Risk Factor Profile In Women Research Articles

The adverse cardiovascular risk factor profile of women with pre-eclampsia develops over time in the years before pregnancy.

Women with a history of pre-eclampsia have an elevated lifetime risk of cardiovascular disease that may be partly attributed to an adverse cardiovascular risk factor profile, the etiology of which is unclear. Hypothesising that this adverse risk profile may begin to arise over time in the years before pregnancy, we sought to evaluate the pregravid changes over time in cardiovascular risk factors in women who go on to develop pre-eclampsia and those who do not. Retrospective cohort study using population-based administrative databases. Ontario, Canada. All nulliparous women who had singleton pregnancies between January 2011 and December 2018. All results for the following analytes between January 2008 and the start of pregnancy were identified: A1c, glucose, lipids, and transaminases. Mean values were compared between those with and without preeclampsia. The annual change for each analyte in the years before pregnancy was estimated using generalized estimating equations. Preeclampsia. The 156 278 women (of whom 3827 developed preeclampsia) had mean 4.0 ± 3.3 pregravid tests overall. The two most recent pregravid tests were performed at median 0.6 and 1.9 years before pregnancy, respectively. Women who developed pre-eclampsia had higher pregravid A1c, fasting glucose, random glucose, LDL-cholesterol, triglycerides, and ALT, and lower HDL-cholesterol, than their peers (all P < 0.0001). In the years before pregnancy, women who went on to develop pre-eclampsia had higher annual increases than their peers in triglycerides (13.8-fold higher; P = 0.0004) and random glucose (1.55-fold higher; P = 0.001), coupled with a greater annual decrease in HDL-cholesterol (9.7-fold higher; P = 0.002). During this time, fasting glucose increased in women who developed pre-eclampsia but decreased in their peers (P = 0.01). In women who develop pre-eclampsia, an adverse cardiovascular risk factor profile evolves over time in the years before pregnancy. In women who develop pre-eclampsia, an adverse CV risk factor profile evolves in the years before pregnancy.

Prospective analysis of risk factors and angiographic profile in women with coronary artery disease –A hospital based study

Background: In order to facilitate diagnosis and timely intervention, it is essential to understand the presentation pattern of cardiac symptoms, and distribution of risk factors in women with Coronary Artery Disease (CAD). However, limited data is available regarding the salient features of CAD in women like distribution of risk factors and anatomical extent. Aims and Objective: The purpose of the present study was to determine the clinical and risk factor profile of women admitted with CAD and to analyze their angiographic findings in relation to the clinical presentation and risk factors in a tertiary care referral center of eastern India. Materials and Methods: In this study we prospectively analysed risk factors and angiographic patterns of 140 consecutive female patients who underwent coronary angiography for suspected CAD over a period of 2 years. Results: CAD most commonly affected females of age group &gt;60yrs with higher incidence among postmenopausal as compared to premenopausal women. Unstable angina was the commonest presentation among patients with normal coronaries as well as obstructive CAD.A substantial percentage of women presenting with anginal pain were angiographically normal. Hypertension was the most common associated risk factor followed by diabetes, elevated total cholesterol, high LDL &amp; low HDL. Most common coronary angiography finding was single vessel disease. On analysis, diabetes mellitus, elevated cholesterol, elevated LDL &amp; triglycerides were most commonly associated with triple vessel disease. Conclusion: The incidence of CAD in females increased with age. Single vessel disease was the commonest presentation with Left Anterior Descending Artery, the most frequently involved vessel.

Lifestyle management and compliance in coronary patients: The gender gap. Results from the ESC EORP EUROASPIRE V survey

