Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Inflammation Research
Published in: Inflammation Research 8/2020

01-08-2020 | Fertility | Review

Fertility and infertility implications in rheumatoid arthritis; state of the art

Authors: Abolfazl Fattah, Amirhooman Asadi, Mohammad Reza Hooshangi Shayesteh, Forough Hatefi Hesari, Sirous Jamalzehi, Mojtaba Abbasi, Mohammad Javad Mousavi, Saeed Aslani

Published in: Inflammation Research | Issue 8/2020

Login to get access

Abstract

Background

A bulk of investigations imply that women with rheumatoid arthritis (RA) deliver fewer children in comparison to healthy women.

Purpose

This review article attempts to clarify the involvement of infertility-related issues in both RA men and women. Moreover, the effect of RA disease on the fertility quality and quantity will be discussed.

Results

Declined fertility rate in RA women seems to stem from modified inflammatory settings, advanced maternal age, limited sexual activity, and adverse effects of drugs on ovarian function. Women with RA may have smaller families and seem to be slower to conceive relative to their peer women. The chance of gestation in RA women may drop due to suppressed sexual function through pain and fatigue. In addition, treatment of RA women with non-steroidal anti-inflammatory drugs (NSAIDs) may prevent ovulation and therefore hinder the conception.

Conclusions

A complex interaction between RA disease and fertility related issues is present. Despite an increase rate of infertility in RA females or males, the mechanisms involved in this outcome is still unknown. Plausible causes of the decreased fertility rate in RA patients might be due to inflammatory cytokines, suppressed sexual activity, drug treatments, mother age, personal choice, or a combination of these elements.
Literature
1.
Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg B-Y, Koldingsnes W, et al. Fertility in women with chronic inflammatory arthritides. Rheumatology. 2011;50:1162–7.PubMed
2.
Wallenius M, Skomsvoll J, Irgens L, Salvesen K, Nordvåg B, Koldingsnes W, et al. Parity in patients with chronic inflammatory arthritides childless at time of diagnosis. Scand J Rheumatol. 2012;41:202–7.PubMed
3.
Skomsvoll JF, Ostensen M, Baste V, Irgens LM. Number of births, interpregnancy interval, and subsequent pregnancy rate after a diagnosis of inflammatory rheumatic disease in Norwegian women. J Rheumatol. 2001;28:2310–4.PubMed
4.
Förger F, Vallbracht I, Helmke K, Villiger PM, Ostensen M. Pregnancy mediated improvement of rheumatoid arthritis. Swiss Med Wkly. 2012;142:w13644.PubMed
5.
Østensen M, Villiger PM, Förger F. Interaction of pregnancy and autoimmune rheumatic disease. Autoimmun Rev. 2012;11:A437–A446446.PubMed
6.
7.
8.
Del Junco D, Annegers J, Coulam C, Luthra HS. The relationship between rheumatoid arthritis and reproductive function. Br J Rheumatol. 1989;28:33.PubMed
9.
Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy C, Englert Y. Stable serum levels of anti-Müllerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22:1837–40.PubMed
10.
Leverenz DL, Eudy AM, Jayasundara M, Haroun T, McDaniel G, Nowell WB, et al. Contraception methods used by women with rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol. 2019;38:1207–12.PubMed
11.
Provost M, Eaton JL, Clowse ME. Fertility and infertility in rheumatoid arthritis. Curr Opin Rheumatol. 2014;26:308–14.PubMed
12.
Katz PP. Childbearing decisions and family size among women with rheumatoid arthritis. Arthritis Care Res. 2006;55:217–23.
13.
Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res. 2012;64:668–74.
14.
Eudy AM, McDaniel G, Hurd WW, Clowse ME. Fertility and ovarian reserve among women with rheumatoid arthritis. J Rheumatol. 2019;46:455–9.PubMed
15.
