Sex-specific Risk Factors Research Articles

High Rate of Attendance at a Young Adult Clinic Embedded in an Adult Sickle Cell Center: If You Build It, They Will Come

Introduction The transition from pediatric to adult care for people with sickle cell disease (SCD) is associated with multifactorial vulnerabilities including life stage of affected individuals (emerging adulthood), accumulating SCD morbidities, lack of adult specialists to provide care, and limited resources to ensure successful integration into adult care. Much of the data on transition in SCD is reported from pediatrics. The purpose of this study is to describe attendance of young adults with SCD at a young adult clinic embedded in an adult SCD center. Methods The Johns Hopkins IRB approved this single-center, retrospective cohort study that included all patients scheduled with the hematologist at the Young Adult Clinic (YAC) in the Sickle Cell Center for Adults at Johns Hopkins between March 1, 2019 and June 31, 2023. YAC referrals come mostly from pediatric hematology centers or Center staff who refer patients <30 years old without an assigned hematologist. The YAC has an “infinite reschedule” policy: there is no limit on rescheduling missed appointments. We included all patients scheduled to see the YAC hematologist and captured patient demographic and SCD characteristics, referral sources, and clinic attendance. Patients' YAC referral indication was categorized as pediatric referral for aging out of care, internal referral, re-entering care, relocation, transfer from outside adult care, no prior care, or pregnancy. Subjects were classified as “attended” if they ever had a YAC visit and “never attended” if they never had a YAC visit. We compared subject characteristics using tests of proportions, non-parametric, or t-tests as appropriate. Results The 193 subjects with a scheduled visit were mean age 23.8+/-2.4 years, 61% female, 74% HbSS/HbSβ 0 genotypes, 58% were publicly insured, 56% received hydroxyurea or chronic transfusions, and 82% previously received care at a regional pediatric SCD care center (Table 1). For 40%, the appointment indication was pediatric referral for aging out of care. Most scheduled subjects (89%, 171/193) attended a YAC appointment; 11% (22/193) did not. Among those who attended a visit, 61% (105/171) attended the first scheduled visit and 39% (66/171) attended rescheduled visits. The median number of rescheduled visits was 1 (IQR 1). Median days from last pediatric to first YAC visit varied by indication; It was shortest for pediatric referrals (107 days, IQR 193), longer for relocation (304 days, IQR 1022), and longest for those re-entering care (1575 days, IQR 843). Referral from pediatrics for aging out of care was associated with 99% attendance (76/77 attended vs 1/77 never attended, p<0.001). Risks for not attending any visit included re-entering care (14/171 attended vs 7/22 never attended, p<0.001), relocation (11/171 attended vs 6/22 never attended, p<0.01), and longer time from last pediatric visit to first scheduled YAC visit (median 333 days attended vs 1533 days never attended, p<0.01). Visit attendance was not associated with age, sex, genotype, pediatric care site, insurance, SCD treatment, or reschedule attempts. Among 22 subjects who never attended a YAC visit, 7 were seen by a Center Advanced Practice Provider (APP). Among the 15 subjects never seen in the Center (Table 2), most (N=7) were re-entering care and last pediatric visit was over 3 years (median 1296 days, IQR 1855) before scheduled YAC appointment. In total 92% of YAC-eligible subjects engaged in SCD care, 171 with the YAC hematologist and 7 with an APP. In this cohort, there were 4 deaths and 4 successful bone marrow transplants. Conclusion Most young adults offered repeated opportunities to engage in comprehensive SCD care at the YAC ultimately pursue care. Rates of attendance at a specialty clinic for young adults with SCD were especially high, 99%, for referred from pediatric SCD care without no difference in attendance by sex, referral site or insurance, a proxy for socioeconomic status. Patients with care gaps are less likely to attend visits, but the low number of subjects who never attended limits conclusions. The outcomes underscore the high stakes of SCD care: most (57%) used SCD treatment, 2% died, and 2% were cured of SCD. There is overrepresentation of women in the cohort, but men and women are equally represented among clinic non-attenders. Sex-specific risk factors for continuing, or not, in SCD care need study. Resources are needed to identify and bring patients into care.

