Obesity and diabetes in heart disease in women

Abstract

Heart disease remains a major health threat in women. Cardiometabolic risk factors such as obesity and diabetes differentially and adversely impact heart disease risk. Although obstructive coronary artery disease is an important cause of ischemic heart disease in women and is prognostic, women are more likely to have angina and myocardial ischemia without obstructive atherosclerosis, which has been attributed to coronary microvascular dysfunction (CMD). Heart failure with preserved ejection fraction (HFpEF) is another condition that predominates in women. CMD and HFpEF are both associated with cardiometabolic risk factors that are prevalent in women. Women are also more likely to have additional risk-enhancing conditions such as autoimmune dysfunction, chronic inflammation, and sex-specific hormonal factors that adversely influence risk. In this review, we focus on cardiometabolic risk factors of obesity and diabetes in heart disease in women, including ischemic heart disease from CMD, HFpEF, and arrythmias. Team-based care to focus on cardiometabolic risk reduction is needed to alter adverse heart disease outcomes in women. Identification, education, treatment, and active surveillance of these dysmetabolic risk factors are imperative in the primary and secondary prevention of heart disease in women.

Keywords

Sex differences / obesity / diabetes / type 2 diabetes mellitus / cardiovascular disease / endothelial dysfunction / inflammation / coronary atherosclerosis / hormone therapy

References

[1] National Center for Health Statistics. National health interview survey. Available from:https://www.cdc.gov/nchs/nhis/[Last accessed on 14 Jun 2024]

[2] Gupta A,Spertus JA.Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010.J Am Coll Cardiol2014;64:337-45 PMCID:PMC4415523

[3] Benjamin EJ,Alonso A.American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics SubcommitteeHeart disease and stroke statistics-2019 update: a report from the american heart association.Circulation2019;139:e56-e528

[4] Sullivan PW,Wyatt HR,Hill JO.Impact of cardiometabolic risk factor clusters on health-related quality of life in the U.S.Obesity2007;15:511-21

[5] Isomaa B,Tuomi T.Cardiovascular morbidity and mortality associated with the metabolic syndrome.Diabetes Care2001;24:683-9

[6] Hirode G.Trends in the prevalence of metabolic syndrome in the United States, 2011-2016.JAMA2020;323:2526-8 PMCID:PMC7312413

[7] Aggarwal NR,Mehta LS.Sex differences in ischemic heart disease: advances, obstacles, and next steps.Circ Cardiovasc Qual Outcomes2018;11:e004437

[8] Peh ZH,Hutton D.Inflammation as a therapeutic target in heart failure with preserved ejection fraction.Front Cardiovasc Med2023;10:1125687 PMCID:PMC10339321

[9] Schiattarella GG,Hill JA.Metabolic inflammation in heart failure with preserved ejection fraction.Cardiovasc Res2021;117:423-34 PMCID:PMC8599724

[10] Powell-Wiley TM,Burke LE.American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke CouncilObesity and cardiovascular disease: a scientific statement from the american heart association.Circulation2021;143:e984-e1010 PMCID:PMC8493650

[11] Lopez-Jimenez F,Bays H.Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the world heart federation and world obesity federation.Eur J Prev Cardiol2022;29:2218-37.

[12] Kyle TK,Allison DB.Regarding obesity as a disease: evolving policies and their implications.Endocrinol Metab Clin North Am2016;45:511-20 PMCID:PMC4988332

[13] Lavie CJ,Church TS,Blair SN.Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox.J Am Coll Cardiol2014;63:1345-54.

[14] Mahabadi AA,Rosito GA.Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the framingham heart study.Eur Heart J2009;30:850-6 PMCID:PMC3693564

[15] Félix-Redondo FJ,Baena-Díez JM.Prevalence of obesity and associated cardiovascular risk: the DARIOS study.BMC Public Health2013;13:542 PMCID:PMC3695785

[16] Ross R,Yamashita S.Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity.Nat Rev Endocrinol2020;16:177-89 PMCID:PMC7027970

[17] Zhang C,van Dam RM,Hu FB.Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women.Circulation2008;117:1658-67

[18] Peters SAE,Woodward M.Sex Differences in the association between measures of general and central adiposity and the risk of myocardial infarction: results from the UK biobank.J Am Heart Assoc2018;7 PMCID:PMC5866342

[19] Oikonomou EK.The role of adipose tissue in cardiovascular health and disease.Nat Rev Cardiol2019;16:83-99.

