Women-Specific Factors to Consider in Risk, Diagnosis and Treatment of Cardiovascular Disease

Harvey, Ronée E.; Coffman, Kirsten E.; Miller, Virginia M.

doi:10.2217/whe.14.64

Cited by 106 publications

(97 citation statements)

References 191 publications

(252 reference statements)

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“…These studies show that the age-adjusted prevalence of AF is higher in men than women (596 per 100 000 in men and 373 per 100 000 in women),5 but with greater longevity, women make up the greater proportion (60%) of those with AF who are over the age of 75 years 58 9 The prognosis for women with AF markedly differs from men 10. Female gender independently increases the risk of stroke,11–16 and women with AF have a higher mortality rate, even after adjustment for baseline comorbid conditions and treatment with anticoagulants (ACs) 17…”

Section: Introductionmentioning

confidence: 94%

Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry

Camm

Accetta

Mahmeed³

et al. 2017

BMJ Open

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ObjectivesGlobal Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) explored the impact of gender, risk factors and anticoagulant (AC) treatment on 1-year outcomes in patients with non-valvular atrial fibrillation (NVAF).DesignGARFIELD-AF is a prospective non-interventional registry.SettingInvestigator sites (n=1048) are representative of the care settings/locations in each of the 35 countries.ParticipantsPatients ≥18yrs with newly diagnosed (≤6 weeks' duration) NVAF and ≥1 investigator-determined stroke risk factors.Main outcome measuresEvent rates per 100 person-years were estimated from the Poisson model and HRs and 95% CIs calculated.ResultsOf 28 624 patients (women 44.4%; men 55.6%) enrolled, there were more elderly (≥75 years) women (46.9%) than men (30.4%). All-cause mortality rates per 100 person-years (95% CI) for women and men were 4.48 (4.12 to 4.87) and 4.04 (3.74 to 4.38), respectively, stroke/systemic embolism (SE) (1.62 (1.41 to 1.87) and 1.17 (1.01 to 1.36)) and major bleeding (0.93 (0.78 to 1.13) and 0.79 (0.66 to 0.95)). After adjustment for baseline risk factors in treated and untreated patients, HRs (95% CI) for women (relative to men) for stroke/SE rates were 1.3-fold higher in women (HR 1.30 (1.04 to 1.63)), and similar for major bleeding (1.13 (0.85 to 1.50)) and all-cause mortality (1.05 (0.92 to 1.19)). Antithrombotic treatment patterns in men and women were almost identical. 63.8% women and 62.9% men received AC± antiplatelets. Relative to no AC treatment, the reduction in stroke/SE rates with AC treatment was greater (p=0.01) in men (HR 0.45 (0.33 to 0.61)) than women 0.77 (0.57 to 1.03). All-cause mortality reduction with AC treatment was similar (women: 0.65 (0.54 to 0.77); men: 0.57 (0.48 to 0.68)). The risk of major bleeding when treated with AC versus no AC was 2.33 (1.41 to 3.84) in men and 1.86 (1.16 to 2.99) in women (p value=0.53).ConclusionsWomen have a higher risk of stroke/SE and the reduction in stroke/SE events rates with AC treatment is less in women than in men.Trial registration numberNCT01090362.

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Section: Introductionmentioning

confidence: 94%

Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry

Camm

Accetta

Mahmeed³

et al. 2017

BMJ Open

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“…[17] Also in menopause the so-called “female advantage” is reversed due to rapid decrease in female steroid hormones, and thus, sex-associated differences must be considered in hypertension management of women. [1819] So identification of cardiovascular risk factors and its more sensitive anthropometric indicator even in apparently healthy female population is crucial for prevention and control of cardiovascular causalities in the long run. In this respect the present study is significant.…”

Section: Introductionmentioning

confidence: 99%

BMI is a better indicator of cardiac risk factors, as against elevated blood pressure in apparently healthy female adolescents and young adult students: Results from a cross-sectional study in Tripura

