Women and men with stable coronary artery disease: different risk factors but similar outcomes!

Abstract

Men and women differ in terms of presentation and management in coronary artery disease (CAD). In recent years many clinical trials have provided evidence that there are substantial gender differences in the pathophysiology, clinical presentation, diagnosis, and treatment of CAD [1][2][3][4][5]. Although women have a higher atherosclerotic burden, they are more symptomatic and have a lower prevalence of obstructive CAD than men [6][7][8][9][10].Whether these gender differences translate into different clinical outcomes in stable CAD has been unclear. While some reports found gender differences in outcomes for stable angina or acute coronary syndromes, others did not [11][12][13][14][15]. Furthermore, most contemporary studies of CAD patients are limited to a single country or specific geographical region, or a particular manifestation of disease such as angina symptoms or acute myocardial infarction [16][17][18]. Recently, dr. Gabriel Steg et al. (Paris, France) analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD [19]. CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an ongoing international prospective observational longitudinal registry in 33,000 patients with stable CAD in 45 countries. One-year outcomes were analysed in 30,977 outpatients with stable CAD of whom 23,975 (77.4 %) were men and 7002 (22.6 %) were women. Based on risk profiles, women were older than men, were more likely to have hypertension and diabetes, did less exercise and smoked less. Women had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimised treatment for stable CAD. However, 1-year outcomes were similar for men and women: 1) for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke (1.7 vs. 1.8 %, respectively), 2) all-cause death (1.5 vs. 1.6 %), 3) fatal or non-fatal myocardial infarction (1.0 vs. 0.9 %,), and 4) cardiovascular death or non-fatal myocardial infarction (1.4 vs. 1.4 %,). Fewer women underwent revascularisation (2.6 vs. 2.2 %).It was concluded by the authors that, although the risk profiles of women and men with stable CAD differed substantially, the 1-year outcomes were similar in terms of mortality and cardiovascular events. These results suggest that there is no discernible excess of cardiovascular events in women with stable CAD compared with men and that, if anything, among younger patients or lower risk patient groups, women actually fare better than men.The study has been criticised by dr. Eva Swahn (Stockholm, Sweden) in an accompanying Editorial comment [20]. Her main critical comments were the following. First, the patients seem to be highly selected, as only 22.6 % were women and, according to epidemiological investigations, the prevalence is usually the same and in fact even slightly higher in women with angina. As the physicians involve...