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Gender differences in heart failure
GENDERMEDICINE
not appreciated that in men. The concentration of HbAlc couM be a diagnosis criteria in w o m e n with MS. We didn't find differences, using SCORE charts, to evaluate risk of developing a CVE between patients with or without MS. M e s h t e r m s : Cardiovascular risk, gender, metabolic syndrome.
F2.53 17:15-17:30, Saturday, February 25, 2006 Prevalence of Hypercholesterolemia in Japan Katsumi Yoshidal; M a c h i Sukal; a n d Kuniaki Yamauchi 2
i St. Marianna University School ofl Medicine, Kawasaki, Japan; and 2japan Association of Health Service, Tokyo, Japan O b j e c t i v e : To compare age- and BMI-specific prevalence of hypercholesterolemia in Japanese m e n and women. M e t h o d s : Health examination data were accumulated from 24 different prefectural health service associations affiliated with the Japan Association of Health Service. Eligible 338,677 m e n and 294,429 w o m e n were analyzed to estimate age- and BMI-specific prevalence of hypercholesterolemia. Hypercholesterolemia was defined by a total cholesterol of _>220 mg/dL or an LDL cholesterol of _>140 mg/dL according to the 2002 Japanese expert committee criteria. BMI was classified as underweight (-18.5), normal (18.624.9), obese1 (25.0-29.9), and obese2 (30.0-). R e s u l t s : Prevalence of hypercholesterolemia showed a significant sex difference in every age group: m e n > w o m e n in 49 years or younger, m e n < w o m e n in 50 years or older. For men, the prevalence reached a peak in 50-59 years, which was 4049 years in the obese1 and obese2 groups. For women, the prevalence reached a peak in 60-69 years, which was 5059 years in the obese1 and obese2 groups. The prevalence was increased with BMI a m o n g men, but n o t a m o n g women. Overall, the estimated rates by total cholesterol criteria were larger than those by LDL cholesterol criteria. These differences were 40% or more especially in the underweight group. C o n c l u s i o n : Prevalence of hypercholesterolemia is associated with age and BMI, differently in m e n and women.
F2.54 17:30-17:45, Saturday, February 25, 2006 The Effects of Changes in Testosterone Level on the Development o f Metabolic Syndrome A l e x a n d e r Pecherskyl; A l e x a n d e r Semiglazov2; Oleg Loran3; V a d i m Mazurovl; A n a t o l y Karpischenk04; Aleksy NikiforovS; Natalya KalininaS; Laryssa DryginaS; Natalya DavydovaS; a n d Marina S k o r o b o g a t i k h s
iMedical Academy of Post-Graduate Studies, St. Petersburg,Russia; 2Research Institute of Oncology, St. Petersburg, Russia; 3Russian Medical Academy oflPost-Graduate Studies, Moscow, Russia; 4Russian Military Medical Academy, St. Petersburg, Russia; and SAil-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia O b j e c t i v e s : The probability of development of insulin-resistance significantly increases after 40 years of age; from this period a decrease of testosterone circulating in the blood is observed in men. M e t h o d s : 14 Patients with cancer of the prostate of the 3M stage were held under examination. The ages of the patients ranged from 60-79. R e s u l t s : Upon initial tests the average indicators of IL-I[~, acid phosphatase, alkaline phosphatase, TNFa, and PSA had increased, while the indicators of testosterone and [~TGF had decreased. A m o n t h after orchiectomy all patients showed a significant decrease in levels of testosterone (P < 0.005), 5~-dihydrotestosterone, and
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17[~-estradiol (P < 0.05) in comparison to initial indicators, while levels of LH and FSH had increased (P < 0.001). The reduction of testosterone was accompanied by a statistically meaningful increase of prolacthl, STH, and estrone (P < 0.05). The reduction of 5~-dihydrotestosterone determined the reduction of EGF (P < 0.05). The decrease in the level of testosterone was accompanied by a statistically significant increase in the levels of insulin, IGF-1 (P < 0.05), bFGF (P < 0.01), 25-OHVitD3, and Ca ++(P < 0.05), as well as by a reduction in the levels of [~TGF, IL-I[~, TNF~ (P < 0.05), acid phosphatase (P < 0.01), alkaline phosphatase (P < 0.05), and PSA (P < 0.005). C o n c l u s i o n s : The increase in the levels of IGF-1 and insulin in patients after orchiectomy is a compensatory answer to the development of hlsulin-resistance. Insulin, along with IGF-1, raises the kariokynetic activity of the cells. From these positions it's possible to examine insulhl-resistance as an i n s ~ u m e n t for the increase of the level of insulin, STH, IGF-1 and, accordingly, they're kariokynetic activity.