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Fonds voor hartchirurgie - Fonds pour la Chirurgie Cardiaque OnBehalf EUROASPIRE studygroup BACKGROUND Although previous EUROASPIRE (European Survey Of Cardiovascular Disease Prevention And Diabetes) findings suggest only limited gender differences in the medication intake of coronary patients, the CVD risk factor profile in women remains suboptimal compared to men. Therefore, to further lower the risk of subsequent cardiovascular events, lifestyle behaviour in secondary prevention is crucial. Little is known about gender differences in prescribed lifestyle and patient compliance in tackling lifestyle related risk factor targets. PURPOSE The aim of this study is to identify gender differences in lifestyle prescription and lifestyle compliance after a coronary event. METHODS Analyses were carried out on the ESC EORP EUROASPIRE V survey data, including information from coronary patients recruited in 27 European countries. Consecutive patients &amp;lt;80 years were hospitalized for a CABG, PCI, acute myocardial infarction or acute myocardial ischaemia. Information on lifestyle prescription and lifestyle compliance, were obtained from standardized patient interviews (6 months to 2 years following hospital discharge). Logistic regression analyses adjusting for medical history (stroke, heart failure and diabetes) were performed. RESULTS Data was available for 8261 patients of which 25.8% were women. The mean (SD) age at interview was 62.9 (9.7) years for men and 65.4 (9.2) for women. Overall, no gender differences were observed in smoking cessation advice (85.2% vs. 84.5%; P = 0.90) and in smokers’ attempts to quit smoking (62.6% vs. 63.9%; P= 0.58). Also, no gender differences were observed in dietary advice (85.5% vs. 84.9%; P= 0.32) and in attempts to adopt a healthier diet (87.1% vs. 88.4%; P= 0.14). In contrast, although no gender differences were seen in weight changes among obese patients (60.1% vs. 58.2%; P = 0.49), women were less likely to receive advice on losing weight (75.1% vs. 71.6%; P = 0.02). Interestingly, the latter findings were driven by educational level. Women with a low education level were less likely to receive weight loss advice (71.8% vs. 52.9%; P &amp;lt; 0.001) and a lower proportion of them tried to lose weight (52.3% vs. 36.7%; P &amp;lt; 0.001), while no significant differences were observed in those with a high educational level. Furthermore, women were less likely to receive physical activity advice (63.8% vs. 59.6%; P &amp;lt; 0.001) and a lower proportion of them attempted to increase their physical activity levels (55.5% vs. 48.0%; P &amp;lt; 0.001). CONCLUSION These findings suggest worse lifestyle prescription and lifestyle changes for physical activity in women and worse weight loss prescription and weight loss compliance in low educated but not highly educated women. Specific attention should be given to women with a low educational level. Further quantitative and qualitative research is needed to understand the gender gap in lifestyle management.

Risk factor management in coronary patients: results from the EUROASPIRE V survey

Abstract Background Previously, there has been a misperception that cardiovascular disease (CVD) mainly affects males. Although lately, there is increasing awareness about the risk of CVD in women, evidence suggests that the management of women with CVD is suboptimal. Purpose The aim of this study is to look at gender differences in treatment and risk factor control after a coronary event across countries with varying income levels. Methods Analyses were based on the ESC-EORP EUROASPIRE V survey, including patient information from 27 European countries. Patients included (18–80 years), were hospitalised for an ischaemic coronary event. Information on medical treatment, risk factors and behavioural changes were obtained during patient interviews (6 months to 2 years after hospitalization). Findings on treatment and risk factor control were compared with the European guidelines on CVD prevention (2016). Country classification by income level (low/medium income vs. high income) was done according to the World Bank Atlas method. Logistic regression analyses adjusted for sex, age, education level, country income, surgical intervention, stroke, heart failure and diabetes were performed. Results Data from 8261 coronary patients, of which 25.8% women, were included in the analyses. Mean (SD) age at the interview was 62.95 (9.72) years for men and 65.36 (9.21) years for women. First, when looking at the evidence based medication intake, no gender differences were seen in the prescription of antiplatelets/aspirin, whereas statins were more often prescribed in men (82.8% vs. 77.7%; p=0.002). A closer look by country income revealed that this difference is entirely due to the higher statin use among men from low/medium income countries (79.6% vs. 72.3%; p=0.004). Second, the risk factor profile differed substantially between genders. Overall, a worse risk factor profile was seen in women. Although, men were more likely to smoke (20.7% vs. 12.8%; p&amp;lt;0.001), women were less physically active (63.2% vs. 72.5%; p&amp;lt;0.001), had more obesity (34.9% vs. 45.7%; p&amp;lt;0.001) and central obesity (51.8% vs. 78.0%; p&amp;lt;0.001), and had a worse lipid control (65.9% vs. 74.3%; p&amp;lt;0.001). Overall, no gender differences were seen in diabetes prevalence and blood pressure control. A closer look at country income level showed that the gender difference in smoking prevalence dissolved in high income countries. In addition, women in low income countries were more likely to suffer from diabetes (26.7% vs. 38.9%; p&amp;lt;0.001). Conclusion These findings suggest a worse risk factor profile in women despite little to no gender differences in medical treatment. Further research is needed to understand the gender-differential in risk factor control. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Fonds voor hartchirurgie - Fonds pour la Chirurgie Cardiaque

