Clinical characteristics of patients undergoing coronary artery bypass surgery: Focus on gender differences

Year 2020, Volume: 50 Issue: 3, 153 - 159, 30.12.2020

Gülsev Özen Khadija Aljesri Öznur Kızar Gökçe Topal Gülsüm Türkyılmaz Saygın Türkyılmaz

Abstract

Background and Aims: The aim of the present study is to investigate whether the clinical characteristics of patients undergoing coronary artery bypass surgery (CAGB) differ by sex. Methods: This study was performed with a total of 58 patients who underwent CABG. The age, weight, height, systolic and diastolic blood pressure, HbA1c, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol values together with the demographic characteristics of patients undergoing CABG were collected and compared between male and female patients. Results: In the present study, 71% of patients undergoing CABG were men and 29% of them were women. There was no significant difference in weight, systolic and diastolic blood pressure, HbA1c, and total cholesterol values between male and female patients. Body mass index, LDL and HDL levels, the ratios of LDL/total cholesterol and HDL/total cholesterol were higher while height was lower in females compared to male patients. Conclusion: Our study highlights the need for sex-specific approaches in the prevention of coronary artery diseases. Risk factors including obesity, diabetes, hypertension, and dyslipidemia influence the outcome of death in patients undergoing CABG. Correct management of controllable risk factors with the focus on gender differences could be beneficial in reducing mortality and morbidity rates by altering the prognosis of coronary artery diseases.

Keywords

Coronary artery bypass surgery, patient characteristics, gender differences, cardiovascular risk factors