Exploring the impact of left ventricular diastolic dysfunction on postoperative cardiac surgery outcomes, with a focus on sex disparities: a comprehensive literature review

IntroductionLeft ventricular diastolic dysfunction (LVDD) is known to cause worse outcomes after cardiac surgery. Females have twice the risk of developing LVDD compared with males. The aim of this literature review was to evaluate the association between LVDD and early (≤30 days) outcomes after cardiac surgery, including sex disparities.MethodsWe identified 454 studies in Medline and Embase, of which 19 were included. Articles were assessed for inclusion of female patients with LVDD, ≥50 years of age undergoing cardiac surgery (on or off-pump) or transcatheter aortic valve replacement. The primary outcome was early postoperative mortality. Secondary outcomes were early postoperative complications, ICU length of stay (ICULOS), hospital length of stay (HLOS), and other sex-related postoperative outcomes.ResultsIn patients with LVDD, the majority of studies showed that higher LVDD grades correlate with higher early postoperative mortality. In patients with LVDD, who underwent on-pump cardiac surgery, female sex was significantly associated with higher LVDD grades and baseline E/e' ratios. Females with LVDD, were associated with prolonged HLOS after off-pump coronary artery bypass grafting (CABG). In combined cardiac surgery, a twofold increased risk of prolonged HLOS and increased ICULOS was reported. Furthermore, increased left ventricular end-diastolic filling pressure, an increased need for postoperative inotropic support, and difficult separation from cardiopulmonary bypass were observed.DiscussionDespite the limited number of studies focusing on sex differences, females with LVDD appear to have worse early outcomes after cardiac surgery compared to men with LVDD. Future research will need to identify sex-specific risk factors and target treatment optimization.

Prevalence of Sex-Specific Cardiovascular Disease Risk Factors, Medical Risk, and Engagement in Health-Promoting Behaviours in Premenopausal Females

BackgroundSeveral sex-specific risk factors (SS-RFs) increase a women’s risk for cardiovascular disease (CVD) but are often overlooked during risk assessment. The purpose of this study was to identify the prevalence of SS-RFs and assess CVD risk, knowledge, perceptions and behaviours in premenopausal Canadian women. MethodsAn online survey was distributed across Canada to premenopausal biological females (19-49 years of age). The survey gathered demographics, medical history, engagement in health-promoting behaviours, and knowledge and perceptions of CVD risk. CVD risk was calculated using medical risk and SS-RFs were tabulated from medical history. ResultsA total of 2559 participants (33 ± 8 years) completed the survey. The majority of our sample (82%) was classified as low medical risk. Of those classified as low risk, 35% had at least 1 SS-RF. Of high-risk individuals, 70% underestimated their risk, 21% of whom perceived themselves as low risk. Engagement in health behaviours was suboptimal. Knowledge of traditional CVD risk factors and prevention was relatively high; however, less than one-half were aware of SS-RFs such as early menopause (39.4%). ConclusionsConsidering both traditional and SS-RFs, 47% of premenopausal Canadian women may be at risk for developing CVD. Of those deemed low medical risk for developing CVD, more than one-third reported having at least 1 SS-RF. Canadian women have poor knowledge of the risks associated with SS-RFs, lack sufficient awareness of the need for prevention of CVD, and are not engaging in sufficient health-promoting behaviours to mitigate future CVD risk.

Abstract 16496: Future Hypertension Risk Among a Peripartum Cardiomyopathy Cohort From Kaiser Permanente Northern California

Introduction: Women have unique sex-specific risk factors related to pregnancy and reproduction that are increasingly recognized as risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD). While studies have established hypertensive disorders of pregnancy as a risk factor for long-term maternal CVD and mortality, the long-term cardiovascular sequelae following peripartum cardiomyopathy (PPCM) are not as well established. Aims: To determine whether the occurrence of PPCM increases later risk of hypertension. Methods: Retrospective case-control study of pregnant patients identified within a Kaiser Permanente Northern California (KPNC) cohort of women with and without peripartum cardiomyopathy between 1998-2004, with up to 23 years follow up. Results: We identified 62 PPCM cases, matched by age, delivery year, gestational age, pre-existing hypertension, hypertensive disorders of pregnancy, and hyperlipidemia to a control group of women without PPCM (Table 1). There was a statistically significant greater odds of incident essential hypertension among those with PPCM, 58.1% compared to 20.4% of matched controls, OR 5.39 (95%CI: 2.9, 10.02) at a mean 11 years of follow-up. Conclusion: In the KPNC cohort, PPCM was a predictor for the development of essential hypertension later in life.*P<0.0001Table 1. Baseline demographic and cardiovascular risk factors for women with peripartum cardiomyopathy compared to a matched cohort. Unless otherwise specified, numbers shown represent frequency (percentage of total).

