Case Series of Coronary Artery Anomalies in Athletes: Challenges in Clinical Management and Sports Eligibility.

Coronary artery anomalies include a spectrum of pathologic changes associated with sudden cardiac death in athletes. We highlight the inherent challenges in risk stratification and management of athletes with coronary artery anomalies by presenting 3 cases, each with distinct pathologic coronary anatomy and clinical management decisions. (Level of Difficulty: Intermediate.).

Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI) in younger women, often treated conservatively due to revascularization risks. Revascularization outcomes are largely unknown in SCAD presenting with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The purpose of this study was to compare revascularization strategies and outcomes of STEMI-SCAD with STEMI atherosclerosis (STEMI-ATH). METHODS: Consecutive STEMI patients were retrospectively analyzed (2003 to 2017) at 2 regional STEMI programs (Minneapolis Heart Institute and Cedars-Sinai Smidt Heart Institute) with 3-year outcomes. RESULTS: Among 5,208 STEMI patients, SCAD was present in 53 (1%; 93% female). SCAD prevalence was 19% in female STEMI patients age ≤50 years. Compared with STEMI-ATH, STEMI-SCAD patients were younger (age 49 ± 10 years vs. 63 ± 13 years), were more often female (93% vs. 27%), and had more frequent cardiogenic shock (19% vs. 9%); all p ≤ 0.03. In STEMI-SCAD, the culprit artery was more commonly left main (13% vs. 1%) or left anterior descending (47% vs. 38%); both p = 0.003. Acute revascularization was lower in STEMI-SCAD (70% vs. 97%); p < 0.001. In STEMI-SCAD, acute revascularization included percutaneous coronary intervention (PCI), n = 33 (62%), or bypass grafting, n = 4 (8%); PCI success was 91%. Those with revascularization were more likely to have shock, left main culprit, proximal dissection, and initial TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to 1. The 3-year survival was 98% for STEMI-SCAD versus 84% for STEMI-ATH; p < 0.001. CONCLUSIONS: STEMI-SCAD represents an important STEMI subset, particularly among younger women, characterized by significantly greater frequency of left main or left anterior descending culprit and cardiogenic shock than STEMI-ATH. Primary PCI is successful in most STEMI-SCAD patients, with low 3-year mortality.

Fertile and selectively flirty: women's behavior toward men changes across the ovulatory cycle.

Past research shows that men respond to women differently depending on where women are in their ovulatory cycle. But what leads men to treat ovulating women differently? We propose that the ovulatory cycle alters women's flirting behavior. We tested this hypothesis in an experiment in which women interacted with different types of men at different points in their cycle. Results revealed that women in the ovulatory phase reported more interest in men who had purported markers of genetic fitness as short-term mates, but not as long-term mates. Furthermore, behavioral ratings of the interactions indicated that women displayed more flirting behaviors when they were at high than at low fertility. Importantly, fertile women flirted more only when interacting with men who had genetic-fitness markers, not with other men. In summary, fertility not only alters women's behavior but does so in a context-dependent way that follows adaptive logic.

Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases.

INTRODUCTION: Emerging evidence supports an immunologic role for 25-hydroxyvitamin D (25(OH)D) in inflammatory bowel disease (IBD). Here we examined if pretreatment vitamin D status influences durability of anti-tumor necrosis factor (TNF)-α therapy in patients with Crohn's disease (CD) or ulcerative colitis (UC). METHODS: All IBD patients who had plasma 25(OH)D level checked <3 months prior to initiating anti-TNF-α therapy were included in this retrospective single-center cohort study. Our main predictor variable was insufficient plasma 25(OH)D (<30 ng/mL). Cox proportional hazards model adjusting for potential confounders was used to identify the independent effect of pretreatment vitamin D on biologic treatment cessation. RESULTS: Our study included 101 IBD patients (74 CD; median disease duration 9 years). The median index 25(OH)D level was 27 ng/mL (interquartile range, 20-33 ng/mL). One-third of the patients had prior exposure to anti-TNF-α therapy. On multivariate analysis, patients with insufficient vitamin D demonstrated earlier cessation of anti-TNF-α therapy (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.03-4.39; P = .04). This effect was significant in patients who stopped treatment for loss of response (HR, 3.49; 95% CI, 1.34-9.09) and stronger for CD (HR, 2.38; 95% CI, 0.95-5.99) than UC (P = NS). CONCLUSIONS: Our findings suggest that vitamin D levels may influence durability of anti-TNF-α induction and maintenance therapy. Larger cohort studies and clinical trials of supplemental vitamin D use with disease activity as an end point may be warranted.

When the economy falters, do people spend or save? Responses to resource scarcity depend on childhood environments.

Just as modern economies undergo periods of boom and bust, human ancestors experienced cycles of abundance and famine. Is the adaptive response when resources become scarce to save for the future or to spend money on immediate gains? Drawing on life-history theory, we propose that people's responses to resource scarcity depend on the harshness of their early-life environment, as reflected by childhood socioeconomic status (SES). In the three experiments reported here, we tested how people from different childhood environments responded to resource scarcity. We found that people who grew up in lower-SES environments were more impulsive, took more risks, and approached temptations more quickly. Conversely, people who grew up in higher-SES environments were less impulsive, took fewer risks, and approached temptations more slowly. Responses similarly diverged according to people's oxidative-stress levels-a urinary biomarker of cumulative stress exposure. Overall, whereas tendencies associated with early-life environments were dormant in benign conditions, they emerged under conditions of economic uncertainty.

Ovulation leads women to perceive sexy cads as good dads.

Why do some women pursue relationships with men who are attractive, dominant, and charming but who do not want to be in relationships--the prototypical sexy cad? Previous research shows that women have an increased desire for such men when they are ovulating, but it is unclear why ovulating women would think it is wise to pursue men who may be unfaithful and could desert them. Using both college-age and community-based samples, in 3 studies we show that ovulating women perceive charismatic and physically attractive men, but not reliable and nice men, as more committed partners and more devoted future fathers. Ovulating women perceive that sexy cads would be good fathers to their own children but not to the children of other women. This ovulatory-induced perceptual shift is driven by women who experienced early onset of puberty. Taken together, the current research identifies a novel proximate reason why ovulating women pursue relationships with sexy cads, complementing existing research that identifies the ultimate, evolutionary reasons for this behavior.

Sex ratio and women's career choice: does a scarcity of men lead women to choose briefcase over baby?

Although the ratio of males to females in a population is known to influence behavior in nonhuman animals, little is known about how sex ratio influences human behavior. We propose that sex ratio affects women's family planning and career choices. Using both historical data and experiments, we examined how sex ratio influences women's career aspirations. Findings showed that a scarcity of men led women to seek high-paying careers and to delay starting a family. This effect was driven by how sex ratio altered the mating market, not just the job market. Sex ratios involving a scarcity of men led women to seek lucrative careers because of the difficulty women have in finding an investing, long-term mate under such circumstances. Accordingly, this low-male sex ratio produced the strongest desire for lucrative careers in women who are least able to secure a mate. These findings demonstrate that sex ratio has far-reaching effects in humans, including whether women choose briefcase over baby.