New Perspectives on Cardiovascular Disease: Women's Treatment and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (15 June 2023) | Viewed by 14585

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Special Issue Editors


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Guest Editor
Fondazione Toscana Gabriele Monasterio, Cardiovascular Endocrinology and Metabolism Medicine and Surgery, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
Interests: cardiovascular risk; cardiovascular; cardiovascular disease; cardiology; osteoporosis; insulin resistance; metabolic syndrome; cardiovascular system; endocrinology; coronary artery disease; women

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Guest Editor
1. Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
2. U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
Interests: cardiac imaging; blood disorders; gender differences; cardiovascular disease; women
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Special Issue Information

Dear Colleagues,

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in women, despite the overall reduction in age-adjusted CVD mortality in the past few years. Aside from the traditional risk factors, predictors of increased CVD risk in both sexes, there are also unique RFs in women, related to their reproductive and gynecological history. Moreover, among women, there is a lack of knowledge and perception of CVD. In comparison to men, women with CVD are typically underdiagnosed and undertreated.

The problem is more significant among women due to the incorrect and ingrained belief that CVD is primarily, if not exclusively, a male disease. This misunderstanding is generated by the differences in the clinical presentation of CVD in the two sexes, and by the increased prevalence of advanced postmenopausal age among women. 

The aim of this Special Issue is to gather new data on peculiar features of CVD and risk factors in women, in order to reduce the underestimation of CVD risk, and to find strategies that are for prevention, management and therapy that is tailor made to the specific woman’s needs. 

Cutting-edge research (original article and reviews, etc.) are welcome.

Dr. Silvia Maffei
Dr. Antonella Meloni
Guest Editors

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Keywords

  • cardiovascular risk factors
  • cardiovascular disease
  • women
  • sex hormones
  • precision medicine
  • cardiometabolic risk
  • menopause
  • knowledge and perception of CVD
  • pathological pregnancies
  • gender differences

Published Papers (10 papers)

