Role of Sex in Atherosclerosis: Does Sex Matter?

Trivedi, Bhavi; Desai, Rohan; Mishra, Kunal; Hechanova, Lisa Aimee; Abolbashari, Mehran

doi:10.1007/s11886-022-01800-7

Cited by 9 publications

(7 citation statements)

References 91 publications

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“…There are also well-known sex differences in atherosclerotic burden, where women have a known lower prevalence, possibly due to protective effect of oestrogen before menopause. 45 This has also previously been reported in SCAPIS. 46 …”

Section: Discussionsupporting

confidence: 79%

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population

Wuopio

Lin

Orho‐Melander

et al. 2023

European Heart Journal Open

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Aims A high intake of salt raises blood pressure and the risk of cardiovascular disease. Previous studies have reported on the association between salt intake and carotid stenosis, but the association with coronary atherosclerosis has not been reported. Therefore, this project aimed at studying the association between salt intake and both carotid and coronary atherosclerosis in a contemporary community-based cohort. Methods and results Estimated 24-h sodium excretion (est24hNa) was calculated by the Kawasaki formula for participants of two sites (Uppsala and Malmö) of the Swedish Cardiopulmonary bioImage Study, who underwent a coronary computed tomography (n = 9623) and measurement of coronary artery calcium score (CACS, n = 10 289). Carotid ultrasound was used to detect carotid plaques (n = 10 700). Ordered logistic regression was used to calculate odds ratios (OR) per 1000 mg increase in est24hNa. We also investigated potential J-formed associations using quintiles of est24hNa. Increased est24hNa was associated with increased occurrence of carotid plaques [OR: 1.09, P < 0.001, confidence interval (CI): 1.06–1.12], higher CACS (OR: 1.16, P < 0.001, CI: 1.12–1.19), and coronary artery stenosis (OR: 1.17, P < 0.001, CI: 1.13–1.20) in minimal adjusted models. Associations were abolished when adjusting for blood pressure. When adjusting for established cardiovascular risk factors (not including blood pressure), associations remained for carotid plaques but not for coronary atherosclerosis. There was no evidence of J-formed associations. Conclusion Higher est24hNa was associated with both coronary and carotid atherosclerosis in minimal adjusted models. The association seemed mainly mediated by blood pressure but to some degree also influenced by other established cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 79%

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population

Wuopio

Lin

Orho‐Melander

et al. 2023

European Heart Journal Open

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“…A total of 2.1% (n = 7/336) of patients with right-sided endocarditis had pulmonary MA, with none developing extrathoracic aneurysms (data not shown); this corresponds to the logical spread of embolisms to right-side circulation. On the other hand, the higher burden of atherosclerotic peripheral arteriopathy in male patients could explain the higher proportion of extracranial MA in this subgroup [ 29 , 30 ]. Finally, Candida spp.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort

Calderón-Parra,

Domínguez,

González-Rico

et al. 2024

Open Forum Infectious Diseases

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Background Several aspects of the occurrence and management of mycotic aneurism (MA) in patients with infective endocarditis (IE) have not been studied. Objectives To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results Out of 4,548 IE cases, 85 (1.9%) developed MA. 46 (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (HR 2.33, 95% CI 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (IQR 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, p = 0.004). Of patients with initially unruptured MA, there was a trend to better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, p = 0.170), higher rate of aneurism resolution in control imaging (66.7% vs 31.3%, p = 0.087), lower MA-related mortality (7.1% vs 16.7%, p = 0.232), and lower MA-related sequalae (0% vs 27.8%, p = 0.045). Conclusions MA occurred in 2% of the patients with IE. Half of the MA present intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurisms suffer from rupture during the first days, being more common in intracranial aneurisms. Early specific treatment could potentially lead to better outcomes.

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“…Cardioprotective effects of estradiol and progesterone have been studied in general populations; however, little is known about how sex hormones influence cardiovascular physiology among individuals with PTSD. Studies in general populations show that circulating estradiol and progesterone play a role in lowering BP via vasodilation, upregulation of low density lipoprotein (LDL) receptors to help lower cholesterol, promotion of endothelial repair after vascular injury, and the slowing of cardiac hypertrophy (Niță et al, 2021 ; Palmisano et al, 2017 ; Regitz-Zagrosek & Kararigas, 2017 ; Trivedi et al, 2022 ; Xue et al, 2014 ). Randomised controlled clinical trials have shown that starting hormone replacement therapy with synthetic estradiol and progestin in early post-menopausal women led to significantly decreased risk of myocardial infarction and heart failure at 10 years follow-up, as well as slowed progression of atherosclerosis (Hodis et al, 2016 ; Schierbeck et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms

Chen,

Jain,

Merker

et al. 2024

European Journal of Psychotraumatology

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Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones – estradiol and progesterone – have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood. Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women. Method: Sixty-six trauma-exposed women ( M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP. Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity. Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.

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Role of Sex in Atherosclerosis: Does Sex Matter?

Cited by 9 publications

References 91 publications

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population

Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort

The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms

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