Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Environmental Health Department, T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Open Heart. 2021 Jan;8(1). doi: 10.1136/openhrt-2020-001470.
Our aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce.
We examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation.
A total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001).
Women presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.
我们旨在探索在一个医学专业文献翻译为简体中文医学管理和心血管疾病（CVD）结局方面的性别差异和不平等，因为在这个低/中等收入国家（LMIC）相关报告很少。
我们在印度喀拉拉邦进行的急性冠脉综合征质量改善试验（Kerala Acute Coronary Syndrome Quality Improvement trial）中，检查了 21374 例急性冠脉综合征（ACS）患者的表现、管理和临床结局方面的性别差异。主要结局是住院期间和 30 天内主要不良心血管事件（MACE）的发生率，定义为死亡、再梗死、卒中和大出血的复合事件。我们使用对数泊松多变量随机效应模型获得了女性与男性相比的相对风险，并根据中心和年龄、心血管危险因素和心脏表现进行了聚类调整。
共有 5191 例（24.3%）患者为女性。与男性相比，ACS 女性患者年龄更大（65±12 岁 vs 58±12 岁；p<0.001），更可能患有高血压和糖尿病。她们的症状出现到就诊的时间也更长（中位数，300 分钟 vs 238 分钟；p<0.001），ST 段抬高型心肌梗死患者接受直接经皮冠状动脉介入治疗的可能性也更小（女性为 45.9%，男性为 49.8%，p<0.001）。调整后，女性更有可能发生住院期间（调整后的相对风险（RR）=1.53；95%CI 1.32 至 1.77；p<0.001）和 30 天 MACE（调整后的 RR=1.39；95%CI 1.23 至 1.57，p<0.001）。
在印度喀拉拉邦，ACS 女性患者的心血管疾病危险因素负担更大，包括高血压和糖尿病，就诊延迟时间更长，接受指南推荐治疗的可能性更低。女性患者的住院和 30 天结局也更差。需要进一步努力了解和减少中低收入国家男女之间心血管保健的差异。
