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Effect of Acute Weight Gain and Physical Activity on Arterial Stiffness in Pregnant Women at High Risk for Hypertensive Disorders of Pregnancy
S4
Canadian Journal of Cardiology Volume 32 2016
2016 Canadian Women’s Heart Health Summit Approved Poster Presentation Abstracts 6 HARD TRUTHS ABOUT THE RED DRESS: A DISCOURSE ANALYSIS OF THE HEART TRUTH CAMPAIGN IN CANADA CM Norris, M Clark, KR McGannon, TR Berry, WC Rodgers, JC Spence Edmonton, Alberta
Heart disease is widely perceived to be a ‘man’s disease’ although women are as likely to die from heart disease as men in North America. To increase awareness of risk for heart disease among women, The Heart and Stroke Foundation in Canada launched the Heart Truth campaign in 2008. Such campaigns have been shown to increase awareness, but little is known about how meanings of heart disease, risk, and prevention are socially constructed. This is important because how individuals make meaning of health issues shapes behavior. METHODS AND RESULTS: A discourse analysis of the Heart Truth campaign materials and associated media coverage was conducted to explore the social construction of heart disease risk and prevention among women in a Canadian context. Twenty-four articles, advertisements, videos and testimonials appearing in the Heart and Truth campaign were analyzed. Two primary discourses (meanings that shape understanding) were identified: one of acceptable and non-acceptable femininity, and another of selfless prevention. Our analysis suggests that through particular portrayals of women’s roles (i.e., mother, caregiver), women were categorized and assigned varying levels of risk. The discourse of selfless prevention further assigned responsibility for one’s health at the individual level and reinforced understandings of successful survivors as white, middle-class, mothers and caregivers. CONCLUSIONS: This study reveals the absence of women of diverse ethnic, cultural, sexual and socio-economic backgrounds within the campaign. Findings also suggest prevention is constructed as a personal choice, which eclipses conversations about broader social-determinants of health and the socio-political context in which heart disease occurs. BACKGROUND:
7 YIELD OF CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH ACUTE CORONARY SYNDROME AND NO OBSTRUCTIVE CORONARY ARTERY DISEASE
coronary angiography (CA). The etiology of presentation in these patients is often unclear. We examined the diagnostic yield of cardiac magnetic resonance imaging (CMR) in women and men with ACS and no obstructive CAD. METHODS: We retrospectively studied all patients with an ACS and no obstructive CAD on CTA or CA, who had a CMR performed at St. Paul’s Hospital, British Columbia, Canada, from 2013 to 2015. CMR had to be performed within the year following index CTA or CA. No obstructive CAD was defined as <50% stenosis in any epicardial artery. All patients had diagnostic uncertainty about the cause of ACS. We examined baseline characteristics of the cohort including sex. CMR diagnostic yield was calculated as the percentage of CMRs whereby an etiology for ACS was determined divided by the total number of CMRs performed over the two years. We then compared diagnostic yield in troponin positive and troponin negative patients and determined the etiology of presentation in each category. RESULTS: Ninety-eight patients met inclusion criteria. The average age was 55.8 years; 60% were troponin positive upon presentation and 70% were female. Sixty one percent of troponin positive patients were female; whereas 82.1% of troponin negative patients were female. Abnormal CMR was observed in 35.7% of patients. Troponin positive patients had a significantly higher prevalence of an abnormal CMR than troponin negative patients (44.1% vs 23.1%, p-value ¼ 0.03). Myocarditis was more common in troponin positive patients (25.4% vs 2.6%, p-value ¼ 0.002); whereas microvascular coronary dysfunction was more common in troponin negative patients (17.9% vs 0%, p-value ¼ 0.001). In troponin positive patients, other etiologies of an abnormal CMR included infarct (8%), hypertrophic cardiomyopathy (6.8%), and Takotsubo cardiomyopathy (3.4%); in troponin negative patients, other etiologies included pericardial effusion (2.6%). CONCLUSIONS: Seventy percent of patients with ACS and no obstructive CAD are women. In patients with an unclear diagnosis, CMR revealed an etiology 44% of the time in troponin positive ACS and 23% of the time in troponin negative ACS. CMR should be considered in patients with ACS and no obstructive CAD, particularly in those with a troponin positive presentation.