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Research

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11 pages, 1537 KiB  
Article
Sex Differences in Repolarization Markers: Telemonitoring for Chronic Heart Failure Patients
by Federica Moscucci, Susanna Sciomer, Silvia Maffei, Antonella Meloni, Ilaria Lospinuso, Myriam Carnovale, Andrea Corrao, Ilaria Di Diego, Cristina Caltabiano, Martina Mezzadri, Anna Vittoria Mattioli, Sabina Gallina, Pietro Rossi, Damiano Magrì and Gianfranco Piccirillo
J. Clin. Med. 2023, 12(14), 4714; https://doi.org/10.3390/jcm12144714 - 16 Jul 2023
Cited by 1 | Viewed by 1003
Abstract
Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of the electrocardiogram (ECG) repolarization phase. Recently, some short period repolarization–dispersion parameters have been proposed as markers of acute decompensation and of mortality risk in CHF patients. Some important differences in [...] Read more.
Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of the electrocardiogram (ECG) repolarization phase. Recently, some short period repolarization–dispersion parameters have been proposed as markers of acute decompensation and of mortality risk in CHF patients. Some important differences in repolarization between sexes are known, but their impact on ECG markers remains unstudied. The aim of this study was to evaluate possible differences between men and women in ECG repolarization markers for the telemonitoring of CHF patients. Method: 5 min ECG recordings were collected to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 215 decompensated CHF (age range: from 49 to 103 years). Thirty-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. Results: A total of 34 patients (16%) died during the 30-day follow-up, without differences between sexes. Women showed a more preserved ejection fraction and higher LDL and total cholesterol levels. Among female patients, implantable cardioverter devices, statins, and antiplatelet agents were less used. Data for Te mean showed increased values among deceased men and women compared to survival, but TeSD was shown to be the most reliable marker for CHF reacutization in both sexes. Conclusion: TeSD could be considered a risk factor for CHF worsening and complications for female and male patients, but different cut offs should be taken into account. (ClinicalTrials.gov number, NCT04127162.) Full article
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12 pages, 896 KiB  
Article
Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation
by Raffaella Ronco, Federico Rea, Amelia Filippelli, Aldo Pietro Maggioni and Giovanni Corrao
J. Clin. Med. 2023, 12(8), 2972; https://doi.org/10.3390/jcm12082972 - 19 Apr 2023
Cited by 1 | Viewed by 773
Abstract
At the time of first acute coronary syndrome (ACS) hospital admission, women are generally older and have more comorbidities than men, which may explain differences in their short-term prognosis. However, few studies have focused on differences in the out-of-hospital management of men and [...] Read more.
At the time of first acute coronary syndrome (ACS) hospital admission, women are generally older and have more comorbidities than men, which may explain differences in their short-term prognosis. However, few studies have focused on differences in the out-of-hospital management of men and women. This study investigated (i) the risk of clinical outcomes, (ii) the use of out-of-hospital healthcare and (iii) the effects of clinical recommendations on outcomes in men vs. women. A total of 90,779 residents of the Lombardy Region (Italy) were hospitalized for ACS from 2011 to 2015. Exposure to prescribed drugs, diagnostic procedures, laboratory tests, and cardiac rehabilitation in the first year after ACS hospitalization were recorded. To evaluate whether sex can modify the relationship between clinical recommendations and outcomes, adjusted Cox models were separately fitted for men and women. Women were exposed to fewer treatments, required fewer outpatient services than men and had a lower risk of long-term clinical events. The stratified analysis showed an association between adherence to clinical recommendations and a lower risk of clinical outcomes in both sexes. Since improved adherence to clinical recommendations seems to be beneficial for both sexes, tight out-of-hospital healthcare control should be recommended to achieve favourable clinical benefits. Full article
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9 pages, 639 KiB  
Article
Lipoprotein(a), Cardiovascular Events and Sex Differences: A Single Cardiological Unit Experience
by Beatrice Dal Pino, Francesca Gorini, Melania Gaggini, Patrizia Landi, Alessandro Pingitore and Cristina Vassalle
J. Clin. Med. 2023, 12(3), 764; https://doi.org/10.3390/jcm12030764 - 18 Jan 2023
Viewed by 1151
Abstract
Lipoprotein(a)-Lp(a), which retains proatherogenic and prothrombotic properties, may be modified by hormonal and metabolic factors. However, few studies have focused on differences related to sex and cardiometabolic risk factors in the relationship between Lp(a) and cardiovascular disease, especially in terms of prognosis. This [...] Read more.
Lipoprotein(a)-Lp(a), which retains proatherogenic and prothrombotic properties, may be modified by hormonal and metabolic factors. However, few studies have focused on differences related to sex and cardiometabolic risk factors in the relationship between Lp(a) and cardiovascular disease, especially in terms of prognosis. This study aimed at evaluating the predictive value of Lp(a) (cut-off 30 mg/dL) for hard events (HEs: mortality and non-fatal myocardial infarction) according to sex and cardiometabolic risk factors in 2110 patients (1501 males, mean age: 68 ± 9 years) undergoing coronary angiography for known or suspected coronary artery disease. There were 211 events over a median follow-up period of 33 months. Lp(a) > 30 mg/dL did not confer a worse prognosis on the overall population. However, Kaplan–Meier subgroup analysis evidenced a worse prognosis in type 2 diabetes (T2D) females with elevated Lp(a) (log-rank test: p = 0.03) vs. T2D males and no-T2D patients, but not in other high-risk cardiovascular states (e.g., smoking, hypertension, reduced left ventricular ejection fraction or obesity). After Cox multivariate adjustment, Lp(a) remained an independent determinant for HEs in the T2D female subgroup, conferring an HR of 2.9 (95% CI 1.1–7.7, p < 0.05). Lp(a) is therefore a strong independent predictor of HR in T2D women, but not in T2D men, or in noT2D patients. Full article
