sex differences in cardiovascular aging – cardiovascular ...on memory – susan bell, mbbs, msci,...
TRANSCRIPT
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Sex Differences in Cardiovascular Aging – Cardiovascular Disease, Cognition and Health Policy
Overview: Can Inclusion of Women Improve Men’s Heart Health?
C. Noel Bairey Merz MD Medical Director Barbra Streisand Women’s Heart Center Smidt Heart Institute Cedars-Sinai Medical Center
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https://www.statista.com/statistics/274513/life- expectancy-in-north-america/
Average Life Expectancy for North America for those born in 2018 by gender and region (years)
What can we learn about female aging that can improve human health for women and men?
https://www.statista.com/statistics/274513/life-
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Sex Differences in Cardiovascular Aging Which May Lead to Improved Men’s Health
1) Coronary Microvascular Dysfunction
2) Coronary Arterial Remodeling 3) Left Ventricular Remodeling
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Younger women: Plaque erosionYounger women: Plaque erosion:: Thrombus over a base rich in smooth muscle with proteglycan-rich matrix (necrotic core -
often absent): 40% of thrombi in sudden cardiac death
Men and older women: Plaque ruptureMen and older women: Plaque rupture:: Thin fibrous cap over large necrotic core Infiltrated by foamy macrophages: 60% of thrombi
in sudden cardiac death
Source: Burke Circulation 1998;97:2110-2116.
Plaque E rosion Plaque Rupture
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1615PC Bairey-Merz/Slide # 6
Morphology of Intramyocardial Emboli in Epicardial Plaque Thrombosis
Women vs. men: – Any emboli: 73% vs. 37%, p
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INOCA (ischemia with no obstructive CAD): Cardiac MRI demonstrating microvascular coronary dysfunction.
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8
WARRIOR: Women’s IschemiA TReatment Reduces Events In Non-ObstRuctive CAD Trial
Carl J. Pepine MD C. Noel Bairey Merz MD
Eileen Handberg PhD Rhonda Cooper-DeHoff PharmD
Janet Wei MD Andre Rogatko PhD
Bernard Chaitman MD William Weintraub MD
4,422 subjects with angina, no obstructive CAD randomized to IMT (intensive statin and
ACE/ARB) vs UC (usual care primary risk factor management) for reduction of MACE (all-cause death, non-fatal-MI, -stroke, or hospitalization for chest pain or HF) funded by the
Congressionally Directed Medical Research Program, Department of Defense, USA (NCT03417388)
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Normal Coronaries
22%
1V Non-Obstructive
CAD 14%
2V Non-Obstructive
CAD 8%
3V Non-Obstructive
CAD 3%
1V Obstructive
CAD 23%
2V Obstructive
CAD 14%
3V/LM Obstructive
CAD 16%
37,674 male VA patients – 47% non-obstructive CAD
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Sex Differences in Cardiovascular Aging
1) Coronary Microvascular Dysfunction
2) Coronary Arterial Remodeling 3) Left Ventricular Remodeling
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Female coronary arteries enlarge when transplanted into males (JACC 2003;41:1539-46)
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Women erode Men explode
WISE Study: Sex Differences in Heart Attack Plaques
Burke et al Circ 1998
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Female BM-MNCs were more beneficial than male cells
Nelson, Zenovich, …Taylor
Circ Res 2007
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Exploratory Clinical Study to Evaluate the Potential Bioactivity of CLBS14 in Patients with Coronary
Microvascular Dysfunction
October 6, 2017 NHLBI-SBIR
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Incidence of Myocardial Infarction 46,086 hospitalized predominantly male patients with
myocardial infarction over 18,691,131 person-years
