Sex Differences in Cardiac Diseases: Pathophysiology, Presentation, Diagnosis and Management

Front-Matter_2021_Sex-Differences-in-Cardiac-Diseases
Front Matter
Copyright_2021_Sex-Differences-in-Cardiac-Diseases
Copyright
Dedication_2021_Sex-Differences-in-Cardiac-Diseases
Dedication
Contributors_2021_Sex-Differences-in-Cardiac-Diseases
Contributors
Preface_2021_Sex-Differences-in-Cardiac-Diseases
Preface
Acknowledgments_2021_Sex-Differences-in-Cardiac-Diseases
Acknowledgments
Chapter-1---Introduction--Past--Present--and-Futur_2021_Sex-Differences-in-C
Introduction: Past, Present, and Future of Heart Disease in Men and Women
References
Chapter-2---Epidemiology-and-Prevalen_2021_Sex-Differences-in-Cardiac-Diseas
Epidemiology and Prevalence
Definitions
Sex‐Specific Awareness of Heart Disease in the Public and Medical Community
Public Awareness
Medical Awareness
The Burden of Heart Disease in Men and Women
Prevalence and Epidemiology of Risk Factors in Women
Diabetes
Hypertension
Dyslipidemia
Obesity
Physical Inactivity
Smoking
Psychological Stress
Risk Factors Unique to Women
Early Menopause
Adverse Pregnancy Outcomes
Multiparity
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
Contemporary Challenges
Opportunities for Equitable Outcomes
Methodologic Limitations of CVD Research in Women
Women’s Heart Centers
Government Mandates, Policies, and Advocacy
Acknowledgment
Sources of Funding
References
Chapter-3---Prevention-of-Cardiovascular-_2021_Sex-Differences-in-Cardiac-Di
Prevention of Cardiovascular Disease
Introduction
Traditional (Modifiable) Risk Factors and Sex Differences
Diabetes Mellitus
Hypertension
Dyslipidemia
Tobacco Use
Obesity
Physical Inactivity
Family History of Premature CAD
Emerging Risk Factors for CVD in Women
Parity
Adverse Pregnancy Outcomes Overview
Preeclampsia and Hypertensive Disorders of Pregnancy
Preterm Birth
Small for Gestational Age Infant
Gestational Diabetes Mellitus
Polycystic Ovary Syndrome
Menarche
Early Menopause
Hormone Replacement Therapy
Emerging Risk Factors for CVD in Men
Erectile Dysfunction
Novel Risk Markers in Women and Men
Inflammatory Disorders
Human Immunodeficiency Virus (HIV) Infection
Pharmacologic Prevention Treatments
Antihypertensive Management
Statins and Other Lipid-Directed Pharmacotherapy
Aspirin Therapy
Novel Diabetes Medications for ASCVD Outcome Reduction
Enrollment of Women in Cardiovascular Trials
Conclusion
Funding
References
References
Chapter-4---Acute-Coronary-Syndrome_2021_Sex-Differences-in-Cardiac-Diseases
Acute Coronary Syndrome
Introduction
Clinical Presentation
Pathophysiologic Mechanisms
Role of Biomarkers
Sex-Based Disparities in Management
Delay in Presentation
Guideline Recommendations
Pharmacotherapy
Potential Bias With Revascularization Therapies
Cardiac Rehabilitation After ACS
Disparities in Outcomes
Conclusion
References
References
Chapter-5---Spontaneous-Coronary-Artery-Di_2021_Sex-Differences-in-Cardiac-D
Spontaneous Coronary Artery Dissection
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
References
Chapter-6---Interventions-in-Ischemic-Hear_2021_Sex-Differences-in-Cardiac-D
Interventions in Ischemic Heart Disease
Introduction
Sex Differences in Pathophysiology of Coronary Artery Disease
Procedural Characteristics of Coronary Interventions in Women
Radial Approach
Stent Choice
Thrombotic Events, Antiplatelet Strategies, and Bleeding
DAPT Choice
DAPT Duration
Clinical Outcomes After PCI
Primary PCI in ACS
Spontaneous Coronary Artery Dissection
Complex PCI Including Left Main Stenting
