Mark Heslin, an MD candidate at the Cooper Medical School of Rowan University in Camden, New Jersey, reviewed treatment differences in men and women who underwent PCI at Cooper University Hospital from January 2014 to May 2018. PCI is a nonsurgical procedure that uses a catheter to place a stent in a narrowing coronary artery to restore blood flow to the heart. The researchers analyzed data from 5,872 men and 2,681 women before, during, and after the procedure. There was no significant difference between the male and female groups in smoking status, prevalence of dyslipidemia, or family history of premature coronary artery disease, though on average, the women were older and had a higher prevalence of hypertension and diabetes, according to Heslin. Their research was presented in March 2020 at the American College of Cardiology conference. There were a few key differences identified between the groups of men and women that could potentially be driving these outcomes, says Heslin. The women’s group appeared to have higher rates of medical management for heart disease–related symptoms, according to researchers. In the two weeks before the PCI, women were taking more antianginal therapies to relieve chest pain. “There was a statistically significant increased use of calcium channel blockers and nitrates, which relieve stress and increase blood flow to the heart,” says Heslin. Although these are good drugs, taking them is more like using a Band-Aid without looking at the underlying cause of the chest pain, he adds. In contrast, when men have these chest pain symptoms, they are more likely to have imaging done to look for plaque buildup and a subsequent procedure if necessary.
A Deeper Look Into the Differences Between Men and Women
Women do have more atypical symptoms and it sometimes takes longer for them to undergo further investigation, says Laxmi Mehta, MD, a cardiologist, professor, and director of Preventive Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus. “That could be patient-driven or physician-driven, and potentially because they are older and the potential risks of the procedure,” says Dr. Mehta. The procedure may also be used less in women because it’s not as helpful, says Heslin. “Women tend to have more microvascular disease — problems in the little smaller vessels — and less of the big obstructive fatty plaques. These really can’t be seen on these pictures of the arteries supplying the heart,” he says. These factors often lead to women having a PCI urgently after they’ve come to the emergency room with a heart attack which can lead to more complications, says Heslin. RELATED: Many Women, And Their Doctors, Don’t Recognize Female Heart Attack Symptoms
Women More Likely to Die After a Heart Attack Than Men
Cardiovascular disease is the leading cause of mortality for women in the United States, accounting for 299,578, or about 1 in 5 female deaths in 2017, according to the Centers for Disease Control and Prevention (CDC). Although the management guidelines are the same, women have higher 30-day and one-year mortality rates related to acute coronary syndrome (ACS), a range of conditions brought on by the sudden reduction in blood flow to the heart, including a heart attack, according to a study published in January 2017 in the American Journal of Cardiology. There are a few factors that may be contributing to this disparity, says Heslin, coauthor of the research. “Women are usually older by almost 5 years and have more comorbidities when they have a heart attack, including hypertension and diabetes,” says Heslin. There’s also research that indicates women are being undertreated at discharge and are less likely to be on optimal medical therapy at one year, he adds.
Post Procedure Treatment Shows More Parity for Men and Women
The guideline directed medical therapy for secondary prevention after heart attack is exactly the same for men and women, and includes four types of medication: aspirin, statins, angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin-receptor blockers (ARB), and beta-blockers, says Heslin. “Some previous data shows differences in medication at discharge based on gender even though the guidelines are the same,” says Mehta. Studies have consistently shown that after a heart attack, women are less likely than men to receive guideline-recommended therapies, according to an analysis published by the American College of Cardiology. “This research uses more recent data than those studies, and it shows that women were being prescribed the same amount of all the drugs,” says Mehta. “That’s reassuring and a good sign that we are making progress in this way in terms of discharge medical therapy.”
Next Steps in Research
“This research adds to what we know about women having worse outcomes after cardiac events, and I look forward to seeing all the data once this study is published,” says Mehta. More information, such as the age difference of these patient populations, as well as differences in symptoms will help give more context to these findings, she adds. “Sometime symptom differences can be why women present later; they don’t have the classic symptoms that we’re so used to thinking of.” Next steps in research could include using data like this to create more accurate risk models for women, says Heslin. “We also need to further understand the relationship between the delay of a diagnosis of coronary artery disease and the increase of complications among women after PCI. Women’s increased risk of a major bleeding event is particularly important as this is a significant driving force for serious complications,” he says.
