Sex differences in Cardiac Diseases

Pathophysiology, Presentation, Diagnosis and Management

1st Edition - January 26, 2021
Imprint: Elsevier
Editors: Niti R. Aggarwal, Malissa J. Wood
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 1 9 3 6 9 - 3
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 1 9 3 7 0 - 9

Significant biological differences exist between men and women that contribute to sex-specific differences in cardiovascular disease (CVD) risk factors, pathophysiology,… Read more

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Significant biological differences exist between men and women that contribute to sex-specific differences in cardiovascular disease (CVD) risk factors, pathophysiology, presentation, response to therapy, and prognosis. It is essential for clinicians to be cognizant of these sex-specific differences in order to reduce the disparity in diagnosis and management of cardiovascular diseases in both genders.

Sex Differences in Cardiac Disease provides a timely review of the contemporary data on these sex-specific differences in pathophysiology, clinical presentation, diagnostic evaluation, and management of cardiovascular diseases that fills a void for clinicians in practice and training. With contributions from renowned experts in the field and guideline writers, the text provides a state-of-the-art review of each topic encompassing the full spectrum of CVD in men and women. Sex-specific guideline-based recommendations are highlighted when available. Tailored to meet the needs of the busy clinicians and researchers, this text provides concise practical data to care for men and women at risk for or with CVD. The book serves as an essential resource for researchers, cardiologists, obstetricians, gynecologists, internists, family practitioners, nurse practitioners and physician assistants, and respective trainees who treat men and women with CVD.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Preface
Acknowledgments
Section I: Introduction
Chapter 1: Introduction: Past, Present, and Future of Heart Disease in Men and Women
Section II: Epidemiology and Prevalence
Chapter 2: Epidemiology and Prevalence
Abstract
Definitions
Sex‐Specific Awareness of Heart Disease in the Public and Medical Community
The Burden of Heart Disease in Men and Women
Prevalence and Epidemiology of Risk Factors in Women
Risk Factors Unique to Women
Incidence and Prevalence of Coronary Heart Disease
Incidence and Prevalence of Heart Failure
Incidence and Prevalence of Atrial Fibrillation
Incidence and Prevalence of Peripheral Arterial Disease
Temporal Trends
Cardiovascular Health Disparities Persist
Race/Ethnicity
Methodologic Limitations of CVD Research in Women
Womeńs Heart Centers
Government Mandates, Policies, and Advocacy
Section III: Ischemic Heart Disease
Chapter 3: Prevention of Cardiovascular Disease
Abstract
Introduction
Traditional (Modifiable) Risk Factors and Sex Differences
Emerging Risk Factors for CVD in Women
Emerging Risk Factors for CVD in Men
Novel Risk Markers in Women and Men
Pharmacologic Prevention Treatments
Enrollment of Women in Cardiovascular Trials
Conclusion
Editor’s Summary
Chapter 4: Acute Coronary Syndrome
Abstract
Introduction
Clinical Presentation
Pathophysiologic Mechanisms
Role of Biomarkers
Sex-Based Disparities in Management
Disparities in Outcomes
Conclusion
Editor’s Summary
Chapter 5: Spontaneous Coronary Artery Dissection
Abstract
Definition and Epidemiology
Distribution of SCAD
Pathophysiology
Genetic Predisposition Including Heritable Connective Tissue Diseases
Precipitating Factors
Clinical Presentation
Diagnosis
Acute Inpatient Management
Outpatient Medications
Cardiac Rehabilitation
Symptom Recurrence
Fibromuscular Dysplasia and Other Extracoronary Vascular Abnormalities
Pregnancy-Associated SCAD and Reproductive Counseling
Psychological Health Considerations
Long-Term Outcomes
Conclusion
Chapter 6: Interventions in Ischemic Heart Disease
Abstract
Introduction
Sex Differences in Pathophysiology of Coronary Artery Disease
Procedural Characteristics of Coronary Interventions in Women
Clinical Outcomes After PCI
Management After Elective PCI in Women
Mechanical Support
Conclusion
Editor’s Summary
Chapter 7: Stable Ischemic Heart Disease
Abstract
Introduction
