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Coronary Artery Disease: The Role of Sex

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 18941

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Prof. Dr. Manuel Martínez-Sellés

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1. Cardiology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 16, 28007 Madrid, Spain
2. Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
Interests: coronary artery disease; heart failure; heart transplant; endocarditis; aortic stenosis; sex influence in cardiovascular conditions
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Dear Colleagues,

Coronary artery disease is the leading cause of death. Sex has a significant influence on the etiology, clinical manifestation, diagnosis, treatment, and prognosis of this condition. Numerous reports suggest sex-related differences in atherosclerosis and in plaque ocurrence, distribution, morphology, and composition. In addition, men and women have different presentations of coronary artery disease, with atypical symptoms more frequent in women as is myocardial infarction with nonobstructive coronary arteries. Men usually develop coronary artery disease 15 years earlier than women. Further, the prevalence and influence of risk factors and comorbidities is different in men and in women. Women’s significant protection against coronary artery disease during their reproductive years is multifactorial and explains the increased risk of cardiovascular events found in postmenopausal females. Women are frequently underdiagnosed or have a delay in diagnosis; suboptimal therapy is also more common in women, and some of these factors might explain why women have a poorer outcome than men. Women are also at a higher risk for adverse cardiac events following percutaneous coronary intervention compared to men. Various factors, such as old age, higher prevalence of comorbidities, and misdiagnosis or delayed recognition of ischemia, have been considered to account for the worse clinical outcomes of coronary artery disease in women than in men. However, biological intrinsic sex differences probably play a role.

Prof. Dr. Manuel Martínez-Sellés
Guest Editor

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Keywords

coronary artery disease
ischemic heart disease
sex
gender
prognosis

Published Papers (7 papers)

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Editorial

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4 pages, 218 KiB

Open AccessEditorial

Sex, Lies, and Coronary Artery Disease

by Helena Martínez-Sellés, David Martínez-Sellés and Manuel Martínez-Sellés

J. Clin. Med. 2021, 10(14), 3114; https://doi.org/10.3390/jcm10143114 - 15 Jul 2021

Cited by 2 | Viewed by 1757

Abstract

Epidemiological and clinical data have shown clear differences in several aspects of cardiovascular disease, particularly in the case of coronary artery disease (CAD), between men and women, including risk factors, response to therapy, quality of care, and natural history.[...] Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

Research

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12 pages, 1176 KiB

Open AccessArticle

Sex Differences in Characteristics and Outcomes among Low-Risk Non-ST-Elevation Acute Coronary Syndrome Patients during Long Term Follow-Up

by Ivica Kristić, Andrija Matetic, Nikola Crnčević, Frane Runjić, Ozren Polašek and Mislav Vrsalovic

J. Clin. Med. 2021, 10(13), 2802; https://doi.org/10.3390/jcm10132802 - 25 Jun 2021

Cited by 3 | Viewed by 1730

Abstract

Previous heterogenous studies show conflicting data about sex-based outcomes of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. This study evaluated 300 NSTE-ACS patients undergoing a coronary angiography between September 2012 and May 2015 that were managed with all-treatment strategies. The sample was stratified by sex and analyzed for the baseline characteristics and outcomes. The main outcome included major adverse cardiovascular and cerebrovascular events (MACCE), which were a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. The female patients were older (median of 69.0 vs. 63.0 years, p = 0.008) and had lower values of BMI (median of 26.3 vs. 28.2 kg/m², p < 0.001) and eGFR (76.44 ± 22.43 vs. 94.04 ± 27.91 mL/min, p < 0.001). There was no significant difference in the treatment strategies, angiographic characteristics and discharge therapy between the groups (p > 0.05). The female patients had significantly higher unadjusted rates of ischemic stroke (4.2% vs. 0.5%, p = 0.023), cardiac mortality (11.3%, vs. 3.9%, p = 0.022) and MACCE (33.8%, vs. 19.5%, p = 0.014); female sex was a significant predictor of MACCE in the univariate analysis (HR 1.86, 95%CI 1.12–3.09, p = 0.014); and the cumulative incidence of MACCE was higher in female patients (p = 0.014). After the adjustment, the predictive effect of female sex became non-significant (HR 1.60, 95%CI 0.94–2.73, p = 0.083), while there was no difference in the cumulative incidence of MACCE among the propensity score matched cohort (p = 0.177). Female NSTE-ACS patients have worse long-term outcomes compared to their male counterparts. However, the differences disappear after adjustment and propensity score matching. Continuing efforts and health measures are required to alleviate any sex-based differences in the NSTE-ACS population. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

