scholarly journals Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

2021 ◽  
Vol 14 (4) ◽  
pp. 368
Author(s):  
Gabriella Frisk ◽  
Helena Bergström ◽  
Maria Helde Frankling ◽  
Linda Björkhem-Bergman
Keyword(s):  
Sex Differences ◽  
Advanced Cancer ◽  
Cardiovascular Events ◽  
Statin Treatment ◽  
Men And Women ◽  
Time Points ◽  
Disease Trajectory ◽  
Significant Difference ◽  
History Of ◽  
One Year

Statin treatment is often terminated in patients with advanced cancer but guidelines for statin discontinuation are still lacking. The aim of this study was to investigate sex-differences in time-points of statin discontinuation in patients with advanced cancer. Medical records from 1535 deceased patients enrolled at a Palliative Home Care Unit were reviewed. A total of 149 patients (42 women and 107 men) who were diagnosed with cancer, and were treated with statins one year before death, were identified. Statin treatment was terminated earlier in women than in men, 3.0 months prior to death (IQR 0.88–7.25) as compared to 1.5 months (IQR 0.5–4.0) (p < 0.05), respectively. In a longitudinal analysis there was a significant difference between men and women still on statin treatment at all studied time-points, 9, 6, and 3 months before death (p < 0.05), where women terminated statin treatment earlier in the disease trajectory. Baseline demographics were similar between the sexes except that more men than women had a history of previous cardiovascular events (p < 0.01). However, neither the indication for statin treatment, i.e., primary prevention versus secondary prevention, nor age could explain the sex-difference in statin discontinuation. There was no difference in cardiovascular events or mortality between men and women after statin discontinuation.

Abstract P355: Predicting the 20-year Risk of First Coronary or Ischemic Stroke Event in Northern Italy: The CAMUNI Absolute Risk Equation

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Giovanni Veronesi ◽  
Lloyd E Chambless ◽  
Francesco Gianfagna ◽  
Giuseppe Mancia ◽  
Giancarlo Cesana ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Absolute Risk ◽  
Northern Italy ◽  
Men And Women ◽  
Basic Model ◽  
History Of

Aims. Recent US guidelines advocate the introduction of lifetime or long-term absolute risk prediction for primary prevention of cardiovascular events, especially for young people and women. Therefore, long-term prediction models might be specially beneficial in population considered at low incidence. We aim to develop a 20-year absolute risk prediction equation in a Northern Italy population. Methods. Four independent population-based cohorts were enrolled between 1986 and 1994 from the Brianza population (Northern Italy), adopting standardized MONICA procedures. The study sample comprises n=2574 men and 2673 women, aged 35 to 69 years and free of CVD at baseline. Participants were followed-up for incidence of first coronary and ischemic stroke events (fatal and non-fatal; all MONICA validated) for a median time of 15 years (IQ range: 12-20) and up to the end of 2008. We compared several gender-specific Cox Proportional Hazards models: the basic one includes age, total cholesterol, HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. Candidates to model addition were diastolic blood pressure, triglycerides, BMI, family history of CHD, and education. Model calibration was tested using the Grønnesby-Bogan goodness-of-fit statistic. The Area Under the ROC-Curve (AUC) was a measure of discrimination, corrected for over-optimism via bootstrapping. Changes in discrimination (Δ-AUC) and reclassification (Net Reclassification Improvement, NRI) defined the improvement from the basic model due to an additional risk factor. Intermediate risk was defined as 20-year risk between 10% and 40%. Results. We observed n=286 events in men (incidence rate 7.7 per 1000 person-years) and n=108 in women (2.6 per 1000 person-years). All risk factors included in the basic model were predictive of first cardiovascular event in both genders; discrimination was 0.725 and 0.802 in men and women, respectively. Average specificity in the top risk quintile (cut-off value: 23% in men and 8.5% in women) was similar in men and women (85% vs. 83%), while sensitivity was higher in women (63% vs. 46%). All the models were well-calibrated (p-values >0.05). The addition of a positive family history of CHD in men (Hazard Ratio: 1.6; 95%CI 1.2-2.1) and of diastolic blood pressure in women (HR: 1.4 for 11 mmHg increase; 1.1-1.8) significantly improved discrimination (Δ-AUC=0.01; 95%CI 0.002-0.02 [men] and Δ-AUC=0.005; 95%CI 0.0001-0.01 [women]) and reclassification of subjects at intermediate risk (NRI=8.4%;1.7%-19.1% [men]; and NRI=11.7%; -3.2%-33.5% [women]). Conclusions. Traditional risk factors are predictive of cardiovascular events after 20 years, with good discrimination. The addition of family history of CHD may contribute to model improvement, at least among men; the role of diastolic blood pressure in women should be carefully evaluated.

