Electronic Journal Club 2007
FEBRUARY 2007: Article and the analysis
Welcome to our first monthly electronic journal club! This month's article investigates sex differences in atrial fibrillation.
MARCH 2007: Article and the analysis
This month's article proposes a new risk prediction score for women (The Reynold's Risk Score).
http://www.reynoldsriskscore.org/
APRIL 2007: Article and the analysis
Women don't always do worse... This month's article demonstrates that women with systolic heart failure (both ischemic and nonischemic) have better survival than men.
MAY 2007: Article and the analysis
This month's article shows significant improvement in short-term mortality in patients undergoing CABG, particularly in women.
JUNE 2007: Article and the analysis
This month's article is very interesting. Women are less likely than men to present with an abdominal aortic aneurysm (AAA), but the women who do present are more likely to present with a rupturing AAA. Women also have a lower rate of repair and higher adjusted in-hospital mortality. There are currently recommendations for screening all men aged 65 to 75 for AAA because it has been shown to decrease their rupture risk by 50% and decrease their need for emergency operation by 68%. There are currently no national screening recommendations for women.
JULY 2007: Article and the analysis
As a reminder, Dr. Maria Stefanick will be giving a lecture entitled New Perspectives on Menopausal Hormones and Heart Disease: Role of Age and Years since Menopause and the WHI Coronary Artery Calcification Study at the Wednesday, July 18th Littlefield Women's Health Medical Forum from noon-1pm in M-112 (School of Medicine, Alway Bldg). There will be a roundtable discussion following the lecture from 1-2pm in the same room. Lunch will be provided.
As a prelude to this lecture and roundtable discussion, I have reviewed the most recent article from the WHI reporting lower coronary calcium scores in women age 50-59 years who received conjugated equine estrogen (CEE) compared with those who received placebo. I have also attached an article published in April suggesting a trend in reduced CHD risk in younger women (age 50-59) taking CEE vs. placebo compared with a significantly increased risk in those women who were 20 or more years since menopause. All ages taking CEE had a higher risk of stroke compared with those taking placebo.
AUGUST 2007: Article and the analysis
This month's article examines sex differences in mortality trends among diabetics. CVD and all-cause mortality rates are decreasing for non-diabetic patients and men with diabetes, but not for women with diabetes. In addition, disparities in mortality rates between women with and without diabetes have worsened so that diabetic women no longer have a survival advantage over men like their non-diabetic counterparts.
In the accompanying editorial, Dr. Nanette Wenger discusses why deaths among diabetic women may be increasing, including suboptimal risk factor management and disparities in the acute care of CHD.
SEPTEMBER 2007: Article and the analysis
This month's article is an assessment of sex differences claims made in genetic association studies. The focus is not so much on CVD, but on performing sex subgroup differences analyses. While this article evaluates genetic association studies, the points raised are worth considering when doing any subgroup analysis of sex differences.
OCTOBER 2007: Article and the analysis
This was the "hot" sex differences article in October and got quite a bit of press. Thank you to everyone who brought it to my attention. It reiterates what other studies have suggested, which is that men are more likely to get ICDs for primary and secondary prevention of sudden cardiac death. The reason for this remains unclear. From the data we have, women and men seem to derive the same survival benefit from ICD therapy, and differences in use don't seem to be related to age, comorbid conditions, or patient preference.
NOVEMBER 2007: Article and the analysis
This article was published the week after Dr. Natalie Rasgon gave her provocative talk on "The Impact of Depression on Women's Cardiovascular Disease" at the Littlefield Women's Health Medical Forum, so I thought it would be nice to have a consistent theme. While depression and inflammation are highly associated, inflammation appears to be an independent predictor of cardiovascular events rather than an intermediary in the relationship between depression and cardiovascular disease.
I have also included a non-inclusive list of 30 abstracts featured at the American Heart Association this month that covered a broad range of sex-specific and sex-differences research in cardiovascular disease.
DECEMBER 2007: Article and the analysis
It has been over 2.5 years since Taxus IV published data demonstrating that women benefit similarly to men from the use of paclitaxel-eluting stents (PES) (article attached). This was an important publication because it indicated that the benefits of drug-eluting stents (DES) were generalizable to women. This month's article makes the same conclusion about sirolimus-eluting stents (SES), the only other DES currently available in the US. While the analysis of SES was post-hoc (whereas Taxus IV was a pre-specified subset analysis) and women remain under-represented (28% women vs. 72% men), both studies support the use of DES in women (as well as men) presenting with stable or unstable angina and de novo coronary lesions.
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