Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study

Araújo, Carla; Laszczyńska, Olga; Viana, Marta; Melão, Filipa; Henriques, Ana; Borges, Andreia; Severo, Milton; Maciel, Maria Júlia; Moreira, Ilídio; Azevedo, Ana

doi:10.1136/bmjopen-2017-018798

Cited by 45 publications

(34 citation statements)

References 40 publications

(42 reference statements)

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“…Women with ACS were more likely to experience higher overall symptoms distress compared to men, but the difference was not statistically significant. Araújo et al 24 found a strong relationship between female sex and pain intensity greater than 8 (range 0-10) among females less than 65 years old. Our results may have differed because our sample include females aged 21-98 years and we asked about overall symptom distress, not simply pain intensity.…”

Section: Discussionmentioning

confidence: 97%

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

Mirzaei¹,

Steffen²,

Vuckovic³

et al. 2019

Journal of Emergency Nursing

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Introduction: More than 5.5 million patients present to emergency departments (EDs) in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in the EDs. Our aim was to describe the quality of symptoms (chest discomfort/pain description, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in the EDs. Methods: The sample consisted of 1,064 patients presenting to the EDs with symptoms that triggered a cardiac workup. Trained research staff obtained data using the ACS Patient Information Questionnaire upon patient presentation to the EDs. Results: The sample (n = 1,064) included 474 (44.55%) patients ruled-in and 590 (55.45%) patients ruled-out for ACS. Symptom distress was significantly higher in patients ruled-in versus

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Section: Discussionmentioning

confidence: 97%

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

Mirzaei¹,

Steffen²,

Vuckovic³

et al. 2019

Journal of Emergency Nursing

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“…Women who present with acute and chronic cardiovascular diseases remain under-studied and, therefore, are likely under-treated (15). The clinical presentation, management, and response to therapies for MI may also be different in women compared to men (16,17). Women with NSTEMI are less likely to be treated with an early invasive strategy than men though, curiously, this did not contribute to increased mortality in women (18).…”

Section: Introductionmentioning

confidence: 99%

A Sex-Specific Switch in Platelet Receptor Signaling Following Myocardial Infarction

Kim

Auerbach

Sadhra

et al. 2019

Preprint

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Word Count: abstract 244 (abstract), 3639 (main) ABSTRACT BACKGROUND: A Sex-specific, personalized approach to anti-platelet therapy may be important in patients with myocardial infarction (MI). OBJECTIVES:Our goal was to determine whether platelets activate differently in healthy men and women compared to following MI. METHODS:Blood was obtained from healthy subjects or patients presenting acutely with STsegment Elevation Myocardial Infarction (STEMI) and non-ST Segment Elevation Myocardial Infarction (NSTEMI). Platelet function through surface receptor activation was examined in healthy subjects, in patients with MI, and in age-and strain-matched mice before and after MI.Multivariate regression analyses revealed clinical variables associated with platelet receptor sensitivity at the time of MI. RESULTS:Platelets from healthy women are dose-dependently more active compared to men, particularly through the platelet thromboxane signaling pathway (7.8-fold increase in women vs.3.0-fold in men, P=0.02). At the time of MI, platelet activation through surface proteaseactivated receptor 1 (PAR1) was less in women than men (3.5-fold vs. 8.5-fold, respectively, P=0.0001). Multivariate regression analyses revealed male sex (P=0.04) and NSTEMI (P=0.003) as independent predictors of enhanced platelet PAR1 signaling at the time of MI. Similar to humans, healthy female mice showed preferential thrombin-mediated platelet activation compared to male mice (8.7-fold vs. 4.8-fold, respectively; P<0.001). In the immediate post-MI environment, male mice showed preferential thrombin-mediated platelet activation compared to female mice (12.4-fold vs. 5.5-fold, respectively; P<0.001).3 CONCLUSIONS: These results outline a previously unrecognized sex-dependent platelet phenotype where inhibition of thrombin signaling in the peri-MI environment-particularly in males-may be an important consideration. CONDENSED ABSTRACTPreclinical studies evaluating anti-platelet drugs are generally conducted in platelets isolated from healthy individuals. Growing evidence suggests changes in platelet signaling properties in certain disease conditions compared to healthy platelets may alter the response to anti-platelet medications. This investigation revealed that platelets from men and women who are healthy and following MI signal differently, particularly through thromboxane and PAR1 receptors. This effect was especially noted in patients with NSTEMI compared to STEMI. These observations raise the possibility of considering a sex-specific anti-platelet regimen for males and females in atheroembolic vascular diseases such as NSTEMI..

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“…Analyses of symptoms were stratified by age, and interaction of symptom by age was tested. Potential covariates were chosen because of reports of gender differences in prior studies 31–33 and because obesity, 17 diabetes, 34 and functional status 35 can confound the symptom experience.…”

Section: Methodsmentioning

confidence: 99%

“… 15 In contrast, women ≥65 years with ACS have been shown to experience fewer symptoms, less chest pain, and more dyspnea than younger women. 16 Many studies of symptoms of ACS focused on sex differences, 17 but few focused on how symptoms may vary between older and younger women. 16 It is important to determine (1) how symptoms experienced by older and younger women vary during an episode of potential ACS, (2) whether differences in symptoms are significant enough to warrant intervention, and (3) what interventions would be appropriate to improve clinical and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women

DeVon

Vuckovic

Burke

et al. 2018

BioResearch Open Access

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The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21–98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management.

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Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study

Cited by 45 publications

References 40 publications

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

A Sex-Specific Switch in Platelet Receptor Signaling Following Myocardial Infarction

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women

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