Gender and cardiovascular risk in rotational shift workers in the Arctic

Objective. To study gender differences in potential risk factors (RF) for cardiovascular diseases in rotational shift workers in the Arctic.

Design and methods.Out of 213 examined patients, 183 individuals were enrolled in groups within 6 days of September 2019, in the polar settlement of Yamburg (68 N), on the basis of Health Service LLC “Gazprom Dobycha Yamburg” medical unit. They were comparable by age: 99 were males (M) aged 48 years (41,5; 58,5) and 81 were females (F) aged 49 years (43,6; 58,1) (p = 0,441); by number of years of rotational shift work: 16,5 (9,0; 26,4) years in M and 16,3 (8,5; 26,9) years in F (p = 0,635); by number of individuals with hypertension: 49,5% were M, 43,9% were F (p = 0,344) and normotensive individuals (p = 0,544). Office blood pressure was 149,4 (119,1; 180,2) mmHg in M group, 149,6 (128,5; 178,5) mmHg in F group (p = 0,250). All patients underwent ultrasound examination of carotid arteries (CA) for the detection of atherosclerotic plaque (ASP), and assessment of local stiffness parameters of CA and femoral arteries (FA); cardio-ankle vascular index, and pulse wave velocity. In addition, ambulatory blood pressure monitoring, echocardiography with calculation of HFpEF probability using H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); blood tests (lipid spectrum, levels of high-sensitivity C-reactive protein (hs-CRP), homocysteine, C-peptide, insulin, brain natriuretic propeptide (NT-pro-BNP)) were performed. The following RF were assessed: smoking, physical activity, and perceived stress level.

Results. Overweight (p = 0,039), smoking (p = 0,014) were more common in M than in F. Low self-esteem level of psychosocial stress was more frequently registered in F: 93% vs 54 % (p < 0,0001), while mean level was more often found in M: 46% vs 7 % (p < 0,0001). In M group, there was a significant increase in homocysteine (p < 0,001), which was associated with higher stiffness index β in CA (p = 0,004) and FA (p = 0,004), Peterson’s elastic modulus Ep CA (p = 0,009), higher detection rate of ASP in CA (p = 0,021). F group showed significant increase in hs-CRP (p = 0,03), and NT-pro-BNP, (p < 0,001). Odds ratio of gender-related indicators showed association of male sex with arterial stiffness, formation of ASP in CA, while female sex was associated with markers of systemic inflammation and neurohumoral activation. There were no significant differences between M and F regarding HFpEF probability, assessed by H2FPEF score (p = 0,303).

Conclusions. Our data will allow for identifying the most significant factors with high gender-specific cardiovascular risk in rotating shift-workers in the Arctic which can play role in cardiovascular prevention and early diagnosis with the focus on economic efficiency.

1. Tihonov DG, Nikolaev VP, Sedalishchev VI. Some problems of pathogenesis and clinical manifestations of atherosclerosis (coronary heart disease, hypertension) in the Far North. Ter Arch. 2011;83(1):63–69. In Russian.

2. Appelman Y, van Rijn BB, Ten Haaf ME. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015;241(1):211–218. doi:10.1016/j.atherosclerosis.2015.01.027

3. Shufelt CL, Pacheco C, Tweet MS, Miller VM. Sexspecific physiology and cardiovascular disease. Adv Exp Med Biol. 2018;1065:433–454. doi:10.1007/978-3-319-77932-4_27

4. Merz NB, Ramineni T, Leong D. Sex-specific risk factors for cardiovascular disease in women-making cardiovascular disease real. Curr Opin Cardiol. 2018;33(5):500–505. doi:10.1097/HCO.0000000000000543

5. Chazova IE, Zhernakova Yu V. Diagnosis and treatment of arterial hypertension. Sistemnye Gipertenzii = Systemic Hypertension. 2019;1:6–31. doi:10.26442/2075082X.2019.1.190179. In Russian.

6. Barnett HJ, Meldrum HE, Eliasziw M. North American Symptomatic Carotid Endarterectomy Trial (NASCET) collaborators. The appropriate use of carotid endarterectomy. Can Med Assoc J. 2002;166(9):1169–1179.

7. Boitsov SA, Pogosova NV, Bubnova MG, Drapkina OM, Gavrilov IE, Egaryan RA et al. Cardiovascular prevention 2017. Russian national recommendations. Rossijskij Kardiologicheskij Zhurnal = Russian Journal of Cardiology. 2018;23:7–122. doi:10.15829/1560-4071-2018-6-7-122. In Russian.