[20] Hall JE,da Silva AA,Hall ME.Obesity, kidney dysfunction and hypertension: mechanistic links.Nat Rev Nephrol2019;15:367-85 PMCID:PMC7278043

[21] Iliescu R,Irwin ED.Chronic baroreflex activation restores spontaneous baroreflex control and variability of heart rate in obesity-induced hypertension.Am J Physiol Heart Circ Physiol2013;305:H1080-8. PMCID:PMC3798752

[22] Mansukhani MP,Caples SM.Chemoreflexes, sleep apnea, and sympathetic dysregulation.Curr Hypertens Rep2014;16:476. PMCID:PMC4249628

[23] Machleidt F,Krapalis AF,Lehnert H.Experimental hyperleptinemia acutely increases vasoconstrictory sympathetic nerve activity in healthy humans.J Clin Endocrinol Metab2013;98:E491-6.

[24] Palmer BF.The sexual dimorphism of obesity.Mol Cell Endocrinol2015;402:113-9 PMCID:PMC4326001

[25] Liu J,Hickson DA.Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson heart study.J Clin Endocrinol Metab2010;95:5419-26 PMCID:PMC2999970

[26] Aydin Ö,Gerdes V.The gut microbiome as a target for the treatment of type 2 diabetes.Curr Diab Rep2018;18:55. PMCID:PMC6013535

[27] Heuvelman VD,Smits MM.Cardiovascular effects of glucagon-like peptide 1 receptor agonists: from mechanistic studies in humans to clinical outcomes.Cardiovasc Res2020;116:916-30

[28] Caron A.Neuronal systems and circuits involved in the control of food intake and adaptive thermogenesis.Ann N Y Acad Sci2017;1391:35-53.

[29] Gaur A,Ananthanarayanan PH.Role of Ventromedial hypothalamus in high fat diet induced obesity in male rats: association with lipid profile, thyroid profile and insulin resistance.Ann Neurosci2014;21:104-7. PMCID:PMC4158776

[30] Dube MG,Kalra PS,Kalra SP.Disruption in neuropeptide Y and leptin signaling in obese ventromedial hypothalamic-lesioned rats.Brain Res1999;816:38-46

[31] Kim AY,Choi HJ.Comparison of volumetric and shape changes of subcortical structures based on 3-dimensional image between obesity and normal-weighted subjects using 3.0 T MRI.J Clin Neurosci2020;73:280-7.

[32] Xu Y,Zhu L.Distinct hypothalamic neurons mediate estrogenic effects on energy homeostasis and reproduction.Cell Metab2011;14:453-65. PMCID:PMC3235745

[33] Ezzat-Zadeh Z,Chase PB.The cooccurrence of obesity, osteoporosis, and sarcopenia in the ovariectomized rat: a study for modeling osteosarcopenic obesity in rodents.J Aging Res2017;2017:1454103. PMCID:PMC5471594

[34] El Khoudary SR,Beckie TM.Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the american heart association.Circulation2020;142:e506-32

[35] Rajendran A,Kazzi B.Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women.Atherosclerosis2023;384:117269 PMCID:PMC10841060

[36] Manfrini O,van der Schaar M.Sex differences in modifiable risk factors and severity of coronary artery disease.J Am Heart Assoc2020;9:e017235 PMCID:PMC7792418

[37] Wang Y,Jiao Y.Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants.BMC Med2019;17:136. PMCID:PMC6625042

[38] Madonna R,De Rosa S.Impact of sex differences and diabetes on coronary atherosclerosis and ischemic heart disease.J Clin Med2019;8:98 PMCID:PMC6351940

[39] Manson JE,Stampfer MJ.A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women.Arch Intern Med1991;151:1141-7.

