Gender comparisons in non-acute cardiac symptom recognition and subsequent help-seeking decisions: a mixed methods study protocol

Introduction: Coronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CHD is a ‘man's disease’, it is now well accepted that women endure worse clinical outcomes than men following CHD-related events. A number of studies have explored whether or not gender differences exist in patients presenting with CHD, and specifically whether women delay seeking help for cardiac conditions. UK and overseas studies on help-seeking for emergency cardiac events are contradictory, yet suggest that women often delay help-seeking. In addition, no studies have looked at presumed cardiac symptoms outside an emergency situation. Given the lack of understanding in this area, an explorative qualitative study on the gender differences in help-seeking for a non-emergency cardiac events is needed. Methods and analysis: A purposive sample of 20–30 participants of different ethnic backgrounds and ages attending a rapid access chest pain clinic will be recruited to achieve saturation. Semistructured interviews focusing on help-seeking decision-making for apparent cardiac symptoms will be undertaken. Interview data will be analysed thematically using qualitative software (NVivo) to understand any similarities and differences between the way men and women construct help-seeking. Findings will also be used to inform the preliminary development of a cardiac help-seeking intentions questionnaire. Ethics and dissemination: Ethical approvals were sought and granted. Namely, the University of Westminster (sponsor) and St Georges NHS Trust REC, and the Trust Research and Development Office granted approval to host the study on the Queen Mary's Roehampton site. The study is low risk, with interviews being conducted on hospital premises during working hours. Investigators will disseminate findings via presentations and publications. Participants will receive a written summary of the key findings.

Structure-inhibition relationship of phenylethanoid glycosides on angiotensin-converting enzyme using ultra-performance liquid chromatography-tandem quadrupole mass spectrometry

Angiotensin-converting enzyme (ACE) plays a critical role in rennin-angiotensin system. Recently, natural products isolated from herbal medicines revealed inhibitory effects against ACE which suggested their potential activities in regulating blood pressure. In this study, ACE inhibition (ACEI) of 21 phenylethanoid glycosides and related phenolic compounds were investigated by measuring the production of HA a rapid, sensitive, accurate and specific ultra-performance liquid chromatography-tandem quadrupole mass spectrometry (UPLC-MS/MS) method. The test compounds showed different inhibitory potencies on ACE ranging from 5.29 to 95.01% at 50 mM, and the compounds with ACEI higher than 50% were selected for further IC50 determination. The IC50 values were from 0.53 ± 0.04 to 15.035 ± 0.036 mM. The structure-inhibition relationship were then explored and the result showed that cinnamoyl groups played an essential role in ACEI of phenylethanoid glycosides. Furthermore, the sub-structures of increasing ACEI for phenylethanoid glycosides is more hydroxyls and less steric hindrance to chelate the active site Zn2+ of ACE. In summary, our results suggested that phenylethanoid glycosides are a widely available source of anti-hypertensive natural products and the information provided from structure-inhibition relationship study could aid the design of structurally modified phenylethanoid glycosides as anti-hypertensive drugs.