Abstract 15469: Projected Heart Failure Incidence in US Adults From 2018-2050

Background Heart failure (HF) currently affects 6.7 million people in the US accounting for $40 billion in annual healthcare costs. Projecting future trends in the clinical burden of HF may guide strategic investments in prevention and treatment as well as workforce planning. This study projects the incidence of heart failure in the US population through 2050. Methods: The Cardiovascular Disease (CVD) Policy Model is an established computer-simulation, state-transition model for the US population ages 35-94 years. Age- and sex- specific HF incidence rates were derived from NHLBI pooled cohort studies; the probability of HF hospitalizations associated with coronary heart disease (CHD) or stroke were derived from the National Inpatient Sample and published literature. We applied age- and sex-specific risk factor distributions, incidence, and event rates from 2018 to population projections through 2050 from the US Census. The model estimated absolute number of incident HF cases in subpopulations with CHD (ischemic HF) and without CHD (non-ischemic HF). Results: In 2018, 11% of the US population without HF was aged >=75 years, which compares with 16% projected in 2050. The estimated HF incidence rate was higher in males. The annual incidence of HF in US adults aged 35 to 94 years is projected to increase by 39% from 836,000 in 2018 to 1.2 million by 2050 (Table 1). Most incident HF is estimated to occur in the population without CHD, accounting for three quarters of HF in women and over half in men. Among those with HF, the proportion of the population aged >=75 years was projected to increase from 42% in 2018 to 54% in 2050. Conclusion A large increase in incident HF is expected in coming years, primarily due to an aging population. Most incident HF is estimated to be non-ischemic. Primary prevention, specifically controlling risk factors associated with non-ischemic HF, may offer the greatest opportunity to reduce HF incidence.

Exploring spatial patterns of cardiovascular disease among women in India

Abstract Cardiovascular disease (CVD) has become a leading cause of mortality and morbidity in India, surpassing the global rate. While CVD is influenced by gender due to sex-specific risk factors in women, it remains underdiagnosed, and undertreated in women. WHO provides a list of ‘best buys’ which does not consider sex-specific risk factors. Hence, we assessed prevalence, unawareness and spatial variations of CVDs in women (15-49 years). We used NFHS (2019-20) WHO causal links between underlying drivers, behavioral risk factors, metabolic/physiological risk factors, and CVDs. We used ordinary kriging interpolation techniques to measure the spatial heterogeneity of CVD prevalence and spatial autocorrelation techniques using global Moran I statistic. Furthermore, ordinary least square were used to examine spatial predictors and geographically weighted regression and multiscale geographically weighted regression model were used to map the local spatial variations. CVDs prevalence in women is 11.7% [95%, CI: 0.117-0.118], its unawareness is 12% [95%, CI: 0.116-0.117] among women. Spatial regression analysis suggests observed geographical variation of CVDs significantly correlated with risk factors- metabolic (BMI), behavioral (tobacco consumption), and underlying (sex-specific - women's education as a proxy for autonomy and socioeconomic depriviation- household wealth). India has a high burden of CVDs in women, with state-level disparities and a lack of awareness about the disease. Women are not a target population for CVDs in SDG 3.4 and India's National Health policy, 2017; however, its rising epidemic burden on women demands a need for policy choices targeted at women. The study provides evidence to inform the policy choices in reducing CVDs burden in women. It suggests a need to develop gender-specific guidelines for CVD prevention and management in India. Key messages • The study provides evidence to inform the policy choices in reducing CVDs burden in women and suggests a need to develop gender-specific guidelines for CVD prevention and management in India. • India has high burden & unawareness of CVDs in women with risk factors- BMI, tobacco consumption, sex-specific - women's education as a proxy for autonomy; socioeconomic deprivation- household wealth.

Risk Factors for Hyperuricemia or Gout in Men and Women: The Circulatory Risk in Communities Study (CIRCS).

