Multidisciplinary management of cardiovascular disease in women: Delphi consensus

BackgroundCurrent clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women.MethodsThrough a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up.ResultsAfter two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men.ConclusionsThe high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic

Lipid profile changes during the menopausal transition

Objectives:There is evidence that the menopausal transition in women is accompanied by changes in themetabolic profile. We evaluated the lipid profile during the perimenopause to postmenopause transition and itsassociation with menopausal status.Methods:This is a retrospective observational study of laboratory studies from women presenting to thegynecology unit of Hospital Quiro ́ n Salud, Madrid (2007-2018) with irregular menstruation, amenorrhea ormenopausal symptoms. Inclusion criteria were one or more blood samples with determinations of fasting glucoseand lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol[HDL-c] and triglycerides [TGs]) from women with a menopause diagnosis recorded in the hospital database. Thedeterminations were classified as perimenopausal or postmenopausal based on the date of last menstruation.Results:In total, 13,517 laboratory studies (3,073 perimenopausal and 10,444 postmenopausal) from 275 womenwere analyzed. Total cholesterol, LDL-c, and TG levels were significantly higher in postmenopausal women than inperimenopausal women, whereas HDL-c levels were significantly lower (P<0.05 in all cases). Further adjustmentby age showed differences only in LDL-c levels. Menopausal status, TG levels, and the number of pregnancies wereindependently related with total cholesterol and LDL-c levels. HDL-c levels were independently affected bymenopausal age, TG levels, and number of pregnancies. Finally, TG concentration was independently affected bytotal cholesterol, LDL-c, and HDL-c levels.Conclusion:Our study suggests that significant changes in LDL-c levels occur during the menopausal transition.Total cholesterol and LDL-c changes are independently affected by menopausal status and HDL-c is influenced bymenopausal age.Sin financiación2.953 JCR (2020) Q2, 35/83 Obstetrics & Ginecology1.086 SJR (2020) Q1, 37/181 Obstetrics and GynecologyNo data IDR 2020UE

Fasting plasmatic glucose changes during the menopausal transition

OBJETIVO: Evaluar los cambios en la glucemia en ayunas en mujeres en transición a la menopausia. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, de una cohorte de mujeres atendidas en el Hospital Quirón Salud de Madrid entre 2007 y 2018. Criterios de inclusión: diagnóstico del ginecólogo y al menos una medición en ayunas de la glucemia y perfil lipídico. Los reportes del laboratorio se clasificaron en perimenopáu-sicos o posmenopáusicos, según la fecha de la última menstruación. Para el análisis estadístico se utilizaron las siguientes pruebas: χ2, t de Student, U-Mann Whitney (dependiendo del comportamiento paramétrico) y ANOVA. RESULTADOS: Se incluyeron 1949 reportes de glucemia en ayunas: 459 (23.6%) en pacientes en la perimenopausia y 1490 (76.4%) en la posmenopausia (n = 275). La glucemia en ayunas fue significativamente mayor en las mujeres en la posmenopausia (p < 0.001). En el cambio de la glucemia en ayunas a lo largo del tiempo, según la fecha de la última menstruación, se observó un aumento continuo de la glucemia, sin diferencias significativas entre la peri y posmenopausia. La edad al momento de los estudios, la diabetes gestacional, los antecedentes familiares de diabetes y las con-centraciones de triglicéridos se asociaron, de forma independiente, con la glucemia en ayunas (p < 0.001 en todos los casos). CONCLUSIONES: Las diferencias en la glucemia en ayunas entre los periodos de pe-rimenopausia y posmenopausia son significativas; sin embargo, los datos del cambio de la glucemia ajustados por edad y tratamiento sugieren que el estado menopáusico no actúa de forma independiente en la glucemia en ayunas. Los que sí influyeron fue-ron: la edad al momento de las mediciones, la diabetes gestacional, los antecedentes familiares de diabetes y las concentraciones de triglicéridosOBJECTIVE: To evaluate the fasting plasmatic glucose changes during the menopausal transition. MATERIALS ANDMETHODS: This is a retrospective observational study of laboratory studies from women visited in hospital Quirón Salud de Madrid from 2007-2018 years. The inclusion criteria were one or more laboratory studies of fasting plasmatic glucose and lipid profile from women visited because of irregular menstruation, menopausal symptoms and/or amenorrhea. Laboratory studies values were classified as perimeno-pausal or posmenopausal based on their date of last menstruation. For quantitative variables, Student's T or Mann-Whitney U tests (depending on the normality distribu-tion) were applied to analyze differences between perimenopausal and posmenopausal values. Chi-square or Fisher's exact test were used for qualitative variables. ANOVA test was performed to compare the glucose quartiles. RESULTS: 1949 laboratory reports of fasting glucose were included: 459 (23.6%) were perimenopausal and 1490 (76.4%) were posmenopausal, from 275 women with 7.3 laboratory report-women. Fasting plasmatic glucose was higher at the posmenopausal samples (p < 0.001). The evolution of the fasting plasmatic glucose showed a continuous increase that starts during perimenopause. There were no significant differences in the evolution trend between perimenopause and posmenopause. Age in the moment of the blood sample, gestational diabetes, family history of diabetes and triglycerides levels were independently associated with fasting plasmatic glucose (p < 0.001 in all cases). CONCLUSION: The differences in fasting blood glucose between periods of perimeno-pause and posmenopause are significant; however, data on age-adjusted blood glucose change and treatment suggest that menopausal status does not act independently on fasting blood glucose. Those that did influence were: age at the time of the measure-ments, gestational diabetes, family history of diabetes and triglyceride concentrationsSin financiaciónNo data JCR 20200.126 SJR (2020) Q4, 2219/2447 Medicine (miscellaneous)No data IDR 2020UE

Multidisciplinary management of cardiovascular disease in women: Delphi consensus.

Background: Current clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women. Methods: Through a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up. Results: After two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men. Conclusions: The high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic.809 K