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J Thorac Cardiovasc Surg 2003;126:1704-1706
© 2003 The American Association for Thoracic Surgery

Editorial

Improving outcomes for women after coronary artery bypass grafting: A case for prevention

^a Division of Cardiovacular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Ala, USA

Received for publication September 9, 2003; accepted for publication October 7, 2003.

^* Address for reprints: Suzanne Oparil, MD, Division of Cardiovacular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 703 19th St S, ZRB 1034, Birmingham, AL 35294-0007, USA
soparil@uab.edu

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Editorial Note: The gender initiative, a provocative series addressing gender differences in the surgical treatment of cardiac, vascular, and thoracic disease, continues with editorials addressing long-term outcomes of coronary artery surgery in women. Suzanne Oparil, MD, a cardiologist renowned for clinical and laboratory studies of women with cardiovascular disease, provides an excellent overview. Viola Vaccarino, MD, PhD, and Colleen Koch, MD, address specific issues involving cardiac rehabilitation, quality of life, relief of symptoms, and long-term survival after cardiac surgery. The series continues next month with editorials addressing valvular heart disease in women. Nancy A. Nussmeier, MD Texas Heart Institute

 

In this issue of the Journal,Vaccarino and Koch¹ and Koch and associates^2,3 come to grips with the knotty and contentious problem of why women have poorer outcomes than men after coronary artery bypass grafting (CABG). They use a database of 15,597 patients, including 3596 women, who underwent isolated CABG surgery at a single institution between 1993 and 2002 to address the question: "Is female gender a marker or a cause of increased risk of poor outcomes after coronary revascularization?" They observe an increased burden of cardiovascular disease risk factors and comorbid conditions, including hypertension, insulin-treated diabetes, heart failure, renal disease, peripheral vascular disease, and elevated low-density lipoprotein cholesterol and triglyceride levels, in women compared with men. Further, women had a more unstable presentation, including a higher prevalence of unstable angina, preoperative intra-aortic balloon pump usage, and emergency surgery, compared with men. When propensity modeling techniques were used, . . . [Full Text of this Article]

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