Sex bias in cardiovascular testing, intervention due to patient preference
Mumma B. Ann Emerg Med. 2010; doi:10.1016/j.annemergmed.2010.09.026
Despite presenting in ED’s with similar symptoms of acute coronary syndrome, women are less likely than men to receive the appropriate diagnostic tests and interventions because they are less apt to follow their physician’s recommendations, according to a cohort study published in Annals of Emergency Medicine.
Researchers enrolled 1,080 patients, 54% of them women, who presented in the ED with symptoms of acute coronary syndrome; 60% were admitted to the hospital. After receiving an explanation of the potential risks and benefits of each test and intervention, patients were surveyed on their preference for noninvasive procedures versus PCI or coronary artery bypass grafting. Patients were also asked about their predilection for compliance with physician recommendations. After 30 days, 96% of study participants were contacted for follow-up on outcomes.
After their initial hospital admission, women were less likely to receive diagnostic testing of any type (38% vs. 45%; 95% CI for the difference –13% to –1.5%). Cardiac catheterization for women was 7% less than for men (10% vs. 17%; 95% CI –11% to –2%). Revascularization was less frequent in either group (4% vs. 6%; 95% CI –5% to 0.6%).
Women and men both preferred stress tests to catheterization (58% vs. 52%; 95% CI –0.06% to 12%), and the proportion of both groups stating they would accept medical advisement for stress testing was similar (85% for both). However, women were less likely than men to state their acceptance for cardiac catheterization (65% vs. 75%; 95 CI –15% to –4%). Women also were less inclined to choose PCI over medical therapy (67% vs. 73%; 95% CI for difference 12% to 0.5%) and less likely to choose coronary artery bypass grafting over medical therapy (61% vs. 68%; 95% CI for difference –13% to 1%).
The researchers posited the disparity in testing and treatment was due in part to women being more risk-averse than men, and to women’s perception that their disease was not severe. “Future studies should focus on delineating why women appear less likely than men to accept physician-recommended evaluation of potential acute coronary syndromes,” the researchers wrote.
__________________________________________________ ________________________
Whey protein beverages lowered BP in young adults
Fluegel S. Int Dairy J. 2010;doi:10.1016/j.idairyj.2010.06.005.
Beverages supplemented with whey protein were associated with lower BP in young adults who had slightly elevated BP or prehypertension, according to researchers from Washington State University.
“Due to the side effects of pharmacological treatment, many people are interested in using diet to control hypertension,” the researchers wrote. “Dairy products contain compounds and minerals that may lower blood pressure, and consumption of dairy and fermented milk products has been associated with lower blood pressure.”
The researchers created whey beverages using whey protein concentrate 80 (WPC80 TemPro, Leprino Foods). Half of the beverages also contained supplemental whey protein, whereas the other half of the beverages served as the control group. Volunteers were recruited using advertisements. The study population was students aged 18 to 26 years, whose BP measurements were taken at the initial screening.
The students were randomly assigned to consume either 28 g per day of the control whey beverage or 28 g per day of the beverage with supplemental protein (along with consuming a normal diet). Among the 71 students enrolled, 25 had normal systolic and diastolic BP at baseline, 42 had prehypertension and four had stage I hypertension.
After 6 weeks of consuming the whey beverages, there was no difference in systolic BP, diastolic BP or mean arterial pressure between the two groups. In the young adults who began the study with elevated diastolic BP and/or systolic BP, the consumption of the whey beverages decreased the systolic BP by 8 mm Hg, decreased the diastolic BP by 8.6 mm Hg and decreased the mean arterial pressure by 6.4 mm Hg.
“The average BP decreases seen in this study are significant from a public health point of view,” the researchers wrote. “Similar decreases in systolic BP and diastolic BP have been associated with large reductions in the risk of stroke, heart disease and overall mortality.”
|