sodium-ethylxanthate and Heart-Failure

The ongoing debate about the FDA approval of BiDil in 2005 demonstrates how the first racially/ethnically licensed drug is entangled in both Utopian and dystopian future visions about the continued saliency of race/ethnicity in science and medicine. Drawing on the sociology of expectations, this paper analyzes how scientists in the field of pharmacogenetics are constructing certain visions of the future with respect to the use of social categories of race/ethnicity and the impact of high-throughput genotyping technologies that promise to transform scientific practices.

Topics: Drug Combinations; Genetics, Population; Heart Failure; Humans; Hydralazine; Isosorbide Dinitrate; Pharmacogenetics; Racial Groups; Sex; Vasodilator Agents

In the effort to explain gender-related differences of the cardiovascular system, the renin-angiotensin system experienced intensive exploration. Indeed, the development of hypertension as well as the progression of coronary artery disease and heart failure have two factors in common: (1) display distinct gender specific characteristics and (2) are enhanced by the renin-angiotensin system. It is therefore interesting to note that data from experimental animals, epidemiological surveys, and clinical investigations suggest that the components of the circulating as well as tissue-based renin-angiotensin system are markedly affected by gender. However, the issue is complicated by counter-regulatory effects of estrogen on the system with the substrate, on one hand, and the processing enzymes as well as the chief receptor, on the other hand. In fact, angiotensinogen is up-regulated particularly by oral administration of estrogen, whereas renin, angiotensin-converting enzyme (ACE), and AT-1 receptor are down-regulated by the hormone. While under well-defined experimental conditions the net effect of estrogen appears to result in suppression of the renin-angiotensin system, the clinical situation may be more complex. The judgment is further complicated by the difficulty in precisely measuring the activity of the system at the tissue level. Moreover, clinically relevant read-outs for the activity of the renin-angiotensin system may be regulated multifactorially or only indirectly affected by the system. Nevertheless, the undisputable, profound biochemical changes in the renin-angiotensin system related to the estrogen status allow speculation that such interaction explains some of the differences in the cardiovascular system of men and women.

Topics: Angiotensin I; Cardiovascular Physiological Phenomena; Coronary Disease; Estrogens; Female; Genotype; Heart Failure; Humans; Hypertension; Male; Renin; Renin-Angiotensin System; Sex

The effect of donor-recipient sex matching on long-term survival in pediatric heart transplantation is not well known. Adult data have shown worse survival when male recipients receive a sex-mismatched heart, with conflicting results in female recipients. We analyzed 5795 heart transplant recipients ≤ 18 yr in the Scientific Registry of Transplant Recipients (1990-2012). Recipients were stratified based on donor and recipient sex, creating four groups: MM (N = 1888), FM (N = 1384), FF (N = 1082), and MF (N = 1441). Males receiving sex-matched donor hearts had increased unadjusted allograft survival at five yr (73.2 vs. 71%, p = 0.01). However, this survival advantage disappeared with longer follow-up and when adjusted for additional risk factors by multivariable Cox regression analysis. In contrast, for females, receiving a sex-mismatched heart was associated with an 18% higher risk of allograft loss over time compared to receiving a sex-matched heart (HR 1.18, 95% CI: 1.00-1.38) and a 26% higher risk compared to sex-matched male recipients (HR 1.26, 95% CI: 1.10-1.45). Females who receive a heart from a male donor appear to have a distinct long-term survival disadvantage compared to all other groups.