RESULTS
Age-Sex-Adjusted Incidence of Myocardial Infarction by Year
0
50
100
150
200
250
300
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Inci
denc
e(p
er 1
00 0
00 p
erso
n-ye
ars)
Any MI NSTEMI
STEMI
Outpatient Medication Use Prior to Myocardial Infarction
0
10
20
30
40
50
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Prop
ortio
n of
Use
(%)
ACE-I/ARB
Thienopyridine
Non-Statin Lipid Lowering
β-Blocker
Statin
STEMI
Alan S. Go, MD Kaiser Division of Research University of California, San Francisco
STEMI-related large plaque ruptures are going away
Due to outpatient meds
Chart1
1999199919998.19769223848.19769223845.72761449025.72761449026.22881463546.2288146354
2000200020008.29842488678.29842488675.52870830715.52870830716.51076308616.5107630861
2001200120017.8626460487.8626460485.17284049975.17284049976.24124363646.2412436364
2002200220027.60142709437.60142709434.9766609244.9766609246.02292455496.0229245549
2003200320037.61887497687.61887497684.52411873484.52411873486.38209130076.3820913007
2004200420047.40734702747.40734702743.94890218393.94890218396.47783520816.4778352081
2005200520057.17092917577.17092917573.68948370213.68948370216.33773862636.3377386263
2006200620066.85511261956.85511261953.54989771283.54989771286.04065251756.0406525175
2007200720076.5372615166.5372615163.30714879643.30714879645.79701326735.7970132673
2008200820086.34786738736.34786738733.1462126373.1462126375.67680531155.6768053115
All MI
STEMI
NSTEMI
Year
Incidence(per 100 000 person-years)
Age-Sex-Adjusted Incidence of Myocardial Infarction by Year
273.7707149768
132.552159238
154.7884789612
287.0015151655
126.8339192138
172.350547134
279.4333270003
119.7200145469
172.8511411731
276.1284567018
116.5800953663
171.0215123158
279.2178726307
96.8048451433
193.2662462824
268.0628211507
74.7613045283
202.4963773569
256.6155147841
66.6504276817
198.1607966138
238.2706216596
62.6774328869
183.1075801505
218.9983888943
55.0165274653
170.5308384734
208.458666459
50.2315304458
165.2407978591
Incidence with revision
CRUDEDecline over study period for MI0.1313684725
BurdenSTEMI0.58752082260.4124791774
All19992000200120022003200420052006200720080.5798666564
Rate3.0234428513.20531441823.2103203053.23549883243.28942173233.20166298793.13547553962.95180026272.70632165532.6262577819302.3442851022320.5314418191321.0320304992323.5498832369328.9421732312320.1662987935313.5475539562295.1800262709270.6321655275262.6257781927ALAN: FIGURES FOR SENS ANAL ARE BELOW
LCI2.94135151973.1212569623.1286718873.154303253.20774530113.12113811543.05644599042.87564191712.633624662.554765209294.1351519727312.1256962031312.867188699315.4303249967320.7745301146312.1138115357305.6445990449287.5641917103263.3624660046255.4765208974
UCI3.10553418233.28937187443.2919687233.31669441483.37109816353.28218786053.21450508873.02795860832.77901865052.6977503549310.5534182316328.9371874352329.1968722994331.6694414772337.1098163478328.2187860513321.4505088674302.7958608315277.9018650504269.7750354879
Error Bars8.20913312948.40574561618.16484180028.11955824038.16764311668.05248725787.90295491127.61583456067.26969952297.1492572952
STEMI8.20913312948.40574561618.16484180028.11955824038.16764311668.05248725787.90295491127.61583456067.26969952297.1492572952
Rate1.35593666151.32952264711.25515469751.24858430351.02731739550.80186553670.73992452370.69357843640.6043982810.5592956387135.5936661454132.9522647144125.5154697456124.8584303508102.731739545580.186553674473.992452372369.35784363660.439828101555.9295638744
LCI1.300961551.27538631921.20410158551.19814481050.9816728070.76156665340.70153333970.65666182680.57004340670.5263033103130.0961550014127.5386319244120.4101585538119.814481045298.167280702976.156665335970.153333969965.666182675657.004340666152.6303310271
