bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women's heart clinics to prevent cardiovascular disease in women with pregnancy-related risk factors: a prospective study
Authors: Marschner S , Mukherjee S , Watts M , Min H , Beale A L , O'brien J , Juneja A , Tremmel J , Zaman S 
Published: November 2023

Abstract

Background
A woman’s risk of cardiovascular disease (CVD) is substantially increased after a diagnosis of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), or have had a small for gestational age (SGA) baby. However, evidence for models of care that mitigate CVD risk in women with these pregnancy-related conditions is lacking.

Purpose
To assess the effectiveness of a Women’s Heart Clinic (WHC) on blood pressure (BP) and lipid control in women with past pregnancy-related cardiovascular risk factors.

Method
A six-month prospective cohort study of women aged 30-55 years with a past pregnancy diagnosis of HDP, GDM or an SGA baby. All women attended a multidisciplinary WHC comprising a cardiologist, a cardiac nurse, and a dietician, located in three cardiovascular healthcare service centers in Australia. Women were assessed at their first attendance of the WHC and at 6 months. The co-primary endpoints were: 1) BP&lt;140/90mmHg or &lt;130/80mmHg if diabetes mellitus and 2) total cholesterol to high density lipoprotein-cholesterol ratio (TC:HDL-C)&lt;4.5.

Results
156 women were recruited with a mean age of 41.0±4.2 years, 68.6% Caucasian, 20.5% South/East Asian and 80.5% university educated. Women were a mean of 3.9±2.9 years from last delivery with 23.1% past HDP only, 60.3% GDM only, 13.5% both HDP and GDM and, 3.2% with an SGA baby. All women attended a WHC at least once, with 69.5% reviewed by a dietician. The proportion meeting BP target increased (69.2% to 80.5%, p=0.004); with no significant change in women meeting lipid targets (80.6% to 83.7%, p=0.182). Women had significant reductions in mean systolic BP (-6.9mmHg, 95% confidence interval (CI): -9.1,-4.7, p&lt;0.001), body mass index (-0.6kg/m2, CI: -0.8,-0.3, p&lt;0.001), LDL-cholesterol (-4.2mg/dL, CI: -8.2,-0.2, p=0.042) and total cholesterol (-4.6mg/dL, CI: -9.1,-0.2, p=0.042). Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, p=0.012) and decreased fast food consumption (33.8% to 11.0%, P&lt;0.001), with more women meeting exercise recommendations (84.0% to 92.9%, p=0.025).

Conclusion
Women at high risk for CVD due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors, after attending a Women’s Heart Clinic. This female-specific cardiovascular healthcare model has the potential to improve long-term CVD outcomes for women.Figure 1:Visual abstract
Mortality and predictors of death in women and men with congestive heart failure due to ischemic and nonischemic cardiomyopathy
Authors: Mansur A D P , Del Carlo C H , Avakian S D , Ianni B M , Fernandes F , Cesar L A M , Bocchi E A , Pereira-Barreto A C 
Published: November 2023

Abstract

Background
Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Studies have shown that women have better survival than men, despite the higher number of hospitalizations among women. However, little is known about differences in mortality and predictors of death in women and men with heart failure due to ischemic (iCMP) and nonischemic (niCMP) cardiomyopathy.

Purpose
To analyze the mortality and predictors of death in women and men with iCMP and niCMP cardiomyopathy.

Methods
From February 2017 to September 2020, we analyzed mortality and predictors of death in women and men with CHF by iCMP and niCMP. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method and Cox proportional hazards methods to analyze mortality rates in women and men. We used the Score Chi-Square of Cox regression to search for death predictors for women and men.

