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The combination of classic chemotherapy agents like anthracyclines with novel targeted medications has had a positive impact on women's survival from breast cancer. GnRH analogues are primarily employed to temporarily suppress ovarian function in premenopausal women with hormone-receptor-positive (HR+) breast cancer. Despite their benefits, the true degree of their collateral effects has been widely understudied, especially when it comes to ischemic heart disease. This review aims at summarizing the current state of the art on this issue, with particular focus on the risk for cardiotoxicity associated with the combined use of GnRH analogues and anthracyclines. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, mechanisms, and manifestation remain poorly defined. Ischemia secondary to coronary artery vasospasm is thought to be the most frequent cardiotoxic effect of 5-FU. The available evidence of 5-FU-induced epicardial coronary artery spasm and coronary microvascular dysfunction suggests that endothelial dysfunction or primary vascular smooth muscle dysfunction (an endothelial-independent mechanism) are the possible contributing factors to this form of cardiotoxicity. In patients with 5-FU-related coronary artery vasospasm, termination of chemotherapy and administration of nitrates or calcium channel blockers may improve ischemic symptoms. However, there are variable results after administration of nitrates or calcium channel blockers in patients treated with 5-FU presumed to have myocardial ischemia, suggesting mechanisms other than impaired vasodilatory response. Clinicians should investigate whether chest pain and ECG changes can reasonably be attributed to 5-FU-induced cardiotoxicity. More prospective data and clinical randomized trials are required to understand and mitigate potentially adverse outcomes from 5-FU-induced cardiotoxicity. [ABSTRACT FROM AUTHOR]

An increasing proportion of women believe that smoking few cigarettes daily substantially reduces their risk of developing cardiovascular (CV) related disorders. The effect of low intensity smoking is still largely understudied. We investigated the relation among sex, age, cigarette smoking and ST segment elevation myocardial infarction (STEMI) as initial manifestation of CV disease. We analyzed data of 50,713 acute coronary syndrome patients with no prior manifestation of CV disease from the ISACS-Archives (NCT04008173) registry. We compared the rates of STEMI in current smokers (n = 11,530) versus nonsmokers (n = 39,183). In the young middle age group (<60 years), there was evidence of a more harmful effect in women compared with men (RR ratios: 1.90; 95% CI: 1.69–2.14 versus 1.68; 95% CI: 1.56–1.80). This association persisted even in women who smoked 1 to 10 packs per year (RR ratios: 2.02; 95% CI: 1.65 to 2.48 versus 1.38; 95% CI: 1.22 to 1.57). In the older group, rates of STEMI were similar for women and men (RR ratios: 1.36; 95% CI: 1.22–1.53 versus 1.39; 95% CI: 1.28–1.50). STEMI was associated with a twofold higher 30-day mortality rate in young middle age women compared with men of the same age (odds ratios, 5.54; 95% CI, 3.83–8.03 vs. 2.93; 95% CI, 2.33–3.69). Low intensity smoking provides inadequate protection in young - middle age women as they still have a substantially higher rate of STEMI and related mortality compared with men even smoking less than 10 packs per year. This finding is worrying as more young - middle age women are smoking, and rates of smoking among young-middle age men continue to fall. [Display omitted] • Many female light smokers consider smoking as not harmful; while they understood smoking to be risky, they did not consider the risk as high as non-smokers. • Young – middle aged women who smoke have a 22% higher risk of STEMI as initial clinical manifestation of CVD than young-middle age men compared with nonsmokers. • STEMI was associated with a twofold higher 30-day mortality rate in young-middle age women compared with men of the same age. • Low intensity smoking provides inadequate protection in young-middle age women as they still have a substantial high rate of STEMI and related mortality even smoking less than 10 packs per year. • Patients' age and sex must be considered in assessments of health promotion initiatives for quitting smoking and preventing CVD. [ABSTRACT FROM AUTHOR]

