Cardiovascular Risk in Women: Focus on Hypertension

Hypertension is a major concern in women, contributing to the risk for morbidity and mortality and the development of cardiovascular disease (CVD), heart attack, and stroke. A woman's risk for the development of hypertension increases with age. Although it also affects younger women, hypertension is prevalent in approximately 60% of women >65 years of age. In addition to age, there are specific risk factors and lifestyle contributors for the development of hypertension in women, including obesity, ethnicity, diabetes, and chronic kidney disease. Risk reduction strategies need to be used to help reduce hypertension; maintaining a healthy body weight through diet and exercise, reduced sodium intake, and lower alcohol intake are a few of the approaches for hypertension risk reduction in women. There are several proposed mechanisms for the development of hypertension that are unique to women and pertain to the aging-related elevated risk for hypertension resulting from falling estrogen levels during menopause. Oral contraceptives, pre-eclampsia and polycystic ovary syndrome are special considerations concerning the development and progression of hypertension in women. There are significant awareness issues and care gaps in the treatment of hypertension in women. Therefore, these problems must be faced and efforts need to be taken to resolve the issues surrounding the treatment and control of hypertension in women.     

Cocaine and the Long-Term Risk of Cardiovascular Disease in Women

BackgroundCocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women.MethodsWe analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization.ResultsThe cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72).ConclusionsWomen with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.     

High Risk, High Stakes: Optimizing Cardiovascular Risk Assessment in Women

Women worldwide are at risk for cardiovascular disease (CVD), with CVD mortality accounting for > 50% of deaths in women in the United States. CVD risk stratification in women was traditionally similar to that in men, leading to under-detection of disease in women. Recently women-specific guidelines have raised awareness of female-specific risk factors. Pre-eclampsia has a striking correlation with increased CVD events in women decades after pregnancy. New serum markers of CVD such as C-reactive protein show promise of early detection but have uncertain clinical value since they may not help re-stratify women at intermediate risk. Imaging tests such as coronary artery calcium scoring and carotid intimal medial thickness have been investigated in women. They too may fail to recognize women at long-term increased risk and how to apply these tests clinically is uncertain. This article critically reviews new developments in risk stratification of CVD in women.     

Hormone Replacement Therapy and Cardiovascular Risk in Post-menopausal Women with NIDDM

Female patients with NIDDM have a high prevalence of, and mortality from, coronary heart disease (CHD). Hormone replacement therapy (HRT) may favourably influence several CHD risk factors in post-menopausal NIDDM patients, including dyslipidaemia, hypertension, prothrombotic changes, and endothelial dysfunction. Insulin resistance appears to have a central role in the pathogenesis of these abnormalities and can also be modified by HRT. However, the potentially beneficial effects of HRT in women with NIDDM have been extrapolated from the results of studies in non-diabetic females, as to date there have been few studies in NIDDM patients. In view of their excessive CHD mortality, further research is needed to investigate the effects of different HRT preparations on lipid and non-lipid risk factors in this high-risk population.     

绝经后妇女骨质疏松症与心血管病危险因素的相关性研究

目的探讨绝经后妇女骨密度与冠心病危险因素的相关性研究。方法选取2007年10月—2011年10月航空总医院心内科门诊及住院的绝经后妇女460例,分为骨质疏松组和非骨质疏松组,记录其存在的心血管病危险因素。结果骨质疏松组中,吸烟、高血脂、糖尿病、冠心病所占的比例高于非骨质疏松组,两组比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,糖尿病,高脂血症是绝经后妇女骨质疏松患者的主要危险因素。雌激素水平与绝经后妇女骨密度呈负相关,绝经后妇女体内雌激素水平明显下降。结论老年人骨质疏松是一个全身性疾病,与高脂血症等心血管疾病的危险因素密切相关,治疗时应采取系统全身性措施,绝经后妇女骨质疏松患者更应采取积极的预防和治疗措施。     