[40] Barrett-Connor EL,Wingard DL.Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The rancho bernardo study.JAMA1991;265:627-31.

[41] Kautzky-Willer A,Pacini G.Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus.Endocr Rev2016;37:278-316 PMCID:PMC4890267

[42] Hevener AL. The impact of estrogen receptor α expression in the pathogenesis of the metabolic syndrome. In: Spangenburg EE, editor. Integrative Biology of Women’s Health. New York: Springer; 2013. pp. 87-121.

[43] Fatma J,Siddiqui Z,Chandra A.Cardio-metabolic risk profile in women with previous history of pre-eclampsia.J Assoc Physicians India2017;65:23-7.

[44] Heidema WM,Lotgering FK.History of preeclampsia is more predictive of cardiometabolic and cardiovascular risk factors than obesity.Eur J Obstet Gynecol Reprod Biol2015;194:189-93

[45] Bellamy L,Hingorani AD.Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.Lancet2009;373:1773-9.

[46] Kramer CK,Retnakaran R.Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis.Diabetologia2019;62:905-914

[47] Yu Y,Sørensen HT,Arah OA.Gestational diabetes mellitus and the risks of overall and type-specific cardiovascular diseases: a population- and sibling-matched cohort study.Diabetes Care2022;45:151-9. PMCID:PMC8753767

[48] Moran LJ,Wild RA.Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis.Hum Reprod Update2010;16:347-63.

[49] Kakoly NS,Joham AE.Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression.Hum Reprod Update2018;24:455-67.

[50] Osibogun O,Michos ED.Polycystic ovary syndrome and cardiometabolic risk: opportunities for cardiovascular disease prevention.Trends Cardiovasc Med2020;30:399-404.

[51] Oliver-Williams C,Pinborg A.Risk of cardiovascular disease for women with polycystic ovary syndrome: results from a national Danish registry cohort study.Eur J Prev Cardiol2021;28:e39-41.

[52] Eslam M,Sarin SK.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol2020;73:202-9

[53] Lonardo A,Osna N.Effect of cofactors on NAFLD/NASH and MAFLD. A paradigm illustrating the pathomechanics of organ dysfunction.Metab Target Organ Damage2022;2:12 PMCID:PMC9453927

[54] Wu S,Zhang Y.Sex and age differences in the association between metabolic dysfunction-associated fatty liver disease and heart failure: a prospective cohort study.Circ Heart Fail2024;17:e010841.

[55] Sousa P.MAFLD under the lens: the role of gut microbiota.Metab Target Organ Damage2022;2:14

[56] Ross R.Atherosclerosis--an inflammatory disease.N Engl J Med1999;340:115-26.

[57] Libby P.From focal lipid storage to systemic inflammation: JACC review topic of the week.J Am Coll Cardiol2019;74:1594-607. PMCID:PMC6910128

[58] Ait-Oufella H,Mallat Z.Recent advances on the role of cytokines in atherosclerosis.Arterioscler Thromb Vasc Biol2011;31:969-79

[59] Ference BA,Graham I.Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European atherosclerosis society consensus panel.Eur Heart J2017;38:2459-72. PMCID:PMC5837225

[60] Libby P.The changing landscape of atherosclerosis.Nature2021;592:524-33.

[61] Lumeng CN,Saltiel AR.Obesity induces a phenotypic switch in adipose tissue macrophage polarization.J Clin Invest2007;117:175-84 PMCID:PMC1716210

[62] Wu ZJ,Gu WJ.Adiponectin is associated with increased mortality in patients with already established cardiovascular disease: a systematic review and meta-analysis.Metabolism2014;63:1157-66

[63] Lee S.Role of adiponectin in metabolic and cardiovascular disease.J Exerc Rehabil2014;10:54-9 PMCID:PMC4025550

[64] Fuente-Martín E,Ros P,Chowen JA.Sex differences in adipose tissue: it is not only a question of quantity and distribution.Adipocyte2013;2:128-34 PMCID:PMC3756100

[65] Moran CA,Beydoun N.Cardiovascular implications of immune disorders in women.Circ Res2022;130:593-610. PMCID:PMC8869407

[66] Nelson MD,Bairey Merz CN.Coronary microvascular dysfunction and heart failure with preserved ejection fraction as female-pattern cardiovascular disease: the chicken or the egg?.Eur Heart J2018;39:850-2 PMCID:PMC5939623

[67] Camici PG.Coronary microvascular dysfunction.N Engl J Med2007;356:830-40.

