Women who had survived a first coronary event had a significantly lower risk of major adverse cardiovascular events (MACE) and recurrent coronary heart disease (CHD) than men, a population-based cohort study has found. However, women had a higher risk of stroke, heart failure, and all-cause mortality compared with men.

Data were obtained from the Clinical Practice Research Datalink (CPRD GOLD) linked to hospital episode statistics and death records in the UK.

The investigators identified 143,702 adults (63,078 women) with incident CHD and no prior history of MACE between 1 January 1998 and 31 December 2017. The median age of the women was 73 compared with 66 years for the men.

Incident CHD included angina, myocardial infarction or coronary revascularisation. MACE was defined as a composite of recurrent CHD, stroke, peripheral vascular disease, heart failure and cardiovascular-related mortality.

The primary outcome was the first subsequent MACE after incident CHD and the secondary outcome was all-cause mortality.

The median follow-up period was 13.4 years. A first subsequent MACE was observed in 91,706 patients (63.8%); 55,087 men (68.3%) vs 36,619 women (58.1%). Most events occurred within two years of the incident CHD.

Multivariable models were used to assess the differences between the sexes.

After adjusting for confounding factors, women had a significantly lower risk of MACE and recurrent CHD compared with men.

• MACE: hazard ratio (HR) 0.68 (95% CI: 0.67-0.69)

• Recurrent CHD: HR 0.60 (95% CI: 0.59-0.61)

However, women had a significantly higher risk of any stroke, heart failure, and all-cause mortality, compared with men.

• Stroke: HR 1.26 (95% CI: 1.19-1.33)

• Heart failure: HR 1.09 (95% CI: 1.04-1.15)

• All-cause mortality: HR 1.05 (95% CI: 1.02-1.07)

The risk profiles of men and women differ when diagnosed with CHD and as this study has shown they fare differently after incident CHD.

The cause of these disparities relates to differences in the baseline cardiovascular profile, access to care, use of resources and evidence-based guidelines, and social as well as environmental factors, the study authors say.

They conclude: ‘In this large population-based cohort study of patients with any type of incident CHD, we identified, after appropriate adjustments for confounders, a lower risk of MACE and recurrent CHD in women when compared with men. However, there was a higher risk of stroke, heart failure and all-cause mortality in women.’ 

‘As more people are surviving their incident CHD events, further attention to all patients with incident CHD is needed to narrow this range of sex disparities in major subsequent clinical outcomes. Improving the standard and equity of care for women and men with incident CHD should recognise a ‘one size fits all’ approach may not hold,’ they add.

Dr Peter Savill