Brouwer J, Laven JS, Hazes JM, Schipper I, Dolhain RJ. Levels of Serum anti-müllerian hormone, a marker for ovarian reserve, in women with rheumatoid arthritis. Arthritis Care Res. 2013;65:1534–8.
16.
Silman A, Roman E, Beral V, Brown A. Adverse reproductive outcomes in women who subsequently develop rheumatoid arthritis. Ann Rheum Dis. 1988;47:979.PubMedPubMedCentral
17.
18.
Nørgård BM, Larsen MD, Friedman S, Knudsen T, Fedder J. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis. 2019;78:328–34.PubMed
19.
Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheumatol. 2006;54:899–907.
20.
Lin H, Chen S, Lin H, et al. Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study. Ann Rheum Dis. 2010;69:715–7.PubMed
21.
Bowden AP, Barrett JH, Fallow W, Silman AJ. Women with inflammatory polyarthritis have babies of lower birth weight. J Rheumatol. 2001;28:355–9.PubMed
22.
Kishore S, Mittal V, Majithia V. Obstetric outcomes in women with rheumatoid arthritis: results from nationwide inpatient sample database 2003–2011✰. Semin Arthritis Rheum. 2019;49(2):236–40.PubMed
23.
24.
Jethwa H, Lam S, Smith C, Giles I. Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol. 2019;46:245–50.PubMed
25.
Jabbour H, Sales K. Prostaglandin receptor signalling and function in human endometrial pathology. Trends Endocrinol Metab. 2004;15:398–404.PubMed
26.
Rashid NA, Lalitkumar S, Lalitkumar PG, Gemzell-Danielsson K. Endometrial receptivity and human embryo implantation. Am J Reprod Immunol. 2011;66:23–30.PubMed
27.
Gemzell-Danielsson K, Hamberg M. Endocrinology: the effect of antiprogestin (RU 486) and prostaglandin biosynthesis inhibitor (naproxen) on uterine fluid prostaglandin F2α concentrations. Hum Reprod. 1994;9:1626–30.PubMed
28.
King AE, Critchley HO. Oestrogen and progesterone regulation of inflammatory processes in the human endometrium. J Steroid Biochem Mol Biol. 2010;120:116–26.PubMed
29.
Dawood MY. Nonsteroidal anti-inflammatory drugs and reproduction. Am J Obstet Gynecol. 1993;169:1255–65.PubMed
30.
Eppig JJ. Prostaglandin E2 stimulates cumulus expansion and hyaluronic acid synthesis by cumuli oophori isolated from mice. Biol Reprod. 1981;25:191–5.PubMed
31.
Hizaki H, Segi E, Sugimoto Y, Hirose M, Saji T, Ushikubi F, et al. Abortive expansion of the cumulus and impaired fertility in mice lacking the prostaglandin E receptor subtype EP2. Proc Natl Acad Sci. 1999;96:10501–6.PubMedPubMedCentral
32.
Reich R, Daphna-Iken D, Chun S, Popliker M, Slager R, Adelmann-Grill B, et al. Preovulatory changes in ovarian expression of collagenases and tissue metalloproteinase inhibitor messenger ribonucleic acid: role of eicosanoids. Endocrinology. 1991;129:1869–75.PubMed
33.
Markosyan N, Duffy DM. Prostaglandin E2 acts via multiple receptors to regulate plasminogen-dependent proteolysis in the primate periovulatory follicle. Endocrinology. 2008;150:435–44.PubMedPubMedCentral
34.
Hester KE, Harper MJ, Duffy DM. Oral administration of the cyclooxygenase-2 (COX-2) inhibitor meloxicam blocks ovulation in non-human primates when administered to simulate emergency contraception. Hum Reprod. 2009;25:360–7.PubMed
35.
Duffy DM, Stouffer RL. Follicular administration of a cyclooxygenase inhibitor can prevent oocyte release without alteration of normal luteal function in rhesus monkeys. Hum Reprod. 2002;17:2825–31.PubMed
36.
Duffy DM, Stouffer RL. The ovulatory gonadotrophin surge stimulates cyclooxygenase expression and prostaglandin production by the monkey follicle. MHR Basic Sci Reprod Med. 2001;7:731–9.
37.
McCann NC, Lynch TJ, Kim SO, Duffy DM. The COX-2 inhibitor meloxicam prevents pregnancy when administered as an emergency contraceptive to nonhuman primates. Contraception. 2013;88:744–8.PubMed
38.
Yoshinaga K. Uterine receptivity for blastocyst implantation. Ann N Y Acad Sci. 1988;541:424–31.PubMed
