1,721,092 research outputs found
Behavioural risk factors and cardiovascular disease: are women at higher risk?
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Reply: Sex-Related Differences in Heart Failure After ST-Segment Elevation Myocardial Infarction: The Role of S-Nitrosylation
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Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography.
No full textBackground: The prognostic implication of chest pain associated with normal or near-normal findings on angiography is still unknown. We explored outcomes and methods of risk stratification in patients with nonobstructive coronary artery disease in the setting of non-ST-segment elevation acute coronary syndromes. Methods: Data were pooled from 3 Thrombolysis in Myocardial Infarction (TIMI) trials (TIMI 11B, TIMI 16, and TIMI 22). Angiographic data were available on 7656 patients with non-ST-segment elevation acute coronary syndromes. The primary end point of this analysis was the composite of the rates of death, myocardial infarction, unstable angina requiring rehospitalization, revascularization, and stroke at 1-year follow-up. Outcomes were evaluated by mean of the TIMI risk score for developing at least 1 component of the primary end point. Results: Angiographic findings showed that 710 (9.1%) of 7656 patients had nonobstructive coronary artery disease; 48.7% of these had normal coronary arteries (0% stenosis), and 51.3% had mild coronary artery disease (>0% to >50% stenosis). A primary end-point event occurred in 101 patients (12.1%). It is noteworthy that a 2% event rate of deaths and myocardial infarctions had occurred in these patients at the 1-year follow-up. Event rates of death and myocardial infarction increased significantly as the TIMI risk score increased from 0.6% for a score of 1 to 4.0% for a score greater than 4. Conclusions: Patients with non-ST-segment elevation acute coronary syndromes with nonobstructive coronary artery disease detected by angiography have a substantial risk of subsequent coronary events within 1 year. The risk is not univariately high, and the TIMI risk score helps to reveal patients at high risk
Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap
No full textPurpose of review: The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event.
Recent findings: Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient's body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction.PURPOSE OF REVIEW: The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event. RECENT FINDINGS: Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient's body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction
Net adverse clinical events with P2Y12 inhibitor therapy in older patients after percutaneous coronary interventions
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Heart and Vascular Disorders: Gender Differences in Acute Coronary Syndrome
No full textDiseases of the heart and circulatory system, also called cardiovascular diseases (CVD), are the leading cause of mortality globally, both in men and in women. The “Europe Cardiovascular Disease Statistics 2017" reported that CVD is currently responsible for over 3.9 million deaths in 1 year, that is, 45% of all deaths. Specifically, CVD accounts for 1.8 million deaths (40% of all deaths) in men, and 2.1 million deaths (49% of all deaths) in women. By comparison, cancer-the next most common cause of death-accounts for just under 1.1 million deaths (24%) in men and just under 900, 000 deaths (20%) in women
The Role of Vasospasm and Microcirculatory Dysfunction in Fluoropyrimidine-Induced Ischemic Heart Disease
Full text linkCardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, mechanisms, and manifestation remain poorly defined. Ischemia secondary to coronary artery vasospasm is thought to be the most frequent cardiotoxic effect of 5-FU. The available evidence of 5-FU-induced epicardial coronary artery spasm and coronary microvascular dysfunction suggests that endothelial dysfunction or primary vascular smooth muscle dysfunction (an endothelial-independent mechanism) are the possible contributing factors to this form of cardiotoxicity. In patients with 5-FU-related coronary artery vasospasm, termination of chemotherapy and administration of nitrates or calcium channel blockers may improve ischemic symptoms. However, there are variable results after administration of nitrates or calcium channel blockers in patients treated with 5-FU presumed to have myocardial ischemia, suggesting mechanisms other than impaired vasodilatory response. Clinicians should investigate whether chest pain and ECG changes can reasonably be attributed to 5-FU-induced cardiotoxicity. More prospective data and clinical randomized trials are required to understand and mitigate potentially adverse outcomes from 5-FU-induced cardiotoxicity
Sex Disparities in Ischemic Heart Disease Mortality in Europe
Full text linkBackground: Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and countries can help in tailoring effective public health policies. Objectives: The purpose of the study was to examine trends in sex differences in IHD prevalence and prognosis within the EU. Methods: We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex-specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019. Results: Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women (from 1.752 to 1.662) and men (from 3.372 to 3.135), sex disparities in ASMR-to-ASPR index (EU average: 4.96% vs 4.34%) persisted (with a women-to-men ratio ranging from 1.05 to 1.44). No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania, which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12, and Germany: 4.79% vs 3.80%; ratio: 1.26). Conclusions: Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality
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