The truth about women and heart disease
Filed under: Women Heart Health
Although breast cancer seems to be getting a lot more press lately, the biggest threat to women's health today is actually heart disease. And although men are more often thought of when picturing a heart attack victim, the truth is women are actually more likely to both have heart disease and they're more likely to die from a heart attack in the weeks immediately following than men are. The Mayo Clinic has a handy quiz for women regarding the truth on a variety of health topics, heart disease and breast cancer included, and it's interesting to read the explanations after you take it because some of the answers are surprising!
[RESEARCH] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
Objective To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women.
Design Randomised, placebo controlled trial.
Setting Academic medical centre in an urban setting in New Zealand.
Participants 1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo.
Main outcome measures Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death.
Results Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49).
Conclusion Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.
Trial registration Australian Clinical Trials Registry ACTRN 012605000242628.
Young women need to pay attention to their hearts too
Filed under: Diet, Family history, Prevention, Research, Exercise, Women Heart Health
Recently, a friend of mine went to the ER with pain in her left shoulder and shortness of breath. I'm too young for heart disease, she said to me when I called to check on her. But they soon had admitted her overnight for some tests, and though thankfully everything was fine, we both learned a lesson that day. We may be young at heart, but we aren't too young for heart disease. Cardiovascular disease is the leading cause of death in women over the age of 25 and it takes more lives than all cancers combined in that age group. I was astonished by that fact. Though women under 50 are less likely to have a heart attack than men, they are more likely to die from them -- likely because women's symptoms can be vague and because women also tend to ignore them. Though those statistics may concern you, there are steps you can take to keep your ticker ticking in a healthy way. Check out this article from Women's Health Magazine that'll give you eight steps you to a healthy heart. There's a ton of good information there, including specific screening tests you can ask for at your next doctor's visit.
[RESEARCH] Effect of reducing caffeine intake on birth weight and length of gestation: randomised controlled trial
Objective To estimate the effect of reducing caffeine intake during pregnancy on birth weight and length of gestation.
Design Randomised double blind controlled trial.
Setting Denmark.
Participants 1207 pregnant women drinking at least three cups of coffee a day, recruited before 20 weeks' gestation.
Interventions Caffeinated instant coffee (568 women) or decaffeinated instant coffee (629 women).
Main outcome measures Birth weight and length of gestation.
Results Data on birth weight were obtained for 1150 liveborn singletons and on length of gestation for 1153 liveborn singletons. No significant differences were found for mean birth weight or mean length of gestation between women in the decaffeinated coffee group (whose mean caffeine intake was 182 mg lower than that of the other group) and women in the caffeinated coffee group. After adjustment for length of gestation, parity, prepregnancy body mass index, and smoking at entry to the study the mean birth weight of babies born to women in the decaffeinated group was 16 g (95% confidence interval -40 to 73) higher than those born to women in the caffeinated group. The adjusted difference (decaffeinated group-caffeinated group) of length of gestation was -1.31 days (-2.87 to 0.25).
Conclusion A moderate reduction in caffeine intake in the second half of pregnancy has no effect on birth weight or length of gestation.
Trial registration Clinical Trials NCT00131690.
[RESEARCH] Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review
Objective To review the spot protein:creatinine ratio and albumin:creatinine ratio as diagnostic tests for significant proteinuria in hypertensive pregnant women.
Design Systematic review.
Data sources Medline and Embase, the Cochrane Library, reference lists, and experts.
Review methods Literature search (1980-2007) for articles of the spot protein:creatinine ratio or albumin:creatinine ratio in hypertensive pregnancy, with 24 hour proteinuria as the comparator.
