It is now recognized that there are sex differences regarding the prevalence and the clinical significance of the traditional cardiovascular (CV) risk factors as well as the pathology underlying a range of CVDs. Unfortunately, women have been under-represented in most CVD imaging studies and trials regarding diagnosis, prognosis, and therapeutics. There is therefore a clear need for further investigation of how CVD affects women along their life span. Multimodality CV imaging plays a key role in the diagnosis of CVD in women as well as in prognosis, decision-making, and monitoring of therapeutics and interventions. However, multimodality imaging in women requires specific consideration given the differences in CVD between the sexes. These differences relate to physiological changes that only women experience (e.g. pregnancy and menopause) as well as variation in the underlying pathophysiology of CVD and also differences in the prevalence of certain conditions such as connective tissue disorders, Takotsubo, and spontaneous coronary artery dissection, which are all more common in women. This scientific statement on CV multimodality in women, an initiative of the European Association of Cardiovascular Imaging of the European Society of Cardiology, reviews the role of multimodality CV imaging in the diagnosis, management, and risk stratification of CVD, as well as highlights important gaps in our knowledge that require further investigation.

A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone.

Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the United States. To assess health care utilization related to cardiovascular disease (CVD) and bone health (BH) events (atrial fibrillation [AF], heart failure [HF], myocardial infarction [MI], stroke, and osteoporosis/fractures [FX]) in participants taking LT4+LT3 or DTE surveyed in the Medical Expenditure Panel Survey database. Multi-year cross-sectional analysis examining 5437 participants (≥18 years old) treated with LT4, LT4+LT3, or DTE between 2016 and 2020. Health care utilization was assessed through outpatient, emergency, and hospital visits for AF, HF, MI, stroke, FX, and a composite index. A weighted analysis provided national estimates of health care utilization parameters. Utilization was re-analyzed following propensity score-based matching to balance sociodemographic and clinical covariates between treatment groups. Additionally, provider type and specialty data were obtained from visits associated with TH prescriptions. 5106 participants were treated with LT4 monotherapy, 252 with DTE, and 79 with LT4 + LT3. Prevalence of combined outpatient CVD and BH-related care utilization was lower among DTE/LT4+LT3 vs LT4 users (3.5% vs 7.7%; P = .008). There were no differences in emergency/hospital events. After covariate balancing, CVD and BH-related care utilization was similar between groups in outpatient and emergency/hospital settings. LT3 and DTE made up 7.6% of all TH prescriptions. For visits associated with DTE prescriptions, nurse practitioners and alternative medicine professionals were more likely to be identified as the primary provider type. No significant differences in CVD- and BH-related health care utilization were identified between LT4 and DTE/LT4+LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.

Gender differences in cardiovascular disease risk: Adolescence to young adulthood

Background and aimsGender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. Methods and resultsData are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk.At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. ConclusionYoung adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.

MP-453085-9 SEX DIFFERENCES IN ALL-CAUSE AND CVD MORTALITY ASSOCIATED WITH NEW-ONSET INCIDENT ATRIAL FIBRILLATION: THE VITAL STUDY

Conflicting data exist as to whether women with atrial fibrillation (AF) are at higher risk of adverse outcomes and mortality than men. To examine the association between a new diagnosis of AF and cardiovascular (CV) outcomes and death in women as compared to men. We prospectively examined the association between incident AF and non-fatal cardiovascular disease (CVD) (stroke, myocardial infarction, or heart failure) and CV mortality and total mortality among 12,693 women and 12,285 men without a prior history of CVD or AF from the VITAL study. Multivariable Cox proportional-hazards - models with updated time-varying covariates, and comparison test were used to assess for sex differences. During a median follow-up of 6.3 years, 459 women and 554 men developed new-onset AF. After multivariable adjustment for CVD risk factors, women with incident AF had similarly high relative risks of subsequent non-fatal CVD (HR 5.6; 95% CI, 4.1-7.6) as men (HR 4.9; 95% CI, 3.7-6.5) with no significant difference (p=0.36). In contrast, incident AF was associated with significantly higher multivariable-adjusted relative risks for subsequent CVD mortality in women (HR 6.1; 95% CI, 3.5-10.5) as compared to men (HR 2.0; 95% CI, 1.0-4.0); p, for difference= 0.01. The magnitude of the HR for the association between incident AF and total mortality was also significantly greater in women (HR 3.4; 95% CI, 2.5-4.6) as compared to men (HR 1.8; 95% CI, 1.3-2.5); p, difference= 0.005. In multivariable models that further controlled for interim non-fatal CVD events, incident AF remained significantly associated with higher risks of CVD mortality (HR 22; 95% CI, 1.3-4.0) and total mortality (HR 1.7; 95% CI 1.2-2.3) in women; however, the relative risk elevations were completely attenuated in men (HR 0.7; 95% CI 0.3-1.4 for CVD mortality; HR 1.0; 95% CI 0.7-1.4 for total mortality; p for difference 0.009 and 0.02 respectively). In a prospective cohort of women and men without baseline AF or CVD, the magnitudes of the relative risk elevations for CVD and all-cause mortality associated with incident AF were greater in women as compared to men. As opposed to men, the elevation in risk persisted for women even after controlling for interim CVD events, suggesting that other factors beyond interim CVD events account for the elevated mortality risk associated with AF in women.

Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function

While patients receiving dialysis therapy in the United States are more likely to develop cardiovascular disease (CVD) than those in Japan, direct comparisons of patients with predialysis chronic kidney disease (CKD) are rare. To study this, we compared various outcomes in patients with predialysis CKD using data from the Chronic Renal Insufficiency Cohort (CRIC) and CKD Japan Cohort (CKD-JAC) studies and determined mediators of any differences. Candidate mediators included left ventricular (LV) indices assessed by echocardiography. Among 3125 CRIC and 1097 CKD-JAC participants, the mean LV mass index (LVMI) and ejection fraction (EF) were 55.7 and 46.6 g/m2 and 54% and 65%, respectively (both significant). The difference in body mass index (32 and 24 kg/m2, respectively) largely accounted for the differences in LVMI and C-reactive protein levels across cohorts. Low EF and high LVMI were significantly associated with subsequent CVD in both cohorts. During a median follow-up of five years, CRIC participants were at higher risk for CVD (adjusted hazard ratio [95% confidence interval]: 3.66 [2.74-4.89]) and death (4.69 [3.05-7.19]). A three-fold higher C-reactive protein concentration and higher phosphate levels in the United States cohort were moderately strong mediators of the differences in CVD. However, echocardiographic parameters were stronger mediators than these laboratory measures. LVMI, EF and their combination mediated the observed difference in CVD (27%, 50%, and 57%, respectively) and congestive heart failure (33%, 62%, and 70%, respectively). Thus, higher LV mass and lower EF, even in the normal range, were found to be predictive of CVD in CKD.

Abstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022

Journal of Women's HealthVol. 31, No. 10 AbstractsFree AccessAbstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022Published Online:26 Oct 2022https://doi.org/10.1089/jwh.2022.29042.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Building Interdisciplinary Research Careers in Women's Health (BIRCWH)Introduction to the Scientific Abstracts for the 2022 Annual BIRCWH MeetingLisa Begg, Dr.P.H., RN1The Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program is now in its twenty‐second year and has produced more than 730 highly qualified and successful junior investigators. The BIRCWH program was created by the Office of Research on Women's Health (ORWH), National Institutes of Health (NIH) and several NIH institutes and centers in 2000. The program continues to utilize an institutional mentored research and career development grant program that has increased the number and skills of junior faculty called Scholars, who recently completed clinical training or postdoctoral fellowships.The BIRCWH program supports the ORWH mission and advances its goal to promote the independent scientific careers for a diverse, and robust workforce to advance science for the health of women, and where appropriate, the use of both sexes to better understand the influence of sex as a variable for health and disease.When the BIRCWH Program was originally created, most of the scientific abstracts focused on reproductive health research. Over the years, the abstract topics have greatly expanded across many areas of science. In terms of the 2022 BIRCWH abstracts, seven categories have been created so that the abstracts can be clustered during the virtual poster session on November 2, 2022. It should be noted that there is overlap between some abstract categories such as Sex and Gender Differences and Clinical Research. For example, one abstract focuses on sex differences in guideline‐consistent diagnostic testing of acute pulmonary embolism among adult emergency department patients; 1,173 adults were studied, 777 of which were females and 440 were males.From the number of abstracts contained in this Fall issue, the number in each category from highest to lowest include ten abstracts that have a Clinical research focus and ten abstracts with a Sex and Gender Differences focus, followed closely by Reproductive Health with eight abstracts. Basic research topics and Public Health topics are represented with seven abstracts each, followed by smaller groupings, four each, for Neuroscience and Health Disparities.Some of the topics for the 2022 BIRCWH abstracts have described complex research topics such as machine learning using electronic medical records to predict risk for probable depression in early pregnancy in people of color, and development of organ‐on‐chip to determine the effects of race/ethnicity and sex on intra‐amniotic infection leading to fetal brain inflammation. There have also been an increasing number of public health topics accepted for the 2022 Annual BIRCWH meeting, such as how air pollution affects the sex‐specific associations with cardio‐metabolic health, and the social determinants of health and premature death among women and men in the United States.Health disparity abstracts include such topics as racial disparities in incident stroke documented in the Women's Health Initiative: exploring biological, behavioral, psychosocial, and social risk factors. We invite the reader to review all the BIRCWH abstracts included in this issue which also include research across the lifespan in civilian populations as well as military and Veteran groups of women and men.The career development associated with these BIRCWH abstracts is built around three pillars: interdisciplinary research, mentoring, and career development. Interdisciplinary science teams work to advance fundamental understanding and solve problems that those from a single discipline cannot. The interdisciplinary research can be basic, translational, behavioral, clinical, and/or health‐services research relevant to the health of women. Most BIRCWH Scholars move on to obtain independent NIH grant funding following their participation in the BIRCWH Program.The interdisciplinary mentoring teams are essential to the BIRCWH Program, with a team‐based approach for mentoring BIRCWH Scholars. These teams include mentors from diverse disciplines to carry out interdisciplinary projects. Team members may include individuals from medical, dentistry, pharmacy, nursing, veterinary medicine, biotechnology, social sciences, anthropology, genetics, public health, and other disciplines representing different perspectives and areas of expertise. These teams come together to collaborate as a unit, with the common goal of supporting a BIRCWH Scholar in the transition from trainee to independent researcher.The 2022 Annual BIRCWH meeting will be held virtually on November 2, 2022. There will be a plenary session in the morning, with two special talks ‐ the Ruth L. Kirschstein Memorial Lectureship, and the Legacy of Leadership lecture. There will also be three Podium talks for the top Scholar abstracts – these abstracts are listed first in the abstract file below. In the afternoon, there will be a virtual poster session with all of the abstracts. The published abstracts below will form the basis of the virtual poster session. More detailed information about the November 2, 2022 meeting and the BIRCWH program can be found on the ORWH website, www.nih.gov/womenDr. Begg is the Senior Research Program Officer in the NIH Office of Research on Women's Health, overseeing the BIRCWH Program. For further information about the BIRCWH Program and the 2022 Annual BIRCWH Meeting, please contact Dr. Begg at, beggl@od.nih.gov2022 BIRCWH Podium AbstractsO‐1. Gender Differences in Care Networks of Older Adults with DementiaPhillip A. Cantu (presenting author),1 Tsai‐Chin Cho,2 Mary F. Wyman,3 Brooke Helppie‐McFall,4 Kristine J. Ajrouch4,51Department of Internal Medicine, The University of Texas Medical Branch at Galveston; 2University of Michigan School of Public Health; 3William S. Middleton Memorial Veterans Hospital and the University of Wisconsin School of Medicine and Public Health; 4Survey Research Center, University of Michigan; 5Department of Sociology, Anthropology and Criminology, Eastern Michigan UniversityBackground: Gender differences in care networks, the use of paid and informal caregivers, and the need for care among older adults with dementia remain unclear.Objective: To evaluate gender differences in care networks of community‐dwelling older adults with dementia in the United States.Methods: We used data from the 2018 wave of the University of Michigan Health and Retirement Survey, a nationally representative sample of older adults in the United States. We included individuals age 70 or older with dementia. We estimated the total annual care hours received from paid and unpaid informal caregivers. Paid care was categorized as formal institutional care, paid care from a family member or friend, or care paid by insurance. Informal care was categorized as care from a spouse, a child, or another source. We used ordinary least squares regression to predict gender differences in types of care, controlling for demographic characteristics, wealth, and level of disability.Results: Our sample was 61.3% women, with a mean age of 85.1. On average, women received 1,384 hours of care a year, compared with 1,015 hours for men, with a greater proportion of women's care coming from paid sources. Differences in hours of care from all sources except for spouses and children were explained by higher levels of disability for women.Conclusions: There were more women than men with dementia, and as a result, they had higher levels of disability. The greater cost of care for older women is reflected by more hours of formal and informal care.O‐2. Factors Associated with Postpartum Initiation of Antihypertensive Medications Following Hospital DischargeAlisse Hauspurg (presenting author),1,2 Kripa Venkatakrishnan,2 Latima Collins,2 Malamo Countouris,3 Beth Quinn,2 Lara Lemon,2 Hyagriv Simhan1,21Magee‐Womens Research Institute; 2Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee‐Womens Hospital, University of Pittsburgh School of Medicine; 3Heart and Vascular Institute, University of Pittsburgh School of MedicineBackground: Hypertension is the most common reason for postpartum readmission and a major contributor to maternal morbidity.Objective: To identify risk factors and characterize outcomes among postpartum individuals with hypertensive disorders of pregnancy (HDPs) requiring initiation of antihypertensive medication post‐ discharge.Methods: We performed a cohort study of individuals with an HDP who delivered between September 2019 and June 2021 and enrolled in our remote blood pressure (BP) management program. We compared demographics and clinical outcomes among 3 groups: individuals who required no antihypertensive medication, those who were initiated on medication while inpatients, and those who were initiated on medication post‐discharge. We modeled odds of readmission and emergency room (ER) visits using logistic regression for those initiated on medication post‐discharge, with adjustments for age, race, body mass index, maternal length of stay, and delivery type.Results: Of 2,705 individuals, 1,458 (54%) required no antihypertensive medication postpartum, 637 (24%) were discharged on medication, and 610 (23%) required medication initiation post‐discharge. An inpatient threshold of ≥150/100 mmHg, in line with current guidelines for medication initiation postpartum, failed to identify 63% of individuals who ultimately required medication. These individuals had higher home BP and higher odds of an ER visit (aOR, 1.70; 95% CI, 1.18–2.45) and hospital readmission postpartum (aOR, 3.31; 95% CI, 2.00–5.52) compared with individuals discharged on medication.Conclusions: Over 20% of individuals with an HDP required initiation of antihypertensive medication post‐discharge, yet current guidelines and clinical risk factors failed to identify the majority during the delivery hospitalization. These data indicate that remote monitoring plays a critical role and highlight the need for improved tools for risk stratification in this population.O‐3. Higher Risk of Cardiovascular Disease with Prediabetes and Undiagnosed Diabetes in Women Compared with MenYilin Yoshida (presenting author),1,5 Zhipeng Chen,2 Robin L. Baudier,4 Marie Krousel‐Wood,3–5 Amanda H. Anderson,4 Vivian A. Fonseca,1,6 Franck Mauvais‐Jarvis1,5,61Section of Endocrinology & Metabolism, John W. Deming Department of Medicine, Tulane University School of Medicine; 2Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine; 3Section of General Internal Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine; 4Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine; 5Tulane Center of Excellence in Sex‐Based Biology & Medicine, Tulane University School of Medicine; 6Southeast Louisiana Veterans Health Care SystemBackground: Women have a higher risk of cardiovascular disease (CVD) related to diabetes mellitus (DM) than men. It is unclear whether the risk of CVD differs between sexes in prediabetes (preDM) and undiagnosed DM states.Objective: To examine the effect of preDM and undiagnosed DM on CVD in men and women.Methods: Individuals (n = 17,419) were pooled from the Atherosclerosis Risk in Communities study, the Multi‐Ethnic Study of Atherosclerosis, and the Jackson Heart Study. We defined CVD as incident coronary heart disease or ischemic or hemorrhagic stroke. Cox models examined the outcomes associated with preDM (fasting glucose [FG] 100–125 mg/dL or HbA1c 5.7–6.4% and FG and HbA1c in quartiles) and undiagnosed DM (FG ≥126 mg/dL or HbA1c ≥6.5% and without a DM diagnosis), adjusted for age, race/ethnicity, education, body mass index, blood pressure, cholesterol, smoking status, antihypertensive and lipid‐lowering medication status, and cohort.Results: During follow‐up a median of 15 years later, preDM was associated with more than an 8% higher risk of CVD overall in women, but the risk was not significant in men. Notably, in women, compared with those with normoglycemia, having a slightly elevated FG level (preDM first quartile 100–103 mg/dL) or HbA1c level (preDM first quartile 5.7–5.8%) was associated with about a 10% higher risk of CVD. We also found a significant sex difference in CVD associated with undiagnosed DM, with a higher risk observed in women (33%) compared with men (14%).Conclusions: The increased risk of CVD in women versus men with preDM and undiagnosed DM may explain women's disadvantage in diabetic CVD risk. Cardiovascular risk screening, health education, and management should start from preDM in women.2022 BIRCWH Poster AbstractsBasic Research1. Proteomic Analysis of Urogynecologic Mesh Complications Suggests Importance of Fibrosis in PainAmanda Artsen (presenting author),1 Nathan Yates,2 Halina Zyczynski,1 Megan Bradley,1 Pamela A. Moalli11Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee‐Womens Hospital, University of Pittsburgh School of Medicine; 2Biomedical Mass Spectrometry Center, University of PittsburghBackground: Mesh exposure through the vaginal epithelium and pain are complications of urogynecologic mesh procedures, but the associated molecular events are poorly understood.Objective: To define proteomic profiles of vagina–mesh complexes of women with mesh exposure or pain compared with the profiles of controls.Methods: From our mesh biorepository, 10 well‐integrated, 10 exposure, and 10 pain mesh samples were compared with 10 age‐ and body mass index–matched control samples from vaginas without mesh using nanoscale liquid chromatographic tandem mass spectrometry. Peptides were selected for analysis if the probability value was less than 0.01 on analysis of variance and, to isolate proteins unique to complications rather than an expected foreign body response, the probability value was greater than 0.01 between well‐integrated mesh samples and control biopsies (MATLAB). Cluster analysis was performed using STRING (ELIXIR).Results: Of 30,588 peptide sequences from 2,803 protein groups, 75 passed selection criteria. Twenty were upregulated in both complication groups, with the exposure samples demonstrating the highest levels, primarily related to post‐translational processing and antioxidant activity. Six were downregulated in the exposure samples, with half related to cytoskeleton and cell motility. Protein S100A9, an antioxidant, was increased in both groups but highest in the exposure samples, and laminin subunit alpha 5, though downregulated in both