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      Factores de riesgo y cardiopatías prevalentes en mujeres internadas en la división de medicina cardiovascular del Hospital de Clínicas Translated title: Risk factors and prevalent cardiopathies in hospitalized women in the Cardiovascular Medicine Division of the Clinical Hospital

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          Abstract

          RESUMEN La representación de las mujeres ha sido marginal en la mayoría de los ensayos clínicos o registros dedicados a las enfermedades cardiovasculares (ECV). Por eso, recientemente, se ha adoptado una política de estimular la inclusión de mujeres en los ensayos clínicos. En este estudio descriptivo retrospectivo y de corte transversal, nos hemos propuesto determinar la forma de presentación de las cardiopatías, describir los factores de riesgo cardiovasculares presentes en estas pacientes, determinar el número de mujeres que presentaron cardiopatía isquémica, y establecer el tratamiento recibido por las mujeres que presentaron cardiopatía isquémica en mujeres internadas en la División de Medicina Cardiovascular del Hospital de Clínicas. El estudio incluyó un total de 250 pacientes, de los cuales 187 (75%) correspondían al sexo masculino y 63 (25%) al sexo femenino. Las edades de las mujeres se encontraban entre 25 y 94 años (60±7,3 años). Las mujeres estudiadas presentaron: insuficiencia cardiaca 26 (41%), síndromes coronarios agudos 20 (32%), valvulopatías 8 (13%), bloqueo AV completo 7 (11%) y otros 2 (3%). De las mujeres con síndrome coronario agudo, 3 pacientes tuvieron enfermedad de 3 vasos, 1 sola tuvo coronarias normales, y 8 (40%) tenían lesiones de la arteria descendente anterior. Los factores de riesgo más frecuentes fueron el sedentarismo en la totalidad de las mujeres, la hipertensión arterial en 55 (87%), dislipidemias en 39 (62%), obesidad en 34 (54%), diabetes mellitus tipo 2 en 12 (19%) y tabaquismo en 12 pacientes (19%). La magnitud del riesgo cardiovascular de la mujer depende no solamente de la alteración de un parámetro sino también de la presencia de otros factores de riesgo, razón por la cual se requiere de un manejo multifactorial integral dentro del concepto de riesgo cardiovascular global en la mujer.

          Translated abstract

          ABSTRACT Most of the clinical trials on cardiovascular diseases had scant women representation in the population studied. Hence, there has been a movement to stimulate the inclusion of more women in the clinical studies. In this present descriptive retrospective cross-sectional study we aimed to determine the form of presentation of cardiopathies, to describe the cardiovascular risk factors, to determine the incidence of ischemic cardiopathy and the treatment received in hospitalized women in the Division of Cardiovascular Medicine of the Clinical Hospital. The study included 250 patients with 187 male patients (75%) and 63 (25%) female patients. The age of the women was between 25 and 94 years old, with an average of 60±7,3 years. The women had heart failure 26 (41%), acute coronary syndrome 20 (32%), valvulopathy 8 (13%), and complete AV block 7 (11%). Out of the women with acute coronary syndrome, 3 patients had three vessel disease, only 1 had normal coronary arteries, and 8 patients had stenosis of the anterior descendent coronary artery. All women had sedentary lifestyle as cardiovascular risk factor, 55 (87%) arterial hypertension, 39 (62%) dyslipidemia, 34 (54%) obesity, 12 (19%) type II diabetes mellitus, and 12 (19%) smoking. The magnitude of the cardiovascular risk factors in women depends not only on the alteration of one parameter but also on the presence of other risk factors. Therefore, an adequate integral multifactorial management in the global concept of cardiovascular risk factor in women is required.

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          Most cited references 39

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          A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.

          Randomized trials have shown that low-dose aspirin decreases the risk of a first myocardial infarction in men, with little effect on the risk of ischemic stroke. There are few similar data in women. We randomly assigned 39,876 initially healthy women 45 years of age or older to receive 100 mg of aspirin on alternate days or placebo and then monitored them for 10 years for a first major cardiovascular event (i.e., nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes). During follow-up, 477 major cardiovascular events were confirmed in the aspirin group, as compared with 522 in the placebo group, for a nonsignificant reduction in risk with aspirin of 9 percent (relative risk, 0.91; 95 percent confidence interval, 0.80 to 1.03; P=0.13). With regard to individual end points, there was a 17 percent reduction in the risk of stroke in the aspirin group, as compared with the placebo group (relative risk, 0.83; 95 percent confidence interval, 0.69 to 0.99; P=0.04), owing to a 24 percent reduction in the risk of ischemic stroke (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.93; P=0.009) and a nonsignificant increase in the risk of hemorrhagic stroke (relative risk, 1.24; 95 percent confidence interval, 0.82 to 1.87; P=0.31). As compared with placebo, aspirin had no significant effect on the risk of fatal or nonfatal myocardial infarction (relative risk, 1.02; 95 percent confidence interval, 0.84 to 1.25; P=0.83) or death from cardiovascular causes (relative risk, 0.95; 95 percent confidence interval, 0.74 to 1.22; P=0.68). Gastrointestinal bleeding requiring transfusion was more frequent in the aspirin group than in the placebo group (relative risk, 1.40; 95 percent confidence interval, 1.07 to 1.83; P=0.02). Subgroup analyses showed that aspirin significantly reduced the risk of major cardiovascular events, ischemic stroke, and myocardial infarction among women 65 years of age or older. In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point. Copyright 2005 Massachusetts Medical Society.
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            ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction).

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              Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative.

              We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS. Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS. Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women. Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                iics
                Memorias del Instituto de Investigaciones en Ciencias de la Salud
                Mem. Inst. Investig. Cienc. Salud
                Instituto de Investigaciones en Ciencias de la Salud (Asunción, , Paraguay )
                1812-9528
                August 2017
                : 15
                : 2
                : 45-55
                Affiliations
                Asunción orgnameUniversidad Nacional de Asunción orgdiv1Facultad de Ciencias Médicas orgdiv2Hospital de Clínicas Paraguay
                Article
                S1812-95282017000200045
                10.18004/mem.iics/1812-9528/2017.015(02)45-055

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 11
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