Women and men should receive similar treatment decisions for heart disease, study argues

March 9, 2018 by Iqbal Pittalwala, University of California - Riverside
Illustration of a typical coronary artery bypass surgery. A vein from the leg is removed and grafted to the coronary artery to bypass a blockage. Credit: Blausen Medical Communications, Inc

Women have conventionally been considered a risk factor for coronary artery bypass grafting (CABG), a type of open-heart surgery that improves blood flow to the heart. But a research paper by an international team of researchers, including two cardiologists at the University of California, Riverside, argues that sex should not influence treatment decisions about CABG.

Investigating the association of sex and the long-term benefit of CABG in male and female patients with ischemic enrolled in the STICH trial (Surgical Treatment for Ischemic Heart Failure Study), the largest surgical trial testing versus CABG in ischemic diseases affecting the heart muscles, the researchers found that sex is not associated with the effect of CABG on mortality due to all causes, cardiovascular mortality, cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction.

"Despite worse risk factors, women fared better than men in our study," said Dr. Ramdas G. Pai, a professor of cardiology at the UCR School of Medicine and a coauthor on the study published in Circulation and led by Dr. Ileana L. Piña of the Albert Einstein College of Medicine in New York. "The surgical complications were similar in both men and women. This refutes the prevailing myth that women do worse than men when they need CABG and must, therefore, be denied ."

The study involved 1,212 patients with ischemic left ventricular dysfunction, of which 148 were women. Roughly half the men and women were randomly selected and given CABG and medical therapy (MED); the rest were given MED alone. The researchers then compared the long-term (10-year) outcomes with each treatment according to sex.

"We wanted to explore the following questions in these patients: Is surgery beneficial? Should you take just medication? Or should that be supplemented by surgery?" said Pai, who chairs the Division of Clinical Sciences and Department of Internal Medicine. "We found that surgery was a far superior option for both men and women. Despite women having higher risk profile for heart disease than men, women do not have a higher surgical risk. Indeed, after 10 years of follow-up, women had better survival with surgery, with significantly lower rates of long-term all-cause mortality and than men. Therefore, sex should not influence their treatment decisions where CABG is concerned."

Generally, women are underrepresented in clinical trials. Data based on predominantly male subjects in cardiovascular clinical trials have been extrapolated to women. Coronary heart disease, widely seen as a problem for men, resulted in women being understudied, underdiagnosed, and undertreated.

"We all need to recognize that the female heart is vulnerable to coronary heart disease and that appropriate intervention, such as CABG, has the potential to delay or avert coronary events," Pai said. "Even when signs are present, women often do not get medical attention. And when they get medical attention, their physicians may not consider them for surgery. Physicians should consider them to be appropriate surgical candidates."

Explore further: CABG may be best for patients with DM, LV dysfunction

Related Stories

CABG may be best for patients with DM, LV dysfunction

February 27, 2018
(HealthDay)—Coronary artery bypass grafting (CABG) is associated with a significant reduction in major adverse cardiac and cerebrovascular events and mortality compared with percutaneous coronary intervention (PCI) among ...

Study results show bypass surgery extends lives of patients with heart failure

April 5, 2016
Scientists funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health have found that a greater number of patients with coronary artery disease may benefit from coronary artery bypass ...

CABG may be best method to revascularize in diabetes

December 12, 2017
(HealthDay)—In patients with diabetes and multivessel coronary artery disease (MV-CAD), coronary artery bypass grafting (CABG) may be the preferred method of revascularization, with lower rates of major adverse cardiac ...

On-pump CABG leads to higher rates of five-year survival

August 18, 2017
(HealthDay)—Five years after coronary-artery bypass grafting (CABG) surgery, patients whose operation was performed with cardiopulmonary bypass (on pump) lived longer than those whose surgeons performed the procedure without ...

Coronary artery bypass surgery effective in patients with type 1 diabetes

August 28, 2017
Coronary artery bypass surgery (CABG) is the best method of treating artherosclerotic coronary arteries in diabetes patients with multivessel disease, even in the presence of type 1 diabetes, a new study from Karolinska Institutet ...

Risk of infection higher for patients with obesity after bypass surgery

June 19, 2017
Patients with obesity have a higher risk of infection within 30 days after receiving heart bypass surgery, according to a series of studies conducted by University of Alberta researchers at the Faculty of Rehabilitation Medicine.

Recommended for you

New cellular pathway helps explain how inflammation leads to artery disease

June 21, 2018
Investigators have identified a new cellular pathway that may help explain how arterial inflammation develops into atherosclerosis—deposits of cholesterol, fats and other substances that create plaque, clog arteries and ...

'Smart stent' detects narrowing of arteries

June 19, 2018
For every three individuals who have had a stent implanted to keep clogged arteries open and prevent a heart attack, at least one will experience restenosis—the renewed narrowing of the artery due to plaque buildup or scarring—which ...

Marriage may protect against heart disease / stroke and associated risk of death

June 18, 2018
Marriage may protect against the development of heart disease/stroke as well as influencing who is more likely to die of it, suggests a pooled analysis of the available data, published online in the journal Heart.

Deaths from cardiac arrest are misclassified, overestimated

June 18, 2018
Forty percent of deaths attributed to cardiac arrest are not sudden or unexpected, and nearly half of the remainder are not arrhythmic—the only situation in which CPR and defibrillators are effective—according to an analysis ...

Tick-borne meat sensitivity linked to heart disease

June 15, 2018
University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat—a sensitivity spread by tick bites—with a buildup of fatty plaque in the arteries of the heart. This buildup may ...

Tobacco aside, e-cigarette flavorings may harm blood vessels

June 14, 2018
Flavor additives used in electronic cigarettes and related tobacco products could impair blood vessel function and may be an early indicator of heart damage, according to new laboratory research in Arteriosclerosis, Thrombosis ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.