Gender difference in long-term prognosis among patients with cardiovascular disease

Differences in prognosis between women and men with atherosclerosis are currently under attention. Previous studies describe contradictory results and are restricted to one cardiovascular bed, while atherosclerosis is a systemic disease. We therefore studied the prognosis of women versus men in the SMART study, a large cohort of patients with clinically manifest atherosclerosis with extensive baseline and follow-up information.

5349 patients (1347 women, 4002 men) with at least one type of atherosclerotic vascular disease (coronary artery disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm) were included in the SMART study, an ongoing long-term follow-up study. They all received a standardized cardiovascular work-up with a personalized therapy advice. All future cardiovascular events were collected prospectively. All-cause mortality, cardiovascular mortality and cardiovascular outcome (composite of myocardial infarction, stroke and cardiovascular death) were evaluated using Cox regression and expressed as hazard ratios (HR) with 95% confidence intervals (95%CI). Men served as the reference category. Different models were used to adjust for differences in baseline characteristics.

Women and men had a mean age of 60 years and their median follow-up (range) was five years (13.5). The hazard ratios of all-cause mortality, cardiovascular death and cardiovascular outcome were 0.62 (95%CI: 0.51-0.75), 0.59 (95%CI: 0.46-0.75) and 0.73 (95%CI: 0.60-0.87). Neither differences in risk-factor profile nor the different vascular beds involved could explain this advantage.

Women with cardiovascular disease who received a similar standardized cardiovascular work-up and personalized therapy advice as men had a favourable long-term outcome.