8 EFFECT OF ACUTE WEIGHT GAIN AND PHYSICAL ACTIVITY ON ARTERIAL STIFFNESS IN PREGNANT WOMEN AT HIGH RISK FOR HYPERTENSIVE DISORDERS OF PREGNANCY
M Parvand, A Starovoytov, TL Sedlak
K Phan, P Bidulka, YH Gomez, J Gorgui, A El-Messidi, R Gagnon, SS Daskalopoulou
Vancouver, British Colombia
Montreal, Quebec
PURPOSE: Ten to twenty five percent of women and 6-10% of men with an acute coronary syndrome (ACS) are found to have no obstructive coronary artery disease (CAD) on coronary computed tomography angiogram (CTA) or invasive
PURPOSE: Increased gestational weight gain and decreased physical activity have been associated with increased risk for hypertensive disorders of pregnancy (HDP). However, it is unclear whether these associations are related to changes in
S5 CWHHS Abstracts
arterial stiffness, which has been shown to be an independent predictor of cardiovascular health. The aim of this study was to evaluate the association between the level of acute weight changes and physical activity on arterial stiffness throughout pregnancy in women at high risk for HDP. METHODS: In this ongoing prospective longitudinal study, 96 women with singleton high-risk pregnancies (mean age: 36.74.0 years; pre-pregnancy mean body mass index (BMI): 26.06.6 kg/m2) were followed every 4 weeks from the first trimester up until delivery. Maternal weight and peripheral blood pressure (BP) were recorded at each visit while indices of arterial stiffness (carotid-femoral pulse wave velocity [cfPWV], carotid-radial PWV) and hemodynamics (augmentation index, central BP, and subendocardial viability ratio [SEVR]) were measured using applanation tonometry (Sphygmocor; AtCor Medical, Sydney). Each woman’s level of physical activity during pregnancy at each trimester was also assessed via the Pregnancy Physical Activity Questionnaire (PPAQ). RESULTS: After adjusting for covariates including maternal age and history of chronic hypertension and diabetes mellitus, maternal weight changes throughout pregnancy was an independent determinant of changes in carotid-femoral PWV (p<0.001), central and peripheral BPs (p<0.001), and SEVR (p<0.001). PPAQ scores were not associated with changes in arterial stiffness and hemodynamic parameters in any trimester (p>0.05). Eleven women developed a HDP (5 gestational hypertension, 6 pre-eclampsia). Women’s risk for HDP was increased with 2nd trimester increases in cfPWV (odd ratio [OR]:3.08, 95% confidence interval [CI]: 1.40-8.97; p<0.05) and peripheral (OR: 1.13, 95%CI: 1.03-1.25; p<0.05) and central systolic BPs (OR: 1.14, 95%CI: 1.021.29). While gestational weight gain was associated with increased risk for HDP (OR: 1.20, 95%CI: 1.04-1.40; p<0.05), this statistical significance was not maintained when adjusted for cfPWV. PPAQ scores in each trimester were not associated with risk for HDP (p>0.05). CONCLUSION: Central arterial stiffness appears to play a role in the association between weight gain and increased risk for HDP.The women’s level of physical activity, as assessed by selfreporting questionnaires, was not associated with their arterial stiffness throughout pregnancy, nor their risk for HDP. However, this may be attributed to highly-skewed PPAQ score distributions representing little to no physical activity.
9 FEMALE SEX IS ASSOCIATED WITH EXTENDED LENGTH OF HOSPITAL STAY FOLLOWING CABG SURGERY IN PATIENTS WITH SEVERE OBESITY M Forhan, W Qiu, T Terada, R Padwal, J Johnson, AM Sharma, CM Norris Edmonton, Alberta BACKGROUND:
Obesity is associated with cardiac disease and is known to increase the risk of post surgical complications.
