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Angina After Heart Attack and Early Menopause
Early menopause predicts angina after myocardial infarction.
Menopause. 2010 Jul 21.
Parashar S, et al
Abstract
OBJECTIVE:: Population studies have shown that age at menopause (AAM) predicts coronary heart disease.
It is unknown, however, whether early menopause predicts post-myocardial infarction (MI) angina.
We examined whether younger AAM increases risk of post-MI angina.
METHODS:: In a prospective multicenter MI registry, 493 postmenopausal women were enrolled (mean +/- SD age, 65.4 +/- 11.3 y, and mean +/- SD AAM, 45.2 +/- 7.8 y).
We categorized AAM into 40 years or younger, 41 to 49 years, and 50 years or older. In the multivariable analysis, we examined whether AAM predicted 1-year post-MI angina and severity of angina after adjusting for angina before MI, demographics, comorbidities, MI severity, and quality of care (QOC).
RESULTS:: Women with early AAM (</=40 y; n = 132, 26.8%) were younger and more often smokers but were as likely to have comorbidities as were women with an AAM of 50 years or older. Although there were no differences in pre-MI angina, MI severity, obstructive coronary disease, and QOC based on AAM, the rate of 1-year angina was higher in women with an AAM of 40 years or younger (32.4%) than in women with an AAM of 50 years or older (12.2%).
In the multivariable analysis, women with an AAM of 40 years or younger had more than twice the risk of angina (relative risk, 2.09; 95% CI, 1.38-3.17) and a higher severity of angina (odds ratio, 2.65; 95% CI, 1.34-5.22 for a higher severity level) compared with women with an AAM of 50 years or older.
CONCLUSIONS:: Women with early menopause are at higher risk of angina after MI, independent of comorbidities, severity of MI, and QOC. The use of a simple question regarding AAM may help in the identification of women who need closer follow-up, careful evaluation, and intervention to improve their symptoms and quality of life after MI.
Featured Angina| Acute Coronary Syndrome and Heart Disease Interviews
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Author Interview: Claes Held MD
Associate professor at Uppsala Clinical Research Center and the
Cardiology department at Uppsala University Hospital in Sweden
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Publication:
Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study
Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432
2012 doi:10.1093/eurheartj/ehr432
Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf
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What are the main findings of the study?
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The main findings are he following:
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It is well known that physical inactivity is a risk factor for developing cardiovascular disease.
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Our study shows that being physically active reduces the risk of having a heart attack.
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Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries.
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We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %.
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We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.
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Were any of the findings unexpected?
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We looked at the relationship between physical activity both at work and during leisure time.
A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did.
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What should clinicians and patients take away from this study?
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The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines.
This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away.
All PA does a good job for the heart as compared to not doing anything at all!
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What recommendations do you have for cardiology health care providers as a result of your study?
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It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true.
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Abstract
Background— Despite data showing the benefits of implantable cardioverter-defibrillator (ICD) insertion for primary prevention in populations at risk for sudden death, professional society guidelines recommending primary prevention, and recognition by payers of the clinical value of ICDs in these populations, ICDs for primary prevention remain underused. We sought to determine whether implementing a screening tool would increase appropriate identification of patients showing clinical evidence of ICD benefit and prompt referral to an electrophysiologist for ICD implantation.
Methods and Results— Screening tools were affixed to medical records for patients seen in 2 outpatient cardiology offices that queried ejection fraction and whether referral to an electrophysiologist was made (N=6632).
The number of appropriate referrals in the screening period were compared with analogous data collected before implementation of the screening tool (control period) through retrospective record review (n=3606). Significantly more eligible patients were offered referral during the screening period than during the control period at both sites, 80% (8/10 eligible) versus 33% (5/15) at site 1 (P<0.02) and 100% (44/44) versus 60% (21/35) at site 2 (P<0.001). Of all patients offered referral, 41% (32/78) accepted.
Conclusions— The use of a screening tool increases referral to electrophysiology for patients in whom placement of an ICD confers the benefit of sudden cardiac death primary prevention. Barriers to referral include both physician and patient factors. Verification of these findings on a larger scale as well as studies defining the foundation of these barriers may further improve use of ICDs in patients for whom their mortality benefit is well described.
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