Prevalence, Assessment and Clinical Outcome in Cardiovascular Disease: Impact of Gender Disparities

Research Article

Austin J Pharmacol Ther. 2014; 2 (8). 1046

Prevalence, Assessment and Clinical Outcome in Cardiovascular Disease: Impact of Gender Disparities

Bhatt PA1*, Parikh PK2 and Parikh KH2

1Department of Pharmacology, L.M. College of Pharmacy, India

2CIMS Hospital, India

*Corresponding author: : Bhatt PA, Department of Pharmacology, L.M. College of Pharmacy, Navrangpura, Ahmedabad–380060, Gujarat, India

Received: August 04, 2014; Accepted: September 24, 2014; Published: September 25, 2014


Epidemiologic and clinical research suggests important gender-related differences in the prevalence, presentation, management and outcomes of Coronary Heart Disease (CHD) patients. Adequate data is not documented for Indian population where prevalence of CHD is high. An observational, single-centric, study was conducted from January 2008 to December 2010 on 10450 consecutive patients visiting a tertiary care centre, Ahmedabad, Gujarat, India with complains related to cardiovascular disease. Of these 6867 patients had CHD as confirmed by angiographic investigations. Treatment options were Coronary Artery Bypass Grafting (CABG)/Percutaneous Transluminal Angioplasty (PTCA)/medical therapy as per cardiologist’s discretion and patient’s choice. Among 6867 patients, 5678 were males while 1189 were females with a mean age of 57.02±11.79 and 56.24±11.76 years (p = 0.01), respectively. As compared to males, females had higher prevalence of hypertension, diabetes, obesity and family history of CHD (p<0.01), while males had higher prevalence of smoking (p<0.0001). CHD was more prevalent in post-menopausal women as compared to pre-menopausal women (p<0.0001).Invasive treatment options like CABG (12.42% vs. 18.45%, p<0.0001) and PTCA (40.73% vs. 45.04%, p=0.001) were used less often to treat females (vs. males), where medical therapy (46.83% vs. 36.49%, p<0.0001) was the preferred treatment option irrespective of the contributing risk factors/extent of CHD. Clinical outcomes were worse in females as compared to male CHD patients at 3 years follow up. Major gender-related differences in contributing risk factors and treatment options prevail in Indian CHD patients.

Keywords: Coronary heart disease; Risk factors; Gender difference


CHD: Coronary Heart Disease; CABG: Coronary Artery Bypass Grafting; PTCA: Percutaneous Transluminal Angioplasty; ACS: Acute Coronary Syndrome; MACE: Major Adverse Cardiac Event; BP: Blood Pressure


In 2020, 2.6 million Indians are predicted to die of Coronary Heart Disease (CHD) which will constitute 54% of all cardiovascular disease deaths [1]. According to the recent update of American Heart Association guidelines (2011), disparities in CHD presentation and management relate to variability’s in presentation, health beliefs, cultural values and preferences, and patients’ inability to communicate symptoms in a language other than their own, among other factors [2]. Lacks of recognition of CHD in women because of differences in clinical presentation are of particular relevance, because it contributes significantly to delay improper diagnosis, inadequate treatment and adverse outcomes [3]. For example, women are twice as likely to die of a myocardial infarction [4] and have a less favorable long-term survival as compared with men. Further, it has been suggested that women have smaller coronary arteries than men, and are twice as likely to die as a result from Coronary Artery Bypass Surgery (CABG) and are more likely to need repeat revascularization [5]. Gender differences among patients with Acute Coronary Syndrome (ACS) are fueled by beliefs that biological differences influence the pathogenesis of CHD and patients’ response to medical therapies. It appears that women present with CHD in general about 10 years later than men, but after menopause the prevalence and mortality from CHD increase and overall rates become similar to men [6].

Despite the substantial risk of developing or dying from CHD, studies reveal that women with CHD or risk factors are less likely than men to receive recommended therapies [7]. Gender differences in the management of ACS with invasive strategy have been described in both observational and randomized clinical studies [8,9]. It has been suggested that women are less likely to undergo reperfusion therapy when they present with ACS [10]. It has also been shown that women receive cardiac procedures such as cardiac catheterization, Percutaneous Transluminal Coronary Angioplasty (PTCA) and CABG less than men [11-15].

There is lack of data on gender disparity with regard to CHD in India. Western states of India viz. Gujarat, Maharashtra and Rajasthan are economically advanced with high family earnings, socioeconomic status and education as compared to other Indian states. This study was designed to determine gender differences in CHD risk factors, and most importantly in the treatment options availed by men and women presenting with CHD in a tertiary care hospital.


This was an observational study enrolling consecutive 6867 cardiovascular disease patients out of 10450 patients of either gender (age >18 years; pregnant/lactating women were excluded) visiting a tertiary centre in Gujarat, India from January 2008 to December 2010.Study evaluation criteria included gender based demographic data, risk factors like hypertension, diabetes, obesity, family history and smoking and vital signs. Data were collected of the treatment option (PTCA,CABG,medical therapy)undertaken. Primary clinical outcome measures were death, Major adverse cardiac event (MACE),revascularization and rehospitalization at 3 years. The protocol was approved by an independent ethics committee (Reg. #: ECR/206/Inst/GJ/2013) and written consent was taken for enrolled subjects.

For statistical analysis, continuous variables including age are presented as mean±SD. The categorical data, including CHD risk factors, coronary procedures performed and clinical outcomes are presented by frequency and percentage of patients. Statistical methods used for analysis were t- test, chi-square test and p value <0.05 was considered statistically significant. All analysis was performed using graph pad prism version 5.04.


A total of 10,450 consecutive subjects visited the centre with complaints related to CHD. Of these 6867 depicted CHD (males: 5681(82.69%); females:1189 (13.31%)) as confirmed by coronary angiography and other investigations. Prevalence of hypertension, diabetes, obesity and family history of CHD were higher in female CHD patients as compared to male patients with similar average mean age. Table 1 depicts patient characteristics, vitals and associated risk factors.