Name:
Benefits and Risks of Colcichine in Cardiovascular Disease
Description:
Benefits and Risks of Colcichine in Cardiovascular Disease
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Duration:
T00H04M54S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's the Heart Board Review and other online resources available only through accesscardiology.com. >> On prior podcasts, I reported on sex differences of men and women and myocardial infarction, but many of these studies included data on myocardial infarction particularly in older patients. What about young patients and particularly young women in myocardial infarction?
Hi, Dr. Bernie here, and welcome to Practice Impact Extra. Sex differences in presentation, treatment, and outcomes of myocardial infarction have been well-documented in the cardiovascular literature. Prior studies have shown that women present with MI at a later age with greater risk factor burdens and with worse outcomes. Women are also less likely than men to receive standard of care therapies including coronary arteriography, reperfusion, and/or prescribed guideline-directed cardiovascular medications at the time of discharge.
Most data on sex differences primarily focus on older patients, and there's a scarcity of data regarding MI in younger men and women. However, there is obviously an important need to better understand the sex differences in outcomes among young individuals following acute myocardial infarction. A study published in the European Heart Journal October 2020 of the YOUNG-MI registry investigated sex differences among individuals who experienced their first MI at a young age.
Consecutive patients with type 1 MI less than 50 years of age were assessed and reviewed charts between the years 2000 and 2016. Of that, 2097 individuals were identified, of which 404 were women, about 19%, and 1693 were men, 81%. So, what were the results?
Risk factors were similar for both men and women, although women were more likely to have insulin-dependent diabetes. Invasive valuation was significantly less in women. Revascularization in women was significantly less, and they were less likely to undergo revascularization. MI coronary anatomy revealed women were more likely to have MI associated with non-obstructive disease on angiography, as well as single-vessel disease.
Women also experienced a substantially higher rate of spontaneous coronary artery dissection compared with their male counterparts, 7% versus 0.2%. Mortality. There was no significant difference in the in-hospital mortality. However, women who survive the hospital discharge have a higher all-cause mortality at 11 years followup. But actually, there was no significant difference in the cardiovascular mortality.
Discharge medication. Women were less likely to be discharged on aspirin, antiplatelet medications, beta-blockers, ACE or ARBs, and satins. So, what can we conclude from this study? Women who experienced MI under the age of 50 had a higher burden of insulin-dependent diabetes compared with men. Fewer women had invasive evaluation and had a higher incidence of non-obstructive coronary artery disease.
Women were less likely to be discharged with guideline-directed, post-MI medical therapy. And importantly, at 11 years, a higher all-cause mortality was noted. Concerning to me is the fact that the rates of MI had been declining in the United States, but yet the rates of MI in young individuals have remained stable. I think this says that we need to study and improve the incidence of cardiovascular disease in the young and especially women.
Thank you for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to Access Cardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
