Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design

Raparelli, Valeria; Proietti, Marco; Lenzi, Andrea; Basili, Stefania

doi:10.1007/s12265-018-9846-5

Cited by 14 publications

(11 citation statements)

References 81 publications

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“…Data for the present analysis comes from the "Endocrine Vascular Disease Approach" (EVA) project (ClinicalTrials.gov identifier NCT02737982), an ongoing observational, prospective study, aimed at exploring sex and gender-related differences in the interaction between platelet function, sex hormone balance, and coronary microvascular dysfunction in IHD. The EVA study design has been previously published [22]. Briefly, EVA is an observational registry of men and women (≥18 years) that were referred to the cardiac catheterization laboratory (cath-lab) to undergo coronary angiography or percutaneous coronary intervention for suspected IHD.…”

Section: Methodsmentioning

confidence: 99%

Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease

et al. 2020

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Background: The reasons behind low adherence to the Mediterranean diet (Med-diet) are still not entirely known. We aimed to evaluate the effect of biological (i.e., sex-related) and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence. Methods: Baseline Med-diet adherence was measured using a self-administered questionnaire among adults with ischemic heart disease (IHD) from the EVA (Endocrine Vascular Disease Approach) study. A multivariable analysis was performed to estimate the effect of sex- and gender-related factors (i.e., identity, roles, relations, and institutionalized gender) on low adherence. Results: Among 366 participants (66 ± 11 years, 31% women), 81 (22%) adults with low adherence demonstrated higher rates of diabetes, no smoking habit, lower male BSRI (Bem Sex Role Inventory) (median (IQR) 4.8 (4.1 to 5.5) vs. 5.1 (4.5 to 5.6) and p = 0.048), and higher Perceived Stress Scale 10 items (PSS-10) (median (IQR) 19 (11 to 23) vs. 15 (11 to 20) and p = 0.07) scores than those with medium-high adherence. In the multivariable analysis, only active smoking (odds ratio, OR = 2.10, 95% confidence interval, CI 1.14 to 3.85 and p = 0.017), PPS-10 (OR = 1.04, 95% CI 1.00 to 1.08, and p = 0.038) and male BSRI scores (OR = 0.70, 95% CI 0.52 to 0.95, and p = 0.021) were independently associated with low adherence. Conclusions: Male personality traits and perceived stress (i.e., gender identity) were associated with low Med-diet adherence regardless of the sex, age, and comorbidities. Therefore, gender-sensitive interventions should be explored to improve adherence in IHD.

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Section: Methodsmentioning

confidence: 99%

Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease

et al. 2020

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“…Data for the present analysis come from the “Endocrine Vascular disease Approach” (EVA) project (ClinicalTrials.gov Identifier: NCT02737982), an ongoing prospective observational study aiming to explore sex and gender differences in the interaction of platelet function, sex hormone balance, and coronary microvascular dysfunction in IHD (25). In brief, EVA is a registry of men and women, aged 18 and older, who were referred to the cardiac catheterization laboratory to undergo coronary angiography and/or percutaneous coronary intervention for suspected IHD, Patients with active cancer (i.e., currently treated with chemotherapy or at ≤5 years from diagnosis), current pregnancy, previous coronary artery bypass graft, documented moderate-severe valvular heart disease, and prosthetic valve carriers were excluded.…”

Section: Methodsmentioning

confidence: 99%

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

et al. 2019

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Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated. Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD. Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence. Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99). Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner.

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“…The "Endocrine Vascular disease Approach" (EVA) project (ClinicalTrials.gov identifier NCT02737982), is an observational, prospective study, aimed at exploring sex-and gender-related differences in the interaction between platelet function, sex hormones, and coronary microvascular dysfunction in IHD. The EVA Study design has been previously published [14]. Briefly, EVA enrolled consecutively Italian adults (> 18 years), who were referred to the cardiac catheterization laboratory (cath-lab) undergoing coronary angiography and/or percutaneous coronary intervention for suspected IHD.…”

Section: Study Populationmentioning

confidence: 99%

Testosterone-to-estradiol ratio and platelet thromboxane release in ischemic heart disease: the EVA project

Raparelli

Nocella

Proietti

et al. 2022

J Endocrinol Invest

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Background Data on the interplay between sexual hormones balance, platelet function and clinical outcomes of adults with ischemic heart disease (IHD) are still lacking. Objective To assess the association between the Testosterone (T)-to-Estradiol (E2) Ratio (T/E2) and platelet activation biomarkers in IHD and its predictive value on adverse outcomes. Methods The EVA study is a prospective observational study of consecutive hospitalized adults with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Serum T/E2 ratios E2, levels of thromboxane B2 (TxB2) and nitrates (NO), were measured at admission and major adverse events, including all-cause mortality, were collected during a long-term follow-up. Results Among 509 adults with IHD (mean age 67 ± 11 years, 30% females), males were older with a more adverse cluster of cardiovascular risk factors than females. Acute coronary syndrome and non-obstructive coronary artery disease were more prevalent in females versus males. The lower sex-specific T/E2 ratios identified adults with the highest level of serum TxB2 and the lowest NO levels. During a median follow-up of 23.7 months, the lower sex-specific T/E2 was associated with higher all-cause mortality (HR 3.49; 95% CI 1.24–9.80; p = 0.018). In in vitro, platelets incubated with T/E2 ratios comparable to those measured in vivo in the lowest quartile showed increased platelet activation as indicated by higher levels of aggregation and TxB2 production. Conclusion Among adults with IHD, higher T/E2 ratio was associated with a lower long-term risk of fatal events. The effect of sex hormones on the platelet thromboxane release may partially explain such finding.

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Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design

Cited by 14 publications

References 81 publications

Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease

Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Testosterone-to-estradiol ratio and platelet thromboxane release in ischemic heart disease: the EVA project

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