UCI1.41091177291.3836589751.30620780941.29902379661.07296198390.84216442010.77831570770.7304950460.63875315540.5922879672141.0911772894138.3658975045130.6207809374129.9023796564107.296198388184.21644201377.831570774773.049504596463.875315536859.2287967216
Error Bars5.4975111445.41363279015.10531119185.04394930564.56445884264.02988833853.83911840243.69166096043.43548743533.2992328473
NSTEMI5.4975111445.41363279015.10531119185.04394930564.56445884264.02988833853.83911840243.69166096043.43548743533.2992328473
Rate1.66750618961.8757917711.95516560751.98691452892.26210433692.39979745122.39555101582.25822182632.10192337432.0669621432166.7506189568187.5791771047195.5165607536198.6914528862226.2104336857239.9797451191239.5551015839225.8221826349210.1923374261206.6962143183
LCI1.60654125051.81148847461.89144713361.9232860752.19437243192.33008192132.32647289612.19160908332.03785625542.0035374299160.6541250497181.1488474571189.1447133561192.3286074991219.4372431853233.0081921345232.6472896132219.1609083268203.7856255366200.3537429945
UCI1.72847112861.94009506752.01888408152.05054298272.32983624192.4695129812.46462913552.32483456942.16599049322.1303868564172.8471128638194.0095067522201.8884081511205.0542982732232.9836241861246.9512981036246.4629135545232.483456943216.5990493155213.0386856421
Error Bars6.0964939076.43032964756.37184739756.36284538716.77319050046.97155298456.90781197066.66127430816.40671188956.3424713238
Incident6.0964939076.43032964756.37184739756.36284538716.77319050046.97155298456.90781197066.66127430816.40671188956.3424713238
All
Rate2.46509243662.61148768972.58727066282.64793085712.67867995792.6100201912.51373009272.34372271772.16609429712.077312573246.5092436593261.14876897258.7270662771264.7930857093267.8679957924261.0020191023251.3730092672234.3722717724216.6094297083207.7312573031
LCI2.39077800562.53540483852.51376173582.57425345032.60473329992.53705864952.44270498412.27559876732.10080139972.013476311239.0778005638253.5404838481251.3761735848257.4253450251260.473329993253.7058649475244.27049841227.5598767347210.0801399691201.3476310969
UCI2.53940686752.68757054092.66077958972.72160826392.75262661592.68298173262.58475520122.41184666812.23138719452.1411488351253.9406867547268.757054092266.0779589694272.1608263935275.2626615917268.298173257258.4755201243241.18466681223.1387194475214.1148835092
Error Bars7.43144309557.60828512197.35089269237.36774068427.39466579937.29615415487.10251085716.81239503766.52928973926.3836262062
STEMI7.43144309557.60828512197.35089269237.36774068427.39466579937.29615415487.10251085716.81239503766.52928973926.3836262062
Rate1.2130097631.17938153731.12863498551.13345528830.9437285470.73957651060.66447728140.62729504010.55433160580.5096258476121.3009762979117.9381537284112.8634985483113.345528828494.372854696973.957651059766.447728135562.72950401355.433160582950.9625847563
LCI1.16087964591.12825222511.08008423971.08525127380.89983691970.70073790560.62796048640.59205124760.5213013390.4780072759116.0879645913112.82522251108.0084239728108.525127380689.983691965770.073790561462.796048642659.205124760652.130133900247.8007275883
UCI1.265139881.23051084951.17718573121.18165930280.98762017430.77841511560.70099407630.66253883270.58736187270.5412444192126.5139880045123.0510849468117.7185731237118.165930276298.762017428277.84151155870.099407628366.253883265358.736187265654.1244419242
Error Bars5.21301170665.11293121844.85507457544.82040144784.38916273133.88386049833.65167949283.52437925233.30302668273.161857168
NSTEMI5.21301170665.11293121844.85507457544.82040144784.38916273133.88386049833.65167949283.52437925233.30302668273.161857168
Rate1.40837431621.5798173431.61901492621.66336164481.88108054971.99892718051.96574529071.8215782021.70346819721.6621564467140.8374316151157.9817342996161.9014926189166.3361644812188.1080549702199.8927180472196.5745290674182.1578201987170.3468197209166.215644671
