Observation of serious adverse cardiovascular events over 3 years in patients with advanced atherosclerosis: is there a gender difference?

Dyslipidemia has been widely acknowledged as one of the major predisposing factors for the development and progression of atherosclerosis. While advanced atherosclerosis confirmed to influence the prognosis of patients with acute coronary syndrome (ACS), it has not yet been established, whether this impact is gender-dependent. AIM: The aim of study was to investigate possible gender-related effect of dyslipidemia and generalized atherosclerosis on the long-term outcomes in patients with ACS. MATERIALS AND METHODS: A total of 247 patients (88 women and 159 men) with ACS were included. Sample was divided into two groups, according to gender. Patients' lipid and comorbidity profiles were assessed. Cumulative major adverse coronary events (MACE) were estimated throughout 3-year follow-up period. RESULTS: Women were older and had more comorbidities. Cumulative 3-year MACE rates were higher in women than in men (33% vs. 23%, p=0.06). In the multivariable Cox regression analysis abnormal lipid profiles were more significantly associated with higher MACE in females (HR=1.5, 95% CI [1-2,28], p<0.00001), compared with males (HR=1.0, 95% CI [0.5-2.08], p=0.4), as well as prior MI: (HR=3.8, 95% CI [1.4- 10.5], p<0.00001) vs. (HR=1.9, 95% [0.8-4.2], p=0.009) and concomitant peripheral artery disease (PAD): (HR=5.2, 95% CI [1.5-18.2], p<0.00001) vs. (HR=2.2, 95% CI [0.73-6.6], p=0.02) respectively. CONCLUSIONS: In our study dyslipidemia, concomitant PAD and history of MI were independent predictors of higher MACE more significantly in females with ACS than in males. Thus, it can be assumed that female patients require an increased medical attention with strict serum lipid control.

The impact of combining educational program with the improving of infrastructure to diagnose on early detection of primary immunodeficiencies in children.

Early detection of primary immunodeficiency diseases (PID) is vital for adequate prevention and management of PID infectious complications. The objective of this study was to evaluate the impact of a model combining physician education and public awareness with the infrastructure to diagnose PID to improve its early detection in children. Three approaches were combined and the results were followed from February 2017 to February 2019 in Ternopil region, Ukraine: the education of primary care physicians and other specialists on early PID detection using workshops, trainings, and targeted publications; organization of public events and media appearances to raise PID awareness; performing immunological testing for patients with suspected PID. Among the 150 individuals that were screened, PID was diagnosed in 19 patients (12.7%). The majority of diagnosed PID cases were combined immunodeficiency with associated or syndromic features, followed by antibody deficiencies. Patients referred by the specialist doctors had the highest percentage of confirmed PID compared with those referred by primary care physicians (p = 0.0273) and risk group patients (p = 0.0447). Among warning signs in patients with PID, two or more pneumonias within 1 year occurred most often (26.3%), followed by failure of an infant to gain weight or grow normally (21.1%). Among other signs of PID, dysmorphic features and microcephaly were the most prevalent (31.6%). In conclusion, a program combining physician education and public awareness with infrastructure needed to diagnose primary immunodeficiency diseases is an effective tool for early PID diagnosis. Physician education was a more effective tool compared with rising public awareness.