Louise Pilote

Background: Hypertensive disorders of pregnancy (HDP) are associated with increased long-term cardiovascular, cerebrovascular, and renal risk, yet pathways linking HDP to later organ damage remain poorly understood. Persistent vascular dysfunction after HDP and subsequent cardiovascular risk factors may contribute to long-term hypertension-mediated organ damage (HMOD). We evaluated associations between HDP and long-term cerebral, cardiac, vascular, and renal HMOD across clinically relevant risk subgroups. Methods: In this UK Biobank matched cohort study, parous females with a history of HDP were matched 1:4 to females without HDP by age at first delivery and parity. HMOD was assessed using white matter hyperintensity volume, left ventricular ejection fraction, pulse wave arterial stiffness index, and urine albumin-to-creatinine ratio. Multivariate linear regression models adjusted for cardiovascular risk factors assessed associations between HDP and each HMOD marker. Analyses were stratified by subsequent hypertension, menopausal status, age ≥50 years, antihypertensive medication use, and time since HDP ≥10 years. Results: Among participants (mean age 50 ± 7 years), HDP was not associated with white matter hyperintensity volume ( β = −0.31, 95% CI −1.04 to 0.41, p = 0.401), left ventricular ejection fraction ( β = 0.76, 95% CI −0.38 to 1.90, p = 0.193), pulse wave arterial stiffness index ( β = 0.14, 95% CI −0.36 to 0.64, p = 0.595), or urine albumin-to-creatinine ratio ( β = −0.12, 95% CI −0.51 to 0.26, p = 0.535) after multivariate adjustment. Subgroup analyses revealed an isolated significant adjusted association with lower log-transformed white matter hyperintensity volume among participants with subsequent hypertension ( β = −0.41, 95% CI −0.79 to −0.03, p = 0.033), while other associations were not consistently significant. Discussion: HDP was not consistently associated with selected measures of long-term subclinical HMOD across clinically relevant subgroups. Established long-term cardiovascular and renal risks following HDP may not be uniformly reflected by HMOD markers assessed at a single time point later in life. Future longitudinal studies using repeated assessments are needed to identify which HMOD phenotypes emerge following HDP and whether they predict or mediate subsequent cardiovascular, cerebrovascular, and renal outcomes.

For decades, researchers have largely studied aspects of sex and gender separately; the former as a basic science and the latter as a social construct with real world consequences, including health inequities. In recent years, as our collective understanding of how the biological and social intersect has advanced, the realization that sex and gender are interactional and deeply interwoven has deepened. It is not either sex or gender but both, together. We are calling this ensemble, Sex and Gender Science, a transdisciplinary, integrative field, combining diverse methods to investigate how sex and gender dynamically interact and influence disease outcomes and illness insights. In this article, we propose Sex and Gender Science as an emerging bio-social-medical field and describe the need, its growth, and future directions.

Background: Individuals with atrial fibrillation remain at high risk for major adverse cardiovascular events despite advances in treatment. Social determinants of health (SDOH) are associated with cardiovascular outcomes, yet how these factors cluster to create distinct vulnerability profiles remains poorly understood. Methods: Using UK Biobank data, we examined 15 SDOH indicators across economic, psychological, and neighborhood domains among 3842 participants with atrial fibrillation (35.1% female). Multigroup latent class analysis evaluated sex‐based differences in vulnerability pattern distribution. Cox proportional hazards models assessed the association between identified SDOH clusters and composite cardiovascular outcomes comprising major adverse cardiovascular events and all‐cause mortality. Results: Five distinct SDOH vulnerability clusters were identified: (1) low vulnerability across all domains, (2) primarily economic vulnerability, (3) primarily neighborhood‐related vulnerability, (4) economic and neighborhood vulnerability with favorable psychological conditions, and (5) high vulnerability across all domains. Men were more represented in advantaged profiles than women (Cluster 1: 37.0% versus 26.6%; Cluster 4: 25.3% versus 14.1%), and women showed the greatest representation in the highest vulnerability cluster (Cluster 5: 35.1% versus 25.2%). Compared with Cluster 1, Cluster 2 had a 30% higher risk (hazard ratio [HR], 1.30 [95% CI, 1.07–1.58]), Cluster 4 had 37% increased risk (HR, 1.37 [95% CI, 1.13–1.68]), and Cluster 5 more than twice the risk (HR, 2.05 [95% CI, 1.67–2.52]). Conclusions: Five distinct SDOH vulnerability patterns were identified among individuals with atrial fibrillation, with economic determinants as pivotal drivers of cardiovascular risk. These findings support incorporating comprehensive SDOH assessment into atrial fibrillation clinical management.

