Added: Tasheika Losada - Date: 05.11.2021 12:19 - Views: 24501 - Clicks: 9102
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C ardiovascular disease CVD is the leading cause of death in the United States, ing for one in every three deaths. Annual CVD prevalence and mortality remains higher in women than men, a trend that has persisted for decades. Despite these advances, female CVD mortality rate remains disproportionately high and the root causes underlying this inequity remain speculative.
However, when they adjust using the Killip or TIMI risk scoring system, the unexplained additional risk in women disappears. This finding highlights the need for further investigation in comparing the variables of the three aforementioned risk-scoring systems to elucidate the strongest mortality risk factors in women with STEMI. As shown in Table 1the Killip scoring system is comprised of only two variables: severity of heart failure and systolic blood pressure.
In addition, however, the impact of heart failure as a risk factor for STEMI mortality brings up the point that relatively less is known regarding heart failure with preserved ejection fraction HFpEFwhich is more common in women, and therefore specific strategies to investigate and understand HFpEF in women are urgently needed.
These variables may be responsible for some of the sex-specific differences in mortality by either raising female risk or lowering male risk. The most commonly used cardiac enzymes in risk stratification, such as cardiac troponin I cTnI and cardiac troponin T cTnThave been shown to have ificantly different mean concentrations between men and women, suggesting the need for establishment of sex-specific ranges.
Subsequently, they found that the women identified using high sensitivity cTnI sex-specific thresholds had the highest risk of mortality or recurrent MI, indicating that these women can potentially greatly benefit from reclassification and treatment. Sex-specific differences in cardiac enzymes by gender can be partially explained by the finding that troponin levels correlate with left ventricular mass, and women have smaller left ventricular mass regardless of adjustment for height or body surface area.
Similar to differences in cardiac enzyme levels, sex-specific differences in circulating creatinine levels have been discussed in the literature. Women in general have less muscle mass and therefore lower baseline serum creatinine. Barthelemy et al. Decreased kidney function is associated with higher risk of recurrent CHD events and mortality from CHD and all causes.
In terms of sex differences in cardiac arrest, several studies have shown that women who suffer a cardiac arrest have higher survival to hospital admission but worse prognosis in the hospital. The higher prevalence of nonshockable rhythms could be secondary to lower incidence of bystander cardiopulmonary resuscitation, an intervention that has been shown to maintain ventricular fibrillation, as well as cardiac arrests due to noncardiac etiologies in women compared with men.
Overall, women who present with cardiac arrest at admission are at higher risk for mortality than men who present with cardiac arrest at admission. The sex differences in cardiac enzymes, creatinine, and cardiac arrest at admission that are utilized in the GRACE scoring system but not in the Killip and TIMI scoring systems contributes to our understanding regarding why the GRACE scoring system identifies the excess mortality in women with STEMI and provides insight into sex-specific risk stratification.
Specifically, because the GRACE score correctly identifies the higher mortality experienced by women with STEMI, and includes variables that vary ificantly according to sex, these data identify areas of focus for both investigation and guideline formation. Further sex-specific investigation into high sensitivity cardiac troponin cTnI or cTnTnovel biomarkers of relevance to ischemic heart disease and sudden death is ongoing and needed.
Guidelines whereby clinical chemistry laboratory reporting stratifies troponin and creatinine according to male and female ranges should be tested and established. It is clear that current risk scores, which are based on ACS thresholds determined in predominantly male-based populations, do not work well for predicting risk in women. These data combined with the disparate CVD outcomes in women call for the further development and use of sex-specific biomarker ranges and risk stratification tools in order to enhance the diagnosis, treatment, and follow-up in female populations.
Lastly, while risk scores are particularly useful for quality assurance purposes, they have demonstrated strong discriminatory utility in understanding outcomes following percutaneous intervention at the individual level both in the short and long term and therefore should be maintained and evolved with new sex-specific criteria. This work was supported by contracts from the National Heart, Lung. National Center for Biotechnology InformationU. Journal of Women's Health. J Womens Health Larchmt. Find articles by Shilpa Agrawal. Find articles by Jennifer Van Eyk. Find articles by Kimia Sobhani.
Find articles by Janet Wei. Find articles by C. Noel Bairey Merz. Author information Copyright and information Disclaimer. Corresponding author. CopyrightMary Ann Liebert, Inc. This article has been cited by other articles in PMC. Table 1. Risk Scoring System Component Variables. Open in a separate window. Acknowledgments This work was supported by contracts from the National Heart, Lung.
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Sex, Myocardial Infarction, and the Failure of Risk Scores in Women