LCI1.35220287061.52064125841.56086561461.60496682091.81911335541.93507576131.90293711111.7615202361.64556610241.605054295135.2202870621152.0641258394156.0865614641160.4966820903181.9113355368193.5075761294190.2937111091176.1520236034164.5566102352160.5054295036
UCI1.46454576171.63899342761.67716423771.72175646871.9430477442.06277859972.02855347031.88163616791.76137029211.7192585984146.4545761681163.8993427598167.7164237736172.1756468722194.3047744037206.277859965202.8553470257188.163616794176.1370292067171.9258598383
Error Bars5.6171445535.91760846025.81493115485.8394823916.19671943346.38514191786.28081795836.00579659535.79020948575.7102151674
5.6171445535.91760846025.81493115485.8394823916.19671943346.38514191786.28081795836.00579659535.79020948575.7102151674
AGE-SEX ADJUSTED
Burden163148658299116133150168
All1999200020012002200320042005200620072008
Rate3.34761455763.50873188083.45388279783.35825082963.41114417083.26991164523.18170326732.98606578142.72470962152.6257593885334.7614557641350.873188083345.3882797807335.825082957341.1144170767326.9911645203318.170326727298.6065781366272.4709621547262.5759388457decline0.2156327011
LCI3.25585406423.41591473373.36556305193.27371451413.32623791833.18754700653.10142863662.90897723182.65151142222.5542803829325.5854064186341.5914733702336.5563051891327.3714514119332.6237918263318.754700653310.1428636594290.8977231796265.1511422168255.4280382883
UCI3.43937505113.6015490283.54220254373.4427871453.49605042333.35227628393.26197789793.06315433092.79790782092.697238394343.9375051095360.1549027958354.2202543723344.278714502349.6050423271335.2276283876326.1977897946306.3154330937279.7907820926269.7238394032
9.17604934549.28171471288.83197459168.4536315458.49062525048.23646386738.02746306767.70885495717.31981993797.1479005575
STEMI9.17604934549.28171471288.83197459168.4536315458.49062525048.23646386738.02746306767.70885495717.31981993797.1479005575
Rate1.48799129741.43899926031.34291051241.29507584621.06324852590.81912634750.75075697490.70137600210.60797375980.5591894994148.7991297447143.8999260278134.291051237129.5075846199106.324852590181.912634746475.075697493270.137600205360.797375983755.9189499394
LCI1.42713365841.37995350491.28801236681.2426018961.01589508680.77789915950.71176341690.66402060680.57341172980.526203432142.7133658421137.9953504934128.8012366781124.2601896018101.589508682977.789915953971.176341685466.402060683557.341172978952.6203431982
UCI1.54884893651.49804501561.3978086581.34754979641.1106019650.86035353540.7897505330.73873139730.64253578990.5921755668154.8848936472149.8045015622139.7808657959134.7549796379111.060196497486.035353538978.97505330173.873139727164.253578988559.2175566805
6.08576390255.90457553445.48981455895.2473950184.73534390734.12271879253.89935580783.73553952183.45620300483.2986067411
NSTEMI6.08576390255.90457553445.48981455895.2473950184.73534390734.12271879253.89935580783.73553952183.45620300483.2986067411
Rate1.85962326022.06973262062.11097228542.06317498342.34789564492.45078529772.43094629232.28468977932.11673586172.0665698891185.9623260194206.9732620552211.0972285437206.3174983371234.7895644866245.0785297739243.0946292338228.4689779313211.673586171206.6569889064
LCI1.79094767551.99811822552.04178723551.99689622972.27742065982.3794813522.36077850232.21725670942.05221111862.0031572121179.0947675513199.8118225513204.1787235537199.6896229744227.7420659784237.9481351989236.0778502301221.7256709362205.2211118616200.315721214
UCI1.92829884492.14134701562.18015733532.1294537372.41837062992.52208924352.50111408242.35212284932.18126060482.129982566192.8298844874214.134701559218.0157335337212.9453736998241.8370629948252.2089243489250.1114082374235.2122849264218.1260604803212.9982565988
6.8675584687.16143950396.918504996.62787536277.04749850827.1303945757.01677900366.74330699516.45247430936.3412676924
Incident6.8675584687.16143950396.918504996.62787536277.04749850827.1303945757.01677900366.74330699516.45247430936.3412676924