39.
Dimitriadis E, White C, Jones R, Salamonsen L. Cytokines, chemokines and growth factors in endometrium related to implantation. Human Reprod Update. 2005;11:613–30.
40.
Brouwer J, Hazes JMW, Laven JSE, et al. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2015;74:1836–41.PubMed
41.
Akintayo RO, Aworinde OO, Ojo O, Akintayo FC, Akinlade OM, Awodun RO, et al. Is rheumatoid arthritis an innocent bystander in female reproductive problems? A comparative study of fertility in Nigerian women with and without rheumatoid arthritis. European J Rheumatol. 2018;5:179.
42.
Ince-Askan H, Dolhain RJ. Pregnancy and rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2015;29:580–96.PubMed
43.
Saketos M, Sharma N, Santoro NF. Suppression of the hypothalamic–pituitary–ovarian axis in normal women by glucocorticoids. Biol Reprod. 1993;49:1270–6.PubMed
44.
Whirledge S, Cidlowski JA. A role for glucocorticoids in stress-impaired reproduction: beyond the hypothalamus and pituitary. Endocrinology. 2013;154:4450–68.PubMedPubMedCentral
45.
Gordon D, Beastall G, Thomson J, Sturrock R. Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. QJM Int J Med. 1986;60:671–9.
46.
O'moráin C, Smethurst P, Doré CJ, Levi A. Reversible male infertility due to sulphasalazine: studies in man and rat. Gut. 1984;25:1078–84.PubMedPubMedCentral
47.
Visser K, Katchamart W, Loza E, Martinez-Lopez J, Salliot C, Trudeau J, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis. 2009;68:1086–93.PubMed
48.
Wallenius M, Lie E, Daltveit AK, Salvesen KÅ, Skomsvoll JF, Kalstad S, et al. Brief report: no excess risks in offspring with paternal preconception exposure to disease-modifying antirheumatic drugs. Arthritis Rheumatol. 2015;67:296–301.PubMed
49.
Weber-Schoendorfer C, Hoeltzenbein M, Wacker E, Meister R, Schaefer C. No evidence for an increased risk of adverse pregnancy outcome after paternal low-dose methotrexate: an observational cohort study. Rheumatology. 2013;53:757–63.PubMed
50.
Millsop JW, Heller MM, Eliason MJ, Murase JE. Dermatological medication effects on male fertility. Dermatol Ther. 2013;26:337–46.PubMed
51.
Puchner R, Danninger K, Puchner A, Pieringer H. Impact of TNF-blocking agents on male sperm characteristics and pregnancy outcomes in fathers exposed to TNF-blocking agents at time of conception. Clin Exp Rheumatol. 2012;30:765–7.PubMed
52.
Ramonda R, Foresta C, Ortolan A, Bertoldo A, Oliviero F, Lorenzin M, et al. Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertil Steril. 2014;101:359–65.PubMed
53.
Micu MC, Micu R, Surd S, Gîrlovanu M, Bolboacă SD, Ostensen M. TNF-α inhibitors do not impair sperm quality in males with ankylosing spondylitis after short-term or long-term treatment. Rheumatology. 2014;53:1250–5.PubMed
54.
55.
Martini AC, Molina RI, Tissera AD, Ruiz RD, De Cuneo MF. Analysis of semen from patients chronically treated with low or moderate doses of aspirin-like drugs. Fertil Steril. 2003;80:221–2.PubMed
56.
Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in women with rheumatoid arthritis in Washington State. Matern Child Health J. 2006;10:361–6.PubMed
57.
Wolfberg AJ, Lee-Parritz A, Peller AJ, Lieberman ES. Association of rheumatologic disease with preeclampsia. Obstet Gynecol. 2004;103:1190–3.PubMed
58.
Nørgaard M, Larsson H, Pedersen L, Granath F, Askling J, Kieler H, et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med. 2010;268:329–37.PubMed
59.
Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, et al. Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the organization of teratology information specialists autoimmune diseases in pregnancy project. J Rheumatol. 2015;42:1376–82.PubMed
60.