F2.55 17:45-18:00, Saturday, February 25, 2006 Gender Differences in Heart Failure Vera Regitz-Zagrosek
Charite Universitatsmedizin Berlin, Germany; and DHZBDeutsches Herzzentrum Berlin, Germany Gender differences are found in epidemiological and risk factors for heart failure (HF), in its clinical manifestations and underlying pathophysiology and in the response to therapy and are probably relevant for HF prevention and treatment. The prevalence of HF is similar in w o m e n and men. It is strikhlgly high and a disease of old age in both. However, HF with preserved systolic function is more frequent in women. Hypertension and diabetes are the major underlying risk factors in women, whereas myocardial infarction is the major risk factor in men. A link between gender, diabetes and HF is created by the renhl-angiotenshl system since estrogens downregulate the activity of this system, which may mean that diabetes and arteriosclerosis progress w h e n this inhibition ceases at menopause. Differences in gene expression between the failing male and female heart have been found in rodent models and also in humans. Estrogen receptor alpha, expressed in the h u m a n heart, changes its expression and localization durhlg the development of HF. Metabolic alterations in myocardial disease may be caused by the interaction of estrogen receptors and peroxisome proliferator activated receptors. Estrogens affect the expression of about 2%-5% of proteins in the h u m a n heart. They are also expressed in arteries and are down-regulated in arteriosclerosis. Various drugs are metabolized differently in w o m e n and m e n and some, affecting heart failure have different gender specific effects/side effects. Examples are ACE-inhibitors, aspirin, and digitalis, but probably not angiotensin-receptor blockers. Further investigations are needed to better understand the differences in pharmacotllerapy between w o m e n and men.
F2.56 18:00-18:15, Saturday, February 25, 2006 Gender-Related Effects of Chronic Non-Malignant Pain and Opioid Therapy on Plasma Levels of Macrophage Migration Inhibition Factor (MIF) A n n a Maria Aloisil; Gilberto Pari2; Ilaria Ceccarellil; a n d Luana Paulesu 1
not appreciated that in men. The concentration of HbAlc couM be a diagnosis criteria in w o m e n with MS. We didn't find differences, using SCORE charts, to evaluate risk of developing a CVE between patients with or without MS. M e s h t e r m s : Cardiovascular risk, gender, metabolic syndrome.
F2.53 17:15-17:30, Saturday, February 25, 2006 Prevalence of Hypercholesterolemia in Japan Katsumi Yoshidal; M a c h i Sukal; a n d Kuniaki Yamauchi 2
i St. Marianna University School ofl Medicine, Kawasaki, Japan; and 2japan Association of Health Service, Tokyo, Japan O b j e c t i v e : To compare age- and BMI-specific prevalence of hypercholesterolemia in Japanese m e n and women. M e t h o d s : Health examination data were accumulated from 24 different prefectural health service associations affiliated with the Japan Association of Health Service. Eligible 338,677 m e n and 294,429 w o m e n were analyzed to estimate age- and BMI-specific prevalence of hypercholesterolemia. Hypercholesterolemia was defined by a total cholesterol of _>220 mg/dL or an LDL cholesterol of _>140 mg/dL according to the 2002 Japanese expert committee criteria. BMI was classified as underweight (-18.5), normal (18.624.9), obese1 (25.0-29.9), and obese2 (30.0-). R e s u l t s : Prevalence of hypercholesterolemia showed a significant sex difference in every age group: m e n > w o m e n in 49 years or younger, m e n < w o m e n in 50 years or older. For men, the prevalence reached a peak in 50-59 years, which was 4049 years in the obese1 and obese2 groups. For women, the prevalence reached a peak in 60-69 years, which was 5059 years in the obese1 and obese2 groups. The prevalence was increased with BMI a m o n g men, but n o t a m o n g women. Overall, the estimated rates by total cholesterol criteria were larger than those by LDL cholesterol criteria. These differences were 40% or more especially in the underweight group. C o n c l u s i o n : Prevalence of hypercholesterolemia is associated with age and BMI, differently in m e n and women.
