Traditional Cardiovascular Risk Factors and the Presence of Obstructive Coronary Artery Disease in Men and Women

Ko, Dennis T.; Wijeysundera, Harindra C.; Udell, Jacob A.; Vaccarino, Viola; Austin, Peter C.; Guo, Helen; Velianou, James L.; Lau, Kelly; Tu, Jack V.

doi:10.1016/j.cjca.2014.04.032

Cited by 21 publications

(13 citation statements)

References 23 publications

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“…Repeat revascularizations may be related to younger women with premature atherosclerosis having an aggressive form of CAD. Consistent with prior data revealing a clustering of cardiovascular risk factors in women with premature CAD [17], young women in the Dynamic Registry had a higher prevalence of multiple cardiovascular comorbidities including hypertension, diabetes, cerebrovascular disease, obesity, and smoking. Previous data showed that young and middle aged women (<60 years) were less likely to develop coronary artery disease compared to men; however, the risk is equalized in the setting of diabetes mellitus [18].…”

Section: Discussionsupporting

confidence: 85%

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Epps

Holper

Selzer

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Women <50 years of age with coronary artery disease (CAD) may represent a group at higher risk for recurrent ischemic events following percutaneous coronary intervention (PCI); however, no long-term, multi-center outcomes assessment exists in this population. Methods and Results Using the NHLBI Dynamic Registry we evaluated the association of sex and age on cardiovascular-related outcomes in10,963 patients (3,797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and repeat PCI were primary outcomes comprising major adverse cardiovascular events (MACE). While procedural success rates were similar by sex, the cumulative rate of MACE at 1 year was higher in young women (27.8 vs. 19.9%, p=0.003) driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (CABG: 8.9% vs. 3.9%, p<0.001, adjusted hazard ratio [aHR] 2.4, 95% CI 1.5-4.0; PCI: 19.0% vs. 13.0%, p=0.005, aHR 1.6, 95% CI 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (CABG: 10.7% vs. 6.8%, p=0.04, aHR 1.71, 95% CI 1.01-2.88; repeat PCI [target vessel]: 19.7% vs. 11.8%, p=0.002, aHR 1.8, 95% CI 1.24-2.82). Compared to older women, younger women remained at increased risk of MACE, while all outcome rates were similar in older women and men. Conclusions Young women, despite having less severe angiographic CAD have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.

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Section: Discussionsupporting

confidence: 85%

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Epps

Holper

Selzer

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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“…Moreover, Pilz et al found that women had higher serum FFA levels than men although there were fewer women participants [22], implying that women may be at greater risk of SCD. Besides, female patients with type 2 diabetes had greater cardiac risk than males [40]. In contrast, the rate of SCD is higher among males compared to females in HCM [4].…”

Section: Discussionmentioning

confidence: 99%

Sex-related differences in the associations between plasma free fatty acid levels and clinical features in patients with hypertrophic cardiomyopathy

et al. 2016

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BackgroundPrevious studies have indicated that inefficient energy utilization may play a pivotal role in hypertrophic cardiomyopathy (HCM). However, whether plasma free fatty acid (FFA), a main energy substrate of heart, has an effect on HCM remains unclear. Besides, several studies have suggested sex-related differences in HCM features and FFA metabolism. Here, we aimed to explore the association between plasma FFA levels and HCM and potential effects of sex on this relation.MethodsA total of 412 patients (age 47.8 ± 12.7 years, 243 males (59.0%)) with HCM were recruited. Complete medical history was collected. Echocardiography and cardiovascular magnetic resonance imaging (CMRI) were performed. Fasting plasma FFA was determined by clinical laboratory. Left ventricular mass (LVM), maximum wall thickness (MWT), and left atrium diameter (LAD) were assessed with CMRI.ResultsThe median FFA levels were 0.38 (interquartile range (IQR) 0.27–0.52) mmol/L in men and 0.40 (IQR 0.30–0.59) mmol/L in women. The FFA levels were significantly lower in men compared with those in women (p = 0.005). Compared with women, men had greater LVM index (LVMI) (96.8 ± 37.6 vs. 78.6 ± 31.5 g/m2, p < 0.001). FFA levels in male patients correlated positively with LVM, LVMI, LAD, cholesterol levels, high-density lipoprotein-cholesterol (HDL-C) levels, heart rate, and systolic blood pressure (SBP). However, none of these variables were significantly associated with sqrt (FFA) in female patients except a borderline correlation of LAD (p = 0.050). Multiple linear regression analysis was performed in male patients and revealed that HDL-C (β = 0.191, p = 0.002), heart rate (β = 0.182, p = 0.004), SBP (β = 0.167, p = 0.007), LVMI (β = 0.132, p = 0.032), and LAD (β = 0.165, p = 0.009) were independently associated with increasing FFA levels.ConclusionsIn patients with HCM, LVMI, LAD, HDL-C, SBP, and heart rate were independently associated with increasing plasma FFA levels in males, whereas not in females. These results suggest that sex may affect the pathogenesis of HCM through influencing FFA metabolism. And these sex-related differences should be taken into account in therapeutic approaches to influence myocardial FFA metabolism in HCM.

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“…homocysteine) [9]. Similarly, a recently published observational study was conducted in a population-based cohort of stable patients who underwent cardiac catheterization to examine the relationship between traditional risk factors and the presence of coronary artery disease [4]. Of 46, 490 patients included in the study, 3% of those with disease had no traditional cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…While some individuals may not be knowledgeable about risk factors or solely underreport them, it is possible that screening may detect disease in the absence of risk factors entirely. A recent study found that 3% of the population examined presented with coronary artery disease in the presence of no traditional cardiovascular risk factors [4]. A similar study reported even higher numbers, with 11.7% of study participants with coronary artery disease presenting with no risk factors [5].…”

Section: Introductionmentioning

confidence: 99%

Community-Based Cardiovascular Screening: Detection of Disease in Individuals with No Self-Reported Risk Factors

Weisman¹,

Garbani²,

Manganaro³

2015

OJPM

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Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the presence of those risk factors in those who are unaware of their health status. Identification of both disease and risk factors (e.g. high cholesterol, high blood pressure, diabetes, etc.) creates an opportunity for treatment and management to reduce and prevent cardiovascular events from occurring. Methods: Over 230,000 screening records for individuals who had undergone carotid artery stenosis (CAD), abdominal aortic aneurysm (AAA), or peripheral artery disease (PAD) screening were reviewed. Participants were stratified based on self-reported risk factors as having no risk factors, one risk factor, or two or more risk factors. Self-reported risk factors were also compared with results of screening for blood pressure, blood glucose, and lipid level status. Results: Abnormal findings of CAS, AAA, and PAD were all uncovered in individuals who self-reported as having no traditional risk factors. These abnormal findings included those defined as severe. The review of self-reported risk factors for accuracy demonstrated varying levels of inaccuracies in both under and over-reporting of risk factors. Conclusions: Communitybased cardiovascular screening may result in the identification of cardiovascular disease in individuals with no established risk factors. While the underreporting of risk factors has also be demonstrated, it is clear that further research is warranted to better understand the presence of disease in the absence of risk factors.

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Traditional Cardiovascular Risk Factors and the Presence of Obstructive Coronary Artery Disease in Men and Women

Cited by 21 publications

References 23 publications

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Sex-related differences in the associations between plasma free fatty acid levels and clinical features in patients with hypertrophic cardiomyopathy

Community-Based Cardiovascular Screening: Detection of Disease in Individuals with No Self-Reported Risk Factors

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