[68] Murphy E.Estrogen signaling and cardiovascular disease.Circ Res2011;109:687-96 PMCID:PMC3398381

[69] Ter Horst R,Schraa K.Sex-specific regulation of inflammation and metabolic syndrome in obesity.Arterioscler Thromb Vasc Biol2020;40:1787-800 PMCID:PMC7310302

[70] Ndumele CE,Chow SL.American Heart AssociationCardiovascular-kidney-metabolic health: a presidential advisory from the American heart association.Circulation2023;148:1606-35

[71] Bairey Merz CN,Walsh MN.Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade.Circulation2017;135:1075-92 PMCID:PMC5385930

[72] Anand SS,Rosengren A.INTERHEART InvestigatorsRisk factors for myocardial infarction in women and men: insights from the INTERHEART study.Eur Heart J2008;29:932-40.

[73] Benjamin EJ,Callaway CW.American Heart Association Council on epidemiology and prevention statistics committee and stroke statistics subcommitteeHeart disease and stroke statistics-2018 update: a report from the american heart association.Circulation2018;137:e67-e492.

[74] Bagi Z,Feher A.Obesity and coronary microvascular disease - implications for adipose tissue-mediated remote inflammatory response.Curr Vasc Pharmacol2014;12:453-61 PMCID:PMC4167722

[75] Sara JD,Kolluri N,Lerman LO.Coronary microvascular dysfunction is associated with poor glycemic control amongst female diabetics with chest pain and non-obstructive coronary artery disease.Cardiovasc Diabetol2019;18:22 PMCID:PMC6393964

[76] Das SR,Chen AY.Impact of body weight and extreme obesity on the presentation, treatment, and in-hospital outcomes of 50,149 patients with ST-Segment elevation myocardial infarction results from the NCDR (National Cardiovascular Data Registry).J Am Coll Cardiol2011;58:2642-50 PMCID:PMC3523323

[77] Cho JH,Kim MA.Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women: data from the KoRean wOmen'S chest pain rEgistry (KoROSE).Menopause2019;26:1272-6

[78] Kulie T,Redmer J,Eglash A.Obesity and women's health: an evidence-based review.J Am Board Fam Med2011;24:75-85

[79] Katta N,Lavie CJ.Obesity and coronary heart disease: epidemiology, pathology, and coronary artery imaging.Curr Probl Cardiol2021;46:100655

[80] Maggio CA.Obesity and type 2 diabetes.Endocrinol Metab Clin North Am2003;32:805-22, viii

[81] Donahue RP,Chen Z,Alpert JS.The influence of sex and diabetes mellitus on survival following acute myocardial infarction: a community-wide perspective.J Clin Epidemiol1993;46:245-52

[82] Abbott RD.The impact of diabetes on survival following myocardial infarction in men vs women: the Framingham study.JAMA1988;260:3456.

[83] Gajardo-Navarrete J,Concha M.[Coronary artery disease in pre and postmenopausal women. The influence of type 2 diabetes mellitus].Rev Med Chil2020;148:145-50

[84] Juutilainen A,Lehto S,Pyörälä K.Gender difference in the impact of type 2 diabetes on coronary heart disease risk.Diabetes Care2004;27:2898-904

[85] Shimokawa H,Takahashi J.Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the coronary vasomotor disorders international study (COVADIS) group.Eur Heart J2021;42:4592-600 PMCID:PMC8633728

[86] Bajaj NS,Gupta A.Coronary microvascular dysfunction and cardiovascular risk in obese patients.J Am Coll Cardiol2018;72:707-17 PMCID:PMC6592712

[87] Merz CN.The Yentl syndrome is alive and well.Eur Heart J2011;32:1313-5.

[88] Arnett DK,Albert MA.2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the american college of cardiology/American heart association task force on clinical practice guidelines.Circulation2019;140:e596-646. PMCID:PMC7734661

[89] Wexler DJ,Meigs JB,Cagliero E.Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes.Diabetes Care2005;28:514-20

[90] Abuful A,Henkin Y.Physicians' attitudes toward preventive therapy for coronary artery disease: is there a gender bias?.Clin Cardiol2005;28:389-93 PMCID:PMC6654010

[91] Bairey Merz CN,Sprague E.Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the women's heart alliance.J Am Coll Cardiol2017;70:123-32

[92] Savji N,Bartz TM.The association of obesity and cardiometabolic traits with incident HFpEF and HFrEF.JACC Heart Fail2018;6:701-9. PMCID:PMC6076337

[93] Upadhya B.Heart failure with preserved ejection fraction: New approaches to diagnosis and management.Clin Cardiol2020;43:145-55 PMCID:PMC7021648

[94] Kenchaiah S,Levy D.Obesity and the risk of heart failure.N Engl J Med2002;347:305-13.

[95] von Bibra H,St John Sutton W.Cardiometabolic syndrome and increased risk of heart failure.Curr Heart Fail Rep2016;13:219-29. PMCID:PMC5069335

[96] Lala A,Hamo CE.Sex differences in heart failure.J Card Fail2022;28:477-98.

[97] Paulus WJ.A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.J Am Coll Cardiol2013;62:263-71.

[98] Packer M,Lund LH,Borlaug BA.Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease.Eur J Heart Fail2020;22:1551-67 PMCID:PMC7687188

[99] Zeller CB.Cardiovascular disease in systemic lupus erythematosus: the role of traditional and lupus related risk factors.Curr Cardiol Rev2008;4:116-22 PMCID:PMC2779351

[100] Mehta PK,Wood MJ.American College of Cardiology Cardiovascular Disease in Women CommitteeChronic rheumatologic disorders and cardiovascular disease risk in women.Am Heart J Plus2023;27:100267 PMCID:PMC10945906

[101] Sirichand S,Padmanabhan D.Incidence of Idiopathic ventricular arrhythmias: a population-based study.Circ Arrhythm Electrophysiol2017;10 PMCID:PMC5319731

[102] Ko D,Schnabel RB,Benjamin EJ.Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis.Nat Rev Cardiol2016;13:321-32 PMCID:PMC5579870

[103] Huxley RR,Folsom AR.Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the atherosclerosis risk in communities (ARIC) study.Circulation2011;123:1501-8. PMCID:PMC3181498

[104] Tedrow UB,Ridker PM.The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study).J Am Coll Cardiol2010;55:2319-27 PMCID:PMC2880879

[105] Pietrasik G,McNitt S,Zareba W.Obesity as a risk factor for sustained ventricular tachyarrhythmias in MADIT II patients.J Cardiovasc Electrophysiol2007;18:181-4.

[106] Aune D,Norat T.Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies.Eur J Epidemiol2018;33:711-22. PMCID:PMC6061127

[107] Chi PC,Yun CH.The associations between various ectopic visceral adiposity and body surface electrocardiographic alterations: potential differences between local and remote systemic effects.PLoS One2016;11:e0158300. PMCID:PMC4938552

[108] Patel KHK,Se Liebers C.Epicardial adipose tissue as a mediator of cardiac arrhythmias.Am J Physiol Heart Circ Physiol2022;322:H129-44. PMCID:PMC8742735

[109] Omran J,Koerber S,Alpert MA.Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta-analysis.Obes Rev2016;17:520-30

[110] Wang TJ,Levy D.Obesity and the risk of new-onset atrial fibrillation.JAMA2004;292:2471-7.

[111] Benjamin EJ.Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham heart study.JAMA1994;271:840.

[112] January CT,Calkins H.2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons.Circulation2019;140:e125-51.