Alcohol and HIV Risk Among Russian Women of Childbearing Age

Russia has one of the fastest rising rates of HIV among women in the world. This study sought to identify key factors in HIV transmission among women in Russia. Data were collected as part of a larger clinical trial to prevent alcohol-exposed pregnancies (AEP). Women at risk for an AEP were recruited at women’s clinics; 708 women, aged 18–44 (M = 29.04 years), completed HIV risk surveys. Structural Equation Modeling was used to test the relationships between alcohol use and sex behavior constructs with HIV/STI risk. While the model indicated that multiple factors are involved in women’s HIV/STI risk, the independent alcohol use variable explains 20 % of the variance in women’s HIV/STI risk. The findings suggest that alcohol use directly and indirectly predicts HIV/STI risk among women, and its effect is mediated by alcohol use before sex.     

Racial/Ethnic Differences in Cardiovascular Risk Factors Among Women Veterans

BACKGROUND

Heart disease is the leading cause of death for women in the United States, accounting for 24.5 % of all deaths among women. Earlier research has demonstrated racial/ethnic differences in prevalence of cardiovascular (CVD) risk factors.

OBJECTIVE

To empirically examine the prevalence of CVD risk factors among a national sample of women Veterans by race/ethnicity, providing the first portrait of women Veterans’ cardiovascular care needs.

DESIGN AND PARTICIPANTS

Cross-sectional, national population-based telephone survey of 3,611 women Veterans.

MEASUREMENTS

Women Veterans were queried about presence of diabetes, hypertension, obesity, tobacco use and physical activity. Four racial/ethnic categories were created: Hispanic, Non-Hispanic White (White), Non-Hispanic Black (Black), and Other. Logistic regressions were conducted for each risk factor to test for racial/ethnic differences, controlling for age (under 40 vs. 40 and over).

KEY RESULTS

Racial/ethnic differences in CVD risk factors persisted after adjusting for age. Black women Veterans were more likely to report a diagnosis of diabetes (OR: 2.58, 95 % CI: 1.07, 6.21) or hypertension (OR: 2.31, 95 % CI: 1.10, 4.83) and be obese (OR: 2.06, 95 % CI: 1.05, 3.91) than White women Veterans. Hispanic women Veterans were more likely than White women Veterans to report diabetes (OR: 4.20, 95 % CI: 1.15, 15.39) and daily smoking (OR: 3.38, 95 % CI: 1.01, 11.30), but less likely to report a hypertension diagnosis (OR 0.21, 95% CI: 0.07, 0.64) or to be obese (OR: 0.39, 95 % CI: 0.18, 0.81).

CONCLUSIONS

Among women Veterans, CVD risks vary by race/ethnicity. Black women Veterans consistently face higher CVD risk compared to White women Veterans, while results are mixed for Hispanic women Veterans.

     

Alcohol Consumption and Menstrual Distress in Women at Higher and Lower Risk for Alcoholism

This study investigated whether alcohol consumption varied as a function of menstrual cycle, menstrual distress symptomatology, and global stress in nonalcoholic drinking young women at higher and lower (HR, LR) risk for alcoholism as assessed by family history. Eighty-two normally menstruating women (52 LR and 30 HR) monitored their alcohol intake, physical and affective distress symptoms, and global stress level daily for two consecutive menstrual cycles. Subjects were unaware that their menstrual cycles were being monitored. The results confirmed the presence of increased physical distress symptomatology during the premenstrual and menstrual phases but did not show variation in negative affect or global stress throughout the menstrual cycle. High risk subjects were aware that they were at higher risk for alcoholism and consumed more alcohol. However, alcohol consumption was not related to the menstrual cycle, distress symptoms, or global stress. Subjects reported that they drank most frequently with others for pleasure enhancement and rarely for pain or tension-reduction. Subjects also drank more on weekends than weekdays. These findings argue against the menstrual cycle as etiological in the development of alcoholism. It would appear that social factors influence alcohol consumption in young nonalcoholic women.     