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12 pages, 1632 KiB

Open AccessArticle

Major Left Bundle Branch Block and Coronary Heart Disease—Are There Any Differences between the Sexes?

by Diana Gurzău, Alexandra Dădârlat-Pop, Bogdan Caloian, Gabriel Cismaru, Horaţiu Comşa, Raluca Tomoaia, Dumitru Zdrenghea and Dana Pop

J. Clin. Med. 2021, 10(11), 2284; https://doi.org/10.3390/jcm10112284 - 25 May 2021

Viewed by 2722

Abstract

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

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11 pages, 898 KiB

Open AccessArticle

Ischemic Etiology and Prognosis in Men and Women with Acute Heart Failure

by Lourdes Vicent, Jose Guerra, Rafael Vazquez-García, José R. Gonzalez-Juanatey, Luis Martínez Dolz, Javier Segovia, Domingo Pascual-Figal, Ramón Bover, Fernando Worner, Juan Delgado, Francisco Fernández-Avilés and Manuel Martínez-Sellés

J. Clin. Med. 2021, 10(8), 1713; https://doi.org/10.3390/jcm10081713 - 15 Apr 2021

Cited by 7 | Viewed by 2110

Abstract

Coronary heart disease is common in heart failure (HF). Our aim was to determine the impact of ischemic etiology on prognosis among men and women with HF. This study is a prospective national multicenter registry. The primary endpoint was 12-month mortality. Patients with HF and ischemic heart disease were stratified according to sex. A total of 1830 patients were enrolled of which 756 (41.3%) were women. Ischemic etiology was more common in men (446 (41.6%)) than in women (167 (22.2%)). Among patients with ischemic HF, diabetes was more frequent in women than in men. Ischemic etiology was not associated with higher mortality risk, and this was true for women (Hazard Ratio [HR] 1.51, 95% Confidence Interval [CI] 0.98–2.32; p = 0.61) and men (HR 1.14, 95% CI 0.81–1.61; p = 0.46), p-value for interaction: 0.067. Mortality/readmission risk in ischemic HF increased in men with previous readmissions (HR 1.15, 95% CI 1.02–1.29; p = 0.022), chronic obstructive pulmonary disease (HR1.20, 95% CI 1.02–1.41; p = 0.026) and in women with diabetes (HR 2.23, 95% CI 1.05–4.47; p = 0.035). Ischemic etiology was not associated with mortality in HF patients. In ischemic HF, the variables associated with a poor prognosis were diabetes in women and previous readmissions and chronic obstructive pulmonary disease in men. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

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18 pages, 299 KiB

Open AccessArticle

The Role of Emotional Regulation and Affective Balance on Health Perception in Cardiovascular Disease Patients According to Sex Differences

by Bárbara Luque, Rosario Castillo-Mayén, Esther Cuadrado, Tamara Gutiérrez-Domingo, Sebastián J. Rubio, Alicia Arenas, Javier Delgado-Lista, Pablo Pérez Martínez and Carmen Tabernero

J. Clin. Med. 2020, 9(10), 3165; https://doi.org/10.3390/jcm9103165 - 30 Sep 2020

Cited by 8 | Viewed by 3383

Abstract

One of the challenges of aging is the increase of people with chronic diseases, such as cardiovascular disease (CVD). Men and women experience the disease differently. Therefore, it has an impact on how CVD is treated and its outcomes. This research analyzed the relationship between psychosocial variables and health promotion among cardiovascular patients, paying special attention to sex differences. A longitudinal study with cardiovascular patients (747 in phase 1 (122 women) and 586 in phase 2 (83 women)) was carried out. Participants were evaluated based on their sociodemographic characteristics, affective balance, regulatory negative affect self-efficacy, stress and anxiety regulation strategies, and perceived global health. Results showed that men presented significantly higher scores in positive affect, affective balance, and self-efficacy to regulate negative emotions, while women presented significantly higher scores in negative affect and the use of passive strategies to cope with stressful situations. Regression analyses showed that all psychological variables studied in phase 1 were significant predictors of health perception in phase 2. According to the results, it is necessary to include strategies to improve cardiovascular health through education and emotional regulation, with a gender focus. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