8. Laurent S, Cockcroft J, Bortel LV. Expert consensus document on arterial stiffness: methodological issues and clinical applications on behalf of the European Network for Non-invasive Investigation of Large Arteries. Eur Heart J. 2006;27(21):2588–2605. doi:10.1093/eurheartj/ehl254

9. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;28(1):1–39. e14. doi:10.1016/j.echo.2014.10.003

10. Mareev VYu, Fomin IV, Ageev FT, Begrambekova YuL, Vasyuk YuA, Garganeeva AA et al. Russian Heart Failure Society, Russian Society of Cardiology, Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58:8–164. doi:10.18087/cardio.2475. In Russian.

11. Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug B. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018; 138(9):861–870. doi:10.1161/CIRCULATIONAHA.118.034646

12. Dzhioeva O, Belyavskiy E. Diagnosis and management of patients with heart failure with preserved ejection fraction (HFpEF): current perspectives and recommendations. Ther Clin Risk Manag. 2020;16:769–785. doi:10.2147/TCRM.S207117

13. Shirai K. Analysis of vascular function using the cardioankle vascular index (CAVI). Hypertens Res.2011;34(6):684–685.

14. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396.

15. Ababkov VA, Baryshnikova K, Vorontsova-Venger OV. Validation of the Russian version of the questionnaire “Scale of stress perception-10”. Vestnik SPbGU. Seriya 16: Psikhologiya. Pedagogika = Bulletin of SPbGU. Series 15: Psychology. Pedagogics. 2016. № 2. In Russian.

16. Гринберг Дж. Управление стрессом. СПб.: Питер, 2002. 496 с. ISBN 0000–0000. [Grinberg G. Stress management. SPb: Piter, 2002. 496 p. ISBN 0000–0000. In Russian].

17. Mathur P, Ostadal B, Romeo F, Mehta JL. Genderrelated differences in atherosclerosis. Cardiovasc Drugs Ther. 2015;29(4):319–327. doi:10.1007/s10557-015-6596-3

18. Balling M, Afzal S, Varbo A, Langsted A, Smith GD, Nordestgaard BG. VLDL cholesterol accounts for one-half of the risk of myocardial infarction associated with apoB-containing lipoproteins. J Am Coll Cardiol. 2020;76(23):2725–2735.

19. Balint B, Jepchumba VK, Guéant JL, Gueant RR. Mechanisms of homocysteine-induced damage to the endothelial, medial and adventitial layers of the arterial wall. Biochimie. 2020; pii: S0300–9084(20)30040–7. doi:10.1016/j.biochi.2020.02.012

20. Vetoshkin AS, Shurkevich NP, Gapon LI, Simonyan AA. Carotid atherosclerosis, arterial hypertension, and left ventricular remodeling in men in the Northern watch. Sibirskij Meditsinskij Zhurnal = Siberian Medical Journal. 2020;35(1):159–166. doi:10.29001/2073-8552-2020-35-1-159-166. In Russian.

21. Sumin AN, Korok EV, Gaĭfulin RA. Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis. Klinicheskaya Medicina = Klin Med. 2014;92(1):34–40. doi:10.1097/01.hjh.0000234104.15992.df. In Russian.

22. Rodriguez-Granillo GA, Campisi R, Reynoso E. Atherosclerotic plaque burden evaluated from neck to groin: effect of gender and cardiovascular risk factors. Int J Cardiovasc Imaging. 2019;35(5):907–915. doi:10.1007/s10554-018-1512-0

23. Vasic D, Walcher D. C-peptide: a new mediator of atherosclerosis in diabetes. Rev Diabet Stud Fall. 2009;6(3):180–186. doi:10.1155/2012/858692

24. Bansilal S, Farkouh ME, Fuster V. Role of insulin resistance and hyperglycemia in the development of atherosclerosis. Am J Cardiol. 2007;99(4A):6B-14B. doi:10.1016/j.amjcard.2006.11.002

25. Vitale C, Miceli M, Rosano GM. Gender-specific characteristics of atherosclerosis in menopausal women: risk factors, clinical course and strategies for prevention. Climacteric. 2007;10(Suppl:2):16–20. doi:10.1097/01.hjh.0000234104.15992.df

26. Protogerou AD, Blacher J, Aslangul E, Jeunne CL, Lekakis J, Mavrikakis M. Gender influence on metabolic syndrome’s effects on arterial stiffness and pressure wave reflections in treated hypertensive subjects. Atherosclerosis. 2007;193(1):151–158. doi:10.1016/j.атеросклероз.2006.05.046

27. Eisenberg E, Di Palo KE, Piña IL. Sex differences in heart failure. 2018;41(2):211–216. doi:10.1002/clc.22917

28. Scantlebury DS, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Curr Opin Cardiol. 2011;26(6):562–568. doi:10.1097/HCO.0b013e32834b7faf

29. Beale AL, Meyer Ph, Marwick TH, Marwick TH, Lam CSP, Kaye DM. Sex differences in cardiovascular pathophysiology: why women are overrepresented in heart failure with preserved ejection fraction. Circulation. 2018;138(2):198–205. doi:10.1161/CIRCULATIONAHA.118.034271