Results 13 studies concerned the spot protein:creatinine ratio (1214 women with primarily gestational hypertension). Nine studies reported sensitivity and specificity for eight cut-off points, median 24 mg/mmol (range 17-57 mg/mmol; 0.15-0.50 mg/mg). Laboratory assays were not well described. Diagnostic test characteristics were recalculated for a cut-off point of 30 mg/mmol. No significant heterogeneity in cut-off points was found between studies over a range of proteinuria. Pooled values gave a sensitivity of 83.6% (95% confidence interval 77.5% to 89.7%), specificity of 76.3% (72.6% to 80.0%), positive likelihood ratio of 3.53 (2.83 to 4.49), and negative likelihood ratio of 0.21 (0.13 to 0.31) (nine studies, 1003 women). Two studies of the spot albumin:creatinine ratio (225 women) found optimal cut-off points of 2 mg/mmol for proteinuria of 0.3 g/day or more and 27 mg/mmol for albuminuria.
Conclusion The spot protein:creatinine ratio is a reasonable "rule-out" test for detecting proteinuria of 0.3 g/day or more in hypertensive pregnancy. Information on use of the albumin:creatinine ratio in these women is insufficient.
Phone survey shows disparity in awareness
Filed under: Research, Women Heart Health
500,000 women die annually from heart disease in the U.S., making it the leading cause of death. African-American women have the highest mortality rate from heart disease. Minority women are less likely than white women to be aware of the dangers of heart disease.
Three facts that add up to trouble.
In the January/February issue of the Journal of Women's Health, researchers from the New York Presbyterian Hospital published a study based on data collected to determine awareness of heart disease amount minorities. Comparing the results of a phone survey of 1,000 people with the results of a similar survey taken in 1997, the researcher found that 31 percent of African-American women and 29 percent of Hispanic women were aware of the disease, whereas 57 percent of white women were cognizant of the disease and its dangers.
In conducting the study, researchers also discovered that this disparity in awareness among white women and minority women has gone unchanged since the initial survey was conducted in 1997.
The entire study is available for online viewing in .PDF form at: http://www.kaisernetwork.org
[RESEARCH] Effect of high throughput RHD typing of fetal DNA in maternal plasma on use of anti-RhD immunoglobulin in RhD negative pregnant women: prospective feasibility study
Objectives To assess the feasibility of applying a high throughput method, with an automated robotic technique, for predicting fetal RhD phenotype from fetal DNA in the plasma of RhD negative pregnant women to avoid unnecessary treatment with anti-RhD immunoglobulin.
Design Prospective comparison of fetal RHD genotype determined from fetal DNA in maternal plasma with the serologically determined fetal RhD phenotype from cord blood.
Setting Antenatal clinics and antenatal testing laboratories in the Midlands and north of England and an international blood group reference laboratory.
Participants Pregnant women of known gestation identified as RhD negative by an antenatal testing laboratory. Samples from 1997 women were taken at or before the 28 week antenatal visit.
Main outcome measures Detection rate of fetal RhD from maternal plasma, error rate, false positive rate, and the odds of being affected given a positive result.
Results Serologically determined RhD phenotypes were obtained from 1869 cord blood samples. In 95.7% (n=1788) the correct fetal RhD phenotype was predicted by the genotyping tests. In 3.4% (n=64) results were either unobtainable or inconclusive. A false positive result was obtained in 0.8% (14 samples), probably because of unexpressed or weakly expressed fetal RHD genes. In only three samples (0.2%) were false negative results obtained. If these results had been applied as a guide to treatment, only 2% of the women would have received anti-RhD unnecessarily, compared with 38% without the genotyping.
Conclusions High throughput RHD genotyping of fetuses in all RhD negative women is feasible and would substantially reduce unnecessary administration of anti-RhD immunoglobulin to RhD negative pregnant women with an RhD negative fetus.
[RESEARCH] Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial
Objectives To determine the effects of two computer based decision aids on decisional conflict and mode of delivery among pregnant women with a previous caesarean section.
Design Randomised trial, conducted from May 2004 to August 2006.
Setting Four maternity units in south west England, and Scotland.
Participants 742 pregnant women with one previous lower segment caesarean section and delivery expected at ≥37 weeks. Non-English speakers were excluded.
Interventions Usual care: standard care given by obstetric and midwifery staff. Information programme: women navigated through descriptions and probabilities of clinical outcomes for mother and baby associated with planned vaginal birth, elective caesarean section, and emergency caesarean section. Decision analysis: mode of delivery was recommended based on utility assessments performed by the woman combined with probabilities of clinical outcomes within a concealed decision tree. Both interventions were delivered via a laptop computer after brief instructions from a researcher.
