Achieving gender equality in cardiovascular care may require attention to individualizing care, especially for women, according to a study presented in American College of Cardiology (ACC) 2023 Annual Scientific Sessions in New Orleans, Louisiana.
The results suggested that women with premature coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) had a higher incidence of adverse cardiovascular events (MACE) at 1 year compared with men.
Study co-author Birgit Vogel, MD, Icahn School of Medicine, Mount Sinai Hospital, emphasized the importance of recognizing underestimation of risk in women and increasing screening to identify and treat early heart disease risk factors.
“At Mount Sinai, we’ve now launched the Women’s Heart Vascular Center, and it’s a big goal of ours to increase screening in young women, especially if they’re from certain risk groups, like women with a history of negative outcomes of pregnancy,” Vogel. said. “We look for risk factors and get them the treatment they need to reduce their risk of heart disease later.”
In a question and answer with HCPLiveIntroducing author Alexandra Murphy MBBS of Mount Sinai discussed the findings, describing sex-specific differences in quality of care and how the inherent limitations of the analysis do not diminish her findings.
This Q&A has been edited for clarity.
Can you describe to me the impetus behind this study and provide a brief summary of the results?
So at Mount Sinai and at the Icahn Institute, we’ve focused a lot on gender equity research and a lot on the female model of cardiovascular disease and the differences between men and women. This is important to identify these types of differences in order to try and improve outcomes in women with cardiovascular disease.
In this abstract, we looked at young patients, so this is defined differently between men and women. So men less than 55 years old and women less than 65 years old who underwent percutaneous coronary intervention (PCI) at our hospital between 2012 and 2019. So we have a very large database of data of PCI results we have produced a large amount of research from very high quality research.
We then stratified these young patients by gender and identified the main risk factors for poor outcomes. We defined the primary outcome as major adverse cardiovascular events. And so, of the over 4,000 patients we studied, just under half were women.
And we found that these women were older than the men, even within that young age. They were more likely to have a higher body mass index (BMI), and also to have a higher comorbidity burden. But when we broke it down and looked at the different risk factors that were more prominent in men versus women, we found that there were differences in that, and that information is important because it can then be used to target six specific directives to improve outcomes . both in men and women.
To your last point, would you say that is the most important point from a practicing clinician’s perspective?
Absolutely. And I think we should always be thinking about how we can apply our research findings to change health outcomes in our patients. It’s about getting it from the database to the clinical room. And I think the really important thing here is to improve public awareness and improve heart disease risk and prevention by targeting specific features that are unique to women.
Are these findings the result of physiological differences, the quality of care provided to women, or a mixture of the two?
I believe there is a mix of factors here. First, we can account for patient-specific factors and differences in how women present with cardiovascular disease, including their symptoms, which are often poorly recognized and poorly publicized, leading to poorer outcomes when women they are not aware that they are having a heart attack. or experience chest pain that manifests itself differently.
Second, we need to consider the potential biases that physicians may have against women when they are under investigation or treatment for cardiovascular disease. This is a common issue in women’s health research. Finally, we can address the need for more effective public health campaigns and awareness efforts to highlight the existence of disparities and the need for improvement.
Are there any inherent limitations that you would like our audience to consider before interpreting the study results?
I think that whenever we look at retrospective analyzes of databases, we have to understand that there are inherent limitations with those data. Perspective, random data will always be of the highest quality. But when we’re seeing large populations like this, I think that’s still a very strong message. It allows us to look at people who have been consecutive patients and find out what the burden of disease is and better understand potential disparities. And this can still be done with very high quality on large databases, even in a retrospective nature.