Definition and Prevalence
Sex Differences in Pathophysiology
Clinical Presentation
Clinical Recognition
Role of Noninvasive Imaging
Relevance of Radiation Exposure Regarding Diagnostic Testing
Management
Conclusion
Editor’s Summary
Chapter 8: Coronary Microvascular Dysfunction
Abstract
Introduction
Pathophysiology of Coronary Microvasculature Disease
Risk Factors for CMD
Clinical Features and Prognosis
Diagnosis of CMD
Treatment
Summary and Conclusion
Editor’s Summary
Chapter 9: Myocardial Infarction With Nonobstructive Coronary Disease
Abstract
Acknowledgment
Definition
Epidemiology
Clinical Presentation of Patient With MINOCA
Causes of MINOCA
Diagnostic Evaluation
Role of Psychological Stress
Management
Prognosis
Conclusion
Section IV: Heart Failure
Chapter 10: Heart Failure With Reduced Ejection Fraction
Abstract
Epidemiology
Risk Factors
Etiologies of HFrEF
Outcomes
Treatment
Knowledge Gaps and Future Directions
Conclusion
Editor’s Summary
Chapter 11: Heart Failure With Preserved Ejection Fraction
Abstract
Epidemiology of HFpEF
Risk Factors and Comorbidities in HFpEF
Pathophysiology of HFpEF
Clinical Presentation of HFpEF
Diagnosis of HFpEF
Prognosis
Management of HFpEF
Conclusion
Existing Gaps in Knowledge and Future Directions
Editor’s Summary
Chapter 12: Pulmonary Arterial Hypertension
Abstract
Introduction
PAH Epidemiology and Sex-Based Differences
PAH Mortality
Right Ventricular Function in PAH
PAH Pathology and Impact of Sex Hormones
PAH Therapies
PAH and Pregnancy
Conclusion
Chapter 13: Takotsubo Syndrome
Abstract
Background and Diagnostic Criteria
Epidemiology
Pathophysiology
Clinical Presentation
Diagnostic Testing
Treatment and Clinical Course
Complications and Prognosis
Recurrence
Knowledge Gaps
Conclusion
Editor’s Summary
Chapter 14: Peripartum Cardiomyopathy
Abstract
Epidemiology
Risk Factors
Pathophysiology
Clinical Presentation and Diagnosis
Treatment and Complications
Prognosis
Mechanical Support and Transplantation
Predictors of Recovery
Subsequent Pregnancy Recommendations
Conclusion
Editor’s Summary
Section V: Valvular Heart Disease
Chapter 15: Valvular Heart Disease
Abstract
Introduction
Aortic Stenosis
Aortic Regurgitation
Mitral Regurgitation
Mitral Stenosis
Tricuspid Regurgitation
Valvular Heart Disease in Pregnancy
Summary and Future Directions
Editor’s Summary
Section VI: Arrhythmias
Chapter 16: Atrial Fibrillation
Abstract
Introduction
Epidemiology
Pathophysiology
Clinical Presentation
Access to Treatment
Management and Prognosis
Rate vs. Rhythm Control
Stroke and Thromboembolism Risk
Future Directions
Conclusion
Editor’s Summary
Chapter 17: Ventricular Arrhythmias
Abstract
Sudden Cardiac Death
Ventricular Arrhythmias Associated With Structural Heart Disease
Ventricular Arrhythmias in the Absence of Underlying Structural Heart Disease
Potential Mechanisms for Sex Differences in Sudden Cardiac Death and Ventricular Arrhythmias
Implantable Cardioverter Defibrillator Therapy and Ventricular Arrhythmias
Conclusion
Editor’s Summary
Chapter 18: Role of ICD and CRT
Abstract
Incidence of Sudden Cardiac Death and HF
Use of Implantable Cardioverter Defibrillators to Prevent Sudden Cardiac Death
Use of Cardiac Resynchronization Therapy Devices
Meta-Analyses and Registries for ICD and CRT
Explaining the Differential Benefits of Primary ICD and CRT on Mortality in Women
Utilization of Cardiac Devices
Complications of Cardiac Devices
Section VII: Vascular Disease
Chapter 19: Peripheral Arterial Disease
Abstract
Risk Factors for PAD
Role of Inflammatory Markers in PAD
Presentation of PAD
Treatment of Patients With PAD
Prognosis and Outcomes After Revascularization
FMD and Other Forms of Nonatherosclerotic Vascular Disease
Conclusion
Editor’s Summary
Section VIII: Congenital Heart Disease
Chapter 20: Congenital Heart Disease
Abstract
Impact of Sex on Congenital Heart Disease: Incidence and Outcomes
Contraception in Women With Congenital Heart Disease
Risk Assessment and Counseling of Adult Congenital Heart Disease Patients
Pregnancy in Women With Congenital Heart Disease
Congenital Heart Lesions in Pregnancy
Anesthesia and Delivery
Sex Differences in Advanced Care Planning in Patients With Adult Congenital Heart Disease
Conclusion
Section IX: Pregnancy-Related Heart Disease
Chapter 21: Pregnancy and Cardiovascular Disease
