Age- and Gender-Normalized Coronary Incidence and Mortality Risks in Primary and Secondary Prevention

Abstract

Epidemiologic differences in ischemic heart disease incidence between women and men remain largely unexplained. The reasons of women’s “protection” against coronary artery disease (CAD) are not still clear. However, there are subsets more likely to die of a first myocardial infarction. The purpose of this review is to underline different treatment strategies between genders and describe the role of classical and novel factors defined to evaluate CAD risk and mortality, aimed at assessing applicability and relevance for primary and secondary prevention. Women and men present different age-related risk patterns: it should be important to understand whether standard factors may index CAD risk, including mortality, in different ways and/or whether specific factors might be targeted gender-wise. Take home messages include: HDL-cholesterol levels, higher in pre-menopausal women than in men, are more strictly related to CAD. The same is true for high triglycerides and Lp(a). HDL-cholesterol levels are inversely related to incidence and mortality. In primary prevention the role of statins is not completely ascertained in women although in secondary prevention these agents are equally effective in both genders. Weight and glycemic control are effective to reduce cardiovascular disease (CVD) mortality in women from middle to older age. Blood pressure is strongly and directly related to CVD mortality, from middle to older age, particularly in diabetic and over weighted women. Kidney dysfunction, defined using UAE and eGFR predicts primary CVD incidence and risk in both genders. In secondary prediction, kidney dysfunction predicts sudden death in women in conjunction with left ventricular ejection fraction evaluation. Serum uric acid does not differentiate gender-related CVD incidences, although it increases with age. Age-related differences between genders have been related to loss of ovarian function traditionally and to lower iron stores more recently. QT interval, physiologically longer in women than men, may be an index of arrhythmic risk in patients with mitral valve prolapse and increased circulating levels of catecholamines. However, there are no large population-based studies to assess this. In conjunction with novel parameters, such as inflammatory markers and reproductive hormones, classical risk score in women may be implemented in the future.

Incidence of and Risk Factors for Recurrent Cardiovascular Disease Events in Middle-Eastern Adults

“…The probability of CVD recurrence in our study increased by 98% among patients with diabetes mellitus, while in other studies, the probability ranged between 65% 15 and 75% [21]. For sex-based differences, particularly related to prognosis and mortality, previous studies showed that females have more favorable results than males [22][23][24]. In our study, females are at an 85% higher risk for recurrent CVD, although the differences between the sexes for those with diabetes mellitus and poorly controlled lipid levels are marginal, it was not the same for smoking.…”

Serum Uric Acid as a Marker of Coronary Calcification in Patients with Asymptomatic Coronary Artery Disease with Preserved Left Ventricular Pump Function

“…Nevertheless, in the majority of studies there was a significant interrelationship between hyperuricemia (above 7 mg/dL) and cardiovascular outcomes [28–30]. Besides, recent clinical studies have shown that age and sex were significant effective modulators for the relation of serum uric acid to fatal congestive heart failure and ischemia events, with markedly stronger associations found in younger individuals [31, 32]. Although women and men present different age-related cardiovascular risk patterns, serum uric acid is independently and significantly associated with risk of cardiovascular events.…”

“…However, taking into consideration that serum uric acid would have a protective antioxidant activity [35, 36] we agreed that serum uric acid was an independent risk factor for coronary calcification, and it was able to preserve predict value in high concentration without several biological markers with defined potential toward vascular remodeling (osteopontin, osteoprotegerin, and type two diabetes mellitus). Theoretically, serum uric acid assessment may be useful in a population of children and adolescents with overweight or obese, as there is an association between the risk of asymptomatic coronary atherosclerosis and the level of uric acid in the blood [31]. Finally, we presumed that the dual paradoxical action of serum uric acid in the pathophysiology of asymptomatic coronary artery disease patients with preserved left ventricular systolic function required further discussions.…”