Although the leading cause of death of women and men is heart disease, a large, recent study suggests women are far less likely to undergo a potentially life-saving procedure than men.
According to the Centers for Disease Control and Prevention about 18.2 million adults over the age of 20 have coronary heart disease (CAD) in the US. CAD is a condition whereby major arteries that feed blood to the heart become blocked with fatty deposits. As deposits build and block the artery, the amount of blood—and oxygen—reaching the heart is reduced.
When blood supply to the heart fails, so does the heart. According to estimates, a heart attack occurs in the US every 40 seconds. About 360,000 of those who suffer CAD die each year. There are a range of treatments for CAD, including lifestyle changes, medication, procedures like balloon angioplasty, stenting, and coronary artery bypass graft (CABG).
CABG is an open-chest procedure that requires stoppage of the heart in order to graft a blood vessel to the artery above and below the blockage. By grafting part of an artery from another part of the body to the heart muscle, oxygenated blood once again flows freely to the heart.
A recent study from Duke University and the Johns Hopkins School of Medicine looked at records of adult patients who underwent CABG for the first time between the years 2011 and 2019. The large-scale study took advantage of data from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD). By using the database, researchers were able to evaluate approximately 1.2 million procedures and review clinical, gender, demographic, and other information.
Study authors sought to understand the use of CABG procedures in men and women during the study period. The results of the study were presented at the annual meeting of The Society of Thoracic Surgeons. Overall, the study found women are 14 to 22 percent less likely than men to undergo CABG interventions that provide complete revascularization (grafting) of blocked coronary arteries.
Of the results, lead researcher, Dr. Jawitz from Duke University noted, “With these findings, we did in fact see less aggressive treatment strategies with women. It is clear that sex disparities exist in all aspects of care for patients with coronary artery disease (CAD), including diagnosis, referral for treatment, and now, in surgical approaches to CABG. We must ensure that female patients undergoing CABG are receiving evidence-based, guideline-concordant techniques.”
Potential reasons for the disparity include:
- Less focus on cardiac issues and more focus on early diagnosis of breast cancer in women
- Differences in symptoms of heart disease in women which may not be caught as early as classic symptoms experienced by men
- Longer periods of time between onset of symptoms and medical diagnosis
- Failure to diagnose heart disease in a timely way to promote better surgical outcomes
Researchers also found women represent less than 40 percent of patients enrolled in clinical trials. Across the medical spectrum, lack of gender diversity in clinical studies leads to myopic data and treatment development around male symptoms and disease progression.
Said Dr. Jawitz “These findings will help inform the development of sex-specific guidelines for the diagnosis and management of cardiovascular disease.” Let’s hope so.
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