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153. Sex Differences in Young Patients with Acute Myocardial Infarction: A VIRGO Study Analysis

Author

Bucholz, Emily M., Strait, Kelly M., Dreyer, Rachel P., Lindau, Stacy T., D’Onofrio, Gail, Geda, Mary, Spatz, Erica S., Beltrame, John F., Lichtman, Judith H., Lorenze, Nancy P., Bueno, Hector, and Krumholz, Harlan M.

Subjects
Adult, Male, Adolescent, Myocardial Infarction, Middle Aged, Prognosis, Risk Assessment, Article, United States, Young Adult, Sex Factors, Risk Factors, Spain, Humans, Female, Prospective Studies, Sex Distribution, Follow-Up Studies
Abstract

Young women with acute myocardial infarction (AMI) have a higher risk of adverse outcomes than men. However, it is unclear how young women with AMI are different from young men across a spectrum of characteristics. We sought to compare young women and men at the time of AMI on six domains of demographic and clinical factors in order to determine whether they have distinct profiles.Using data from Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO), a prospective cohort study of women and men aged ⩽55 years hospitalized for AMI ( n = 3501) in the United States and Spain, we evaluated sex differences in demographics, healthcare access, cardiovascular risk and psychosocial factors, symptoms and pre-hospital delay, clinical presentation, and hospital management for AMI. The study sample included 2349 (67%) women and 1152 (33%) men with a mean age of 47 years. Young women with AMI had higher rates of cardiovascular risk factors and comorbidities than men, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, renal failure, and morbid obesity. They also exhibited higher levels of depression and stress, poorer physical and mental health status, and lower quality of life at baseline. Women had more delays in presentation and presented with higher clinical risk scores on average than men; however, men presented with higher levels of cardiac biomarkers and more classic electrocardiogram findings. Women were less likely to undergo revascularization procedures during hospitalization, and women with ST segment elevation myocardial infarction were less likely to receive timely primary reperfusion.Young women with AMI represent a distinct, higher-risk population that is different from young men.

Published
2016

154. Sexual Activity and Function in the Year After an Acute Myocardial Infarction Among Younger Women and Men in the United States and Spain

Author

Lindau, Stacy Tessler, primary, Abramsohn, Emily, additional, Bueno, Hector, additional, D’Onofrio, Gail, additional, Lichtman, Judith H., additional, Lorenze, Nancy P., additional, Sanghani, Rupa Mehta, additional, Spatz, Erica S., additional, Spertus, John A., additional, Strait, Kelly M., additional, Wroblewski, Kristen, additional, Zhou, Shengfan, additional, and Krumholz, Harlan M., additional

Published
2017
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160. Sexual Activity and Function in the Year After an Acute Myocardial Infarction Among Younger Women and Men in the United States and Spain

Author

Lindau, Stacy Tessler, primary, Abramsohn, Emily, additional, Bueno, Hector, additional, D’Onofrio, Gail, additional, Lichtman, Judith H., additional, Lorenze, Nancy P., additional, Sanghani, Rupa Mehta, additional, Spatz, Erica S., additional, Spertus, John A., additional, Strait, Kelly M., additional, Wroblewski, Kristen, additional, Zhou, Shengfan, additional, and Krumholz, Harlan M., additional

Published
2016
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161. Gender Differences in the Trajectory of Recovery in Health Status Among Young Patients With Acute Myocardial Infarction: Results From the VIRGO Study

Author

Dreyer, Rachel P., Wang, Yongfei, Strait, Kelly M., Lorenze, Nancy P., D’Onofrio, Gail, Bueno, Héctor, Lichtman, Judith H., Spertus, John A., and Krumholz, Harlan M.