groups, was lowest in the exposure samples. Fibronectin was highest in the pain samples (1.7 times the level of the exposure samples, P = 0.014).Conclusions: Many proteins were similarly regulated in women with complications, with the greatest deviation from normal in the exposure samples, suggesting a single trajectory for these phenotypes. High fibronectin corroborates pain as a fibrotic response, and downregulation of cytoskeletal proteins and integrins supports matrix degradation in exposure. Increased antioxidants in exposure most likely counteract macrophage‐derived reactive oxygen species.2. Ubiquitination of Zika Virus Envelope Protein Affects Gene Expression in the Placenta and Embryos of Infected Pregnant MiceMaria I. Giraldo (presenting author),1 Maria Gonzalez Orozco,1 Stephanea Sotcheff,3 Victoria Morris,3 Nathan Elrod,3 Andrew Routh,3 Scott C. Weaver,1,2 Pei‐Yong Shi,2,3 Ricardo Rajsbaum1,2,41Department of Microbiology and Immunology, The University of Texas Medical Branch at Galveston; 2Institute for Human Infections and Immunity, The University of Texas Medical Branch at Galveston; 3Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch at Galveston; 4Center for Virus‐Host‐Innate‐Immunity, Institute for Infectious & Inflammatory Diseases, and Department of Medicine, Rutgers New Jersey Medical SchoolBackground: The envelope (E) protein of Zika virus (ZIKV) is an important protein for viral replication because it mediates attachment to host cell receptors and promotes viral fusion to host endosome membranes. These processes are both vital for virus internalization. We recently reported that ZIKV E is ubiquitinated at 2 lysine residues, K38 and K281, and that ubiquitination of E on K38 is important for virus attachment to host cells. However, the exact role of ubiquitination of E on K281 remains unclear.Objectives: To determine how ubiquitination of ZIKV E affects gene expression in the placenta and brain tissues of embryos from infected pregnant mice and to identify target cells via single‐cell sequencing.Methods: Pregnant mice were infected with ZIKV E‐WT, E‐K281R mutant virus, or mock control at embryonic day 10.5. At embryonic day 18.5, the mothers were euthanized to recover placentas and embryos. Viral load was determined in tissues by plaque assay and via polymerase chain reaction quantification of RNA. Next‐generation sequencing and single‐cell RNA sequencing were utilized to identify differences in the global gene expression profiles of placentas and embryos of infected pregnant mice from each group.Results: We identify differences in expression levels of genes associated with placenta and brain development and microcephaly among embryos infected with ZIKV E‐WT, embryos infected with E‐K281R mutant virus, and embryos infected with mock control.Conclusion: These data provide information on the specific cell types in the placenta and the embryo's brain that are infected and the specific identification of genes whose expression may be altered in infected versus noninfected cells.3. Gender Transition as a Model to Elucidate the Effects of Sex Hormones and Sex Chromosomes on Gene Expression at the Single‐Cell LevelRebecca M. Harris (presenting author),1–3 Troy Whitfield,2 Linyong Mao,2 Helen Skaletsky,2 Yee‐Ming Chan,3 David C. Page21Harvard Medical School; 2Whitehead Institute; 3Division of Endocrinology, Boston Children's HospitalBackground: Sex hormones (estradiol and testosterone) and sex chromosomes (X and Y) are implicated as the bases for sex differences in healthy traits and diseases. Sex hormones and chromosomes exert their effects through alterations in gene expression; however, their independent and interdependent contributions in humans are unknown. Additionally, the effects of gender‐affirming hormones (estradiol in XY individuals and testosterone in XX individuals) on gene expression are unknown.Objective: To determine the contributions of sex hormones and chromosomes to gene expression in humans using gender transition as a model.Methods: Peripheral blood mononuclear cells (PBMCs) from 70 subjects (n = 21 transgender males on testosterone, n = 14 transgender females on estradiol, n = 15 cisgender males, and n = 20 cisgender females) were isolated and sequenced using 10x Genomics 3′ single‐cell RNA sequencing. Quality was assessed based on numbers of expressed genes, unique molecular identifiers, percentage of mitochondrial gene expression, and doublet scores. Cell clusters were identified via dimensionality reduction using UMAP, and cell types were assigned using Azimuth.Results: A total of 19,443 genes from 312,007 cells were sequenced. Twenty‐eight unique cell types were identified, including monocytes, dendritic cells, B cells, NK cells, MAIT cells, CD4 T cells, and CD8 T cells, as well as additional subtypes. Differential gene expression is ongoing and will be completed using pseudobulk (DESeq2) and mixed‐effects (MAST) models.Conclusions: A translational approach of recruiting transgender and cisgender individuals and isolating and sequencing individual PBMCs will allow us to determine the independent and interdependent contributions of sex hormones and chromosomes to gene expression in humans at the single‐cell level.4. Impact of Tension on Myofibroblast Response to Deformed Mesh: An In Vivo AnalysisKatrina M. Knight (presenting author),1,2 Gabrielle E. King,2 Stacy L. Palcsey,2 Pamela A. Moalli1–31Department of Bioengineering, University of Pittsburgh; 2Magee‐Womens Research Institute; 3Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee‐Womens Hospital, University of Pittsburgh School of MedicineBackground: Urogynecologic meshes deform after implantation, leading to complications that include mesh encapsulation with fibrosis, a myofibroblast‐mediated response. We hypothesized that tension applied to the mesh at implantation drives the fibroblast‐to‐myofibroblast transition.Objective: To define the impact of tension on the myofibroblast response.Methods: Deformed mesh was implanted onto the vaginas of rhesus macaques in the presence (T) and absence of tension (NT) (n = 10 per group, IACUC 16088646). Sham animals served as controls (n = 8). After 12 weeks, mesh–vagina complexes were excised and analyzed. One‐way analysis of variance and Kruskal–Wallis tests with post hoc testing or independent t‐tests and Mann–Whitney U tests, when appropriate, were used to compare fiber area, myofibroblast quantity, TGF‐ββ1, collagenase activity, and glycosaminoglycan (GAG) content among the groups.Results: Fiber area within the NT adventitia was 2 times greater than the fiber area in the T group (P = 0.012). There were 5 times as many myofibroblasts per fiber in the T group than in the NT group (P = 0.006). The ratio of active to latent TGF‐ββ1, a profibrotic cytokine, was 2 times higher for T than it was for NT, consistent with the observed increase in myofibroblasts (P = 0.001). GAG, a sign of tissue injury, and collagenase activity were significantly higher for the NT group than they were for the sham and T groups.Conclusions: The results of this study demonstrated that tension increases myofibroblast formation, resulting in less collagenase activity and GAG formation, most likely mediated by increased TGF‐ββ1. The presence of tension and not increased mesh fiber area induced this myofibroblast response. Research into the role that