Gender differences in clinical status at time of coronary revascularisation in Spain

Abstract

Objective: To study gender differences in clinical status at the time of coronary revascularisation. Design: Retrospective study of clinical records. Two stage stratified cluster sampling was used to select a nationally representative sample of patients receiving a coronary revascularisation procedure in 1997. Setting: All of Spain. Main outcome measures: Odds ratios (OR) in men and women for different clinical and diagnostic variables related with coronary disease. A logistic regression model was developed to estimate the association between coronary symptoms and gender. Results: In the univariate analysis the prevalence of the following risk factors for coronary heart disease was higher in women than in men: obesity (OR=1.8), hypertension (OR=2.9) and diabetes (OR=2.1). High surgical risk was also more prevalent among women (OR=2.6). In the logistic regression analysis women's risk of being symptomatic at the time of revascularisation was more than double that of men (OR=2.4). Conclusions: Women have more severe coronary symptoms at the time of coronary revascularisation than do men. These results suggest that women receive revascularisation at a more advanced stage of coronary disease. Further research is needed to clarify what social, cultural or biological factors may be implicated in the gender differences observed. Many studies have shown large variations in the use of health services by such sociodemographic variables as social class, income, educational level, race or gender.1-7 Gender has traditionally been used as a potential confounding factor in most studies of health inequalities, but recent studies suggest that it may be predictive of health services use.5 8 In general, women have poorer perceived health status than men, with higher morbidity and greater use of primary health care services. For the same level of morbidity, however, women tend to use fewer hospital services than do men. 5Cardiovascular disease, and particularly coronary heart disease, is one of the most prevalent health conditions in the developed world. Coronary disease has classically been considered a man's disease, in part because it appears later in women than in men. Despite the fact that mortality rates in men are considerably higher than those in women, however, women's longer life expectancy means that the number of deaths from coronary disease in the developed countries is about the same in both sexes.9 Given the huge social and health implications of coronary disease, large amounts of resources have been allocated for its treatment in recent years, with particular attention to providing equipment and improving hospital infrastructure for the performance of the two most widely used procedures for coronary revascularisation: percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG).Whether or not women truly have poorer access to diagnostic and therapeutic procedures for coronary disease is a subject of debate in the scientific literature. A number of studies have shown that wome...

Sensibilidad de género en la formulación de planes de salud en España: lo que pudo ser y no fue

“…Por ello, existe actualmente un gran escalón entre lo que «se sabe» y lo que «se hace» para abordar las desigualdades de género. Los profesionales han producido información sobre las desigualdades de salud por género [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] y evidencian que es un problema importante en cuanto a su magnitud. Sin embargo, que este problema de salud entre en la agenda no tiene que ver con su importancia, sino con la capacidad de persuasión y la capacidad de definirlo conceptualmente [22][23][24] .…”

“…El sexo, en el sentido biológico, interfiere por las diferencias en los efectos de los tratamientos, los resultados de las pruebas diagnósticas y la presentación de los signos y síntomas clínicos entre los hombres y las mujeres [2][3][4][5][6][7][8][9][10][11][12][13][14] . El sexo, relacionado con el hecho diferencial reproductivo, produce diferencias entre hombres y mujeres, y necesidades específicas [2][3][4][5]15,16 .…”

“…La invisibilidad de estas formas de producir desigualdad perpetúa la cadena de situaciones que acaba produciendo un patrón diferencial respecto de qué y cómo enfermar y morir entre los hombres y las mujeres. Desde una perspectiva de salud pública, el interés por las desigualdades de género aparece porque esta situación de salud diferenciada se produce por la consistencia epidemiológica de que el género (masculino y femenino) es un determinante de la salud frente a la consideración del sexo como un factor de confusión [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Que además este conocimiento se transforme en intervención tiene que ver con la acción de políticas de salud, por su capacidad potencial de actuar sobre los factores de la distinta vulnerabilidad de las mujeres y los hombres para modificarlos, y su capacidad de organizar los recursos sanitarios para abordar la enfermedad.…”

Does the influence of obesity on prognosis differ in men and women? A study of obesity paradox in patients with acute coronary syndrome

“…Obesity is an established risk factor for cardiovascular diseases (CVD) [1,2]. It is related to higher prevalence of cardiovascular risk factors and plays a major role in the development of metabolic syndrome and atherosclerosis [3][4][5][6].…”

“…However, the occurrence of obesity paradox in men and women has not yet been thoroughly investigated, even though both genders differ in patterns and incidence of obesity [3] and women are known to differ from men in terms of risk factors, course, and prognosis in CVD [2]. Therefore, the aim of this study was to investigate whether obesity influence on outcomes of patients with ACS varies by gender.…”