Women and Men With Stable Coronary Artery Disease Have Similar Clinical Outcomes: Insights From the International Prospective CLARIFY Registry

Study Questions:

Do clinical outcomes differ by gender among patients with stable coronary artery disease (CAD)?

Methods:

One-year outcomes were examined among patients with stable CAD from the CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) registry. This is an ongoing prospective observational longitudinal study of 33,285 outpatients with stable CAD receiving standard management. Patients were enrolled in 45 countries in Africa, Asia, Australia, Europe, the Middle East, and North, Central, and South America. Patients were treated according to usual clinical practice at each institution, with no specific tests or therapies defined in the study protocol. Eligible patients had stable CAD defined as at least one of the following: documented myocardial infarction (MI) >3 months before enrollment, angiographic demonstration of coronary stenosis >50%, chest pain with evidence of myocardial ischemia (stress electrocardiogram), or coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) >3 months before enrollment.

Results:

A total of 30,977 outpatients were included (22.6% women). Women were older and more likely to have hypertension and diabetes compared to the men. Women were also more sedentary and more likely to be nonsmokers compared to the men. Women had more frequent angina, but were less likely to have undergone diagnostic noninvasive testing or coronary angiography. Women received less optimized treatment for stable CAD (including statins and aspirin therapies) and were less likely to undergo revascularization. One-year outcomes were similar for men and women for the composite of cardiovascular death, nonfatal MI, or stroke (adjusted rates, 1.7 vs. 1.8%, respectively; odds ratio [OR], 0.93; 95% confidence interval [CI], 0.75-1.15). Other outcomes including all-cause mortality (OR, 0.91; 95% CI, 0.72-1.13), fatal or nonfatal MI (OR, 0.81; 95% CI, 0.60-1.08), and cardiovascular disease death or nonfatal MI (OR, 0.89; 95% CI, 0.70-1.12) were also similar between men and women.

Conclusions:

The authors concluded that risk profiles between men and women with stable CAD differ; however 1-year outcomes are similar, despite women being less likely to undergo revascularization.

Perspective:

As with other studies, these data from the CLARIFY registry find women and men with stable CAD differ in terms of risk factors. It is interesting that the investigators did not note increased risk among young women as had been observed in other studies. This may be due to the CLARIFY cohort including those with stable disease rather than acute coronary syndrome. Despite similar outcomes, the differences in evidence-based medications such as aspirin, highlight an ongoing need to examine why women do not receive similar medical management as men.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Hypertension

Keywords: Coronary Artery Disease, Stroke, Australia, South America, Europe, Hypertension, Middle East, Percutaneous Coronary Intervention


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