[113] Hindricks G,Dagres N.ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the european association for cardio-thoracic surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC.Eur Heart J2021;42:373-498.

[114] Donnellan E,Kanj M.Outcomes of atrial fibrillation ablation in morbidly obese patients following bariatric surgery compared with a nonobese cohort.Circ Arrhythm Electrophysiol2019;12:e007598.

[115] Chang SH,Chiou MJ.Association of metformin with lower atrial fibrillation risk among patients with type 2 diabetes mellitus: a population-based dynamic cohort and in vitro studies.Cardiovasc Diabetol2014;13:123. PMCID:PMC4149273

[116] Abumuamar AM,Dorian P.Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation.J Interv Card Electrophysiol2019;54:289-97.

[117] Pedersen OD,Kober L.Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction.Circulation1999;100:376-80.

[118] Albert MA,Buring J.Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events.Circulation2006;114:2619-26

[119] Vaccarino V,Mehta PK.Brain-heart connections in stress and cardiovascular disease: implications for the cardiac patient.Atherosclerosis2021;328:74-82 PMCID:PMC8254768

[120] Mehta PK,Bremner JD.Mental stress-induced myocardial ischemia.Curr Cardiol Rep2022;24:2109-20 PMCID:PMC9628301

[121] Mulle JG.Cardiovascular disease, psychosocial factors, and genetics: the case of depression.Prog Cardiovasc Dis2013;55:557-62 PMCID:PMC3639443

[122] Vaccarino V,Sheps DS.National Heart, Lung, and Blood InstituteDepression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the national heart, lung, and blood institute-sponsored WISE study.J Am Coll Cardiol2007;50:2044-50

[123] Mehta PK,Vaccarino V.Coronary artery spasm, coronary reactivity, and their psychological context.Psychosom Med2019;81:233-6 PMCID:PMC6443496

[124] Vaccarino V,Kim JH.Association of mental stress-induced myocardial ischemia with cardiovascular events in patients with coronary heart disease.JAMA2021;326:1818-28. PMCID:PMC8579237

[125] Sullivan S,Al Mheid I.Sex differences in hemodynamic and microvascular mechanisms of myocardial ischemia induced by mental stress.Arterioscler Thromb Vasc Biol2018;38:473-80. PMCID:PMC5785428

[126] Rajan S,Rangarajan S.Prospective Urban Rural Epidemiology (PURE) Study InvestigatorsAssociation of symptoms of depression with cardiovascular disease and mortality in low-, middle-, and high-income countries.JAMA Psychiatry2020;77:1052-63 PMCID:PMC7287938

[127] Salk RH,Abramson LY.Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms.Psychol Bull2017;143:783-822 PMCID:PMC5532074

[128] Thombs BD,Ford DE.Prevalence of depression in survivors of acute myocardial infarction.J Gen Intern Med2006;21:30-8 PMCID:PMC1484630

[129] Smolderen KG,Gosch K.Depression treatment and 1-year mortality after acute myocardial infarction: insights from the TRIUMPH registry (translational research investigating underlying disparities in acute myocardial infarction patients' health status).Circulation2017;135:1681-9 PMCID:PMC9901181

[130] Lichtman JH,Blumenthal JA.American Heart Association Prevention Committee of the Council on Cardiovascular NursingAmerican Heart Association Council on Clinical CardiologyAmerican Heart Association Council on Epidemiology and PreventionAmerican Heart Association Interdisciplinary Council on Quality of Care and Outcomes ResearchAmerican Psychiatric AssociationDepression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American heart association prevention committee of the council on cardiovascular nursing, council on clinical cardiology, council on epidemiology and prevention, and interdisciplinary council on quality of care and outcomes research: endorsed by the American psychiatric association.Circulation2008;118:1768-75

[131] Lau ES,Guseh JS.Sex differences in circulating biomarkers of cardiovascular disease.J Am Coll Cardiol2019;74:1543-53 PMCID:PMC6756178