Results
We studied 7,487 patients, mean age of 64.3 ± 14.2 years, 4,417 (59%) males. Women with iCMP and niCMP had, respectively, higher mean age (p&lt;0.0001), higher mean left ventricular ejection fraction (LVEF) (p&lt;0.001), and smaller left ventricular diastolic diameter (LVDD) (p&lt; 0.001). The mean dose of carvedilol was similar in both genders for iCMP and niCMP. Over a 3-year follow-up period, 420 (15.7%) men and 325 (14.7%) women with niCMP died (p=NS), and in iCMP, 519 (29.8%) men and 211 men died. (24.5%) women (p=0.004). Higher mortality was observed in women with iCMP compared to men with iCMP (p&lt;0.0001). The cumulative incidence of death was higher in men (K-M: log-rank p&lt;0.0001) with iCMP, but similar for niCMP (Figure). Cox regression for death adjusted for age, sex, previous myocardial infarction (MI), diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), HF phenotype (systolic, diastolic, or mildly reduced ejection fraction), and LVEF showed that CKD, AF, diabetes, stroke, LVEF, and age, in descending order of Score Chi-Square, were the main predictors of death for niCMP and CKD, stroke, diabetes, AF, LVEF, age, and MI for iCMP.

Conclusions
Women had a better prognosis than men in iCMP, but similar mortality in niCMP. Gender was not an independent variable of death. Secondary prevention of cardiovascular events from the main predictors of death can significantly reduce the death rate in women and men with CHF by iCMP and niCMP.
A female acronym is not enough: underrepresentation of women in cardiovascular trials
Authors: Spiering A E , Van Ommen A M L N , Onland-Moret N C , Den Ruijter H M 
Published: November 2023

Abstract

Introduction
Cardiovascular disease is the leading cause of death for women worldwide. Yet, women are often underrepresented in clinical trials of cardiovascular disease compared to population prevalence. Reasons for underrepresentation are multifactorial, and often attributed to trial criteria. Yet, women may also decide not to participate for more subconscious reasons, such as the perception of the trial acronym. Trial acronyms are used in patient communication and are often chosen to have a certain meaning, which can be perceived as gendered. We hypothesize that masculine trial names are associated with underrepresentation of women in clinical trials.

Purpose
To investigate if the perceived gender of the trial acronym, and other study characteristics affect the representation of women in cardiovascular clinical trials.

Methods
We performed a systematic search of ClinicalTrials.gov to collect information on randomized clinical trials testing drug interventions for cardiovascular disease. We extracted trial characteristics and acronyms from primary outcome publications. We conducted a survey among 148 cardiovascular patients (both women and men) recruited via an online patient forum and asked them whether they perceived trial acronyms names as more masculine, feminine or neutral. We defined female underrepresentation as those trials where the proportion of included women divided by the proportion of women in the disease population was below 0.8. We analyzed female underrepresentation and study setting, participant characteristics, and female first and last authorship.

Results
We identified 148 eligible clinical trials of which 29.9% of participants were women. Women were underrepresented in 61.5% of trials (Figure 1). Only 45.3% of publications reported sex-stratified results. The proportion of trials in which women were underrepresented increased between 1992 and 2022 from 48.3% to 70.5%. A total of 148 patients (67.6% women, mean age 61 y) evaluated the trial acronyms for their perceived gender. The majority (70.9%) of trial names was perceived as neutral, 17.6% as masculine and 11.5% as feminine. Female representation was not associated with the perceived gender of the trial name (OR 0.92, 95% CI 0.63 – 1.35) (Figure 2A). Trials had a higher odds of female underrepresentation if they recruited at an in-patient setting (OR 2.47, 95% CI 1.14 – 5.58), or if their participants were in the second-highest age group between 64.0 and 66.3 years (OR 3.93, 95% CI 1.25 – 14.18). Trials had lower odds of female underrepresentation if the last author was a woman (OR 0.10, 95% CI 0.01 – 0.49).

Conclusion
Female representation in cardiovascular clinical trials remains poor but is not depending on the perceived gender of the trial acronym. Female representation varies with recruitment type, participant age and last author gender, which are important starting points to improve participation rates of women.
Sex differences in patients with MINOCA: baseline characteristics and prognosis
Authors: Rodriguez Montes P , Fraile Sanz A , Izquierdo Coronel B , Gil Mancebo N , Alvarez Bello M , Martin Munoz M , Perela Alvarez C , Nieto Ibanez D , Abad Romero R , Olsen Rodriguez R , Espinosa Pascual M , Awamleh Garcia P , Mata Caballero R , Moreno Vinues C , Alonso Martin J J 
Published: November 2023

Abstract

Background
The difference between men and women regarding the diagnosis and treatment of cardiovascular diseases has been an object of study during the last few years, with an underrepresentation of female patients in old studies. The epidemiology, diagnosis, and treatment of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) has not yet been wholly elucidated up to this day. The aim of this study is to compare the characteristics and prognosis of MINOCA patients based on sex.