F2.54 17:30-17:45, Saturday, February 25, 2006 The Effects of Changes in Testosterone Level on the Development o f Metabolic Syndrome A l e x a n d e r Pecherskyl; A l e x a n d e r Semiglazov2; Oleg Loran3; V a d i m Mazurovl; A n a t o l y Karpischenk04; Aleksy NikiforovS; Natalya KalininaS; Laryssa DryginaS; Natalya DavydovaS; a n d Marina S k o r o b o g a t i k h s
iMedical Academy of Post-Graduate Studies, St. Petersburg,Russia; 2Research Institute of Oncology, St. Petersburg, Russia; 3Russian Medical Academy oflPost-Graduate Studies, Moscow, Russia; 4Russian Military Medical Academy, St. Petersburg, Russia; and SAil-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia O b j e c t i v e s : The probability of development of insulin-resistance significantly increases after 40 years of age; from this period a decrease of testosterone circulating in the blood is observed in men. M e t h o d s : 14 Patients with cancer of the prostate of the 3M stage were held under examination. The ages of the patients ranged from 60-79. R e s u l t s : Upon initial tests the average indicators of IL-I[~, acid phosphatase, alkaline phosphatase, TNFa, and PSA had increased, while the indicators of testosterone and [~TGF had decreased. A m o n t h after orchiectomy all patients showed a significant decrease in levels of testosterone (P < 0.005), 5~-dihydrotestosterone, and
$34
17[~-estradiol (P < 0.05) in comparison to initial indicators, while levels of LH and FSH had increased (P < 0.001). The reduction of testosterone was accompanied by a statistically meaningful increase of prolacthl, STH, and estrone (P < 0.05). The reduction of 5~-dihydrotestosterone determined the reduction of EGF (P < 0.05). The decrease in the level of testosterone was accompanied by a statistically significant increase in the levels of insulin, IGF-1 (P < 0.05), bFGF (P < 0.01), 25-OHVitD3, and Ca ++(P < 0.05), as well as by a reduction in the levels of [~TGF, IL-I[~, TNF~ (P < 0.05), acid phosphatase (P < 0.01), alkaline phosphatase (P < 0.05), and PSA (P < 0.005). C o n c l u s i o n s : The increase in the levels of IGF-1 and insulin in patients after orchiectomy is a compensatory answer to the development of hlsulin-resistance. Insulin, along with IGF-1, raises the kariokynetic activity of the cells. From these positions it's possible to examine insulhl-resistance as an i n s ~ u m e n t for the increase of the level of insulin, STH, IGF-1 and, accordingly, they're kariokynetic activity.
F2.55 17:45-18:00, Saturday, February 25, 2006 Gender Differences in Heart Failure Vera Regitz-Zagrosek
Charite Universitatsmedizin Berlin, Germany; and DHZBDeutsches Herzzentrum Berlin, Germany Gender differences are found in epidemiological and risk factors for heart failure (HF), in its clinical manifestations and underlying pathophysiology and in the response to therapy and are probably relevant for HF prevention and treatment. The prevalence of HF is similar in w o m e n and men. It is strikhlgly high and a disease of old age in both. However, HF with preserved systolic function is more frequent in women. Hypertension and diabetes are the major underlying risk factors in women, whereas myocardial infarction is the major risk factor in men. A link between gender, diabetes and HF is created by the renhl-angiotenshl system since estrogens downregulate the activity of this system, which may mean that diabetes and arteriosclerosis progress w h e n this inhibition ceases at menopause. Differences in gene expression between the failing male and female heart have been found in rodent models and also in humans. Estrogen receptor alpha, expressed in the h u m a n heart, changes its expression and localization durhlg the development of HF. Metabolic alterations in myocardial disease may be caused by the interaction of estrogen receptors and peroxisome proliferator activated receptors. Estrogens affect the expression of about 2%-5% of proteins in the h u m a n heart. They are also expressed in arteries and are down-regulated in arteriosclerosis. Various drugs are metabolized differently in w o m e n and m e n and some, affecting heart failure have different gender specific effects/side effects. Examples are ACE-inhibitors, aspirin, and digitalis, but probably not angiotensin-receptor blockers. Further investigations are needed to better understand the differences in pharmacotllerapy between w o m e n and men.
F2.56 18:00-18:15, Saturday, February 25, 2006 Gender-Related Effects of Chronic Non-Malignant Pain and Opioid Therapy on Plasma Levels of Macrophage Migration Inhibition Factor (MIF) A n n a Maria Aloisil; Gilberto Pari2; Ilaria Ceccarellil; a n d Luana Paulesu 1