Women with stable CAD have similar 1-year major cardiovascular event rates compared to men.
Why the study?
Men and women differ in coronary artery disease presentation and management, but whether these differences translate into different clinical outcomes in stable CAD is unclear.
Do women with stable coronary artery disease have different clinical outcomes compared to men?
Population
30 977 outpatients with stable CAD
Comparison
Women vs men
Design
International prospective registry study
Follow-up
1 year
Key result
Women with stable CAD had similar 1-year rates of cardiovascular death, non-fatal MI, or stroke compared to men (adjusted rates 1.8% vs 1.7%; OR 0.93, 95% CI 0.75-1.15).
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“For the first time, we can see that many patients with CAD have too high resting heart rate levels, and combined internal evidence from CLARIFY and external evidence from prior sources indicate that this is associated with worse symptoms and worse clinical outcomes. These findings suggest tighter control of baseline heart rate with heart-rate-lowering medications may benefit CAD patients by improving symptom control and outcomes.”
Overview
Similar 1-year outcomes in men and women with stable CAD despite management differences; challenges assumptions of inherent disparities and leaves open need for sex-specific strategies.
Key Points
- To determine whether sex-based differences in presentation and clinical management translate into divergent one-year cardiovascular outcomes among patients with stable coronary artery disease.
- Analyzed one-year follow-up data from the international prospective CLARIFY registry of 30,977 outpatients with stable CAD (23,975 men [77.4%] and 7,002 women [22.6%]).
- Compared baseline risk factors, clinical presentation, diagnostic evaluations, medical therapies, and adjusted clinical endpoints between sexes.
- The primary composite outcome of cardiovascular death, non-fatal myocardial infarction, or stroke occurred in 1.7% of men versus 1.8% of women (adjusted OR 0.93, 95% CI: 0.75–1.15).
- All-cause mortality (adjusted 1.5% in men vs. 1.6% in women, OR 0.91, 95% CI: 0.72–1.13) and fatal or non-fatal myocardial infarction (adjusted 1.0% vs. 0.9%, OR 0.81, 95% CI: 0.60–1.08) did not differ significantly.
- Significantly fewer women underwent coronary revascularization compared with men (2.2% vs. 2.6%, OR 0.77, 95% CI: 0.64–0.93) despite women reporting higher rates of angina and having more comorbidities.
Study Design
Type
Cohort (n=30,977)
Multicenter
Yes
Structured PICO
Do women with stable coronary artery disease have different clinical outcomes compared to men?
P
Population
30,977 outpatients with stable coronary artery disease (22.6% women) followed for 1 year.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
Composite of cardiovascular death, non-fatal myocardial infarction, or stroke at 1 yearcomposite
Main Result
Odds Ratio: 0.93 (95% CI 0.75–1.15)
Absolute Event Rate: 1.8% vs 1.7%
Despite differences in risk profiles and less optimized treatment, women and men with stable coronary artery disease have similar 1-year cardiovascular outcomes, though women undergo fewer revascularizations.
Limitations
- Appropriateness of revascularization was not analysed
Cite This Study
Steg et al. (2012) conducted a cohort in stable coronary artery disease (n=30,977). Female sex vs. Male sex was evaluated on composite of cardiovascular death, non-fatal myocardial infarction, or stroke (OR 0.93, 95% CI 0.75-1.15). Women with stable CAD had similar 1-year rates of cardiovascular death, non-fatal MI, or stroke compared to men (adjusted rates 1.8% vs 1.7%; OR 0.93, 95% CI 0.75-1.15).