Women's Heart Research Articles

TCT-365 Pregnancy-Induced Disorders Identify High-Risk Women who Benefit from Cardiovascular Screening: Results from the Women's Heart Health Initiative, an OB/GYN Screening Pilot Program

Cardiovascular (CV) disease is the leading cause of mortality among women in the US. Despite targeted public health initiatives, many women remain unaware of and undertreated for their CV risk factors. We surveyed women presenting to obstetrics and gynecology (OB/GYN) clinics for the presence of

Influence of common genetic variation on blood lipid levels, cardiovascular risk, and coronary events in two British prospective cohort studies.

The aim of this study was to quantify the collective effect of common lipid-associated single nucleotide polymorphisms (SNPs) on blood lipid levels, cardiovascular risk, use of lipid-lowering medication, and risk of coronary heart disease (CHD) events. Analysis was performed in two prospective cohorts: Whitehall II (WHII; N = 5059) and the British Women's Heart and Health Study (BWHHS; N = 3414). For each participant, scores were calculated based on the cumulative effect of multiple genetic variants influencing total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Compared with the bottom quintile, individuals in the top quintile of the LDL-C genetic score distribution had higher LDL-C {mean difference of 0.85 [95% confidence interval, (CI) = 0.76-0.94] and 0.63 [95% CI = 0.50-0.76] mmol/l in WHII and BWHHS, respectively}. They also tended to have greater odds of having 'high-risk' status (Framingham 10-year cardiovascular disease risk >20%) [WHII: odds ratio (OR) = 1.36 (0.93-1.98), BWHHS: OR = 1.49 (1.14-1.94)]; receiving lipid-lowering treatment [WHII: OR = 2.38 (1.57-3.59), BWHHS: OR = 2.24 (1.52-3.29)]; and CHD events [WHII: OR = 1.43 (1.02-2.00), BWHHS: OR = 1.31 (0.99-1.72)]. Similar associations were observed for the TC score in both studies. The TG score was associated with high-risk status and medication use in both studies. Neither HDL nor TG scores were associated with the risk of coronary events. The genetic scores did not improve discrimination over the Framingham risk score. At the population level, common SNPs associated with LDL-C and TC contribute to blood lipid variation, cardiovascular risk, use of lipid-lowering medications and coronary events. However, their effects are too small to discriminate future lipid-lowering medication requirements or coronary events.

Stable or not, woman or man: is there a difference?

This editorial refers to ‘Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry’, by P.G. Steg et al. , doi:10.1093/eurheartj/ehs289 In 2010 a dedicated group of researchers interested in women's hearts, gathered in Brussels for a workshop discussing gender differences in cardiovascular disease (CVD).1 The workshop was undertaken as a result of an earlier report the same year from the European Heart Health Strategy (Euro-Heart) project showing that women are still under-represented in many cardiovascular clinical trials.2 Fewer women than men have been included in cardiovascular trials and, consequently, the evidence base is less firm for women regarding several treatments. The mean percentage of women enrolled in cardiovascular clinical trials since 2006 was 30%, while only 50% of trials reported results by gender analysis. Fewer evidence-based preventive, diagnostic, and therapeutic options for women with CVD may lead to undertreatment and a lower quality of care in comparison with men. Prospective studies to elucidate whether there are true differences in the effects of different treatment strategies according to gender and outcome are greatly needed to identify the most appropriate treatment for men and women, respectively ( Table …

Inflammation, coagulation and risk of locomotor disability in elderly women: findings from the British Women’s Heart and Health Study

This study investigated associations between chronic inflammation and coagulation and incident locomotor disability using prospective data from the British Women's Heart and Health Study. Locomotor disability was assessed using self-reported questionnaires in 1999/2000, and 3 and 7years later. Scores for inflammation and coagulation were obtained from summation of quartile categories of all available biomarkers from blood samples taken at baseline. 534 women developed locomotor disability after 3years, 260 women after 7years, while 871 women remained free of locomotor disability over the whole study period. After adjustment for demographic characteristics, lifestyle factors and health conditions, we found associations between inflammation and incident locomotor disability after three (OR per unit increase in score=1.08, 95% confidence interval (CI): 1.03, 1.13) and 7years (OR=1.10, 95% CI: 1.03, 1.18) and between coagulation and incident locomotor disability after 3 (OR=1.06, 95% CI: 0.98, 1.14) and 7years (OR=1.09, 95% CI: 1.00, 1.18). This corresponds to ORs between 1.8 and 2.4 comparing women with highest to lowest inflammation or coagulation scores. These results support the role of inflammation and coagulation in the development of locomotor disability in elderly women irrespective of their lifestyle factors and underlying age-related chronic diseases.