Abstract
Introduction
Hemodynamics of Pregnancy
Preconception Counseling and Risk Stratification Tools
Mode of Delivery and Interdisciplinary Team
Medication Use During Pregnancy
Safety and Utility of Imaging in Pregnancy
Pregnancy and Valvular Heart Disease
Management of Anticoagulation in Pregnant Women With Prosthetic Valves
Ischemic Heart Disease and Pregnancy
Hypertensive Diseases of Pregnancy
Aortopathies
Arrhythmias During Pregnancy
Pulmonary Hypertension During Pregnancy
Future Directions
Editor’s Summary
Chapter 22: Unique Features of Cardiovascular Pharmacology in Pregnancy and Lactation
Abstract
Introduction
Labeling Risks
Pharmacokinetics in Pregnancy
General Approach to Prescription During Pregnancy and Lactation
Medications
Lipid-Lowering Therapy
Antiplatelet and Antiinflammatory Agents
Hypertension, Heart Failure, and Angina
Pulmonary Hypertension
Anticoagulants
Medications for Arrhythmia Management
Conclusion and Future Directions
Section X: Cardiac Disorders Unique or More Specific to Women
Chapter 23: CardioRheumatology
Abstract
Introduction
Sex-Specific Predominance of Rheumatologic Disorders
Conduction Disease and Arrhythmias
Pericardial Diseases
Myocardial Dysfunction
Valvular Heart Disease
Atherosclerosis/Coronary Artery Disease
Conclusion
Editor’s Summary
Chapter 24: CardioOncology
Abstract
Introduction
The Scope of the Problem and Epidemiology
Sex Susceptibility to Cancer
Cancer and Cardiovascular Complications
Breast Cancer
Cancer Therapy-Related Cardiac Dysfunction (CTRCD)
Breast Cancer Chemotherapy Agents
Predicting Risk of CTRCD
Female-Specific Risk Factors for Chemotherapy-Related Cardiovascular Dysfunction
Detection, Prevention, and Management of Cardiotoxicity Due to Chemotherapy
Risk Factors, Detection, Prevention, and Management of Radiation Associated Cardiac Dysfunction (RACD)
Prostate Cancer Treatment-Related Cardiotoxicity
Conclusion
Chapter 25: Sex Hormones and Their Impact on Cardiovascular Health
Abstract
Overview of the Sex Hormones
Hormone Excess or Deficiency in Men and Women
Cardiovascular Impact of Therapeutic Hormones, Agonists and Antagonists
Cardiovascular Health in Transgender Individuals
Conclusion
Section XI: Psychological Health in CVD
Chapter 26: Psychosocial Issues in Cardiovascular Disease
Abstract
Epidemiology of Depression and Anxiety
Relationship of Depression and Anxiety With CVD
Relationship of Psychosocial Stressors With CVD
Mechanisms Linking Psychosocial Factors to CVD
Management of Psychosocial Issues Among Patients With CVD
Editor’s Summary
Section XII: Pharmacotherapy Considerations in Men and Women
Chapter 27: Cardiovascular Medications
Abstract
Acknowledgment
Introduction
Sex-Related Differences in Pharmacokinetics
Sex-Related Differences in Pharmacodynamics
Adverse Drug Reactions
Female Representation in Clinical Trials
Medication Use, Adherence, and Prescribing Alignment With Clinical Guidelines
Current Challenges and Next Steps
Conclusion
Editor’s Summary
Section XIII: Current Challenges, Opportunities, and Next Steps for Clinicians
Chapter 28: Disparity in Care Across the CVD Spectrum
Abstract
Introduction
Evidence of Sex and Gender Disparities
Sex and Gender Differences in CVD: Risk Factors and Disparities in Their Management
Race and Ethnic Disparities in CVD: Prevalence, Management, and Outcomes
Nonbiological Variables and Their Association With Increased CVD
Flawed Risk Scores Can Result in Risk Miscalculation for Women
History of National Efforts to Reduce CVD in Women
National and Other Significant Community Efforts to Reduce CVD in Ethnic Groups
Current Challenges and Next Steps
Conclusion
Editor’s Summary
Chapter 29: Women’s Heart Programs
Abstract
Introduction
Historical Perspective
Structure and Specialized Areas of Focus of a Women’s Heart Program
Multidisciplinary Approach
Unique Role of Women’s Heart Programs: Enhancing Awareness of Sex-Specific Symptoms, Cardiovascular Risk Factors, Diagnoses, Treatments, and Improving Outcomes
The Role of Women’s Heart Programs in Providing Trainee Guidance and Experience
Role of Women’s Heart Programs in Women-Centered CVD Registries and Research
Role of Women’s Heart Programs in Patient Education
Role of Women’s Heart Programs in Guidelines and Policy Making
Summary and Conclusion
Editor’s Summary
Index