[132] Maas AH.Women's health in menopause with a focus on hypertension.Neth Heart J2009;17:68-72. PMCID:PMC2644382

[133] Wang D,Karvonen-Gutierrez CA.Healthy lifestyle during the midlife is prospectively associated with less subclinical carotid atherosclerosis: the study of women's health across the nation.J Am Heart Assoc2018;7:e010405. PMCID:PMC6405552

[134] Janssen I,Crawford S,Sutton-Tyrrell K.Menopause and the metabolic syndrome: the study of women's health across the nation.Arch Intern Med2008;168:1568-75 PMCID:PMC2894539

[135] Rossouw JE,Prentice RL.Writing Group for the Women's Health Initiative InvestigatorsRisks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women's health initiative randomized controlled trial.JAMA2002;288:321-33.

[136] Rossouw JE,Manson JE.Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause.JAMA2007;297:1465-77.

[137] Boardman HM,Eisinga A.Hormone therapy for preventing cardiovascular disease in post-menopausal women.Cochrane Database Syst Rev2015;2015:CD002229. PMCID:PMC10183715

[138] Bergendal A,Sundström A,Kocoska-Maras L.Risk of venous thromboembolism associated with local and systemic use of hormone therapy in peri- and postmenopausal women and in relation to type and route of administration.Menopause2016;23:593-9.

[139] Santen RJ,Bernick B.Systemic estradiol levels with low-dose vaginal estrogens.Menopause2020;27:361-70. PMCID:PMC7050796

[140] Fihn SD,Abrams J.American College of Cardiology Foundation/American Heart Association Task Force2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American college of cardiology foundation/American heart association task force on practice guidelines, and the American college of physicians, American association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons.Circulation2012;126:e354-471.

[141] Jensen MD,Apovian CM.2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society.Circulation2014;129 PMCID:PMC5819889

[142] Christensen P,Westerterp-Plantenga M.Men and women respond differently to rapid weight loss: metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW).Diabetes Obes Metab2018;20:2840-51 PMCID:PMC6282840

[143] Garvey WT,Brett EM.Reviewers of the AACE/ACE Obesity Clinical Practice GuidelinesAmerican association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.Endocr Pract2016;22 Suppl 3:1-203.

[144] Wilding JPH,Calanna S.STEP 1 Study GroupOnce-weekly semaglutide in adults with overweight or obesity.N Engl J Med2021;384:989-1002.

[145] Pi-Sunyer X,Fujioka K.SCALE Obesity and Prediabetes NN8022-1839 Study GroupA randomized, controlled trial of 3.0 mg of liraglutide in weight management.N Engl J Med2015;373:11-22.

[146] Marso SP,Brown-Frandsen K.LEADER Steering CommitteeLEADER trial investigatorsliraglutide and cardiovascular outcomes in type 2 diabetes.N Engl J Med2016;375:311-22. PMCID:PMC4985288

[147] Marso SP,Consoli A.Semaglutide and cardiovascular outcomes in patients with type 2 diabetes.N Engl J Med2016;375:1834-1844

[148] Lincoff AM,Colhoun HM.SELECT Trial InvestigatorsSemaglutide and cardiovascular outcomes in obesity without diabetes.N Engl J Med2023;389:2221-32

[149] Jastreboff AM,Ahmad NN.SURMOUNT-1 InvestigatorsTirzepatide once weekly for the treatment of obesity.N Engl J Med2022;387:205-16

[150] Jensen MD,Apovian CM.American College of Cardiology/American Heart Association Task Force on Practice GuidelinesObesity Society2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society.J Am Coll Cardiol2014;63:2985-3023.

[151] van Veldhuisen SL,van Woerden G.Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis.Eur Heart J2022;43:1955-69 PMCID:PMC9123239

[152] Doumouras AG,Paterson JM.Association between bariatric surgery and major adverse diabetes outcomes in patients with diabetes and obesity.JAMA Netw Open2021;4:e216820. PMCID:PMC8076963

[153] Hauner H.[Life expectancy after bariatric surgery: Swedish obese subjects study].Internist2021;62:212-4.