Ashley Gallagher

Investing in and improving research, awareness, and equity in women’s cardiovascular health is critical for their health and well-being, according to a new presidential advisory message from the American Heart Association.

, is a call to action to identify and remove barriers to health care access, quality, and equity for women.

“We are losing ground on key indicators of cardiovascular health among women, including blood pressure control, weight management, and diabetes,” Véronique Roger, MD, MPH, FAHA, a senior investigator at the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health, said in a statement.

The advisory also focuses on the need for a cultural shift in how cardiovascular health data are presented to achieve health equity for women.

Comparing data from women with data from men could be harmful to women, Roger said.

For example, women having a heart attack could present more often with atypical symptoms, but she suggested that women are presenting symptoms in the “wrong way.”

The advisory suggests that data specific to women would not label women’s symptoms as “atypical” and could lead to an improved way of diagnostic and therapeutic choices and could help increase equitable care. It includes an actionable roadmap that is divided into 4 key areas to better address women’s cardiovascular health: access and delivery of equitable health care; awareness; epidemiology and prevention; and involvement of communities, health care professionals, and investigators.

“We must urgently address the pervasive gaps in knowledge and health care delivery to reduce gender-based disparities and achieve equity. There is no improving cardiovascular health without achieving health equity,” Nanette Wenger, MD, FAHA, an emeritus professor of medicine in the division of cardiology at Emory University School of Medicine, said in the statement.

The advisory listed 6 specific calls to action for health care professionals, investigators, and the public. These are:

Create and implement heart health-awareness campaigns that are appropriate and culturally sensitive and emphasize the benefits of education and prevention.

Encourage advocacy for legislative interventions and public policy that address social determinants of health, including access to healthy food, high-quality prevent and treatment, and public spaces for physical activity.

Engage communities in heart health programs, including students in primary schools.

Increase the number of research studies for women, especially individuals from diverse backgrounds and those are younger.

Optimize clinical care and prevention through partnerships among cardiology and other specialties, including obstetrics/gynecology and primary care, to improve the recognition of heart disease risk factors and ensure tools to calculate risk specific to women.

Survey and monitor disease and risk factor data to better capture information that is crucial to improving prevention and outcomes while delivering more effective health care.

“Making these advances in research and addressing gaps in and barriers to access health care are fundamental to the American Heart Association’s commitment to advancing cardiovascular health for everyone,” Roger said.

This article was initially published by our sister publication Pharmacy Times.

1. Investment, action urged to improve access, quality and equity in women’s heart health. EurekAlert. News release. May 9, 2022. Accessed May 10, 2022. https://www.eurekalert.org/news-releases/951697

Articles

The advisory, published in Circulation, is a call to action for a cultural shift to identify and remove barriers.

AHA urges taking steps to improve access, quality, equity in women’s heart health

Postpartum depression symptoms increased among women in the United States during the first year of the COVID-19 pandemic, results from a University of Virginia Health System study showed.

During that time, the national rates of postpartum depression increased to 6.9% from 6.5%.

States with a greater increase in postpartum depression symptoms tended to have fewer deaths from COVID-19 and lower unemployment rates among women, according to investigators from the University of Virginia School of Medicine, Johns Hopkins University, and Flo Health.

“Rates of postpartum depression symptoms have clearly been impacted by the pandemic,” Jennifer Payne, MD, director of the Reproductive Psychiatry Research Program at the UVA School of Medicine, said in a statement. “Nationwide, the rates of postpartum depression symptoms increased during the pandemic and continued to rise as the pandemic extended.”

To better understand the pandemic’s effects on postpartum depression, investigators analyzed more than 278,000 responses between January 2018 and March 2021 to a post-pregnancy survey on the Flow application, which helps women track their menstrual cycles, as well as their moods and physical symptoms during and after pregnancy.

The data was synced with US government data on COVID-19 cases and deaths from March 2020 to March 2021, along with unemployment data.

Investigators found that, nationally, the rates of postpartum depression symptoms steadily increased during the pandemic’s first year, reaching a high of 7.7% between December 2020 and March 2021.