Sex and gender medicine: how women's heart is vulnerable

Sex and gender medicine: how women's heart is vulnerable

Does a woman's heart beat faster?

Recent publications have identified a different epidemiological prevalence related to sex in some of the most common supraventricular and ventricular arrhythmias. This fact is attributed to the effect of sex hormones on myocardial cell electrophysiology. Women, in particular, have a higher prevalence than males with regard to intranodal reentrant tachycardia, idiopathic monomorphic ventricular tachycardia and ventricular arrhythmias in congenital or acquired long QT syndrome. A higher incidence in females with regard to complications during atrial fibrillation has also been reported. This paper examines data from the literature regarding gender differences in the prevalence of the most common arrhythmias, the causes of these differences, and some discriminating aspects related to female sex in the architecture of published clinical studies.

Fragile XX: the women's heart

Fragile XX: the women's heart

Complexity of a complex trait locus: HP, HPR, haemoglobin and cholesterol

HP and HPR are related and contiguous genes in strong linkage disequilibrium (LD), encoding haptoglobin and haptoglobin-related protein. These bind and chaperone free Hb for recycling, protecting against oxidation. A copy number variation (CNV) within HP (Hp1/Hp2) results in different possible haptoglobin complexes which have differing properties. HPR rs2000999 (G/A), identified in meta-GWAS, influences total cholesterol (TC) and LDL-cholesterol (LDL-C). We examined the relationship between HP CNV, HPR rs2000999, Hb, red cell count (RCC), LDL-C and TC in the British Women's Heart and Health Study (n=2779 for samples having CNV, rs2000999, and phenotypes). Analysing single markers by linear regression, rs2000999 was associated with LDL-C (β=0.040mmol/L, p=0.023), TC (β=−0.040mmol/L, p=0.019), Hb (β=−0.044g/dL, p=0.028) and borderline with RCC (β=−0.032×1012/L, p=0.066). Analysis of CNV by linear regression revealed an association with Hb (Hp1 vs Hp2, β=0.057g/dL, p=0.004), RCC (β=0.045×1012/L, p=0.014), and showed a trend with LDL-C and TC. There were 3 principal haplotypes (Hp1-G 36%; Hp2-G 45%; Hp2-A 18%). Haplotype comparisons showed that LDL-C and TC associations were from rs2000999; Hb and RCC associations derived largely from the CNV. Distinct genotype–phenotype effects are evident at the genetic epidemiological level once LD has been analysed, perhaps reflecting HP–HPR functional biology and evolutionary history. The derived Hp2 allele of the HP gene has apparently been subject to malaria-driven positive selection. Haptoglobin-related protein binds Hb and apolipoprotein-L, i.e. linking HPR to the cholesterol system; and the HPR/apo-L complex is specifically trypanolytic. Our analysis illustrates the complex interplay between functions and haplotypes of adjacent genes, environmental context and natural selection, and offers insights into potential use of haptoglobin or haptoglobin-related protein as therapeutic agents.

Myocardial Ischemia in Women: Lessons From the NHLBI WISE Study

Cardiovascular disease (CVD) remains the leading cause of death for women. For almost 3 decades, more women than men have died from CVD, with the most recent annual statistics on mortality reporting that CVD accounted for 421 918 deaths among women in the United States. Although there have been significant declines in coronary heart disease (CHD) mortality for females, these reductions lag behind those seen in men. In addition, where there has been a decrease in mortality from CHD across all age groups over time in men, in the youngest women (age <55 years) there has been a notable increase in mortality from CHD. There are differences in the prevalence, symptoms, and pathophysiology of myocardial ischemia that occurs in women compared with men. In this paper, we review the pathophysiology and mechanisms of ischemic heart disease (IHD) in women, particularly focusing on what we have learned from the WISE study. We examine the sex-specific issues related to myocardial ischemia in women in terms of prevalence and prognosis, traditional and novel risk factors, diagnostic testing, as well as therapeutic management strategies for IHD.