Divergent Trajectories of Cardiovascular Risk Factors in the Years Before Pregnancy in Women With and Without Gestational Diabetes Mellitus: A Population-Based Study.

Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of cardiovascular disease, which has been attributed to an adverse cardiovascular risk factor profile that is apparent even within the first year postpartum. Given its presence in the early postpartum, we hypothesized that this adverse cardiovascular risk factor profile may develop over time in the years before pregnancy. With population-based administrative databases, we identified all nulliparous women in Ontario, Canada, who had singleton pregnancies between January 2011 and December 2016 and two or more measurements of the following analytes between 2007 and the start of pregnancy: A1C, fasting glucose, random glucose, lipids, and transaminases. This population consisted of 8,047 women who developed GDM and 93,114 women who did not. The two most recent pregravid tests were performed at a median of 0.61 years and 1.86 years before pregnancy, respectively. Women who went on to develop GDM had higher pregravid A1C, fasting glucose, random glucose, LDL cholesterol, triglycerides, and ALT and lower HDL cholesterol than their peers (all P < 0.0001). Notably, in the years before pregnancy, women who went on to develop GDM had higher annual increases than their peers in A1C (1.9-fold higher) (difference 0.0089%/year [95% CI 0.0043-0.0135]) and random glucose (4.3-fold), greater annual decrease in HDL cholesterol (5.5-fold), and lesser annual decline in LDL cholesterol (0.4-fold) (all P ≤ 0.0002). During this time, fasting glucose and triglycerides increased in women who developed GDM but decreased in their peers (both P < 0.0001). The adverse cardiovascular risk factor profile of women with GDM evolves over time in the years before pregnancy.

The risk factor profile of women with secondary infertility: an unmatched case-control study in Kigali, Rwanda

BackgroundSecondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.MethodsBetween November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).ResultsRisk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or Treponema pallidum antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.ConclusionsThe main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.

The postpartum cardiovascular risk factor profile of women with isolated hyperglycemia at 1-hour on the oral glucose tolerance test in pregnancy

Background and aims Women with gestational diabetes mellitus (GDM) have an enhanced cardiovascular risk factor profile at 3-months postpartum and an elevated risk of future cardiovascular disease, as compared to their peers. Recently, it has emerged that even mild dysglycemia on antepartum oral glucose tolerance test (OGTT) predicts an increased risk of future cardiovascular disease, although it is not known whether there exists an identifiable high-risk subgroup within this patient population. Since gestational impaired glucose tolerance (GIGT) due to isolated hyperglycemia at 1-h during the OGTT (1-h GIGT) bears metabolic similarity to GDM, we hypothesized that, like GDM, 1-h GIGT may predict a high-risk postpartum cardiovascular phenotype. Methods and results In this prospective cohort study, 485 women underwent antepartum OGTT, followed by cardiovascular risk factor assessment at 3-months postpartum. The antepartum OGTT identified 4 gestational glucose tolerance groups: GDM ( n = 137); 1-h GIGT ( n = 39); GIGT at 2- or 3-h (2/3-h GIGT)( n = 50); and normal glucose tolerance (NGT)( n = 259). After adjustment for age, ethnicity, breastfeeding and waist circumference, mean levels of the following cardiovascular risk factors progressively increased from NGT to 2/3-h GIGT to 1-h GIGT to GDM: LDL cholesterol ( p = 0.0026); total cholesterol:HDL ( p = 0.0030); apolipoprotein B ( p = 0.004); apolipoprotein B:apolipoprotein A1 ( p = 0.026); leptin ( p = 0.018); and C-reactive protein ( p = 0.011). Conclusions Amongst women without GDM, 1-h GIGT predicts an enhanced postpartum cardiovascular risk factor profile. It thus emerges, that amongst young women with mild dysglycemia in pregnancy, those with 1-h GIGT may comprise an unrecognized patient population at risk for future cardiovascular disease.

