Gender and the Extent of Coronary Atherosclerosis, Plaque Composition, and Clinical Outcomes in Acute Coronary Syndromes

Lansky, Alexandra J.; Ng, Vivian G.; Maehara, Akiko; Weisz, Giora; Lerman, Amir; Mintz, Gary S.; Bruyne, Bernard De; Farhat, Naim; Niess, Gary S.; Janković, Ivana; Lazar, Dana; Xu, Ke; Fahy, Martin; Serruys, Patrick W.; Stone, Gregg W.

doi:10.1016/j.jcmg.2012.02.003

Cited by 244 publications

(154 citation statements)

References 37 publications

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“…POC is a simple and harmless method that provides a new tool to protect an organ, namely heart, brain and liver (10,26). Results from several studies suggested that the early moments of reperfusion were important in the pathogenesis of post ischemic injury, and that manipulation of this early reperfusion phase reduced renal IR injury (22).…”

Section: Histological Findingsmentioning

confidence: 99%

Postconditioning is protective in renal reperfusion injury only in male rats. A gender difference study

Mahmoudi¹,

Kadkhodaee²,

Golab³

et al. 2015

Acta Physiologica Hungarica

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Purpose:We investigated the impact of sex on the protective effect of postconditioning (POC), a series of brief ischemia-reperfusion (IR) cycles at the reperfusion onset, as a recently described novel approach to attenuate renal IR injury. In this study, the left renal pedicles of uni-nephrectomized male and female rats were clamped for 45 minutes followed by 24 hours of reperfusion as IR groups. Uni-nephrectomized, sham-operated male and female rats served as control groups. Ischemic postconditioning was performed using 4 cycles of 10 seconds IR of renal pedicle at the end of the ischemia. Twenty-four hours later, BUN (blood urea nitrogen), plasma creatinine (Cr), and renal histological changes, as well as kidney levels of MDA (malondialdehyde) and SOD (superoxide dismutase) as oxidative stress markers were evaluated to detect the protective effect of POC against IR injury in rats. Results: Induction of IR resulted in significant reduction in renal function, demonstrated by increase in plasma Cr and BUN, histological changes and oxidative stress in both genders. Application of POC afforded significant protection against these injuries in male rats, namely decreased levels of BUN and Cr, histological improvements and less oxidative damages. However, there were no significant differences in the above-mentioned parameters in female rats. Conclusion: While POC is shown to be beneficial against renal IR injury in male rats, it did not show any protective effect in female rats.

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Section: Histological Findingsmentioning

confidence: 99%

Postconditioning is protective in renal reperfusion injury only in male rats. A gender difference study

Mahmoudi¹,

Kadkhodaee²,

Golab³

et al. 2015

Acta Physiologica Hungarica

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“…4,8 Studies are conflicting regarding whether women are treated less aggressively than their male counterparts. 9-15 Women tend to have more complications and worse outcomes after cardiac catheterization 16 and are less likely to receive evidence-based medical therapy after discharge.…”

mentioning

confidence: 99%

Characteristics and Outcomes of Women Veterans Undergoing Cardiac Catheterization in the Veterans Affairs Healthcare System

Davis

Maddox

Langner

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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C oronary artery disease (CAD) remains the leading cause of death among women in the United States.1 Prior research has demonstrated that women with CAD are typically older than men and have more risk factors, such as diabetes mellitus, 2 hypertension, 3,4 hyperlipidemia, 5 obesity, 6 and congestive heart failure.4,7 Despite these higher rates of CAD risk factors, women have less obstructive CAD. 4,8 Studies are conflicting regarding whether women are treated less aggressively than their male counterparts. 9-15 Women tend to have more complications and worse outcomes after cardiac catheterization 16 and are less likely to receive evidence-based medical therapy after discharge. 17Women who have served in the military may have an even higher risk of CAD than nonveteran women, given the overall worse health status and higher number of CAD risk factors in the veteran population, 18-20 but little is known about the characteristics and treatment of women veterans suspected of having clinically significant CAD. The number of women seeking care at veterans affairs (VA) facilities has doubled over the past decade, 21 providing a unique opportunity to understand cardiac care and outcomes among women veterans. By extension, these lessons could improve our understanding of the sex differences noted in nonveteran cardiac populations.Background-The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse outcomes, despite having less obstructive coronary artery disease than men. Whether these differences exist among women veterans in the veterans affairs healthcare system is unknown. Methods and Results-Data on 85 936 veterans (3181 women) undergoing initial cardiac catheterization between October 1, 2007, and September 30, 2012, were examined using the national veterans affairs Clinical Assessment Reporting and Tracking (CART) Program. Sex differences in demographics, indications, coronary anatomy, cardiac treatments, and outcomes were analyzed. Women veterans were younger (56.9 versus 63.0 years, P<0.0001) with fewer traditional cardiovascular risk factors, but with more obesity, depression, and posttraumatic stress disorder than men. Women had lower rates of obstructive coronary artery disease than men (22.6% versus 53.3%). Rates of procedural complications were similar in both genders. Adjusted outcomes at 1 year showed women had lower mortality (hazard ratio, 0.74; confidence interval, 0.60-0.92) and less all-cause rehospitalization (hazard ratio, 0.87; confidence interval, 0.82-0.93), but no difference in rates of unplanned percutaneous coronary intervention. Conclusions-Women veterans undergoing catheterization are younger, have more obesity, depression, and posttraumatic stress disorder, less obstructive coronary artery disease, and similar long-term outcomes, compared with m...

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“…17,18) Although IVUS studies showed lower CAC volumes in the target lesions in women than in men, 19) the impact of sex on CAC in the entire coronary artery vasculature has not been fully addressed.…”

Section: Discussionmentioning

confidence: 99%

Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography

et al. 2017

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SummaryPrevious studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.(Int Heart J 2017; 58: 695-703) Key words: Coronary plaque burden, Low-risk, Statin, Multi-detector computed tomography, Sex difference T he presence of calcified plaques in the coronary artery is associated with future adverse coronary events.1-3) Statin therapy was proven efficient for the primary and secondary preventions of coronary adverse events 4,5) through stabilization of unstable plaques and management of low-density lipoprotein (LDL) cholesterol levels.6,7) However, it remains to be elucidated whether there is any association between statin and coronary artery calcium (CAC) formation. 8) Recent intravascular ultrasound (IVUS) studies indicated that high-dose statin therapy leads to a reduction in the necrotic core volume, but to an increase in tissue calcification.9-12) These IVUS studies were conducted on high-risk patients diagnosed with coronary artery disease (CAD) [9][10][11] or STsegment elevation myocardial infarction (STEMI).12) As those patients received statin therapy regardless of the presence or absence of dyslipidemia, we could not differentiate the effect of statins and dyslipidemia on CAC. Furthermore, the region of interest in IVUS was limited to the proximal coronary vessels, instead of the entire coronary vasculature.Multi-detector computed tomography (MDCT) provides images of all coronary arteries with a higher specificity of CAC. The efficiency of MDCT remains controversial as some studies reported a significant impact of statin therapy on coronary plaque burden and/or CAC, 13,14) whereas others re...

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Gender and the Extent of Coronary Atherosclerosis, Plaque Composition, and Clinical Outcomes in Acute Coronary Syndromes

Cited by 244 publications

References 37 publications

Postconditioning is protective in renal reperfusion injury only in male rats. A gender difference study

Postconditioning is protective in renal reperfusion injury only in male rats. A gender difference study

Characteristics and Outcomes of Women Veterans Undergoing Cardiac Catheterization in the Veterans Affairs Healthcare System

Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography

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