Such complications contribute to excess hospital costs due to extended length of stay (LOS). It is not known if there is a difference based on sex for post surgical complications and LOS. The objective of this study was to explore whether obesity is a risk factor associated with complications and extended LOS post coronary artery bypass graft (CABG) surgery. METHODS: This retrospective study used data from 7560 adult patients [1407 (19%) female] who underwent CABG between 2003 and 2014 registered in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Forty-one percent of females and 39% of males had obesity. Using normal BMI (18.5-24.9 kg/ m2) as a reference group, the association of three classes of obesity with rates of operative mortality, overall early complications, subgroups of early complications (i.e., infection, renal and pulmonary complications), intensive care unit length of stay (ICU-LOS), and total LOS were separately assessed for females and males while adjusting for clinical covariates. RESULTS: In both females and males, there were no differences in operative mortality, pulmonary, or renal complications between patients with normal BMI and all classes of obesity. The ratio of overall early complications was higher in patients with class III obesity only in males (adjusted odds ratio [aOR]: 1.65; 95% CI 1.24-2.20, p¼0.001). All classes of obesity were independent risk factors for infection in both females (Class I: aOR: 2.07; 95% CI 1.25-3.43, p¼0.005; Class II: aOR: 2.45;95% CI 1.34-4.48, p¼0.004; Class III:aOR: 3.57; 95% CI 1.76-7.22, p<0.001) and males (Class I: aOR 1.49; 95% CI 1.12-2.00 p¼0.006; Class II: aOR 2.32; 95% CI 1.63-3.30 p<0.001 Class III: aOR 3.27: 95% CI 2.15-4.98, p<0.001). Compared to patients with normal BMI, only female patients with class III obesity had longer adjusted ICU-LOS (2.4 days, 95% CI 0.3 to 4.5, p¼0.028) and total LOS (8.8 days, 95% CI 4.5 to 13.1, p<0.001). CONCLUSIONS: BMI 40 kg/m2 was an independent risk factor for the increased ICU-LOS and total LOS only in female patients. Greater perioperative attention and intervention may be required for female patients to improve patient outcomes and reduce healthcare cost.
10 EFFECTIVENESS OF A MOSQUE-BASED PHYSICAL ACTIVITY INTERVENTION FOR SOUTH ASIAN MUSLIM WOMEN e A PILOT STUDY J Price, AT Banerjee, M Zawi, D Childerhose, M Landry Toronto, Ontario BACKGROUND:
The immigrant population in Canada is diverse and growing. South Asian’s (SA) are one of the largest non-European ethnic origin groups in Canada. SA Muslim women living in Canada have higher mortality and morbidity from cardiovascular diseases (CVD) and type 2 diabetes compared to the general population. For those living with or
Canadian Journal of Cardiology Volume 32 2016
2016 Canadian Women’s Heart Health Summit Approved Poster Presentation Abstracts 6 HARD TRUTHS ABOUT THE RED DRESS: A DISCOURSE ANALYSIS OF THE HEART TRUTH CAMPAIGN IN CANADA CM Norris, M Clark, KR McGannon, TR Berry, WC Rodgers, JC Spence Edmonton, Alberta
Heart disease is widely perceived to be a ‘man’s disease’ although women are as likely to die from heart disease as men in North America. To increase awareness of risk for heart disease among women, The Heart and Stroke Foundation in Canada launched the Heart Truth campaign in 2008. Such campaigns have been shown to increase awareness, but little is known about how meanings of heart disease, risk, and prevention are socially constructed. This is important because how individuals make meaning of health issues shapes behavior. METHODS AND RESULTS: A discourse analysis of the Heart Truth campaign materials and associated media coverage was conducted to explore the social construction of heart disease risk and prevention among women in a Canadian context. Twenty-four articles, advertisements, videos and testimonials appearing in the Heart and Truth campaign were analyzed. Two primary discourses (meanings that shape understanding) were identified: one of acceptable and non-acceptable femininity, and another of selfless prevention. Our analysis suggests that through particular portrayals of women’s roles (i.e., mother, caregiver), women were categorized and assigned varying levels of risk. The discourse of selfless prevention further assigned responsibility for one’s health at the individual level and reinforced understandings of successful survivors as white, middle-class, mothers and caregivers. CONCLUSIONS: This study reveals the absence of women of diverse ethnic, cultural, sexual and socio-economic backgrounds within the campaign. Findings also suggest prevention is constructed as a personal choice, which eclipses conversations about broader social-determinants of health and the socio-political context in which heart disease occurs. BACKGROUND:
7 YIELD OF CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH ACUTE CORONARY SYNDROME AND NO OBSTRUCTIVE CORONARY ARTERY DISEASE