Subjects
Adult, Male, Sex Characteristics, Time Factors, Health Status, Myocardial Infarction, Recovery of Function, Middle Aged, Article, Treatment Outcome, Risk Factors, Surveys and Questionnaires, Humans, Female, Longitudinal Studies, Prospective Studies, Mortality
Abstract

Despite the excess risk of mortality in young women (≤55 years of age) after acute myocardial infarction (AMI), little is known about young women's health status (symptoms, functioning, quality of life) during the first year of recovery after an AMI. We examined gender differences in health status over time from baseline to 12 months after AMI.A total of 3501 AMI patients (67% women) 18 to 55 years of age were enrolled from 103 US and 24 Spanish hospitals. Data were obtained by medical record abstraction and patient interviews at baseline hospitalization and 1 and 12 months after AMI. Health status was measured by generic (Short Form-12) and disease-specific (Seattle Angina Questionnaire) measures. We compared health status scores at all 3 time points and used longitudinal linear mixed-effects analyses to examine the independent effect of gender, adjusting for time and selected covariates. Women had significantly lower health status scores than men at each assessment (all P values0.0001). After adjustment for time and all covariates, women had Short Form-12 physical/mental summary scores that were -0.96 (95% confidence interval [CI], -1.59 to -0.32) and -2.36 points (95% CI, -2.99 to -1.73) lower than those of men, as well as worse Seattle Angina Questionnaire physical limitations (-2.44 points lower; 95% CI, -3.53 to -1.34), more angina (-1.03 points lower; 95% CI, -1.98 to -0.07), and poorer quality of life (-3.51 points lower; 95% CI, -4.80 to -2.22).Although both genders recover similarly after AMI, women have poorer scores than men on all health status measures, a difference that persisted throughout the entire year after discharge.

Published
2015

163. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association

Author

Bushnell, Cheryl, McCullough, Louise D, Awad, Issam A, Chireau, Monique V, Fedder, Wende N, Furie, Karen L, Howard, Virginia J, Lichtman, Judith H, Lisabeth, Lynda D, Piña, Ileana L, Reeves, Mathew J, Rexrode, Kathryn M, Saposnik, Gustavo, Singh, Vineeta, Towfighi, Amytis, Vaccarino, Viola, Walters, Matthew R, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research

Subjects
sex differences, preeclampsia/eclampsia, Aging, Clinical Sciences, Council on Epidemiology and Prevention, menopause, Guidelines as Topic, Cardiorespiratory Medicine and Haematology, Cardiovascular, Council for High Blood Pressure Research, Council on Cardiovascular and Stroke Nursing, Medical, Humans, atrial fibrillation, Council on Clinical Cardiology, Nutrition, Neurology & Neurosurgery, Prevention, Neurosciences, American Heart Association, stroke, American Heart Association Stroke Council, United States, Brain Disorders, AHA Scientific Statements, hormone replacement therapy, Heart Disease, Good Health and Well Being, Women's Health, Female, metabolic syndrome X, Societies
Abstract

PurposeThe aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation.MethodsWriting group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.ResultsWe provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura.ConclusionsTo more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.

Published
2014

164. Heart disease and stroke statistics--2014 update: a report from the American Heart Association

Author

Go, Alan S, Mozaffarian, Dariush, Roger, Véronique L, Benjamin, Emelia J, Berry, Jarett D, Blaha, Michael J, Dai, Shifan, Ford, Earl S, Fox, Caroline S, Franco, Sheila, Fullerton, Heather J, Gillespie, Cathleen, Hailpern, Susan M, Heit, John A, Howard, Virginia J, Huffman, Mark D, Judd, Suzanne E, Kissela, Brett M, Kittner, Steven J, Lackland, Daniel T, Lichtman, Judith H, Lisabeth, Lynda D, Mackey, Rachel H, Magid, David J, Marcus, Gregory M, Marelli, Ariane, Matchar, David B, McGuire, Darren K, Mohler, Emile R, Moy, Claudia S, Mussolino, Michael E, Neumar, Robert W, Nichol, Graham, Pandey, Dilip K, Paynter, Nina P, Reeves, Matthew J, Sorlie, Paul D, Stein, Joel, Towfighi, Amytis, Turan, Tanya N, Virani, Salim S, Wong, Nathan D, Woo, Daniel, Turner, Melanie B, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Subjects
Heart Diseases, Clinical Sciences, Cardiology, American Heart Association, Cardiorespiratory Medicine and Haematology, stroke, United States, cardiovascular diseases, AHA Scientific Statements, Cardiovascular System & Hematology, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, statistics, Public Health and Health Services, Humans, risk factors, epidemiology
Abstract

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update. © 2013 American Heart Association, Inc.

