Risk Profile In Women Research Articles

Improved outcomes for women undergoing contemporary percutaneous coronary intervention: A report from the national heart, lung, and blood institute dynamic registry

ObjectivesThe goal of this study was to determine whether women undergoing contemporary percutaneous coronary intervention (PCI) remain at increased risk in comparison with men and whether the outcomes in women have improved. BackgroundPrevious studies have shown that women treated with coronary angioplasty have a higher incidence of procedural morbidity and mortality than men. MethodsGender differences in wave 1 of the National Heart, Lung and Blood Institute (NHLBI) Dynamic registry were evaluated. Baseline characteristics and outcomes in women in the Dynamic registry were compared with those in women in the 1985–1986 and 1993–1994 NHLBI Percutaneous Transluminal Coronary Angioplasty (PTCA) registries. ResultsWomen were older with a higher prevalence of diabetes mellitus, hypertension, congestive heart failure, unstable angina and single vessel disease in comparison with men. Although procedural success and in-hospital death (2.2% vs. 1.3%), myocardial infarction (MI) (2.3% vs. 3.0%) and coronary artery bypass graft surgery (CABG) (1.3% vs. 1.4%) were similar in women and men, respectively, one-year mortality (6.5% vs. 4.3%, p = 0.02) and combined end point of death/MI/CABG (18.3% vs. 14.4%, p = 0.03) were higher in women than in men. After controlling for other factors, gender was not a significant predictor of death or death plus MI at one year. Despite a higher risk profile in women in the Dynamic registry in comparison with women in the 1985–1986 NHLBI PTCA registry, in-hospital death/MI/CABG was lower (6.0% vs. 11.6%, p < 0.001). ConclusionsDespite persistent high-risk characteristics in women, gender differences in outcomes in patients undergoing contemporary PCI have decreased, and outcomes in women have improved.

Deterioration of the metabolic risk profile in women. Respective contributions of impaired glucose tolerance and visceral fat accumulation.

To determine whether the impaired glucose tolerance (IGT) state contributes to the deterioration of the metabolic profile in women after taking into account the contribution of visceral adipose tissue (AT) accumulation, as measured by computed tomography. We studied 203 women with normal glucose tolerance (NGT) and 46 women with IGT, defined as a glycemia between 7.8 and 11.1 mmol/l measured 2 h after a 75-g oral glucose load. Women with IGT were characterized by a higher visceral AT accumulation and by higher concentrations of fasting plasma glucose, insulin, and C-peptide as well as by higher plasma concentrations of cholesterol, triglycerides, and apolipoprotein B (apoB) and by greater cholesterol-to-HDL-cholesterol ratio, reduced LDL peak particle size, lower HDL-cholesterol and HDL2-cholesterol concentrations, and higher blood pressure (P < 0.01) than women with NGT. When we matched 27 pairs of women for visceral AT and fat mass as well as for menopausal status, differences previously found in LDL-cholesterol, LDL peak particle size, HDL-cholesterol, and HDL2-cholesterol concentrations as well as in the cholesterol-to-HDL-cholesterol ratio and blood pressure were eliminated, whereas triglyceride concentrations remained significantly higher in women with IGT. A high visceral AT accumulation is a major factor involved in the deterioration of many metabolic variables in women with IGT, with the notable exception of triglyceride concentrations, which remained significantly different between women with NGT and women with IGT after adjustment for visceral fat.

Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women.