local stress variations play in pathological fibroblast responses is ongoing.5. Sex‐Specific Hypothalamic‐Mediated Adiposity in an Animal Model of Maternal–Offspring ObesityMegan Paulsen (presenting author),1 Debra Kulhanek,1 Lauren Buckley11Division of Neonatology, Department of Pediatrics, University of Minnesota Medical SchoolBackground: There is an established relationship between maternal obesity and offspring obesity. Female offspring demonstrate higher sensitivity to stress‐induced hypothalamic programming compared with male offspring. Sex‐specific hypothalamic mechanisms contributing to programming of adiposity in offspring are poorly characterized.Objective: To describe sex differences in hypothalamic‐mediated adiposity in adult C57Bl/6 mice offspring exposed to maternal obesity.Methods: Female C57Bl/6 mice (n = 16) were fed a control (CON) diet and a high‐fat, high‐sugar (OB) diet. Offspring (n = 31, 48% female) were challenged with an OB diet. In vivo body composition was measured by quantitative magnetic resonance imaging. Energy intake, energy expenditure, and activity were assessed using metabolic chambers. Plasma lipid and hormone concentrations were measured by ELISA. The hypothalamic transcriptome was measured by RNA sequencing in Galaxy. Differentially expressed genes (DEGs) were analyzed in Ingenuity pathway analysis. The effect of sex was determined by two‐way analysis of variance. An unpaired Student's t‐test measured differences between groups for each sex. Strength of relationships was assessed by Pearson's correlation coefficient; P < 0.05 was significant.Results: OB offspring had higher fat mass (+31%, P < 0.001), lower fat‐free mass (‐4%, P < 0.002), higher plasma leptin (+40%, P = 0.03), and higher plasma insulin (+40%, P = 0.07) levels than CON offspring. There were no differences in energy intake or basal metabolic rate between groups for either sex or between sexes. OB‐F had 32% lower activity than CON‐F (P = 0.04). There were no differences in activity between male offspring groups. About 9% of genes (38/417) associated with quantity of adipose tissue were differentially expressed in OB offspring's (versus CON) hypothalami. Twenty‐two genes were expressed in OB‐F but not OB‐M. Sixty‐seven percent of DEGs in OB‐F were upregulated versus CON‐F. APOB (+215.2‐fold), FABP2 (+131.1‐fold), APOA4 (+28.3‐fold), and TNF (+18.9‐fold) were genes with more than a tenfold differential expression in OB‐F (versus CON‐F, P < 0.0001). Fourteen genes were expressed in OB‐M but not OB‐F. Nineteen percent of DEGs were upregulated in OB‐M versus CON‐M. There were no genes in OB‐M with greater than a tenfold differential expression compared with CON‐M. Hypothalamic IGFBP2 was lower in OB‐F (‐2.95‐fold) and OB‐M (‐1.81‐fold) compared with CON. There was an interaction between maternal diet and offspring sex in the expression of LCN2 (M: ‐3.45‐fold, F: +2.95‐fold; P < 0.001). Maternal weight at conception (r = +0.45, P = 0.01) and cholesterol level (r = +0.54, P = 0.02) were directly correlated to fat mass in adult offspring.Conclusion: While adult offspring exposed to maternal obesity share a common metabolic phenotype, hypothalamic mechanisms that may explain this relationship are sex‐specific.6. Sex Differences in Interferon Gamma Release in Response to Tuberculosis InfectionJerry S. Zifodya (presenting author),1 Jay Kolls11Department of Medicine, Tulane University School of MedicineBackground: One‐quarter of the world's population has latent tuberculosis (TB) infection, which serves as a reservoir for active TB disease. Men are 1.7 times more likely to develop active TB than women, possibly because of greater interferon gamma (IFN‐γ) release and immune response in women infected with TB.Objective: To determine whether women have higher IFN‐γ release.Methods: This was a cross‐sectional analysis of a cohort of Kenyan adults (age >30) with well‐controlled HIV and sex‐matched HIV‐negative adults in Kisumu, Kenya. Participants underwent QuantiFERON‐TB Gold Plus testing. Multivariable linear regression analyses were used to compare IFN‐γ release in men versus women, adjusting for age, HIV status, and prior TB.Results: Of the 398 participants, 51% were women and 56% were HIV‐positive. On average, the women were younger than the men (44 versus 49, P < 0.001). Median TB1 and TB2 responses were similar in women and men (TB1: 0.54 IU/mL in women versus 0.34 IU/mL in men [P = 0.16], TB2: 0.61 IU/mL in women versus 0.32 IU/mL in men [P = 0.18]). In multivariable models, female sex was not associated with TB1 IFN‐γ release (β = 0.21; 95% CI, ‐0.36 to 0.78) or with TB2 IFN‐γ release (β = 0.21; 95% CI, ‐0.37 to 0.78). Older age and HIV infection were associated with lower INF‐γ release. In analyses limited to people living with HIV, female sex was not associated with TB1 IFN‐γ release (β = 0.88; 95% CI, ‐0.64 to 2.4) or with TB2 IFN‐γ release (β = 0.62; 95% CI, ‐1.1 to 2.3).Conclusions: We did not find a sex difference in IFN‐γ release in this cohort of Kenyan adults with and without HIV.7. Sex Differences in Aging‐Related Myocardial Stiffening Assessed Noninvasively with Magnetic Resonance ElastographyArvin Arani (presenting author),1 Matthew C. Murphy,1 Huzefa Bhopalwala,1 Shivaram P. Arunachalam,1 Phillip J. Rossman,1 Joshua D. Trzasko,1 Kevin Glaser,1 Yi Sui,1 Tina Gunderson,2 Adelaide M. Arruda‐Olson,3 Armando Manduca,1 Kejal Kantarci,1 Richard L. Ehman,1 Philip A. Araoz11Department of Radiology; Mayo Clinic; Rochester, Minnesota; 2Department of Quantitative Health Sciences; Mayo Clinic; Rochester, Minnesota; 3Department of Cardiology; Mayo Clinic; Rochester, MinnesotaBackground: Heart failure hospitalization rates disproportionately increase in women as they age, even when they present with normal (>50%) left ventricle ejection fraction (LVEF). We hypothesize that changes in myocardial stiffness are a major contributor to this trend, because increased stiffness can impair cardiac function. Current clinical quantitative stiffness measurements are invasive, hampering their use in routine clinical practice.Objective: To investigate the feasibility of using quantitative magnetic resonance elastography (MRE) to characterize the influence of aging and sex on left ventricle (LV) stiffness.Methods: LV systolic myocardial shear stiffness was measured in 109 healthy (ages 18–84) volunteers (57 females) using MRE. The 5‐minute MRE acquisition was included in a routine clinical magnetic resonance imaging (MRI) examination protocol. Linear regression models were used to estimate the association of cardiac MRI/MRE characteristics with age and sex; models were also fit to assess potential age–sex interaction.Results: A significant increase in myocardial stiffness was observed with age in women (P = 0.009) but not in men. LVEF increased (P = 0.005) and LV end systolic volume (LVESV) decreased (P = 0.005) disproportionately in women. Conventional MRI parameters—including endogenous T1, circumferential strain, longitudinal strain, radial strain, and LV mass—did not demonstrate this interaction (P > 0.05). Stiffness measured with MRE was not found to be significantly correlated with LVEF, LVESV, body mass index, or any MRI strain metrics (P > 0.05).Conclusions: These data support the hypothesis that women (but not men) experience disproportionate elevation in LV stiffness as t