Abstract 14715: Diabetes and Relative Rates of Cardiovascular Events in Women Compared With Men

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Denis Angoulvant ◽  
Pierre Henri Ducluzeau ◽  
Peggy Renoult Pierre ◽  
Gregoire Fauchier ◽  
Julien Herbert ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Incidence Rate ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Incidence Rates ◽  
Adverse Cardiovascular Event ◽  
Men And Women ◽  
Diabetes Status

Data are inconsistent regarding sex-differences in the relative rates of cardiovascular events associated with diabetes. We aimed to investigate whether diabetes confers higher relative rates of cardiovascular events in women compared with men using contemporary data, and whether these sex-differences depend on age. Methods: All patients seen in French hospitals in 2013 with at least 5 years or follow-up (or dying earlier) without a history major adverse cardiovascular event, were identified and characterized by individual-level linkage of French nationwide administrative registers. They were categorized by diabetes-status and followed-up until 31 December 2019. Using Cox models, we calculated overall and age-dependent incidence rates, incidence rate ratios, and women-to-men ratios for myocardial infarction, heart failure, ischemic stroke, or cardiovascular death (MACE-HF). Results: The study included 3,381,472 individuals among whom 482,848 (14.3%) had diabetes (88.1% with type 2 diabetes). Among 482,848 (45% women) patients with diabetes, the absolute rate of MACE-HF was higher in men than in women (9.7 vs. 7.4 per 100 person-years). Corresponding absolute rates in men and women without diabetes were 4.9 vs. 3.1 per 100 person-years. Comparing individuals with and without diabetes, women had higher incidence rate ratio (IRR) of MACE-HF than men (IRR 2.42 95% confidence interval [CI] 2.40-2.44) in women vs. 1.99, 95% CI 1.98-2.01 in men) with a women-to-men ratio (WMR) of 1.22 (CI 1.20-1.23, p<0.001). The IRRs of MACE-HF for diabetes vs no diabetes were highest in women aged 45 and in the youngest men and decreased with advancing age for both men and women, but the IRRs were higher in women across all ages, with the highest WMR between age 45 and 70 years. This effect was more apparent for myocardial infarction (women-to-men ratio 1.43, 95%CI 1.39-1.47 after adjustment) than for ischemic stroke (WMR 1.10, 95%CI 1.07-1.13 after adjustment) or overall MACE-HF (WMR 1.16, 95%CI 1.15-1.18 after adjustment). Conclusion: Although men have higher absolute rates of cardiovascular complications, the relative rates of cardiovascular complications associated with diabetes are higher in women than in men across all ages in recent years.

Conséquences psychologiques de la retraite en fonction du sexe et du niveau occupationnel antérieur

1994 ◽  
Vol 13 (2) ◽  
pp. 149-168 ◽  
Author(s):  
Gaston-René de Grâce ◽  
Purushottam Joshi ◽  
René Pelletier ◽  
Claudine Beaupré
Keyword(s):  
Life Satisfaction ◽  
Cross Sectional ◽  
Men And Women ◽  
Occupational Level ◽  
Significant Difference ◽  
Dependent Variables ◽  
One Year

ABSTRACTThis research, taking into account sex and previous occupational level, examines the influence of retirement on three dependent variables: loneliness, depression, and life satisfaction. One hundred and six men and women, aged 65 and receiving governmental pensions (Régie des rentes du Québec) completed on two occasions (with a one year interval) the Échelle de solitude de l'Université Laval, the Questionnaire de dépression de Beck and the Échelle de satisfaction de vie. The resulte indicate that there is no significant difference between Time 1 and Time 2 of evaluation on the three questionnaires (temporal view). However, from a cross-sectional perspective, newly retired men and professionals may be more lonely, less satisfied with their life and more depressed. The results are discussed in the light of Atchley's (1976b) model.