Topics: Adolescent; Algorithms; Child; Child, Preschool; Female; Heart Failure; Heart Transplantation; Humans; Infant; Kaplan-Meier Estimate; Male; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; Sex; Tissue and Organ Procurement; Tissue Donors; Treatment Outcome

Variations in the rates of major procedures by race and gender are well described, but few studies have assessed the quality of care by race and gender for basic hospital services.. To assess quality of care by race and gender.. Retrospective review of medical records.. Stratified random sample of 2,175 Medicare beneficiaries hospitalized for congestive heart failure or pneumonia in Illinois, New York, and Pennsylvania during 1991 and 1992.. Explicit process criteria and implicit review by physicians.. In adjusted analyses, black patients with congestive heart failure or pneumonia received lower quality of care overall than other patients with these conditions by both explicit process criteria and implicit review (P < 0.05). On explicit measures, overall quality of care did not differ by gender for either condition, but significant differences were noted on explicit subscales. Women received worse cognitive care than men from physicians for both conditions, better cognitive care from nurses for pneumonia, and better therapeutic care for congestive heart failure (P < 0.05). Women received worse quality of care than men by implicit review (P = 0.03) for congestive heart failure but not pneumonia.. Consistent racial differences in quality of care persist in basic hospital services for two common medical conditions. Physicians, nurses, and policy makers should strive to eliminate these differences. Gender differences in quality of care are less pronounced and may vary by condition and type of provider or service.

Topics: Aged; Black or African American; Female; Heart Failure; Humans; Illinois; Linear Models; Male; Medicare; New York; Outcome and Process Assessment, Health Care; Pennsylvania; Pneumonia; Quality of Health Care; Racial Groups; Retrospective Studies; Severity of Illness Index; Sex; United States

To seek direct evidence for a cause-effect relation between sympathetic activation and arrhythmogenesis.. Rats underwent open-chest surgery with either coronary artery occlusion or sham operation, and were studied 8 weeks later using in situ heart perfusion and nerve stimulation methods.. Infarcted rats showed cardiac functional impairment and increased heart and lung weight. The extent of these changes correlated well with infarct size (IS). In in situ perfused hearts, sympathetic nerve stimulation (2 and 4 Hz, 45 s duration) induced a frequency-dependent release of norepinephrine (NE). NE release was lower in MI than that in control groups. In hearts with large IS (> or = 40%, n = 19) ventricular arrhythmias were rare at baseline, but nerve stimulation evoked the onset of ventricular premature beats (95%), tachycardia (37%) and fibrillation (26%), IS and stimulation frequency were key determinants for the inducibility of arrhythmias. Lower K- concentration enhanced arrhythmia inducibility. beta-blockade inhibited the frequency of arrhythmias produced by nerve stimulation.. In infarcted rat hearts sympathetic activation is a potent trigger for the onset of ventricular tachyarrhythmias.

Topics: Adrenergic beta-Antagonists; Adrenergic Uptake Inhibitors; Analysis of Variance; Animals; Atenolol; Cardiac Pacing, Artificial; Desipramine; Electric Stimulation; Electrocardiography; Female; Heart Failure; Lung; Male; Myocardial Infarction; Myocardium; Norepinephrine; Perfusion; Potassium; Propanolamines; Rats; Rats, Sprague-Dawley; Sex; Statistics, Nonparametric; Sympathetic Nervous System; Tachycardia, Ventricular

We analyzed potential gender differences in the use and prognostic value of stress technetium 99m sestamibi tomography, image results, and cardiac event rates over a period of 15 +/- 8 months in 1226 men and 1151 women. Men had more abnormal tomographic images, but referral for catheterization and revascularization similarly increased in relation to the number of defects. Men and women with abnormal images had similar event rates, 19.6% and 18.2%, respectively, although men more often had myocardial infarction or cardiac death (7.6% vs 4.1 %, p < 0.05), whereas women had an increased likelihood of unstable angina or congestive heart failure (11.5% vs 7.6%, p < 0.05). Normal images predicted a low yearly rate of myocardial infarction or death: 1.7% for men and 0.8% for women. Image findings, particularly defect extent, were independent predictors of events in both groups. Thus, after stress Tc-99m sestamibi single-photon emission computed tomography perfusion imaging, there was no gender bias in referral for invasive procedures, and for both men and women image findings were strongly associated with prognostic outcome.

