Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.

Publisher: Elsevier Country of Publication: United States NLM ID: 101467978 Publication Model: Print Cited Medium: Internet ISSN: 1876-7591 (Electronic) Linking ISSN: 18767591 NLM ISO Abbreviation: JACC Cardiovasc Imaging Subsets: MEDLINE

Original Publication: New York : Elsevier

Health Status Disparities* ; Healthcare Disparities* ; Heart Function Tests* ; Outpatients*; Angina Pectoris/*diagnosis ; Angina Pectoris/*epidemiology ; Coronary Artery Disease/*diagnosis ; Coronary Artery Disease/*epidemiology; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Comorbidity ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; North America ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Assessment ; Risk Factors ; Sex Factors

Objectives: The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD).
Background: Although established CAD presentations differ by sex, little is known about stable, suspected CAD.
Methods: The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression.
Results: Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men.
Conclusions: Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.

Comment in: JACC Cardiovasc Imaging. 2016 Apr;9(4):347-9. (PMID: 27017235)
Comment in: Nat Rev Cardiol. 2016 May;13(5):246. (PMID: 27053460)

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T32 HL076136 United States HL NHLBI NIH HHS; T32 HL069749 United States HL NHLBI NIH HHS; R01 HL098237 United States HL NHLBI NIH HHS; R01 HL098235 United States HL NHLBI NIH HHS; R01 HL098236 United States HL NHLBI NIH HHS; R01 HL098305 United States HL NHLBI NIH HHS

Date Created: 20160328 Date Completed: 20170117 Latest Revision: 20201216

20240829

PMC4982809

10.1016/j.jcmg.2016.02.001

27017234