All
Rate2.73770714982.87001515172.794333272.7612845672.79217872632.68062821152.56615514782.38270621662.18998388892.0845866646273.7707149768287.0015151655279.4333270003276.1284567018279.2178726307268.0628211507256.6155147841238.2706216596218.9983888943208.458666459
LCI2.65573022742.78703090282.71570680952.68527029612.71598997652.60655474122.49444585612.31415509042.12461127382.0211079907265.5730227384278.7030902788271.5706809523268.5270296075271.5989976539260.6554741233249.4445856084231.4155090401212.4611273784202.1107990717
UCI2.81968407222.95299940052.87295973052.8372988382.86836747612.75470168182.63786443962.45125734282.25535650412.1480653385281.9684072152295.2999400522287.2959730483283.7298837962286.8367476076275.470168178263.7864439599245.1257342792225.5356504103214.8065338462
8.19769223848.29842488677.8626460487.60142709437.61887497687.40734702747.17092917576.85511261956.5372615166.3478673873
STEMI8.19769223848.29842488677.8626460487.60142709437.61887497687.40734702747.17092917576.85511261956.5372615166.3478673873
Rate1.32552159241.26833919211.19720014551.16580095370.96804845140.74761304530.66650427680.62677432890.55016527470.5023153045132.552159238126.8339192138119.7200145469116.580095366396.804845143374.761304528366.650427681762.677432886955.016527465350.2315304458
LCI1.26824544751.21305210911.14547174051.11603434440.92280726410.70812402340.62960943980.59127535170.51709378670.4708531781126.8245447479121.3052109067114.5471740472111.603434442392.280726408470.812402344462.960943979659.127535174151.709378668847.0853178088
UCI1.38279773731.32362627521.24892855051.21556756291.01328963880.78710206710.70339911380.6622733060.58323676260.5337774308138.2797737282132.3626275209124.8928550465121.5567562904101.328963878178.710206712270.339911383866.227330599758.323676261753.3777430827
5.72761449025.52870830715.17284049974.9766609244.52411873483.94890218393.68948370213.54989771283.30714879643.146212637
NSTEMI5.72761449025.52870830715.17284049974.9766609244.52411873483.94890218393.68948370213.54989771283.30714879643.146212637
Rate1.54788478961.72350547131.72851141171.71021512321.93266246282.02496377361.98160796611.83107580151.70530838471.6524079786154.7884789612172.350547134172.8511411731171.0215123158193.2662462824202.4963773569198.1607966138183.1075801505170.5308384734165.2407978591
LCI1.48559664331.65839784051.66609897541.64998587761.86884154981.96018542151.91823057991.77066927631.64733825211.5956399255148.5596643258165.8397840479166.6098975366164.998587761186.8841549817196.0185421489191.8230579876177.066927633164.7338252061159.5639925475
UCI1.6101729361.78861310221.79092384811.77044436871.99648337582.08974212562.04498535241.89148232671.76327851741.7091760317161.0172935965178.86131022179.0923848095177.0444368707199.6483375831208.974212565204.4985352401189.148232668176.3278517407170.9176031706
6.22881463546.51076308616.24124363646.02292455496.38209130076.47783520816.33773862636.04065251755.79701326735.6768053115
6.22881463546.51076308616.24124363646.02292455496.38209130076.47783520816.33773862636.04065251755.79701326735.6768053115
Total Mis With 411, 413, 414
1999200020012002200320042005200620072008
Incidence314.281331.53319.765311.213304.365290.59284.778264.1247.204241.711
Lower CI305.919322.99311.624303.257296.515282.925277.253256.902240.261234.86
Upper CI322.643340.07327.905319.168312.215298.255292.393271.298254.146248.563
Error Bars8.3628.548.1417.9567.857.6657.5257.1986.9436.851
8.3628.548.147.9557.857.6657.6157.1986.9426.852
NSTEMIs with 411, 413, 414Don't have
1999200020012002200320042005200620072008
Incidence186.951208.983205.769198.845211.836218.002221.067204.064194.666194.423
Lower CI180.498202.199199.235192.482205.285211.361214.435197.735188.503188.277
Upper CI193.405215.768212.303205.208218.388224.643227.7210.393200.828200.57
Error Bars6.4536.7846.5346.3636.5516.6416.6326.3296.1636.146
