Study Finds Sex-Specific Approaches Needed For CAD Evaluation
Separate Studies Find Women Experience Differences in Advice, Treatment and Outcomes
Gender may affect the way risk of coronary artery disease (CAD) is factored, and there is a need for gender-specific approaches to CAD evaluation, according to a study published March 23 in JACC: Cardiovascular Imaging. These findings will be presented at ACC.16 in Chicago and will be included in a special issue of JACC: Cardiovascular Imaging focused on imaging in women on April 4.
Kshipra Hemal, et al., look at 10,003 men and women enrolled in the PROMISE trial – comprised of low- to intermediate-risk, stable outpatients with symptoms suggested of CAD – and found that compared to men, women had a greater number of cardiac risk factors, but were more likely to be characterized as lower risk – not only by providers, but also by risk scores. In addition, risk factors for cardiovascular disease more commonly found in women than men – depression, sedentary lifestyle, and family history of early-onset cardiovascular disease – were found to be excluded from most risk-assessment questionnaires. The authors further found that chest pain and shortness of breath were the most common symptoms reported by both men and women with suspected cardiovascular disease.
“This study shows the importance of taking into account the differences between women and men throughout the entire diagnostic process for suspected heart disease,” says Hemal. “The next step in this research will be to examine whether and how the differences we have identified between women and men influence outcomes.”
Meanwhile, a separate study by C. Noel Bairey Merz, MD, FACC, et al., found that many women are aware of cardiovascular disease risk factors, yet few are advised of risk.
The study looked at 1,011 U.S. women ages 25 to 60, and found that 74 percent reported one or more risk factors, yet only 16 percent were told they were at risk. In addition, 76 percent reported rarely or never discussing cardiovascular health with family and friends. The report also found that 34 percent of women were told to lose weight and 45 percent said that they would cancel or postpone a health appointment until losing weight.
The authors conclude that “social stigma regarding body weight may contribute to women not discussing heart health,” and suggest that moving forward, communication and outreach are needed to counter lack of awareness and stigma.
Women also experience differences in treatment and outcomes, and according to a study led by Edina Cenko, MD, et al., admission delays in primary percutaneous coronary intervention (PCI) of more than two hours are significantly more frequent in women than in men, and women have a higher risk of short-term mortality than men.
The study analyzed 6,679 patients with ST-segment elevation myocardial infarction (STEMI) who had a primary PCI within 24 hours of symptom onset. Results showed that hospital admission of less than two hours were associated with a lower risk of death. Further, admission delays of more than two hours were more frequent in women vs. men. According to the authors, “after multivariable adjustment, women remained significantly associated with a higher risk of death.”
Delays also can be significant in door-to-balloon (DTB) times for women compared to men, according to a separate study by Mostafa El-Refai, MD, et al..
The study looked at 193 STEMI patients, of which 21 percent were women, and found a “substantial difference” in DTB time between women and men. Further, women had more after-hours presentations and lower maximum ST elevation on ECG compared to men.
The authors conclude that the delays were associated with both clinical- and system-related factors, and that a delay in cath lab activation “disproportionately affects women.”
These findings from Bairey Merz, Cenko and El-Refai will also be presented at ACC.16.
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