Innate differences in gender physiology result in unique exposures, risk, and protection that are specific to women. Recognition and appreciation of these differences results in better treatment adaptations for women and better outcomes. Disparities between genders in the treatment of major cardiovascular risk factors still exist and are mostly secondary to underestimating or misunderstanding a woman's risk. Preventive therapies are less often recommended to women. Women are more likely to be diagnosed and treated for hypertension, but are less likely to reach treatment goals. High-risk women-including diabetic women-are less likely to be on lipid-lowering agents and reach a low-density lipoprotein level less than 100 mg/dL. Diabetic women are less likely to achieve a hemoglobin A(1c) level less than 7%. Through understanding these disparities, health care providers will be better able to screen female patients and institute evidence-based therapies for the prevention of cardiovascular disease.
Lifestyle intervention remains the cornerstone of management of type 2 diabetes mellitus (T2DM). However, adherence to physical activity (PA) recommendations and the impact of that adherence on cardiorespiratory fitness in this population have been poorly described. We sought to investigate adherence to PA recommendations and its association with cardiorespiratory fitness in a population of patients with T2DM.
RESEARCH DESIGN AND METHODSA cross-sectional analysis of baseline data from a randomized clinical trial (NCT00424762) was performed. A total of 150 individuals with medically treated T2DM and atherosclerotic cardiovascular disease (ASCVD) or risk factors for ASCVD were recruited from outpatient clinics at a single academic medical center. All individuals underwent a graded maximal exercise treadmill test to exhaustion with breath-by-breath gas exchange analysis to determine VO 2peak . PA was estimated using a structured 7-Day Physical Activity Recall interview.
RESULTSParticipants had a mean 6 SD age of 54.9 6 9.0 years; 41% were women, 40% were black, and 21% were Hispanic. The mean HbA 1c was 7.7 6 1.8% and the mean BMI, 34.5 6 7.2 kg/m 2 . A total of 72% had hypertension, 73% had hyperlipidemia, and 35% had prevalent ASCVD. The mean 6 SD reported daily PA was 34.3 6 4 kcal/kg, only 7% above a sedentary state; 47% of the cohort failed to achieve the minimum recommended PA. Mean 6 SD VO 2peak was 27.4 6 6.5 mL/kg fat-free mass/min (18.8 6 5.0 mL/kg/min).
CONCLUSIONSOn average, patients with T2DM who have or are at risk for ASCVD report low levels of PA and have low measured cardiopulmonary fitness. This underscores the importance of continued efforts to close this therapeutic gap.Lifestyle interventions, including weight loss and physical activity (PA), are cornerstones in treating type 2 diabetes mellitus (T2DM) and preventing associated atherosclerotic cardiovascular disease (ASCVD)-related complications (1). Weight loss and PA have long been promoted as the first line of treatment to prevent many
Women with HDP had twice the risk of CV readmission within 3 years of delivery, with higher rates among AA women. More work is needed to explore preventive strategies for HDP-associated events.
Higher levels of physical activity are associated with lower rates of coronary heart disease (CHD). Prior studies suggest this is partly due to lower levels of inflammation and insulin resistance. We sought to determine whether physical activity level was associated with inflammation or insulin resistance during a 5-year period in outpatients with known CHD. We evaluated 656 participants from the Heart and Soul Study, a prospective cohort study of outpatients with documented CHD. Self-reported physical activity frequency was assessed at baseline and after 5 years of follow-up. Participants were classified as low versus high activity at each visit, yielding 4 physical activity groups: stable low activity, decreasing activity (high at baseline to low at Year 5), increasing activity (low at baseline to high at Year 5), and stable high activity. We compared Year 5 markers of inflammation (C-reactive protein [CRP], interleukin-6, and fibrinogen) and insulin resistance (insulin, glucose, and A1c) across the 4 activity groups. After 5-years of follow-up, higher activity was associated with lower mean levels of all biomarkers. In the fully adjusted regression models CRP, interleukin-6, and glucose remained independently associated with physical activity frequency (log CRP p-trend across activity groups = 0.03; log interleukin-6 p-trend = 0.01; log glucose p-trend = 0.003). Individuals with Stable High Activity typically had the lowest levels of biomarkers. In conclusion, in this novel population of outpatients with known CHD followed for 5 years, higher physical activity frequency was independently associated with lower levels of CRP, interleukin-6, and glucose.
In a large, community-based sample of women nationwide, this comprehensive analysis shows remarkable geographic variation in risk factors, which provides opportunities to improve and reduce a woman's CVD risk. Further investigation is required to understand the reasons behind such variation, which will provide insight toward tailoring preventive interventions to narrow gaps in CVD risk reduction in women.
D rug-eluting stents (DES) have revolutionized the approach to percutaneous coronary interventions and have substantially reduced restenosis compared with bare metal stents. 1,2 Despite their advantages, DES are not without disadvantages. In particular, patients who receive DES remain at risk of a 1% to 2% incidence of stent thrombosis, which is often fatal. 3,4 Dual-antiplatelet therapy (DAT) in the form of a thienopyridine and aspirin improves outcomes in patients who receive DES, 3,5 and early termination of DAT is associated with worse outcomes. 6 Consequently, recommendations for the sirolimus-eluting stent and the paclitaxeleluting stent include a minimum of 12 months of uninterrupted thienopyridine therapy, while maintaining long-term aspirin therapy for the patients' underlying coronary disease. 7 As such, early discontinuation of a thienopyridine should only be considered if bleeding risk substantially outweighs thrombotic risk or considered temporarily if a major invasive procedure is necessary. 7
Article see p 1017While a strong body of evidence and evidence-based guidelines support the importance of continuing DAT for a full year with a DES to improve outcomes and reduce stent thrombosis and the negative consequences of early discontinuation, adherence rates are suboptimal. Ho et al (2007) 8 found that 20% of patients had discontinued clopidogrel therapy within 6 months of receiving a bare-metal stent or DES. Results from the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery Registry showed that 14% of acute coronary syndrome patients had discontinued DAT within the first 30 days following placement of a DES 9 -a period with a high risk of stent thrombosis. 10 Results from the current article by Ferreira-González et al 11 are similar, suggesting that over 14% of patients had permanently or temporarily interrupted at least one antiplatelet therapy (AT) following DES.Medication nonadherence in general and discontinuation of DAT specifically are associated with poor outcomes in high-risk coronary artery disease patients. 12 In fact, the single greatest predictor of stent thrombosis is premature discontinuation of DAT. 6 Studies from Canada have demonstrated higher mortality among patients who delayed filling a clopidogrel prescription after hospital discharge due to formulary restrictions for clopidogrel. 13,14 In a contemporary cohort receiving DES, Ho et al (2010) 15 determined that 1 in 6 patients have a delay in filling clopidogrel after hospital discharge, and this delay was associated with adverse effects. This study noted an increased risk of death or myocardial infarction among patients with any delay in filling clopidogrel after hospital discharge. A large proportion of these adverse events occurred within the first 30 days of hospital discharge, particularly for patients with any delay in filling clopidogrel. These early adverse events coincide with the timing of early stent thrombosis seen in various observational data sets. 16 While there are posited to be many poten...
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