Background: Despite improvements in diagnostic and therapeutic options, individuals with atrial fibrillation (AF) remain at high risk for major adverse cardiovascular events (MACE). Social determinants of health (SDOH) are strongly associated with cardiovascular outcomes, yet the complex patterns through which these factors cluster to create distinct vulnerability profiles remain poorly understood. Methods: We conducted a latent class analysis utilizing data from the UK Biobank cohort, examining 15 SDOH indicators across economic, psychological, and neighborhood domains among 3,842 participants with AF (35.1% female). Multi-group latent class analysis (LCA) evaluated differences in vulnerability pattern distribution, and explored whether SDOH clusters of vulnerability varies by sex. Cox proportional hazards models assessed the association between identified SDOH clusters and composite cardiovascular outcomes comprising major adverse cardiovascular events (MACE) and all-cause mortality. Results: We identified five distinct SDOH vulnerability clusters based on multi-group LCA: 1) low vulnerability across all domains; 2) primarily economic vulnerability; 3) primarily neighborhood-related vulnerability; 4) economic and neighborhood vulnerability with favorable psychological conditions; and 5) high vulnerability across all domains. Male participants demonstrated a higher representation in more advantaged profiles than their female counterpart (Cluster 1: 37.0% vs. 26.6%; Cluster 4: 25.3% vs. 14.1%). Female participants exhibited the greater representation in the overall highest vulnerability cluster(Cluster 5: 35.1% vs. 25.2%) as compared with male participants. Compared to Cluster 1, individuals with AF from classes with adverse economic conditions (Cluster 2, 4 and 5) had a higher risk of MACE events with individuals in Cluster 5 having twice the risk. No sex interactions were observed with SDOH clusters in their association with MACE. Conclusions: We identified five distinct SDOH vulnerability patterns among individuals with AF, revealing economic determinants as pivotal drivers of cardiovascular risk. These findings provide an evidence-based framework for implementing precision medicine approaches that incorporate comprehensive SDOH assessment into AF clinical management.

Background: Despite anticoagulation, patients with atrial fibrillation (AF) experience persistent elevated cardiovascular risk, with conflicting evidence regarding sex-based outcome disparities. Social determinants of health (SDOH)—encompassing economic, psychosocial and environmental factors—demonstrate robust associations with cardiovascular outcomes and exhibit significant sex-specific patterns, yet remain understudied in AF populations. This study aimed to clarify sex differences in the association of SDOH and adverse cardiovascular outcomes in patients with AF. Methods: Data came from the UK Biobank. Participants with AF enrolled between 2006 and 2010 were included. SDOH comprised economic, psychosocial and neighbourhood environmental factors. The primary outcome was a composite of major adverse cardiovascular events (ie, stroke/transient ischaemic attack, arterial thromboembolic events, myocardial infarction and cardiovascular mortality) and all-cause mortality. Sex-stratified, Cox proportional hazards models were used. Results: Among 3842 participants (mean age 62.5±6.1 years; 35.1% female), males demonstrated higher adverse outcome event rates than females (29.1% vs 21.3%) over median 11.6-year follow-up. Multivariate analyses revealed independent SDOH associations with adverse outcomes, with distinct sex-specific patterns. In male participants, low income (HR 1.30, 95% CI 1.08 to 1.55), unemployment (HR 1.28, 95% CI 1.06 to 1.55), living alone (HR 1.29, 95% CI 1.07 to 1.55) and housing insecurity (HR 1.26, 95% CI 1.01 to 1.57) were associated with adverse outcomes, while emotional distress was the only predictor (HR 1.33, 95% CI 1.04 to 1.69) in females. Conclusions: SDOH demonstrate sex-specific associations with adverse cardiovascular outcomes in AF populations. Integration of SDOH into risk prediction algorithms may enhance cardiovascular risk stratification and inform targeted intervention strategies in AF management.

Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092

Background: Climate change is intensifying extreme heat events, posing significant risks to cardiovascular health. While sex differences in heat vulnerability have been observed, the evidence remains inconsistent. This systematic review and meta-analysis examined sex-specific associations between extreme heat exposure and cardiovascular disease (CVD) outcomes over the past decade. Methods: We searched PubMed, Embase, and Scopus for studies published between 2004 and 2024 that reported sex-stratified cardiovascular outcomes associated with heat exposure following the PRISMA guidelines. The quality of the evidence was evaluated following the Navigation Guide Criteria. Random-effects meta-analysis was conducted to calculate pooled relative risk ratios (RRR) comparing males to females for studies addressing incremental temperature increase. Heat wave studies were synthesized narratively due to methodological heterogeneity. Results: Of 6126 articles, 79 met inclusion criteria (62 in meta-analysis, 17 in narrative synthesis), primarily from East Asia, Europe, and North America. A 1 °C temperature increase was associated with elevated cardiovascular risks for both sexes. The pooled relative risk ratio (RRR) comparing males to females was 1.008 [1.002–1.014] for mortality, suggesting slightly higher female vulnerability, but not for morbidity (RRR 0.996 [0.987–1.004]). Significant heterogeneity was noted (Mortality I² = 50.3%, Morbidity I² = 70.3%). Heat wave studies showed inconsistent sex-specific impacts across populations. Conclusions: Females showed marginally higher vulnerability to heat-related cardiovascular mortality compared to males, while no significant sex differences were observed for morbidity outcomes. Future research should focus on understanding these mechanisms and developing sex-specific interventions.