10 pages, 558 KiB

Open AccessArticle

Cardiogenic Shock Clinical Presentation, Management, and In-Hospital Outcomes in Patients Admitted to the Acute Cardiac Care Unit of a Tertiary Hospital: Does Gender Play a Role?

by Adrian Jerónimo, Marcos Ferrández-Escarabajal, Carlos Ferrera, Francisco J. Noriega, Jesús Diz-Díaz, Rodrigo Fernández-Jiménez, Angela McInerney, Antonio Fernández-Ortiz and Ana Viana-Tejedor

J. Clin. Med. 2020, 9(10), 3117; https://doi.org/10.3390/jcm9103117 - 27 Sep 2020

Cited by 4 | Viewed by 2590

Abstract

Cardiogenic shock (CS), as the most severe form of heart failure, is associated with very high mortality rates despite therapeutic advances in the last decades. Gender differences in outcomes have been widely reported regarding several cardiovascular diseases. The aim of our study was to evaluate potential gender disparities in clinical presentation, management, and in-hospital outcomes of all (n = 138) patients admitted to the Acute Cardiac Care Unit of a tertiary hospital from 2013 to 2019. Information on demographic characteristics, past medical history, haemodynamic and clinical status at admission, therapeutic management, and in-hospital outcomes was retrospectively collected. Women represented 31.88% of the cohort, were significantly older than the men and had a lower proportion of smokers, chronic obstructive pulmonary disease, and previous acute myocardial infarction (AMI). Most CSs in both groups were AMI-related. Left ventricular ejection fraction at admission was higher in women, who were less likely to receive vasopressors. No differences were observed regarding mechanical circulatory support use and in-patient outcomes, with age being the only factor associated with in-hospital mortality on multivariate analysis. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

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13 pages, 1999 KiB

Open AccessArticle

Observed and Expected Survival in Men and Women after Suffering a STEMI

by Isaac Pascual, Daniel Hernandez-Vaquero, Marcel Almendarez, Rebeca Lorca, Alain Escalera, Rocío Díaz, Alberto Alperi, Manuel Carnero, Jacobo Silva, Cesar Morís and Pablo Avanzas

J. Clin. Med. 2020, 9(4), 1174; https://doi.org/10.3390/jcm9041174 - 19 Apr 2020

Cited by 13 | Viewed by 3435

Abstract

Introduction: Mortality caused by ST elevation myocardial infarction (STEMI) has declined because of greater use of primary percutaneous coronary intervention (PCI). It is unknown if patients >75 have similar survival as peers. We aim to know it stratifying by sex and assessing how the sex may impact the survival. Methods: We retrospectively selected all patients >75 who suffered a STEMI treated with primary PCI at our institution. We compared their survival with that of the reference population (general population matched by age, sex, and geographical region). A Cox-regression analysis controlling for clinical factors was performed to know if sex was a risk factor. Results: Total of 450 patients were studied. Survival at 1, 3, and 5 years of follow-up for patients who survived the first 30 days was 91.22% (CI95% 87.80–93.72), 79.71% (CI95% 74.58–83.92), and 68.02% (CI95% 60.66–74.3), whereas in the reference population it was 93.11%, 79.10%, and 65.01%, respectively. Sex was not a risk factor, Hazard Ratio = 1.02 (CI95% 0.67-1.53; p = 0.92). Conclusions: Life expectancy of patients suffering a STEMI is nowadays intimately linked to survival in the first 30 days. After one year, the risk of death for both men and women seems similar to that of the general population. Full article

(This article belongs to the Special Issue Coronary Artery Disease: The Role of Sex)

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