Published
2014

166. Editor’s Choice-Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis

Author

Bucholz, Emily M, primary, Strait, Kelly M, additional, Dreyer, Rachel P, additional, Lindau, Stacy T, additional, D’Onofrio, Gail, additional, Geda, Mary, additional, Spatz, Erica S, additional, Beltrame, John F, additional, Lichtman, Judith H, additional, Lorenze, Nancy P, additional, Bueno, Hector, additional, and Krumholz, Harlan M, additional

Published
2016
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173. Return to Work After Acute Myocardial Infarction

Author

Dreyer, Rachel P., primary, Xu, Xiao, additional, Zhang, Weiwei, additional, Du, Xue, additional, Strait, Kelly M., additional, Bierlein, Maggie, additional, Bucholz, Emily M., additional, Geda, Mary, additional, Fox, James, additional, D’Onofrio, Gail, additional, Lichtman, Judith H., additional, Bueno, Héctor, additional, Spertus, John A., additional, and Krumholz, Harlan M., additional

Published
2016
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174. Executive Summary: Heart Disease and Stroke Statistics—2016 Update

Author

Mozaffarian, Dariush, primary, Benjamin, Emelia J., additional, Go, Alan S., additional, Arnett, Donna K., additional, Blaha, Michael J., additional, Cushman, Mary, additional, Das, Sandeep R., additional, de Ferranti, Sarah, additional, Després, Jean-Pierre, additional, Fullerton, Heather J., additional, Howard, Virginia J., additional, Huffman, Mark D., additional, Isasi, Carmen R., additional, Jiménez, Monik C., additional, Judd, Suzanne E., additional, Kissela, Brett M., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Liu, Simin, additional, Mackey, Rachel H., additional, Magid, David J., additional, McGuire, Darren K., additional, Mohler, Emile R., additional, Moy, Claudia S., additional, Muntner, Paul, additional, Mussolino, Michael E., additional, Nasir, Khurram, additional, Neumar, Robert W., additional, Nichol, Graham, additional, Palaniappan, Latha, additional, Pandey, Dilip K., additional, Reeves, Mathew J., additional, Rodriguez, Carlos J., additional, Rosamond, Wayne, additional, Sorlie, Paul D., additional, Stein, Joel, additional, Towfighi, Amytis, additional, Turan, Tanya N., additional, Virani, Salim S., additional, Woo, Daniel, additional, Yeh, Robert W., additional, and Turner, Melanie B., additional

Published
2016
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175. National Trends in Outcomes Among Elderly Patients with Heart Failure

Author

Kosiborod, Mikhail, Lichtman, Judith H., Heidenreich, Paul A., Normand, Sharon-Lise T., Wang, Yun, Brass, Lawrence M., and Krumholz, Harlan M.

