Sex disparity in subsequent outcomes in survivors of coronary heart disease.

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  • Additional Information
    • Source:
      Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BMJ Pub. Group, c1996-
    • Subject Terms:
      Coronary Disease*/epidemiology ; Heart Failure*/epidemiology ; Heart Failure*/etiology ; Myocardial Infarction* ; Stroke*/epidemiology ; Stroke*/etiology; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Risk Factors ; Survivors
    • Abstract:
      Objective: Evidence on sex differences in outcomes after developing coronary heart disease (CHD) has focused on recurrent CHD, all-cause mortality or revascularisation. We assessed sex disparities in subsequent major adverse cardiovascular events (MACE) in adults surviving their first-time CHD.
      Methods: Using a population-based cohort obtained from the Clinical Practice Research Datalink (CPRD GOLD) linked to hospitalisation and death records in the UK, we identified 143 702 adults (aged ≥18 years) between 1 January 1998 and 31 December 2017 with no prior history of MACE. MACE outcome was a composite of recurrent CHD, stroke, peripheral vascular disease, heart failure and cardiovascular-related mortality. Multivariable models (Cox and competing risks regressions) were used to assess differences between sexes.
      Results: There were 143 702 adults with any incident CHD (either angina, myocardial infarction or coronary revascularisation). Women (n=63 078, 43.9%) were older than men (median age, 73 vs 66 years). First subsequent MACE outcome was observed in 91 706 (63.8%). Women had a significantly lower risk of MACE (hazard ratio (HR), 0.68 (95% CI 0.67 to 0.69); sub-hazard ratio (HRsd), 0.71 (0.70 to 0.72), respectively) and recurrent CHD (n=66 543, 46.3%) (HR, 0.60 (0.59 to 0.61); HRsd, 0.62 (0.61 to 0.63)) when compared with men after incident CHD. However, women had a significantly higher risk of stroke (n=5740, 4.0%) (HR, 1.26 (1.19 to 1.33); HRsd, 1.32 (1.25 to 1.39)), heart failure (n=7905, 5.5%) (HR, 1.09 (1.04 to 1.15); HRsd, 1.13 (1.07 to 1.18)) and all-cause mortality (n=29 503, 20.5%) (HR, 1.05 (1.02 to 1.07); HRsd, 1.11 (1.08 to 1.13)).
      Conclusions: After incident CHD, women have lower risk of composite MACE and recurrent CHD outcomes but higher risk of stroke, heart failure, and all-cause mortality compared with men.
      Competing Interests: Competing interests: RKA currently holds an NIHR-SPCR funded studentship (2018-2021). SW is currently an employee of Janssen R&D. NQ was a member of the most recent NICE Familial Hypercholesterolaemia and Lipid Modification Guideline Development Groups (CG71 and CG181). NQ and SW have previously received honorarium from AMGEN. RSP has funding from the British Heart Foundation and the National Institute for Health Research. FWA is supported by UCL Hospitals NIHR Biomedical Research Centre. The remaining authors have no competing interests.
      (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Comments:
      Comment in: Heart. 2022 Jan;108(1):4-6. (PMID: 34667090)
    • Grant Information:
      FS/14/76/30933 United Kingdom BHF_ British Heart Foundation; United Kingdom DH_ Department of Health
    • Contributed Indexing:
      Keywords: competing risks; coronary heart disease; major adverse cardiovascular events; secondary prevention; sex difference
    • Publication Date:
      Date Created: 20210825 Date Completed: 20220429 Latest Revision: 20220429
    • Publication Date:
      20221213
    • Accession Number:
      10.1136/heartjnl-2021-319566
    • Accession Number:
      34429368