Treatment Of Cardiovascular Disease In Women Research Articles

Sex differences in acute myocardial infarction - Preliminary results from an umbrella review

Abstract Background Cardiovascular disease (CVD) is the leading cause of premature death among women, and the negative impact on public health is profound. Women have higher rates of comorbidities, complications such as stroke, in addition to higher mortality compared to men (1-6) and targeting sex-related differences regarding the treatment of CVD in women is of great importance to prevent the number of CVD events. The purpose of this study was to get an overview of the systematic reviews and meta-analyses investigating sex differences in patients with acute myocardial infarction (AMI) the past 10 years. Methods A systematic search was carried out in Epistemonikos, the largest database of systematic reviews that screens PubMed, Cochrane, Embase, CINAHL, PsycInfo and others (i.e., currently nine databases) (7, 8). The search was conducted 12 January 2024, with the general search strings: (1) sex differences OR gender differences AND myocardial infarction, (2) sex differences OR gender differences OR women OR female AND myocardial infarction. The search was restricted to systematic reviews conducted the last 10 years. Results Forty-nine (search 1: 19, search 2: 30) systematic reviews and meta-analyses were identified, and five studies investigating sex differences in relation to AMI were included. Two systematic reviews, Babioakis (2021) and Meer (2015), reported of longer door-to-balloon (D2B) time and/or symptom-to-balloon (S2B) time in female patients presenting with STEMI and referred for PCI, compared to male patients (9). Chaudhary (2022) investigated adverse event of MINOCA (more commonly in women/ younger age (51-59 years) and reported higher risk of MACE among women than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23), in addition to higher incidence of stroke (3.5% vs. 2.2%, OR 1.3, 1.01-1.68), however no significantly differences were observed for all-cause mortality, non-fatal AMI, and cardiovascular readmissions between the groups (10). Three systematic reviews reported of higher risk of mortality after STEMI among women, compared to men (11-13). Xi (2022) reported of higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96)) (adjusted RR, 1.24; 95% CI 1.11 to 1.38) (13), Pancholy (2014) reported of higher risk of in-hospital mortality (RR, 1.93; 95% CI, 1.75-2.14) (adjusted RR, 1.48; 95% CI, 1.07-2.05) (11), and van der Meer (2015) reported of higher crude short- and long-term mortality in women, in addition to less use of GP IIb/IIIa inhibitors in women, compared to men (women 51%, men 57%) (12). Conclusions Our umbrella review revealed that women had longer timeline for treatment in AMI, had less use of medication and higher risk of mortality and MACE compared to men. Clinical practice needs further improvements in management in female patients.

Gender-Related Differences in Atherosclerosis.

Atherosclerotic cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Considerable research has been done over the last several decades to understand the pathophysiology of atherosclerosis. It is widely believed that estrogen is responsible for the protection of women from CVD in the premenopausal age group. However, hormone replacement therapy has failed to decrease CVD events in clinical studies which points to the complexity of the relationship between vascular biology and estrogen hormones. Interestingly, preponderance of vascular and connective tissue disorders in women also points to an inherent role of hormones and tissue factors in maintenance of vascular endothelial function. The differential effect of GPER, lipoprotein A, TLRs, leucocyte-platelet aggregate markers in men and women also suggests inherent gender-related differences in the pathophysiology of atherosclerosis. A better understanding of the pathophysiology is likely to open ways to improve evidence-based treatment of CVD in women.

Eliminating untimely deaths of women from heart disease: Highlights from the Minnesota Women's Heart Summit

Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains their leading cause of death, annually killing more women than men. Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning. The Minnesota Women's Heart Summit was convened to chart a course to eliminate premature deaths of women from heart disease. The multidisciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic. Presentations highlighted sex-based differences in symptoms, treatment, and outcomes, and panel experts provided commentary. Invited faculty and summit participants worked in small-group sessions to identify strategies to dissolve barriers, improve primary and secondary prevention, and enhance women's care and outcomes. This report summarizes strategies identified during the conference to serve as springboards for more substantive future initiatives. These include, for example, standardized data collection and use of existing data sets to inform perspectives on sex-related cardiovascular issues, mandatory reporting of sex-specific data, and increased attention to underserved/high-risk women. Participants acknowledged that implementing these ideas would be challenging and recommended key priorities/next action steps such as providing services close to "point-of-life" rather than "point-of-care" and creation of policies and regulations so that resources and environmental modifications encouraging healthier lifestyle choices are promoted. Additional research is needed to improve identification, treatment, and health behaviors and to address continued lack of awareness, symptom recognition delays, barriers to care, and outcome disparities-especially in diverse populations.

