SCIENCE / MEDICINE : Women Run Greater Risk in Heart Bypass Surgery : Research: Twice as many die on the operating table. Study blames a tendency among doctors to ignore symptoms in women.
Women are nearly twice as likely as men to die from a common form of coronary artery surgery--a fact that researchers now suspect reflects a tendency among physicians to neglect heart disease symptoms in women.
Researchers in Los Angeles, in findings published this week in the Annals of Internal Medicine, have found that women are generally older and sicker than men when they are referred for coronary artery bypass surgery, apparently because doctors tend to take women’s symptoms less seriously than men’s.
And that difference in age and degree of sickness at the time of surgery explains women’s higher risk of dying from the operation, the researchers found. Their smaller size is not responsible for the increased risk, as had been thought.
“Often, I think, physicians are trying to prove that women don’t have coronary disease,” said Dr. Steven S. Khan of Cedars-Sinai Medical Center. “It’s in the teaching of cardiology, that chest pain (in women) is most likely due to something other than the heart.”
Khan’s findings refocus attention on the shifting demographics of heart disease in the United States--in this case, the rising incidence of coronary disease in women as the population ages and lifestyles change.
Cigarette smoking and job stress are among the factors that put many women at a greater risk of coronary artery disease than in the past. And as the population ages, there are more and more women in the older age bracket in which women tend to come down with symptoms.
“Doctors should have a greater awareness of the potential for serious cardiac illness in women,” said Dr. Richard J. Gray, one of the study’s co-authors. “And women themselves should feel less complacent about their freedom from heart disease.”
Khan, Gray and four other researchers at Cedars-Sinai and UCLA reviewed the cases of 2,297 patients who had undergone coronary artery bypass surgery, a procedure used to circumvent a narrowed or blocked artery by grafting on other blood vessels.
Four out of five of the patients were men. But the women were much more likely to die from the operation. The researchers found that 4.6% of the women and 2.6% of the men died in the operating room or within the following month.
On average, the women were more than four years older than the men. They were also sicker. More of the women had been referred because of heart failure or other serious symptoms, while more of the men had been referred simply after a worrisome exercise stress test.
“Overall, women were referred significantly more often than men with severe symptoms of coronary disease,” the researchers wrote. Coronary disease occurs when cholesterol-laden fatty deposits narrow the coronary arteries, limiting blood flow to the heart.
There may be other consequences of delayed referral beyond the risk of death.
The researchers noted that one type of bypass grafting believed to be more reliable in the long run is not advisable in emergencies or in older patients. For that reason, they said, women may be receiving less effective treatment.
As for why physicians might wait longer to refer women for surgery, Khan and Gray noted that tests for diagnosing coronary artery disease are less reliable in women than in men. Furthermore, physicians generally believe women are at less risk than men: Men are six to eight times more likely to develop heart disease than pre-menopausal women.
But after menopause, women lose the innate protection conferred by hormones. By age 65 to 70, their risk is about equal to that of men, said Gray, director of surgical cardiology at Cedars-Sinai and a professor of medicine at UCLA.
As the population ages, physicians will be seeing more and more women in that age bracket, the researchers said. They said it is no longer appropriate to automatically assume that complaints such as chest pain are traceable to sources other than the heart.
“Now that women are smoking more and may be exposed to more of the stresses and factors that in men cause coronary disease, they need to be aware that the symptoms they are having may be due to significant blockages in their heart,” Khan said.
“Their physicians should be aware of that, too,” he added.
The study did not explore whether women would be better off with earlier surgery, but Khan said there is reason to suspect they would. However, he said it is also possible that some men are being referred too early, before they really need the operation.