Subjects
Heart failure -- Complications and side effects, Heart failure -- Care and treatment, Aged patients -- Health aspects, Mortality -- United States, Mortality -- Research, Health, Health care industry
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.11.019 Byline: Mikhail Kosiborod (a), Judith H. Lichtman (b), Paul A. Heidenreich (c), Sharon-Lise T. Normand (d), Yun Wang (e), Lawrence M. Brass (b)(f)(g), Harlan M. Krumholz (e)(h)(i)(j) Keywords: Heart failure; Health services research; Trends Abstract: Despite dramatic changes in heart failure management during the 1990s, little is known about the national heart failure mortality trends during this time period, particularly among the elderly. The purpose of this study was to determine temporal trends in outcomes of elderly patients with heart failure between 1992 and 1999. Author Affiliation: (a) Mid America Heart Institute of Saint Luke's Hospital and the University of Missouri, Kansas City, Mo (b) Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (c) VA Palo Alto Health Care System, and the Department of Medicine, Stanford University, Stanford, Calif (d) Department of Health Care Policy, Harvard Medical School and the Department of Biostatistics, Harvard School of Public Health, Boston, Mass (e) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (f) Department of Neurology, Yale University School of Medicine, New Haven, Conn (g) Neurology Service of the VA Connecticut Healthcare System, West Haven, Conn (h) Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (i) Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn (j) Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn. Article Note: (footnote) This publication was supported by grant number 1 K01 DP000085-01 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. The Centers for Medicare and Medicaid Services (CMS) reviewed and approved the use of its data for this work, and approved submission of the manuscript; this approval is based on data use only, and does not represent a CMS endorsement of or comment on the manuscript content. Neither CDC nor CMS played a role in the design and conduct of the study, or in the analysis and interpretation of the data. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis.

Published
2006

177. Association of Somatic and Cognitive Depressive Symptoms and Biomarkers in Acute Myocardial Infarction: Insights from the TRIUMPH Registry

Author

Smolderen, Kim G., Spertus, John A., Reid, Kimberly J., Buchanan, Donna M., Vaccarino, Viola, Lichtman, Judith H., Bekelman, David B., and Chan, Paul S.

Subjects
Adult, Blood Platelets, Male, Depression, Myocardial Infarction, Health Status Disparities, Middle Aged, Prognosis, Article, Peptide Fragments, Translational Research, Biomedical, Leukocyte Count, Young Adult, C-Reactive Protein, Surveys and Questionnaires, Acute Disease, Natriuretic Peptide, Brain, Humans, Regression Analysis, Female, Registries, Cognition Disorders, Aged, Retrospective Studies
Abstract

Somatic depressive symptoms and certain biomarkers are each associated with worse acute myocardial infarction (AMI) prognosis, but the relationship between depressive symptom domains and inflammatory, neurohormonal, and coagulation markers is unknown.We examined the relationship between depressive symptoms and 1-month biomarker levels (high-sensitivity C-reactive protein [hs-CRP], N-terminal pro-brain natriuretic peptide [NT-proBNP], white blood cell [WBC], platelet counts) in 1265 AMI patients. Depressive symptoms (9-item Patient Health Questionnaire) were assessed during index hospitalization and categorized as somatic or cognitive. Using median regression models, the upper quartile of somatic and cognitive depression scores and each biomarker were compared with the lower three quartiles, adjusting for site, demographics, and clinical characteristics.Although hs-CRP values were higher in patients with somatic symptoms, this association was attenuated after adjustment (B(per SD increase) = .02, 95% confidence interval: .00; .05, p = .07). WBC count was independently associated with somatic depressive symptoms (B(per SD increase) = .28, 95% confidence interval: .12; .44, p.001). Cognitive depressive symptoms were not associated with hs-CRP or WBC count. Neither dimension was associated with NT-proBNP or platelet levels. For each biomarker, the depression dimensions explained1% of their variation.Neither somatic nor cognitive depressive symptoms were meaningfully associated with hs-CRP, NT-proBNP, WBC, or platelet counts 1 month after AMI, suggesting that the association between depression and long-term outcomes may be unrelated to these biomarkers. Future research should explore other biomarkers to better illuminate pathways by which depression adversely impacts AMI prognosis.