6.4546.7856.5346.3636.5526.6416.6336.3296.1626.147
Total Mis with Enzyme + UA
1999200020012002200320042005200620072008
Incidence297.402310.351303.174297.58292.8280.168274.586253.525235.19225.576
Lower CI289.268302.087295.247289.8285.101272.641267.196246.472228.418218.956
Upper CI305.537318.614311.101305.36300.5287.694281.975260.578241.962232.195
Error Bars8.1348.2647.9277.787.6997.5277.397.0536.7726.62
8.1358.2637.9277.787.77.5267.3897.0536.7726.619
NSTEMIs with Enzyme + UA
1999200020012002200320042005200620072008
Incidence170.085187.822189.19185.22200.275207.581210.876193.491182.653178.291
Lower CI163.929181.389182.924179.078193.904201.1204.298187.328176.684172.405
Upper CI176.241194.254195.455191.361206.646214.061217.354199.654188.623184.178
Error Bars6.1566.4336.2666.1426.3716.4816.5786.1635.9695.886
6.1566.4326.2656.1416.3716.486.4786.1635.975.887
Total Mis No Exit , Age-Adjusted
1999200020012002200320042005200620072008
Person years1018259.331639894.81
N3390362638253992416040524058380237023631
Incidence330.639331.09330.191323.009318.316296.334285.995256.297237.868221.417
Lower CI319.489320.215319.581312.816308.444287.017277.051248.045230.145214.223
Upper CI341.789341.965340.8333.203328.188305.65294.94264.548245.591228.611
Error Bars11.1510.87510.6110.1939.8729.3178.9448.2527.7237.194
11.1510.87510.60910.1949.8729.3168.9458.2517.7237.194
STEMI No Exit Age Adjusted
1999200020012002200320042005200620072008
Person years
N
Incidence150.418138.389132.627129.995104.36177.398968.526863.969755.769549.6373
Lower CI142.891131.352125.897123.52298.70372.636264.143659.843452.026746.2283
Upper CI157.946145.427139.357136.468110.0282.165372.910168.095959.512453.0464
Error Bars7.5277.0376.736.4735.6584.76274.38324.12633.74283.409
7.5287.0386.736.4735.6594.76644.38334.12623.74293.4091
NSTEMI No Exit Age Adjusted
1999200020012002200320042005200620072008
Person years
N
Incidence180.221192.701197.564193.015213.954218.935217.469192.327182.098171.779
Lower CI171.983184.398189.352185.13205.857210.924209.666185.177175.339165.441
Upper CI188.459201.003205.775200.9222.052226.945225.271199.477188.857178.117
Error Bars8.2388.3038.2127.8858.0978.0117.8037.156.7596.338
8.2388.3028.2117.8858.0988.017.8027.156.7596.338
Total Mis No Entry, No Exit Age Adjusted
1999200020012002200320042005200620072008
Person years
N
Incidence479.082489.233482.269473.987487.443447.01435.359391.169361.511339.011
Lower CI462.285472.168465.181456.919470.01430.217418.75375.228346.099324.032
Upper CI495.879506.298499.357491.055504.876463.804452.068407.109376.923353.99
Error Bars16.79717.06517.08817.06817.43316.79316.60915.94115.41214.979
16.79717.06517.08817.06817.43316.79416.70915.9415.41214.979
STEMI No Entry, No Exit Age Adjusted
1999200020012002200320042005200620072008
Person years
N
Incidence210.261192.768185.676188.674152.829110.95694.971788.555781.035471.9166
Lower CI199.118182.04175.057177.89143.051102.57587.154380.959773.728365.0083
Upper CI221.404203.496196.295199.458162.607119.337102.78996.151788.342678.825
Error Bars11.14310.72810.61910.7849.7788.3817.81747.5967.30716.9083
11.14310.72810.61910.7849.7788.3817.81737.5967.30726.9084
NSTEMI No Entry, No Exit Age Adjusted
1999200020012002200320042005200620072008
Person years
N
Incidence268.821296.465296.593285.314334.614336.055340.387302.613280.475267.094
Lower CI256.225283.168283.18272.059320.158321.485325.606288.586266.895253.794
Upper CI281.416309.762310.006298.569349.069350.624355.168316.64294.056280.395
Error Bars12.59613.29713.41313.25514.45614.5714.78114.02713.5813.3
12.59513.29713.41313.25514.45514.56914.78114.02713.58113.301
Incidence with revision
8.20913312948.20913312945.4975111445.4975111446.0964939076.096493907
8.40574561618.40574561615.41363279015.41363279016.43032964756.4303296475
8.16484180028.16484180025.10531119185.10531119186.37184739756.3718473975
