Sex-related characteristics in hospitalized patients with acute coronary syndromes – the Greek Study of Acute Coronary Syndromes (GREECS)

Abstract

We studied the sex-specific distribution of various factors in hospitalized patients who presented with acute coronary syndromes (ACS), as well as the annual incidence and the in-hospital and short-term outcomes in males and females. A sample of six hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all nonfatal admissions with a first event of ACS, from October 2003 to September 2004. Sociodemographic, clinical, dietary, and other lifestyle characteristics were recorded. A total of 2,172 patients were included in the study (1,649, 76% male and 523, 24% female). The annual incidence rate was almost three times higher in males than in females (34 per 10,000 males and 10.9 per 10,000 females). The highest frequency of events was observed in winter, in both sexes. Females had higher in-hospital mortality rate as compared to males (5.7% vs 3.2%, P = 0.007), while the 30-day mortality and rehospitalization rate was 17% in male and 16% in female patients. The most common discharged diagnosis for males was Q-wave myocardial infraction (35%), while females were more likely to suffer from unstable angina (42%). Females were older than males, waited longer between seeking and receiving medical advice, and were more likely to have a history of hypertension, obesity, and diabetes mellitus as compared to males. On the other hand, males were more likely to be smokers, to follow a more typical Mediterranean diet, and to be more physically active (P < 0.05). We revealed a sex-related difference in the profile of clinical characteristics and other cardiovascular risk factors in hospitalized patients for ACS.

Coronary vessels and cardiac myocytes of middle-aged rats demonstrate regional sex-specific adaptation in response to postmyocardial infarction remodeling

“…Therefore, our study is the first to conduct a side-by-side comparison of the global and regional patterns of LV remodeling between post-MI male and female middle-aged rats. We focused specifically on middle-aged animals because this age group, along with older individuals, corresponds to a human population, including both sexes, which are most vulnerable for myocardial ischemia and infarction [17,18,33,34]. We also chose to evaluate the hearts at the end of the first post-MI month because it usually represents a compensated phase of the infarct-induced LV remodeling process.…”

Gender‐specific aspects in the clinical presentation of cardiovascular disease

“…Particularly, diabetes is an independent predictor of ‘atypical’ presentation of acute myocardial infarction in women [33]. This atypical presentation of CAD causes a delay in diagnosis and treatment in women [34,35] and may lead to worse outcomes characterized by increased hospital morbidity, higher mortality and fewer evidence‐based therapies, including revascularization, anticoagulation, β‐blockade, statins and antiplatelet agents [36]. As demonstrated by the Global registry of Acute Coronary Events (GREECS) study, patients with ST‐segment elevation myocardial infarction were less likely to receive percutaneous coronary intervention or fibrinolysis if their symptoms were atypical [34].…”

Socioeconomic status, cardiovascular disease and health care services: highlighting the gender gap

“…Women are reported to wait longer between seeking and receiving medical advice; for example, there is evidence showing that women arrive 1 h later at hospital than men [9,10]. At the same time, female patients are susceptible to under-diagnosis and inappropriate therapeutic decisions, or even remain untreated because physicians usually underestimate their risk burden [11,12]. The striking part here is that all these observations have been revealed irrespective of women's SES.…”