We aimed to examine sex-specific risk factors for hyperuricemia or gout in Japanese cohorts. We followed up 3,188 men (mean age, 55.6 years) and 6,346 women (mean age, 54.1 years) without hyperuricemia, gout, or elevated liver enzymes at baseline from 1986 to 1990 for a median of 14.6 years. The participants were considered as having hyperuricemia or gout if their serum uric acid levels were ≥ 7.0 mg/dL or they were receiving treatment for hyperuricemia or gout during annual health checkups. The sex-specific multivariable hazard ratios (HRs) of hyperuricemia or gout incidence were calculated after adjustment for smoking and drinking status, body mass index, hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia using the Cox proportional-hazard model. During follow-up, 733 men and 355 women had hyperuricemia or gout. Among men, the multivariable HRs (95% confidence intervals) of hyperuricemia or gout were 1.23 (1.00-1.52) and 1.41 (1.13-1.75) for drinkers of ＜46 and ≥ 46 g ethanol/day, respectively, compared with non-drinkers; 1.00 (0.81-1.24) and 1.18 (0.93-1.50) for smokers of 1-19 and ≥ 20 cigarettes/day, respectively, compared with never smokers; and 1.41 (1.20-1.65) for hypertensive compared with non-hypertensive participants. The HRs for women were 1.02 (0.70-1.48), 1.66 (1.05-2.63), and 1.12 (0.88-1.42) for current drinkers, current smokers, and hypertensive participants, respectively. For both men and women, body mass index, diabetes, hypercholesterolemia, and hypertriglyceridemia were not associated with hyperuricemia or gout incidence. Hypertension and alcohol drinking are risk factors for hyperuricemia or gout among men and smoking among women.

Sex-specific prevalence and risk factors of metabolic-associated fatty liver disease among 75,570 individuals in eastern China.

Metabolic-associated fatty liver disease (MAFLD) is a newly proposed definition and there is limited data on MAFLD prevalence. We aimed to investigate the prevalence of MAFLD in an eastern Chinese population. This cross-sectional study included participants from an eastern Chinese population who underwent regular health checkups. Based on current diagnostic criteria, MAFLD was diagnosed in individuals with both hepatic steatosis and metabolic disorders. The overall and stratified prevalence derived based on sex, age, body mass index (BMI), and various metabolic disorders were estimated. Multivariate logistic regression analysis was used to determine the risk factors for MAFLD. Among the 75,570 participants, the overall prevalence of MAFLD was 37.32%, with higher rates in men (45.66%) than in women (23.91%). MAFLD prevalence was highest in men aged 40-49 years (52.21%) and women aged 70-79 years (44.77%). In all the BMI subgroups, the prevalence was higher in men than in women. In both sexes, the prevalence of MAFLD increased as BMI levels increased. Furthermore, MAFLD was associated with metabolic disorders, especially in the female participants with severe obesity (odds ratio 58.318; 95% confidence interval: 46.978-72.397). MAFLD is prevalent in the general adult population in eastern China. Sex-specific differences in MAFLD prevalence were identified based on age, BMI, and metabolic disorders. MAFLD is associated with metabolic disorders, particularly obesity.

The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes

BackgroundHeart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. MethodsThis study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. ResultsA total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. ConclusionsThe risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.

Sex differences in effect of patients-centered intervention on blood pressure in patients with hypertension

Hypertension exhibits sex-related differences in its causes, symptoms, and complications. In this study, we aimed to confirm the efficacy of hypertension intervention by applying a patient-centered approach based on sex differences. We enrolled 95 hypertensive patients in this prospective quasi-experimental pretest–posttest study. The patient-centered lifestyle intervention included penalized nutrition and exercise education in 30-min one-on-one sessions. Before the intervention, we conducted a pretest to evaluate physical examination, behavioral status, quality of life (QoL), blood pressure (BP) measurements, and routine blood tests. The same evaluations were conducted again in a posttest after 3 months. After 3 months of patient-centered intervention, all patients showed a decrease in systolic BP by 2.87 mmHg and diastolic BP by 1.04 mmHg. However, there was no significant difference in BP between men and women after the 3-month follow-up. There were differences in lipid profiles based on sex, with total cholesterol and low-density lipoprotein cholesterol levels decreasing in men and increasing in women. Behavioral and QoL scores improved after the intervention; however, there was no significant difference based on sex. A patient-centered lifestyle intervention for hypertensive patients can effectively lower BP, and sex-specific risk factors affecting its efficacy have been identified.

Functional Hypothalamic Amenorrhea and Preclinical Cardiovascular Disease.

