Sex-gender and atrial fibrillation treatment in the ATA-AF Study

Politi, Cecilia; Ciarambino, Tiziana; Riva, Letizia; Frasson, Stefania; Lucci, Donata; Gussoni, Gualberto; Gonzini, Lucio; Campanini, Mauro; Gulizia, Michele Massimo; Pasquale, Giuseppe Di; Mathieu, Giovanni; Investigators,

doi:10.4081/itjm.2016.649

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Subsequently, revascularization was also less likely in women compared to men (HR = 0.68, 95% CI = 0.66–0.71, p < .0001). This gender gap in optimal medical treatment is also observed in other clinical conditions such as atrial fibrillation 18 . At this point it is very important to underline that ACS guidelines highlight that primary PCI is recommended in STEMI regardless of age and sex 3 .…”

Section: Discussionmentioning

confidence: 99%

Sex‐gender disparities in nonagenarians with acute coronary syndrome

Cepas‐Guillén

Echarte-Morales

Flores‐Umanzor

et al. 2021

Clinical Cardiology

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Background Acute coronary syndrome (ACS) remains one of the leading causes of mortality for women, increasing with age. There is an unmet need regarding this condition in a fast‐growing and predominantly female population, such as nonagenarians. Hypothesis Our aim is to compare sex‐based differences in ACS management and long‐term clinical outcomes between women and men in a cohort of nonagenarians. Methods We included consecutive nonagenarian patients with ACS admitted at four academic centers between 2005 and 2018. The study was approved by the Ethics Committee of each center. Results A total of 680 nonagenarians were included (59% females). Of them, 373 (55%) patients presented with non‐ST‐segment elevation ACS and 307 (45%) with ST‐segment elevation myocardial infarction (STEMI). Men presented a higher disease burden compared to women. Conversely, women were frailer with higher disability and severe cognitive impairment. In the STEMI group, women were less likely than men to undergo percutaneous coronary intervention (PCI) (60% vs. 45%; p = .01). Overall mortality rates were similar in both groups but PCI survival benefit at 1‐year was greater in women compared to their male counterparts (82% vs. 68%; p = .008), persisting after sensitivity analyses using propensity‐score matching (80% vs. 64%; p = .03). Conclusion Sex‐gender disparities have been observed in nonagenarians. Despite receiving less often invasive approaches, women showed better clinical outcomes. Our finding may help increase awareness and reduce the current gender gap in ACS management at any age.

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Section: Discussionmentioning

confidence: 99%

Sex‐gender disparities in nonagenarians with acute coronary syndrome

Cepas‐Guillén

Echarte-Morales

Flores‐Umanzor

et al. 2021

Clinical Cardiology

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“…Female patients with AF are older, with more frequent cognitive and functional impairment, and higher rate of comorbidity than males 37,38 . The risk of stroke is known to increase with increasing age 39 .…”

Section: Noacs In Elderlymentioning

confidence: 99%

Atrial fibrillation: all the elderly go hospitalized? A minireview

Ciarambino

Para

et al. 2020

JGG

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Patients with Atrial fibrillation (AF) are at greater risk for thromboembolic events, hospitalization, heart failure and death 1-3. Clinical risk factors for AF are reported in Table I. The prevalence of AF is high after the age of 65 years and it is 1.5 times more frequent in men than women 4-5. For example, the prevalence rate in males 75-79 aged is doubled compared to males aged 65-69 years and more than 5 times greater than males 55-59 years old 6. However, in the European Union by 2030, about 120.000-215.000 newly diagnosed patients per year are estimated 7 .

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“…At discharge, amiodarone and ACE-I were preferred in male subjects, while ARBs and diuretics were more frequently prescribed in female subjects. 26 Other studies have reported a significant negative association between the CHADS 2 score and left atrial emptying fraction only in women. 27 Many studies reported that despite a similar extent of remodeling, the pattern in women had greater atrial myocardial deformation and smaller RA size.…”

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confidence: 93%

Young FADOI and gender medicine: sex gender differences in cardiovascular disease

Ciarambino

Gino

Gnerre³

et al. 2018

Ital J Med

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IntroductionBernardine Healy, in an editorial of 1991 on the NEJ The Yentl Syndrome, 1,2 showed how cardiovascular disease in women is understudied, under diagnosed and undertreated. The adverse ischemic heart disease is leading cause of death, less common in young women, where myocardial infarction (MI) mortality is two-fold higher in women younger than 50 years compared with age-matched men. The literature suggests that when women look like men, with male-pattern obstructive cardiovascular diseases (CHD), they are more likely to be diagnosed and treated like men. Two new analyses suggest that the Yentl syndrome is alive and well 10 years later. The first event in women takes about 10-20 years later than men. Women are more likely than men to have highrisk presentations and less likely to manifest central chest pain. 1,3 Pain in the upper back, arm, neck, and jaw, as well as unusual fatigue, dyspnea, indigestion, nausea/vomiting, palpitations, weakness, and a sense of dread, occur more frequently in women compared with men. The absence of chest pain or silent heart attack is more common in women than in men (35% vs 28%). So, women often turn later to the doctor and are treated less aggressively.1 Cardiovascular disease is the most common cause of death and hospitalization in worldwide. Recognition of important gender differences plays an important role in cardiovascular disease prevention. New sensitivity about gender differences, and particularly attention among women, will be necessary for more analytic view about cardiovascular disease in both sexes. Possible causesThe Framingham study already described the risk factors for CHD in women; then the INTERHEART, conducted in 52 countries around the world, identified nine risk factors, measurable and modifiable. These factors measurable and modifiable are: i) smoking; ii) hypertension; iii) diabetes; iv) dyslipidemia; v) abdominal obesity (waist/hip ratio); vi) stress and psychosocial factors; vii) physical inactivity; viii) low intake of fruits and vegetables; ix) alcohol. More risk factors greatly multiply the probability of infarction. 4,5 These risk factors explain more than 90% of myocardial infarctions and in about 96% of CHD in women. For example, in women, it has been shown that family and marital stress increase the risk of Young FADOI and gender medicine: sex gender differences in cardiovascular disease ABSTRACTWe have evaluated gender-related differences in cardiovascular disease. In particular, in coronary heart disease, atrial fibrillation, arterial hypertension, venous thromboembolism and diabetes mellitus. ©Copyright T. Ciarambino et al., 2018 Licensee PAGEPress, Italy Italian Journal of Medicine 2018 12:23-31 doi:10.4081/itjm.2018.864 Italian Journal of Medicine 2018; volume 12:23-31 N o n -c o m m e r c i a l u s e o n l y ischemic heart disease. In women there is another condition that simulates the coronary heart disease. This condition is the Takotsubo syndrome. [6][7][8][9][10][11][12][13][14][15][16] Depression is one aspect of psycho...

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Sex-gender and atrial fibrillation treatment in the ATA-AF Study

Cited by 3 publications

References 22 publications

Sex‐gender disparities in nonagenarians with acute coronary syndrome

Sex‐gender disparities in nonagenarians with acute coronary syndrome

Atrial fibrillation: all the elderly go hospitalized? A minireview

Young FADOI and gender medicine: sex gender differences in cardiovascular disease

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