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Clinical Summary

Sex Differences in Subsequent Outcomes after Incident CHD

Takeaway

  • Women vs men had a lower risk of first subsequent major adverse cardiovascular event (MACE) and recurrent coronary heart disease (CHD), but a higher risk of stroke, heart failure and all-cause mortality, after the first CHD event.

Why this matters

  • As more people survive their initial CHD events, a better understanding of the risk of subsequent events is required to ensure more targeted secondary prevention strategies in this patient population.

Study details

  • This UK population-based cohort study assessed electronic health records (EHRs) of 143,702 adults (women, 43.9%) with any incident non-fatal CHD using data from primary (UK Clinical Practice Research Datalink) or secondary (Hospital Episode Statistics) care and the national death registry (median follow-up, 13.4 years).
  • Primary outcome: first subsequent MACE after incident CHD.
  • Funding: None.

Key results

  • Overall, 91,706 individuals had a MACE after incident CHD.
  • The incidence rate for MACE was higher among men vs women (31.03 vs 19.62 per 100 person-years).
  • Women vs men had a lower risk of first subsequent MACE (HR, 0.67; 95% CI, 0.66-0.68) and recurrent CHD (HR, 0.60; 95% CI, 0.59-0.61) after incident CHD.
  • Following incident CHD, women vs men had a higher risk of:
  • stroke (HR, 1.26; 95% CI, 1.19-1.33);
  • heart failure (HR, 1.09; 95% CI, 1.04-1.15); and
  • all-cause mortality (HR, 1.05; 95% CI, 1.02-1.07).

Limitations

  • Retrospective design.
  • CHD subtyping in EHRs is unreliable. 
 

Akyea RK, Kontopantelis E, Kai J, Weng SF, Patel RS, Asselbergs FW, Qureshi N. Sex disparity in subsequent outcomes in survivors of coronary heart disease. Heart. 2021 Aug 24 [Epub ahead of print]. doi: 10.1136/heartjnl-2021-319566. PMID: 34429368. View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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