Sex disparity in subsequent outcomes in survivors of coronary heart disease

Akyea, Ralph Kwame; Kontopantelis, Evangelos; Kai, Joe; Weng, Stephen F; Patel, Riyaz S; Asselbergs, Folkert W; Qureshi, Nadeem

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.

Citation

Akyea, R. K., Kontopantelis, E., Kai, J., Weng, S. F., Patel, R. S., Asselbergs, F. W., & Qureshi, N. (2022). Sex disparity in subsequent outcomes in survivors of coronary heart disease. Heart, 108(1), 37-45. https://doi.org/10.1136/heartjnl-2021-319566

• Journal Article Type: Article
• Acceptance Date: Aug 3, 2021
• Online Publication Date: Aug 24, 2021
• Publication Date: 2022-01
• Deposit Date: Sep 20, 2021
• Publicly Available Date: Sep 21, 2021
• Journal: Heart
• Print ISSN: 1355-6037
• Electronic ISSN: 1468-201X
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Issue: 1
• Pages: 37-45
• DOI: https://doi.org/10.1136/heartjnl-2021-319566
• Keywords: Cardiology, Cardiovascular Medicine, sex disparity, survivors, coronary heart disease
• Public URL: https://nottingham-repository.worktribe.com/output/6094252
• Publisher URL: https://heart.bmj.com/content/108/1/37