Women’s Risk in Angioplasty Found Greater
Women who undergo angioplasty--a common procedure in which a tiny balloon is used to reopen clogged arteries--are 10 times more likely than men to die in the hospital, according to a study that may renew debate about a possible bias in the treatment of female heart patients.
The study, which appears today in Circulation, a journal published by the American Heart Assn., found that women angioplasty patients were likely to be older and sicker than the men. Yet even after risk factors such as hypertension, diabetes and old age were taken into account, women were still 4 1/2 times more likely to die in the hospital. Researchers said they could not fully explain the disparity.
“I’m afraid that’s the unknown,” said Sheryl F. Kelsey, an epidemiologist at the University of Pittsburgh and the lead author of the study. “Other than the risk factors, there may be some other things that we didn’t measure, that we don’t know about.”
The study examined the records of 2,136 angioplasty patients--546 of whom were women--who underwent the procedure during 1985 and 1986. The records of these operations, from 16 medical centers across the country, were culled from a registry maintained by the National Heart, Lung and Blood Institute.
Long-term survival rates for men and women angioplasty patients were about the same, the study found, and relatively few of the patients died before leaving the hospital. But the most striking finding was that of the 18 patients who died, 14 were women. Elderly women were particularly at risk; of the 14 women who died, 12 were 65 or older.
One expert, Dr. Marianne Legato, a Columbia University medical professor, said the study demonstrates that heart disease is being detected later in women than in men.
“I don’t think that this is very reassuring,” said Legato, author of “The Female Heart,” a recent book on heart disease in women. “I think that we have to pick this disease up in women sooner and treat it aggressively sooner, and until we try that . . . I think we are still going to have statistics like this.”
The findings add to a body of evidence that women who suffer from heart disease fare worse than men. In 1991, researchers at the University of Washington reported that although almost as many women as men die of heart disease each year, women were only half as likely to receive state-of-the-art heart attack treatment. That study, however, found that angioplasty was no riskier for women than men.
And in 1990, researchers in Los Angeles found that women were nearly twice as likely as men to die from a common form of coronary artery surgery--a fact that, the authors maintained, reflected a tendency among physicians to neglect heart disease symptoms in women.
Those reports heightened concern about treatment of women and sparked “a movement . . . to compensate for sex bias,” according to an editorial accompanying the Pittsburgh study published today.
But the cardiologists who wrote the editorial said the new study’s findings should put “a sobering caution” on that movement, and suggested that doctors may be doing more harm than good in recommending angioplasty, particularly for elderly women.
“From our perspective, the data that . . . refer to female gender being a risk factor for angioplasty is still as true today as it was five years ago,” one of the editorial’s authors, Dr. Mark A. Greenberg of the Montefiore Medical Center in New York, said Monday in a telephone interview.
Angioplasty, which is performed on about 300,000 patients annually in this country, is one of two popular “revascularization” techniques used to restore blood supply to the heart muscle through the coronary arteries. The other method is coronary bypass surgery.
The procedure involves inserting a catheter with a tiny deflated balloon on its tip into a blood vessel. The balloon is pushed through the body into the diseased vein or artery then inflated to widen the constricted vessel.
According to Greenberg and other heart experts, this technique was developed largely based on medical studies in which men were the only subjects.
This may be one reason that women angioplasty patients in the study fared worse than men; women have smaller arteries than men and therefore may be more susceptible to complications during surgery. But experts say the technology is being refined.
“All of the balloons and catheters were made for a larger size,” said Dr. David Kawanishi, who teaches cardiology at the USC School of Medicine. “There has been a gain or improvement in performance of these procedures in all people with smaller vessels as the technology has improved.”
While the Pittsburgh study found that female patients did not receive angioplasty at a later stage in their disease than men, it did find that the female patients were far less healthy as well as older. On average the female patients were 4 1/2 years older than males in the study.
Researchers found that women in the study were significantly more likely than men to have had a history of congestive heart failure, diabetes, high cholesterol or some other severe medical problem not related to heart disease. As a result, women were more often judged to be high-risk candidates for surgery than were men.
In addition, the study found that women were more likely to have unstable angina--meaning they suffer from a spectrum of symptoms, including chest pain, that changes unpredictably--than men at the time of their treatment.
“In conclusion,” the study said, “women undergoing (angioplasty) have a higher procedural mortality risk that is explained partly, but not entirely, by their worse cardiovascular risk profile.”