Stent Thrombosis
Residual Angina After PCI
Management After Elective PCI in Women
Mechanical Support
Conclusion
References
References
Chapter-7---Stable-Ischemic-Heart-Dise_2021_Sex-Differences-in-Cardiac-Disea
Stable Ischemic Heart Disease
Introduction
Definition and Prevalence
Sex Differences in Pathophysiology
Coronary Artery Anatomy and Pathology
Coronary Function
Risk Factor Burden and Emerging Risk Factors in Women
Traditional Risk Factors
Emerging Risk Factors
Clinical Presentation
Definition of Angina
Clinical Recognition
Assessment of Pretest Probability
Role of Noninvasive Imaging
Noninvasive Functional and Physiologic Assessment
Exercise Treadmill Stress Testing
Stress Imaging Tests With Echocardiography
Stress Imaging With MPI
Stress PET MPI
Cardiac Magnetic Resonance Imaging
Multimodality Imaging Features of Myocardial Infarction
Noninvasive Anatomical Assessment
Relevance of Radiation Exposure Regarding Diagnostic Testing
Management
Lifestyle Modification and Cardiac Rehabilitation
Pharmacotherapy
Percutaneous or Surgical Revascularization
INOCA and Microvascular Disease
Conclusion
References
Reference
Chapter-8---Coronary-Microvascular-Dysfu_2021_Sex-Differences-in-Cardiac-Dis
Coronary Microvascular Dysfunction
Introduction
Pathophysiology of Coronary Microvasculature Disease
Risk Factors for CMD
Clinical Features and Prognosis
Diagnosis of CMD
Invasive Modalities
Noninvasive Modalities
Treatment
Statins
Beta-Blockers
ACE Inhibitors/ARBs
Calcium Channel Blockers
Nitrates
Xanthine Derivatives
Ranolazine
Ivabradine
Estrogens
Other Pharmacotherapies
Nonpharmacologic Therapies
Future Directions
Summary and Conclusion
Source of Funding
References
References
Chapter-9---Myocardial-Infarction-With-Nonobstr_2021_Sex-Differences-in-Card
Myocardial Infarction With Nonobstructive Coronary Disease
Definition
Epidemiology
Clinical Presentation of Patient With MINOCA
Causes of MINOCA
Coronary Etiologies
Plaque Disruption
Coronary Embolism
Coronary Artery Spasm
Microvascular Dysfunction
Spontaneous Coronary Artery Dissection
Noncoronary Etiologies
Takotsubo Cardiomyopathy
Myocarditis
Supply-Demand Mismatch
Truly Unexplained MINOCA
Diagnostic Evaluation
Invasive Imaging
Functional Coronary Testing
Coronary Spasm Provocation Testing
Microvascular Testing
Left Ventricular Assessment
Cardiac MRI
Assessment for Coronary Thromboembolism
Role of Psychological Stress
Management
General Management Principles
Treatment of Underlying Cause
Plaque Disruption
Coronary Vasospasm
Coronary Microvascular Dysfunction
Coronary Emboli
Prognosis
Conclusion
Acknowledgment
References
Chapter-10---Heart-Failure-With-Reduced-Ejec_2021_Sex-Differences-in-Cardiac
Heart Failure With Reduced Ejection Fraction
Epidemiology
Prevalence
Incidence and Lifetime Risk
Risk Factors
Nonmodifiable Risk Factors
Age and Race
Reproductive Factors
Modifiable Risk Factors
Etiologies of HFrEF
Outcomes
Symptoms and Quality of Life
Hospitalization
Mortality
Treatment
Pharmacologic Treatments
Device Therapies
Nonpharmacologic/Nondevice-Based Treatments
VAD and Transplant
Knowledge Gaps and Future Directions
Conclusion
References
References
Chapter-11---Heart-Failure-With-Preserved-Ej_2021_Sex-Differences-in-Cardiac
Heart Failure With Preserved Ejection Fraction
Epidemiology of HFpEF
Prevalence
Incidence
Lifetime Risk
Risk Factors and Comorbidities in HFpEF
Risk Factors
Age
Race
Reproductive Characteristics
Comorbidities
Hypertension
Obesity
Diabetes Mellitus
Coronary Artery Disease
Atrial Fibrillation
Risk Factors Specific to Women