Among all states and the District of Columbia, 36 showed an increase in postpartum depression symptoms across the first year of the pandemic, while 7 saw a decrease and 8 saw no change.

At the state level, states with fewer deaths per 100,000 residents from COVID-19 showed a greater increase in postpartum depression symptoms caused by a greater feeling of anxiety and hopelessness.

States with lower unemployment rates among women in 2020 also showed a greater increase in symptoms, but that was related to emotional exhaustion and no energy to take care of a child, investigators said.

The reason states that were less affected by the pandemic saw a larger increase in postpartum depression is that women in those states had less access to support systems, investigators said.

They also said that previous research showed that these support systems help protect women from developing these symptoms.

“Because postpartum depression not only has deleterious effects on the mother but also on the child, it’s important that we identify risk factors as well as protective factors.” said Payne, who received an honorarium from CMEtoGO, Karuna Therapeutics, and UptoDate. “The pandemic clearly increased the risk for postpartum depression symptoms.”

 and the study was supported by the National Institutes of Mental Health.

1. Postpartum depression increased during pandemic’s first year, study finds. EurekAlert. News release. May 9, 2022. Accessed May 10, 2022. https://www.eurekalert.org/news-releases/952084

Larger increases were typically seen in states with fewer deaths related to COVID-19, lower unemployment among women, analysis finds.

Postpartum depression increased during pandemic’s first year

The FDA has approved cabotegravir and rilpivirine (Cabenuva, ViiV Healthcare) for every-2-month dosing treatment of HIV-1 in virologically suppressed adults on a stable regimen, with no history of prior treatments not working and with no known or suspected resistance to either cabotegravir or rilpivirine, ViiV said in a statement.

Virologically suppressed adults are defined as HIV-1 RNA less than 50 copies per c/ml.

 is the first and only complete long-acting HIV treatment regimen, and the FDA first approved it in January 2021 as a once-monthly treatment for HIV-1 in virologically suppressed adults.Cabenuva contains ViiV Healthcare’s cabotegravir extended-release (ER) injectable suspension in a single-dose vial and rilpivirine ER injectable suspension in a single-dose vial, a product of Janssen Sciences Ireland Unlimited Company, 1 of the Janssen Pharmaceutical Companies of Johnson & Johnson.

“Many people living with HIV face challenges with daily therapies and are interested in alternative dosing options. In clinical trials, approximately 9 out of every 10 trial participants preferred long-acting cabotegravir and rilpivirine dosed every2 months compared to daily oral cabotegravir and rilpivirine taken as the oral lead-in per trial protocol,” Turner Overton, MD, professor in the department of medicine at the University of Alabama at Birmingham, said in the statement. “This preference data highlights the meaningful impact long-acting regimens can have on the treatment experience for the HIV community.”.

The approval is based on the global ATLAS-2M phase 3b trial results, which demonstrated that every-2-month dosing was non-inferior to once monthly dosing. Non-inferiority was determined by comparing the proportion of individuals with plasma HIV-1 RN ≥ 50 c/ml using the FDA snapshot algorithm at week 48.

It showed that the every-2-month dosing arm and once-monthly dosing arm were similar in effectiveness. The study results also showed that rates of virologic suppression, a key secondary endpoint, were similar for every-2-month dosing and once-monthly dosing.

The most common adverse reactions observed after receiving the injection were dizziness, fatigue, headaches, injection site reactions, musculoskeletal pain, nausea, pyrexia, rash, and sleep disorders.

In ATLAS-2M, the frequency and type of adverse reactions reported for individuals receiving long-acting cabotegravir and rilpivirine once monthly or every 2 months for 48 weeks were similar.

In the every-2-month arm, rates of serious adverse events and withdrawals because of adverse events were low and similar to those experienced in the once monthly arm.

Individuals’ preference data were collected from individuals in the clinical trial who received long-acting cabotegravir and rilpivirine.

In a pooled analysis of this intent-to-threat exposed population with no prior experience with long-acting cabotegravir and rilpivirine, 327 individuals completed a single-item question at week 48, and 92% of them preferred every-2-month injections compared with 1% who preferred oral cabotegravir and rilpivirine that was taken as the required oral lead-in.

