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Aims Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However, little is known about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study.Methods and Results Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events, including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event, symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms, the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2·3 (95% CI 1·2–4·5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1·9 (95% CI 1·02–3·6).Conclusions The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis. [ABSTRACT FROM PUBLISHER]

AimsSocial relations have been repeatedly linked to coronary heart disease in men, even after careful control for standard risk factors. Women have rarely been studied and results have not been conclusive. We investigated the role of social support in the severity and extent of coronary artery disease in women.Methods and ResultsOne hundred and thirty-one women, aged 30 to 65 years, who were hospitalized for an acute coronary event and were included in the Stockholm Female Coronary Risk Study, were examined with com-puter assisted quantitative coronary angiography. Angio-graphic measures included presence of stenosis greater than 50% in at least one coronary artery (severity) and the number of stenoses greater than 20% within the coronary tree (extent). Social factors included two measures of social support, which were previously shown to predict coronary disease in prospective studies of men. After adjustment for age, lack of social support was associated with both measures of coronary artery disease. With further adjustment for smoking, education, meno-pausal status, hypertension, high density lipoprotein and body mass index, the risk ratio for stenosis greater than 50% in women with poor as compared to those with strong social support was 2·5 (95% confidence interval 1·2 to 5·3;P=0·003). Also, women with poor social support had more stenoses obstructing at least 20% of the coronary lumen with multivariate adjustment, but the difference from women with strong support was only of borderline significance (P=0·09).ConclusionThe findings suggest that lack of social support contributes to the severity of coronary artery disease in women, independent of standard risk factors.The European Society of Cardiology [ABSTRACT FROM PUBLISHER]

Background A variety of vascular effects have been ascribed to 17β-oestradiol. These effects may partially explain the reduced incidence of cardiovascular disease found in post-menopausal women on oestrogen replacement therapy. Objectives To evaluate the effects of 2mg sublingual 17β-oestradiol on exercise capacity, exercise-induced myocardial ischaemia and circulating levels of endothelin-1 in post-menopausal women with stable coronary artery disease. Methods Twelve post-menopausal women, mean age 61 (range 52–72) years, with angiographically verified significant coronary artery disease, were randomly assigned to 2mg of sublingual 17β-oestradiol, 2·5mg of buccal nitroglycerine and to placebo in a double-blind cross-over study design with at least 2 days between each of the study arms. Antianginal medications, with the exception of beta-blockers, were discontinued before investigation. All study patients underwent a maximal bicycle exercise test 30min after drug intake. Blood was withdrawn immediately before and up to 8h after medication for analyses of circulating levels of oestradiol and endothelin-1. Results The mean serum levels of oestradiol increased from a control level of 72±28pmol.l−1to 3557± 1631pmol.l−1after 30min and to 5028±3971pmol.l−1after 60min with a gradual decline thereafter. Sublingual 17β-oestradiol did not induce any improvement in exercise duration when compared with nitroglycerin and placebo (500±112s, 505±107s, 498±157s), and did not influence time to onset of ST-segment depression (358±89s, 436±93s, 384±116s). The plasma levels of endothelin-1 did not change after administration of 17β-oestradiol, nitroglycerin or placebo. Conclusions No effects on exercise capacity, exercise-induced acute ischaemia, or plasma levels of endothelin-1 were found after a single dose of 2mg 17β-oestradiol in post-menopausal women with documented coronary artery disease. [ABSTRACT FROM PUBLISHER]

In prospectively collected consecutive patient data from two coronary care units (CCU), 32 patients with acute myocardial infarction (AMI) developed primary or complicating ventricular fibrillation (VF). A I2-lead ECG on the day of admission was available in 30 patients, and was compared to similar ECGs from a control group of 90 consecutive AMI patients without VF. Left anterior hemiblock (LAH) occurred in 33% of the VF patients and in 11% of the controls; the difference is statistically significant. In 20 of the 32 patients the VF occurred during continuous ECG registration. The QRS complex initiating the VF was as frequently of left as it was of right bundle branch block configuration. When compared with a second control group of 77 consecutive AMI patients under continuous ECG recording who did not develop VF, the heart rate in the VF patients was significantly higher just prior to the development of this arrhythmia. The VF initiating coupling interval was shorter than the upper normal limit of the Q T interval in 40% of the VFs. In primary VF and in patients not treated with antiarrhyth-mic drugs the coupling intervals were close to the upper normal limit of the QT interval. In complicating VF and particularly when antiarrhythmic therapy was used the coupling intervals showed a wider variation. [ABSTRACT FROM PUBLISHER]