LDL-C control according to risk: Is there a gender paradox?

Background and Aims : Background Low density lipoprotein cholesterol (LDL-C) treatment goals used for cardiovascular disease (CVD) prevention. Sex differences in CVD have been reported and women are less likely to receive statin therapy for secondary prevention. Nevertheless, little is known about gender according to risk categories Aims

Socioeconomic disparity in cardiovascular disease: Possible biological pathways based on a proteomic approach

Background and aimsLarge social disparities in the occurrence of cardiovascular disease (CVD) have been documented but the underlying biological mechanisms are largely unknown. We investigated a panel of biomarkers linked to CVD to improve our understanding and quantify the biological pathways in socioeconomic disparity in CVD and their mediation through behavioural and biological risk factors. MethodsWe included 1142 participants from the Copenhagen City Heart Study aged 55–64 years. Socioeconomic position (SEP) was defined by the length of education and household income. Blood samples were analysed for 184 biomarkers (Olink). Pearson's correlation analysis and linear regression with multivariate adjustment for CVD risk factors were performed. ResultsThe median length of education was 10 (IQR 7–11) years and associated with age, sex, BMI, smoking, blood pressure, physical activity and income. 48 biomarkers were significantly correlated (p < 0.05) to the length of education. The strongest negative associations were seen for interleukin-6 (IL-6), metalloproteinase 12, growth/differentiation factor 15 (GDF-15), retinoic acid receptor responder protein 2 (RARRES2), leptin (LEP), von Willebrand factor (vWF), and renin (REN) (all p < 0.0001) while the strongest positive associations were seen for chymotrypsin, paraoxonase, epidermal growth factor receptor (EGFR) and brother of CDO (cell adhesion and platelet activation) (all p < 0.001). Proportion mediated by CVD risk factors ranged from <1% to 100%. After multivariate adjustment, 14 biomarkers remained significantly associated with education. ConclusionsSEP was associated with multiple biomarkers, indicating pathways involving inflammation (IL-6, RARRES2), platelet-activation (vWF, IL-6), blood pressure (REN, LEP) and Mitogen-activated protein kinase cascade (GDF-15, EGFR) may contribute to the socioeconomic differences in CVD.

Clinical Correlations of Lipid Profiles with the Age and Gender in the Coronary Artery Disease Patients: A Study of 3878 CAD Patients from India.

Cardiovascular diseases (CVDs) are crucial cause of death and hospitalization all over the world including India. The CVDs including the coronary artery disease (CAD) are developed by the interaction of genetic and environmental factors. Hyperlipidemia is a traditional risk factor for CVD. The aim of this study was to study the clinical correlations of lipid profiles with the age and gender in the Coronary Artery Disease Patients: Methods: In this study, we have investigated the effect of age and sex on in lipid profile in 3878 (1171 females and 2707 males) CAD patients from India. The plasma TG was higher in males than in females regardless of the age. Results showed that CAD female patients had significantly increased HDL-C than their aged matched males. Moreover, the plasma TC and LDL-C were significantly higher in males than females until age 40 years. Then after the age of 40 years, TC and LDL-C become significantly higher in females than in males. In addition, we found that more than 85% of CAD cases were <55 years old, and about 30% of CAD cases had normal lipid profile. We conclude that elderly females are at a greater risk for CAD than males. Moreover, there were no significant differences in CVDs causes between nonelderly and elderly females. In addition, a higher percentage of cases were premature CAD, and 30% of CAD may be caused by loci that are not related to lipid metabolism.

Update on Management of Cardiovascular Diseases in Women.

Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.

Role of Biological Sex in the Cardiovascular-Gut Microbiome Axis.