Published
2011

179. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials

Author

Hicks, Karen A., primary, Tcheng, James E., additional, Bozkurt, Biykem, additional, Chaitman, Bernard R., additional, Cutlip, Donald E., additional, Farb, Andrew, additional, Fonarow, Gregg C., additional, Jacobs, Jeffrey P., additional, Jaff, Michael R., additional, Lichtman, Judith H., additional, Limacher, Marian C., additional, Mahaffey, Kenneth W., additional, Mehran, Roxana, additional, Nissen, Steven E., additional, Smith, Eric E., additional, and Targum, Shari L., additional

Published
2015
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180. Frequency and Effects of Excess Dosing of Anticoagulants in Patients ≤55 Years With Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention (from the VIRGO Study)

Author

Gupta, Aakriti, primary, Chui, Philip, additional, Zhou, Shengfan, additional, Spertus, John A., additional, Geda, Mary, additional, Lorenze, Nancy, additional, Lee, Ike, additional, D' Onofrio, Gail, additional, Lichtman, Judith H., additional, Alexander, Karen P., additional, Krumholz, Harlan M., additional, and Curtis, Jeptha P., additional

Published
2015
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184. Depressive Symptoms in Younger Women and Men With Acute Myocardial Infarction: Insights From the VIRGO Study

Author

Smolderen, Kim G., primary, Strait, Kelly M., additional, Dreyer, Rachel P., additional, D'Onofrio, Gail, additional, Zhou, Shengfan, additional, Lichtman, Judith H., additional, Geda, Mary, additional, Bueno, Héctor, additional, Beltrame, John, additional, Safdar, Basmah, additional, Krumholz, Harlan M., additional, and Spertus, John A., additional

Published
2015
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186. Abstract P274: Physical Activity Patterns and Determinants Following Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients)

Author

Minges, Karl E, primary, Strait, Kelly M, additional, Camhi, Sarah, additional, Lichtman, Judith H, additional, Dreyer, Rachel P, additional, Geda, Mary, additional, Bueno, Hector, additional, Curtis, Jeptha P, additional, and Krumholz, Harlan M, additional

Published
2015
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188. Sex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients With Acute Myocardial Infarction

Author

Xu, Xiao, primary, Bao, Haikun, additional, Strait, Kelly, additional, Spertus, John A., additional, Lichtman, Judith H., additional, D’Onofrio, Gail, additional, Spatz, Erica, additional, Bucholz, Emily M., additional, Geda, Mary, additional, Lorenze, Nancy P., additional, Bueno, Héctor, additional, Beltrame, John F., additional, and Krumholz, Harlan M., additional

Published
2015
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192. Heart Disease and Stroke Statistics—2015 Update

Author

Mozaffarian, Dariush, primary, Benjamin, Emelia J., additional, Go, Alan S., additional, Arnett, Donna K., additional, Blaha, Michael J., additional, Cushman, Mary, additional, de Ferranti, Sarah, additional, Després, Jean-Pierre, additional, Fullerton, Heather J., additional, Howard, Virginia J., additional, Huffman, Mark D., additional, Judd, Suzanne E., additional, Kissela, Brett M., additional, Lackland, Daniel T., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Liu, Simin, additional, Mackey, Rachel H., additional, Matchar, David B., additional, McGuire, Darren K., additional, Mohler, Emile R., additional, Moy, Claudia S., additional, Muntner, Paul, additional, Mussolino, Michael E., additional, Nasir, Khurram, additional, Neumar, Robert W., additional, Nichol, Graham, additional, Palaniappan, Latha, additional, Pandey, Dilip K., additional, Reeves, Mathew J., additional, Rodriguez, Carlos J., additional, Sorlie, Paul D., additional, Stein, Joel, additional, Towfighi, Amytis, additional, Turan, Tanya N., additional, Virani, Salim S., additional, Willey, Joshua Z., additional, Woo, Daniel, additional, Yeh, Robert W., additional, and Turner, Melanie B., additional

Published
2015
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193. Executive Summary: Heart Disease and Stroke Statistics—2015 Update

