Pulmonary Arterial Hypertension in Women

Memon, Humna Abid; Park, Myung H.

doi:10.14797/mdcj-13-4-224

Cited by 18 publications

(4 citation statements)

References 84 publications

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“…Se incluyeron 528 (100,0%) pacientes, con una mediana de edad de 67 años (RIQ: 19 y 98), en el 58,71% (310) fueron mujeres. Solo en el 6,6% (35) informaron que viven a más de 3,500 m. En el 29,2% (154) se encontró hipertensión pulmonar (HP) idiopática, encontrándose HP leve en 117 (76,0%) casos, HP moderada en 22 (14,3%) casos y la HP severa en 15 (9,7%) casos. En el 20,5% (108) se encontró DDVI, de los cuales en el 81 (75,0%) casos estuvo asociado a HP.…”

Section: Resultsunclassified

Asociación entre disfunción diastólica del ventrículo izquierdo e hipertensión pulmonar en pobladores de zona rural andina

Díaz-Lazo

Carbajal

Montalvo

2022

Rev. Cuerpo Med. HNAAA

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Objetivos: Determinar la asociación entre la disfunción diastólica del ventrículo izquierdo (DDVI) y la hipertensión pulmonar (HP) en pacientes andinos de zona rural que viven a gran altitud. Material y métodos: Estudio observacional, transversal analítico. Se definió y evalúo la HP y la DDVI de acuerdo con las guías de la Sociedad Americana de Ecocardiografía. Para evaluar la asociación se empleó el modelo lineal generalizado de Poisson con estimación robusta. Se consideró significativo un valor de p < 0,05. Resultados: Se incluyeron 528 (100%) personas con informes ecocardiográficos, con mediana de edad de 67 años (rango intercuartílico: 19 y 98), 58,71% (310) fueron mujeres. Se encontró DDVI en 20,5% (108) de los casos. La frecuencia de HP fue de 29,5% (154), correspondiendo a grado leve, moderado y severo en 76,0%; 14,3% y 9,7% respectivamente. El análisis de regresión simple reportó que las personas con DDVI, obesidad e índice E/e’ > a 14 tenían mayor frecuencia de HP en comparación a quienes no presentaban DDVI. En la regresión múltiple se encontró asociación entre la DDVI (RPa= 0.17; 95% CI: 0.11-0.24; p = 0.000) y el índice E/e’ > a 14 (RPa= 1,93; 95% CI: 1,27-2,91; p = 0.002) en personas con HP. Conclusiones: La DDVI y el índice E/e’ se asoció con elevada frecuencia a HP en pobladores andinos de zona rural, ello sugiere que la presencia de alteraciones en la relajación y distensibilidad del ventrículo izquierdo está asociado a HP.

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Section: Resultsunclassified

Asociación entre disfunción diastólica del ventrículo izquierdo e hipertensión pulmonar en pobladores de zona rural andina

Díaz-Lazo

Carbajal

Montalvo

2022

Rev. Cuerpo Med. HNAAA

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“…Population features such as sociodemographic and general health factors can influence the probability of an individual receiving treatment and/or diagnosis, which can either obscure significant differences between populations or create erroneous differences. Moreover, it is known that patients with PAH are generally older and more likely to be female than patients without PAH 22 . Thus, propensity score matching was used to control for disparity between PAH and non‐PAH cohorts.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, it is known that patients with PAH are generally older and more likely to be female than patients without PAH. 22 Thus, propensity score matching was used to control for disparity between PAH and non‐PAH cohorts. Propensity score matching was conducted using the features of age, sex, race/ethnicity, insurance type, geographic region, income, education level, and year of first early PAH symptom.…”

Section: Methodsmentioning

confidence: 99%

A claims‐based, machine‐learning algorithm to identify patients with pulmonary arterial hypertension

et al. 2023

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Many patients with pulmonary arterial hypertension (PAH) experience substantial delays in diagnosis, which is associated with worse outcomes and higher costs. Tools for diagnosing PAH sooner may lead to earlier treatment, which may delay disease progression and adverse outcomes including hospitalization and death. We developed a machine‐learning (ML) algorithm to identify patients at risk for PAH earlier in their symptom journey and distinguish them from patients with similar early symptoms not at risk for developing PAH. Our supervised ML model analyzed retrospective, de‐identified data from the US‐based Optum® Clinformatics® Data Mart claims database (January 2015 to December 2019). Propensity score matched PAH and non‐PAH (control) cohorts were established based on observed differences. Random forest models were used to classify patients as PAH or non‐PAH at diagnosis and at 6 months prediagnosis. The PAH and non‐PAH cohorts included 1339 and 4222 patients, respectively. At 6 months prediagnosis, the model performed well in distinguishing PAH and non‐PAH patients, with area under the curve of the receiver operating characteristic of 0.84, recall (sensitivity) of 0.73, and precision of 0.50. Key features distinguishing PAH from non‐PAH cohorts were a longer time between first symptom and the prediagnosis model date (i.e., 6 months before diagnosis); more diagnostic and prescription claims, circulatory claims, and imaging procedures, leading to higher overall healthcare resource utilization; and more hospitalizations. Our model distinguishes between patients with and without PAH at 6 months before diagnosis and illustrates the feasibility of using routine claims data to identify patients at a population level who might benefit from PAH‐specific screening and/or earlier specialist referral.

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“…IR was demonstrated to be significantly more prevalent in PAH female patients than in the general population, and this might affect morbidity in those PH patients. Moreover, PH seems to occur more often in postmenopausal and obese females ( 22 ).…”

Section: Correlation Of Ir With Pahmentioning

confidence: 99%

Pulmonary hypertension and insulin resistance: a mechanistic overview

Zanotto,

Gonçalves,

Saad

2024

Front. Endocrinol.

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Pulmonary arterial hypertension (PAH) is a vascular remodeling disease, characterized by increased blood pressure levels in pulmonary circulation, leading to a restriction in the circulation flow and heart failure. Although the emergence of new PAH therapies has increased survival rates, this disease still has a high mortality and patients that receive diagnosis die within a few years. The pathogenesis of PAH involves multiple pathways, with a complex interaction of local and distant cytokines, hormones, growth factors, and transcription factors, leading to an inflammation that changes the vascular anatomy in PAH patients. These abnormalities involve more than just the lungs, but also other organs, and between these affected organs there are different metabolic dysfunctions implied. Recently, several publications demonstrated in PAH patients a disturbance in glucose metabolism, demonstrated by higher levels of glucose, insulin, and lipids in those patients. It is possible that a common molecular mechanism can have a significant role in this connection. In this regard, this narrative review intends to focus on the recent papers that mainly discuss the molecular determinants between insulin resistance (IR) associated PAH, which included obesity subclinical inflammation induced IR, PPAR gamma and Adiponectin, BMPR2, mitochondrial dysfunction and endoplasmic reticulum stress. Therefore, the following review will summarize some of the existing data for IR associated PAH, focusing on the better understanding of PAH molecular mechanisms, for the development of new translational therapies.

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Pulmonary Arterial Hypertension in Women

Cited by 18 publications

References 84 publications

Asociación entre disfunción diastólica del ventrículo izquierdo e hipertensión pulmonar en pobladores de zona rural andina

Asociación entre disfunción diastólica del ventrículo izquierdo e hipertensión pulmonar en pobladores de zona rural andina

A claims‐based, machine‐learning algorithm to identify patients with pulmonary arterial hypertension

Pulmonary hypertension and insulin resistance: a mechanistic overview

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