Publications by authors named "Nanette K Wenger"

293 Publications

Diagnostic Cardiovascular Imaging and Therapeutic Strategies in Pregnancy: JACC Focus Seminar 4/5.

J Am Coll Cardiol 2021 Apr;77(14):1813-1822

Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

The prevalence of cardiovascular disease (CVD) in pregnancy, both diagnosed and previously unknown, is rising, and CVD is a leading cause of maternal morbidity and mortality. Historically, women of child-bearing potential have been underrepresented in research, leading to lasting knowledge gaps in the cardiovascular care of pregnant and lactating women. Despite these limitations, clinicians should be familiar with the safety of frequently used diagnostic and therapeutic interventions to adequately care for this at-risk population. This review, the fourth of a 5-part series, provides evidence-based recommendations regarding the use of common cardiovascular diagnostic tests and medications in pregnant and lactating women.
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http://dx.doi.org/10.1016/j.jacc.2021.01.056DOI Listing
April 2021

Management of Women With Acquired Cardiovascular Disease From Pre-Conception Through Pregnancy and Postpartum: JACC Focus Seminar 3/5.

J Am Coll Cardiol 2021 Apr;77(14):1799-1812

Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

Acquired cardiovascular conditions are a leading cause of maternal morbidity and mortality. A growing number of pregnant women have acquired and heritable cardiovascular conditions and cardiovascular risk factors. As the average age of childbearing women increases, the prevalence of acute coronary syndromes, cardiomyopathy, and other cardiovascular complications in pregnancy are also expected to increase. This document, the third of a 5-part series, aims to provide practical guidance on the management of such conditions encompassing pre-conception through acute management and considerations for delivery.
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http://dx.doi.org/10.1016/j.jacc.2021.01.057DOI Listing
April 2021

Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association.

Circ Cardiovasc Qual Outcomes 2021 Apr 1:HCQ0000000000000103. Epub 2021 Apr 1.

Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.
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http://dx.doi.org/10.1161/HCQ.0000000000000103DOI Listing
April 2021

Dapagliflozin effects on lung fluid volumes in patients with heart failure and reduced ejection fraction: Results from the DEFINE-HF trial.

Diabetes Obes Metab 2021 Feb 19. Epub 2021 Feb 19.

Saint Luke's Mid America Heart Institute, Kansas City, Missouri.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been shown to reduce the risk of cardiovascular death or worsening heart failure (HF), and improve symptom burden, physical function and quality of life in patients with HF and reduced ejection fraction. The mechanisms of the HF benefits of SGLT2 inhibitors, however, remain unclear. In this substudy of the DEFINE-HF trial, patients randomized to dapagliflozin or placebo had lung fluid volumes (LFVs) measured by remote dieletric sensing at baseline and after 12 weeks of therapy. A significantly greater proportion of dapagliflozin-treated patients (as compared with placebo) experienced improvement in LFVs and fewer dapagliflozin-treated patients had no change or deterioration in LFVs after 12 weeks of treatment. To our knowledge, this is the first study to suggest a direct effect of dapagliflozin (or any SGLT2 inhibitor) on more effective "decongestion", contributing in a meaningful way to the ongoing debate regarding the mechanisms of SGLT2 inhibitor HF benefits.
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http://dx.doi.org/10.1111/dom.14352DOI Listing
February 2021

A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999-2018.

Eur Heart J Qual Care Clin Outcomes 2021 Feb 8. Epub 2021 Feb 8.

Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Aims: To compare premature heart disease- and cancer-related deaths in women in the USA.

Methods And Results: We analysed the US national database of death certificates of women aged <65 from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database between 1999 and 2018. We measured annual percentage changes (APCs) in age-adjusted mortality rates (AAMRs) and years of potential life lost per 100 000 persons due to heart disease and cancer. Overall, cancer was a more prevalent cause of premature death compared with heart disease. Between 1999 and 2018, the AAMRs decreased for both cancer (61.9/100 000 to 45.6/100 000) and heart disease (29.2/100 000 to 22.6/100 000). However, while APC in AAMR for cancer declined consistently over time, after an initial decline, APC in AAMR for heart disease increased between 2010 and 2018 [0.53 95% confidence interval (0.18-0.89)], with a significant rise in Midwest, medium/small metros, and rural areas after 2008. Compared with cancer, APC in AAMR for heart disease increased in women aged 25-34 years [2.24 (0.30-4.22); 2013-18) and 55-64 years [0.46 (0.13-0.80); 2009-13], as well as Non-Hispanic (NH) Whites [APC, 0.79 (0.46-1.13); 2009-18] and NH American Indian/Alaskan Native [2.71 (0.59-4.87); 2011-2018]. Consequently, the mortality gap between cancer and heart disease has narrowed from an AAMR of 32.7/100 000 to 23.0/100 000.

