scholarly journals Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

2021 ◽  
Vol 10 (6) ◽  
pp. 1314
Author(s):  
Rebeca Lorca ◽  
Isaac Pascual ◽  
Andrea Aparicio ◽  
Alejandro Junco-Vicente ◽  
Rut Alvarez-Velasco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Young Women ◽  
Artery Dissection ◽  
Men And Women ◽  
High Prevalence

Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

P3647Spontaneous coronary artery dissection: new insights on presentation, clinical and angiographic characteristics from the French multicenter registry DISCO study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Bouajila ◽  
N Combaret ◽  
G Souteyrand ◽  
C Spaulding ◽  
H Benamer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Intramural Hematoma ◽  
Stress Factors ◽  
Artery Dissection ◽  
Coronary Artery Dissection

Abstract Background Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and poorly understood cause of acute coronary syndrome (ACS). Clinical, angiographic features and management remain to be better defined in large cohorts. Purpose The aim of this study was to evaluate clinical, angiographic characteristics, treatment modalities and prognosis of patients with SCAD from a multicenter national registry. Methods From 2016 to 2018, SCAD patients were enrolled retrospectively and prospectively in the French multicenter regristry DISCO study in 61 cardiology interventional centers. All coronary angiograms were reviewed by 2 experienced cardiologists for diagnosis confirmation and classified according to current angiographic SCAD classification. Results A total of 373 confirmed SCAD patients were included, 45.6% prospectively, 54.4% retrospectively. Mean age was 51.5±10.3 years, with 90.6% women of whom 51.2% were postmenauposal. Ninety percent of patients had ≤2 cardiovascular risk factors, 96.2% presented with ACS, with a positive troponin in 95.4%, and ST-segment elevation in 45.0%. Precipitating emotional stress factors were reported in 46.0% and a physical trigger in 12.4%. Systemic inflammatory disease was present in 5 patients (1.4%). Peripartum SCAD accounted for only 4.4% of cases. The majority of patients (75.1%) had type 2 angiographic SCAD (diffuse long smooth tubular lesions due to intramural hematoma), with only 13.8% and 8.9% having type 1 (longitudinal filling defect) and type 3 (multiple focal tubular lesions due to intramural hematoma) respectively. Multivessel SCAD occurred in 6.2%. While 84.2% of SCAD patients were initially treated conservatively, 15.5% underwent percutaneous coronary intervention as the initial strategy and 1 patient (0.3%) required surgical implantation of a left ventricular assist device. Repeat angiogram was conducted in 288 patients (median 38 [8–70] days) showing improvement of the culprit lesion in 81.9%. At 1 year follow-up, recurrent SCAD occurred in 2.5%, major adverse cardiac events (stroke, myocardial infarction, and revascularization) in 7.7%, and all patients survived. Conclusion Our study confirms that SCAD predominantly affects early middle-aged women with few cardiovascular risk factors, with peripartum SCAD accounting for a minority of cases. Type 2 angiographic SCAD which is difficult to recognize was the most frequent angiographic appearance. This may contribute to the underestimation of SCAD in clinical practice. The majority of patients were treated conservatively with favorable outcomes. Longer-term follow-up of this large cohort and further investigations on physiopathology are warranted to improve management and risk stratification of patients. Acknowledgement/Funding Fondation Coeur et Recherche, French Coronary Atheroma and Interventional Cardiology Group, French Society of Cardiology

scholarly journals A Cross Sectional Analysis of the Prevalence of Co-Morbidities in Older Transgender Individuals Receiving Hormone Affirming Therapy in Comparison With the General Population

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A786-A787
Author(s):  
Ido Breda ◽  
Iris Yaish ◽  
Yael Sofer ◽  
Karen Michele Tordjman ◽  
Yona Greenman
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Transgender Women ◽  
Cardiovascular Morbidity ◽  
Men And Women ◽  
The Impact ◽  
Transgender Men

Abstract Background: Transgender individuals feel an incongruity between the assigned gender at birth and their gender identity. Because the prevalence of cardiovascular risk factors and morbidity associated with cross-sex hormonal therapy is not well established, particularly in the older transgender population, we set out to compare it to that of the general population. Methods: Data were collected from medical records of transgender patients treated in the Endocrine Institute at the Tel Aviv-Sourasky Medical Center until October 2018. Data from the Israel National Health Survey INHIS-3 2013-2015 were used as reference. Results: 104 (75 transgender women and 29 transgender men) patients over 35 y were identified. The median follow up time was 3 y (1-6.1). Transgender women had a high standardized prevalence rate (SPR) of overweight, smoking and engaging in physical exercise, but not of dyslipidemia compared with cisgender men and women. The SPR for overweight was high in transgender males compared with cisgender men and women. The SPR for smoking and dyslipidemia was high in transgender men compared with cisgender women but not men. Depression and anxiety were markedly increased in transgender women compared with cisgender men [SPR 5.5 (95% CI 3.3-8.5), p&lt;0.001] and women [SPR 2.8 (95% CI 1.7-4.3), p&lt;0.001] in the control population. The SPR of hypertension, diabetes and cerebrovascular disease was not elevated among transgender patients. Conclusions: The prevalence of cardiovascular risk factors but not cardiovascular morbidity was higher in the transgender patients compared with the general population. Further studies including a larger population and a longer follow up time are needed to better assess the impact of a high prevalence of risk factors on cardiovascular morbidity on the long run.