coronary angiography (CA). The etiology of presentation in these patients is often unclear. We examined the diagnostic yield of cardiac magnetic resonance imaging (CMR) in women and men with ACS and no obstructive CAD. METHODS: We retrospectively studied all patients with an ACS and no obstructive CAD on CTA or CA, who had a CMR performed at St. Paul’s Hospital, British Columbia, Canada, from 2013 to 2015. CMR had to be performed within the year following index CTA or CA. No obstructive CAD was defined as <50% stenosis in any epicardial artery. All patients had diagnostic uncertainty about the cause of ACS. We examined baseline characteristics of the cohort including sex. CMR diagnostic yield was calculated as the percentage of CMRs whereby an etiology for ACS was determined divided by the total number of CMRs performed over the two years. We then compared diagnostic yield in troponin positive and troponin negative patients and determined the etiology of presentation in each category. RESULTS: Ninety-eight patients met inclusion criteria. The average age was 55.8 years; 60% were troponin positive upon presentation and 70% were female. Sixty one percent of troponin positive patients were female; whereas 82.1% of troponin negative patients were female. Abnormal CMR was observed in 35.7% of patients. Troponin positive patients had a significantly higher prevalence of an abnormal CMR than troponin negative patients (44.1% vs 23.1%, p-value ¼ 0.03). Myocarditis was more common in troponin positive patients (25.4% vs 2.6%, p-value ¼ 0.002); whereas microvascular coronary dysfunction was more common in troponin negative patients (17.9% vs 0%, p-value ¼ 0.001). In troponin positive patients, other etiologies of an abnormal CMR included infarct (8%), hypertrophic cardiomyopathy (6.8%), and Takotsubo cardiomyopathy (3.4%); in troponin negative patients, other etiologies included pericardial effusion (2.6%). CONCLUSIONS: Seventy percent of patients with ACS and no obstructive CAD are women. In patients with an unclear diagnosis, CMR revealed an etiology 44% of the time in troponin positive ACS and 23% of the time in troponin negative ACS. CMR should be considered in patients with ACS and no obstructive CAD, particularly in those with a troponin positive presentation.
8 EFFECT OF ACUTE WEIGHT GAIN AND PHYSICAL ACTIVITY ON ARTERIAL STIFFNESS IN PREGNANT WOMEN AT HIGH RISK FOR HYPERTENSIVE DISORDERS OF PREGNANCY
M Parvand, A Starovoytov, TL Sedlak
K Phan, P Bidulka, YH Gomez, J Gorgui, A El-Messidi, R Gagnon, SS Daskalopoulou
Vancouver, British Colombia
Montreal, Quebec
PURPOSE: Ten to twenty five percent of women and 6-10% of men with an acute coronary syndrome (ACS) are found to have no obstructive coronary artery disease (CAD) on coronary computed tomography angiogram (CTA) or invasive
PURPOSE: Increased gestational weight gain and decreased physical activity have been associated with increased risk for hypertensive disorders of pregnancy (HDP). However, it is unclear whether these associations are related to changes in
S5 CWHHS Abstracts
arterial stiffness, which has been shown to be an independent predictor of cardiovascular health. The aim of this study was to evaluate the association between the level of acute weight changes and physical activity on arterial stiffness throughout pregnancy in women at high risk for HDP. METHODS: In this ongoing prospective longitudinal study, 96 women with singleton high-risk pregnancies (mean age: 36.74.0 years; pre-pregnancy mean body mass index (BMI): 26.06.6 kg/m2) were followed every 4 weeks from the first trimester up until delivery. Maternal weight and peripheral blood pressure (BP) were recorded at each visit while indices of arterial stiffness (carotid-femoral pulse wave velocity [cfPWV], carotid-radial PWV) and hemodynamics (augmentation index, central BP, and subendocardial viability ratio [SEVR]) were measured using applanation tonometry (Sphygmocor; AtCor Medical, Sydney). Each woman’s level of physical activity during pregnancy at each trimester was also assessed via the Pregnancy Physical Activity Questionnaire (PPAQ). RESULTS: After adjusting for covariates including maternal age and history of chronic hypertension and diabetes mellitus, maternal weight changes throughout pregnancy was an independent determinant of changes in carotid-femoral PWV (p<0.001), central and peripheral BPs (p<0.001), and SEVR (p<0.001). PPAQ scores were not associated with changes in arterial stiffness and hemodynamic parameters in any trimester (p>0.05). Eleven women developed a HDP (5 gestational hypertension, 6 pre-eclampsia). Women’s risk for HDP was increased with 2nd trimester increases in cfPWV (odd ratio [OR]:3.08, 95% confidence interval [CI]: 1.40-8.97; p<0.05) and peripheral (OR: 1.13, 95%CI: 1.03-1.25; p<0.05) and central systolic BPs (OR: 1.14, 95%CI: 1.021.29). While gestational weight gain was associated with increased risk for HDP (OR: 1.20, 95%CI: 1.04-1.40; p<0.05), this statistical significance was not maintained when adjusted for cfPWV. PPAQ scores in each trimester were not associated with risk for HDP (p>0.05). CONCLUSION: Central arterial stiffness appears to play a role in the association between weight gain and increased risk for HDP.The women’s level of physical activity, as assessed by selfreporting questionnaires, was not associated with their arterial stiffness throughout pregnancy, nor their risk for HDP. However, this may be attributed to highly-skewed PPAQ score distributions representing little to no physical activity.
