Knowledge of and Accordance with the Academy Evidence-Based Nutrition Practice Guideline for Disorders of Lipid Metabolism

The purpose of this study was to determine knowledge of and accordance with practices recommended by the Academy of Nutrition and Dietetics Guideline for Disorders of Lipid Metabolism. Knowledge and food frequency questionnaires were completed by dyslipidemic patients from an outpatient cardiology clinic (n = 51). Participants were primarily white (74.5%), obese (64.7%), female (64.7%) adults 62.0 ± 9.3 years of age. Mean Disorders of Lipid Metabolism guideline knowledge score was 53.l ± 13.4% correct. Mean accordance was 35.4 ± 13.0% correct. There were no significant associations between knowledge and accordance (rs = 0.175, P = .219). In addition to increasing knowledge, registered dietitians should focus on behavior modification to increase accordance

The Association between KIF6 Single Nucleotide Polymorphism rs20455 and Serum Lipids in Filipino-American Women

The Trp719Arg allele of KIF6 rs20455, a putative risk factor for CHD especially in those with elevated low-density lipoprotein cholesterol (LDL-C), was investigated in Filipino-American women (FAW, n=235) participating in health screenings in four cities. The rs20455 genotype of each subject was determined by a multiplex assay using a Luminex-OLA procedure. The risk allele Trp719Arg was present in 77% of the subjects. The genotype distribution was 23% Trp/Trp, 51% Arg/Trp, and 26% Arg/Arg. Genotype did not predict the presence of CHD risk factors. Moreover, LDL-C, HDL-C, and triglycerides mean values did not vary as a function of genotype. However, those with the Arg/Arg genotype on statin medication exhibited a significantly higher mean triglycerides level (P<0.01). Approximately 60% of participants regardless of genotype exhibited LDL-C levels ≥100 mg/dL but were not taking medication. Approximately 43% of those with the Trp719Arg risk allele on statins exhibited elevated LDL-C levels. Our study suggests that the Trp719Arg allele of KIF 6 rs20455 is common among Filipino-American women; thus, even with borderline LDL-C levels would benefit from statin treatment. Secondly, many participants did not exhibit guideline recommended LDL-C levels including many who were on statin drugs

Proprotein-Convertase Subtilisin-Kexin Type 9 and Low-Density Lipoprotein Receptor Genotype Distribution and Statin Association in Filipino American Women

Filipino American women (FAW) have high incidence of coronary heart disease and high low-density lipoprotein cholesterol (LDL-C). The distribution of rs11206510 proprotein-convertase subtilisin-kexin type 9 (PCSK9) and rs1122608 low-density lipoprotein receptor (LDLR) single nucleotide polymorphisms (SNPs), known for genetic influences on LDL-C, is unknown in this population. The objective of this study was to examine the genetic determinants of LDL-C, their association with LDL-C, and effects of statins on LDL-C given the genetic determinants in this high-risk population. Data were obtained from the FAW Cardiovascular Study ( N = 338) of women ages 40 to 65 years from four major U.S. cities between 2011 and 2013. Roche Modular methodology and Luminex-oligonucleotide ligation assay procedure were used for allele frequency, genotype, LDL-C, and lipid analysis. Analysis of variance was used to determine differences between genotype groups. Genotype and statin effect on LDL-C were tested using the generalized linear model procedure of SAS. The distribution of rs11206510 PCSK9 genotypes was 88% TT, 11% TC, and 1% CC, and the rs1122608 LDLR genotype distribution was 83% GG, 17% GT, and 0% TT. These SNPs showed no association with mean LDL-C in this cohort. FAW on statin medications had lower LDL levels regardless of their PCSK9 or LDLR genotypes. Most FAW had a gain-of-function allele of PCSK9 and LDLR. This predominance in FAW cohort may account for the high percentage of subjects with elevated LDL-C. In a population at high risk for hypercholesterolemia, optimal treatment with statins should be considered where appropriate

Trends of sex differences in outcomes of cardiac electronic device implantations in the United States

Background The disparity in outcomes of CIED implantations between sexes has been previously demonstrated in device-specific cohorts (e.g. implantable cardioverter defibrillators (ICD)). However, it is unclear whether sex differences are present with all types of CIED and, if so, what the trends of such differences were in recent years. Methods Using the National Inpatient Sample, all hospitalizations between 2004 and 2014 for de novo implantation of permanent pacemakers (PPM), cardiac resynchronization therapy with or without a defibrillator (CRT-D and CRT-P, respectively) and ICD were analyzed to examine the association between sex and in-hospital acute complications of CIED implantation. Results Out of 2,815,613 hospitalizations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds of adverse procedural complications (major adverse cardiovascular complications: 1.17 [1.16, 1.19], bleeding: 1.13 [1.12, 1.15], thoracic: 1.42 [1.40, 1.44], cardiac: 1.44 [1.38, 1.50]), while the adjusted odds of in-hospital all-cause mortality compared to men was 0.96 [0.94, 1.00]. The odds of adverse complications in the overall CIED cohort were persistently raised in women throughout the study period, whereas similar odds of all-cause mortality across the sexes were observed throughout the study period. Conclusion In a national cohort of CIED implantations we demonstrate that women are at an overall higher risk of procedure-related adverse events compared to men, but no increased risk of all-cause mortality. Further studies are required to identify procedural techniques that would improve outcomes amongst women undergoing such procedures

Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis

Background: In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis showed that the use of SGLT-2is among women with diabetes resulted in less reduction in primary composite outcomes compared with men. This study aims to explore potential sex differences in primary composite outcomes among patients with HF treated with SGLT-2is. Methods: We systematically searched the medical database from 2017 to 2022 and retrieved all the RCTs using SGLT-2is with specified cardiovascular outcomes. We used the PRISMA (Preferred Reporting Items for a Review and Meta-analysis) method to screen for eligibility. We evaluated the quality of studies using the Cochrane Risk of Bias tool. We pooled the hazard ratio (HR) of the primary composite outcomes in both sexes, performed a meta-analysis, and calculated the odds ratio (OR) of the primary composite outcomes based on sex. Results: We included 5 RCTs with a total number of 21,947 patients. Of these, 7837 (35.7 %) were females. Primary composite outcomes were significantly lower in males and females taking SGLT-2is compared to placebo (males - HR 0.77; 95 % CI 0.72 to 0.84; p = 0.00001; females - HR 0.75; 95 % CI 0.67 to 0.84; p = 0.00001). Pooled data from four of the RCTs ( n = 20,725) revealed a greater occurrence of the primary composite outcomes in females compared with males (OR 1.32; 95 % CI 1.17 to 1.48; p = 0.0002). Conclusion: SGLT-2is reduce the risk of primary composite outcomes in patients with HF, regardless of sex; however, the benefits were less pronounced in women. Further research needs to be done to better explain these observed differences in outcomes

Chronic rheumatologic disorders and cardiovascular disease risk in women

Cardiovascular disease (CVD) is a major health threat to women worldwide. In addition to traditional CVD risk factors, autoimmune conditions are increasingly being recognized as contributors to adverse CVD consequences in women. Chronic systemic autoimmune and inflammatory disorders can trigger premature and accelerated atherosclerosis, microvascular dysfunction, and thrombosis. The presence of comorbid conditions, duration of the autoimmune condition, disease severity, and treatment of underlying inflammation are all factors that impact CVD risk and progression. Early identification and screening of CVD risk factors in those with underlying autoimmune conditions may attenuate CVD in this population. Treatment with non-steroidal anti-inflammatory drugs, corticosteroids, disease modifying agents and biologics may influence CVD risk factors and overall risk. Multi-disciplinary and team-based care, clinical trials, and collaborative team-science studies focusing on systemic autoimmune conditions will be beneficial to advance care for women

Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update

Background Transcatheter aortic valve replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI). Summary TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use, and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE) and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and nonmodifiable risk factors and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized. Key Message This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients