男性和女性在心肌梗死前的心血管风险差异（英文）.pdf

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1、Nystrmetal. BMC Cardiovascular Disorders (2022) 22:110 https:/doi.org/10.1186/s12872-022-02555-3RESEARCHCardiovascular risks beforemyocardial infarction differences betweenmen andwomenAlice Nystrm1, Susanne Strmberg1, Karin Jansson2, shild Olsen Faresj1 and Tomas Faresj1* Abstract Background: Prodro

2、mal cardiac symptoms are warning signals preceding cardiac disease. Previous studies have shown some gender differences in prodromal symptoms as well as established risk factors for MI. This study aims to map possible gender differences in social factors and established risk factors preceding myocar

3、dial infarction (MI).Methods: The study includes data of N = 213 middle-aged men and women, all diagnosed with myocardial infarc-tion (ICD-10 I21.9) from the region of south-east Sweden. They answered a questionnaire at discharge from the car-diologic clinic and additional clinical data from medical

4、 records were merged from the National Swedeheart Register.Results: The dominant prodromal symptom for both sexes were experience of chest pain at the onset of MI. The major gender differences were that significantly more females (p = 0.015) had a hyperlipidemia diagnose. Females also reported to ha

5、ve experienced higher stress load the year preceding myocardial infarction with serious life events (p = 0.019), strained economy (p = 0.003), and reports of sadness/depression (p 0.001). Females reported higher perceived stress load than men (p = 0.006). Men had higher systolic blood pressure than

6、women at hospital admission and a higher systolic- and diastolic blood pressure at discharge.Conclusions: Influences of the social environment, such as serious life events, strained economy, depression, stress, and sleep deprivation were stronger as potential risk factors for myocardial infarction i

7、n women than among men. Of the traditional risk factors only, hyperlipidemia was more frequent among women. These findings could contribute to a deeper understanding of diagnostic differences between gender, as well as a more gender-oriented cardiovascular preventive work.Keywords: Prodromal cardiac

8、 symptoms, Myocardial infarction, Gender, Risk factors for myocardial infarction The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as

9、long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articles Creative Commons licence, unless indicated otherwise

10、in a credit line to the material. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, v

11、isit http:/ creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:/ creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.IntroductionProdromal car

12、diac symptoms are early warning signals preceding an acute cardiovascular event within days to months 1, 2. At the onset of myocardial infarction (MI) both men and women present chest pain as predominant symptoms 35. Prodromal symptoms of chest pain in acute coronary syndromes have been reported amo

13、ng up to 43% of the cases. However, women tend to report and experience more and not the same prodromal symptoms as men 6, 7. Reports of sleep disturbances, anxiety, and fatigue and not prodromal chest pain are more frequent among women 68. Patients under 65years, regardless of gender, are more like

14、ly to report depression or major life events compared with elderly patients the year prior their MI 9. In the acute stage, women are more likely to assign their prodromal symptoms to stress or anxiety, while men tend to assign their symptoms to cardiac dis-ease 2.The risk for MI can to a large exten

15、t be attributed to modifiable risk factors i.e. those that can be reduced or controlled with altered behavior. Besides heredity, also biological chronic stress and psychosocial stress con-tribute to the risk of MI 1014. Among established Open Access*Correspondence: tomas.faresjoliu.se1 Department of

16、 Health, Medicine and Care, General Practice, Linkping University, 581 83 Linkoping, SwedenFull list of author information is available at the end of the articlePage 2 of 7Nystrmetal. BMC Cardiovascular Disorders (2022) 22:110 risk factors, certain risk factors, such as hypertension 14 and an advers

17、e lipid profile 11, are more predomi-nant than others on the risk of developing MI 11, 14. Both genders have comparable risks for the association of MI with hyperlipidemia 13 and the prevalence is also similar in men and women 15. The prevalence of hypertension is equal between the sexes globally 15

18、, 16. However, the impact of risk factors on each gender may differ. Smoking 13, 15, 17 and diabetes mellitus 15, 17 are more prevalent as risk factors in men than women. Smoking and obesity have the same risk on the sexes 13, while diabetes mellitus has a greater effect on females than males 13, 15

19、, 17. Men with hypertension, high BMI (body mass index) and type II diabetes have higher rates of MI than women with similar risk factors 18. MI is more common in men than in women throughout life, but the gender differences in the risk MI decrease with age 19.The overall aim in this study was to an

20、alyze if prodro-mal symptoms and social factors might differ between middle-aged men and women that suffers a myocardial infarction. We hypothesized that more men than women that had suffered an MI had established risk factors at the time of their myocardial infarction, and that chest pain was more

21、prevalent in men than in women.MethodologySubjectsData within the Stressheart study were collected from N = 213 patients, all diagnosed with myocardial infarc-tion (ICD-10 I21.9) between 2017 and 2019 10. The cases were consecutively recruited during a three-year period from the cardiological clinic

22、s at three major hos-pitals in the region of south-east Sweden. The patients were invited to participate in the study at the time of discharge from the cardiology clinic, in general 23days after the MI. Inclusion criteria were ST segment Eleva-tion Myocardial Infarction (STEMI) or non-ST segment Ele

23、vation Myocardial Infarction (NSTEMI), and age up to 65years. Exclusion criteria were not Swedish speaking. Overall, the exclusion and inclusions criteria in this study is identical to those applied in the Stressheart study 10.Data collectionAt discharge from the cardiologic clinic at the hospi-tal

24、all patients were requested to fill in a questionnaire concerning social data and cardiovascular risk factors. The questionnaire included established risk factors and comorbidities such as hypertension, hyperlipidemia, diabetes mellitus, and smoking, but also questions of medical history (i.e. angin

25、a pectoris, heart failure, stroke, previous MI), medical treatment and potential heredity for MI or stroke. Questions about psychosocial factors (marital status, education, employment, social support) were also included in the questionnaire. Reliance for someone was defined as social support. Furthe

26、rmore, participants were asked about various life events during the year that preceded MI, such as experience of seri-ous life events, strained economy, and unemployment. Further, questions of depression, duration and quality of sleep and perceived stress levels. All scales and ques-tions about psyc

27、hosocial factors, serious life events, depression, sleep, and perceived stress were established and validated and derive from the large National Swed-ish CArdioPulmonary BioImage Study 22. When the patients arrived at the hospital with suspected MI, clini-cal biomarkers on systolic blood pressure (S

28、BP), diastolic blood pressure (DBP), heart rate (HR), high-density lipo-proteins (HDL), low-density lipoproteins (LDL), choles-terol and triglycerides were collected. Risk prediction threshold values for lipids are based on the consensus-based recommendations from European Atherosclerosis Society an

29、d European Federation of Clinical Chemistry and Laboratory Medicine 20. Height and weight i.e. BMI, was documented by research nurses.Data for all the participants were merged with clinical data from medical records in the Swedish National Reg-ister of Myocardial Infarction (The Swedeheart Register)

30、. The study was approved by the Regional Ethical Review Board in Linkping, Sweden (Dnr 2016-79-31, Dnr 2016-453-32, Dnr 2017-106-32).Statistical analysisDescriptive statistics were performed with gender as the independent variable. Variables with normal distribution were presented as mean and standa

31、rd deviation (SD). Variables with skewed distribution were presented as the median and interquartile range (Q1Q3). Significance of difference between gender was assessed with T-test for normally distributed variables, and with Mann Whitney U for skewed variables. The significance of differences betw

32、een categorical variables and gender was assessed by using Chi-square tests and Mann Whitney U. Statis-tical significance was set at p 0.05 for all analyses. All statistical analyses were assessed in IBM Statistical pack-age SPSS for social sciences version 27 (SPSS, Chicago, Illinois, USA).ResultsA

33、ll the N = 213 participants in this study were diagnosed with MI of which 73% were males and 27% females. Myo-cardial Infarction with STEMI was diagnosed for 56.8% of men and 60.7% of females and 43.2% of men and 39.3% of females had NSTEMI. There was no significant differ-ence of infarction type be

34、tween the sexes (p = 0.618). No age difference between the sexes (p = 0.431), mean age Page 3 of 7Nystrmetal. BMC Cardiovascular Disorders (2022) 22:110 for males was 58 6years and for females 57 7years. A vast majority of both males and females debuted their onset of MI with chest pain (males 93.9%

35、 vs females 94.4%) and a smaller proportion with dyspnea or other (males 6.1% vs females 5.6%). There was no significant difference in symptoms at MI onset between the sexes (p = 0.885) (data not shown).Demographics for males and females in the study are presented in Table1. No differences in marita

36、l status between the sexes found, neither the access to a sup-portive person. Highest level of education did not dif-fer significantly between the sexes (p = 0.794), however, employment did. More males were working 79.5% vs. 62.5% among females (p = 0.021). Unemployment rates was significantly highe

37、r (p = 0.008) among females than among men (8.3% vs 0.8%) and females were more frequent (p = 0.053) on sick leave over the last three months before MI (10.4% vs 3.1%), see Table1.During the year preceding the MI, more females than males had experienced various serious life events (Table2). Signific

38、ant differences between the sexes were evident for serious life events in general (p = 0.019), strained economy (p = 0.003) and sadness/depression for two weeks or more (p 3 months4 (3.1)5 (10.4)0.053Table 2 Experience of serious life events past year for males and females with MIStatistical signifi

39、cance was set at p 0.05 and marked as boldMales (N = 156)Females (N = 57)p valuen (%)n (%)Serious life events past yearSerious life event61 (39.9)33 (57.9)0.019Death/accident among friends/family40 (26.1)22 (39.3)0.065Divorce/ separation3 (2.4)3 (6.4)0.209Severe illness in the family13 (10.5)10 (21.

40、3)0.065Economic crisis4 (3.2)3 (6.4)0.354Unemployment2 (1.6)2 (4.3)0.309Strained economy6 (4.7)9 (18.8)0.003Sadness/ depression 2 weeks40 (26.5)30 (53.6) 0.001Page 4 of 7Nystrmetal. BMC Cardiovascular Disorders (2022) 22:110 Men and women evaluated their sleep quality differ-ently (p = 0.043), see F

41、ig. 2. More females than males perceived their sleep quality as poor (35.4% vs 21.4%) and contrary, more males than females estimated their sleep quality as good (49.2% vs 29.2%). Further, women tend to have a shorter sleep duration than men. The median sleep hours for males were 7h (IQR = 68) and f

42、or females 6h (IQR = 57) (p = 0.02).Table 3 Previous cardiovascular diseases and established risk factors for males and females with MIStatistical significance was set at p 0.05 and marked as boldMales (N = 156)Females (N = 57)p valuen (%)n (%)Previous cardiovascular diseasesMyocardial infarction36

43、(26.1)11 (20.8)0.444Angina pectoris16 (12.6)3 (6.3)0.228Heart failure4 (3.1)1 (2.1)0.706Stroke8 (6.3)2 (4.2)0.588Heredity stroke41 (37.3)14 (32.6)0.585Established risk factorsDiabetes (type 1 and type 2)35 (22.9)17 (32.1)0.184Hypertension80 (54.1)29 (50.9)0.683Heredity myocardial infarction60 (51.7)

44、26 (59.1)0.404Current smoker71 (45.5)34 (59.6)0.068Current or former smoker127 (81.4)52 (91.2)0.083Obesity (BMI 30)47 (30.1)15 (26.8)0.637BMI kg/m2 Mean (SD)28 (4)26.8 (5.5)0.135Hyperlipidemia23 (18.1)17 (35.4)0.015 Cholesterol mmol/L Median (IQR)5.3 (4.36.1)5.4 (4.36.1)0.866 Triglycerides mmol/L Me

45、dian (IQR)1.7 (1.32.9)1.8 (1.22.8)0.833 LDL mmol/L Mean (SD)2.9 (1.2)3.1 (1.2)0.256 HDL mmol/L Median (IQR)1.2 (0.91.4)1.1 (0.91.3)0.262 LDL/HDL-ratio Mean (SD)2.7 (1.1)3 (1.1)0.103Fig. 1 Assessments of stress levels on a visual analog scale from 1 (low) to 10 (high) for males and females with MIFig

46、. 2 Estimated sleep quality among males and females with MIPage 5 of 7Nystrmetal. BMC Cardiovascular Disorders (2022) 22:110 Females had a higher Systolic Blood Pressure (SBP) at hospital admission compared to men 153mmHg (IQR 139168) versus 146mmHg (IQR 124162), p = 0.046. Further, men had a higher

47、 SBP the day of discharge com-pared to women 127mmHg (SD = 16) versus 118mmHg (SD = 17) p 0.001). At admission there was no sig-nificant difference in Diastolic Blood Pressure (DBP) between the sexes, males 90mmHg (IQR 80105) ver-sus females 96mmHg (IQR = 85105) p = 0.227). How-ever, men had a highe

48、r DBP than women at discharge 80mmHg (IQR 7485) versus 74mmHg (IQR 6485) p = 0.001). The Heart Rate (HR) in men was 78 (SD = 19) at admission compared to 76 (SD = 18) beats per minute in females (p = 0.684). At discharge the HR in men was 71 (SD = 11), compared to 75 (SD = 13) beats per minute in fe

49、males (p = 0.035).DiscussionThe main findingsThe main findings in this study of middle-aged men and women that had suffered a myocardial infarction was that more women than men had hyperlipidemia diagnosed at the cardiac event and that more females had experienced higher stress load including percei

50、ved stress, serious life events, strained economy, and depres-sion the year preceding their MI. Females also estimated poorer sleep quality and shorter sleep duration than men. More females than men were unemployed or on sick leave. Blood pressure and heart rate differed signifi-cantly between gende