Endothelial dysfunction is a preclinical cardiovascular disease (CVD) marker. Due to various neuroendocrine aberrations, functional hypothalamic amenorrhea (FHA) may be a sex-specific risk factor for CVD in young women. To investigate endothelial function in women with FHA, compared with eumenorrheic controls and recently menopausal women. We performed a cross-sectional analysis among women with FHA (n = 30), eumenorrheic controls (n = 29), and recently menopausal women (n = 30). FHA was defined as amenorrhea ≥3 consecutive months, estradiol <50 pg/mL, follicle-stimulating hormone (FSH) < 10 mIU/mL, and luteinizing hormone (LH) < 10 mIU/mL, excluding other etiologies. Participants were recruited through obstetrics and gynecology referrals, social media advertising, and review of electronic health records. Preclinical CVD was measured using EndoPAT 2000 to calculate reactive hyperemic index (RHI). RHI ≤1.67 indicates endothelial dysfunction. Mean estradiol levels in women with FHA, as compared with eumenorrheic controls and recently menopausal women, were 29.0 ± 18.1, 46.4 ± 15.7, and 10.9 ± 14.4 pg/mL (P < .0001), respectively. Women with FHA had lower insulin (P = .0095) and higher cortisol (P = .0004) compared with controls. RHI was significantly lower in women with FHA compared with eumenorrheic controls and recently menopausal women (1.8 ± 0.5 vs 2.2 ± 0.5 vs 2.2 ± 0.6, respectively; P = .008), and 35% of women with FHA had RHI ≤1.67, consistent with endothelial dysfunction. These results demonstrate endothelial dysfunction in 1 out of 3 young women with FHA. FHA may be a contributor to preclinical CVD, and it is not explained by hypoestrogenemia alone.

Advanced Cardiac Imaging and Women's Chest Pain: A Question of Gender.

Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.

Association of fruit and vegetable intake with predicted 10-year cardiovascular disease risk among hypertensive patients in Addis Ababa, Ethiopia: a cross-sectional study

ObjectiveIn low-income countries, such as Ethiopia, few studies have evaluated the risk of cardiovascular disease (CVD) among hypertensive patients. We assessed the 10-year CVD risk of hypertensive patients.DesignThis cross-sectional study...

Addressing Cardiovascular Risk Across the Arc of a Woman's Life: Sex-Specific Prevention and Treatment.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in womenin the United States of America. Despite this, women are underdiagnosed, less often receive preventive care, and are undertreated for CVD compared to men. There has been an increase in sex-specific risk factors and treatments over the past decade; however, sex-specific recommendations have not been included in the guidelines. We aim to highlight recent evidence behind thedifferential effect of traditional risk factors and underscore sex-specific risk factors with an intention to promote awareness, improve risk stratification, and early implementation of appropriate preventive therapies in women. Women are prescribed fewer antihypertensives and lipid-lowering agents and receive less cardiovascular care as compared to men. Additionally, pregnancy complications have been associated with increased cardiovascular mortality later in life. Findings from theARIC study suggest that there is a perception of lower risk of cardiovascular disease in women. The SWEDEHEART study which investigated sex differences in treatment, noted a lower prescription of guideline-directed therapy in women. Women are less likely to be prescribed statin medications by their providers in both primary and secondary prevention as they are considered lower risk than men, while also being more likely to decline and discontinue treatment. A woman's abnormal response to pregnancy may serve as her first physiological stress test which can have implications on her future cardiovascular health. This was supported by the CHAMPs study noting a higher premature cardiovascular risk after maternal complications. Adverse pregnancy outcomes have been associated with a 1.5-4.0 fold increase in future cardiovascular events in multiple studies. In this review, we highlight the differences in traditional risk factors and their impact on women. Furthermore, we address the sex-specific risk factors and pregnancy-associated complications that increase the risk of CVD in women. Adherence to GDMT may have implications on overall mortality in women. An effort to improve early recognition of CVD risk with implementation of aggressive risk factor control and lifestyle modification should be emphasized. Future studies should specifically report on differences in outcomes between males and females. Increased awareness and knowledge on sex-specific risks and prevention are likely to lower the prevalence and improve outcomes of CVD in women.

Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily.