References

• • Ades, P. A., & Savage, P. D. (2017). Obesity in coronary heart disease: An unaddressed behavioral risk factor. Preventive Medicine, 104, 117–119. https://doi.org/10.1016/j.ypmed.2017.04.013
• • Ahmad, M., Arifi, A. A., Onselen, R. van, Alkodami, A. A., Zaibag, M., Khaldi, A. A. A., & Najm, H. K. (2010). Gender differences in the surgical management and early clinical outcome of coronary artery disease: Single centre experience. Journal of the Saudi Heart Association, 22(2), 47–53. https://doi.org/10.1016/j. jsha.2010.02.004
• • Ajay, V. S., & Prabhakaran, D. (2010). Coronary heart disease in Indians: Implications of the INTERHEART study. Indian Journal of Medical Research, 132(5), 561–566. https://doi.org/10.4103/0971- 5916.73396
• • Alam, M., Bandeali, S. J., Kayani, W. T., Ahmad, W., Shahzad, S. A., Jneid, H. … Virani, S. S. (2013). Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men. American Journal of Cardiology, 112(3), 309–317. https://doi.org/10.1016/j.amjcard.2013.03.034
• • Alexander, J. H., & Smith, P. K. (2016). Coronary-artery bypass grafting. The New England Journal of Medicine, 375(10), 22–33. https:// doi.org/10.1056/NEJMc1608042
• • Aronson, S., Boisvert, D., & Lapp, W. (2002). Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesthesia and Analgesia, 94(5), 1079–1084. https://doi.org/10.1097/00000539-200205000-00005
• • Bachar, B. J., & Manna, B. (2020). Coronary artery bypass graft. statpearls. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/29939613
• • Bonow, R. O., Smaha, L. A., Smith, S. C., Mensah, G. A., & Lenfant, C. (2002). World Heart Day 2002: The international burden of cardiovascular disease: Responding to the emerging global epidemic. Circulation, 106(13), 1602–1605. https://doi.org/10.1161/01. CIR.0000035036.22612.2B
• • Bukkapatnam, R. N., Yeo, K. K., Li, Z., & Amsterdam, E. A. (2010). Operative Mortality in Women and Men Undergoing Coronary Artery Bypass Grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program). American Journal of Cardiology, 105(3), 339–342. https://doi.org/10.1016/j.amjcard.2009.09.035
• • Castelli, W. P. (1983). Cardiovascular disease and multifactorial risk: Challenge of the 1980s. American Heart Journal, 106(5), 1191– 1200. https://doi.org/10.1016/0002-8703(83)90174-6
• • Cornwell, L. D., Omer, S., Rosengart, T., Holman, W. L., & Bakaeen, F. G. (2015). Changes over time in risk profiles of patients who undergo coronary artery bypass graft surgery: The Veterans Affairs Surgical Quality Improvement Program (VASQIP). Journal of the American Medical Association (JAMA), 150(4), 308–315. https://doi. org/10.1001/jamasurg.2014.1700
• • Cowell, S. J., Newby, D. E., & Boon, N. A. (2004). Coronary artery disease in the elderly patient. Reviews in Clinical Gerontology, 14(2), 105–118..https://doi.org/10.1017/S095925980400139X
• • Coyan, G. N., Reeder, K. M., & Vacek, J. L. (2014). Diet and exercise interventions following coronary artery bypass graft surgery: A review and call to action. Physician and Sportsmedicine, 42(2), 119–129. https://doi.org/10.3810/psm.2014.05.2064
• • Davis, C. E., Williams, D. H., Oganov, R. G., Tao, S. C., Rywik, S. L., Stein, Y., & Little, J. A. (1996). Sex difference in high density lipoprotein cholesterol in six countries. American Journal of Epidemiology, 143(11), 1100–1106. https://doi.org/10.1093/oxfordjournals.aje. a008686
• • Di Angelantonio, E., Sarwar, N., Perry, P., Kaptoge, S., Ray, K. K., Thompson, A., … Danesh, J. (2009). Major lipids, apolipoproteins, and risk of vascular disease. Journal of the American Medical Association (JAMA), 302(18), 1993–2000. https://doi.org/10.1001/ jama.2009.1619
• • Dinh, D. T., Lee, G. A., Billah, B., Smith, J. A., Shardey, G. C., & Reid, C. M. (2008). Trends in coronary artery bypass graft surgery in Victoria, 2001– 2006: findings from the Australasian society of cardiac and thoracic surgeons’ database project. The Medical Journal of Australia, 188, 214–217. https://doi.org/10.5694/j.1326-5377.2008.tb01587.x
• • Elbardissi, A. W., Aranki, S. F., Sheng, S., O’Brien, S. M., Greenberg, C. C., & Gammie, J. S. (2012). Trends in isolated coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons adult cardiac surgery database. Journal of Thoracic and Cardiovascular Surgery, 143(2), 273–281. https://doi.org/10.1016/j.jtcvs.2011.10.029
• • Emmert, M. Y., Salzberg, S. P., Seifert, B., Schurr, U. P., Odavic, D., Reuthebuch, O., & Genoni, M. (2010). Despite modern off-pump coronary artery bypass grafting women fare worse than men☆. Interactive CardioVascular and Thoracic Surgery, 10(5), 737–741. https://doi.org/10.1510/icvts.2009.220277
• • Ference, B. A., Ginsberg, H. N., Graham, I., Ray, K. K., Packard, C. J., Bruckert, E. …Catapano, A. L. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal, 38(32), 2459–2469. https://doi. org/10.1093/eurheartj/ehx144.
• • Goldman, S., Zadina, K., Moritz, T., Ovitt, T., Sethi, G., Copeland, J. G. … Henderson, W. (2004). Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. Journal of the American College of Cardiology, 44(11), 2149–2156. https://doi.org/10.1016/j.jacc.2004.08.064
• • Hemal, K., Pagidipati, N. J., Coles, A., Dolor, R. J., Mark, D. B., Pellikka, P. A. … Douglas, P. S. (2016). Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease ınsights from the PROMISE Trial. Journal of the American College of Cardiology (JACC):Cardiovascular Imaging, 9(4), 337–346. https://doi. org/10.1016/j.jcmg.2016.02.001
• • Jannati, M., Navaei, M., & Ronizi, L. (2019). A comparative review of the outcomes of using arterial versus venous conduits in coronary artery bypass graft (CABG). Journal of Family Medicine and Primary Care, 8(9), 2768. https://doi.org/10.4103/jfmpc. jfmpc_367_19