Antenatal diagnosis of placenta accreta leads to reduced blood loss

Placenta accreta is one of the most devastating pregnancy complications. We sought to compare outcomes between women with placenta accreta when diagnosed antenatally or intrapartum, and to define predictors of the antenatal diagnosis. Retrospective case-control study. University teaching hospital. Twenty-four women with placenta accreta diagnosed antenatally and 20 women discovered intrapartum. Chart review of historical and delivery-associated variables. Rates were compared between the groups. Placenta accreta diagnosed antenatally or intrapartum. Women with antenatal diagnosis had a lower estimated blood loss of a median of 4500ml (range 100-15000ml) compared with 7800ml (range 2500-17000ml, p=0.012) and required fewer units of packed red blood cells transfused (median 7; range 0-27 compared with 13.5; range 4-31, p=0.026). Nineteen (79%) women diagnosed antenatally had balloon catheter occlusion carried out during the cesarean section. Five (21%) had the entire placenta left in situ. There was no difference in the rate of surgical complications or duration of hospitalization. The clinical diagnosis among women with antenatal diagnosis was more often placenta percreta (p=0.013). The risk factor profile of women with antenatal diagnosis of placenta accreta included higher gravidity (p=0.014) and parity (p<0.0001), history of cesarean section (p=0.004), and placenta previa in the current pregnancy (p<0.001). Antenatal diagnosis of placenta accreta may reduce peripartum blood loss and the need for blood transfusion. Women with antenatal diagnosis more often have placenta previa and history of previous cesarean section, and the clinical diagnosis is more often placenta percreta.

Dietary intake, body composition and physical activity levels in women with polycystic ovary syndrome compared with healthy controls

Background: Polycystic ovary syndrome (PCOS) affects up to 10% of women of reproductive age in the UK. Obesity is a common feature of PCOS with approximately 33% of UK women with PCOS (wPCOS) being obese (Barr et al., 2007) compared with 20% of women in the general population (Ruston et al., 2004). This research aims to compare the diet and lifestyle of wPCOS (normal and overweight) with matched controls.Methods: A 7‐day food and activity diary, and medical questionnaire were completed by 37 wPCOS and 31 age and weight matched controls. A pedometer was also provided to on the same 7 days. Anthropometric measurements (body mass index, percentage body fat, and waist‐to‐hip ratio), and dietary intakes were compared. Percentage body fat measurements were taken using Bodystat tetrapolar bioimpedance (BodyStat, UK). Ethical approval was obtained from Roehampton University Ethics Board and the Huntingdon Research Ethics Committee.Results: There were no significant differences for anthropometric measurements or mean energy intake between wPCOS and controls. However, percentage energy (%E) from fat, and absolute and percentage saturated fat intakes were all significantly higher for wPCOS compared with controls (Table 1) and further from the recommendations for health. Percentage energy intake from carbohydrate for wPCOS was significantly lower than controls (P = 0.003) with no significant differences in the contribution from protein. Subject characteristics and nutrient intake (mean ± SD). Values Total (n = 68) wPCOS (n = 37) Control (n = 31) Significance Body mass index (kg m−²) 24.3 (4.3) 24.4 (4.1) 24.2 (4.5) NS Waist: Hip ratio 0.77 (0.07) 0.77 (0.07) 0.77 (0.06) NS Body fat (%) 29.5 (7.1) 30 (7) 29 (7) NS Energy intake (kcal day−1) 1867 (388) 1906 (362) 1821 (418) NS Carbohydrate (% intake day−1) 43 (7) 41 (8) 46 (5) 0.003 Protein (% intake day−1) 16 (4) 16 (4) 16 (3) NS Total fat (% intake day−1) 38 (6) 40 (6) 35 (5) 0.007 Saturated fat (% intake day−1) 12.9 (3) 15 (3) 12 (3) 0.023 Saturated fat (g day−1) 26.9 (9.1) 29 (8) 25 (10) 0.002 Steps per day (n = 42) 9318 (2636) 9369 (2430) 9251 (2960) NS Stratification by BMI identified a significant difference in %E from carbohydrate between lean wPCOS (41 ± 6%) and lean controls (P = 0.042) and conversely a higher %E intake from fat in lean wPCOS versus lean controls (P = 0.039).Discussion: Results indicate both qualitative and quantitative differences in the dietary intakes of wPCOS compared to age and weight matched controls. However, no significant differences in activity levels or body composition were identified. Analysis is ongoing and will help to further elucidate the relationship between behaviour, weight and risk factor profile in women with PCOS allowing for the development of more effective management strategies.Conclusions: This is the first study to report the habitual dietary intake of UK wPCOS compared with matched controls, and results are similar to US findings (Wright et al., 2004). Identification of sub‐optimal dietary patterns in wPCOS in the UK will allow dietary information for this population to be more effectively tailored to help maximise the success of lifestyle interventions.References Barr, S., Hart, K., Reeves, S. &amp; Jeanes, Y. (2007) Dietary composition of UK women with Polycystic Ovary Syndrome. Ann. Nutr. Metab.51(Suppl. 1): 345.Ruston, D., Hoare, J., Henderson, L. et al. (2004) The National Diet and Nutrition Survey: Adults aged 19 to 64 years. Volume 4. London: The Stationery Office.Wright, C.E., Zborowski, J.V., Talbott, E.O. et al. (2004) Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int. J. Obes. 28, 1026–1032.