Topics: Angina Pectoris; Angina, Unstable; Cardiac Catheterization; Coronary Disease; Death, Sudden, Cardiac; Dipyridamole; Exercise Test; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Physician-Patient Relations; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Referral and Consultation; Regression Analysis; Selection Bias; Sex; Sex Factors; Stress, Physiological; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Topics: Amebiasis; Black or African American; Black People; Child; Child, Hospitalized; Child, Preschool; Ethnology; Female; Glomerulonephritis; Heart Failure; Humans; Infant; Infant, Newborn; Male; Meningitis; Meningitis, Viral; Nephrotic Syndrome; Poisoning; Rheumatic Fever; Sex; South Africa; Tuberculosis, Meningeal; White People

Topics: Adult; Aged; Aging; Arrhythmias, Cardiac; Female; Glucose; Heart Failure; Humans; Insulin; Male; Middle Aged; Myocardial Infarction; Potassium; Sex; Shock

Topics: Adult; Aged; Aging; Cardiomyopathies; Coronary Disease; Electrocardiography; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Myocardium; Myxedema; Organ Size; Pericardial Effusion; Sex

Topics: Aging; Angiocardiography; Birth Weight; Black or African American; Blood; Child, Preschool; Endocardial Fibroelastosis; Female; Heart Failure; Hemoglobinometry; Humans; Infant; Male; Mumps; Sex; United States; White People

Topics: Biomedical Research; Drug Therapy; Geriatrics; Heart Failure; Hypertension; Placebos; Proteinuria; Rauwolfia; Reserpine; Sex; Toxicology

Topics: Adolescent; Aging; Blood Glucose; Blood Pressure; Cardiovascular Diseases; Cholesterol; Coronary Disease; Epidemiologic Studies; Epidemiology; Geriatrics; Heart Defects, Congenital; Heart Failure; Humans; Hypertension; Michigan; Obesity; Rheumatic Heart Disease; Sex; Smoking

Topics: Birth Weight; Cardiac Catheterization; Cardiomegaly; Child, Preschool; Electrocardiography; Epidemiology; Ethnology; Female; Follow-Up Studies; Heart Failure; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Male; Prognosis; Pulmonary Circulation; Sex; Vascular Resistance

Topics: Adolescent; Aging; Arteriosclerosis; Blood Circulation; Blood Pressure Determination; Blood Volume Determination; Child; Child, Preschool; Female; Heart Failure; Heart Function Tests; Humans; Hypertension; Kidney Diseases; Male; Middle Aged; Pulse; Sex

Topics: Air Pollution; Asphyxia; Bronchitis; Cerebrovascular Disorders; Cough; Craniocerebral Trauma; Electrocardiography; Heart Failure; Humans; Myocardial Infarction; Neoplasm Metastasis; Neoplasms; Occupations; Peptic Ulcer; Pneumonia; Pneumothorax; Polycythemia; Pulmonary Emphysema; Pulmonary Heart Disease; Radiography, Thoracic; Respiratory Function Tests; Sex; Smoking; Suicide

Topics: Abdominal Neoplasms; Aging; Ascites; Heart Failure; Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Liver Cirrhosis; Minnesota; Obesity; Sex; Statistics as Topic

Topics: Arrhythmias, Cardiac; Arteriosclerosis; Atrial Fibrillation; Atrial Flutter; Cardiac Complexes, Premature; Cardiomegaly; Coronary Disease; Geriatrics; Heart Block; Heart Diseases; Heart Failure; Hypertension; Myocardial Infarction; Obesity; Sex; Statistics as Topic

Topics: Adrenal Cortex Hormones; Anticoagulants; Arrhythmias, Cardiac; Cerebrovascular Disorders; Drug Therapy; Estrogens; Geriatrics; Heart Arrest; Heart Block; Heart Failure; Heart Massage; Humans; Hypertension; Italy; Mortality; Myocardial Infarction; Occupations; Oxygen Inhalation Therapy; Pacemaker, Artificial; Prognosis; Sex; Statistics as Topic; Thromboembolism; Thrombophlebitis