Pathophysiology of HFpEF
LV Diastolic Dysfunction
LV Systolic Dysfunction
Arterial Stiffness
Pulmonary Hypertension and Right Ventricular Dysfunction
Coronary Microvascular Dysfunction
Peripheral and Skeletal Musculature Abnormalities
Systemic Inflammation
Chronotropic Incompetence
Atrial Fibrillation or Left Atrial Function
Molecular and Cellular Changes
Clinical Presentation of HFpEF
Phenotypes of HFpEF
Diagnosis of HFpEF
Prognosis
Symptoms and Quality of Life
Hospitalizations
Mortality
Cause of Death With HFpEF and HFrEF
Management of HFpEF
Management of Acute HFpEF
Management of Chronic HFpEF
Beta-Blockers
Renin-Angiotensin Blockers/Neprilysin Inhibitors
Mineralocorticoid Receptor Antagonists
Diuretics
Conclusion
Existing Gaps in Knowledge and Future Directions
References
References
Chapter-12---Pulmonary-Arterial-Hyperte_2021_Sex-Differences-in-Cardiac-Dise
Pulmonary Arterial Hypertension
Introduction
PAH Epidemiology and Sex-Based Differences
PAH Mortality
Right Ventricular Function in PAH
PAH Pathology and Impact of Sex Hormones
PAH Therapies
Phosphodiesterase-5 Inhibitors
Soluble Guanylate Cyclase
Endothelin Receptor Antagonist
Prostacyclins
PAH and Pregnancy
Conclusion
References
Chapter-13---Takotsubo-Syndrome_2021_Sex-Differences-in-Cardiac-Diseases
Takotsubo Syndrome
Background and Diagnostic Criteria
Epidemiology
Pathophysiology
Clinical Presentation
Diagnostic Testing
Treatment and Clinical Course
Complications and Prognosis
Recurrence
Knowledge Gaps
Conclusion
References
References
Chapter-14---Peripartum-Cardiomyopath_2021_Sex-Differences-in-Cardiac-Diseas
Peripartum Cardiomyopathy
Epidemiology
Risk Factors
Age
Race
Preeclampsia and Hypertensive Disorders
Multiple Gestations
Pathophysiology
Prolactin Hypothesis
Angiogenic Factors
Genetic Predisposition
Clinical Presentation and Diagnosis
Treatment and Complications
Thromboembolism and Arrhythmia
Arrhythmias and Antiarrhythmic Therapies
Decompensated Heart Failure
Advanced Mechanical Support
Management of PPCM During Pregnancy
Bromocriptine
Cessation of Breastfeeding
Prognosis
Mechanical Support and Transplantation
Predictors of Recovery
Baseline LV Function and Other Cardiac Imaging Parameters
Racial Differences
Preeclampsia and Hypertension
Subsequent Pregnancy Recommendations
Conclusion
References
References
Chapter-15---Valvular-Heart-Disease_2021_Sex-Differences-in-Cardiac-Diseases
Valvular Heart Disease
Introduction
Aortic Stenosis
Clinical Case
Epidemiology and Prevalence
Sex Differences in Ventricular Response to Severe AS and Reverse Remodeling After AVR
Evaluation of AS
Baseline Characteristics of Women With Severe AS Presenting for AVR
Complications and Outcomes After AVR
Mortality
Procedural Complications
Stroke
Paravalvular Regurgitation
Patient-Prosthesis Mismatch
Aortic Regurgitation
Mitral Regurgitation
Clinical Case
Epidemiology and Prevalence
Sex-Based Differences in the Pathophysiology of Mitral Regurgitation
Mitral Valve Prolapse
Ischemic MR
Challenges to the Treatment of Mitral Regurgitation in Women
Referral to Surgical Intervention
Choice of Mitral Valve Intervention
Surgical Mitral Valve Repair or Replacement
Transcatheter Mitral Valve Repair
Mitral Stenosis
Epidemiology and Prevalence
Challenges to the Treatment of Mitral Stenosis in Women
Degenerative (Calcific) Mitral Stenosis
Tricuspid Regurgitation
Epidemiology and Prevalence
Challenges to the Treatment of Tricuspid Regurgitation in Women
Concomitant Left-Sided Heart Disease
Isolated Tricuspid Regurgitation
Valvular Heart Disease in Pregnancy