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by obesity, hyperandrogenism, and insulin resistance. An adverse lipid profile has also been observed in PCOS-affected women, suggesting that these individuals may be at increased risk for coronary heart disease at a young age. The objective of the present study was to evaluate subclinical atherosclerosis among women with PCOS and age-matched control subjects. A total of 125 white PCOS cases and 142 controls, aged >/=30 years were recruited. Collection of baseline sociodemographic data, reproductive hormone levels, and cardiovascular risk factors was conducted from 1992 to 1994. During follow-up (1996 to 1999), these women underwent B-mode ultrasonography of the carotid arteries for the evaluation of carotid intima-media wall thickness (IMT) and the prevalence of plaque. A significant difference was observed in the distribution of carotid plaque among PCOS cases compared with controls: 7.2% (9 of 125) of PCOS cases had a plaque index of >/=3 compared with 0.7% (1 of 142) of similarly aged controls (P=0.05). Overall and in the group aged 30 to 44 years, no difference was noted in mean carotid IMT between PCOS cases and controls. Among women aged >/=45 years, PCOS cases had significantly greater mean IMT than did control women (0.78+/-0.03 versus 0.70+/-0.01 mm, P:=0. 005). This difference remained significant after adjustment for age and BMI (P:<0.05). These results suggest that (1) lifelong exposure to an adverse cardiovascular risk profile in women with PCOS may lead to premature atherosclerosis, and (2) the PCOS-IMT association is explained in part by weight and fat distribution and associated risk factors. There may be an independent effect of PCOS unexplained by the above variables that is related to the hormonal dysregulation of this condition.

HRT to prevent cardiovascular disease

PREVIEWHow should you advise postmenopausal patients who are considering estrogen therapy? Do the potential cardiovascular benefits outweigh the risks? Does hormone therapy improve the cardiovascular risk profile in women with established coronary artery disease? In this article, Drs Wood and Cox help clarify the current clinical data for and against hormone replacement therapy for prevention of cardiovascular disease. In addition, they discuss current treatment recommendations and future directions in hormone therapy.

Physical activity and cardiovascular disease risk profile in women.

In a population of 4,576 Dutch women aged 49-70 years who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) in 1993-1995, the relation between physical activity and the presence of cardiovascular disease risk indicators was assessed cross-sectionally. Physical activity was determined from a self-administered questionnaire, while blood pressure, heart rate, body mass index, waist/hip ratio, and waist circumference were measured at the study center. Mean risk indicator levels were calculated for different activity categories. Blood pressure was most clearly associated with time spent in sports (mean systolic blood pressure, adjusted for age, level of education, and smoking, 128.9 mmHg in the highest sports tertile, and 132.1 mmHg in the lowest sports tertile; mean diastolic blood pressure, 77.8 mmHg and 79.0 mmHg, respectively). Body mass index, waist/hip ratio, and waist circumference showed an inverse relation with cycling, gardening, do-it-yourself-activities, and sports. In this population, leisure-time activity was inversely related to cardiovascular disease risk indicators, but work activity and housework were not. The authors conclude that if investigators wish to measure physical activity in women over age 50 years with the aim to identify high- and low-risk groups for cardiovascular disease, they should consider not only housework activity, but also leisure-time activities such as cycling, sports, and do-it-yourself activities.

Risk profile in women with stroke: role of plasma fibrinogen

In 96 women with ischemic stroke, (mean age 77.9 +/- 7.4, S.D., years, body mass index, BMI = 23.7 +/- 3.91, we assessed the presence of risk factors for atherosclerosis, particularly of hyperfibrinogenemia. A control group of 96 women without relevant diseases, namely neoplasms, cardiovascular and inflammatory diseases, well matched for age and BMI was also studied. Subjects with stroke show higher values of systolic and diastolic blood pressure, total serum cholesterol, fibrinogen, hematocrit and more frequent habit of cigarette smoking. Levels of HDL-cholesterol, triglyceridemia and glycemia do not differ between the 2 groups. In stroke group fibrinogen is positively correlated with systolic and diastolic blood pressure and triglyceridemia. These findings confirm the presence of a risk profile for stroke, in which hypertension plays the most relevant role. The weight of fibrinogen in pathogenesis of stroke is likely to be related to the presence of other risk factors.

Cardiorespiratory fitness and coronary heart disease risk factor association in women

Objectives. The purpose of this study was to examine the association between cardiorespiratory fitness and coronary risk factors in healthy, nonsmoking adult women.Background. A sedentary life-style is recognized as an independent risk factor for coronary heart disease, and increasing physical activity is strongly recommended to reduce this risk. However, studies examining the effects of increased physical activity on coronary heart disease risk factors in women are relatively few, and the findings have been equivocal.Methods. Subjects provided written informed consent, completed a questionnaire on medical history and performed an exercise tolerance test. Blood chemistry and lipid levels were determined from fasting blood samples. Three fitness categories were established on the basis of treadmill time to exhaustion and were adjusted for age.Results. The women in the lowest fitness category had less favorable lipid profiles, blood glucose levels, blood pressures and anthropometric indexes than those in the moderate and high fitness categories.Conclusions. Moderate fitness (equivalent to 10 metabolic equivalents [METs]) is required to improve the coronary risk profile in women.