Cardiovascular diseases (CVD) are the leading cause of mortality both in men and women. In Europe, about 55% of all females' deaths are caused by CVD, especially coronary heart disease and stroke. Unfortunately, however, the risk of heart disease in women is underestimated because of the perception that women are 'protected' against ischaemic heart disease. What is not fully understood is that women during the fertile age have a lower risk of cardiac events, but this protection fades after menopause thus leaving women with untreated risk factors vulnerable to develop myocardial infarction, heart failure, and sudden cardiac death. Furthermore, clinical manifestations of ischaemic heart disease in women may be different from those commonly observed in males and this factor may account for under-recognition of the disease. The European Society of Cardiology has recently initiated an extensive 'Women at heart' program to coordinate research and educational initiatives on CVD in women. A Policy Conference on CVD in Women was one of the first steps in the development of this program. The objective of the conference was to collect the opinion of experts in the field coming from the European Society of Cardiology member countries to: (1) summarize the state-of-the-art from an European perspective; (2) to identify the scientific gaps on CVD in women; and (3) to delineate the strategies for changing the misperception of CVD in women, improving risk stratification, diagnosis, and therapy from a gender perspective and increasing women representation in clinical trials. The Policy Conference has provided the opportunity to review and comment on the current status of knowledge on CVD in women and to prioritize the actions needed to advance this area of knowledge in cardiology. In the preparation of this document we intend to provide the medical community and the stakeholders of this field with an overview of the more critical aspects that have emerged during the discussion. We also propose some immediate actions that should be undertaken with the hope that synergic activities will be implemented at European level with the support of national health care authorities.

Background: A variety of vascular effects have been ascribed to 17 beta-oestradiol. These effects may partially explain the reduced incidence of cardiovascular disease found in post-menopausal women on oestrogen replacement therapy., Objectives: To evaluate the effects of 2 mg sublingual 17 beta-oestradiol on exercise capacity, exercise-induced myocardial ischaemia and circulating levels of endothelin-1 in post-menopausal women with stable coronary artery disease., Methods: Twelve post-menopausal women, mean age 61 (range 52-72) years, with angiographically verified significant coronary artery disease, were randomly assigned to 2 mg of sublingual 17 beta-oestradiol, 2.5 mg of buccal nitroglycerine and to placebo in a double-blind cross-over study design with at least 2 days between each of the study arms. Antianginal medications, with the exception of beta-blockers, were discontinued before investigation. All study patients underwent a maximal bicycle exercise test 30 min after drug intake. Blood was withdrawn immediately before and up to 8 h after medication for analyses of circulating levels of oestradiol and endothelin-1., Results: The mean serum levels of oestradiol increased from a control level of 72 +/- 28 pmol.l-1 to 3557 +/- 1731 pmol.l-1 after 30 min and to 5028 +/- 3971 pmol.l-1 after 60 min with a gradual decline thereafter. Sublingual 17 beta-oestradiol did not induce any improvement in exercise duration when compared with nitroglycerin and placebo (500 +/- 112 s, 505 +/- 107 s, 498 +/- 157 s), and did not influence time to onset of ST-segment depression (358 +/- 89 s, 436 +/- 93 s, 384 +/- 116 s). The plasma levels of endothelin-1 did not change after administration of 17 beta-oestradiol, nitroglycerin or placebo., Conclusions: No effects of exercise capacity, exercise-induced acute ischaemia, or plasma levels of endothelin-1 were found after a single dose of 2 mg 17 beta-oestradiol in post-menopausal women with documented coronary artery disease.