Aortic Stenosis
Mitral Stenosis
Pulmonic Stenosis
Prosthetic Valves in Pregnancy
Summary and Future Directions
References
References
Chapter-16---Atrial-Fibrillation_2021_Sex-Differences-in-Cardiac-Diseases
Atrial Fibrillation
Introduction
Epidemiology
Prevalence
Incidence
Lifetime Risk
Pathophysiology
Mechanism of Disease
Risk Factors
Genetics and Atrial Fibrillation
Clinical Presentation
Presenting Symptoms
Access to Treatment
Diagnostic Testing
Management and Prognosis
Mortality
Heart Failure
Rate vs. Rhythm Control
Utilization of Rate vs. Rhythm Control
Outcomes With Rate Control Medications
Outcomes With Rhythm Control
Catheter Ablation
Utilization of Catheter Ablation
Outcomes With Catheter Ablation
Stroke and Thromboembolism Risk
Higher Risk of Stroke in Women
Sex Differences in Stroke Prevention
Efficacy of Warfarin and Direct Oral Anticoagulant Use Compared to Antiplatelet Agents and Placebo
Differences in Warfarin Utilization, Efficacy, and Control of Adequate Anticoagulation
Safety and Bleeding With Warfarin
Data on Efficacy and Safety of Direct Anticoagulants
Percutaneous Left Atrial Appendage Closure Devices
Future Directions
Conclusion
References
References
Chapter-17---Ventricular-Arrhythmias_2021_Sex-Differences-in-Cardiac-Disease
Ventricular Arrhythmias
Sudden Cardiac Death
Epidemiology and Predictors
Sex Differences in Presenting Arrhythmia
Ventricular Arrhythmias Associated With Structural Heart Disease
Ischemic and Nonischemic Cardiomyopathy
Arrhythmogenic Right Ventricular Cardiomyopathy
Hypertrophic Cardiomyopathy
Ventricular Arrhythmias in the Absence of Underlying Structural Heart Disease
Idiopathic VT
Channelopathies
Potential Mechanisms for Sex Differences in Sudden Cardiac Death and Ventricular Arrhythmias
Implantable Cardioverter Defibrillator Therapy and Ventricular Arrhythmias
Secondary Prevention
Primary Prevention
Conclusion
References
References
Chapter-18---Role-of-ICD-and-CRT_2021_Sex-Differences-in-Cardiac-Diseases
Role of ICD and CRT
Incidence of Sudden Cardiac Death and HF
Use of Implantable Cardioverter Defibrillators to Prevent Sudden Cardiac Death
Primary Prevention of SCD With ICD Trials
Secondary Prevention of SCD With ICD Trials
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
References
Chapter-19---Peripheral-Arterial-Disea_2021_Sex-Differences-in-Cardiac-Disea
Peripheral Arterial Disease
Risk Factors for PAD
Role of Inflammatory Markers in PAD
Presentation of PAD
Treatment of Patients With PAD
Antiplatelet and Antithrombotic Therapy
Statin Therapy
Antihypertensive Therapy
Exercise and Rehabilitation
Prognosis and Outcomes After Revascularization
FMD and Other Forms of Nonatherosclerotic Vascular Disease
Conclusion
References
References
Chapter-20---Congenital-Heart-Diseas_2021_Sex-Differences-in-Cardiac-Disease
Congenital Heart Disease
Impact of Sex on Congenital Heart Disease: Incidence and Outcomes
Morbidity and Mortality
Pulmonary Hypertension
Aortic Outcomes
Infective Endocarditis
Implantable Cardioverter-Defibrillator Use
Contraception in Women With Congenital Heart Disease
Barrier Method Contraception
Combination Estrogen and Progesterone Contraception
Progesterone-Only Contraception
Nonreversible Contraception
Risk Assessment and Counseling of Adult Congenital Heart Disease Patients
Transition Between Pediatric and Adult Cardiology
Mental Health Risk Assessment and Counseling
Acquired Cardiovascular Disease Risk Assessment and Counseling
Pregnancy in Women With Congenital Heart Disease
Maternal Risk
Preconception Counseling and Risk Assessment