There has been a recent, unprecedented interest in the role of gut microbiota in host health and disease. Technological advances have dramatically expanded our knowledge of the gut microbiome. Increasing evidence has indicated a strong link between gut microbiota and the development of cardiovascular diseases (CVD). In the present article, we discuss the contribution of gut microbiota in the development and progression of CVD. We further discuss how the gut microbiome may differ between the sexes and how it may be influenced by sex hormones. We put forward that regulation of microbial composition and function by sex might lead to sex-biased disease susceptibility, thereby offering a mechanistic insight into sex differences in CVD. A better understanding of this could identify novel targets, ultimately contributing to the development of innovative preventive, diagnostic and therapeutic strategies for men and women.

Sex Differences in the Co-Occurrence of PTSD and Cardiovascular Disease

Posttraumatic stress disorder (PTSD) is a highly impairing psychiatric condition, and women are twice as likely as men to receive a diagnosis. It is thought that chronic arousal and physiological stress place individuals with PTSD at greater risk for cardiovascular disease (CVD). Sex differences in CVD are also well established. For example, premenopausal women have lower CVD risk compared to men, and this is partly explained by higher levels of estradiol in premenopausal women. Estradiol is considered to be a protective factor against PTSD as well; therefore, it is important to understand the role of sex hormones in PTSD and CVD, including whether or not there is shared impact of sex hormones on the co-occurrence of these diseases. In this review, we discuss sex differences in PTSD and CVD, as well as the brain-heart connection in the PTSD-CVD link and current treatment approaches, considering sex as a biological variable. [ Psychiatr Ann . 2022;52(1):26–30.]

Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city.

Studies analyzing relations between cardiovascular diseases (CVDs) and environmental aspects in Latin American cities are relatively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/or hypertension under clinical follow-up who live in deprived areas. At the individual level we evaluated sociodemographic and cardiovascular risk factors from patient's records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher frequency, higher odds, and shorter time to CVD diagnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequalities. Differences between women and men should be considered through a gender perspective.

Sex modifies the association between body mass index and carotid artery intima media thickness in the multi-ethnic Singapore population

Abstract Background and aims Globally cardiovascular disease (CVD) risk is higher in men than in women in the younger age group but the risk is attenuated in later life with an unexpected higher risk in women in some populations. A better understanding of sex differences in CVD is needed. Carotid artery intima-media thickness (CIMT) has been proposed for CVD risk assessment in individuals at intermediate risk. We study the gender interactions in the associations of the traditional cardiovascular risk factors with CIMT. Methods We performed carotid ultrasonography in the large population health study-HELIOS conducted in Singapore. Measurements were performed as per Mannheim consensus, at the far wall of bilateral common carotid artery at 8 sites in each participant. We report the average of all measurements (avgCIMT) and maximum value (maxCIMT). We analysed 2061 healthy participants recruited between 2018–2020. Inclusion criteria for this analysis: non-smokers, not known to have diabetes, hypertension, hyperlipidemia or ischemic heart disease. Individuals with systolic blood pressure &amp;gt;160 mm Hg or fasting glucose &amp;gt;7.0 mmol/L on recruitment were excluded. Multivariable linear regression analysis was performed to examine the association between CIMT and cardiovascular risk factors in the healthy population adjusting for age, sex and ethnicity. All analysis was performed using Stata version 16.0. Results After exclusion, 1407 healthy participants were included in the analysis. Median (IQR) avgCIMT: 0.56 (0.50, 0.65) in men; 0.54 (0.50, 0.58) in women. Median (IQR) maxCIMT: 0.64 (0.57, 0.76) in men; 0.61 (0.54, 0.70) in women. The avgCIMT and the maxCIMT were higher in males when compared to women and all traditional cardiovascular risk factors associated with CIMT after adjustment for age, sex and ethnicity (P&amp;lt;0.05) (Table 1). Interaction tests in multivariable model adjusted for age, ethnicity, pulse pressure, non HDL-C and HbA1c showed a significant interaction between sex and body mass index (BMI) with predicted effects on avgCIMT and maxCIMT being relatively higher in males at the same BMI when compared to females (P-interaction &amp;lt;0.01) (Figure 1). Conclusion Sex modifies the relationship between BMI and CIMT in Singapore's multi-ethnic population. Understanding the intermediary mechanisms involved will help in developing personalized preventive strategies. Funding Acknowledgement Type of funding sources: None. Figure 1

Sex Differences and Regulatory Actions of Estrogen in Cardiovascular System.

Great progress has been made in the understanding of the pathophysiology of cardiovascular diseases (CVDs), and this has improved the prevention and prognosis of CVDs. However, while sex differences in CVDs have been well documented and studied for decades, their full extent remains unclear. Results of the latest clinical studies provide strong evidence of sex differences in the efficacy of drug treatment for heart failure, thereby possibly providing new mechanistic insights into sex differences in CVDs. In this review, we discuss the significance of sex differences, as rediscovered by recent studies, in the pathogenesis of CVDs. First, we provide an overview of the results of clinical trials to date regarding sex differences and hormone replacement therapy. Then, we discuss the role of sex differences in the maintenance and disruption of cardiovascular tissue homeostasis.

Sex-dependent development of enhanced sympathoexcitation in sedentary versus physically active rats.

The rostral ventrolateral medulla (RVLM) may contribute to sex-based differences in cardiovascular disease (CVD) based on overactivation of the sympathetic nervous system observed in sedentary male rats; however, the added influence of the reproductive cycle in females is currently unknown. To our knowledge this is the first study to demonstrate greater increases in sympathetic nerve activity in response to direct activation of the RVLM in female versus male rats prior to the onset of the reproductive cycle, which persisted after the onset of the reproductive cycle. Lower resting blood pressures in females also suggest peripheral adaptations contribute to sex-based differences in CVD. Sedentary versus physically active conditions appear to promote higher resting sympathetic outflow independent of age and sex. Our results demonstrate the importance of examining sedentary conditions in the context of sex differences and the reproductive cycle in contributing to sympathetic overactivity associated with cardiovascular disease. Female reproductive hormones are considered cardioprotective based on higher risks of cardiovascular disease (CVD) in post- versus pre-menopausal women. Similarly, based on epidemiological studies, a sedentary lifestyle is also a major risk factor for CVD. The mechanisms by which sedentary conditions contribute to CVD, and their influences in the presence and absence of female reproductive hormones are unknown. We hypothesized that sexually immature male and female rats would have similar centrally mediated regulation of blood pressure, but upon sexual maturation, female rats would have lower resting blood pressure and centrally-mediated sympathoexcitation compared to age-matched males. We also predicted resting sympathetic activity would increase upon exposure to sedentary versus active conditions (voluntary wheel running) in males but not in females. We recorded splanchnic sympathetic nerve activity (SSNA) and blood pressure in 4-, 8- and 16-week-old male and female rats under Inactin anaesthesia before and during microinjections of glutamate (1-100mM) into the rostral ventrolateral medulla (RVLM). Four-week-old female rats had lower resting blood pressure and greater sympathoexcitation following activation of the RVLM, as did 8- and 16-week-old female rats, independent of age or activity condition. Sedentary animals had higher baseline SSNA compared to active animals, independent of sex or age. Our results reveal a complex influence of the interactions between the female reproductive cycle and sedentary conditions. They also demonstrate the importance of examining sedentary conditions in the context of sex- and female reproductive cycle-dependent incidences of cardiovascular disease.

MO388DEVELOPMENT OF ACUTE KIDNEY INJURY DURING A RHABDOMYOLYSIS EPISODE: DIFFERENCES IN LONG-TERM KIDNEY FUNCTION

Abstract Background and Aims Acute renal failure (AKI) associated to rhabdomyolysis conditions a worse prognosis in short-term, its implication in the long-term renal function has been less evaluated. Method Retrospective analysis of patients diagnosed with rhabdomyolysis defined by creatinine kinase &amp;gt; 5000 IU/L between 2015-2019. Basal and 12-month renal function was evaluated. AKI was classified as either non-severe (AKI-KDIGO 1/2) or severe (AKI-KDIGO 3). Results Eighty-seven patients were included, 25 (28.74%) had some degree of chronic kidney disease (CKD) on admission. 56 (64.37%) had AKI on admission, 17 of which were severe (6 required hemodialysis). The patients with AKI had more cardiovascular disease (CVD) and worse analytical parameters on admission (table). Patients with severe AKI showed no difference in CVD from those with non-severe AKI but were younger and had more hyperkalemia. There were no significant differences between patients with severe AKI who required hemodialysis and those who did not. Inpatient mortality was 8%, higher in patients with AKI but without differences according to severity. In 45 patients kidney function was available 12 months after the episode, loss of eGF was -4.90 ± 14.35 ml/min-1.73m2 (p=0.007). There was no difference between patients who developed AKI and those who did not (-4.10 ± 14.4 vs. -5.39 ± 14.57 ml/min-1.73m2; p=0.67), nor between non-severe and severe AKI (-5.50 ± 14.76 vs. -5.12 ± 15.08ml/min-1.73m2; p=0.98). Of the 33 patients without previous CKD, 5 developed CKD, with greater decrease in eGF than those who did not (-22.69 ± 6.04 vs. -2.63 ± 13.92 ml/min-1.73m2; p=0.003). Female sex (60% vs. 12%; p=0.031) and previous basal eGF (72.22 ± 4.37 vs. 95.6±19.97 ml/min-1.72m2; p=0.016) were related to this deterioration. Conclusion After an episode of rhabdomyolysis, the loss of eGF is similar in patients who develop AKI compared to those who do not.

Abstract P183: Contribution Of Childhood Risk Factors To Sex Differences In Adult Carotid Imt And Plaques: The Childhood Determinants Of Adult Health Study

Background: Understanding the origins of sex differences in cardiovascular diseases (CVD) may help with prevention. We examined sex differences in carotid artery IMT and plaques in adulthood including the contribution of childhood risk factors. Methods: Boys and girls aged 7-15 years old from the Australian Schools Health and Fitness Survey in 1985 were followed up in the Childhood Determinants of Adult Health study at ages 36-49 years between 2014-19. Sex differences in adult carotid IMT and plaques, identified with 2D ultrasound of left and right carotid arteries, were examined with linear and log binomial regression, respectively. Childhood sociodemographic, psychosocial, health-related behavioural and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were identified with purposeful model building. Results: Among 1,286 men and women with vascular measurements of carotid IMT (53% women, mean carotid IMT 0.63 mm ± 0.09 standard deviation) women had thinner carotid IMT measurements than men (β coefficients -0.053 95% CI -0.063, -0.043). Adjusting for age standardised waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR) and systolic blood pressure (SBP) in childhood reduced the sex difference of carotid IMT in adulthood (see Figure), but a significant sex-difference in carotid IMT remained. Women had a 42% lower risk of plaques than men (Relative Risk 0.58 95% CI 0.42, 0.79). School achievement levels, endurance/power fitness and SBP in childhood partially explained the sex difference in the prevalence of plaques at adulthood (see Figure) as the sex difference decreased and became statistically insignificant. Conclusion: Various factors in childhood had contributed to thicker carotid IMT and higher prevalence of carotid plaques in men compared to women. These findings suggest that the origins of adult sex differences in CVD may begin in childhood. There may be benefits of sex-specific primary prevention programs starting in childhood.

Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary Artery Disease.

Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.

Sex Differences in Subclinical Cardiovascular Organ Damage After Renal Transplantation: A Single-Center Cohort Study.

Background: Cardiovascular disease (CVD) is the leading cause of death after renal transplantation (RT). Sex-specific differences in CVD in the general population are well known. The aim of this study was to evaluate sex-specific differences in prevalence and course of subclinical cardiovascular (CV) organ damage in RT recipients during the first year after RT. Methods: In a prospective longitudinal study, we enrolled 121 patients (male 64%, age 51 ± 15 years). CV risk factors, left ventricular mass index (LVMI), and pulse wave velocity (PWV) were assessed at time of RT and 1 year later. Results: Women showed less prediagnosed CVD and better blood pressure (BP) control, and were less likely to be treated with calcium channel blockers (CCBs). Despite similar transplant function, LVMI increased in women and decreased in men (p = 0.027). In multivariable analysis, changes in LVMI were independently associated with female sex and systolic BP. Importantly, women receiving CCBs showed a decrease in LVMI and PWV. Conclusions: Our findings indicate a sex-specific association between RT and changes in LVMI. CCBs seem to have a positive impact on CV risk after RT, especially in women. Further studies on the effect of sex and CCB use in RT recipients are warranted.