Predictors of Heart Failure Among Women With Coronary Disease

Bibbins‐Domingo, Kirsten; Lin, Feng; Vittinghoff, Eric; Barrett‐Connor, Elizabeth; Hulley, Stephen B.; Grady, Deborah; Shlipak, Michael G.

doi:10.1161/01.cir.0000141726.01302.83

Cited by 152 publications

(90 citation statements)

References 44 publications

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“…Incident heart failure was defined as hospitalizations to treat either increased intravascular volume or low cardiac output that was because of cardiac disease. 16 We classified the severity of incident heart failure as requiring either 1 hospitalization during the follow-up period or Ն2 hospitalizations. Finally, incident MI was also included as an adjustment variable.…”

Section: Secondary Predictorsmentioning

confidence: 99%

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

et al. 2008

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Abstract-We evaluated the association between kidney dysfunction and sudden cardiac death risk among ambulatory women with coronary heart disease. The Heart and Estrogen Replacement Study evaluated the effects of hormone treatment on cardiovascular events among 2763 postmenopausal women with coronary heart disease. Kidney dysfunction was categorized by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Multivariate proportional hazards models were used to adjust for cardiovascular risk factors, congestive heart failure, and myocardial infarction. At baseline, 37% (nϭ1027) had an eGFR of Ͼ60 mL/min, 54% (nϭ1503) had an eGFR of 40 to 60 mL/min, and 8% (nϭ230) had an eGFR of Ͻ40 mL/min. During the 6.8-year follow-up period, there were 136 adjudicated sudden cardiac deaths. The rate of sudden cardiac death was higher in those with lower kidney function (0.5% per year among those with an eGFR Ͼ60; 0.6% per year with an eGFR between 40 and 60; and 1.7% per year with an eGFR Ͻ40 mL/min; P for trend Ͻ0.001). After multivariate analysis with baseline risk factors, eGFR at 40 to 60 mL/min was not a significant predictor, but eGFR at Ͻ40 mL/min remained strongly associated with sudden cardiac death (hazard ratio: 3.2; 95% CI: 1.9 to 5.3); adjustment for incident congestive heart failure and myocardial infarction during follow-up diminished this association (hazard ratio: 2.3; 95% CI: 1.3 to 3.9), suggesting that congestive heart failure and myocardial infarction mediated only part of the association between kidney dysfunction and sudden cardiac death. Advanced kidney dysfunction is an independent predictor of sudden cardiac death among women with coronary heart disease. Key Words: kidney dysfunction Ⅲ women Ⅲ sudden cardiac death S udden cardiac death (SCD) is an important clinical and public health problem: Ͼ450 000 Americans died in 1998 from SCD, defined as a sudden pulseless death attributed to cardiovascular disease occurring outside of the hospital. 1 The proportion of cardiovascular deaths caused by SCD has increased over time, as have absolute rates of SCD among women aged 35 to 44 years. 2 The presence and severity of underlying heart disease, including coronary heart disease, chronic heart failure, and depressed left ventricular ejection fraction, are the most predictive risk factors for the future occurrence of SCD. [3][4][5][6] In addition, 1 population-based study among women has demonstrated an association between traditional coronary heart disease risk factors and SCD. 2 Another population at high risk for SCD are persons with end-stage renal disease. 7 According to the US Renal Data System, Ϸ22% of all deaths are caused by SCD, and the incidence increases with age: 2% per year for ages 20 to 44 years, 3.7% per year for ages 45 to 64 years, and 7% per year for ages 65 years and older. 7,8 Despite the high risk for SCD in patients with end-stage renal disease, few studies have evaluated the association between less severe reductions in kidney function and SCD...

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Section: Secondary Predictorsmentioning

confidence: 99%

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

et al. 2008

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“…L eft ventricular (LV) hypertrophy (LVH), whether determined by the ECG [1][2][3][4][5][6][7][8][9] or echocardiogram, 6 -8,10 -18 has been associated with various adverse cardiovascular outcomes, including mortality, myocardial infarction, and heart failure. Although there has been considerable speculation as to why LVH is such an important marker of risk, 19,20 the basic mechanisms that predispose patients with LVH to develop atherosclerotic heart disease (ASHD) are not known.…”

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confidence: 99%

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

et al. 2007

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Abstract-To elucidate mechanisms by which left ventricular (LV) hypertrophy (LVH) increases the risk of atherosclerotic heart disease, we sought to determine whether LVH is independently associated with coronary artery calcium (CAC) and serum C-reactive protein (CRP) levels in the general population. The Dallas Heart Study is a population-based sample in which 2633 individuals underwent cardiac MRI to measure LV structure, electron beam CT to measure CAC, and measurement of plasma CRP. We used univariate and multivariable analyses to determine whether LV mass and markers of concentric LV hypertrophy or dilation were associated with CAC and CRP. Increasing quartiles of LV mass indexed to fat-free mass, LV wall thickness, and concentricity, but not LV volume, were associated with CAC in both men and women (PϽ0.001). After adjustment for traditional cardiovascular risk factors and statin use, LV wall thickness and concentricity remained associated with CAC in linear regression (PϽ0.001 for each). These associations were particularly robust in blacks. LV wall thickness and concentricity were also associated with elevated CRP levels (Pϭ0.001 for both) in gender-stratified univariate analyses, although these associations did not persist in multivariable analysis. In conclusion, concentric LVH is an independent risk factor for subclinical atherosclerosis. LVH is also associated with an inflammatory state as reflected in elevated CRP levels, although this relationship appears to be mediated by comorbid conditions. These data likely explain in part why individuals with LVH are at increased risk for myocardial infarction. , whether determined by the ECG 1-9 or echocardiogram, 6 -8,10 -18 has been associated with various adverse cardiovascular outcomes, including mortality, myocardial infarction, and heart failure. Although there has been considerable speculation as to why LVH is such an important marker of risk, 19,20 the basic mechanisms that predispose patients with LVH to develop atherosclerotic heart disease (ASHD) are not known. Previous hypotheses have included abnormalities in the coronary vasculature 21-25 or platelets, 26 increased blood viscosity, 27 and a prothrombotic state. 28 In addition to these factors, which may contribute to reduced myocardial oxygen supply, myocardial oxygen demand is also increased in patients with LVH. 20 Another simple explanation for the association of LVH and ASHD is that LVH reflects target organ damage from concomitant risk factors, such as hypertension, thus providing a noninvasive barometer of the extent of ASHD. The association of LVH with atherosclerosis in other vascular territories, for example, the carotid artery, 29 supports this hypothesis. There are scant data as to whether LVH is associated with the burden of coronary atherosclerosis as estimated by coronary artery calcium (CAC). 30 -32 Yet another emerging hypothesis is that LVH itself is a low-level inflammatory state, as has been suggested recently from animal 33 and human studies. 34,35 If this is the case, one co...

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“…2,10,15,18,19 Diabetes appears to be a particularly strong risk factor for the development of HF in women. 1,20 The investigation of outcomes in women with HF has been limited by the smaller proportion of women (17%-23%) than men enrolled in clinical trials. 4 Of the two most common causes of death in patients with HF, progressive HF and sudden cardiac death (SCD), men are more likely than women to die from SCD.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…A few observational studies suggested that this subpopulation may actually benefit with HRT, but randomized studies are conflicting. 20,55,56 Several HF-specific benefits of estrogen are noted. For instance, afterload reduction via the vasodilatory properties of estrogen can theoretically improve outcomes in HF.…”

Section: Hf Therapiesmentioning

confidence: 99%

Heart Failure in Women

Shin

Hamad

Murthy

et al. 2012

Clinical Cardiology

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Heart failure (HF) has steadily increased in prevalence and affects both males and females equally. Despite this, there has been a significant underrepresentation of women in large scale HF trials. This disparity has lead to a deficit in understanding important gender-based differences in pathophysiology, diagnosis and treatment strategies. We review these gaps and explore a biological basis for varying outcomes. Endogenous estrogen plays an important role in epidemiology and outcome. The administration of exogenous estrogen has had varied success in treatment and is outlined extensively below. Additionally, we highlight unique HF syndromes through pregnancy and important sex-specific issues concerning transplant and mechanical circulatory support. A central theme remains: there is a clear need for increased female recruitment in clinical trials, and more studies exploring the role of gender-based biology in HF treatment. IntroductionThe prevalence of heart failure (HF) has steadily increased and is now the leading cause of hospital admissions in the adult population in the United States. 1 Women constitute approximately one half of the patients hospitalized for HF, and deaths from HF contribute 35% of the total cardiovascular disease (CVD) mortality in women. 1 -3 Despite this, women have been historically under-represented in clinical HF trials. Although the population estimate of women among patients with HF in the Unites States is about 50%, only 17% to 23% of HF randomized controlled trials enrolled women. 4 This disparity has limited our understanding of gender-related differences in HF. The objective of this article is to review the relationships between sex and the epidemiology, etiology, clinical characteristics, therapeutic management, and outcomes in patients with HF.

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Predictors of Heart Failure Among Women With Coronary Disease

Cited by 152 publications

References 44 publications

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

Heart Failure in Women

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