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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Sex differences in coronary artery bypass grafting-related morbidity and mortality
Jouko Nurkkala1,2, Anni Kauko3, Joonatan Palmu3
1Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland.
Insights
Coronary artery bypass grafting (CABG) outcomes differ significantly by sex. Women experience greater long-term risks of cardiac death and other diseases after CABG compared to men.
Area of Science:
- Cardiovascular Science
- Genetics
- Epidemiology
Background:
- Coronary artery bypass grafting (CABG) is linked to cardiovascular disease (CVD) and non-CVD traits.
- Women generally have worse prognoses after coronary events and revascularizations than men.
- Sex-specific differences in CVD progression necessitate investigation into CABG-related outcomes.
Purpose of the Study:
- To conduct a phenome-wide analysis of sex differences in morbidity and mortality associated with CABG.
- To identify sex-specific predictors and outcomes of CABG.
- To compare the long-term health trajectories of men and women following CABG.
Main Methods:
- An untargeted, phenome-wide analysis was performed on 176,680 FinnGen participants (5,950 CABG patients).
- Over 1,100 traits were analyzed for sex differences in relation to CABG, adjusting for age, smoking, and BMI.
- Cox proportional hazards models with sex-trait interactions were employed to assess associations.
Main Results:
- Women showed stronger associations between CABG and increased risks of hypertension, Alzheimer's, aortic aneurysms, gout, and chronic kidney disease compared to men.
- Post-CABG, men had a 2.5-fold and women a 6.3-fold higher risk of cardiac death.
- Women's elevated risk of death persisted for over 12 years post-CABG, unlike men, whose long-term risk did not increase.
Conclusions:
- Adverse outcomes following CABG, including mortality and comorbidity development, differ significantly between sexes.
- Women experience greater long-term increases in the risk of cardiac death and other diseases after CABG than men.
- The findings suggest a need to evaluate the adequacy of long-term post-operative therapy and follow-up for women undergoing CABG.
Background:
Coronary artery bypass grafting (CABG) is associated with both cardiovascular disease (CVD) and non-CVD traits. In addition, women's prognosis after coronary events and revascularizations is worse than in men. As the course of CVD in women differs from that of men, we performed a phenome-wide analysis on the sex differences in CABG -related morbidity and mortality.
Materials And Methods:
We performed an untargeted analysis on the sex differences in predictors and outcomes of CABG. We studied a sample of 176,680 FinnGen participants, including 5,950 individuals who underwent CABG (4,988 men and 962 women) and were followed between 1998 and 2019. Over 1,100 different traits were analyzed for both sexes and the results were adjusted with age, smoking status and BMI. Cox proportional hazards models with sex-trait interactions were used to estimate the associations between (1) traits and incident CABG; and (2) CABG and incident traits.
Results:
In women, CABG was more strongly related to greater increases in risk of diseases such as hypertension, Alzheimer's, aortic aneurysms, gout, and chronic kidney disease compared to risk increases observed in men (all interaction p-values < 0.03). After CABG, men had 2.5-fold (p = 3.1E-15) and women 6.3-fold (p = 9.4E-08) greater risk of cardiac death compared to same-sex individuals who did not undergo CABG (p for interaction 8.2E-4). Moreover, the risk of death in women remained higher even 12 years after CABG, whereas the long-term risk of death in men was not increased, compared to same-sex individuals who did not undergo CABG.
Conclusion:
The adverse outcomes after CABG, both quantity and quality, also appear to differ between men and women. In women, CABG is related to greater long-term increases in risk of cardiac death and several other disease states than in men. Consideration should therefore be given to whether women receive adequate long-term post-operative therapy and follow-up as CABG is not associated with equally improved cardiovascular disease prognosis in women than in men.
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