Is an ischemic etiology especially detrimental for women with heart failure?

Tilburg University

Is an ischemic etiology especially detrimental for women with heart failure?

Berkvens, C.P.M.; Mommersteeg, P.M.C.

Published in:

International Journal of Cardiology

DOI:

10.1016/j.ijcard.2016.09.108

Publication date:

2017

Document Version

Publisher's PDF, also known as Version of record

Link to publication in Tilburg University Research Portal

Citation for published version (APA):

Berkvens, C. P. M., & Mommersteeg, P. M. C. (2017). Is an ischemic etiology especially detrimental for women

with heart failure? International Journal of Cardiology, 229, 142-142. https://doi.org/10.1016/j.ijcard.2016.09.108

General rights

Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain

• You may freely distribute the URL identifying the publication in the public portal

Take down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Correspondence

Letter to the editor: Is an ischemic etiology especially detrimental for

women with heart failure?

Cornelia P.M. Berkvens, Paula M.C. Mommersteeg

⁎

CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

a r t i c l e i n f o

Received 9 September 2016 Accepted 28 September 2016 Available online 30 September 2016

Orszulak and colleages[1]reported elevated depressive symptoms in women with heart failure (HF) with reduced ejection fraction (LVEF), which is accordant with meta-analytic findings [2]. The difference was marked by more depressive symptoms in women with an ischemic etiology of HF. The authors are complimented for reporting gender as well as ischemic etiology stratified findings. We would like to add to their discussion and suggest an analysis.

Accordant with most cardiovascular studies, the study has a male-dominated gender imbalance (79% men). This is a likely result of the inclusion criteria of a reduced LVEF, since women more often have HF with a preserved LVEF[3]. Consequently, gender biases are present, e.g. women are older and men more often have a history of obstructive ischemic heart disease. This gender bias may coincide with a gender difference in depressive symptoms.

An underlying mechanism could be that women more often have coronary microvascular dysfunction (CMD) in the absence of obstructive coronary arteries[4]. CMD can predispose to HF[4], and is modulated by

chronic inflammation. Depression is related to elevated levels of inflam-matory cytokines[4,5].

We suggest to examine if gender, depression, and their interaction predict an ischemic etiology, adjusted for age, LVEF, diabetes and cardiac event history. A significant gender*depression interaction further validates the notion that women with an ischemic etiology more often have depressive symptoms than men. In future studies, this potential gender difference in ischemic etiology need to be included and it is necessary to expand research on mechanisms.

References

[1] M. Orszulak, K. Mizia-Stec, A. Siennicka, K. Goscinska-Bis, K. Waga, M. Wojcik, G. Kopec, Differences of psychological features in patients with heart failure with regard to gender and aetiology-results of a CAPS-LOCK-HF (complex assessment of psycho-logical status located in heart failure) study, Int. J. Cardiol. 219 (2016) 380–386.

[2]T. Rutledge, V.A. Reis, S.E. Linke, B.H. Greenberg, P.J. Mills, Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clin-ical outcomes, J. Am. Coll. Cardiol. 48 (2006) 1527–1537.

[3] V. Regitz-Zagrosek, S. Oertelt-Prigione, E. Prescott, F. Franconi, E. Gerdts, A. Foryst-Ludwig, V. Stangl, Gender in cardiovascular diseases: impact on clinical manifesta-tions, management, and outcomes, Eur. Heart J. 37 (2016) 24–34.

[4]F. Crea, P.G. Camici, C.N. Bairey Merz, Coronary microvascular dysfunction: an update, Eur. Heart J. 35 (2014) 1101–1111.

[5]A.H. Miller, V. Maletic, C.L. Raison, Inflammation and its discontents: the role of cyto-kines in the pathophysiology of major depression, Biol. Psychiatry 65 (2009) 732–741.

International Journal of Cardiology 229 (2017) 142

⁎ Corresponding author.

E-mail address:p.m.c.mommersteeg@uvt.nl(P.M.C. Mommersteeg).

http://dx.doi.org/10.1016/j.ijcard.2016.09.108

0167-5273/© 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Contents lists available atScienceDirect