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Women with stable coronary artery disease have better clinical outcomes than men, but this association is modified by degree of depression: insights from the STABILITY trial

Session Poster session 1

Speaker Patricia Oliveira Guimaraes

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : P Oliveira Guimaraes (Durham,US), CB Granger (Durham,US), K Chiswell (Durham,US), A Stebbins (Durham,US), C Held (Uppsala,SE), JS Hochman (New York,US), S Krug-Gourley (King of Prussia,US), E Lonn (Ontario,CA), RL Lopes (Durham,US), RAH Stewart (Auckland,NZ), D Vinereanu (Bucharest,RO), L Wallentin (Uppsala,SE), HD White (Auckland,NZ), N Danchin (Paris,FR)

Authors:
P. Oliveira Guimaraes1 , C.B. Granger1 , K. Chiswell1 , A. Stebbins1 , C. Held2 , J.S. Hochman3 , S. Krug-Gourley4 , E. Lonn5 , R.L. Lopes1 , R.A.H. Stewart6 , D. Vinereanu7 , L. Wallentin2 , H.D. White6 , N. Danchin8 , 1Duke Clinical Research Institute - Durham - United States of America , 2Uppsala Clinical Research Center - Uppsala - Sweden , 3New York University Langone Medical Center - New York - United States of America , 4GlaxoSmithKline - King of Prussia - United States of America , 5Mcmaster University - Ontario - Canada , 6Auckland City Hospital - Auckland - New Zealand , 7University of Medicine and Pharmacy Carol Davila - Bucharest - Romania , 8Hôpital Européen Georges Pompidou, Université Paris Descartes - Paris - France ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 188

Background: Greater understanding of the differences in male and female patients with coronary heart disease (CHD) is needed.

Purpose: To describe psychosocial factors, treatments, and outcomes of men versus women with stable CHD, and to explore the association of gender with psychosocial characteristics and cardiovascular risk.

Methods: We analyzed the STABILITY trial database, which includes patients with stable CHD and age ≥60 years or another risk factor. Kaplan-Meier event rates of clinical outcomes were compared between men and women. Cox proportional hazard models were used to assess the relationship between sex and outcomes. Interactions between sex, psychosocial factors, and the composite endpoint of cardiovascular death, myocardial infarction (MI), and stroke were tested.

Results: Of the 15,828 patients, 2967 (19%) were women. At study entry, 22.4% of women and 11.3% of men were living alone, while 82.4% of women and 64.3% of men were not currently working. Among women, 21.2% felt often/always stressed at home (vs. 9.8% of men), while 19.2% felt often/always sad, low in spirits, or depressed (vs. 10.1% of men). The use of evidence-based medications for CHD, at baseline and at 24 months, was similar among sexes, as well event rates for all outcomes analyzed. In the multivariable model including psychosocial measures, female sex was associated with lower cardiovascular risk. There was a statistically significant interaction such that the lower risk in women varied by degree of depression, whereby women who were more depressed had similar risk as men (Figure).

Conclusions: Female sex was independently associated with better clinical outcomes, although that association was modified by degree of depression. This suggests that emotional state may be an important target for improving outcomes in patients with CHD, specifically in women.

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