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Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

BACKGROUND: Greater understanding of differences between men and women with coronary heart disease is needed. METHODS AND RESULTS: In this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatm...

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Autores principales: Guimarães, Patricia Oliveira, Granger, Christopher B., Stebbins, Amanda, Chiswell, Karen, Held, Claes, Hochman, Judith S., Krug‐Gourley, Susan, Lonn, Eva, Lopes, Renato D., Stewart, Ralph A. H., Vinereanu, Dragos, Wallentin, Lars, White, Harvey D., Hagström, Emil, Danchin, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634306/
https://www.ncbi.nlm.nih.gov/pubmed/28912210
http://dx.doi.org/10.1161/JAHA.117.006695
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author Guimarães, Patricia Oliveira
Granger, Christopher B.
Stebbins, Amanda
Chiswell, Karen
Held, Claes
Hochman, Judith S.
Krug‐Gourley, Susan
Lonn, Eva
Lopes, Renato D.
Stewart, Ralph A. H.
Vinereanu, Dragos
Wallentin, Lars
White, Harvey D.
Hagström, Emil
Danchin, Nicolas
author_facet Guimarães, Patricia Oliveira
Granger, Christopher B.
Stebbins, Amanda
Chiswell, Karen
Held, Claes
Hochman, Judith S.
Krug‐Gourley, Susan
Lonn, Eva
Lopes, Renato D.
Stewart, Ralph A. H.
Vinereanu, Dragos
Wallentin, Lars
White, Harvey D.
Hagström, Emil
Danchin, Nicolas
author_sort Guimarães, Patricia Oliveira
collection PubMed
description BACKGROUND: Greater understanding of differences between men and women with coronary heart disease is needed. METHODS AND RESULTS: In this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatments, and outcomes of men versus women with stable coronary heart disease and explored the association of sex with psychosocial characteristics and cardiovascular risk. Cox proportional hazards models were used to assess the relationship between sex and outcomes. Interactions among sex, psychosocial factors, and the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2% felt often or always stressed at home (versus 9.8% of men), and 19.2% felt often or always sad or depressed (versus 10.1% of men; all P<0.0001). The median duration of follow‐up was 3.7 years (25th–75th percentiles: 3.5–3.8 years). Use of evidence‐based medications for coronary heart disease at baseline and 24 months was similar between sexes, as were event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction (P=0.03) such that the lower risk in women varied by depressive symptom frequency, whereby women who were more depressed had a risk similar to men. CONCLUSIONS: Female sex was independently associated with better long‐term clinical outcomes, although this was modified by frequency of depressive symptoms. This suggests that emotional state may be an important target for improving outcomes in patients with coronary heart disease, specifically in women. CLINICAL TRIAL REGISTRATION: STABILITY ClinicalTrials.gov number (NCT00799903).
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spelling pubmed-56343062017-10-18 Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial Guimarães, Patricia Oliveira Granger, Christopher B. Stebbins, Amanda Chiswell, Karen Held, Claes Hochman, Judith S. Krug‐Gourley, Susan Lonn, Eva Lopes, Renato D. Stewart, Ralph A. H. Vinereanu, Dragos Wallentin, Lars White, Harvey D. Hagström, Emil Danchin, Nicolas J Am Heart Assoc Original Research BACKGROUND: Greater understanding of differences between men and women with coronary heart disease is needed. METHODS AND RESULTS: In this post hoc analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, we described psychosocial factors, treatments, and outcomes of men versus women with stable coronary heart disease and explored the association of sex with psychosocial characteristics and cardiovascular risk. Cox proportional hazards models were used to assess the relationship between sex and outcomes. Interactions among sex, psychosocial factors, and the composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2% felt often or always stressed at home (versus 9.8% of men), and 19.2% felt often or always sad or depressed (versus 10.1% of men; all P<0.0001). The median duration of follow‐up was 3.7 years (25th–75th percentiles: 3.5–3.8 years). Use of evidence‐based medications for coronary heart disease at baseline and 24 months was similar between sexes, as were event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction (P=0.03) such that the lower risk in women varied by depressive symptom frequency, whereby women who were more depressed had a risk similar to men. CONCLUSIONS: Female sex was independently associated with better long‐term clinical outcomes, although this was modified by frequency of depressive symptoms. This suggests that emotional state may be an important target for improving outcomes in patients with coronary heart disease, specifically in women. CLINICAL TRIAL REGISTRATION: STABILITY ClinicalTrials.gov number (NCT00799903). John Wiley and Sons Inc. 2017-09-14 /pmc/articles/PMC5634306/ /pubmed/28912210 http://dx.doi.org/10.1161/JAHA.117.006695 Text en © 2017 The Authors and GlaxoSmithKline. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Guimarães, Patricia Oliveira
Granger, Christopher B.
Stebbins, Amanda
Chiswell, Karen
Held, Claes
Hochman, Judith S.
Krug‐Gourley, Susan
Lonn, Eva
Lopes, Renato D.
Stewart, Ralph A. H.
Vinereanu, Dragos
Wallentin, Lars
White, Harvey D.
Hagström, Emil
Danchin, Nicolas
Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title_full Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title_fullStr Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title_full_unstemmed Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title_short Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial
title_sort sex differences in clinical characteristics, psychosocial factors, and outcomes among patients with stable coronary heart disease: insights from the stability (stabilization of atherosclerotic plaque by initiation of darapladib therapy) trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634306/
https://www.ncbi.nlm.nih.gov/pubmed/28912210
http://dx.doi.org/10.1161/JAHA.117.006695
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