Author

Mozaffarian, Dariush, primary, Benjamin, Emelia J., additional, Go, Alan S., additional, Arnett, Donna K., additional, Blaha, Michael J., additional, Cushman, Mary, additional, de Ferranti, Sarah, additional, Després, Jean-Pierre, additional, Fullerton, Heather J., additional, Howard, Virginia J., additional, Huffman, Mark D., additional, Judd, Suzanne E., additional, Kissela, Brett M., additional, Lackland, Daniel T., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Liu, Simin, additional, Mackey, Rachel H., additional, Matchar, David B., additional, McGuire, Darren K., additional, Mohler, Emile R., additional, Moy, Claudia S., additional, Muntner, Paul, additional, Mussolino, Michael E., additional, Nasir, Khurram, additional, Neumar, Robert W., additional, Nichol, Graham, additional, Palaniappan, Latha, additional, Pandey, Dilip K., additional, Reeves, Mathew J., additional, Rodriguez, Carlos J., additional, Sorlie, Paul D., additional, Stein, Joel, additional, Towfighi, Amytis, additional, Turan, Tanya N., additional, Virani, Salim S., additional, Willey, Joshua Z., additional, Woo, Daniel, additional, Yeh, Robert W., additional, and Turner, Melanie B., additional

Published
2015
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194. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

Author

Lichtman, Judith H and Lichtman, Judith H

Abstract

BackgroundAlthough prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.Methods and resultsWriting group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes.ConclusionsDespite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Published
2014

195. Sexual Activity and Counseling in the First Month After Acute Myocardial Infarction Among Younger Adults in the United States and Spain

Author

Lindau, Stacy Tessler, primary, Abramsohn, Emily M., additional, Bueno, Héctor, additional, D’Onofrio, Gail, additional, Lichtman, Judith H., additional, Lorenze, Nancy P., additional, Mehta Sanghani, Rupa, additional, Spatz, Erica S., additional, Spertus, John A., additional, Strait, Kelly, additional, Wroblewski, Kristen, additional, Zhou, Shengfan, additional, and Krumholz, Harlan M., additional

Published
2014
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196. Abstract 18802: Sex Differences in the Risk of 1-year Re-hospitalization in Young Women and Men following Acute Myocardial Infarction

Author

Dreyer, Rachel P, primary, Nkonde-Price, Chileshe, additional, Kennedy, Kevin, additional, Vaccarino, Viola, additional, Parashar, Susmita, additional, Dharmarajan, Kumar, additional, Hammond, Gmerice, additional, Lichtman, Judith H, additional, Smolderen, Kim G, additional, Buchanan, Donna M, additional, Spertus, John A, additional, and Krumholz, Harlan M, additional

Published
2014
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197. Carotid Endarterectomy and Carotid Artery Stenting in the US Medicare Population, 1999-2014.

Author

Lichtman, Judith H., Jones, Michael R., Leifheit, Erica C., Sheffet, Alice J., Howard, George, Lal, Brajesh K., Howard, Virginia J., Yun Wang, Curtis, Jeptha, Brott, Thomas G., and Wang, Yun

Subjects
*CAROTID endarterectomy, *MEDICARE beneficiaries, *SURGICAL stents, *MYOCARDIAL revascularization, *CAROTID artery surgery, *FEE for service (Medical fees), *HEALTH outcome assessment, *PATIENTS, *MEDICAL care, *THERAPEUTICS, *MEDICARE, *MYOCARDIAL infarction, *POISSON distribution, *RESEARCH funding, *STROKE, *CROSS-sectional method, *HOSPITAL mortality, CAROTID artery stenosis
Abstract