Alcohol Consumption and Cardiovascular Health

BackgroundStudies evaluating alcohol consumption and cardiovascular diseases have shown inconsistent results.MethodsWe performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to March 2022 for all studies that reported the association between alcohol consumption in terms of quantity (daily or weekly amounts) and type of beverage (wine, beer or spirit) and cardiovascular disease events.ResultsThe study population included a total of 1,579,435 individuals based on 56 cohorts from several countries. We found that moderate wine consumption defined as 1-4 drinks per week was associated with a reduction in risk for cardiovascular mortality when compared with beer or spirits. However, higher risk for cardiovascular disease mortality was typically seen with heavier daily or weekly alcohol consumption across all types of beverages.ConclusionsIt is possible that the observational studies may overestimate the benefits of alcohol for cardiovascular disease outcomes. Although moderate wine consumption is probably associated with low cardiovascular disease events, there are many confounding factors, in particular, lifestyle, genetic, and socioeconomic associations with wine drinking, which likely explain much of the association with wine and reduced cardiovascular disease events. Further prospective study of alcohol and all-cause mortality, including cancer, is needed.     

Alcohol and the Cardiovascular System

Cardiovascular damage associated with alcohol abuse is predominantly seen with persistent heavy drinking. Occasionally nutritional deficiencies or congeners in alcoholic beverages may cause cardiac disease. Alcohol use is associated with other changes in lifestyle, especially smoking, which may also contribute to the associations between heavy drinking and cardiovascular disease. Alcohol excess is associated with hypertension, heart muscle disease and arrhythmias. Moderate drinking may reduce cardiovascular mortality compared to heavy drinking or abstension, but this is still controversial. Consumption of small amounts of alcohol in patients with angina causes temporary impairment of heart function. Diagnostic awareness of alcohol excess in cardiovascular disease needs to be increased and improvements in screening may be of assistance. The foetal alcohol syndrome includes cardiac malformations and requires greater efforts in prevention.     

Cardiovascular Disease Risk Factors Among Women Veterans at VA Medical Facilities

BACKGROUND

Hypertension, hyperlipidemia, diabetes, and obesity in middle adulthood each elevate the long-term risk of cardiovascular disease (CVD). The prevalence of these conditions among women veterans is incompletely described.

OBJECTIVE

To describe the prevalence of CVD risk factors among women veterans in middle adulthood.

DESIGN

Serial cross-sectional studies of data from the Diabetes Epidemiologic Cohorts (DEpiC), a national, longitudinal data set including information on all patients in the Veterans Health Administration (VA).

PARTICIPANTS

Women veterans (n?=?255,891) and men veterans (n?=?2,271,605) aged 35–64 receiving VA care in fiscal year (FY) 2010.

MAIN MEASURES

Prevalence of CVD risk factors in FY2010 by age and, for those aged 45–54 years, by race, region, period of military service, priority status, and mental illness or substance abuse; prevalence by year from 2000 to 2010 in women veterans receiving VA care in both 2000 and 2010 who were free of the factor in 2000.

KEY RESULTS

Hypertension, hyperlipidemia, and diabetes were common among women and men, although more so among men. Hypertension was present in 13 % of women aged 35–44 years, 28 % of women aged 45–54, and 42 % of women aged 55–64. Hyperlipidemia prevalence was similar. Diabetes affected 4 % of women aged 35–44, and increased more than four-fold in prevalence to 18 % by age 55–64. The prevalence of obesity increased from 14 % to 18 % with age among women and was similarly prevalent in men. The relative rate of having two or more CVD risk factors in women compared to men increased progressively with age, from 0.55 (35–44 years) to 0.71 (45–54) to 0.73 (55–64). Most of the women with a factor present in 2010 were first diagnosed with the condition in the 10 years between 2000 and 2010.

CONCLUSIONS

CVD risk factors are common among women veterans aged 35–64. Future research should investigate which interventions would most effectively reduce risk in this population.