Outcome of Pregnancy and Effects on the Right Heart in Women With Repaired Tetralogy of Fallot

Improved medical techniques have allowed most women with repaired tetralogy of Fallot (TOF) to reach childbearing age. The predictors of adverse events and the effects of pregnancy on cardiac function have not been clearly described in these patients. In the present study we retrospectively reviewed 40 deliveries in 25 patients with repaired TOF. There were 23 patients in New York Heart Association (NYHA) class I, and 2 in classes II-III before pregnancy. The mean age at delivery was 29.1 years and the mean gestational period was 37.8 weeks. Seven pregnancies (17.5%) in 7 patients were complicated with cardiac events such as a decline in NYHA class and arrhythmia. History of ablation and the baseline cardiothoracic ratio on chest radiography were predictors of adverse events. Peak plasma brain natriuretic peptide (BNP) level after the second trimester was higher in patients with cardiac events. Left ventricular size and contraction did not change from before to after pregnancy, but the right ventricle was enlarged at 6 months after delivery. Many of the pregnancies in women with repaired TOF were successful. However, careful management is required for some patients and the BNP level may be a useful marker to identify these patients. Because the right heart tended to be enlarged in the late postpartum period, pregnancy may also affect the long-term prognosis of patients with repaired TOF.

Khote: Study ofI, Durga Khote: An Autobiography

This paper aims to study the book ‘I, Durga Khote’. The book is an autobiography of the famous actress Durga Khote. She has written this in the Marathi language, and it has been translated by Shanta Gokhale with a foreword by Gayatri Chatterjee. It is a wonderful and remarkable story of a woman who has penned down her story in her own words of her struggle and rise to fame. The autobiography talks of her early memories of growing up in a joint family, her marriage, subsequent motherhood and then her husband's bankruptcy, and in her endeavour to put bread on the table, her subsequent entry into movies and finally rising by dint of hard work to being the most sought-after actress. This book is far from just a chronological story; it is about the inner struggles and turmoil of a woman's heart that is personal and yet so universal.

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.

Women and Coronary Heart Disease: A Century after Herrick; Understudied, Underdiagnosed, and Undertreated

In 1912, James B. Herrick, an icon for the clinician/scientist, postulated and documented coronary thrombosis as the mechanism for myocardial infarction (MI), highlighted that sudden death was not inevitable in MI, and later explored the diagnostic potential of the electrocardiogram for MI recognition. Once viewed as a “man's disease,” coronary heart disease (CHD) is currently the leading cause of mortality for women, with more coronary deaths occurring annually among U.S. women than men. Despite their burden of cardiovascular disease, women remain underrepresented in clinical trials (27% in mixed-gender NIH trials) and when included are disadvantaged by absence of gender-specific analyses. Lack of public and professional awareness of women's coronary risk; lack of knowledge regarding women's symptom presentation, optimal screening and diagnostic procedures; and gender disparities in application of evidence-based therapies all contribute to adverse outcomes. Angina is the major initial and subsequent presentation of CHD among women. Despite their excess of angina and its consequent morbidity and mortality, women have less severe obstructive coronary disease at angiography than men. Yet the male model of CHD, i.e., obstructive atherosclerosis of the epicardial coronary arteries, constitutes the basis for diagnostic and therapeutic strategies for both sexes. Comparative effectiveness research is requisite to select optimal strategies to evaluate symptoms of suspected myocardial ischemia in women. Anginal equivalents, the non-chest pain symptoms encountered in both genders but predominating in women, remain underrecognized and understudied. Myocardial ischemia with adverse outcomes, in the absence of coronary obstructive disease, is an emerging paradigm for women, with data derived from the NHLBI Women's Ischemia Syndrome Evaluation (WISE) study. But insights are needed into the underlying mechanism(s) and optimal recognition and therapy for microvascular disease. What do we do when disease discriminates? In numerous clinical settings, women with CHD have more unfavorable outcomes than men. The young woman (&lt; age 50) with CHD, particularly after MI and after CABG surgery, has substantially greater mortality than her male peers. With all coronary presentations, women sustain an excess of bleeding complications; to date, investigations have failed to elucidate mechanisms of gender differences in blood vessels or in blood function underlying women's bleeding risk. In the Get with the Guidelines database, undertreatment of women with ST-elevation MI with evidence-based therapies and delayed reperfusion was associated with increased early mortality, but its remediation offers the opportunity to improve outcomes. Does a woman's heart beat to the tune of a different drummer? Women with heart failure far more frequently than men have intact ventricular systolic function. Effective treatments for diastolic heart failure remain elusive, likely accounting for its unchanged prognosis, in contrast to decreased hospitalizations and improved survival with systolic heart failure. Peripartum cardiomyopathy remains poorly understood. Women with systolic heart failure benefit preferentially from cardiac resynchronization therapies, yet these procedures are underutilized in women. Although atrial fibrillation is more likely associated with stroke and mortality in women, undertreatment with anticoagulation is pervasive. Nonetheless, awareness campaigns and application of evidence-based therapies underlie the dramatic decrease in CV mortality for U.S. women since 2000, due both to preventive interventions and to improved management of established disease. Gender-specific basic and clinical research studies and application of emerging knowledge offer promise to improve CHD outcomes for women, just as Herrick's scholarly observations constituted the underpinnings for a century of antithrombotic strategies for CHD.

Modelling the association of disability according to the WHO International Classification of Functioning, Disability and Health (ICF) with mortality in the British Women's Heart and Health Study

BackgroundThe WHO International Classification of Functioning, Disability and Health (ICF) is now the dominant model for exploring the social consequences of a health condition. This paper investigates the association of...

Always Lonely: Celebrity, Motherhood, and the Dilemma of Destiny

Just what is it about fame that so alienates women? or, why is it that famous women often speak of their experience of celebrity as something that is ultimately lonely and a shabby substitute for love? And why are these statements of loneliness in celebrity attenuated for mothers? Whether it is a famous American author of the nineteenth century and mother of seven, Harriet Beecher Stowe; an iconic and volatile star of the mid–twentieth century and mother of three, Judy Garland; or a twenty-first-century reality celebrity and mother of eight, Kate Gosselin, these women suggest that the experiences of fame are isolating and ultimately unsatisfying. To paraphrase Stowe, it is not fame and celebrity that satisfies the heart of the female star; it is the old-fashioned comforts of love. Their combined comments are thus a corrective to fans' implied perception of famous people as happy, when, indeed, their celebrity seems to have alienated them from love. Whether the female celebrity seeks romantic or familial love is not clear, and we would do well to realize that the abstract palliative is actually a culturally imagined comfort that probably has little to do with either these women in particular or stardom more broadly. But the consistent remarks about fame as a condition of loneliness establish a discursive imperative that the famous woman speak of longing for affective completion, in turn suggesting that public ardor cannot satisfy the woman's heart. In other words, fame cannot replace love.

CardioPulse Articles * Women's heart health: the focus of this issue * Portrait of C. Noel Bairey Merz, MD, FACC, FAHA * The development of novel cardiovascular therapies for the future * Development of cardiology research in Japan * Personal experience of emigre cardiologist Cihan Cevik, MD, FESC * From the heart of Istanbul to the Texas Heart Institute *

CardioPulse Articles * Women's heart health: the focus of this issue * Portrait of C. Noel Bairey Merz, MD, FACC, FAHA * The development of novel cardiovascular therapies for the future * Development of cardiology research in Japan * Personal experience of emigre cardiologist Cihan Cevik, MD, FESC * From the heart of Istanbul to the Texas Heart Institute *

Men Receiving Women's Hearts Have Higher Mortality

Men Receiving Women's Hearts Have Higher Mortality

Genetic Variants Associated with von Willebrand Factor Levels in Healthy Men and Women Identified Using the HumanCVD BeadChip

