Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease
Background It is still unknown whether traditional risk factors may have a sex‐specific impact on coronary artery disease (CAD) burden. Methods and Results We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS‐TC (International Survey of Acute Cor...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.017235 |
| _version_ | 1819175108883775488 |
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| author | Olivia Manfrini Jinsung Yoon Mihaela van der Schaar Sasko Kedev Marija Vavlukis Goran Stankovic Marialuisa Scarpone Davor Miličić Zorana Vasiljevic Lina Badimon Edina Cenko Raffaele Bugiardini |
| author_facet | Olivia Manfrini Jinsung Yoon Mihaela van der Schaar Sasko Kedev Marija Vavlukis Goran Stankovic Marialuisa Scarpone Davor Miličić Zorana Vasiljevic Lina Badimon Edina Cenko Raffaele Bugiardini |
| author_sort | Olivia Manfrini |
| collection | DOAJ |
| description | Background It is still unknown whether traditional risk factors may have a sex‐specific impact on coronary artery disease (CAD) burden. Methods and Results We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries; ClinicalTrials.gov, NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between traditional risk factors and severity of CAD and its relationship with 30‐day mortality. Relative risk (RR) ratios and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Estimates were compared by test of interaction on the log scale. Severity of CAD was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD. The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49 (95% CI, 0.41–0.60) and among those with diabetes mellitus was 0.89 (95% CI, 0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95% CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex‐related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30‐day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with nonobstructive CAD. Conclusions Obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01218776. |
| first_indexed | 2024-12-22T20:49:38Z |
| format | Article |
| id | doaj.art-aea784673c614796811dec83dbe220a6 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:49:38Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-aea784673c614796811dec83dbe220a62022-12-21T18:13:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.017235Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery DiseaseOlivia Manfrini0Jinsung Yoon1Mihaela van der Schaar2Sasko Kedev3Marija Vavlukis4Goran Stankovic5Marialuisa Scarpone6Davor Miličić7Zorana Vasiljevic8Lina Badimon9Edina Cenko10Raffaele Bugiardini11Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna ItalyDepartment of Electrical and Computer Engineering University of California Los Angeles CACambridge Centre for Artificial Intelligence in Medicine Department of Applied Mathematics and Theoretical Physics and Department of Population Health University of Cambridge Cambridge United KingdomUniversity Clinic of Cardiology Medical Faculty University "Ss. Cyril and Methodius" Skopje MacedoniaUniversity Clinic of Cardiology Medical Faculty University "Ss. Cyril and Methodius" Skopje MacedoniaClinic of Cardiology University Clinical Centre of Serbia Belgrade SerbiaDepartment of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna ItalyDepartment for Cardiovascular Diseases University Hospital Center Zagreb University of Zagreb CroatiaMedical Faculty University of Belgrade SerbiaCardiovascular Research Program ICCC, IR‐IIBSant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV‐Institute Carlos III Barcelona SpainDepartment of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna ItalyDepartment of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna ItalyBackground It is still unknown whether traditional risk factors may have a sex‐specific impact on coronary artery disease (CAD) burden. Methods and Results We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries; ClinicalTrials.gov, NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between traditional risk factors and severity of CAD and its relationship with 30‐day mortality. Relative risk (RR) ratios and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Estimates were compared by test of interaction on the log scale. Severity of CAD was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD. The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49 (95% CI, 0.41–0.60) and among those with diabetes mellitus was 0.89 (95% CI, 0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95% CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex‐related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30‐day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with nonobstructive CAD. Conclusions Obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01218776.https://www.ahajournals.org/doi/10.1161/JAHA.120.017235conventional risk factorsdiabetes mellitusobstructive coronary artery diseasesex differencessmoking |
| spellingShingle | Olivia Manfrini Jinsung Yoon Mihaela van der Schaar Sasko Kedev Marija Vavlukis Goran Stankovic Marialuisa Scarpone Davor Miličić Zorana Vasiljevic Lina Badimon Edina Cenko Raffaele Bugiardini Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease conventional risk factors diabetes mellitus obstructive coronary artery disease sex differences smoking |
| title | Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease |
| title_full | Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease |
| title_fullStr | Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease |
| title_full_unstemmed | Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease |
| title_short | Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease |
| title_sort | sex differences in modifiable risk factors and severity of coronary artery disease |
| topic | conventional risk factors diabetes mellitus obstructive coronary artery disease sex differences smoking |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.017235 |
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