scholarly journals Sex-specific reference values and determinants of infra-renal abdominal aortic diameter among women and men from general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Zhu ◽  
B Arshi ◽  
M Ikram ◽  
R De Knegt ◽  
M Kavousi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Reference Values ◽  
Aortic Diameter ◽  
Funding Source ◽  
Men And Women ◽  
Abdominal Aortic

Abstract Introduction Abdominal aortic diameter has shown to be a marker of adverse cardiovascular outcomes. Among the non-aneurysmal populations, studies regarding abdominal aortic diameter normal reference values are sparse. Moreover, data regarding the associations between cardiovascular risk factors and aortic diameter among men and women are limited. Purpose To establish age- and sex-specific distribution of the infra-renal abdominal aortic diameters among non-aneurysmal older adults from the general population and to investigate the associations between cardiovascular risk factors and aortic diameters in men and women. Methods From a population-based cohort, 4032 participants (mean age, 67.2 years; 60.4% women) with infra-renal diameter assessment and without history of cardiovascular disease were included. Mean and quantile values of diameters were calculated in different age groups. Multiple linear regression analysis was used to detect the association of cardiovascular risk factors with diameters in men and women. Results The mean crude diameter was larger in men [mean (SD): 19.5 (2.6) mm] compared to women [17.0 (2.4)mm] but after adjustment for body surface area (BSA), the differences were small. There was a non-linear relationship between age and diameter (p&lt;0.001). After 66 years of age, the increase in diameter with increasing age was attenuated. After age 74 years in women and 71 years in men, the relationship between age and infra-renal aortic diameter was no longer statistically significant (Figure). Waist [standardized β (95% CI): 0.02 (0.0–0.04) in women and 0.03 (0.01–0.06) in men] and diastolic blood pressure [0.04 (0.02–0.05) in women and 0.02 (0.0–0.04) in men] were the risk factors for diameters in both sexes. Body mass index [0.02 (0.01–0.09)], systolic blood pressure [−0.01 (−0.02 to −0.01)], smoking status [0.21 (0.02–0.39)], cholesterol [−0.19 (−0.29 to −0.09)], and lipid-lowering medication [−0.47 (−0.71 to −0.23)] were significantly associated with aortic diameter only in women. Conclusion The differences in the crude abdominal aortic diameter between women and men diminished after taking into account the BSA. The abdominal aortic diameter increased steeply with advancing age and up to 66 years of age. However, after 74 years in women and 71 years in men, the diameter values reached a plateau. We also observed sex differences in the associations of cardiovascular risk factors with abdominal aortic diameter. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE)

P5642A clinical risk score for estimating sudden cardiac death risk in the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Aro ◽  
A Holkeri ◽  
A Eranti ◽  
T Kerola ◽  
M J Junttila ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Risk Score ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
All Cause Mortality ◽  
Male Sex

Abstract Background Sudden cardiac death (SCD) remains a major cause of premature mortality worldwide, so there has been an ongoing pursuit for tools for SCD risk stratification. Coronary artery disease is the major cause for SCD in adults, but the level of risk associated with multiple cardiovascular risk factors is not well established. Purpose To create a clinical risk score for estimating SCD risk in the general population. Methods Using data from a Finnish general population cohort of 7200 adults (mean age 51y, 46% male) with a mean follow-up of 24±11 years, we assessed the incremental SCD risk associated with the presence of several cardiovascular risk factors. SCD events were adjudicated based on death certificates according to the established criteria (autopsy was performed on 48% of SCD cases). Hazard ratios (HR) for SCD and all-cause mortality were calculated using the Cox proportional hazards model. Of the multiple parameters analysed, male sex, increasing age, diabetes, hypertension, smoking and previously diagnosed cardiac disease were independently associated with SCD in a multivariable model. Based on the magnitude of risk, a SCD risk score was created (2 points: age >70y; 1 point: male sex, age 60–70y, diabetes, hypertension, smoking, cardiac disease). Results 75.2% of the study subjects had 0–2 risk points, 12.8% 3 risk points, and 12.0% >3 risk points. During the follow-up, 400 SCDs occurred. Increasing risk score was associated with a progressively greater risk for SCD (Figure). Compared with subjects without risk factors, those with a risk score of 3 had a HR of 21.2 (95% CI 12.7–35.4, p<0.001) and those with a risk score of >3 had a HR of 52.6 (95% CI 31.3–88.3, p<0.001) for SCD. Clinical risk score predicted significantly also all-cause mortality (HR 31.5 with risk score >3 [95% CI 27.6–35.9, p<0.001]). Risk of SCD according to the risk score Conclusions Accumulation of multiple cardiovascular risk factors is associated with a markedly elevated risk for SCD in the general population. This highlights the need for SCD prevention efforts with lifestyle interventions and medical therapy in the high-risk subjects. Studies on focused SCD risk stratification may be warranted in the subjects at highest risk.

