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Original research
Sex disparity in subsequent outcomes in survivors of coronary heart disease
  1. Ralph Kwame Akyea1,
  2. Evangelos Kontopantelis2,
  3. Joe Kai1,
  4. Stephen F Weng1,
  5. Riyaz S Patel3,4,
  6. Folkert W Asselbergs3,4,5,
  7. Nadeem Qureshi1
  1. 1Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
  3. 3Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
  4. 4Health Data Research UK and Institute of Health Informatics, University College London, London, UK
  5. 5Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Ralph Kwame Akyea, Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK; Ralph.Akyea1{at}nottingham.ac.uk

Abstract

Objective Evidence on sex differences in outcomes after developing coronary heart disease (CHD) has focused on recurrent CHD, all-cause mortality or revascularisation. We assessed sex disparities in subsequent major adverse cardiovascular events (MACE) in adults surviving their first-time CHD.

Methods Using a population-based cohort obtained from the Clinical Practice Research Datalink (CPRD GOLD) linked to hospitalisation and death records in the UK, we identified 143 702 adults (aged ≥18 years) between 1 January 1998 and 31 December 2017 with no prior history of MACE. MACE outcome was a composite of recurrent CHD, stroke, peripheral vascular disease, heart failure and cardiovascular-related mortality. Multivariable models (Cox and competing risks regressions) were used to assess differences between sexes.

Results There were 143 702 adults with any incident CHD (either angina, myocardial infarction or coronary revascularisation). Women (n=63 078, 43.9%) were older than men (median age, 73 vs 66 years). First subsequent MACE outcome was observed in 91 706 (63.8%). Women had a significantly lower risk of MACE (hazard ratio (HR), 0.68 (95% CI 0.67 to 0.69); sub-hazard ratio (HRsd), 0.71 (0.70 to 0.72), respectively) and recurrent CHD (n=66 543, 46.3%) (HR, 0.60 (0.59 to 0.61); HRsd, 0.62 (0.61 to 0.63)) when compared with men after incident CHD. However, women had a significantly higher risk of stroke (n=5740, 4.0%) (HR, 1.26 (1.19 to 1.33); HRsd, 1.32 (1.25 to 1.39)), heart failure (n=7905, 5.5%) (HR, 1.09 (1.04 to 1.15); HRsd, 1.13 (1.07 to 1.18)) and all-cause mortality (n=29 503, 20.5%) (HR, 1.05 (1.02 to 1.07); HRsd, 1.11 (1.08 to 1.13)).

Conclusions After incident CHD, women have lower risk of composite MACE and recurrent CHD outcomes but higher risk of stroke, heart failure, and all-cause mortality compared with men.

  • coronary heart disease
  • major adverse cardiovascular events
  • secondary prevention
  • sex difference
  • competing risks

Data availability statement

The data supporting the findings of this study are available from the Clinical Practice Research Datalink (CPRD). Restrictions apply to the availability of these data, which were used under licence for the current study, hence are not publicly available.

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Data availability statement

The data supporting the findings of this study are available from the Clinical Practice Research Datalink (CPRD). Restrictions apply to the availability of these data, which were used under licence for the current study, hence are not publicly available.

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Footnotes

  • Twitter @rkakyea, @dataevan, @StephenFWeng, @DrRiyazPatel, @fwasselbergs

  • FWA and NQ contributed equally.

  • Contributors RKA, SW, FWA and NQ were involved in the design and planning of the study. RKA conducted the main statistical analysis and wrote the first draft of the manuscript. All authors contributed to the interpretation of the data, writing of the manuscript and critical revisions. RKA is the guarantor.

  • Funding RKA is funded by a National Institute for Health Research School for Primary Care Research (NIHR SPCR) PhD Studentship Award, supervised by JK, FWA and NQ.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health and Social Care.

  • Competing interests RKA currently holds an NIHR-SPCR funded studentship (2018-2021). SW is currently an employee of Janssen R&D. NQ was a member of the most recent NICE Familial Hypercholesterolaemia and Lipid Modification Guideline Development Groups (CG71 and CG181). NQ and SW have previously received honorarium from AMGEN. RSP has funding from the British Heart Foundation and the National Institute for Health Research. FWA is supported by UCL Hospitals NIHR Biomedical Research Centre. The remaining authors have no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Additional references can be found in online supplemental file 1.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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