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Gender / Cardiovascular Disease in Women

Landmark Article

Dyslipidemia management in women and men: exploring potential gender differences.
By: Sharma K, Nagy CD, Blumenthal RS.

This chapter first examines gender differences in CVD risk factors, then specifically focuses on dyslipidemia in women and the effects of estrogen on CVD risk, and finally addresses treatment guidelines for dyslipidemia.

Rosuvastatin is similarly effective for primary prevention of cardiovascular disease in women as in men
By: Leventhal A, Michos ED.

Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials.

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The numbers are in – statins for the primary prevention of cardiovascular disease in women.
By: Duvernoy CS, Blumenthal R.
This study indicates that statin therapy among middle-aged and older women with low LDL-C but above average hsCRP achieves better outcomes than those previously observed in primary prevention trials that were conducted with less potent statins in individuals with overt hyperlipidemia. Clearly, the evidence base for statin therapy in asymptomatic middle-aged and older women with other risk factors is now much more compelling, thanks to the work of Mora and colleagues. We await publication of the formal cost-effectiveness analyses from the landmark JUPITER data set, as well as data on the long-term safety of high-potency statin therapy. In the meantime, clinicians will undoubtedly use the data by Mora et al to prescribe statin therapy much earlier for women who meet the entry criteria of the JUPITER study, and this change will improve cardiovascular outcomes in women.
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Sex steroid hormone concentrations and risk of death in U.S. men.
By: Menke A, Guallar E, Rohrmann S, Nelson WG, Rifai N, Kanarek N, Feinleib M, Michos ED, Dobs A, Platz EA.
Men with low free and bioavailable testosterone levels may have a higher risk of mortality within 9 years of hormone measurement. Future studies should be conducted to fully characterize the association of low free and bioavailable testosterone concentrations and mortality in men and to describe the mechanism underlying the association.
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Noninvasive assessment of gender differences in coronary plaque composition with multidetector computed tomographic angiography.
By: Nasir K, Gopal A, Blankstein R, Ahmadi N, Pal R, Khosa F, Shaw LJ, Blumenthal RS, Budoff MJ.
Few data are available that show gender differences in plaque morphology and composition. This report aims to assess the differences in coronary plaque burden and composition in a noninvasive manner between women and men using multidetector computed tomographic angiography. Results show that gender differences exist, not only in the atherosclerotic disease burden, but also in the underlying plaque composition. Women tended to have more exclusively noncalcified plaque and were less likely to have calcified or mixed plaques compared to men. Future studies are needed to elucidate whether these underlying differences in plaque composition might explain the reduced risk of cardiac events in women.
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Effect of Beta-blocker therapy on rehospitalization rates in women versus men with heart failure and preserved ejection fraction.
By: Farasat SM, Bolger DT, Shetty V, Menachery EP, Gerstenblith G, Kasper EK, Najjar SS.

Beta blockers are empirically used in many patients with heart failure (HF) and preserved ejection fraction (HFpEF) because they allow more time for diastolic filling and because they improve outcomes in patients with systolic HF. However, recent data suggest that impaired chronotropic and vasodilator responses to exercise, which can worsen with beta blockade, may play a key role in the pathophysiology of HFpEF. We prospectively examined the association between beta-blocker therapy after hospitalization for decompensated HF and HF rehospitalization at 6 months in 66 consecutive patients with HFpEF (71 +/- 13 years old, 68% women, 42% Black). Subjects were stratified based on receiving (BB+; 15 men, 28 women) or not receiving (BB-) beta-blockers at hospital discharge. In men, HF rehospitalization occurred less frequently in the BB+ than in the BB- group, albeit nonsignificantly (20% vs 50%, p = 0.29). In women, HF rehospitalization occurred more frequently in the BB+ than in the BB- group (75% vs 18%, p <0.001). In univariate analyses, discharge beta-blocker was associated with HF rehospitalization in women (odds ratio [OR] 14.00, 95% confidence interval [CI] 3.09 to 63.51, p = 0.001), but not in men (OR 0.25, 95% CI 0.03 to 1.92, p = 0.18). In a forward logistic regression model that offered all univariate predictors of HF rehospitalization, discharge beta blocker remained an independent predictor of HF rehospitalization in women (OR 11.06, 95% CI 1.98 to 61.67, p = 0.006). In conclusion, this small observational study suggests that beta-blocker therapy may be associated with a higher risk of HF rehospitalization in women with HFpEF. The risks and benefits of beta-blocker therapy in patients with HFpEF should be evaluated in randomized, controlled trials.

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Gender differences in coronary plaque composition by coronary computed tomography angiography.
By: Blaha MJ, Nasir K, Rivera JJ, Choi EK, Chang SA, Yoon YE, Chun EJ, Choi SI, Agatston A, Blumenthal RS, Chang HJ.
In this population of asymptomatic middle-aged Korean individuals, males had a significantly greater burden of mixed coronary artery plaques (MCAP) and calcified arterial plaques (CAP). Future studies will determine whether these differences contribute to the accelerated cardiovascular risk observed in men.
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Dyslipidemia and atherosclerosis in women.
By: Nagy CD, Campbell CY, Blumenthal RS.