Importance: Carotid endarterectomy and carotid artery stenting are the leading approaches to revascularization for carotid stenosis, yet contemporary data on trends in rates and outcomes are limited.Objective: To describe US national trends in performance and outcomes of carotid endarterectomy and stenting among Medicare beneficiaries from 1999 to 2014.Design, Setting, and Participants: Serial cross-sectional analysis of Medicare fee-for-service beneficiaries aged 65 years or older from 1999 to 2014 using the Medicare Inpatient and Denominator files. Spatial mixed models adjusted for age, sex, and race were fit to calculate county-specific risk-standardized revascularization rates. Mixed models were fit to assess trends in outcomes after adjustment for demographics, comorbidities, and symptomatic status.Exposures: Carotid endarterectomy and carotid artery stenting.Main Outcomes and Measures: Revascularization rates per 100 000 beneficiary-years of fee-for-service enrollment, in-hospital mortality, 30-day stroke or death, 30-day stroke, myocardial infarction, or death, 30-day all-cause mortality, and 1-year stroke.Results: During the study, 937 111 unique patients underwent carotid endarterectomy (mean age, 75.8 years; 43% women) and 231 077 underwent carotid artery stenting (mean age, 75.4 years; 49% women). There were 81 306 patients who underwent endarterectomy in 1999 and 36 325 in 2014; national rates per 100 000 beneficiary-years decreased from 298 in 1999-2000 to 128 in 2013-2014 (P < .001). The number of patients who underwent stenting ranged from 10 416 in 1999 to 22 865 in 2006 (an increase per 100 000 beneficiary-years from 40 in 1999-2000 to 75 in 2005-2006; P < .001); by 2014, there were 10 208 patients who underwent stenting and the rate decreased to 38 per 100 000 beneficiary-years (P < .001). Outcomes improved over time despite increases in vascular risk factors (eg, hypertension prevalence increased from 67% to 81% among patients who underwent endarterectomy and from 61% to 70% among patients who underwent stenting) and the proportion of symptomatic patients (all P < .001). There were adjusted annual decreases in 30-day ischemic stroke or death of 2.90% (95% CI, 2.63% to 3.18%) among patients who underwent endarterectomy and 1.13% (95% CI, 0.71% to 1.54%) among patients who underwent stenting; an absolute decrease from 1999 to 2014 was observed for endarterectomy (1.4%; 95% CI, 1.2% to 1.5%) but not stenting (-0.1%; 95% CI, -0.5% to 0.4%). Rates for 1-year ischemic stroke decreased after endarterectomy (absolute decrease, 3.5% [95% CI, 3.2% to 3.7%]; adjusted annual decrease, 2.17% [95% CI, 2.00% to 2.34%]) and stenting (absolute decrease, 1.6% [95% CI, 1.2% to 2.1%]; adjusted annual decrease, 1.86% [95% CI, 1.45%-2.26%]). Additional improvements were noted for in-hospital mortality, 30-day stroke, myocardial infarction, or death, and 30-day all-cause mortality as well as within demographic subgroups.Conclusions and Relevance: Among fee-for-service Medicare beneficiaries, the performance of carotid endarterectomy declined from 1999 to 2014, whereas the performance of carotid artery stenting increased until 2006 and then declined from 2007 to 2014. Outcomes improved despite increases in vascular risk factors. [ABSTRACT FROM AUTHOR]

Published
2017
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198. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association.

Author

Benjamin, Emelia J, Blaha, Michael J, Chiuve, Stephanie E, Cushman, Mary, Das, Sandeep R, Deo, Rajat, de Ferranti, Sarah D, Floyd, James, Fornage, Myriam, Gillespie, Cathleen, Isasi, Carmen R, Jiménez, Monik C, Jordan, Lori Chaffin, Judd, Suzanne E, Lackland, Daniel, Lichtman, Judith H, Lisabeth, Lynda, Liu, Simin, Longenecker, Chris T, and Mackey, Rachel H

Published
2017
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199. Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) Study.