scholarly journals Insulin sensitivity in critically ill patients: are women more insulin resistant?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vincent Uyttendaele ◽  
J. Geoffrey Chase ◽  
Jennifer L. Knopp ◽  
Rebecca Gottlieb ◽  
Geoffrey M. Shaw ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Sex Differences ◽  
Insulin Sensitivity ◽  
Metabolic Response ◽  
Demographic Data ◽  
Randomised Trial ◽  
Preterm Neonates ◽  
Men And Women ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Glycaemic control (GC) in intensive care unit is challenging due to significant inter- and intra-patient variability, leading to increased risk of hypoglycaemia. Recent work showed higher insulin resistance in female preterm neonates. This study aims to determine if there are differences in inter- and intra-patient metabolic variability between sexes in adults, to gain in insight into any differences in metabolic response to injury. Any significant difference would suggest GC and randomised trial design should consider sex differences to personalise care. Methods Insulin sensitivity (SI) levels and variability are identified from retrospective clinical data for men and women. Data are divided using 6-h blocks to capture metabolic evolution over time. In total, 91 male and 54 female patient GC episodes of minimum 24 h are analysed. Hypothesis testing is used to determine whether differences are significant (P < 0.05), and equivalence testing is used to assess whether these differences can be considered equivalent at a clinical level. Data are assessed for the raw cohort and in 100 Monte Carlo simulations analyses where the number of men and women are equal. Results Demographic data between females and males were all similar, including GC outcomes (safety from hypoglycaemia and high (> 50%) time in target band). Females had consistently significantly lower SI levels than males, and this difference was not clinically equivalent. However, metabolic variability between sexes was never significantly different and always clinically equivalent. Thus, inter-patient variability was significantly different between males and females, but intra-patient variability was equivalent. Conclusion Given equivalent intra-patient variability and significantly greater insulin resistance, females can receive the same benefit from safe, effective GC as males, but may require higher insulin doses to achieve the same glycaemia. Clinical trials should consider sex differences in protocol design and outcome analyses.

scholarly journals Sex Differences in Plaque Composition and Morphology Among Symptomatic Patients With Mild-to-Moderate Carotid Artery Stenosis

Stroke ◽  
2022 ◽  
Author(s):  
Dianne H.K. van Dam-Nolen ◽  
Nina C.M. van Egmond ◽  
Kristine Dilba ◽  
Kelly Nies ◽  
Anja G. van der Kolk ◽  
...  
Keyword(s):  
Sex Differences ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Plaque Burden ◽  
Multidetector Row Computed Tomography ◽  
Plaque Composition ◽  
Plaque Volume ◽  
Men And Women ◽  
Fibrous Cap ◽  
Significant Difference

Background and Purpose: Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes. Methods: We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics. Results: We found significant difference in total plaque volume between men and women (β=22.9 mm 3 [95% CI, 15.4–30.5]; mean volume in men 1399±425 mm 3 , in women 1011±242 mm 3 ). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3–6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2–4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2–7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1–5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2–8.6]). Conclusions: In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01208025.

scholarly journals Modulation of Tregs and iNKT by Fingolimod in Multiple Sclerosis Patients

Cells ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 3324
Author(s):  
Diana Ferraro ◽  
Sara De Biasi ◽  
Anna Maria Simone ◽  
Riccardo Orlandi ◽  
Milena Nasi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Safety Data ◽  
Absolute Number ◽  
Clinical Relapse ◽  
Inkt Cells ◽  
Time Points ◽  
Cell Counts ◽  
Significant Difference ◽  
One Year ◽  
Multiple Sclerosis Patients

The altered numbers and functions of cells belonging to immunoregulatory cell networks such as T regulatory (Tregs) and invariant Natural Killer T (iNKT) cells have been reported in Multiple Sclerosis (MS), an immune-mediated disease. We aimed to assess the frequencies of Tregs and iNKT cells in MS patients throughout a one-year treatment with fingolimod (FTY) and to correlate immunological data with efficacy and safety data. The percentage of Tregs (defined as Live Dead-CD3 + CD4 + FoxP3 + CD25++/CD127− cells) increased steadily throughout the year, while there was no significant difference in the absolute number or percentage of iNKT cells (defined as CD3 + CD14−CD19− Vα24-Jα18 TCR+ cells). However, out of all the iNKT cells, the CD8+ iNKT and CD4−CD8− double-negative (DN) cell percentages steadily increased, while the CD4+ iNKT cell percentages decreased significantly. The mean percentage of CD8+ T cells at all time-points was lower in patients with infections throughout the study. The numbers and percentages of DN iNKT cells were more elevated, considering all time-points, in patients who presented a clinical relapse. FTY may, therefore, exert its beneficial effect in MS patients through various mechanisms, including the increase in Tregs and in iNKT subsets with immunomodulatory potential such as CD8+ iNKT cells. The occurrence of infections was associated with lower mean CD8+ cell counts during treatment with FTY.