Methods
We analyzed all consecutive patients with MINOCA diagnosed at a University Hospital between 2016 and 2022. MINOCA diagnostic criteria compelled at the ESC Clinical Guidelines and the AHA Scientific Statement have been followed.

Results
Our sample comprises 107 patients with MINOCA, 61 male (57%) and 46 female (43%), but once the age of 80 years old was reached, MINOCA was more prevalent in women. We found the female population to have a higher prevalence of stress (usually chronic stress) and transient ischaemic attacks. On the contrary, men usually have more night shifts, psychiatric disorders, and a higher prevalence of smoking. We found no significant differences in cardiovascular risk factors (hypertension, dyslipidemia, or DM), clinical presentation, or other symptoms at admission. (Table 1). High-sensitivity troponin peak concentration was higher in women. As for the main MINOCA physiological mechanisms, we found a significantly higher prevalence of vasospasm in men and coronary artery dissection in women. There were no significant differences regarding coronary embolism, type II acute myocardial infarction (AMI), plaque rupture, or unknown mechanisms. Regarding prognosis, with a median follow-up of 45 [20-65] months, no significant differences were found between both groups for the development of in-hospital complications or mortality, nor cardiovascular readmissions, reinfarction or death from any cause (Table 2).

Conclusion
Unlike the previous popular perception of this disease, there are more MINOCA male patients than females in our sample, and psychiatric disorders are more prevalent in men. In octogenary people, MINOCA was more prevalent in women. At admission, symptoms and electrocardiographic parameters were very similar between both groups, while cardiac biomarkers reached higher levels in women, unrelated to coronary artery extension or the severity of left ventricular dysfunction.
Autopsy findings and cardiac arrest rhythms in young obese patients with sudden cardiac death of uncertain etiology
Authors: Goel V , Han H C , Ha F , Fendel K , Teh A , Sanders P , Farouque O , Lim H 
Published: November 2023

Abstract

Background
Obesity is associated with an increased risk of sudden cardiac death (SCD) which can be particularly devastating in young adults. In a significant proportion of SCD cases in the young, a specific cause cannot be identified.

Purpose
The aim of this retrospective analysis was to describe the demographics, pathological changes and cardiac arrest rhythm in young obese individuals with SCD of otherwise unknown etiology.

Methods
Between July 2000 and December 2018, the National Coronial Information System (NCIS) identified cases of young obese (body mass index ≥ 30) individuals with SCD between 17-35 years of age (SCD-obesity). Autopsy reports of individuals with SCD where known causes had been excluded were compared to 2 matched control cohorts of death due to motor vehicle accidents (MVA) (first group matched for age, sex, height and weight (MVA-BMI-matched) and second group matched for age and sex (MVA-age-matched)). Additionally, electrocardiographic rhythms at cardiac arrest were obtained through state-wide ambulance services for SCD-obesity individuals.

Results
We identified 409 cases of SCD in young obese individuals, of which 94 cases met the inclusion criteria (figure 1). Mean age was 28.44±5.6 years (range 17-35). SCD-obesity individuals were commonly males (71%). SCD-obesity individuals had significantly higher cardiac masses (521g vs 417g, p&lt;0.001) compared to the MVA-BMI-matched cohort. SCD-obesity individuals also had significantly increased left ventricular wall thickness (15.6mm vs 13.5mm, p&lt;0.001) and increased rates of left ventricular fibrosis (73% vs 52%, p=0.045) compared to the MVA-BMI-matched cohort. ECG rhythm strips were available for 71 (72%) SCD-obesity cases, of which 16 (23%) were unwitnessed. Asystole was noted on 7 (46.67%) of witnessed cases, and 6 (40%) had a ventricular tachycardia or fibrillation (figure 2).

