CME: Gender, Stress, & Acute Myocardial Infarction

CME: Gender, Stress, & Acute Myocardial Infarction

Studies have shown that women and younger patients are at increased risk for mental stress when compared with the male or older counterparts, respectively. Whether or not the same holds true for young and middle-aged patients presenting with acute myocardial infarction (AMI) has not been well established. “In general, psychosocial factors are increasingly recognized as important influences on patients’ health status and recovery after major health events,” says Xiao Xu, PhD. “However, studies focusing on AMI tend to recruit older patients. Therefore, little is known about how psychosocial factors may influence outcomes among younger people with AMI.”   A Look at Younger Patients Dr. Xu and colleagues conducted a study that looked at the implications of stress on health outcomes and recovery in younger AMI patients. Published in Circulation, the authors used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes in Young AMI Patients) study. “VIRGO is the largest prospective study that has been conducted in the relatively younger AMI patient population,” Dr. Xu explains. “When that data became available, it presented an ideal opportunity to conduct our analysis. Because the VIRGO study focused on a uniquely large sample of young and middle-age patients, we were able to look at how stress is associated with recovery at 1 month in a younger population and also assess how gender affects outcomes.” For the study, the researchers examined gender differences in stress, factors contributing to these differences, and whether these differences helped explain gender-based disparities observed in 1-month recovery after AMI. Data on more than 3,500 AMI patients aged 18 to 55 were assessed. Self-perceived psychological stress...
Gender, Stress, & Acute Myocardial Infarction

Gender, Stress, & Acute Myocardial Infarction

Studies have shown that women and younger patients are at increased risk for mental stress when compared with the male or older counterparts, respectively. Whether or not the same holds true for young and middle-aged patients presenting with acute myocardial infarction (AMI) has not been well established. “In general, psychosocial factors are increasingly recognized as important influences on patients’ health status and recovery after major health events,” says Xiao Xu, PhD. “However, studies focusing on AMI tend to recruit older patients. Therefore, little is known about how psychosocial factors may influence outcomes among younger people with AMI.”   A Look at Younger Patients Dr. Xu and colleagues conducted a study that looked at the implications of stress on health outcomes and recovery in younger AMI patients. Published in Circulation, the authors used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes in Young AMI Patients) study. “VIRGO is the largest prospective study that has been conducted in the relatively younger AMI patient population,” Dr. Xu explains. “When that data became available, it presented an ideal opportunity to conduct our analysis. Because the VIRGO study focused on a uniquely large sample of young and middle-age patients, we were able to look at how stress is associated with recovery at 1 month in a younger population and also assess how gender affects outcomes.” For the study, the researchers examined gender differences in stress, factors contributing to these differences, and whether these differences helped explain gender-based disparities observed in 1-month recovery after AMI. Data on more than 3,500 AMI patients aged 18 to 55 were assessed. Self-perceived psychological stress...
Lifestyle Strategies for Heart Risks

Lifestyle Strategies for Heart Risks

In 2013, the American Heart Association and the American College of Cardiology published a first-ever joint clinical practice guideline on lifestyle management to reduce cardiovascular disease (CVD) risks. Published simultaneously in Circulation and the Journal of the American College of Cardiology, the guideline is based on a systematic evidence review from studies published between 1990 and 2012. It summarizes key nutrition and physical activity topics for managing blood pressure (BP) and cholesterol. Healthy Eating & Physical Activity “To lead a lifestyle that can reduce CVD risks, heart-healthy eating habits and physical activity are paramount,” says Robert H. Eckel, MD, who co-chaired the expert writing group that developed the guidelines. To lower cholesterol, the guideline strongly recommends limiting saturated fat and trans fat. To lower BP, an emphasis is placed on restricting sodium to no more than 2,400 mg/day. Further reductions of sodium intake to no more than 1,500 mg/day are linked to an even greater reduction in BP. “Eating a heart-healthy diet is more about the overall diet rather than isolating specific foods that are eaten,” adds Dr. Eckel. A heart-healthy diet should focus on fruits, vegetables, and whole grains and include low-fat dairy products, poultry, fish, and nuts. It should also limit red meat, sweets, and sugar-sweetened beverages. “Following this pattern should help limit the intake of saturated fat, trans fat, and sodium to the recommended levels,” Dr. Eckel says. Adaptations to heart-healthy diet plans should be considered based on each person’s caloric requirements, personal and cultural food preferences, and nutrition therapy for other health conditions, such as diabetes. The guideline also recommends moderate- to vigorous-intensity aerobic exercise,...
An Update on CAD in Women

An Update on CAD in Women

Coronary artery disease (CAD) is the leading cause of mortality for men and women in the United States. Historically, CAD has been thought to be a “man’s disease,” perhaps because the average age at first myocardial infarction (MI) is 64.5 years for men, compared with 70.3 years for women. However, data show that mortality rates for CAD are higher among women than men. Recent research suggests that CAD-related mortality rates have increased in young women in recent years, despite a significant decline among all Americans. “When stroke is included as a commonality, the lifetime risk of developing heart disease for women is approaching one in two,” says Martha Gulati, MD, MS, FACC, FAHA. “To put that in perspective, the lifetime risk of women developing breast cancer is one in eight. The risks for breast cancer have been well documented in clinical research. That same level of awareness, however, seems to have escaped patients and providers when it comes to CAD in women.” Assessing CAD According to Dr. Gulati, co-author of an update on CAD in women that was published in Global Heart, the presentation of the disease is often similar to that among men. Two-thirds of women present with the classic symptoms—chest pain, chest pressure, shortness of breath, and sweating—that are described and seen quite often in both men and women, she says. The remaining one-third, however, can present with symptoms that are vaguer. These include: • Diffuse body ache. • Shortness of breath not accompanied by chest pain or pressure. • Pain that is present in only the arms, neck, or back. “The traditional risk factors for CAD...

Analyzing Outcomes for Adults Admitted to Trauma Centers

Over the past 2 decades, significant improvements in mortality outcomes have been observed in various conditions thanks to emphasizing the need for patients to receive recommended evidence-based care and treatments. Less attention, however, has been paid to outcomes resulting from trauma, even though it is the leading cause of potential lost years of life before the age of 65. “Trends in mortality among trauma patients have not been explored adequately in recent research,” says Turner M. Osler, MD, FACS. In an effort to fill this void, Dr. Osler and colleagues conducted a study to determine whether or not mortality rates have improved in trauma patients like they have in other disease states. Published in the Archives of Surgery, the analysis examined longitudinal trends in overall mortality of injured patients who were admitted to level I or level II trauma centers using registry data. A secondary analysis stratified the data by injury severity. Fewer Trauma Mortalities In the study, Dr. Osler and colleagues examined the medical records of nearly 209,000 patients admitted to EDs with injuries who were treated for trauma in 28 hospitals throughout Pennsylvania. Most patients involved in the study were men, but the proportion of patients with mild, moderate, and severe injuries was similar. Blunt trauma and car accidents were the most common causes of trauma, but gunshot wounds, low falls, pedestrian injuries, and stabbings were also reported in the data. “It’s likely that several factors may be responsible for helping people survive trauma.” When comparing 2000-2001 data with that from 2008-2009, the overall mortality rate for patients with moderate injuries decreased by 29% (Figure), and the...
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