Fetal Risk and Neonatal Risk
Congenital Heart Lesions in Pregnancy
Atrial Septal Defects
Atrioventricular Septal Defects
Ventricular Septal Defects
Congenital Mitral Stenosis
Congenital Aortic Valve Disease
Coarctation of the Aorta
Marfan Syndrome
Tetralogy of Fallot
Ebstein Anomaly
Congenitally Corrected Transposition of the Great Arteries
d-Looped Transposition of the Great Arteries
Fontan Circulation
Anesthesia and Delivery
Sex Differences in Advanced Care Planning in Patients With Adult Congenital Heart Disease
Conclusion
References
Chapter-21---Pregnancy-and-Cardiovascular_2021_Sex-Differences-in-Cardiac-Di
Pregnancy and Cardiovascular Disease
Introduction
Hemodynamics of Pregnancy
Preconception Counseling and Risk Stratification Tools
Maternal Risk
Risk in CHD
Fetal and Neonatal Risk
Fetal Echocardiography
Preconception Testing
Mode of Delivery and Interdisciplinary Team
Medication Use During Pregnancy
Safety and Utility of Imaging in Pregnancy
Echocardiography
Ionizing Radiation
Chest Radiography
Computed Tomography
Cardiac Magnetic Resonance Imaging
Cardiac Catheterization
Pregnancy and Valvular Heart Disease
Mitral Stenosis
Aortic Stenosis
Regurgitant Lesions
Aortic Insufficiency
Mitral Regurgitation
Right-Sided Obstructive Lesions
Management of Anticoagulation in Pregnant Women With Prosthetic Valves
Ischemic Heart Disease and Pregnancy
The Diagnosis of Acute MI
The Management of ACS
Hypertensive Diseases of Pregnancy
Aortopathies
Arrhythmias During Pregnancy
Arrhythmias Warranting ACLS
Pulmonary Hypertension During Pregnancy
Future Directions
References
References
Chapter-22---Unique-Features-of-Cardiovascular-Pha_2021_Sex-Differences-in-C
Unique Features of Cardiovascular Pharmacology in Pregnancy and Lactation
Introduction
Labeling Risks
Pharmacokinetics in Pregnancy
Absorption
Distribution
Metabolism
Elimination
General Approach to Prescription During Pregnancy and Lactation
Medications
Lipid-Lowering Therapy
Bile Acid Sequestrants
Ezetimibe
Fibrates
Lomitapide
Niacin
Omega-3 Fatty Acids
Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) Inhibitors
Statins
Antiplatelet and Antiinflammatory Agents
Aspirin
Cilostazol
Colchicine
Dipyridamole
Glycoprotein IIb/IIIa Inhibitors
P2Y 12 Inhibitors
Vorapaxar
Hypertension, Heart Failure, and Angina
Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitor
Aldosterone Antagonists
Aliskiren
Beta-Blockers
Calcium Channel Blockers
Dihydropyridine CCBs
Nondihydropyridine CCBs
Digoxin
Diuretics
Inotropes
Ivabradine
Peripartum Cardiomyopathy—Bromocriptine and Pentoxifylline
Ranolazine
Vasodilators
Alpha-2 Agonists
Alpha-Blockers
Hydralazine
Minoxidil
Nitrates
Pulmonary Hypertension
Endothelin Receptor Antagonists (ERAs)
Phosphodiesterase-5 (PDE-5) Inhibitors
Prostacyclins
Riociguat
Anticoagulants
Direct Oral Anticoagulants (DOACs)
Direct Thrombin Inhibitors
Fondaparinux
Heparin
Low Molecular Weight Heparins
Thrombolytics
Warfarin
Medications for Arrhythmia Management
Adenosine
Atropine
Class Ia Antiarrhythmics
Disopyramide
Procainamide
Quinidine
Class Ib Antiarrhythmics
Class Ic Antiarrhythmics
Class III Antiarrhythmics
Amiodarone
Dronedarone
Dofetilide and Ibutilide
Sotalol
Isoproterenol
Conclusion and Future Directions
References
Chapter-23---CardioRheumatology_2021_Sex-Differences-in-Cardiac-Diseases
CardioRheumatology
Introduction
Sex-Specific Predominance of Rheumatologic Disorders
Conduction Disease and Arrhythmias
Pericardial Diseases
Myocardial Dysfunction
Valvular Heart Disease
Atherosclerosis/Coronary Artery Disease