ViiV Healthcare announces US FDA approval of Cabenuva (cabotegravir, rilpivirine) for use every two months, expanding the label of the first and only complete long-acting HIV treatment. GSK. News release. February 1, 2022. Accessed February 1, 2022. https://www.gsk.com/en-gb/media/press-releases/viiv-healthcare-announces-us-fda-approval-of-cabenuva-cabotegravir-rilpivirine-for-use-every-two-months-expanding-the-label-of-the-first-and-only-complete-long-acting-hiv-treatment/

Medication can now be used as few as 6 times a year for virologically suppressed adults living with the disease without prior treatments not working or resistance to cabotegravir or rilpivirine.

FDA approves Cabenuva for 2 month dosing to treat HIV-1

Americans’ use of common outpatient health services dipped sharply at the outset of the COVID-19 pandemic, then rebounded to near-normal levels by the end of 2020, only to decline again between January and February 2021, the results of a new study from the University of California, Los Angeles (UCLA) show.

But the 2020 recovery in care was not equal for all, investigators found. Some of the most socioeconomically disadvantaged patients — those with Medicaid or Medicare-Medicaid dual eligibility insurance — were far less likely than those with other insurance plans to return to using outpatient services at rates approaching normal, pre-pandemic levels.

Journal of the American Medical Association

 and based on data on 14.5 million adults in the United States, raises concerns about patients delaying preventive care, lacking a clear understanding of when to seek help, and missing treatments for acute illnesses during the pandemic, lead author John Mafi, MD, an associate professor of medicine and practicing general internist at the David Geffen School of Medicine at UCLA, said in a statement.

“The worsening access to care we observed among socioeconomically disadvantaged Americans is particularly concerning, because it suggests that the pandemic is widening inequities in access to vital health services, such as emergency care, preventive cancer screening, and behavioral health services,” John Mafi, MD, an associate professor of medicine and practicing general internist at the David Geffen School of Medicine at UCLA, said in the statement.

Investigators examined the use of 6 types of ambulatory care services: doctors’ office or urgent-care visits, behavioral health services, colonoscopy screenings, contraception counseling and HIV screenings, emergency department visits, and mammogram screenings.

They compared the use of those services among individuals with commercial insurance, Medicare Advantage, Medicare fee-for-service insurance, and those with Medicaid or Medicare-Medicaid dual eligibility between January 1, 2019, and February 28, 2021. Patient data were drawn from the Milliman MedInsight Emerging Experience research database and included information on individuals from all US states.

Investigators found that during the initial COVID-19 surge between March 2020 and April 2020, the overall use of the 6 types of ambulatory care services dropped to just 67% of levels that would be expected had the pandemic not occurred.

In those months of the pandemic, the Centers for Medicare and Medicaid Services instructed hospitals and medical practices across the United States to curb some outpatient services to preserve resources for more critical care and to minimize COVID-19 transmission, investigators said.

Additionally, many individuals cancelled outpatient appointments out of fear of contracting the virus.

As a result, many individuals did not receive the outpatient care they otherwise would have.

By November 2020 to December 2020, the use of the 6 types of outpatient services met 97% of expected rates. However, during the second surge from January 2021 to February 2021, overall use dropped again, to 86% of expected rates.

Investigators found that the return to expected rates varied by insurance type with commercial insurance rates at 91%, Medicare Advantage at 83%, Medicare fee-for-service at 81%, Medicaid at 78%, and Medicare-Medicaid dual eligibility at 73%.

The investigators accounted for potential changes to the study population during the pandemic, adjusted for patient characteristics, such as age, national origin, and sex.

Access to vital health services fell during COVID, particularly for poorer Americans. EurekAlert. News release. January 24, 2022. Accessed January 28, 2022. https://www.eurekalert.org/news-releases/941083

This article was originally published on Pharmacy Times®. 

The results of a new UCLA-led study show that the pandemic has exacerbated disparities in care, widening inequities.

Access to vital health services fell during COVID-19, particularly for poorer Americans

Mild to moderate COVID-19 in pregnant women has no effect on the brain of the developing fetus, results of a study presented at the Radiological Society of North America show.