Ince-Askan H, Mandaviya PR, Felix JF, Duijts L, van Meurs JB, Hazes JM, et al. Altered DNA methylation in children born to mothers with rheumatoid arthritis during pregnancy. Ann Rheum Dis. 2019;78:1198–204.PubMed
61.
de Man YA, Hazes JM, van der Heide H, Willemsen SP, de Groot CJ, Steegers EA, et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheumatol. 2009;60:3196–206.
62.
Ong KK, Dunger DB. Perinatal growth failure: the road to obesity, insulin resistance and cardiovascular disease in adults. Best Pract Res Clin Endocrinol Metab. 2002;16:191–207.PubMed
63.
Leunissen RW, Kerkhof GF, Stijnen T, Hokken-Koelega A. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. JAMA. 2009;301:2234–42.PubMed
64.
Steenwinkel F, Hokken-Koelega A, Ridder MA, Hazes JM, Dolhain RJ. Rheumatoid arthritis during pregnancy and postnatal catch-up growth in the offspring. Arthritis Rheumatol. 2014;66:1705–11.PubMed
65.
de Steenwinkel FD, Hokken-koelega AC, Hazes J, Dolhain RJ. Does elevated disease activity or medication use influence the bone density of the prepubertal offspring in pregnant women with rheumatoid arthritis? Arthritis Rheum. 2013;65:S172.
66.
67.
Murray KE, Moore L, O’Brien C, Clohessy A, Brophy C, Minnock P, et al. Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines. Ir J Med Sci. 2019;188:169–72 (1971-).PubMed
68.
Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse ME, et al. State of the art: reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. 2015;14:376–86.PubMed
69.
Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006;8:209.PubMedPubMedCentral
70.
Bermas BL. Non-steroidal anti inflammatory drugs, glucocorticoids and disease modifying anti-rheumatic drugs for the management of rheumatoid arthritis before and during pregnancy. Curr Opin Rheumatol. 2014;26:334–40.PubMed
71.
Skorpen CG, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75:795–810.
72.
Weber-Schoendorfer C, Chambers C, Wacker E, Beghin D, Bernard N, NoFP C, et al. Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy: a prospective multicenter cohort study. Arthritis Rheumatol. 2014;66:1101–10.PubMed
73.
Brent RL. Utilization of animal studies to determine the effects and human risks of environmental toxicants (drugs, chemicals, and physical agents). Pediatrics. 2004;113:984–95.PubMed
74.
Cassina M, Johnson D, Robinson L, Braddock S, Xu R, Jimenez J, et al. Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis Rheum. 2012;64:2085–94.PubMed
75.
Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Lopez-Jimenez J, et al. Birth outcomes in women who have taken leflunomide during pregnancy. Arthritis Rheum. 2010;62:1494–503.PubMedPubMedCentral
76.
Weber-Schoendorfer C, Oppermann M, Wacker E, Bernard N, centres noFp, Beghin D, et al. Pregnancy outcome after TNF-α inhibitor therapy during the first trimester: a prospective multicentre cohort study. Br J Clin Pharmacol. 2015;80:727–39.PubMedPubMedCentral
77.
Chaudrey KH, Kane SV. Safety of immunomodulators and anti-TNF therapy in pregnancy. Curr Treat Options Gastroenterol. 2015;13:77–89.PubMed
78.
Eworuke E, Panucci G, Goulding M, Neuner R, Toh S. Use of tumor necrosis factor-alpha inhibitors during pregnancy among women who delivered live born infants. Pharmacoepidemiol Drug Saf. 2019;28:296–304.PubMed
79.
Kawai Y, Tsuchiya T, Aoki S. Pregnancy outcomes of patients exposed to adalimumab in Japan. Dig Dis. 2019;37:123–30.PubMed
80.
Malek A, Sager R, Kuhn P, Nicolaides KH, Schneider H. Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol. 1996;36:248–55.PubMed
81.
Mahadevan U, Wolf DC, Dubinsky M, Cortot A, Lee SD, Siegel CA, et al. Placental transfer of anti–tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11:286–92.PubMed
82.
Berthelsen BG, Fjeldsøe-Nielsen H, Nielsen CT, Hellmuth E. Etanercept concentrations in maternal serum, umbilical cord serum, breast milk and child serum during breastfeeding. Rheumatology. 2010;49:2225–7.PubMed