Conclusion
References
Chapter-24---CardioOncology_2021_Sex-Differences-in-Cardiac-Diseases
CardioOncology
Introduction
The Scope of the Problem and Epidemiology
Sex Susceptibility to Cancer
Cancer and Cardiovascular Complications
Breast Cancer
Common Modifiable and Inherited Risk Factors That Predispose to CVD and Breast Cancer
Cancer Therapy-Related Cardiac Dysfunction (CTRCD)
Breast Cancer Chemotherapy Agents
Anthracyclines (Doxorubicin, Daunorubicin, Epirubicin, and Idarubicin)
Alkylating Agents (Cyclophosphamide and Carboplatin)
Taxanes (Docetaxel and Paclitaxel)
Antimetabolites (5-Flouro Uracil)
Targeted Therapies
HER2 Antibodies (Trastuzumab, Pertuzumab, and Trastuzumab Emtansine)
Tyrosine Kinase Inhibitors (Lapatinib, Neratinib, and Afatinib)
Endocrine Therapy
Selective Estrogen Receptor Modulators (Tamoxifen)
Selective Estrogen Receptor Degraders (Fulvestrant)
Aromatase Inhibitors (Anastrozole, Exemestane, and Letrozole)
mTOR Inhibitor (Everolimus)
Cycline-Dependent Kinase Inhibitors (Ribociclib, Palbociclib, and Abemaciclib)
Predicting Risk of CTRCD
Female-Specific Risk Factors for Chemotherapy-Related Cardiovascular Dysfunction
Genetics
Age
Female Sex
Menopause
Pregnancy
Detection, Prevention, and Management of Cardiotoxicity Due to Chemotherapy
Detection of Cardiotoxicity Due to Chemotherapy
Imaging Biomarkers
Echocardiography
Speckle-Tracking Echocardiography
Cardiac MRI
Multigated Radionuclide Angiography (MUGA)
Serum Biomarkers
Troponin
Brain-Type Natriuretic Peptides
Combination and Novel Biomarkers in Risk Identification
Screening Intervals for Cardiotoxicity Due to Chemotherapy
Strategies to Prevent and Treat Cardiotoxicity Due to Chemotherapy
Baseline Risk Assessment
Pharmacotherapy and Other Preventive Strategies
Risk Factors, Detection, Prevention, and Management of Radiation Associated Cardiac Dysfunction (RACD)
Mechanism and Risk Factors
Detection of RACD
Biomarkers
Imaging Markers
Echocardiography
Speckle-Tracking Echocardiography
Stress Echocardiography
Coronary Computed Tomographic Angiography
Cardiac Magnetic Resonance
Cardiac Catheterization
Management of RACD
Radiation Associated Pericardial Disease
Radiation Associated Coronary Artery Disease
Radiation Associated Valvular Disease
Strategies to Prevent Radiation Associated Cardiac Dysfunction
Prostate Cancer Treatment-Related Cardiotoxicity
Conclusion
References
Chapter-25---Sex-Hormones-and-Their-Impact-on-_2021_Sex-Differences-in-Cardi
Sex Hormones and Their Impact on Cardiovascular Health
Overview of the Sex Hormones
General Concepts
Androgens
Estrogens
Progesterone
Cardiovascular Effects of Sex Hormones: From Physiology to Epidemiology
Androgens
Estrogens
Progesterone
Hormone Excess or Deficiency in Men and Women
Polycystic Ovarian Syndrome and CVD
Menopause and CVD
Cardiovascular Impact of Premature Menopause
Menopausal Hormonal Therapy: Indications, Efficacy, Safety, Timing, and Duration
Estrogen Therapy
Progesterone Therapy
Indications
Controversy Regarding Safety and Efficacy of Menopausal Hormone Therapy in the Prevention of Cardiovascular Disease
Timing
Assessing Women Before Starting MHT
Duration of Therapy
Contraindications
Low Testosterone in Men
Testosterone Replacement Therapy in Men
Cardiovascular Impact of Therapeutic Hormones, Agonists and Antagonists
Contraception
CVD Impact of Hormonal Antagonism in the Treatment of Cancer
Hormone Suppression for Gynecologic Cancer Treatment
Testosterone Suppression for Prostate Cancer Treatment
Cardiovascular Health in Transgender Individuals
