Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality

Abstract Background/Introduction Ischemic heart diseases (IHD) are not synonymous with obstructive flow-limiting coronary artery disease (CAD), especially in women. Platelet dysfunction is suggested as a potential mechanism favouring ischemia in non-obstructive CAD. However, it is unknown whether sex differences in platelet function of patients with non-obstructive CAD exist. Purpose We assessed for sex differences in in-vivo markers of platelet activation among patients with the acute coronary syndrome and chronic stable angina, with or without obstructive CAD Methods From the “Endocrine Vascular disease Approach” (EVA) study, we selected IHD patients undergoing urgent or elective coronary angiography with complete baseline clinical characteristics and angiographic data. Non-obstructive CAD was defined as the presence of coronary stenosis <50%. Thromboxane B2 (TxB2) and soluble P-selectin (sP-s) were measured at baseline. A sex-stratified analysis of platelet biomarkers was performed. Results Among two-hundred-seventy-seven patients (mean age 67±11, 37% women), non-obstructive CAD was documented in 25% of patients. Acute coronary syndrome (ACS) was the reason for angiography in 61% of cases. Women had more frequently ACS, as compared with men (54.8% vs 41.3%, p=0.001), with predominantly non-obstructive CAD. Median serum TxB2 (121.5 [92.7–174.0] vs 103.5 [83.0–140.2] pg/ml, p=0.005) and plasma sP-s (27.0 [18.7–35.0] vs 22.0 [16.0–30.0] ng/ml, p=0.006) levels were higher in patients with ACS as compared with the ones with stable chronic angina. The median concentration of TxB2 was significantly increased in women as compared with men, regardless of the clinical presentation and the coronary stenosis degree (all comparison, p<0.001). However, women with non-obstructive CAD were the group with the highest serum levels of TxB2 (140.0 [111.0–152.0] pg/ml). Sex differences in the plasma sP-s level were also observed among patients with stable chronic angina (women, 26 [20.0–34.0] vs men, 21 [16.6–27.7] ng/ml, p=0.002) and with non-obstructive CAD (women, 26 [20.5–34.5] vs men, 18.5 [16.6–26.0] ng/ml, p=0.003). Conclusion(s) Women with IHD and non-obstructive CAD had increased level of TxB2 and sP-s as compared with men, independently by the clinical presentation. Further investigations are warranted to verify the role of platelet hyperactivation in the pathogenesis of myocardial ischemia with non-obstructive coronary artery disease among women. Acknowledgement/Funding Scientific Independence of Young Researchers Program (RBSI14HNVT) - Ministry of Education, University and Research (MIUR)

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Sex differences in the quality of life of patients with acute coronary syndrome treated with percutaneous coronary intervention after a 3-year follow-up

Patient Preference and Adherence ◽

10.2147/ppa.s106577 ◽

2016 ◽

Vol Volume 10 ◽

pp. 1279-1287 ◽

Cited By ~ 3

Author(s):

Izabella Uchmanowicz ◽

Beata Jankowska-Polańska ◽

Krzysztof Dudek ◽

Krystyna łoboz-Grudzień

Keyword(s):

Quality Of Life ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Sex Differences ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary

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SEX DIFFERENCES IN CLINICAL OUTCOMES AFTER PREMATURE ACUTE CORONARY SYNDROME

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2015.07.042 ◽

2015 ◽

Vol 31 (10) ◽

pp. S13

Author(s):

J. Choi ◽

N. Winters ◽

R. Pelletier ◽

M. Eisenberg ◽

S. Bacon ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Sex Differences ◽

Clinical Outcomes ◽

Coronary Syndrome

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Abstract 16660: Gender Disparities in the Presentation, Management and Outcomes of Patients With Acute Coronary Syndrome: Insights From the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) Trial

Circulation ◽

10.1161/circ.142.suppl_3.16660 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Haitham Khraishah ◽

Sun Young Jeong ◽

barrak alahmad ◽

Abdulhamied Alfaddagh ◽

Njambi Mathenge ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Sex Differences ◽

Delayed Presentation ◽

Cvd Risk ◽

Middle Income ◽

Variable Effect ◽

Random Effects Models ◽

Killip Class ◽

Coronary Syndrome ◽

Relative Risks

Introduction: Despite the increasing interest in sex differences in acute coronary syndrome (ACS) presentation, management, and outcomes in high-income countries, reports on such differences from low- and middle-income countries (LMICs) are limited. Limited resources in LMICs may worsen health disparities experienced by women and vulnerable populations. Methods: Using ACS QUIK trial database, we examined sex-differences in terms of baseline characteristics, management received, and relevant clinical outcomes of 21,374 patients presenting with ACS. The main outcomes were the rates of in-hospital and 30-day composite of death, reinfarction, stroke, and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing females to males. We used random intercepts for different hospitals and centers as the clustering variable. Effect measure modification by baseline variables was examined by restricting the analysis to each category and comparing the effect estimates for females to males. Results: A total of 5,191 (24.3%) patients were women. Compared to men, women presenting with ACS were older (65±12 vs 58±12 years; p < 0.001), more likely to have hypertension (61.2% vs 42.4%; p < 0.001), and diabetes mellitus (53.5% vs 41.4%; p < 0.001). After symptom onset, women tended to present later to the hospital (medians, 300 vs 238 mins; p < 0.001) and had higher Killip class on presentation (17.8% vs 12.3%; p < 0.001). Women presenting with STEMI were less likely to receive primary PCI (45.9% vs 49.8% of men, p <0.001) and had longer median door-to-balloon times (medians, 90 vs 80 mins for men; p <0.001). Compared to men, women were 53% more likely to experience in-hospital MACE (adjusted RR = 1.53; 95% CI, 1.32-1.77; p<0.001), and 39% higher risk of 30-day MACE (adjusted RR = 1.39; 95% CI, 1.65-2.07, p <0.001). Conclusion: In summary, our study confirms a higher CVD risk profile, delayed presentation, suboptimal medical care in women presenting with ACS in Kerala, India. Women were also found to have higher in-hospital and 30-day MACE, even after adjustment for potential confounders.

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Sex Differences in Radial Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome Are Independent of Body Size

Heart Lung and Circulation ◽

10.1016/j.hlc.2020.06.023 ◽

2021 ◽

Vol 30 (1) ◽

pp. 108-114 ◽

Cited By ~ 1

Author(s):

Julia Stehli ◽

Stephen J. Duffy ◽

Youlin Koh ◽

Catherine Martin ◽

Angela Brennan ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Sex Differences ◽

Body Size ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Radial Access ◽

Percutaneous Coronary

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Sex Differences in the Risk of Developing Acute Coronary Syndrome in Patients With Sleep Disorders: A Population-Based Cohort Study

American Journal of Men s Health ◽

10.1177/1557988316651260 ◽

2016 ◽

Vol 11 (5) ◽

pp. 1560-1568

Author(s):

Wei-Sheng Chung ◽

Hsuan-Hung Lin

Keyword(s):

Acute Coronary Syndrome ◽

Sex Differences ◽

Cohort Study ◽

Sleep Disorders ◽

Population Based ◽

Coronary Syndrome ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Regression ◽

Middle Aged Adults

Studies that focus on the relationship between sex and the risk of acute coronary syndrome (ACS) are scant. The current study investigated the effects of sex differences in the risk of developing ACS in patients with sleep disorders (SDs). This longitudinal population-based cohort study evaluated the incidence and risk of ACS development in 40,232 men and 65,519 women newly diagnosed with SDs between 2002 and 2008 from the Longitudinal Health Insurance Database. The follow-up period began from the entry date and ended on the date of an ACS event or December 31, 2010. Univariable and multivariable Cox proportional hazard regression models were conducted to estimate the sex differences in the risk of ACS. Men with SDs exhibited an increased incidence of ACS compared with women with SDs in all age- and comorbidity-specific subgroups. After covariates were adjusted, the men with SDs exhibited a 1.48-fold adjusted hazard ratio (aHR) of ACS compared with the women with SDs (95% confidence interval [CI] = 1.36-1.60). After age group stratification, the men with SDs in the young adult group exhibited the highest risk of subsequent ACS development compared with the women with SDs (aHR = 2.07, 95% CI = 1.69-2.55), followed by those in middle-aged adults (aHR = 1.52, 95% CI = 1.32-1.76) and older adults groups (aHR = 1.24, 95% CI = 1.11-1.39). This study determined that men with SDs, particularly young men, are at a higher risk of subsequent ACS development compared with women with SDs.

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