Females, versus males, have shown a slower decline in smoking prevalence, greater smoking-related mortality and morbidity, and tend to have more difficulty achieving and maintaining abstinence. Identifying sex-specific risk factors is needed to improve outcomes. Though ovarian hormones have been evaluated for their role in smoking and relapse, measures tend to be static and infrequent, failing to capture the influence of increasing or decreasing levels. The present study evaluated the effect of static and fluctuating levels of ovarian hormones (ie, progesterone, estradiol, and estrogen to progesterone [E/P] ratio) on stress reactivity, cigarette craving, and smoking during a laboratory relapse paradigm. Female participants (assigned female at birth) reporting daily cigarette smoking (N = 91, ages 18-45) were recruited from the community. Participants provided daily salivary ovarian hormone levels leading up to a laboratory session, in which stress was induced and stress reactivity, cigarette craving, latency to smoke, and ad-libitum smoking were measured. Static levels of estradiol were associated with stress reactivity (β = 0.28, SE = 0.13) and static E/P ratio was associated with smoking in the laboratory (HR = 1.4). Preceding 3-day changes in estradiol and E/P ratio, but neither static levels nor preceding 3-day changes in progesterone were associated with stress reactivity, cigarette craving, or smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors involved in the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood. Findings of the present study provide novel information regarding the role of ovarian hormones among female participants who smoke daily in stress reactivity and smoking in the context of a laboratory relapse paradigm and highlight several avenues for future research. We found that same-day estradiol levels were associated with increased subjective stress reactivity and same-day estrogen to progesterone ratio was associated with increased likelihood of smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors contributing to the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

Sex-specific population attributable risk factors for cardiovascular and all-cause mortality in the general population: Findings from the China PEACE million persons project

Little evidence exists regarding the sex-specific population attributable risk factors for cardiovascular and all-cause mortality in the Chinese general population. We used a sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events million persons project to evaluate the overall and sex-specific associations and population attributable fractions (PAFs) of twelve risk factors for cardiovascular and all-cause mortality. 95,469 participants were included between January 2016 and December 2020. The twelve risk factors (including four socioeconomic status and eight modifiable risk factors) were collected or measured at baseline. The outcomes of the study were all-cause mortality and cardiovascular mortality. Overall, 60.7% (N = 57,971) were women, and the mean age was 54.3 ± 10.2 years. After a median of 3.52 years of follow-up, 1311 (1.4%) people died, and 362 (0.4%) people died of cardiovascular causes. Majorities of risk factors were significantly associated with all-cause and cardiovascular mortality, and suboptimal blood pressure and low educational attainment were the two leading attributable risk factors for all-cause and cardiovascular mortality. The twelve risk factors collectively explained 72.4% (95% confidence interval (CI): 63.5, 79.2) and 84.0% (95% CI: 71.1, 91.1) of PAFs for all-cause and cardiovascular mortality. When stratified by sex, men had more risk factors that were significantly attributable to mortality than women, whereas low educational attainment had a more pronounced impact on female cardiovascular health. This study found that the twelve risk factors collectively explained a significant proportion of PAFs for all-cause and cardiovascular mortality. Several sex-related disparities in the associations between risk factors and mortality were noted.

Sex differences in musculoskeletal injury epidemiology and subsequent loss of tactical readiness during Marine Corps Officer Candidates School

IntroductionThe US Marine Corps (USMC) Officer Candidates School (OCS) is a 10-week training course for Marine Officer Candidates (MOCs). OCS training is rigorous and demanding, which results in a high...