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12 pages, 620 KiB  
Article
Differences in Sex and the Incidence and In-Hospital Mortality among People Admitted for Infective Endocarditis in Spain, 2016–2020
by Jose M. De Miguel-Yanes, Rodrigo Jimenez-Garcia, Javier De Miguel-Diez, Valentin Hernández-Barrera, David Carabantes-Alarcon, Jose J. Zamorano-Leon, Concepción Noriega and Ana Lopez-de-Andres
J. Clin. Med. 2022, 11(22), 6847; https://doi.org/10.3390/jcm11226847 - 20 Nov 2022
Cited by 2 | Viewed by 1386
Abstract
(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016–2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We [...] Read more.
(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016–2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We used propensity score matching (PSM) to compare the clinical characteristics and the in-hospital mortality (IHM) between men and women hospitalized with IE. (3) Results: We identified 10,459 hospitalizations for IE (33.26% women). The incidence of IE remained stable during this five-year period. The age-adjusted incidence of IE was two-fold higher among men vs. women (IRR = 2.08; 95%CI 2.0–2.17). Before PSM, women with IE were significantly older than men (70.25 vs. 66.24 years; p < 0.001) and had lower comorbidity according to the Charlson comorbidity index (mean 1.38 vs. 1.43; p = 0.019). After PSM, the IHM among women admitted for IE remained >3 points higher than that among men (19.52% vs. 15.98%; p < 0.001). (4) Conclusions: The incidence of IE was two-fold higher among men than among women. IHM was significantly higher among women after accounting for the potential confounders. Full article
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14 pages, 586 KiB  
Article
Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis
by Christine Friedrich, Mohamed Salem, Thomas Puehler, Bernd Panholzer, Lea Herbers, Julia Reimers, Lars Hummitzsch, Jochen Cremer and Assad Haneya
J. Clin. Med. 2022, 11(7), 1875; https://doi.org/10.3390/jcm11071875 - 28 Mar 2022
Cited by 7 | Viewed by 1161
Abstract
(1) Background: Surgery for infective endocarditis (IE) is associated with considerable mortality and it is controversial whether the female gender is predictive for a worse outcome. This large single-center study investigated the impact of sex on outcomes after surgery for IE. (2) Methods: [...] Read more.
(1) Background: Surgery for infective endocarditis (IE) is associated with considerable mortality and it is controversial whether the female gender is predictive for a worse outcome. This large single-center study investigated the impact of sex on outcomes after surgery for IE. (2) Methods: 413 patients (25.4% female) were included into this retrospective observational study. Univariate and multivariable analyses identified sex-specific risk factors for 30 day and late mortality. Survival was estimated by the Kaplan-Meier-method. (3) Results: Women presented more often with mitral valve infection (p = 0.039). Men presented more frequently with previous endocarditis (p = 0.045), coronary heart disease (p = 0.033), and aortic valve infection (p = 0.005). Blood transfusion occurred more frequently intraoperatively in women (p < 0.001), but postoperatively in men (p = 0.015) and men had a longer postoperative stay (p = 0.046). Women showed a higher 30 day mortality than men (p = 0.007) and female gender was predictive for 30 day mortality (OR 2.090). Late survival showed no sex-specific difference (p = 0.853), and the female gender was not an independent predictor for late mortality (p = 0.718). Risk factors for early and late mortality showed distinct sex-specific differences such as increased preoperative CRP level in women and culture-negative IE in men. Full article
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11 pages, 1016 KiB  
Article
Cardiovascular Risk Perception and Knowledge among Italian Women: Lessons from IGENDA Protocol
by Silvia Maffei, Antonella Meloni, Martino Deidda, Susanna Sciomer, Lucia Cugusi, Christian Cadeddu, Sabina Gallina, Michela Franchini, Giovanni Scambia, Anna Vittoria Mattioli, Nicola Surico, Giuseppe Mercuro and IGENDA Study Group
J. Clin. Med. 2022, 11(6), 1695; https://doi.org/10.3390/jcm11061695 - 18 Mar 2022
Cited by 13 | Viewed by 2273
Abstract
A multicenter, cross-sectional observational study (Italian GENder Differences in Awareness of Cardiovascular risk, IGENDA study) was carried out to evaluate the perception and knowledge of cardiovascular risk among Italian women. An anonymous questionnaire was completed by 4454 women (44.3 ± 14.1 years). The [...] Read more.
A multicenter, cross-sectional observational study (Italian GENder Differences in Awareness of Cardiovascular risk, IGENDA study) was carried out to evaluate the perception and knowledge of cardiovascular risk among Italian women. An anonymous questionnaire was completed by 4454 women (44.3 ± 14.1 years). The 70% of respondents correctly identified cardiovascular disease (CVD) as the leading cause of death. More than half of respondents quoted cancer as the greatest current and future health problem of women of same age. Sixty percent of interviewed women considered CVD as an almost exclusively male condition. Although respondents showed a good knowledge of the major cardiovascular risk factors, the presence of cardiovascular risk factors was not associated with higher odds of identifying CVD as the biggest cause of death. Less than 10% of respondents perceived themselves as being at high CVD risk, and the increased CVD risk perception was associated with ageing, higher frequency of cardiovascular risk factors and disease, and a poorer self-rated health status. The findings of this study highlight the low perception of cardiovascular risk in Italian women and suggest an urgent need to enhance knowledge and perception of CVD risk in women as a real health problem and not just as a as a life-threatening threat. Full article
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Review