Introduction: Information on sex differences in clinical presentation and outcomes of STEMI with nonobstructive CAD is poor as prior studies have pooled together all patients with MI. STEMI and NSTEMI are clinical entities that differ considerably in the pathophysiology and management options Hypothesis: The current study aimed to determine the clinical characteristics, outcomes and predictors of STEMI by sex and CAD status Methods: We identified 5858 patients who underwent coronary angiography for STEMI in the ISACS-TC registry from 2010-2016. Patients with prior revascularization (n=797) and cardiomyopathies/myocarditis (n=12) were excluded, giving a final study population of 5049 STEMI patients. The primary outcome measure was all cause 30 day death. Secondary outcome was the incidence of severe left ventricular dysfunction at discharge (EF<30%). Risk factors, clinical history, presentation, and hospital treatments within 24 hours from admission were compared by sex and CAD status (obstructive vs nonobstructive) by multivariable logistic methods Results: Of the 5049 STEMI patients, 94.2% had significant CAD and 5.8% had nonobstructive CAD. Younger age (OR 1.19 CI 1.05- 1.35), prior MI (OR 1.66 CI 1.01-2.76) and prior heart failure (OR 2.09 CI 1.11-3.92) were independent determinants for clinical presentation with STEMI and nonobstructive CAD. There were no differences between men and women in rates of nonobstructive CAD (5.7% vs 5.9% P=0.77). The primary and secondary outcomes did not differ among men and women with nonobstructive CAD (OR 1.79 P=0.46 and OR 3.27 P=0.26 respectively). Sex specific regression models of obstructive versus nonobstructive CAD showed that older age (OR 1.20 CI 1.04-1.39) only predicts significant CAD in men whereas current smoking (OR 2.19 CI 1.15-4.17) and diabetes (OR 3.57 CI 1.49-8.53) were only significant predictors in women. The relative risk of hypercholesterolemia was similar in men (OR 2.01 CI 1.38-2.92) and women (OR 1.92 CI 1.05-3.51). The risk of death among women with obstructive CAD was most pronounced than their male counterpart (OR 1.45 CI 1.03-2.06) Conclusions: Women have a higher risk of death after STEMI in comparison with men only in patients with obstructive CAD. Development of obstructive CAD is, therefore, the most serious and life-threatening event in women. Diabetes and current smoking were found to have a greater impact on development of obstructive CAD in women compared with men. Prevention of traditional risk factors is a major need for improving cardiovascular health among women. [ABSTRACT FROM AUTHOR]

Aims Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with coronavirus disease 2019 (COVID-19) outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods and results This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes COVID-19 (NCT05188612). Participants were individuals hospitalized with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 2020 to February 2022. Risk-adjusted ratios (RRs) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women vs. men. Estimates were evaluated by inverse probability weighting and logistic regression models. The overall care cohort included 4499 patients with COVID-19-associated hospitalizations. Of these, 1524 (33.9%) were admitted to intensive care unit (ICU), and 1117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU [RR: 0.80; 95% confidence interval (CI): 0.71–0.91]. In general wards (GWs) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95% CI: 0.90–1.42) and 0.86 (95% CI: 0.70–1.05; p interaction = 0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (odds ratios: 2.27, 95% CI: 1.73–2.98; 3.85, 95% CI: 3.21–4.63; and 3.95, 95% CI: 3.04–5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. In contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs: 1.25; 95% CI: 0.94–1.67 vs. 0.83; 95% CI: 0.59–1.16, p interaction = 0.04). Conclusions Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19-related complications. [ABSTRACT FROM AUTHOR]

Background: There is uncertainty regarding the impact of statins on the risk of atherosclerotic cardiovascular disease (ASCVD) and its major complication, acute heart failure (AHF).Objectives: The aim of this study was to investigate whether previous statin therapy translates into lower AHF events and improved survival from AHF among patients presenting with an acute coronary syndrome (ACS) as a first manifestation of ASCVD.Methods: Data were drawn from the International Survey of Acute Coronary Syndromes Archives. The study participants consisted of 14,542 Caucasian patients presenting with ACS without previous ASCVD events. Statin users before the index event were compared with nonusers by using inverse probability weighting models. Estimates were compared by test of interaction on the log scale. Main outcome measures were the incidence of AHF according to Killip class and the rate of 30-day all-cause mortality in patients presenting with AHF.Results: Previous statin therapy was associated with a significantly decreased rate of AHF on admission (4.3% absolute risk reduction; risk ratio [RR]: 0.72; 95% CI: 0.62-0.83) regardless of younger (40-75 years) or older age (interaction P = 0.27) and sex (interaction P = 0.22). Moreover, previous statin therapy predicted a lower risk of 30-day mortality in the subset of patients presenting with AHF on admission (5.2 % absolute risk reduction; RR: 0.71; 95% CI: 0.50-0.99).Conclusions: Among adults presenting with ACS as a first manifestation of ASCVD, previous statin therapy is associated with a reduced risk of AHF and improved survival from AHF. (International Survey of Acute Coronary Syndromes [ISACS] Archives; NCT04008173). [ABSTRACT FROM AUTHOR]