The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.
In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.
Humphries KH, Lee MK, Izadnegahdar M, Gao M, Holmes DT, Scheuermeyer FX, Mackay M, Mattman A, Grafstein E. Sex differences in diagnoses, treatment and outcomes for emergency department patients with chest pain and elevated cardiac troponin. Acad Emerg Med. 2018 Apr;25(4):413-424. Epub 2018 Feb 8.
Four CHÉOS Scientists, Drs. Karin Humphries, Frank Scheuermeyer, Martha Mackay, and Eric Grafstein, and researchers from UBC and the BC Centre for Improved Cardiovascular Health conducted a retrospective cohort study to determine if levels of the protein cardiac troponin (cTn), produced due to heart damage that is used as part of the diagnostic criteria for heart attack, could explain sex differences in diagnosis, treatment, and outcomes of heart attack. Sex differences in treatment and outcomes of patients with acute coronary syndromes have been identified previously and the gaps in understanding of women’s cardiac health were highlighted in a report by Heart and Stroke Foundation earlier this year. More sensitive technology has found cTn levels to be lower on average in women, but the diagnostic cut-point for heart attack is set at the 99th percentile of cTn levels among the entire population. Consequently, it is less likely that females will meet the threshold for diagnosis. Linking data from several administrative data sets, including vital statistics, Discharge Abstract Database, and PharmaNet, the researchers analysed sex differences in the relationship between cTn levels and a number of diagnostic, treatment, and outcome measures including diagnosis of myocardial infarction within 24 hours of emergency department presentation; major adverse cardiac events within 1 years of discharge; and use of cardiac medication after discharge. Data from 7,272 patients at two Vancouver hospitals from 2008 to 2013 were included in the analyses. Men were more likely than women to be diagnosed with heart attack. Sex differences in diagnosis and treatment of heart attack that could not be explained by cardiac troponin (cTn) levels or chest pain at presentation were observed. Among patients with chest pain with cardiac features and cTn levels above the 99th percentile, females were less likely to be diagnosed with heart attack and women in general underwent fewer diagnostic catheterizations than males and were less likely to use evidence-based cardiac medications after discharge. The study also found that women have the highest one-year major adverse cardiac events rate. These findings add to the existing body of research that has demonstrated a sex gap in cardiovascular health and will inform ongoing research, including another study led by Dr. Humphries. The project is testing whether implementing a lower cut point for high sensitivity cTn for female patients can optimize heart attack diagnosis, treatment, and outcomes in women. It also received funding through a spring 2018 CIHR Project Grant. Drs. Aslam Anis, Joel Singer, Frank Scheuermeyer and Wei Zhang are co-investigators on the project. Dr. Humphries discussed this project in a Work in Progress seminar in February.
Munro S, Spooner L, Milbers K, Hudson M, Koehn C, Harrison M. Perspectives of patients, first-degree relatives and rheumatologists on preventive treatments for rheumatoid arthritis: A qualitative analysis. BMC Rheumatology. Epub 2018 Jul 5;2(1):18.
A growing body of evidence points toward the possibility of identifying people at high risk of rheumatoid arthritis (RA). Certain individuals may have genetic predisposition to developing RA or may be at higher risk due to demographic and lifestyle factors. There is also research suggesting the existence of a pre-clinical phase of rheumatoid arthritis, which may be identified through autoantibodies that are highly specific to RA and may be detected years before RA symptoms begin to arise. During this period, it may be possible to provide treatment to prevent or delay the onset of RA. In order to determine whether and how such treatment should be developed, CHÉOS’ Drs. Sarah Munro and Mark Harrison and team of researchers from UBC’s Faculty of Pharmaceutical Sciences, Division of Rheumatology at McGill, and Arthritis Consumer Experts/Joint Health conducted a qualitative study using focus groups that will inform the creation of a discrete choice experiment that can be used to explore preferences for treatment programs. Five focus groups were conducted from January to March of 2016 in 2 Canadian cities with 25 participants consisting of RA patients, first-degree relatives of individuals with RA, and rheumatologists. Two rounds of focus were used to develop a list of attributes that individuals consider in the decision to take preventive treatment and establish clear descriptions and levels for these attributes. Qualitative analysis of the focus groups identified seven attributes involved in the decision to consider or recommend preventative treatment: 1) accuracy of test for RA risk, 2) certainty in test estimates, 3) method of treatment administration, 4) risk of RA and risk of reduction with treatment, 5) risk and seriousness of treatment side effects, 6) person recommending the test (mix of professional and peer confirmation), and 7) opinion of health care professionals. The priorities between patients and first-degree relatives differed to some degree from the rheumatologists. For example, patients and first-degree relatives expressed a desire for evidence from a range of sources, including their health care professional, and rheumatologists were more concerned about how methods of treatment administration might influence treatment adherence. This insight from multiple stakeholder perspectives expands the scope of attributes to be considered in developing preventive treatment for RA and will help ascertain consumer preferences for such a program.
Conklin AI, Guo SX, Tam AC, Richardson CG. Gender, stressful life events and interactions with sleep: A systematic review of determinants of adiposity in young people. BMJ Open. 2018 Jul 18;8(7):e019982.
Excess bodyweight and obesity continues to rise among young people and is problematic as it puts adolescents at risk for a range of other health concerns later in life. Social stressors and sleep have both been researched independently as factors associated with obesity, but rarely together or considering any gender-specific effects, and even less so among adolescents. Adolescence is a period of vulnerability where the confluence of physiological changes, stressful life events, and sleep constraints could affect brain development and metabolic systems, contributing to obesity. CHÉOS Scientists Drs. Annalijn Conklin and Chris Richardson with researchers from UBC’s Department of Psychology conducted a literature review to assess from a gender perspective whether stressful life events result in greater obesity compared to those who do not, and if sleep problems have any influence on this relationship. Six databases were systematically searched for longitudinal prospective studies and reviews on gender-specific changes in adiposity in young adults as a function of stressful life events alone or in combination with sleep problems. Overall, their search uncovered a paucity of research on how stressful life events influence obesity risk through the influence of social stress and a lack of literature that include both stressful life events and sleep problems. Their search yielded 116 studies and 17 reviews, out of which 12 full texts were eligible to be screened and only 1 paper met the criteria for data extraction, quality appraisal, and narrative synthesis. The one study that met the inclusion criteria looked at stressful life events and follow-up body mass index (BMI) from prospective cohort data collected between 1980 and 1986 in Finland. The paper was assessed to be of medium quality and reported a mixed impact of stressful life events on BMI between genders, showing lower BMI among young men who experienced a change in residence and high BMI among women who experienced setting up a family and an internal locus of control. Among the excluded studies perceived overall stress was generally shown to promote weight gain in young adults, but relationships did vary and in some cases no association or inverse relationships were found. Associations also differed between genders. Ultimately, the review illustrates how scant the evidence base is and that better studies are needed to truly elucidate this relationship. As more light continues to be shed on the relationship between sleep and metabolic health and stress and the known vulnerability of adolescents to sleep problems, the authors believe further study is warranted. They also recommend inclusion of outcomes measures beyond BMI, among other methodological considerations for future research.