Differences in Epidemiology and Risk Factors for Atrial Fibrillation Between Women and Men

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is one of the most frequent cardiovascular diseases among both women and men. Although age-adjusted AF incidence and prevalence is larger among men, women are older at the time of AF diagnosis and have larger risk for AF-associated adverse outcomes such as morality and stroke. Based on evidence from epidemiological studies, elevated body mass index seems to confer a higher risk of AF among men. However, evidence regarding sex differences in the association between diabetes mellitus, elevated blood pressure, and dysglycemia with AF remains conflicting. While men with AF have larger burden of coronary artery disease, women with AF tend to have a larger prevalence of heart failure and valvular heart disease. Recently, several women-specific risk factors including pregnancy and its complications and number of children have been associated with AF. Earlier age at menopause, despite being a strong marker of adverse cardiometabolic risk, does not seem to be associated with increased risk of AF. To reduce the AF burden in both genders, better understanding of the differences between women and men with regard to AF is central. Large-scale studies are needed to separately investigate and report on women and men. Besides observations from epidemiological and clinical studies, to improve our understanding of sexual dimorphism in AF, sufficiently large genome-wide association studies as well as well-powered Mendelian randomization studies are essential to shed light on the sex-specific nature of the associations of risk factors with AF

Subclinical Measures of Atherosclerosis: Genetics and Cardiovascular Risk Prediction

__Abstract__ Atherosclerosis is a chronic, progressive, systematic condition with a long asymptomatic phase. Atherosclerosis develops gradually as a subclinical condition over the life course and eventually becomes clinically apparent as ischemic heart disease, cerebrovascular disease, or peripheral arterial disease. Subclinical atherosclerosis, or preclinical atherosclerosis, refers to the early stage of the atherosclerosis process when within the vascular walls “something has started to change”, yet the cardiovascular disease is not clinically evident. Detecting the forthcoming disease at this stage, before the clinical manifestations, has gained interest over the past decade. Coronary artery calcifi cation, carotid intima-media thickness, and ankle- brachial index are three measures of subclinical atherosclerosis burden that can be detected and quantifi ed non-invasively

Genetic Research and Women’s Heart Disease: a Primer

PURPOSE OF REVIEW: This review provides a brief synopsis of sexual dimorphism in atherosclerosis with an emphasis on genetic studies aimed to better understand the atherosclerotic process and clinical outcomes in women. Such studies are warranted because development of atherosclerosis, impact of several traditional risk factors, and burden of coronary heart disease (CHD) differ between women and men. RECENT FINDINGS: While most candidate gene studies pool women and men and adjust for sex, some sex-specific studies provide evidence of association between candidate genes and prevalent and incident CHD in women. So far, most genome-wide association studies (GWAS) also failed to consider sex-specific associations. The few GWAS focused on women tended to have small sample sizes and insufficient power to reject the null hypothesis of no association even if associations exist. SUMMARY: Few studies consider that sex can modify the effect of gene variants on CHD. Sufficiently large-scale genetic studies in women of different race/ethnic groups, taking into account possible gene-gene and gene-environment interactions as well as hormone-mediated epigenetic mechanisms, are needed. Using the same disease definition for women and men might not be appropriate. Accurate phenotyping and inclusion of relevant outcomes in women, together with targeting the entire spectrum of atherosclerosis, could help address the contribution of genes to sexual dimorphism in atherosclerosis. Discovered genetic loci should be taken forward for replication and functional studies to elucidate the plausible underlying biological mechanisms. A better understanding of the etiology of atherosclerosis in women would facilitate future prevention efforts and interventions

The need for national diagnostic reference levels: Entrance surface dose measurement in intraoral radiography

Background: Intraoral radiographies are the most frequent X-ray examinations in humans. According to International Commission on Radiation Protection (ICRP) recommendations, the selection of a diagnostic reference level (DRL) should be specific to a country or region. Critical organs such as thyroid gland are exposed to X-rays in intraoral radiography and these exposures should be kept as low as reasonably achievable. To assist the development of DRLs for intraoral radiography, a National Radiation Protection Department-sponsored pilot study was carried out. Materials and Methods: Thermoluminescent dosimetry (TLD) is widely acknowledged to be the recommended method for measuring entrance surface doses (ESD). In this study, ESD was measured using LiF thermoluminescent dosimeters (TLD-100) on the skin (either mandibular or maxillary arcs) of 40 patients. Three TLD chips were placed on the skin of each patient. The doses were averaged for each radiography and mean ESD of all patients calculated. Results: The mean ± SD entrance surface dose at the center of the beam on the patients' skin in intraoral radiography was 1.173 ± 0.606 mGy (ranged from 0.01 to 0.40 mGy). The mean ESD for male and female patients were 1.380 ± 0.823, and 1.004 ± 0.258 respectively. No statistically significant difference was found between these means. Despite its necessity, in national level, there is no published data on the diagnostic reference levels for intraoral radiography. However, the results obtained in this study are lower than those reported by investigators in other countries. Conclusion: In IR Iran, due to lack of large scale studies, no diagnostic reference levels have been set for X-ray diagnostic procedures. Due to lack of national diagnostic reference levels, it is not possible to clarify whether in intraoral radiographies any dose reduction techniques are needed. We intend to perform similar nationwide studies to set the diagnostic reference level for intraoal radio graphy