Conclusions: The mortality gap between cancer and heart disease is decreasing among women <65 years. Intensive cardiovascular health interventions are required focusing on vulnerable young demographic subgroups and underserved regional areas to meet the American Heart Association's Impact Goal and Million Hearts Initiative.
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http://dx.doi.org/10.1093/ehjqcco/qcaa099DOI Listing
February 2021

Cardiovascular Disease in Women: Understanding the Journey.

Authors:
Nanette K Wenger

Clin Chem 2021 Jan;67(1):24-29

Emory University School of Medicine, Atlanta, GA; Emory Heart and Vascular Center, Atlanta, GA; and Emory Women's Heart Center, Atlanta, GA.

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http://dx.doi.org/10.1093/clinchem/hvaa297DOI Listing
January 2021

Women and atrial fibrillation.

J Cardiovasc Electrophysiol 2020 Dec 17. Epub 2020 Dec 17.

Cooper Medical School of Rowan University, Camden, New Jersey, USA.

Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.
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http://dx.doi.org/10.1111/jce.14838DOI Listing
December 2020

Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review.

J Am Coll Cardiol 2020 12;76(22):2650-2670

Prebys Cardiovascular Institute, Scripps Clinic & Research Foundation, San Diego, California.

The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.
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http://dx.doi.org/10.1016/j.jacc.2020.09.606DOI Listing
December 2020

Why Does Myocardial Infarction Preferentially Disadvantage Women?

Authors:
Nanette K Wenger

J Am Coll Cardiol 2020 10;76(15):1761-1762

Emory University School of Medicine, Atlanta, Georgia. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2020.08.032DOI Listing
October 2020

The Clinical Spectrum of Myocardial Infarction and Ischemia With Nonobstructive Coronary Arteries in Women.

JACC Cardiovasc Imaging 2020 Sep 26. Epub 2020 Sep 26.

Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York. Electronic address:

Women exhibit less burden of anatomic obstructive coronary atherosclerotic disease as compared with men of the same age, but contradictorily show similar or higher cardiovascular mortality rates. The higher prevalence of nonexertional cardiac symptoms and nonobstructive coronary atherosclerotic disease in women may lead to lack of recognition and appropriate management, resulting in undertesting and undertreatment. Leaders in women's health from the American College of Cardiology's Cardiovascular Disease in Women Committee present novel imaging cases that may provoke thought regarding the broad clinical spectrum of myocardial infarction and ischemia with nonobstructive coronary arteries in women. These unique imaging approaches are based on the concept of targeting sex-specific differences in acute and stable ischemic heart disease.
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http://dx.doi.org/10.1016/j.jcmg.2020.06.044DOI Listing
September 2020

Hypertension During Pregnancy.

Curr Hypertens Rep 2020 08 27;22(9):64. Epub 2020 Aug 27.

Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Suite 319, Atlanta, GA, 30322, USA.

Purpose Of Review: Hypertensive disorders of pregnancy affect about 5-10% of pregnancies impacting maternal, fetal, and neonatal outcomes. We review the recent studies in this field and discuss the pathophysiology, diagnosis, and management of hypertension during pregnancy, as well as the short- and long-term consequences on the cardiovascular health of women.

Recent Findings: Although the American College of Cardiology/American Heart Association revised their guidelines for hypertension in the general population in 2017, hypertension during pregnancy continues to be defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate occasions. The addition of stage 1 hypertension will increase the prevalence of hypertension during pregnancy, identifying more women at risk of preeclampsia; however, more research is needed before changing the BP goal because a lower target BP has a risk of poor placental perfusion. Women with chronic hypertension have a higher incidence of superimposed preeclampsia, cesarean section, preterm delivery before 37 weeks' gestation, birth weight less than 2500 g, neonatal unit admission, and perinatal death. They also have a higher risk of developing cardiovascular disease later in life. The guidelines recommend low-dose aspirin for women with moderate and high risk of preeclampsia. While treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks to the fetus. Hypertensive disorders of pregnancy should be appropriately and promptly recognized and treated during pregnancy. They should further be co-managed by the obstetrician and cardiologist to decrease the long-term negative impact on the cardiovascular health of women.
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http://dx.doi.org/10.1007/s11906-020-01070-0DOI Listing
August 2020

Hypertension management in older adults.

F1000Res 2020 19;9. Epub 2020 Aug 19.

Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Vascular aging leads to arterial hypertension, which is the leading cause of cardiovascular mortality and morbidity in older adults. Blood pressure reduction is effective in reducing the cardiovascular risk and is safe in ambulatory older adults. It is important to note that blood pressure control in this group of patients is challenging because of comorbidities, polypharmacy, and frailty. Choice of pharmacotherapy is not simple and should be individualized.
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http://dx.doi.org/10.12688/f1000research.20323.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438964PMC
October 2020

Rationale and design of a smartphone-enabled, home-based exercise program in patients with symptomatic peripheral arterial disease: The smart step randomized trial.

Clin Cardiol 2020 Jun 23;43(6):537-545. Epub 2020 Apr 23.

Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Background: Supervised exercise therapy (SET) is recommended in patients with symptomatic peripheral arterial disease (PAD) as first-line therapy, although patient adoption remains low. Home-based exercise therapy (HBET) delivered through smartphones may expand access. The feasibility of such programs, especially in low-resource settings, remains unknown.

Methods: Smart Step is a pilot randomized trial of smartphone-enabled HBET vs walking advice in patients with symptomatic PAD in an inner-city hospital. Participants receive a smartphone app with daily exercise reminders and educational content. A trained coach performs weekly phone-based coaching sessions. All participants receive a Fitbit Charge HR 2 to measure physical activity. The primary outcome changes in 6-minute walking test (6MWT) distance at 12 weeks over baseline. Secondary outcomes are the degree of engagement with the smartphone app and changes in health behaviors and quality of life scores after 12 weeks and 1 year.

Results: A total of 15 patients are randomized as of December 15, 2019 with a mean (SD) age of 66.1 (5.8) years. The majority are female (60%) and black (87%). At baseline, the mean (SD) ABI and 6MWT were 0.86 (0.29) and 363.5 m, respectively. Enrollment is expected to continue until December 2020 to achieve a target size of 50 participants.

Conclusions: The potential significance of this trial will be to provide preliminary evidence of a home-based, "mobile-first" approach for delivering a structured exercise rehabilitation program. Smartphone-enabled HBET can be potentially more accessible than center-based programs, and if proven effective, may have a potential widespread public health benefit.
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http://dx.doi.org/10.1002/clc.23362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298994PMC
June 2020

Heart failure with preserved ejection fraction: Similarities and differences between women and men.

Int J Cardiol 2020 04 9;304:101-108. Epub 2020 Jan 9.

National Heart Lung and Blood Institute, Bethesda, MD, United States of America.

The syndrome of heart failure (HF) with preserved ejection fraction (HFpEF) is now recognized to account for up to half of HF cases and is the dominant form of HF in older adults, especially women. Multiple factors conspire in this predilection of HFpEF for older women. This review will discuss the epidemiology, pathophysiology, prognosis, and treatment of HFpEF with emphasis on the similarities and differences in cardiovascular aging changes, and the differential impact of comorbidities in women versus men. Responses to pharmacologic and lifestyle interventions are also reviewed. We conclude by suggesting future directions for both prevention and treatment of this common and highly morbid cardiovascular disorder.
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http://dx.doi.org/10.1016/j.ijcard.2020.01.003DOI Listing
April 2020

Adverse Cardiovascular Outcomes for Women-Biology, Bias, or Both?

Authors:
Nanette K Wenger

JAMA Cardiol 2020 03;5(3):27-28

Emory University School of Medicine, Department Cardiology, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jamacardio.2019.5576DOI Listing
March 2020

Reducing the Clinical and Public Health Burden of Familial Hypercholesterolemia: A Global Call to Action.

JAMA Cardiol 2020 02;5(2):217-229

Familial Hypercholesterolemia Foundation, Pasadena, California.

Importance: Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH.

Observations: In 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created.

Conclusions And Relevance: By adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well.
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http://dx.doi.org/10.1001/jamacardio.2019.5173DOI Listing
February 2020

Biomarkers and Noncalcified Coronary Artery Plaque Progression in Older Men Treated With Testosterone.

J Clin Endocrinol Metab 2020 07;105(7)

Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California.

Objective: Recent results from the Cardiovascular Trial of the Testosterone Trials showed that testosterone treatment of older men with low testosterone was associated with greater progression of noncalcified plaque (NCP). We evaluated the effect of anthropometric measures and cardiovascular biomarkers on plaque progression in individuals in the Testosterone Trial.

Methods: The Cardiovascular part of the trial included 170 men aged 65 years or older with low testosterone. Participants received testosterone gel or placebo gel for 12 months. The primary outcome was change in NCP volume from baseline to 12 months, as determined by coronary computed tomography angiography (CCTA). We assayed several markers of cardiovascular risk and analyzed each marker individually in a model as predictive variables and change in NCP as the dependent variable.