Development and Validation of A Simplified Short-term Prognostic Evaluation Nomogram for Patients with Stable Coronary Heart Disease (Preprint)

2019 ◽  
Author(s):  
Qian Lin ◽  
Jianqing Ju ◽  
Zhuye Gao ◽  
Xuezhong Zhou ◽  
Hao Xu
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Total Population ◽  
Diastolic Pressure ◽  
Multivariate Logistic Regression Analysis ◽  
Prognostic Evaluation ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
One Year

UNSTRUCTURED Objective To predict the incidence of recurrent cardiovascular events in patients with stable coronary heart disease in one year, a simple and robust nomogram was established and validated. Method The predictive model was developed and validated in two prospective coronary artery disease cohorts. The total population was 3618, with 589 recurrent cardiovascular events. Seven-tenths of the total population were randomly selected for model development, and LASSO regression was used to extract features from the information needed for routine diagnosis and treatment. Multivariate logistic regression analysis was used to establish the prediction model, which was displayed by nomograph. Internal validation was conducted using the remaining three-tenths of the population.The performance of nomograph was evaluated according to its calibration, identification and clinical practicability. Result Prognostic factors consisting of 10 selected features were significantly associated with recurrent cardiovascular events. Predictors of prognostic evaluation model included age, heart rate, diastolic pressure, triglyceride, red blood cell count, grade of Hypertension， history of hyperlipidemia, history of revascularization, use of clopidogrel, use of ACEI or ARB. The model has good discrimination. The C index is 0.722 in the development set and 0.711 in the validation set. Nomograph also has good calibration. Decision curve analysis shows that radiography is useful in clinic. Conclusion This study developed a relatively accurate nomograph to predict the incidence of recurrent cardiovascular events in patients with stable coronary heart disease within one year.

Abstract P148: Sex Differences in the Genetic Predisposition of Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yunfeng Huang ◽  
Qin Hui ◽  
Marta Gwinn ◽  
Yijuan Hu ◽  
Arshed A Quyyumi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sex Differences ◽  
Coronary Artery ◽  
Genetic Risk ◽  
P Value ◽  
Men And Women ◽  
Specific Effects ◽  
History Of ◽  
Artery Disease ◽  
Cad Risk