83.
Hyrich KL, Verstappen SM. Biologic therapies and pregnancy: the story so far. Rheumatology. 2013;53:1377–85.PubMed
84.
Brooks P. Use and benefits of nonsteroidal anti-inflammatory drugs. Am J Med. 1998;104:9S–13S.PubMed
85.
Wood SF. Women’s health and the FDA. N Engl J Med. 2005;353:1650–1.PubMed
86.
Østensen ME, Skomsvoll JF. Anti-inflammatory pharmacotherapy during pregnancy. Expert Opin Pharmacother. 2004;5:571–80.PubMed
87.
Østensen M. Nonsteroidal anti-inflammatory drugs during pregnancy. Scand J Rheumatol. 1998;27:128–32.
88.
Akil M, Amos R, Stewart P. Infertility may sometimes be associated with NSAID consumption. Rheumatology. 1996;35:76–8.
89.
Smith G, Roberts R, Hall C, Nuki G. Reversible ovulatory failure associated with the development of luteinized unruptured follicles in women with inflammatory arthritis taking non-steroidal anti-inflammatory drugs. Rheumatology. 1996;35:458–62.
90.
Van der Weiden R, Wouters J. Infertility may sometimes be associated with non-steroidal anti-inflammatory drug consumption. Br J Rheumatol. 1997;36:605.PubMed
91.
Nielsen GL, Sørensen HT, Larsen H, Pedersen L. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inlammatory drugs: population based observational study and case-control study. BMJ Br Med J. 2001;322(7281):266–70.
92.
Li D-K, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003;327:368.PubMedPubMedCentral
93.
Nakhai-Pour HR, Broy P, Sheehy O, Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. 2011;183:1713–20.PubMedPubMedCentral
94.
Edelman AB, Jensen JT, Doom C, Hennebold JD. Impact of the prostaglandin synthase-2 inhibitor celecoxib on ovulation and luteal events in women. Contraception. 2013;87:352–7.PubMed
95.
Bata M, Al-Ramahi M, Salhab A, Gharaibeh M, Schwartz J. Delay of ovulation by meloxicam in healthy cycling volunteers: a placebo-controlled, double-blind, crossover study. J Clin Pharmacol. 2006;46:925–32.PubMed
96.
Brouwer J, Hazes J, Laven J, Dolhain R. FRI0145 High disease activity and preconceptional use of prednisone and non-steroidal anti-inflammatory drugs impair fertility in women with rheumatoid arthritis. Ann Rheum Dis. 2013;72:A419–A419419.
97.
Brubaker W, Li S, Baker L, Eisenberg M. Increased risk of autoimmune disorders in infertile men: analysis of US claims data. Andrology. 2018;6:94–8.PubMed
Metadata
Title
Fertility and infertility implications in rheumatoid arthritis; state of the art
Authors
Abolfazl Fattah
Amirhooman Asadi
Mohammad Reza Hooshangi Shayesteh
Forough Hatefi Hesari
Sirous Jamalzehi
Mojtaba Abbasi
Mohammad Javad Mousavi
Saeed Aslani
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
Inflammation Research / Issue 8/2020
Print ISSN: 1023-3830
Electronic ISSN: 1420-908X
DOI
https://doi.org/10.1007/s00011-020-01362-w

Other articles of this Issue 8/2020

Inflammation Research 8/2020 Go to the issue

Original Research Paper

The protective effects of phoenixin-14 against lipopolysaccharide-induced inflammation and inflammasome activation in astrocytes

Letter to the Editor

Thick and yellowish articular effusion: a challenging diagnosis! Focus on cholesterol crystal deposition in joint

Original Research Article

TMEM88 modulates the secretion of inflammatory factors by regulating YAP signaling pathway in alcoholic liver disease

Original Research Article

The unleashing of the immune system in COVID-19 and sepsis: the calm before the storm?

Original Research Article

LPS-induced inflammation disorders bone modeling and remodeling by inhibiting angiogenesis and disordering osteogenesis in chickens

Short Communication

Immunoglobulin free light chains: an inflammatory biomarker of diabetes

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits