Vascular Diseases in Women: Do Women Suffer from Them Differently?

According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.

Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee.

BACKGROUND: Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. OBJECTIVES: The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. METHODOLOGY: A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. RESULTS: A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD-3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.

The efficacy of oral trimetazidine in preventing contrast-induced nephropathy among patients undergoing elective coronary procedures: A meta-analysis of randomized controlled trials

INTRODUCTION: Contrast-induced nephropathy (CIN) is a serious but preventable complication of coronary procedures. Trimetazidine (TMZ) has recently been explored for use in preventing post-procedural CIN due to its cellular anti-ischemic and antioxidant properties. The objective is to assess the efficacy of oral TMZ in the prevention of contrast induced nephropathy during elective coronary angiography and PCI among patients with renal impairment. METHODS: We conducted a systematic search of the Cochrane Central Register of Controlled Trials, Pubmed/ MEDLINE, EMBASE, clinicaltrials.gov for articles published until June 2016 for randomized controlled trials examining the effects of adding oral TMZ to standard therapy in preventing CIN. Outcome measures were incidence of CIN, defined as a 0.5 mg/dl or ?25% increase in serum creatinine 48-72 hours after contrast exposure, and incidence of dialysisrequiring CIN. Validity of studies was assessed through a risk assessment tool available from Cochrane. Treatment effect was estimated by calculating the Mantel-Haenszelweighted risk ratio (RR) using a fixed-effects model available from RevMan 5.3. RESULTS: A total of four studies comprising 714 patients (TMZ group=352, Control group=362) were included in the final analysis. Pooled results revealed the TMZ group was associated with significantly fewer incidences of CIN compared to control (RR 0.33, 95% confidence interval [CI], 0.20, 0.53; P CONCLUSION: The addition of oral TMZ to standard hydration confers a significant benefit in preventing CIN after coronary procedures among patients with mild to moderate renal impairment. We recommend the addition of TMZ to standard prevention strategies. However, a large well-designed trial should be conducted to determine its effect on other outcomes such as prevention of dialysis-requiring CIN and mortality.