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13 pages, 762 KiB  
Review
Gender Effect on Clinical Profiles, Pharmacological Treatments and Prognosis in Patients Hospitalized for Heart Failure
by Luca Fazzini, Mattia Casati, Alessandro Martis, Ferdinando Perra, Paolo Rubiolo, Martino Deidda, Giuseppe Mercuro and Christian Cadeddu Dessalvi
J. Clin. Med. 2024, 13(3), 881; https://doi.org/10.3390/jcm13030881 - 02 Feb 2024
Viewed by 580
Abstract
Heart failure (HF) is a significant disease affecting 1–2% of the general population. Despite its general aspects, HF, like other cardiovascular diseases, presents various gender-specific aspects in terms of etiology, hemodynamics, clinical characteristics, therapy, and outcomes. As is well known, HF with preserved [...] Read more.
Heart failure (HF) is a significant disease affecting 1–2% of the general population. Despite its general aspects, HF, like other cardiovascular diseases, presents various gender-specific aspects in terms of etiology, hemodynamics, clinical characteristics, therapy, and outcomes. As is well known, HF with preserved ejection fraction more frequently affects females, with diabetes and arterial hypertension representing the most critical determinants of HF. On the other hand, women are traditionally underrepresented in clinical trials and are often considered undertreated. However, it is not clear whether such differences reflect cultural behaviors and clinical inertia or if they indicate different clinical profiles and the impact of sex on hard clinical outcomes. We aimed to review the sex-related differences in patients affected by HF. Full article
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19 pages, 512 KiB  
Review
The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review
by Valentina Bucciarelli, Anna Vittoria Mattioli, Susanna Sciomer, Federica Moscucci, Giulia Renda and Sabina Gallina
J. Clin. Med. 2023, 12(13), 4347; https://doi.org/10.3390/jcm12134347 - 28 Jun 2023
Cited by 12 | Viewed by 1726
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects [...] Read more.
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women’s lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations. Full article
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13 pages, 712 KiB  
Review
Physical Activity and Diet in Older Women: A Narrative Review
by Anna Vittoria Mattioli, Valentina Selleri, Giada Zanini, Milena Nasi, Marcello Pinti, Claudio Stefanelli, Francesco Fedele and Sabina Gallina
J. Clin. Med. 2023, 12(1), 81; https://doi.org/10.3390/jcm12010081 - 22 Dec 2022
Cited by 13 | Viewed by 2022
Abstract
Physical activity and diet are essential for maintaining good health and preventing the development of non-communicable diseases, especially in the older adults. One aspect that is often over-looked is the different response between men and women to exercise and nutrients. The body’s response [...] Read more.
Physical activity and diet are essential for maintaining good health and preventing the development of non-communicable diseases, especially in the older adults. One aspect that is often over-looked is the different response between men and women to exercise and nutrients. The body’s response to exercise and to different nutrients as well as the choice of foods is different in the two sexes and is strongly influenced by the different hormonal ages in women. The present narrative review analyzes the effects of gender on nutrition and physical activity in older women. Understanding which components of diet and physical activity affect the health status of older women would help target non-pharmacological but lifestyle-related therapeutic interventions. It is interesting to note that this analysis shows a lack of studies dedicated to older women and a lack of studies dedicated to the interactions between diet and physical activity in women. Gender medicine is a current need that still finds little evidence. Full article
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Other

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13 pages, 1278 KiB  
Systematic Review
Between-Sex Differences in Risk Factors for Cardiovascular Disease among Patients with Myocardial Infarction—A Systematic Review
by Jack Charles Barton, Anna Wozniak, Chloe Scott, Abhisekh Chatterjee, Greg Nathan Titterton, Amber Elyse Corrigan, Ashvin Kuri, Viraj Shah, Ian Soh and Juan Carlos Kaski
J. Clin. Med. 2023, 12(15), 5163; https://doi.org/10.3390/jcm12155163 - 07 Aug 2023
Cited by 2 | Viewed by 1568
Abstract
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic [...] Read more.
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work. Full article
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