Main outcome measures Total score on decisional conflict scale, and mode of delivery.
Results Women in the information programme (adjusted difference –6.2, 95% confidence interval –8.7 to –3.7) and the decision analysis (–4.0, –6.5 to –1.5) groups had reduced decisional conflict compared with women in the usual care group. The rate of vaginal birth was higher for women in the decision analysis group compared with the usual care group (37% v 30%, adjusted odds ratio 1.42, 0.94 to 2.14), but the rates were similar in the information programme and usual care groups.
Conclusions Decision aids can help women who have had a previous caesarean section to decide on mode of delivery in a subsequent pregnancy. The decision analysis approach might substantially affect national rates of caesarean section.
Trial Registration Current Controlled Trials ISRCTN84367722.
Stroke subtypes: Type 1 and 2 women face greater risk
Filed under: Type 1, Type 2, Research, Complications
Just out in the new issue of Diabetes Care: a report that diabetic women are more at risk for the various stroke subtypes. (Today is just a day for bad health news, I guess. See my previous blog on trauma injuries.) Stroke, as you may already know, is where blood supply to the brain is restricted or cut off. The study's authors tracked the progress of 116,316 women through middle age during the period 1976 to 2002. That's a lotta women... They found the women with diabetes were at a higher risk for stroke, generally: four times higher than that of the general population for women with Type 1 diabetes, and twice as high for women with Type 2 diabetes.
That people with diabetes face a higher risk of stroke is not new. What is new? This study also looked at stroke subtypes and relative risk for women with and without diabetes for each of those subtypes. Some results: ischemic stroke (caused by a blood clot to the brain) risk was 6.3 times higher for T1 diabetics, 2.3 times higher for T2 diabetics. The risk for large-artery infarction and lacunar stroke was similar. The study also concluded that while Type 1 diabetic women face a higher risk of hemorrhagic stroke (where bleeding occurs in the brain or between the brain and the skull), Type 2 women did not.
This study was funded by the National Institutes of Health.
Read more about strokes and learn how to recognize signs of stroke by visiting some of the excellent Web-based resources out there. A good starting point is InteliHealth's section on stroke or visit the National Stroke Association's website. You could save someone's life!
[RESEARCH] Preventive strategies for group B streptococcal and other bacterial infections in early infancy: cost effectiveness and value of information analyses
Objective To determine the cost effectiveness of strategies for preventing neonatal infection with group B streptococci and other bacteria in the UK and the value of further information from research.
Design Use of a decision model to compare the cost effectiveness of prenatal testing for group B streptococcal infection (by polymerase chain reaction or culture), prepartum antibiotic treatment (intravenous penicillin or oral erythromycin), and vaccination during pregnancy (not yet available) for serious bacterial infection in early infancy across 12 maternal risk groups. Model parameters were estimated using multi-parameter evidence synthesis to incorporate all relevant data inputs.
Data sources 32 systematic reviews were conducted: 14 integrated results from published studies, 24 involved analyses of primary datasets, and five included expert opinion.
Main outcomes measures Healthcare costs per quality adjusted life year (QALY) gained.
Results Current best practice (to treat only high risk women without prior testing for infection) and universal testing by culture or polymerase chain reaction were not cost effective options. Immediate extension of current best practice to treat all women with preterm and high risk term deliveries without testing (11% treated) would result in substantial net benefits. Currently, addition of culture testing for low risk term women, while treating all preterm and high risk term women, would be the most cost effective option (21% treated). If available in the future, vaccination combined with treating all preterm and high risk term women and no testing for low risk women would probably be marginally more cost effective and would limit antibiotic exposure to 11% of women. The value of information is highest (£67m) if vaccination is included as an option.
Conclusions Extension of current best practice to treat all women with preterm and high risk term deliveries is readily achievable and would be beneficial. The choice between adding culture testing for low risk women or vaccination for all should be informed by further research. Trials to evaluate vaccine efficacy should be prioritised.