February is American Heart Month — the perfect time to remind women that their risk of cardiovascular disease is just as high as that of men.
“Cardiovascular disease is the leading cause of death for men and women in the United States, and it’s the leading cause of death for women across all races and ethnicities,” says Jessica Rove, MD, associate professor of cardiothoracic surgery. “I don’t know if a lot of women know that.”
And while theoretically treatment for cardiovascular disease should be the same for women and men, studies have shown that when it comes to bypass surgery for blocked arteries, the most commonly performed procedure — coronary artery bypass grafting (CABG) — has very different outcomes based on sex, Rove says.
“Shockingly, for the last 20 years, it’s been consistently shown that women have a higher 30-day mortality after CABG compared to men,” she says. “Even as the overall mortality from the operation has improved, women still consistently do worse than men, year over year, even in risk-adjusted analyses.”
Studying the difference
The dire statistic may come partially from the fact that during CABG, women are less likely than men to receive multiple arterial grafts — using more than one artery to divert blood around a blockage. The reasons for the disparity are still being explored, but it is likely due in part to the fact that women tend to be underrepresented in clinical trials comparing the two methods.
The CU Department of Surgery is among the institutions looking to fix that by taking part in ROMA: Women, an international cardiac surgery trial looking at some of the reasons why CABG is a different proposition in women than in men.
“Coronary artery disease in women is more often characterized by coronary microvascular dysfunction and coronary vasospasm, conditions for which CABG is a suboptimal treatment,” leaders of the study write in their introduction. “Coronary arteries and bypass grafts are smaller and more prone to spasm in women, making the operation more technically complex. (And) women referred for CABG are older, with different and more frequent comorbidities compared with men.”
Equal outcomes
Research performed by Rove and third-year medical student Chiagoziem Anigbogu shows that at CU Department of Surgery, women and men have an equivalent 30-day mortality after CABG, which is why the department is an important participant in the ROMA: Women trial.
“We have really worked over the past six years to improve our rates of multiple arterial grafting in both men and women,” she says, adding that the department also is making it a point to train surgery residents in multiple arterial grafting so that the practice begins to spread further.
A study conducted by Rove and former cardiothoracic surgery fellow Neil Venardos, MD, showed that “82% of surgical residents nationwide want to perform multiple arterial grafting, but only 57% of them feel prepared to do so,” she says. “An important aspect of this is that we’re training our trainees to do this procedure. There are more and more data that show multiple arterial grafting improves survival, and we need to help make sure these data penetrate into practice.”