Diabetes in Women: Pathophysiology and Therapy

This book is written for clinicians and scientists with an interest in diabetes, endocrinologists, obstetricians, gynaecologists, generalists, as well as students and trainees in these areas of health. Each chapter has been written by authors who are well known in their respective fields. In the preface the editors explain that they have structured the book into five sections: (1) sex differences in cardiometabolic risk; (2) impact of diabetes on women's health; (3) diabetes and pregnancy; (4) offspring of the diabetic mother; and (5) the disease management of women with diabetes. Unfortunately, the book is then organized into 23 chapters without any sections. With the book's overwhelming bulk at almost 500 pages, the reader would have appreciated logical divisions of the broad subjects. Different chapters without structured divisions in the book give a chaotic first impression. After the first interesting chapter on sex differences in energy balance comes a chapter on menopause and diabetes and thereafter a chapter on cardiovascular disease (CVD) in women with diabetes. Temporal sequence of chapters would have been more logical. The first chapter summarizes the sex differences in energy balance, body composition and body fat distribution. The third chapter on CVD in women with diabetes discusses the effects of diabetes on platelets, coagulation and endothelium. Only a short chapter is devoted to treatment of CVD in women with diabetes. The chapter on developmental programming of polycystic ovarian syndrome (PCOS) reveals new insights into the development of PCOS. Could this syndrome be due to androgen excess in utero? The multiple speculations in this chapter are exhausting. The chapter on anthropological views of the impact of poverty and globalization on the emerging epidemic of obesity is stimulating, but at the end the text is too general and the diabetic woman is missing. Chapter 7 deals with eating disorders and depression. Both are more common in women than in men and could lead to an increased risk of diabetes. But I expected some biological explanations for how depression could be related to diabetes, not only via obesity and eating disorders. One entire chapter is dedicated to pre-eclampsia. Only half a page contains information on diabetes and pre-eclampsia, namely on diabetic nephropathy. The authors also fail to mention the known association between previous pre-eclampsia and subsequent diabetes later in life. The chapters are mainly well written, perhaps too long and containing a large number of references (100–200 per chapter). This reduces readability significantly. Many chapters overlap, e.g. chapters 3 and 4 on cardiovascular risk factors and chapters 4 and 5 on hyperandrogenism. There are three chapters on PCOS. In many chapters concepts are revisited, e.g. endothelial dysfunction. The book would have benefited from more harmonization of the chapters, more good quality figures and less text and references. Despite these criticisms, this is a thorough and informative text on diabetes in women.

Perceived gender bias in the treatment of cardiovascular disease

More women than men die of cardiovascular disease (CVD), and data in the literature point to the existence of gender differences pertaining to CVD. These differences may result in gender bias. Data support the existence of gender bias in referral for testing procedures and the treatment of possible CVD; in addition, research on pharmacologic agents and instruments for assessment of CVD show gender bias. The purpose of this article is to provide an overview of the extent of gender bias in the recognition, evaluation, and treatment of CVD in women. Social forces are considered, and implications for future research, patient education, diagnostic testing, methodology, and effective attitude management are delineated.

Cardiovascular disease in women.

Cardiovascular disease (CVD) is the leading cause of death in women. Clear gender differences exist in the incidence, prevalence, presentation, diagnosis, treatment, and prognosis of cardiovascular diseases. Over the past 15 years, robust efforts focused on the evidence-based prevention and treatment of CVD in women have resulted in a steeper decrease in cardiovascular (CV) mortality rates in women compared to men beginning in 2000. The prominent decline in female CV mortality rates is a new phenomenon, as decreases in male CV mortality rates outpaced those in women during the 1980s and 1990s. Historically, women have been underrepresented in clinical trials investigating cardiovascular diseases. Over the past decade, the representation of women in clinical trials has improved, and nuanced treatment approaches and prevention strategies have resulted from the dedicated study of gender differences. The traditional CV research focus has been on obstructive coronary disease and the development and complications of ischemic heart disease in men. Research has shown multiple layers of complexity in the etiology and pathophysiology of cardiovascular diseases in women differing from those predominating in men. Investigation has also shown a relationship between the hormonal fluctuations women experience throughout life and the development of ischemic heart disease and arrhythmias. Therefore, cardiovascular disease processes in women should not be equated to those traditionally encountered in the male population, and these differences should alter the physicians’ approach to the female patient.