Coronary heart disease: Reasons why women experience worse outcomes after bypass surgery

Sex disparities exist in treatment of coronary artery disease and women are significantly less likely than men to undergo CABG using guideline-recommended approaches, says a new study.

By: Longjam Dineshwori | | Updated: February 5, 2021 9:39 am

A failure to recognize cardiovascular risk factors and symptoms in women is the major reason for undertreatment of coronary artery disease in women, say researchers. © Shutterstock

Coronary heart disease (CHD), also called coronary artery disease, is a condition which occurs due to buildup of cholesterol-containing deposits (plaques) inside the coronary arteries, which supply oxygen and blood to the heart. It is a major cause of death worldwide. For people with severe form of the disease, coronary artery bypass grafting (CABG) is performed to improve blood flow to the heart. Women are said to be at a higher risk of experiencing worse outcomes after bypass surgery compared with men. A new study has provided an explanation to this disparity as well as revealed opportunities to improve outcomes in women. Also Read - Not all good cholesterol is healthy, they can raise heart disease risk: Experts warn

The study, presented recently at the 57th Annual Meeting of The Society of Thoracic Surgeons, suggested that women are significantly less likely than men to undergo CABG using guideline-recommended approaches, resulting in worse outcomes after surgery. Also Read - Air pollution may up risk of cardiovascular diseases; lowering your BP may reduce the effect

The study was conducted by Dr. Jawitz and colleagues from Duke and The Johns Hopkins University School of Medicine in Baltimore, Maryland. Also Read - Women with a history diabetes during pregnancy more likely to develop heart disease

To reach this conclusion, they studied the records of more than 1.2 million adult patients who underwent first-time isolated CABG from 2011 to 2019 in the US.

Sex disparities exist in treatment of coronary artery disease

They examined closely the correlation between female sex and three different CABG surgical techniques that are recommended in official US and European guidelines – grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery, complete revascularization and multiarterial grafting.

These surgical approaches are associated with improved short and/or long-term outcomes, but the researchers found that women were 14%-22% less likely than men to undergo CABG procedures with these revascularization strategies.

According to Dr. Jawitz, this finding shows that sex disparities exist while caring for patients with coronary artery disease (CAD) and less aggressive treatment strategies are followed with women. Therefore, he stressed the importance of ensuring that female patients undergoing CABG get evidence-based, guideline-concordant techniques.

Undertreatment of coronary heart disease in women

A failure to recognize cardiovascular risk factors and symptoms in women is the major reason for undertreatment of coronary artery disease in women, said Dr. Jawitz.

Compared to men, women are much more likely to experience uncommon, subtler symptoms of heart disease such as fatigue, abdominal pain, nausea, vomiting, indigestion, and back pain.

Chest pain and pressure are the characteristics of coronary artery disease, but sometimes women do not even feel these obvious symptoms, the researcher noted.

Women also have their own unique set of risk factors, which include relatively high testosterone levels prior to menopause, increased hypertension during menopause, and higher levels of stress and depression.

In addition, women usually tend to face delay in diagnosis and medical intervention, which leads to worsening of disease, and thereby poor surgical outcomes.

Again, during bypass surgery, women often do not receive CABG with LIMA to LAD, complete revascularization, or multiarterial grafting.

When it comes to women’s health, the focus is largely on mother and child issues, and breast cancer. Dr. Jawitz opined that a stronger emphasis on cardiovascular risk factors and interventions to successfully tackle heart disease, which is the leading cause of death for women in the US.

Raising awareness about cardiovascular disease will go a long way toward minimizing sex differences in CAD outcomes, he added.

Published : February 4, 2021 7:32 pm | Updated:February 5, 2021 9:39 am

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