Niti R. Aggarwal

Niti R. Aggarwal, MD, FACC, FASNC is a Senior Associate Consultant of Cardiovascular Medicine, an Assistant Professor of Medicine at Mayo Clinic- Rochester, MN and a Fellow of the American College of Cardiology (ACC). She is recognized nationally and internationally for her research and clinical expertise focused on heart disease in women and multimodal cardiac imaging. As a faculty at the Mayo Clinic’s Women Heart Center, she attracts patients from all over the world. A thought-leader in her field, she has authored numerous publications, and serves on the editorial board for the Journal of Nuclear Cardiology, the ACC’s Women in Cardiovascular Disease Committee, and the program committees for multiple annual scientific meetings. She also serves on the ACC’s Solution Set Oversight Committee overseeing curation and dissemination of national scientific guidelines.

Affiliations and expertise

Senior Associate Consultant, Mayo Clinic, Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States

Malissa J. Wood

Malissa J. Wood, MD, FACC, is an Associate Professor of Medicine at Harvard Medical School where she serves as the Co-director of Massachusetts General Hospital Heart Center Corrigan Women’s Heart Health Program, and the Cathy E. Minehan Chair of Cardiovascular Disease in Women. Dr. Wood is the Principal Director of the Massachusetts General Hospital Spontaneous Coronary Artery Dissection Registry and is a member of Steering Committee of the International Spontaneous Coronary Dissection Registry (iSCAD). Dr. Wood is also the Governor of the Massachusetts American College of Cardiology Chapter. She is the author of numerous manuscripts, chapters and reviews addressing cardiovascular disease in women as well as development of effective approaches designed to address diversity in cardiovascular medicine. Dr. Wood is also the author of two books, Smart at Heart and Thinfluence.

Affiliations and expertise

Associate Professor of Medicine, Harvard Medical School, Co-director Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Massachusetts General Hospital, Boston, MA

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