The investigators found that women were more likely to develop cardiovascular disease after PCI coronary angioplasty, which included heart attack (myocardial infarction), nonfatal stroke, major bleeding events, and death.
There were a few key differences identified between the groups of men and women that could have motivated these findings, Hesselin says.
The group of women appeared to have higher rates of medical management of symptoms related to heart disease, according to the researchers. In the two weeks prior to PCI, the women were taking more antianginal treatments to relieve chest pain. “There was a statistically significant increase in the use of calcium channel blockers and nitrates, which relieve stress and increase blood flow to the heart,” Hesselin says.
Although these medications are fine, taking them is a lot like using Band-Aid without looking at the underlying cause of the chest pain, he adds.
In contrast, when men have these symptoms of chest pain, they are more likely to undergo imaging to look for plaque buildup and later procedure if necessary.
A deeper look into the differences between men and women
Women have more atypical symptoms, and it sometimes takes longer to undergo further investigation, says Laxmi Mehta, MD, professor and director of Preventive Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus. “This could be driven by the patient or by the doctor, possibly because they are older and the potential risks of the procedure,” says Dr. Mehta.
Heslin says the procedure may also be used less frequently in women because it isn’t helpful. “Women tend to have microvascular disease — problems with the small vessels — and a lower incidence of large, clogged fatty plaques. These cannot be seen on these images of the arteries that supply the heart.
These factors often cause women to develop PCI urgently after they come to the emergency room for a heart attack that can lead to further complications, Heslin says.
Related: Many women and their doctors do not recognize the symptoms of a heart attack in women
Women are more likely to die after a heart attack than men
Cardiovascular disease is the leading cause of death 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 management guidelines are the same, women’s mortality rates are greater than 30 days and 1 year for acute coronary syndrome (ACS), a group of conditions caused by a sudden decrease in blood flow to the heart, including heart attack, according to A study published in January 2017 in American Journal of Cardiology.
Heslin, co-author of the research, says there are a few factors that may contribute to this disparity. “Women are usually about 5 years older and have more comorbidities when they have a heart attack, including high blood pressure and diabetes,” Heslin says. He adds that there is also research indicating that women are treated at discharge and are less likely to receive optimal medical treatment in one year.
Post-procedure treatment shows more parity between men and women
Medical treatment directed at secondary prevention after a heart attack is exactly the same for men and women, and includes four types of medications: aspirin, statins, ACE inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs), and beta blockers, Heslin says.
“Some of the previous data show differences in medications 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 to receive treatments recommended by men, according to one study. Analysis published by the American College of Cardiology.
“This research uses more recent data from those studies, and shows that women were prescribed the same amount of all the drugs,” Mehta says. “This is reassuring and a good sign that we are making progress in this way in terms of getting out of medical treatment.”
Next steps in the search
“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.
She adds that more information, such as the age difference between these patients, as well as differences in symptoms, will help give more context to these findings. “Sometimes, differences in symptoms can be the reason women develop later; they don’t have the classic symptoms we used to think of.”
Heslin says next steps in the research could include using data like this to create more accurate risk models for women.
“We also need more understanding of the relationship between delayed diagnosis of coronary artery disease and increased complications in women after PCI. The increased risk in women of a major bleeding event is of particular interest because this is a major driving force for serious complications,” he says.