Results: Of 170 enrollees, 138 (73 testosterone, 65 placebo) completed the study and were available for the primary analysis. Of 10 markers evaluated, none showed a significant association with the change in NCP volume, but a significant interaction between treatment assignment and waist-hip ratio (WHR) (P = 0.0014) indicated that this variable impacted the testosterone effect on NCP volume. The statistical model indicated that for every 0.1 change in the WHR, the testosterone-induced 12-month change in NCP volume increased by 26.96 mm3 (95% confidence interval, 7.72-46.20).

Conclusion: Among older men with low testosterone treated for 1 year, greater WHR was associated with greater NCP progression, as measured by CCTA. Other biomarkers and anthropometric measures did not show statistically significant association with plaque progression.
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http://dx.doi.org/10.1210/clinem/dgz242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209773PMC
July 2020

Shared decision-making for older adults with cardiovascular disease.

Clin Cardiol 2020 Feb 3;43(2):196-204. Epub 2019 Oct 3.

Cedars-Sinai Smidt Heart Institute and UCLA David Geffen School of Medicine, Los Angeles, California.

Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision-making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision-making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.
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http://dx.doi.org/10.1002/clc.23267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021653PMC
February 2020

Not your grandparents' cardiac care: The future of geriatric cardiology.

Clin Cardiol 2020 02 3;43(2):90-91. Epub 2019 Oct 3.

Cardiology, Duke University, Durham, North Carolina.

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http://dx.doi.org/10.1002/clc.23270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021649PMC
February 2020

Gender Disparities in Cardiac Rehabilitation Among Older Women: Key Opportunities to Improve Care.

Clin Geriatr Med 2019 11 12;35(4):587-594. Epub 2019 Jul 12.

Division of Cardiology, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Southeast, Atlanta, GA 30303, USA. Electronic address:

Older women with cardiovascular disease experience lower referral, participation, and completion rates of cardiac rehabilitation (CR), despite its well-established benefits (improved morbidity, mortality, quality of life, and functional capacity). Multiple social and health care system barriers affect participation of this population, including limitations in accessibility and transportation, competing responsibilities as caregivers, and lack of insight among patients and provider regarding the value of CR. With continued advances in technology and the ubiquity of smartphones, alternative CR programs may be able to better overcome barriers that affect older women.
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http://dx.doi.org/10.1016/j.cger.2019.07.012DOI Listing
November 2019

Do We Need an Apgar Score for Older Adults?

Authors:
Nanette K Wenger

Circulation 2019 09 16;140(12):973-975. Epub 2019 Sep 16.

Emory University School of Medicine, Emory Heart and Vascular Center, and Emory Women's Heart Center, Atlanta, GA.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.039670DOI Listing
September 2019

Relationship Between Pregnancy Complications and Subsequent Coronary Artery Disease Assessed by Coronary Computed Tomographic Angiography in Black Women.

Circ Cardiovasc Imaging 2019 07 15;12(7):e008754. Epub 2019 Jul 15.

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.

Background: Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications.

Methods: We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD.

Results: All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03-5.22; P<0.001) and obstructive CAD (odds ratio, 3.00; 95% CI, 1.55-5.80; P<0.001) on CCTA.

Conclusions: Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.
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http://dx.doi.org/10.1161/CIRCIMAGING.118.008754DOI Listing
July 2019

Female-friendly focus: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.

Authors:
Nanette K Wenger

Clin Cardiol 2019 08 18;42(8):706-709. Epub 2019 Jun 18.

Emory University School of Medicine, Atlanta, Georgia.

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http://dx.doi.org/10.1002/clc.23218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6671777PMC
August 2019

Ranolazine Reduces Angina in Women with Ischemic Heart Disease: Results of an Open-Label, Multicenter Trial.

J Womens Health (Larchmt) 2019 05 19;28(5):573-582. Epub 2019 Mar 19.