Terminology
Role of Exogenous Hormone Therapy in Transgender Individuals
Effects of Testosterone Therapy in Transgender Males
Estrogen Therapy in Transgender Females
Conclusion
References
Chapter-26---Psychosocial-Issues-in-Cardiova_2021_Sex-Differences-in-Cardiac
Psychosocial Issues in Cardiovascular Disease
Epidemiology of Depression and Anxiety
Relationship of Depression and Anxiety With CVD
Depression and CVD
Anxiety and CVD
Relationship of Psychosocial Stressors With CVD
Stress and CVD
Hostility/Anger and CVD
Socioeconomic Status and CVD
Social Integration and CVD
Mechanisms Linking Psychosocial Factors to CVD
Management of Psychosocial Issues Among Patients With CVD
Depression and Anxiety Screening
Pharmacological Management
Behavioral Treatment
Cognitive-Behavioral Therapy
Mind-Body Medicine
Acknowledgment
References
References
Chapter-27---Cardiovascular-Medicatio_2021_Sex-Differences-in-Cardiac-Diseas
Cardiovascular Medications
Introduction
Sex-Related Differences in Pharmacokinetics
Sex-Related Differences in Pharmacodynamics
Antithrombotic Drugs
Anticoagulants
Anticoagulants
Vitamin K Antagonists
Heparins
Factor Xa Inhibitors
Direct Thrombin Inhibitors
Direct Oral Anticoagulants
Antiplatelet Drugs
Acetylsalicylic Acid (Aspirin)
Glycoprotein IIb/IIIa Receptor Inhibitors
Adenosine Diphosphate P2Y12 Receptor Antagonists
Selective Protease-Activated Receptor-1 (PAR-1) Antagonists
Fibrinolytic Drugs
Beta-Blockers
Calcium Channel Blockers
Digoxin
Diuretics
Drugs for Pulmonary Arterial Hypertension
Glucose-Lowering Drugs
Ivabradine
Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS)
Angiotensin-Converting Enzyme Inhibitors
Angiotensin AT1 Receptor Blockers
Aldosterone Antagonists
Sacubitril-Valsartan
Nitrates
Lipid-Lowering Drugs
Statins
Other Lipid-Lowering Drugs
Adverse Drug Reactions
Female Representation in Clinical Trials
Medication Use, Adherence, and Prescribing Alignment With Clinical Guidelines
Current Challenges and Next Steps
Conclusion
Acknowledgment
References
References
Chapter-28---Disparity-in-Care-Across-the-C_2021_Sex-Differences-in-Cardiac-
Disparity in Care Across the CVD Spectrum
Introduction
Evidence of Sex and Gender Disparities
Misunderstood: Moving the Needle to Improved Understanding of CVD in Women
Mistreated: Suboptimal Awareness in Physician Leading to Under Treatment in Prevention
Misdiagnosed: Gender Disparities in the Presentation Leads to Worse Outcomes
Mismanaged: Inappropriate Management Resulting in Increased Mortality and Morbidity
Misfortune: Worse Outcomes in Women vs. Men Across the CVD Spectrum
Misrepresented: Disparities of CVD Research in Women
Sex and Gender Differences in CVD: Risk Factors and Disparities in Their Management
Race and Ethnic Disparities in CVD: Prevalence, Management, and Outcomes
Black and Hispanic Women
South Asian Women
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
Beyond the Traditional Risk Assessment: Contemporary Approach of Identifying Women At Risk of CVD
Women’s Healthcare Team
Sex-Specific Research, Diagnostic Tools, and Guidelines Required
Innovative Use of Technology to Impact CVD in Women
Sustained Efforts in Education and Awareness
Conclusion
References
References
Chapter-29---Women-s-Heart-Programs_2021_Sex-Differences-in-Cardiac-Diseases
Women’s Heart Programs
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 ...
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
References
References
Index_2021_Sex-Differences-in-Cardiac-Diseases
Index
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