Debnath¹

2016

Indian J Community Med

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Background:Anthropometric measures are used as indicators of elevated blood pressure, but reported to have variable sensitivity among populations. This study was undertaken to identify the better indicator of Cardiac-risk factors by statistical comparison of BMI, Waist circumference, and Waist to Height (WtHr) ratio in apparently healthy adolescents and young adult female students of Tripura.Materials and Methods:A cross-sectional study was conducted in a resource limited setup on 210 apparently healthy female adolescents and young adult students in Tripura. Mean (±SD) of all parameters were compared (ANOVA) to recognize significant independent (anthropometric measures) and dependent factors (blood pressure indices and so on). Correlation (r) analysis was used to identify the better (p) indicator of blood pressure indices (dependent variable) and its impact was assessed by Multiple Regression analysis.Results:blood pressure indices are comparatively higher in obese and overweight participants with statistically significant (95.5% confidence) mean differences. Significant correlation with dependent factors is observed with BMI followed by WtHr and Waist Circumference. Impact of anthropometric measures with blood pressure Indices is most significant for BMI (P ≤ 0.020) followed by WtHr (P ≤ 0.500) and waist circumference (P ≤ 0.520).Conclusion:BMI is a superior indicator of blood pressure indices and can identify participants at risk even in apparently healthy adolescent and young adult females.

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“…While the relationships between sex and risk of developing CVD, response to therapies, and prognosis have been examined 4–8 , the directionality and the clinical significance of sex differences remains elusive. Women have been shown to have a lower incidence of CVD and later age of onset, 13 and female sex also seems protective for cardiovascular outcomes among patients at high risk for developing CVD.…”

Section: Discussionmentioning

confidence: 99%

“…1–3 Sex-specific analyses are especially important in the context of CVD with recognized sexual dimorphism in risk, prognosis, and potential for treatment benefit and harm. 4–8 While the majority of CVD prevention guidelines are similar for men and women, there is growing appreciation that there may be sex differences in the magnitude of relative and absolute benefits and harms of preventive interventions. 9 For instance, while aspirin is associated with a reduction in the risk of CVD events in both men and women, the specific types of benefit appear to differ by sex, with some evidence that aspirin therapy lowers myocardial infarction risk in men (but not women), and ischemic stroke risk in women (but not men).…”

mentioning

confidence: 99%

Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease

Paulus

Wessler

Lundquist

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Several widely-used risk scores for cardiovascular disease (CVD) incorporate sex effects, yet there has been no systematic summary of the role of sex in clinical prediction models (CPMs). To better understand the potential of these models to support sex-specific care, we conducted a field synopsis of sex effects in CPMs for CVD. Methods and Results We identified CPMs in the Tufts Predictive Analytics and Comparative Effectiveness (PACE) CPM Registry, a comprehensive database of CVD CPMs published from 1/1990–5/2012. We report the proportion of models including sex effects on CVD incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 592 CVD-related CPMs, 193 (33%) included sex as a predictor or presented sex-stratified models. Sex effects were included in 78% (53/68) of models predicting incidence of CVD in a general population, versus only 35% (59/171), 21% (12/58) and 17% (12/72) of models predicting outcomes in patients with coronary artery disease (CAD), stroke, and heart failure, respectively. Among sex-including CPMs, women with heart failure were at lower mortality risk in 8/8 models; women undergoing revascularization for CAD were at higher mortality risk in 10/12 models. Factors associated with the inclusion of sex effects included the number of outcome events and using cohorts at-risk for CVD (rather than with established CVD). Conclusions While CPMs hold promise for supporting sex-specific decision making in CVD clinical care, sex effects are included in only one third of published CPMs.

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Women-Specific Factors to Consider in Risk, Diagnosis and Treatment of Cardiovascular Disease

Cited by 106 publications

References 191 publications

Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry

Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry

BMI is a better indicator of cardiac risk factors, as against elevated blood pressure in apparently healthy female adolescents and young adult students: Results from a cross-sectional study in Tripura

Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease

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