1 Division of Cardiology and Emory Women's Heart Center, Emory University School of Medicine, Atlanta, Georgia.

Persistent angina is prevalent in women, who more often present with atypical angina, and experience less relief from antianginal therapies. The impact of ranolazine on female-specific angina is unclear. A single-arm, open-label trial was conducted to quantify the impact of ranolazine on angina in women with ischemic heart disease (IHD). Women with IHD and ≥2 angina episodes/week were recruited from 30 U.S. sites. Angina and nitroglycerin (NTG) consumption were assessed using patient-reported diaries, Seattle Angina Questionnaire (SAQ), Duke Activity Score Index (DASI), and Women's Ischemia Symptom Questionnaire (WISQ) at baseline and at 4 weeks of treatment with ranolazine 500 mg twice/day. A modified intent-to-treat analysis and parametric or nonparametric methods were used as appropriate to analyze changes. Of 171 women enrolled, mean age was 65 ± 12 years. Of the 159 women included in the analysis, at week 4 compared to baseline, median angina frequency decreased with ranolazine treatment from 5.0 to 1.5 attacks/week and median change from baseline was -3.3 (95% confidence interval [CI]: -4.0 to -2.5;  ≤ 0.0001). Median NTG consumption decreased from 2.0 to 0.0 per week over the 4 weeks and median change was -1.0 (95% CI: -2.0 to -0.5;  < 0.0001). All five SAQ subscales showed mean improvements: physical limitation 9.2 (standard error [SE] 1.5;  < 0.0001), angina stability 31.8 (SE 2.7;  < 0.0001), angina frequency 17.7 (SE 1.6;  < 0.0001), treatment satisfaction 9.3 (SE 1.6;  < 0.0001), and disease perception 2.9 (SE 0.8;  < 0.0001). DASI score also improved 2.9 (SE 0.8;  = 0.0014). WISQ subscales also showed significant improvements (all  < 0.0001). Thirty-one women reported drug-related adverse events (AEs), predominantly mild to moderate gastrointestinal symptoms. Women with IHD treated with ranolazine for 4 weeks experienced less angina measured by SAQ and WISQ. NTG use decreased, physical activity improved, and treatment satisfaction improved. AEs were consistent with prior reports.
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http://dx.doi.org/10.1089/jwh.2018.7019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537111PMC
May 2019

The Feminine Face of Ischemic Heart Disease: Challenges and Opportunities.

Authors:
Nanette K Wenger

J Am Coll Cardiol 2019 02;73(6):694-697

Division of Cardiology, Emory University School of Medicine, Emory Heart and Vascular Center, and Emory Women's Heart Center, Atlanta, Georgia. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2018.12.011DOI Listing
February 2019

Reply to: Statins for Primary Prevention in Older Adults.

J Am Geriatr Soc 2019 04 28;67(4):857-858. Epub 2019 Jan 28.

University of Massachusetts Medical School and the Meyers Primary Care Institute, Worcester, Massachusetts.

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http://dx.doi.org/10.1111/jgs.15762DOI Listing
April 2019

Non-ST elevation acute coronary syndrome in women and the elderly: recent updates and stones still left unturned.

F1000Res 2018 29;7. Epub 2018 Nov 29.

Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.

Despite the growing awareness of adverse events with acute coronary syndrome and vigilance to refine pharmacological and interventional therapies, the understanding of how these events present in and affect women and the elderly remains limited. Pathophysiological differences in these subgroups and under-representation in large trials create a medical gap in sex- and age-related outcomes and in our knowledge of how best to detect, diagnose, and treat acute coronary syndrome. This review provides a general overview of recent advances in non-ST elevation myocardial infarction management in women and the elderly and elucidates areas where further exploration is needed.
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http://dx.doi.org/10.12688/f1000research.16492.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281006PMC
March 2019

SMARTWOMAN™: Feasibility assessment of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women.

Clin Cardiol 2019 Feb 17;42(2):217-221. Epub 2019 Jan 17.

Department of Medicine (Cardiology), Emory University School of Medicine, Emory Women's Heart Center, Atlanta, Georgia.

Background/hypothesis: SMARTWOMAN™ was designed to develop and assess the feasibility of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women.

Methods: Fourteen African-American women with diabetes and without known cardiovascular disease were enrolled. A weight-scale, glucometer, sphygmomanometer, and FitBit were synchronized to the smartphone, and text messaging was provided. Follow-up was 6 months.

Results: Patients were able to follow instructions for app use and device prompts. Weekly device reporting was 85% for blood glucose, 82.5% for daily steps, and 77% for systolic blood pressure. Patient engagement levels were 85% to 100% at 1 month and 50% to 78% at month 6. The majority reported text messages to be useful, easy to understand, and appropriate in frequency. The women indicated on the exit questionnaire that study participation increased their motivation and ability to take charge of their health.

Conclusions: Use of a smartphone app to control cardiovascular risk factors appears feasible in a population of vulnerable indigent African-American diabetic women, resulted in increased patient satisfaction and positive reinforcement to healthy behaviors, and warrants a larger clinical outcome trial.
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http://dx.doi.org/10.1002/clc.23124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712310PMC
February 2019