Battle of the Sexes: Who Experiences Better Outcomes with Stable Angina and CAD (Journal Wrap)

When it comes to clinical outcomes in patients presenting with stable angina and any level of coronary artery disease (CAD), is the burden greater for women than men? Tara L. Sedlak, MD, from Vancouver General Hospital, and colleagues attempted to answer that question in a recent analysis of adults aged ≥20 years in British Columbia, Canada, with stable angina who underwent coronary angiography. Patients were followed for a median of 1.9 years. Their analysis included data about demographics, clinical characteristics, outcomes, hospitalization admissions, cardiac procedures, and death.

The patient cohort (n = 13,695) was categorized according to presence of CAD: none (0% luminal narrowing), nonobstructive CAD (1-49% luminal narrowing), and obstructive CAD (≥50% luminal narrowing). Hazard ratios for freedom from major adverse cardiac events (MACE)—including the combined endpoints of all-cause mortality, nonfatal acute MI, nonfatal stroke, and HF admissions—were the primary measures of interest in the study.

Most of the patients had obstructive CAD, a minority had nonobstructive CAD, and 15% had no CAD; women were more likely to have no CAD. Women also had a significantly higher proportion of nonobstructive CAD compared with men. Interestingly, in this category, women were older, had more hypertension, and more cancer, but smoked less than men.

Results from the study, published in the American Heart Journal, revealed that women with stable angina and nonobstructive CAD had the greatest risk for MACE within the first year of cardiac catheterization—amounting to three times higher risk than men. Nonobstructive CAD also contributed to a 2.55-fold higher risk of MACE than in women with no CAD. In contrast, men with nonobstructive CAD had a similar risk as men with no CAD (adjusted HR = 0.61).

When HF was excluded from the MACE outcomes, however, the difference between genders among the nonobstructive group was no longer significant. In light of these findings, Sedlak et al. concluded, a prospective trial to examine the impact of medical therapy on MACE in patients with nonobstructive CAD is warranted. Aggressive risk factor prevention and management (particularly of controlling blood pressure among women) would potentially be an important means of reducing MACE among women with nonobstructive CAD, as well.

Sedlak TL, Lee M, Izadnegahdar M, et al. Am Heart J. 2013;166:38-44.

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