9 FEMALE SEX IS ASSOCIATED WITH EXTENDED LENGTH OF HOSPITAL STAY FOLLOWING CABG SURGERY IN PATIENTS WITH SEVERE OBESITY M Forhan, W Qiu, T Terada, R Padwal, J Johnson, AM Sharma, CM Norris Edmonton, Alberta BACKGROUND:
Obesity is associated with cardiac disease and is known to increase the risk of post surgical complications.
Such complications contribute to excess hospital costs due to extended length of stay (LOS). It is not known if there is a difference based on sex for post surgical complications and LOS. The objective of this study was to explore whether obesity is a risk factor associated with complications and extended LOS post coronary artery bypass graft (CABG) surgery. METHODS: This retrospective study used data from 7560 adult patients [1407 (19%) female] who underwent CABG between 2003 and 2014 registered in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Forty-one percent of females and 39% of males had obesity. Using normal BMI (18.5-24.9 kg/ m2) as a reference group, the association of three classes of obesity with rates of operative mortality, overall early complications, subgroups of early complications (i.e., infection, renal and pulmonary complications), intensive care unit length of stay (ICU-LOS), and total LOS were separately assessed for females and males while adjusting for clinical covariates. RESULTS: In both females and males, there were no differences in operative mortality, pulmonary, or renal complications between patients with normal BMI and all classes of obesity. The ratio of overall early complications was higher in patients with class III obesity only in males (adjusted odds ratio [aOR]: 1.65; 95% CI 1.24-2.20, p¼0.001). All classes of obesity were independent risk factors for infection in both females (Class I: aOR: 2.07; 95% CI 1.25-3.43, p¼0.005; Class II: aOR: 2.45;95% CI 1.34-4.48, p¼0.004; Class III:aOR: 3.57; 95% CI 1.76-7.22, p<0.001) and males (Class I: aOR 1.49; 95% CI 1.12-2.00 p¼0.006; Class II: aOR 2.32; 95% CI 1.63-3.30 p<0.001 Class III: aOR 3.27: 95% CI 2.15-4.98, p<0.001). Compared to patients with normal BMI, only female patients with class III obesity had longer adjusted ICU-LOS (2.4 days, 95% CI 0.3 to 4.5, p¼0.028) and total LOS (8.8 days, 95% CI 4.5 to 13.1, p<0.001). CONCLUSIONS: BMI 40 kg/m2 was an independent risk factor for the increased ICU-LOS and total LOS only in female patients. Greater perioperative attention and intervention may be required for female patients to improve patient outcomes and reduce healthcare cost.
10 EFFECTIVENESS OF A MOSQUE-BASED PHYSICAL ACTIVITY INTERVENTION FOR SOUTH ASIAN MUSLIM WOMEN e A PILOT STUDY J Price, AT Banerjee, M Zawi, D Childerhose, M Landry Toronto, Ontario BACKGROUND:
The immigrant population in Canada is diverse and growing. South Asian’s (SA) are one of the largest non-European ethnic origin groups in Canada. SA Muslim women living in Canada have higher mortality and morbidity from cardiovascular diseases (CVD) and type 2 diabetes compared to the general population. For those living with or