Conclusions
SCD-obesity individuals had increased cardiac organ masses, left ventricular wall thickness and cardiac fibrosis. The cardiac arrest rhythm recorded in witnessed cases were predominantly asystole and ventricular arrythmia. Future studies are needed to determine the pathological mechanisms explaining these abnormalities in young obese sufferers of SCD.Figure 1:Case identificationFigure 2:Results
Pregnancy-related cardiovascular events in marfan syndrome
Authors: Poveda Velazquez P , Ibrahim B , Llamas Gomez H , De Frutos F , Tome Esteban M T 
Published: November 2023

Abstract

Background
Some studies have suggested an increased risk of aortic dissection (AoDis) during pregnancy and higher rate of cardiovascular (CV) events on the long-term in Marfan syndrome (MFS) patients.

Purpose
To analyse the rate of CV events during pregnancy and follow up in our cohort of MFS patients.

Methods
We prospectively collected data of a cohort of women with MFS that attended our dedicated clinic between the years 2000-2021. This included demographics, clinical characteristics and pregnancy. CV events were defined as AoDis, urgent AoSurg or CV death. Patients with a previous event before the first pregnancy were excluded.

Results
We identified 148 women with a mean age at last follow up of 40±16 years and a mean follow up of 11 years (IQR 25-75: 4-17 years). Sixty-nine patients fell pregnant (130 pregnancies, median 2, range 1-4 pregnancies, age at delivery 29±5y) and 79 were never pregnant.
Amongst the 69 ever pregnant patients, 2 patients had a type A AoDis during pregnancy (one was unaware of the MFS diagnosis; the other was under follow up with a pre-pregnancy aortic root of 34mm/Z-score 1.5 and at third trimester of 36 mm/Z-score 2.2). No maternal deaths were recorded. Pregnancy related rate of CV events was 2.9% and 1.5% in women with known MFS diagnosis before pregnancy.
Ever-pregnant patients were older at diagnosis (32±17y vs 20±14y, p&lt;0,001) and at the end of follow up (49±14y vs 33±13, p&lt;0,001) compared to never-pregnant patients. Ectopia lentis was significantly higher in never-pregnant patients (45.3% vs 25%, p=0.03). There were no statistically significant differences in time of follow up or other clinical features of MFS. Only 36% of the ever-pregnant cohort were diagnosed before pregnancy.
During follow up, 14 patients from the ever-pregnant group and 16 patients from the never-pregnant group underwent prophylactic AoSurg (p=0,72). Never-pregnant patients were younger at age of elective AoSurg (35±14y vs 45±13y, p=0.031). Eleven (7.4%) patients experienced a CV event (7 type A and 4 type B AoDis), 7 in the ever-pregnant group and 4 in the never pregnant group (p=0.09). Age at CV event was similar in the ever-pregnant and never-pregnant groups (48±11y vs 40±8y, p=0.26)
In the ever-pregnant group, 3 patients experienced ³2 CV events during follow up compared to none in the never-pregnant group (p=0.1).

Conclusion
In our cohort of ever pregnant MFS patients, 2.9% of patients experienced a pregnancy related CV event.
On the long term, never-pregnant patients were younger at age of elective AoSurg but there were no differences between the groups in prophylactic AoSurg or CV events.
Aortic root dimensions in pregnant marfan syndrome women
Authors: Poveda Velazquez P , Ibrahim B , Llamas Gomez H , De Frutos F , Tome Esteban M T 
Published: November 2023

Abstract

Background
Some studies suggest that aortic root dimensions may increase significantly during pregnancy in patients with Marfan syndrome (MFS).

Purpose
To analyse the aortic root (AoRoot) dimensions during pregnancy and presence of significant AoRoot enlargement (SARE) in our cohort of pregnant MFS patients.

Methods
Prospective data of clinically and genetically confirmed women with MFS followed up during pregnancy in our dedicated clinic between the years 2004-2021 was collected, including demographics, pregnancy and cardiovascular events (CVE) during pregnancy and at follow up. AoRoot dimensions were collected before, during and 3 months after pregnancy. SARE was defined as difference ≥3mm before and after pregnancy. Aortic dilation (AoDil) was defined as Z-Score &gt;2. AoRoot rate was calculated with AoRoot change since pregnancy to end of follow up divided by the follow up since pregnancy. Patients with a previous CVE before pregnancy were excluded.

