Q&A: How Individualizing Care Benefits Gender Equity in Cardiovascular Health

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In a Q&A at ACC 2023, Drs. Alexandra Murphy and Birgit Vogel of Mount Sinai discuss sex-specific predictors of MACE and the need for individualization of care to achieve equity in cardiovascular health.

anatomically correct digital illustration of a heart

Achieving gender equity in cardiovascular care may require attention given to the individualization of care, particularly for women, according to a study presented at the American College of Cardiology (ACC) 2023 Annual Scientific Sessions in New Orleans, Louisiana.

The results suggested women with premature coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) had a higher incidence of major adverse cardiovascular events (MACE) at 1 year compared with men.

Co-author of the study, Birgit Vogel, MD, Icahn School of Medicine, Mount Sinai Hospital, stressed the importance of recognizing the underestimation of risk in women and increasing screening to identify and address early risk factors of heart disease.

“At Mount Sinai, we have now launched the Women’s Heart Vascular Center and it is a big target of ours to increase screening in young women, especially if they are from certain risk populations, like women with a history of adverse pregnancy outcomes,” Vogel said. “We look for risk factors and get them the treatment that they need to reduce the risk of heart disease later on.”

In a Q&A with HCPLive, presenting author Alexandra Murphy MBBS of Mount Sinai discussed the findings, describing sex-specific differences in quality of care and how inherent limitations involved in the analysis do not diminish its findings.

This Q&A has been edited for clarity.

Can you take me through the impetus behind this study and provide a brief overview of the results?

So, at Mount Sinai, and at the Icahn Institute, we have focused a lot on gender equity research and a lot on the female pattern of cardiovascular disease and differences between men and women. This is important to identify these sorts of differences in order to try and improve outcomes in women with cardiovascular disease.

In this abstract, we looked at young patients, so that's defined differently between men and women. So, men less than 55 years, and women less than 65 years, who underwent a percutaneous coronary intervention (PCI) at our hospital between the years of 2012 and 2019. So, we've got a very large database of PCI outcomes data that we have produced a huge amount of research from very high-quality research.

We then stratified these young patients by sex, and we identified what were the primary risk factors for poor outcomes. We defined the primary outcome as major adverse cardiovascular events. And so, of over 4,000 patients that we studied, just under half were women.

And we found that these women were older than the men, even within that young age bracket. They were more likely to have a higher body mass index (BMI), and they will also have a higher burden of comorbidity. But when we broke it down and looked at the different risk factors that were most prominent in men versus women, we found that there were differences in this, and this information is important because it can be used to then target six specific directives to improve outcomes in both men and women.

To your last point, would you say that's the most significant takeaway from the perspective of a practicing clinician?

Absolutely. And I think that we always have to think about how we can apply the findings of our research to changing health outcomes in our patients. It's about getting it from the database to the clinical room. And I think that the really important thing here is about improving public awareness and improving risk and prevention of heart disease by targeting specific features that are unique to women.

Are these findings the result of physiological differences, quality of care provided to women, or a mixture of both?

I believe that there is a mixture of factors at play here. Firstly, we can consider patient-specific factors and differences in how women present with cardiovascular disease, including their symptoms, which are often under-recognized and not well-publicized, leading to poorer outcomes when women are not aware they are having a heart attack or experiencing chest pain that presents differently.

Secondly, we should examine potential biases that physicians may have towards women when they are under investigation or treatment for cardiovascular disease. This is a common issue in research related to women's health. Lastly, we can address the need for more effective public health campaigns and awareness efforts to emphasize the existence of disparities and the need for improvement

Are there any inherent limitations you’d want our audience to consider before interpreting study results?

I think whenever we look at retrospective analyses of databases, we have to understand that there are inherent limitations with that data. Perspective, randomized data is always going to be of higher quality. But when we're looking at large populations like this, I think that that is still a very strong message. It allows us to look at people that were consecutive patients coming through and find out what the burden of disease is and better understand potential disparities. And that can still be done to very high quality in large databases, even in a retrospective nature.

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