“Since the impact of severe infection on brain development in the fetus has not been conclusively determined, active protection against SARS-CoV-2 infection during pregnancy remains important,” Sophia Stöcklein, MD, from the department of radiology at Ludwig Maximilian University of Munich, Germany, said in a statement.

The study results show that brain development in the assessed areas was age-appropriate in all fetuses and there was no indication of infection of the fetal brain.

Investigators used fetal magnetic resonance imaging, evaluated by 2 board-certified radiologists, to determine if maternal COVID-19 affected fetal brain health.

They included 33 individuals who were approximately 28 weeks into their pregnancies, on average, with symptom onset occurring at a mean of more than 18 weeks into their pregnancies.

The most common symptoms were a dry cough, fever, loss of or reduced sense of smell and taste, and shortness of breath.

Investigators will follow the individuals over the next 5 years, including detailed neonatal assessment, as well as assessment of neurological development.

COVID-19 during pregnancy doesn’t harm baby’s brain. EurekAlert. News release. November 30, 2021. Accessed November 30, 2021. 

https://www.eurekalert.org/news-releases/935769

 article was originally published on Pharmacy Times®. 

Study results show that fetal cognitive development in the assessed areas was age-appropriate and there was no indication of infection.

 Mild to moderate COVID-19 may have no effect on brain of developing fetuses

The results of a new study suggest that the severity of some menopause symptoms, especially depression and sexual dysfunction, are linked to a woman’s cognitive performance.

, the journal of the North American Menopause Society (NAMS).

Although menopause is natural, not all women experience it the same way. The frequency and severity of symptoms can vary greatly among women.

Previous studies have evaluated the effect of these symptoms on a women’s mental and physical well-being. This study involved more than 400 women to evaluate the effect of the severity of menopause symptoms on overall cognitive performance and its 5 domains: attention, language, orientation, recall, registration, and visuospatial skills.

Among other things, investigators considered the severity of common menopause symptoms, such as anxiety, depression, hot flashes, and sexual dysfunction. They concluded that the cognitive performance of women is sensitive to the severity of certain menopause symptoms, especially depression and sexual dysfunction.

In this study, there was no association identified between the severity of cognitive performance and hot flashes, though other studies have shown that an association may exist.

“This study highlights the effect of menopause symptoms on cognitive functioning and demonstrates a link between severe depressive and sexual symptoms, specifically, with cognitive performance. Mood disturbances are common in the menopause transition and can affect memory and sexual functioning,” Stephanie Faubion, MD, FACP, NCMP, medical director at NAMS, said in a statement.1 “These findings underscore the importance of evaluating women for menopause symptoms and providing appropriate treatment, when indicated, including treatment of depression and sexual dysfunction.”.

Of the individuals in the study, 107 were premenopausal, 90 were perimenopausal, 92 were early postmenopausal, and 115 were late postmenopausal.

The investigators found that the severity of menopausal symptoms, including depression, total psychological, sexual, and somatic dysfunction, were highest for individuals who are late postmenopausal, while anxiety and hot flashes were most prevalent in those in early postmenopause.

In the sample, the severity of psychological symptoms, at 47%, was the highest, followed by depression, at 44.6%, and anxiety, at 43.6%.

Investigators also reported that women experiencing severe menopausal symptoms had lower mean values for orientation, at a mean of 8.11 for those with severe symptoms and 8.9 for those without severe symptoms; attention, at 4.31 and 4.48; language and visuospatial skills, at 7.13 and 7.91; recall, at 2.26 and 2.53; and registration, at 2.77 and 2.91, respectively.

Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later, according to John Hopkins Medicine.

1. Severity of menopause symptoms can affect a woman's cognitive performance. EurekAlert. News release. January 12, 2022. Accessed January 12, 2022. https://www.eurekalert.org/news-releases/939767

2. Kaur M, Kaur M. Is cognitive performance of women sensitive to the severity of menopausal symptoms? 

3. Introduction to menopause. John Hopkins Medicine. Accessed January 12, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause

New study results suggest that severe depression and sexual dysfunction, in particular, can affect a woman's attention, language, orientation, recall, registration, and visuospatial skills.