Results
AoRoot dimensions during pregnancy and after pregnancy were available in 23 pregnancies (17 patients). Mean age at delivery was 32±5years old, mean follow up since pregnancy 8±6 years and complete follow up 14±9 years.
Mean AoRoot before and after pregnancy was similar (35±4mm, range 28-42mm vs 36±4mm, range 29-42mm, p=0.172). Ten patients were on medical treatment with beta-blockers during pregnancy. These patients were younger at diagnosis (17±10y vs 25±5y, p=0,039) and had larger pre-pregnancy AoRoot dimensions (38±4mm vs 34±3mm, p=0,024) than patients on no medication. AoRoot dimensions after pregnancy were similar in both groups (p=0,087). There were no statistically significant differences in SARE during pregnancy.
No CVE were observed during pregnancy. One patient had a type A AoDis 10 days after delivery. Pre-pregnancy AoRoot was 34mm (Z-score 1.5) and at third trimester 36 mm (Z-score 2.2). Risk factors included family history of AoDis.
SARE was observed in 5 (21.7%) pregnancies. Mean pre-pregnancy AoRoot was 35±3mm (Z-Score 1.6, range 30-38mm) and after pregnancy 39±4mm (Z-Score 2.9, range 34-42mm) and mean AoRoot increase before and after pregnancy 3.2±0.5mm (range 3-4mm). No pregnancy-related CVE were recorded.
During follow up, the AoRoot growth rate after pregnancy was 0.05±0.07mm/year in the whole cohort. Twelve patients fulfilled criteria for AoDil before pregnancy (AoRoot 39±2mm, Z-Score 3.4) and 4 developed AoDil after pregnancy (AoRoot 39±1mm, Z-Score 2.9). Rate of AoRoot growth was similar in both groups. During follow up, 2 patients underwent prophylactic aortic surgery.

Conclusion
In our cohort, AoRoot dimensions remained similar before and 3 months post-partum. One patient experienced a pregnancy related type A AoDis with normal AoRoot size during pregnancy.
SARE was observed in 5 patients but no pregnancy-related CVE were registered in this group.
The rate of AoRoot growth after pregnancy was 0.05±0.07mm/year in the whole cohort.
Long-term cardiovascular risk of pre-eclampsia
Authors: Pivato C A , Inversetti A , Cristodoro M , Latini A C , Condorelli G , Stefanini G , De Simone N 
Published: November 2023

Abstract

Background/introduction
Pre-eclampsia is a complication of the second and third trimesters of pregnancy characterized by hypertension and endothelial dysfunction causing multiorgan damage. In 2017 few studies suggested an association between pre-eclampsia and long-term cardiovascular diseases. However, since those first studies, the literature has grown exponentially.

Purpose
To assess the association between a history of pre-eclampsia and subsequent cardiovascular diseases, including 1) cardiovascular death, 2) coronary heart disease, 3) heart failure, and 4) stroke.

Methods
Following PRISMA guidelines, from inception to September 2022, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort or case-control studies in English were included if fulfilling the following criteria: 1) the association between pre-eclampsia and subsequent cardiovascular disease was adjusted for at least maternal age, smoking, and obesity; 2) the presence of a control group; 3) minimum one-year follow-up. Pooled Relative Risk (RRs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model. The primary endpoint was cardiovascular death. The secondary endpoints were coronary heart disease, heart failure, and stroke.

Results
Twenty-one studies met the inclusion criteria, including 478,708 women with a history of pre-eclampsia and 10,533,530 without. Pre-eclampsia was associated with a higher risk of cardiovascular disease death (RR 1.97, 95% CI 1.64-2.35, I2 60%, p&lt;0.00001), coronary heart disease (RR 2.11, 95% CI 1.60-2.77, I2 85%, p&lt;0.00001), heart failure (RR 2.47, 95% CI 1.70-3.59, I2 82%, p&lt;0.00001), and stroke (RR 1.64, 95% CI 1.45-1.85, I2 43%, p&lt;0.00001). Sensitivity analysis excluding those studies with a follow-up of less than 10 years evidenced similar results.

Conclusions
Compared to women who experienced a normal pregnancy, those suffering from pre-eclampsia have about double the risk of cardiovascular disease, including cardiovascular death, coronary heart disease, heart failure, and stroke. This risk becomes evident already in the first ten years after pregnancy. As such, obstetricians should counsel pre-eclamptic women on the importance of an early assessment and risk factors management in a multidisciplinary team with cardiologists.