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In This Issue of JAMA Cardiology
October 2016


JAMA Cardiol. 2016;1(7):741. doi:10.1001/jamacardio.2015.0038


Most young adults with myocardial infarction (MI) are sexually active before MI, but little is known about sexual activity or sexual function afterwards. Lindau and coauthors performed interviews at baseline, 1 month, and 1 year with 1889 women and 913 men enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study in 103 US and 24 Spanish hospitals. Men were more likely than women to resume sexual activity after MI and to report no problems in sexual function. Those who did not communicate with physicians about sex were more likely to delay resuming sex. In a commentary, Weinfurt stresses the need for more research on sexual outcomes and encourages providers to address sexual activity with patients after MI to enhance quality of life.

Invited Commentary

Up to 10% of women experience the onset of natural menopause at 45 years or younger. To determine the association between early menopause and the risk of cardiovascular disease, Muka and coauthors performed a systematic review and meta-analysis of 32 studies that included 310 329 nonoverlapping women. Women with a menopausal age less than 45 years had significantly greater risks of fatal and nonfatal cardiovascular and coronary heart disease events as well as overall mortality than women 45 years or older at the onset of menopause. In a commentary, Woodruff and Manson discuss the complex relationships between accelerated reproductive aging and vascular health and point out that early menopause is a sentinel event that provides opportunities for risk factor modification.

Invited Commentary and Editor’s note

Author Audio Interview

Whether electrocardiograms (ECGs) predict adverse cardiovascular disease events in asymptomatic individuals beyond traditional risk factors is unclear. Shah and coauthors derived a risk score to predict incident nonfatal and fatal cardiovascular disease events based on computer-generated ECG data for 3640 participants enrolled in the First National Health and Nutrition Examination Survey, with validation from 6329 participants enrolled in the Third National Health and Nutrition Examination Survey. Adding ECG data to the Framingham risk score resulted in a 24% improvement in net reclassification, with similar improvement when applied to the pooled cohort equation. Whether this approach will improve prevention efforts and reduce cardiovascular disease events requires additional study.

Patients with peripheral artery disease (PAD) have a higher risk of developing stable coronary artery disease or acute coronary syndromes following percutaneous coronary intervention (PCI). Franzone and coauthors assessed the efficacy and safety of prolonged (24 months) vs short (6 months or less) dual antiplatelet therapy for patients undergoing PCI in the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study trial. Compared with a shorter duration, prolonged dual antiplatelet therapy conveyed a lower risk of the primary efficacy end point in 246 patients with PAD but not in 1724 without PAD, with no apparent bleeding liability. In a commentary, Bonaca emphasizes the higher risk associated with PAD and the need for research into newer and better pharmacologic therapies.

Invited Commentary