Health status after myocardial revascularization: Inferior results in women

We followed up 1,335 patients (287 female, 1,048 male) for 2 to 18 years (mean, 4.3 years) after they had undergone coronary artery bypass grafting. A health status index was calculated on the basis of their responses to annual questionnaires. The female patients were older (64.1 +/- 0.3 versus 60.4 +/- 0.3 years) and had a higher incidence of diabetes (28.6% versus 16.1%). The risk profile of women was otherwise similar to that of men. The hospital mortality was significantly higher in the women, particularly in those younger than age 60. The probability of survival (Kaplan-Meier) at 5, 10, and 15 years was lower in female patients at each interval. The mean health status index was also lower in women at 5, 10, and 15 years, and also lower in all subsets. In nondiabetic patients, the hospital mortality and probability of survival at 10 years did not differ between the female and male patients. In the diabetic patients, the hospital mortality was 11.0% (women) and 3.6% (men); the survival at 10 years was 0.42 (women) and 0.56 (men) (p < 0.001). Thus, the health status in women is less satisfactory than that of men after myocardial revascularization, and the probability of survival is lower. The excess mortality in female patients may be due to the higher incidence of diabetes in this group.

Effects of contraceptive steroids on cardiovascular risk factors in women with insulin-dependent diabetes mellitus

We evaluated established cardiovascular risk factors within lipoprotein metabolism, hemostasis, and endothelial function in women with insulin-dependent diabetes mellitus who were using oral contraceptives. Twenty-five women with uncomplicated insulin-dependent diabetes mellitus, allocated to treatment with a monophasic combination of 30 micrograms ethinyl estradiol and 75 micrograms gestodene (treatment group, n = 12) or with nonhormonal contraception (control group, n = 13), were prospectively followed up for 12 months. Nonparametric methods were used for statistical evaluation. No statistical differences in the biochemical risk markers were noted between the two groups at the start of the study. In the treatment group serum levels of low-density lipoprotein cholesterol decreased, whereas the concentrations of total cholesterol, high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and triglycerides were unchanged. Within the coagulation system factor VII coagulant activity increased, while fibrinogen levels were unchanged. In the fibrinolytic system we found unchanged activities but decreased antigen concentrations of tissue plasminogen activator and plasminogen activator inhibitor. The concentration of von Willebrand factor increased, but no change in albumin excretion rates were found. In the control group no changes in any of the variables were observed. Intake of modern oral contraceptives does not deteriorate the cardiovascular risk profile in women with insulin-dependent diabetes mellitus, but our study indicates a risk of disturbances of the endothelial integrity, which needs further investigation.

Risk profiles of women with cervical neoplasia

Risk-factor profiles were compared in M.D. Anderson Cancer Center patients with various uterine cervix histologic diagnoses. Intraepithelial neoplasia (n = 171) and condyloma (n = 82) were associated with significantly lower patient age (mean 23.6 and 25.8 years, respectively). In addition, these two groups were lowest in annual income, age at beginning intercourse and at first pregnancy, and highest in percentages of black and Hispanic patients, number of sexual partners, and history of gonorrhea. Women with squamous carcinoma in situ (n = 47), who were about a decade older, exhibited a similar socioeconomic distribution and sexual history. All three groups also reported high prevalences of current smokers, were most likely to use oral contraceptives, and were least likely to use diaphragms or condoms. Patients with invasive squamous cell carcinoma (n = 77) had a mean age of 46.3 years, a large lowest-income constituency, and the highest mean number of pregnancies; they were least likely to have used oral contraceptives. Adenocarcinoma (n = 21) was epidemiologically distinct: a predominance of white woman characterized by high socioeconomic status, elevated body mass index, and non of the liberal sexual practices of the other groups. Primary and secondary prevention strategies must be tailored to the unique needs and socioeconomic status of the young at-risk populations.