While coronary artery disease (CAD) is the leading cause of death for both men and women, sex differences in CAD risk are widely observed. Genetic susceptibility for CAD may be modified by sex and contribute to sex disparities in CAD. However, whether such modification exists is not clear given the limited sample size of previous studies. Using the UK Biobank, we constructed a CAD genetic risk score (CAD-GRS) based on 161 known loci, and assessed the sex-specific effect of the CAD-GRS on CAD incidence in ~307,147 men and women of European ancestry without previous history of CAD. During an average follow-up of 6.1 years 9,847 incident CAD events were identified using hospitalization data and the national death registry. To examine if certain intermediate trait contributes more predominantly on sex differences in CAD risk, we constructed three risk factor-based CAD-sub-GRSs after removing pleiotropic SNPs: 1) 26 loci associated with blood pressure (BP) and CAD (BP-sub-GRS); 2) 17 loci associated with lipids and CAD (lipids-sub-GRS); and 3) 16 loci associated with body mass index (BMI) and CAD (BMI-sub-GRS). Sex-specific effects of CAD-sub-GRSs were examined. Cox models were implemented to assess sex-specific genetic effects of CAD adjusted for age, smoking, alcohol drinking, history of hypertension and diabetes, BMI, cholesterol medication, education and SES, and population stratification. To avoid over-adjustment, history of hypertension, cholesterol medication and BMI were not controlled for in the analyses of BP-sub-GRS, lipids-sub-GRS and BMI-sub-GRS, respectively. Both CAD-GRS and CAD-sub-GRSs were categorized using quintiles into “low” (quintile 1), “intermediate” (quintile 2 - 4), and “high” (quintile 5) groups. We observed a strong sex discrepancy in the effect of the overall CAD-GRS on CAD incidence (HR high GRS vs. low GRS = 2.4 (95% CI: 2.2, 2.6) for males vs. HR high GRS vs. low GRS = 1.8 (95% CI: 1.6, 2.0) for females, interaction p-value = 0.002). A similar gene-sex interaction was observed for CAD-sub-GRS driven by BP-associated loci (HR high GRS vs. low GRS = 1.5 (95% CI: 1.4, 1.7) for males vs. HR high GRS vs. low GRS = 1.2 (95% CI: 1.1, 1.3) for females, interaction p-value = 0.0005) but not lipids or BMI-associated loci. The SNP-based analysis revealed significant gene-sex interaction (p=0.0001) at one CAD locus (21q22.11). The lead SNP (rs28451064) is a cis -eQTL for several neighboring genes’ expression ( MRPS6 , SLC5A3 , KCNE2 and AP000318.2 ) in aorta and tibial artery tissues. Previous genome-wide association studies reported significant associations between rs28451064 and bone mineral density, waist-hip ratio as well as pulse pressure. These results suggest that genetic predisposition of CAD based on known loci is stronger in men than in women. Future investigations of genetic risk and mechanism for CAD need to consider sex-specific effects.

scholarly journals Comparison of Distal Hypospadias Repair in Circumcised Patients and Uncircumcised Patients

ISRN Urology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Fahimeh Kazemi Rashed ◽  
Rasool Gholizade
Keyword(s):  
Postoperative Complications ◽  
Functional Results ◽  
Hypospadias Repair ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
History Of ◽  
The Mean ◽  
Distal Hypospadias ◽  
One Year ◽  
Results Of Surgery

Hypospadias is the most common anomaly in the male genital tract with an incidence of 0.8–8.2 per 1000 live male births. Routinely, hypospadias cases are repaired after one year of age, and it is recommended that a child with hypospadias not to be circumcised until hypospadias repair is completed. This study was conducted to determine whether or not circumcision prior to hypospadias repair increases the risk of complications. 30 circumcised patients and 30 persons without a history of circumcision and hypospadias were enrolled in this study and underwent surgery for hypospadias repair. The results of surgery compared between two groups. In the uncircumcised group, the mean durations of surgery and hospitalization were  min and days. In circumcised group, the mean duration of surgery and hospitalization were minutes and days. There was no significant difference between these criteria and other complications of the two groups. This study shows that postoperative complications in circumcised distal hypospadias patients do not increase. Cosmetic and functional results were excellent. If there are failures in therapy and in case of postoperative complications, it is better to notice other factors such as infection.

scholarly journals Pelvic pain and early IUD discontinuation: a prospective cohort study

2019 ◽  
Vol 8 (3) ◽  
pp. 792
Author(s):  
Sharon R. Gerber ◽  
Noah Natell ◽  
Nora Doty ◽  
Xiaoyu Liu ◽  
Jessica R. Overbey ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Pelvic Pain ◽  
Prospective Cohort ◽  
Intrauterine Device ◽  
Significant Difference ◽  
History Of ◽  
One Year

Background: The aim of the study is to assess if pelvic pain is a risk factor for intrauterine device (IUD) discontinuation within one year of placement.Methods: This is a prospective cohort study of women who had IUDs inserted at a family planning office for the primary intent of contraception. Baseline pelvic pain characteristics were assessed using a validated pelvic pain questionnaire.  Women were contacted at 1 year to assess IUD continuation.Results: From February 1, 2014 to August 11, 2015 authors enrolled a sample of 179 women.  Of the 179 enrolled,163 participants completed the questionnaire, 98 reported a history of baseline pelvic pain and 65 reported no history of baseline pelvic pain. 20 participants were lost to follow-up. 86 women in the pelvic pain and 57 in the no pelvic pain group were included in the final analysis. Discontinuation rates at one year follow up were 25.6% (22) and 35.1% (20) respectively. There was no significant difference in those with and without pelvic pain discontinuing IUDs at one year (p = 0.22).Conclusions: Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.

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