8.11955824038.11955824035.04394930565.04394930566.36284538716.3628453871
8.16764311668.16764311664.56445884264.56445884266.77319050046.7731905004
8.05248725788.05248725784.02988833854.02988833856.97155298456.9715529845
7.90295491127.90295491123.83911840243.83911840246.90781197066.9078119706
7.61583456067.61583456063.69166096043.69166096046.66127430816.6612743081
7.26969952297.26969952293.43548743533.43548743536.40671188956.4067118895
7.14925729527.14925729523.29923284733.29923284736.34247132386.3424713238
All MI
STEMI
NSTEMI
Year
Incident (per 100 000 person-years)
Crude Incidence of Any Myocardial Infarction by Year
Covariates Burden
7.43144309557.43144309555.21301170665.21301170665.6171445535.617144553
7.60828512197.60828512195.11293121845.11293121845.91760846025.9176084602
7.35089269237.35089269234.85507457544.85507457545.81493115485.8149311548
7.36774068427.36774068424.82040144784.82040144785.8394823915.839482391
7.39466579937.39466579934.38916273134.38916273136.19671943346.1967194334
7.29615415487.29615415483.88386049833.88386049836.38514191786.3851419178
7.10251085717.10251085713.65167949283.65167949286.28081795836.2808179583
6.81239503766.81239503763.52437925233.52437925236.00579659536.0057965953
6.52928973926.52928973923.30302668273.30302668275.79020948575.7902094857
6.38362620626.38362620623.1618571683.1618571685.71021516745.7102151674
All MI
STEMI
NSTEMI
Year
Incident (per 100 000 person-years)
Crude Incidence of First Myocardial Infarction by Year
Covariates Incident
Table 1. Characteristics of All Hospitalized Myocardial Infarctions, January 1999-December 2008
YearNumbers for Text
PTotal MI57466
1999200020012002200320042005200620072008Value*Total STEMI17873
N5211558659396100623160736047577153245184Total NSTEMI39593
Age (years ± SD)67 ± 1368 ± 1369 ± 1369 ± 1370 ± 1370 ± 1470 ± 1469 ± 1469 ± 1469 ± 14
-
Sex Differences in Cardiovascular Aging
1) Coronary Microvascular Dysfunction
2) Coronary Arterial Remodeling 3) Left Ventricular Remodeling
-
Gender differences in pressure overload
normal
Concentric hypertrophy
Pressure load Hypertension Aortic stenosis
Women?!
Men Adaptive remodeling thick walls, small ventricle better reversibility?
Maladaptive remodeling thin walls, dilatation!
-
Figure 3
Microvascular Dysfunction
LV Remodeling Diastolic and Systolic Dysfunction
Myocardial Ischemia
Genetic and Environmental Factors
Myocardial Fibrosis and Scar MINOCA HFpEF
Arrhythmias Sudden Death
Arteriolar Remodelling
WISE-CVD Continuation (HFpEF) R01 – PI CN Bairey Merz MD - Proposed cascade of events in coronary microvascular dysfunction-related MINOCA, INOCA, and HFpEF
Crea, Camici, Bairey Merz EHJ 12/13
-
Distribution of EF Among Men and Women With HF: 21% and 27% are
HFpEF, respectively
Vasan RS et al. J Am Coll Cardiol. 1999;33:1948-1955.
EF>41
-
Sex Differences in Cardiovascular Aging
1) Vascular Factors in Cognition: The Impact of Sex on Memory – Susan Bell, MBBS, MSCI, MACC
2) Cardiovascular Aging, Sex Differences and Eicosonoids – The Fountain of Youth? – Susan Cheng, MD, MPH, MMSc
3) Bridging the Sex Gap in Early Myocardial Infarction Mortality – Why Sex Matters – Nakela Cook, MD, MPH, FACC
Sex Differences in Cardiovascular Aging – �Cardiovascular Disease, Cognition and Health PolicySlide Number 2Sex Differences in Cardiovascular Aging Which May Lead to Improved Men’s HealthSlide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 837,674 male VA patients – �47% non-obstructive CADSex Differences in Cardiovascular AgingSlide Number 11Slide Number 12Slide Number 13Female BM-MNCs were more beneficial than male cellsSlide Number 16Incidence of Myocardial InfarctionSex Differences in Cardiovascular AgingGender differences in pressure overloadSlide Number 20Distribution of EF Among Men and Women With HF: 21% and 27% are HFpEF, respectivelySex Differences in Cardiovascular Aging