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Sex-based disparities in cardiovascular care may be linked to higher stroke risk among females – News-Medical.Net

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Higher stroke risk among females with atrial fibrillation may be related to sex-based disparities in cardiovascular care, according to a new study from Women’s College Hospital, the Peter Munk Cardiac Centre (PMCC) at University Health Network (UHN) and ICES.

Atrial fibrillation (AF) is a common type of irregular heart rhythm that is associated with a higher risk of stroke-;after the age of 40, one in four strokes are caused by AF. Previous studies have found that female sex (assigned at birth) is a risk factor for AF-associated stroke. Recent research suggested that females are only at higher risk than males with AF if they have another factor predisposing them to stroke (such as older age, hypertension, or diabetes).

The reasons for this higher stroke risk in females has not been well-examined. The authors hypothesized this was because these risk factors were less well-treated in older females, rather than female sex intrinsically predisposing to this higher risk.

The population-based cohort study, published in the European Heart Journal, analyzed health records for people aged 65 and older recently diagnosed with AF in Ontario, Canada. The cohort included 354,254 people (49% female), with an average age of 78 years. The study was made possible through the Early Career Women’s Heart and Brain Health Chair and a National New Investigator Award from the Heart and Stroke Foundation of Canada.

After taking into account the age of the individual and differences in cardiovascular care, the data show that stroke risk was similar between males and females under the age of eighty, but that female sex was an independent risk factor over the age of eighty. Females tend to be diagnosed with atrial fibrillation at older ages, and they may not be receiving adequate monitoring or treatment to reduce their stroke risk.”

Hifza Buhari, lead author, family medicine resident at the University of Toronto and former Temerty medical student at Women’s College Hospital

The data also show that, compared to males:

  • Females were diagnosed more often in emergency departments (30% versus 25% for males)
  • Females received fewer cardiologist appointments, both in the year before (12% versus 17%) and after (31% versus 37%) AF diagnosis.
  • Females were also less likely to get LDL-C testing and be treated with statins, despite having higher LDL-C levels and higher BP than their male counterparts.

“Equalizing cardiovascular care for males and females is an important step towards healthier hearts and lives for everyone,” says senior author Husam Abdel-Qadir, cardiologist at Women’s College Hospital and Peter Munk Cardiac Centre, University Health Network, and scientist with Women’s College Research Institute, Ted Rogers Centre for Heart Research, and ICES. “By addressing sex inequities, we can increase the likelihood that every individual receives the best chance at a heart-healthy future.”

One limitation of the data is that the researchers could not account for variables such as race, AF type or severity, and other clinical factors, which may had led to an underestimation of inequities in cardiovascular care that disproportionately affect older females.

“This study is another reminder that heart disease and stroke are not male diseases. Despite there being widespread appreciation that females with AF are at higher stroke risk than males, they are getting less cardiovascular care with real consequences. These data emphasize that females, particularly those at older ages, require appropriate care to reduce their risk of these serious diseases,” says Dr. Abdel-Qadir.

Journal reference:

Buhari, H., et al. (2023) Stroke risk in women with atrial fibrillation. European Heart Journal. doi.org/10.1093/eurheartj/ehad508.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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