Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome

Pelletier, Roxanne; Choi, Jin; Winters, Nicholas; Eisenberg, Mark J.; Bacon, Simon; Cox, Jafna L.; Daskalopoulou, Stella S.; Lavoie, Kim; Karp, Igor; Shimony, Avi; So, Derek; Thanassoulis, George; Pilote, Louise

doi:10.1016/j.cjca.2016.05.018

Cited by 43 publications

(45 citation statements)

References 27 publications

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“…In summary, most studies suggest that young women have persistently higher rates of mortality and re-hospitalization from AMI. 31 …”

Section: Epidemiologymentioning

confidence: 99%

“…between 1–3% for mortality; 8–9% for MACE) may be a limitation of recruitment inherent to observational registries with in-depth survey follow-up. 31, 48 Work by Pelletier et al suggested that ‘feminine’ personality traits that are traditionally attributed to women (e.g. being shy and/or sensitive to needs of others), as well as social roles (e.g.…”

Section: Long-term Health Outcomesmentioning

confidence: 99%

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Young Women With Acute Myocardial Infarction

Dreyer¹,

Sciria

Spatz

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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In recent years there is growing public awareness and increasing attention to young women with acute myocardial infarction (AMI), who represent an extreme phenotype. Young women presenting with AMI may develop coronary disease by different mechanisms and often have worse recoveries, with higher risk for morbidity and mortality compared with similarly aged men. The purpose of this cardiovascular perspective piece is to review recent studies of AMI in young women. More specifically, we emphasize differences in the epidemiology, diagnosis and management of AMI in young women (as compared with men) across the continuum of care, including their the pre-AMI, in-hospital and post-AMI periods, and highlight gaps in knowledge and outcomes that can inform the next generation of research.

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“…In summary, most studies suggest that young women have persistently higher rates of mortality and re-hospitalization from AMI. 31 …”

Section: Epidemiologymentioning

confidence: 99%

Section: Long-term Health Outcomesmentioning

confidence: 99%

Young Women With Acute Myocardial Infarction

Dreyer¹,

Sciria

Spatz

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…1,2 However, the mechanisms of these relationships are still a source of much debate. One of the strongest potential pathways linking acute psychological stress with worse outcomes is through mental stress-induced myocardial ischemia (MSIMI).…”

mentioning

confidence: 99%

The Importance of Sex in the Stress–Heart Disease Relationship and the Potential Contribution of Gender to Future Research

Bacon

2018

ATVB

Self Cite

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We now have numerous studies that have linked increased levels of negative emotions and stress with the development and progression of cardiovascular disease-a relationship that seems to be sex specific in its pattern of outcomes. 1,2 However, the mechanisms of these relationships are still a source of much debate. One of the strongest potential pathways linking acute psychological stress with worse outcomes is through mental stress-induced myocardial ischemia (MSIMI).3 Though there is a large overlap (ca. 70%) in individuals who demonstrate both MSIMI and more common (ie, exercise or pharmacological) stress-induced ischemia, 4 these seem to be distinctly different entities. Firstly, it would seem that more individuals are likely to have MSIMI only than exercise/pharmacological stress-induced ischemia only (20% versus 10%).5 Furthermore, the profiles and potential mechanistic factors of those at risk for MSIMI compared with exercise/pharmacological stress-induced ischemia are different. For example, those individuals who exhibit MSIMI are more likely to be women, have greater microvascular disease, have poorer left ventricular dysfunction, and display endothelial dysfunction, whereas exercise/pharmacological stress-induced ischemia is generally associated with men and those with larger and more diffuse coronary artery plaque. [4][5][6] Though there are sex differences in the rates of presentations of both MSIMI and exercise/pharmacological stress-induced ischemia, both men and women do exhibit both of these forms of ischemia. However, we do not know if the mechanistic factors that underlie these stress-induced ischemia differ by sex; for example, does MSIMI in women differ from MSIMI in men? Understanding these processes can ultimately help in the development of better tailored diagnostic procedures and interventions to treat cardiovascular disease. See accompanying article on page 473The article by Sullivan et al 7 provides some important initial insights into sex differences in the potential mechanisms driving MSIMI. This secondary analysis of 678 (25% women) patients in the MIPS study (Mental Stress Ischemia Mechanisms and Prognosis) evaluated mental stress (public speaking)-induced vascular and hemodynamic responses. The authors found that MSIMI was generally driven by peripheral vasoconstriction in women compared with increased hemodynamic workload in men, results that were independent of exercise/pharmacological stress-induced ischemia. These results suggest that men with MSIMI are effectively cardiac stress reactors, with increased myocardial oxygen demands, and women with MSIMI are more likely to be vascular reactors, with greater endothelial driven increases in vascular resistance (which leads to increased left ventricular afterload and dysfunction).8 However, the article by Sullivan et al does only provide initial insights, and there is a great deal of further information that we need. For example, building a more complex map of MSIMI, to include additional measures of the autonomic nervous system, the...

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“…(2) socioeconomic status and gender-related factors: marital status, education level, income, physical activity (self-administered questionnaire), independent functional status Duke Activity Status Index [70], alcohol intake, smoking habits, perceived stress at work and at home, personality traits, and psychosocial characteristics and support [12,71]; 3…”

Section: Study Design and Populationmentioning

confidence: 99%

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

Raparelli

Proietti

Lenzi

et al. 2018

J. of Cardiovasc. Trans. Res.

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Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study (Clinicaltrial.gov NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sexand gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes. The integration of sex and gender in this translational project on IHD will contribute to the identification of new targets for further innovative clinical interventions. Keywords Sex. Gender. Coronary microvascular dysfunction. Sex steroid hormones. Platelet function. Clinical outcomes. Myocardial blush grade Abbreviations 1VD One-vessel disease 2VD Two-vessel disease 3VD Three-vessel disease ACS Acute coronary syndrome AR Androgen receptors CAD Coronary artery disease CMD Coronary microvascular dysfunction CMR Cardiac magnetic resonance CVD Cardiovascular disease E2 Estradiol eCRFs Electronic case report forms ER Estrogen receptor GP Glycoprotein IHD Ischemic heart disease INOCA Ischemia and no obstructive CAD MACE Major adverse cardiovascular events MBG Myocardial blush grade MMAS-4 Morisky Medication Adherence Scale-4 Items NOS Nitric oxide synthase NOX2 NADPH oxidase 2 NSTEMI Non-ST elevation myocardial infarction PCI Percutaneous coronary intervention STEMI ST elevation myocardial infarction (c)TFC (corrected) TIMI frame count Associate Editor Enrique Lara-Pezzi oversaw the review of this article

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Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome

Cited by 43 publications

References 27 publications

Young Women With Acute Myocardial Infarction

Young Women With Acute Myocardial Infarction

The Importance of Sex in the Stress–Heart Disease Relationship and the Potential Contribution of Gender to Future Research

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

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