Entrance surface dose measurement on the thyroid gland in orthopantomography: The need for optimization

Background: The anatomic position and proven radiosensitivity of the thyroid make it an organ of concern in dental X-ray examinations. A National Radiation Protection Department (NRPD)-sponsored pilot study carried out in the Dental Radiology Department of RUMS., to assess if the radiation dose in panoramic radiographies could be reduced without significant impairment of the subjective image quality. Materials and Methods: Thermoluminescent dosimetry (TLD) is widely acknowledged to be the recommended method for measuring entrance surface doses (ESD). In this study, ESD was measured using LiF thermoluminescent dosimeters (TLD-100) on the thyroid of 40 patients who had referred to the School of Dentistry, Rafsanjan University of Medical Sciences. Patients were not exposed to any additional radiation and the radiographs were used for diagnostic purposes. TLDs were calibrated with radiation energies similar to those commonly used in orthopantomography. Results: The overall mean ESD on the thyroid in orthopantomography was 0.071 ± 0.012 mGy (ranged from 0.01 to 0.40 mGy). The mean ESD for radiographies performed with 66 kVp (20 patients) and 68 kVp (20 patients) were 0.072 ± 0.019, and 0.070 ± 0.016 respectively. No statistically significant difference was found between these means. Conclusions: The measured surface doses in our study are inconsistent with the only one already reported about the same experiment. However, due to lack of national diagnostic reference levels for orthopantomography, it is not clear whether in case of the PM 2002 CC unit used in this experiment, reducing the radiation dose to a level that still keeps a diagnostically acceptable image quality is necessary

Sex-specific normal values and determinants of infrarenal abdominal aortic diameter among non-aneurysmal elderly population

To establish age- and sex-specific distribution of the infrarenal abdominal aortic diameters (IAD) among non-aneurysmal elderly population and to investigate the associations between traditional cardiovascular risk factors and IAD in men and women. We included 4032 participants (mean age 67.2 years; 60.4% women) from the population-based Rotterdam Study, free of cardiovascular disease, who underwent IAD ultrasound assessment between 2009–2014. Linear regression analysis was used to identify determinants of IAD. The medians (inter-quartile range) of absolute IAD and body surface area (BSA)-adjusted IAD were 17.0 (15.0–18.0) mm and 9.3 (8.5–10.2) mm for women and 19.0 (18.0–21.0) mm and 9.4 (8.6–10.3) mm for men, respectively. There was a non-linear relationship between age and IAD. IAD increased steeply with advancing age and up to 70 years. After around 75 years of age, the diameter values reached a plateau. Waist circumference and diastolic blood pressure were associated with larger diameters in both sexes. Body mass index [Effect estimate (95% CI): 0.04 (0.00 to 0.08)], systolic blood pressure [− 0.01(− 0.02 to 0.00)], current smoking [0.35 (0.06 to 0.65)], total cholesterol levels [− 0.21 (− 0.31 to − 0.11)], and lipid-lowering medication [− 0.43 (− 0.67 to − 0.19)] were significantly associated with IAD in women. Sex differences in IAD values diminished after taking BSA into account. The increase in diameters was attenuated after 70 years. Differences were observed in the associations of several cardiovascular risk factors with IAD among men and women.</p

The healthy beverage index is not associated with insulin resistance, prediabetes and type 2 diabetes risk in the Rotterdam Study

Purpose:Whether beverage quality affects changes in glycaemic traits and type 2 diabetes (T2D) risk is unknown. We examined associations of a previously developed Healthy Beverage Index (HBI) with insulin resistance, and risk of prediabetes and T2D. Methods: We included 6769 participants (59% female, 62.0 ± 7.8 years) from the Rotterdam Study cohort free of diabetes at baseline. Diet was assessed using food-frequency questionnaires at baseline. The HBI included 10 components (energy from beverages, meeting fluid requirements, water, coffee and tea, low-fat milk, diet drinks, juices, alcohol, full-fat milk, and sugar-sweetened beverages), with a total score ranging from 0 to 100. A higher score represents a healthier beverage pattern. Data on study outcomes were available from 1993 to 2015. Multivariable linear mixed models and Cox proportional-hazards regression models were used to examine associations of the HBI (per 10 points increment) with two measurements of HOMA-IR (a proxy for insulin resistance), and risk of prediabetes and T2D. Results: During follow-up, we documented 1139 prediabetes and 784 T2D cases. Mean ± SD of the HBI was 66.8 ± 14.4. Higher HBI score was not associated with HOMA-IR (β: 0.003; 95% CI − 0.007, 0.014), or with risk of prediabetes (HR: 1.01; 95% CI 0.97, 1.06), or T2D (HR: 1.01; 95% CI 0.96, 1.07). Conclusion: Our findings suggest no major role for overall beverage intake quality assessed with the HBI in insulin resistance, prediabetes and T2D incidence. The HBI may not be an adequate tool to assess beverage intake quality in our population.</p