• • Kabakçı, M. G., Oto, A., Oram, E., Karamhmetoğlu, A., Oram, A., & Uğurlu, Ş. (1990). Dilitiazem Therapy in Stable Angina Petoris: A Placebo-Controlled Study. Turk Kardiyoloji Derneği Arsivi, 18(3), 170–175. Retrieved from: https://archivestsc.com/tr/jvi. aspx?pdir=tkd&plng=tur&un=TKDA-53458&look4=
• • Kannel, W. B., & McGee, D. L. (1979). Diabetes and cardiovascular risk factors: The Framingham study. Circulation, 59(1), 8–13. https://doi.org/10.1161/01.CIR.59.1.8
• • Koch, C. G., Khandwala, F., Nussmeier, N., & Blackstone, E. H. (2003). Gender profiling in coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery, 126(6), 2044–2051. https:// doi.org/10.1016/S0022-5223(03)00955-3
• • Madhavan, M. V., Gersh, B. J., Alexander, K. P., Granger, C. B., & Stone, G. W. (2018). Coronary Artery Disease in Patients ≥80 Years of Age. Journal of the American College of Cardiology, 71(18), 2015– 2040. https://doi.org/10.1016/j.jacc.2017.12.068
• • Markou, A. L. P., Evers, M., van Swieten, H. A., & Noyez, L. (2008). Gender and physical activity one year after myocardial revascularization for stable angina. Interactive CardioVascular and Thoracic Surgery, 7(1), 96–101. https://doi.org/10.1510/icvts.2007.160382
• • McNeely, C., Markwell, S., & Vassileva, C. (2016). Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population. Annals of Thoracic Surgery, 102(1), 132–138. https://doi.org/10.1016/j.athoracsur. 2016.01.016
• • Nicolini, F., Vezzani, A., Fortuna, D., Contini, G. A., Pacini, D., Gabbieri, D., … Gherli, T. (2016). Gender differences in outcomes following isolated coronary artery bypass grafting: Long-term results. Journal of Cardiothoracic Surgery, 11(1), 144–150. https:// doi.org/10.1186/s13019-016-0538-4
• • Otsuka, F., Byrne, R. A., Yahagi, K., Mori, H., Ladich, E., Fowler, D. R. … Joner, M. (2015). Neoatherosclerosis: Overview of histopathologic findings and implications for intravascular imaging assessment. European Heart Journal, 36(32), 2147–2159.
• • Prabhakar, G., Haan, C. K., Peterson, E. D., Coombs, L. P., Cruzzavala, J. L., & Murray, G. F. (2002). The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: A study from the society of thoracic surgeons’ database. Annals of Thoracic Surgery 74, 1125–1131 https://doi.org/10.1016/S0003- 4975(02)03899-7
• • Praticò, D., Tangirala, R. K., Rader, D. J., Rokach, J., & FitzGerald, G. A. (1998). Vitamin E suppresses isoprostane generation in vivo and reduces atherosclerosis in ApoE-deficient mice. Nature Medicine, 4(10), 1189–1192. https://doi.org/10.1038/2685
• • Quertermous, T., & Ingelsson, E. (2016). Coronary Artery Disease and Its Risk Factors: Leveraging Shared Genetics to Discover Novel Biology. Circulation Research, 118(1), 14–16. https://doi. org/10.1161/CIRCRESAHA.115.307937
• • Rohlfing, C. L., Wiedmeyer, H. M., Little, R. R., England, J. D., Tennill, A., & Goldstein, D. E. (2002). Defining the relationship between plasma glucose and HbA1c: Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial. Diabetes Care, 25(2), 275–278. https://doi.org/10.2337/diacare.25.2.275
• • Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., … Murray, C. (2017). Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. Journal of the American College of Cardiology, 70(1), 1–25. https:// doi.org/10.1016/j.jacc.2017.04.052
• • Samak, M., Fatullayev, J., Sabashnikov, A., Zeriouh, M., Schmack, B., Ruhparwar, A., … Weymann, A. (2016). Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease. Medical Science Monitor Basic Research, 22, 107–114. https://doi.org/10.12659/MSMBR.901508
• • Seccareccia, F., Perucci, C. A., D’Errigo, P., Arcà, M., Fusco, D., Rosato, S., & Greco, D. (2006). The Italian CABG Outcome Study: Shortterm outcomes in patients with coronary artery bypass graft surgery. European Journal of Cardio-Thoracic Surgery, 29(1), 56–62. https://doi.org/10.1016/j.ejcts.2005.07.017
• • Shao, C., Wang, J., Tian, J., & Tang, Y. D. (2020). Coronary Artery Disease: From Mechanism to Clinical Practice. Advances in Experimental Medicine and Biology,1177, 1–36. https://doi.org/10.1007/978- 981-15-2517-9_1
• • Terada, T., Johnson, J. A., Norris, C., Padwal, R., Qiu, W., Sharma, A. M. … Forhan, M. (2016). Severe obesity is associated with increased risk of early complications and extended length of stay following coronary artery bypass grafting surgery. Journal of the American Heart Association, 5(6), e003282. https://doi.org/10.1161/ JAHA.116.003282
• • Varma, P. K., Kundan, S., Ananthanarayanan, C., Panicker, V. T., Pillai, V. V., Sarma, P. S., & Karunakaran, J. (2014). Demographic profile, clinical characteristics and outcomes of patients undergoing coronary artery bypass grafting—retrospective analysis of 4,024 patients. Indian Journal of Thoracic and Cardiovascular Surgery, 30(4), 272–277. https://doi.org/10.1007/s12055-014-0318-5
• • Kannel, W. B. & Wilson, P. W. F. (1995). Risk Factors That Attenuate the Female Coronary Disease Advantage. Archives of Internal Medicine, 155(1), 57–61. https://doi.org/10.1001/ archinte.1995.00430010063008
• • Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C. … Wright, J. T. (2018). 2017 ACC/AHA/ AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 138(17), e484–e594. https://doi. org/10.1161/CIR.0000000000000596
• • World Health Organization. (2017, 17 May). Cardiovascular diseases. [Web log post]. Retrieved from: https://www.who.int/healthtopics/ cardiovascular-diseases/#tab=tab_1
• • Willerson, J. T., & Holmes D. R. (2015). Coronary artery disease. Switzerland, AG: Springer Nature.
• • Wilson, J. M. (2015). Coronary Artery bypass surgery and percutaneous coronary revascularization: Impact on morbidity and mortality in patients with coronary artery disease. London, UK: Springer.