Do men benefit more than women from an interventional strategy in patients with unstable angina or non-ST-elevation myocardial infarction? The impact of gender in the RITA 3 trial

The RITA 3 trial randomized patients with non-ST-elevation myocardial infarction or unstable angina to strategies of early intervention (angiography followed by revascularization) or conservative care (ischaemia or symptom driven angiography). The aim of this analysis was to investigate the impact of gender on the effect of these two strategies. In total, 1810 patients (682 women and 1128 men) were randomized. The risk factor profile of women at presentation was markedly different to men. There was evidence that men benefited more from an early intervention strategy for death or non-fatal myocardial infarction at 1 year (adjusted odds ratios 0.63, 95% confidence interval 0.41-0.98 for men and 1.79, 95% confidence interval 0.95-3.35 for women; interaction p-value=0.007). Men who underwent the assigned angiogram were more likely to be put forward for coronary artery bypass surgery, even after allowing for differences in disease severity. An early intervention strategy resulted in a beneficial effect in men which was not seen in women although caution is needed in interpretation. Further research is needed to evaluate why women do not appear to benefit from early intervention and to identify treatments that improve the prognosis of women.

Coronary atherogenic risk factors in women.

Cardiovascular disease, primarily coronary heart disease (CHD), remains the most frequent cause of death in Western industrialized nations: nearly one in every two deaths are currently attributable to CHD. Since the 1980s, gender-specific trends have become apparent in these statistics: whereas coronary–vascular mortality has appreciably decreased among men, women have conversely experienced a continuous rise in rates of death from CHD. In 1998 in Germany, for example, there were 94 700 deaths from coronary vascular disease among women (225·3 per 100 000), but only 84 015 among men (210·1 per 100 000). One explanation of this trend may lie in the fact that modern medicine over the past 30 to 40 years has considered CHD a ‘male disease’, and that classical epidemiological studies have consequently concentrated primarily on men. Fortunately for men, this phenomenon, its associated preventive measures, and improved therapeutic approaches have signified a decrease in mortality among men. The contrary development among females may be attributed to two factors: that insights gained in research for men are not automatically applicable to women, and/or that women less often enjoy application of advances in possibilities for diagnosis and therapy resulting from these insights. Since the 1980s, moreover, changes have taken place in the risk factor profile in women and men. Although the overall prevalence of risk factors such as hypertension, overweight, and smoking remains greater for men, the total increase in such risk factors has in recent decades been greater among women to a pronounced degree. This development has become especially apparent in smoking, which has increased among young women in contrast to a decreasing trend among men.

Pre-existing risk factor profiles in users and non-users of hormone replacement therapy: prospective cohort study in Gothenburg, Sweden

Objective: To assess whether risk factor profiles for cardiovascular disease differed, before starting treatment, between women who would subsequently use hormone replacement therapy and those who would remain untreated.Design: Prospective...