Gender, coronary artery disease and coronary bypass surgery

Article Abstract:

In 30 years of data the Framingham Heart Study has shown that coronary artery disease (CAD) occurs at a later age in women than men. Women were an average of 10 years older when clinical symptoms of CAD were first identified and 20 years older when a heart attack (myocardial infarction; MI) occurred. Angina pectoris, or chest pain, was the main symptom of CAD, occurring in 56 percent of the women and 43 percent of the men. Although women developed angina twice as commonly as they did heart attack, angina did not result in heart attack in 86 percent of the women. This data lends evidence to the perception that angina does not necessarily lead to heart problems in women. However, the death rate and incidence of other heart disorders were worse for women who suffered a heart attack than for men who had a heart attack. The mortality during the first year after a heart attack was 45 percent for women, but only 10 percent for men. The increased female mortality is probably due to not identifying high-risk women, and not providing preventive care and coronary risk modification, such as bypass surgery. Women who had bypass surgery had a greater incidence of adverse pre-operative characteristics, such as older age, severe or unstable angina, urgent or emergency operation, and previous heart attack or heart failure. Following bypass surgery, women had less favorable mortality than men. It is not certain if this is due to unknown differences between men and women, or other characteristics, such as the older age of women, their delayed referral and more severe pre-operative condition. Women who were referred for bypass surgery because of an abnormal exercise test and had surgery earlier in the course of illness had more favorable outcomes after surgery than older women with more advanced CAD. Additional studies are needed to clarify these differences. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, editorial, Framingham Heart Study

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Increased mortality of women in coronary artery bypass surgery: evidence for referral bias

Article Abstract:

Women have a higher death rate after coronary artery bypass surgery than men. The reasons for this are not certain. It has been suggested that the smaller size of women's hearts and coronary arteries may lead to technical problems during surgery. Others have felt that there is a bias against referring women for surgery, and that women are referred for bypass surgery at a later stage in their disease. A study was conducted to see if there were differences in the pre-operative characteristics of men and women. A total of 2,297 patients, 1,815 men and 482 women, were examined for pre-operative characteristics and the outcome of bypass surgery. Mortality after bypass surgery was greater in women (4.6 percent) than in men (2.6 percent). The average age of women was 68.2 years, compared with 64 years for men. A higher percentage of women had more serious pre-operative symptoms, including unstable angina, angina after a heart attack, and congestive heart failure. More men were referred for bypass surgery because of an abnormal exercise test. Male and female patients who were referred for surgery because of an abnormal exercise test had lower postoperative mortality. Statistical analysis indicated that severity of pre-operative symptoms and older age accounted for the differences in mortality between men and women. These factors are related to the fact that women are referred for coronary bypass surgery later in the course of disease than men. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Heart, Heart surgery

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Coronary heart disease incidence and survival in African-American women and men: the NHANES I epidemiologic follow-up study

Article Abstract:

The incidence of coronary heart disease seems to be higher among African-American women between the ages of 25 and 54 years than among white women the same age. The disease rate is lower among African-American males 25 to 74 years old than among white males. This was the conclusion of a study of 11,406 white and African-American persons with no history of heart disease who were followed for up to 22 years. There was no difference in survival rates in either group after hospitalization for heart disease, but the use of surgical coronary procedures was much lower among African-Americans.

Health aspects, African Americans, Sex differences, Angiocardiography, Cardiac catheterization, Heart catheterization

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