Traditional Cardiovascular Risk Factors and the Presence of Obstructive Coronary Artery Disease in Men and Women

2014 ◽  
Vol 30 (7) ◽  
pp. 820-826 ◽  
Author(s):  
Dennis T. Ko ◽  
Harindra C. Wijeysundera ◽  
Jacob A. Udell ◽  
Viola Vaccarino ◽  
Peter C. Austin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Obstructive Coronary Artery Disease ◽  
Men And Women ◽  
Artery Disease

P1523Comparative long-term outcomes among men and women after percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Procopi ◽  
M Zeitouni ◽  
M Kerneis ◽  
N Hammoudi ◽  
E Berman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Mortality ◽  
Cardiovascular Death ◽  
Long Term Outcomes ◽  
Men And Women ◽  
All Cause Mortality

Abstract Background Comparative long-term outcomes among women and men treated with percutaneous intervention (PCI) are unknown. Objective To describe and compare mortality and predictors of poor outcomes among men and women who underwent PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up in this cohort study. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificate. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Last detailed cardiovascular and vital status were collected in January 2019. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The follow-up rate was 97.6%. Women were older at baseline (70±13.1 vs. 64.6±12), smoked less often (18.9% vs. 30.4%) but suffered more frequently of hypertension (67.9% vs. 58.1%) and chronic kidney disease (42.6% vs. 22.7%). All-cause death occurred for 30.3% (n=1070) and MACCE for 40.9% (n=1443) of patients in the cohort. In unadjusted analyses, women had a higher risk of all-cause mortality (35% vs 29%, HR = 1.25, 95% CI [1.09–1.43], p=0.0015) and cardiovascular mortality (61% vs. 57%, HR = 1.31, 95% CI [1.10–1.56]) but there was no difference on occurrence of MACCE (HR = 1.079, 95% CI = [0.9271–1.221]). After adjustments for baseline cardiovascular risk factors, presentation and severity of coronary disease, women and men shared a similar risk of mortality along time (adHR = 0.90, 95% CI [0.77–1.05]). Survival curves in women vs. men Conclusions In this long-term follow-up, women had a higher risk of all-cause and cardiovascular mortality after PCI in unadjusted analyses. However, gender was not independently associated with mortality after adjustment for cardiovascular risk factors.

Incidence of arterial cardiovascular events in patients with idiopathic venous thromboembolism

2006 ◽  
Vol 96 (08) ◽  
pp. 132-136 ◽  
Author(s):  
Antonio Marchiori ◽  
Alfonso Noto ◽  
Vincenza Rossi ◽  
Filomena Daniele ◽  
Caterina Santoro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Venous Thromboembolism ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Unknown Origin ◽  
Arterial Disease ◽  
Control Group ◽  
Control Subjects

SummaryRecent data have showna higher incidence of arterial events in patients with venous thromboembolism (VTE) of unknown origin than in those with the secondary form of disease. Whether patients with idiopathic VTE have a higher risk of subsequent arterial events than the general population is unknown. The aim was to evaluate the rates of subsequent arterial events in patients with idiopathic VTE and control subjects. In a retrospective cohort study we compared the rates of subsequent arterial events (i.e. acute myocardial infarction, ischemic stroke and peripheral arterial disease) in 151 consecutive patients with objectively confirmed spontaneousVTE and 151 control subjects randomly selected from the database of two family physicians. We collected information about cardiovascular risk-factors (hypertension, hypercholesterolemia, diabetes, obesity and smoke) at the time of VTE episode, or corresponding date for the controls, and considered the follow-up from this time. Patients and controls who had suffered from arterial events before the index date were excluded. During a mean follow-up of 43.1 (± 21.7) months there were 16 arterial events in theVTE patients and six in the control group (HR, 2.84; 95% CI, 1.11 to 7.27; p= 0.03).The difference remained significant after adjusting for age and other cardiovascular risk factors (HR 2.86; 95% CI, 1.07 to 7.62).Overall mortality was also higher in theVTE patients (12 vs.4 deaths). In conclusion, arterial events are more common in patients with previous idiopathic VTE than in the general population. These findings may have practical implications.

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