We have used the gene-centric Illumina HumanCVD BeadChip to identify common genetic determinants of Von Willebrand factor (vWF) levels in healthy men and women. The Whitehall II (WHII) study (n= 5592) and the British Women's Heart and Health Study (BWHHS) (n= 3445) were genotyped using the HumanCVD BeadChip. Replication was conducted in the British Regional Heart Study (n= 3897) and 1958 Birth Cohort (n= 5048). We identified 48 single nucleotide polymorphisms (SNPs) in four genes/regions associated with vWF at P < 10(-4) . These included 19 SNPs at the ABO blood group locus with the lead variant being rs657152 (P= 9.7 × 10(-233) ). The lead variant in the 24 VWF SNPs was rs1063856 (P= 2.3 × 10(-20) ). SNPs at ESR1 (rs6909023) and NRG1(rs1685103) showed modest associations with vWF, but these were not confirmed in a meta-analysis. Using variable selection, five SNPs at the locus for ABO and two for VWF were found to have independent associations with vWF levels. After adjustment for age and gender, the selected ABO SNPs explained 15% and the VWF SNPs an additional 2% of the variance in vWF levels. Individuals at opposite tails of the additive seven SNP allele score exhibited substantial differences in vWF levels. These data demonstrate that multiple common alleles with small effects make, in combination, important contributions to individual differences in vWF levels.

The heart of a woman: addressing the gender gap in cardiovascular disease

Women's cardiovascular health has been a prominent theme in the medical news during the early months of 2011. In February, the American Heart Association (AHA) published updated effectiveness-based guidelines for the prevention of cardiovascular disease (CVD) in women (Mosca, L. et al. Circulation doi:10.1161/CIR.0b013e31820faaf8), the first revision of these recommendations since 2007. One of the major changes in these new guidelines is the lowering of the threshold for the definition of 'high risk' of cardiovascular death, from ≥20% over 10 years to ≥10% over 10 years. The writing committee also called for the reporting of results from future cardiovascular clinical trials to be sex-specific. This goal is strengthened by the Heart disease Education, Research and Analysis, and Treatment (HEART) for Women Act that was reintroduced into the US Senate on 2 March. If the bill is passed, the sex-based reporting of medical data would become mandatory and an annual report to Congress on the quality of and access to care for women with CVD would be required. On the opposite side of the Atlantic, the European Society of Cardiology has also taken steps to bring CVD in women into the spotlight. Timed to coincide with International Womens' Day on 8 March, the society issued a statement containing a “red alert” for women's hearts (http://www.escardio.org/about/press/press-releases/pr-11/Pages/International-Women-Day-2011.aspx?hit=DontMiss), and has published a special issue of the European Heart Journal focusing on the cardiovascular issues facing women. These stories raise several questions; what is the biological basis for a difference in cardiovascular disease risk and outcomes between the sexes? Why is cardiovascular health in women such a topical and important subject? Finally, what other steps are being taken to address these disparities?

The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: Focus on Knowledge and Awareness Among Women with Cardiometabolic Risk Factors

Abstract Background: The diversity of the U.S. population and disparities in the burden of cardiovascular disease (CVD) require that public health education strategies must target women and racial/ethnic minority groups to reduce their CVD risk factors, particularly in high-risk communities, such as women with the metabolic syndrome (MS). The data reported here were based on a cross-sectional face-to-face survey of women recruited from four participating sites as part of the national intervention program, Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Care in High-Risk Women. Measures included baseline characteristics, sociodemographics, CVD related-knowledge and awareness, and Framingham risk score (FRS). There were 443 of 698 women (63.5%) with one or more risk factors for the MS: non-Hispanic white (NHW), 51.5%; non-Hispanic black (NHB), 21.0%; Hispanic, 22.6%. Greater frequencies of MS occurred among Hispanic women (p<0.0001), those with less than a high school education (70.0%) (p<0.0001), Medicaid recipients (57.8%) (p<0.0001), and urbanites (43.3%) (p<0.001). Fewer participants with MS (62.6%) knew the leading cause of death compared to those without MS (72.1%) (p<0.0001). MS was associated with a lack of knowledge of the composite of knowing the symptoms of a heart attack plus the need to call 911 (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-0.97, p=0.04). Current strategies to decrease CVD risk are built on educating the public about traditional factors, including hypertension, smoking, and elevated low-density lipoprotein cholesterol (LDL-C). An opportunity to broaden the scope for risk reduction among women with cardiometabolic risk derives from the observation that women with the MS have lower knowledge about CVD as the leading cause of death, the symptoms of a heart attack, and the ideal option for managing a CVD emergency.