Author

Yuan Lu, Shengfan Zhou, Dreyer, Rachel P., Spatz, Erica S., Geda, Mary, Lorenze, Nancy P., D'Onofrio, Gail, Lichtman, Judith H., Spertus, John A., Ridker, Paul M., Krumholz, Harlan M., Lu, Yuan, and Zhou, Shengfan

Subjects
MYOCARDIAL infarction diagnosis, MYOCARDIAL infarction-related mortality, MYOCARDIAL infarction treatment, AGE factors in disease, BIOCHEMISTRY, C-reactive protein, CHI-squared test, COMPARATIVE studies, ESTERASES, INFLAMMATORY mediators, LONGITUDINAL method, PHENOMENOLOGY, RESEARCH methodology, MEDICAL cooperation, MULTIVARIATE analysis, MYOCARDIAL infarction, REGRESSION analysis, RESEARCH, RESEARCH funding, RISK assessment, SEX distribution, COMORBIDITY, SOCIOECONOMIC factors, EVALUATION research, HEALTH equity
Abstract

Background: Young women (≤55 years of age) with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. Elevated inflammatory markers are associated with an increased risk of cardiovascular outcomes after AMI, but little is known about whether young women have higher inflammatory levels after AMI compared with young men.Methods and Results: We assessed sex differences in post-AMI inflammatory markers and whether such differences account for sex differences in 12-month health status, using data from 2219 adults with AMI, 18 to 55 years of age, in the United States. Inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 were measured 1 month after AMI. Overall, women had higher levels of hsCRP and lipoprotein-associated phospholipase A2 after AMI compared with men, and this remained statistically significant after multivariable adjustment. Regression analyses showed that elevated 1-month hsCRP was associated with poor health status (symptom, function, and quality of life) at 12 months. However, the association between hsCRP and health status became nonsignificant after adjustment for sociodemographics, comorbidities, and treatment factors. Half of these patients had residual inflammatory risk (hsCRP >3 mg/L) compared with a third who had residual cholesterol risk (Low-density lipoprotein cholesterol >100 mg/dL).Conclusions: Young women with AMI had higher inflammatory levels compared with young men. Elevated 1-month hsCRP was associated with poor health status at 12 months after AMI, but this was attenuated after adjustment for patient characteristics. Targeted anti-inflammatory treatments are worthy of consideration for secondary prevention in these patients if ongoing trials of anti-inflammatory therapy prove effective. [ABSTRACT FROM AUTHOR]

Published
2017
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200. Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study.

Author

Lu, Yuan, Zhou, Shengfan, Dreyer, Rachel P., Caulfield, Michael, Spatz, Erica S., Geda, Mary, Lorenze, Nancy P., Herbert, Peter, D'Onofrio, Gail, Jackson, Elizabeth A., Lichtman, Judith H., Bueno, Héctor, Spertus, John A., Krumholz, Harlan M., and D'Onofrio, Gail

Abstract

Background: Young women with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. An adverse lipid profile is an important risk factor for cardiovascular outcomes after AMI, but little is known about whether young women with AMI have a higher-risk lipid pattern than men. We characterized sex differences in lipid profiles and treatment utilization among young adults with AMI.Methods: A total of 2,219 adults with AMI (1,494 women) aged 18-55 years were enrolled from 103 hospitals in the United States (2008-2012). Serum lipids and lipoprotein subclasses were measured 1 month after discharge.Results: More than 90% of adults were discharged on a statin, but less than half received a high-intensity dose and 12% stopped taking treatments by 1 month. For both men and women, the median of low-density lipoprotein (LDL) cholesterol was reduced to <100 mg/dL 1 month after discharge for AMI, but high-density lipoprotein (HDL) cholesterol remained <40 mg/dL. Multivariate regression analyses showed that young women had favorable lipoprotein profiles compared with men: women had higher HDL cholesterol and HDL large particle, but lower total cholesterol-to-HDL cholesterol ratio and LDL small particle.Conclusions: Young women with AMI had slightly favorable lipid and lipoprotein profiles compared with men, suggesting that difference in lipid and lipoprotein may not be a major contributor to sex differences in outcomes after AMI. In both men and women, statin remained inadequately used, and low HDL cholesterol level was a major lipid abnormality. [ABSTRACT FROM AUTHOR]

Published
2017
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