Age and sex-specific stroke epidemiology in COVID-19

BackgroundCOVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.MethodsA retrospective cohort study was conducted using individual-level data from Optum® de-identified COVID-19 EHR. A total of 387,330 individuals aged ≥ 18 with laboratory-confirmed COVID-19 between March 1, 2020 and December 31, 2020 were included. The primary outcome was cumulative incidence of stroke after COVID-19 confirmation within 180 days of follow-up or until death. Kaplan–Meier cumulative incidence curves for acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and a composite outcome of all strokes were stratified by sex and age, and the differences in curves were assessed using a log-rank test. The relative risk of stroke by demographics and risk factors was estimated using multivariable Cox-proportional hazards regressions and adjusted hazard ratios (aHRs).ResultsOf 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68–0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62–0.67), and ICH in 0.11% (95% CI 0.10–0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially higher stroke risk, with aHR 6.92 (5.72–8.38) for ages 65–74, 9.42 (7.74–11.47) for ages 75–84, and 11.35 (9.20–14.00) for ages 85 and older compared to ages 18–44 years. Men had a 32% higher risk of stroke compared to women. African-American [aHR 1.78 (1.61–1.97)] and Hispanic patients [aHR 1.48 (1.30–1.69)] with COVID-19 had an increased risk of stroke compared to white patients.ConclusionThis study has several important findings. AIS and ICH risk in patients with COVID-19 is highest in the first 3 days of COVID-19 positivity; this risk decreases with time. The incidence of stroke in patients with COVID-19 (both inpatient and outpatient) is 0.65% for AIS and 0.11% for ICH during the 180-day follow-up. Traditional stroke risk factors increase the risk of stroke in patients with COVID-19. Male sex is an independent risk factor for stroke in COVID-19 patients across all age groups. African-American and Hispanic patients have a higher risk of stroke from COVID-19.

Sex differences in the risk factors of disability among community-dwelling older adults with hypertension: Longitudinal results from the Health, Aging, and Retirement in Thailand study (HART).

Hypertension poses a serious health problem among Thai older adults which could subsequently lead to disability. However, little to no research has been conducted to understand modifiable risk factors of disability among community-dwelling older adults with hypertension in Thailand. In addition, sex is an important social determinant of health, but its role in disability among older adults with hypertension is less clear. This study focused on community-dwelling older adults with hypertension in Thailand and investigated predictors of disability and examined sex differences in the risk factors that were associated with disability in this population. Longitudinal data were from the Health, Aging, and Retirement in Thailand (HART) survey (2015-2017; N = 916). The outcome variable was difficulty with the activity of daily living at follow-up. Potential risk factors included sociodemographic information, health behaviors/health status, and disability at baseline. Descriptive analysis and logistic regression analysis were employed to analyze the data. Most of the participants were female and between aged 60 and 69 years old. Being in an older age group (OR = 1.78, 95% CI: 1.07-2.97, p < 0.05), having more chronic conditions (OR = 1.38, 95% CI: 1.10-1.73, p < 0.01), experiencing obesity (OR = 2.02, 95% CI: 1.11-3.69, p < 0.05), and having disability at baseline (OR = 2.42, 95% CI: 1.09-5.37, p < 0.05) significantly predicted disability at 2 year follow-up among community-dwelling Thai older adults with hypertension. The effects of these risk factors on disability at follow-up did not differ by sex. However, different risk factors of disability were observed across sexes. The situations of disability among older adults with hypertension in Thailand are likely to aggravate due to the rapid aging of the population. Our analysis provided useful information regarding significant predictors of disability and sex-specific risk factors of disability. Tailored promotion and prevention programs should be readily available to prevent disability among community-dwelling older adults with hypertension in Thailand.

Sex differences in the association between minor nonspecific ST-segment and T-wave abnormalities and coronary artery calcification

Background and aimsAlthough minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) have been associated with adverse cardiovascular outcomes, their relationship with subclinical atherosclerosis remains controversial. Therefore, the associations between electrocardiographic (ECG) abnormalities, including NSSTTA, and coronary artery calcification (CAC) were investigated in this study. MethodsThis cross-sectional study included 136,461 Korean participants with no known cardiovascular disease or cancer, who underwent a health checkup including ECG and computed tomography to measure the coronary artery calcium score (CACS) by Agatston method between 2010 and 2018. ECG abnormalities were defined in accordance with the Minnesota Code using an automated ECG analysis program. A multinomial logistic regression model was used to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for each CACS category. ResultsIn men, both NSSTTA and major ECG abnormalities were associated with all levels of CACS. The multivariable-adjusted PRs (95% CI) for CACS >400 comparing NSSTTA and major ECG abnormalities to the reference (neither NSSTTA nor major ECG abnormalities) were 1.88 (1.29–2.74) and 1.50 (1.18–1.91), respectively. Women with major ECG abnormalities were more likely to have a CACS of 101–400, the PRs (95% CI) comparing major ECG abnormalities to the reference group was 1.75 (1.18–2.57). NSSTTA were not associated with any CACS level in women. ConclusionsNSSTTA and major ECG abnormalities are associated with CAC in men, though NSSTTA were not associated with CAC in women, suggesting that NSSTTA should be considered sex-specific risk factors for coronary artery disease in men, but not in women.