Each month there are approximately 2,400 internet searches for information related to heart bypass surgery. While there is a wealth of information on this common cardiovascular procedure, scientists are still seeking the answer to one critical question – why do women have a higher risk than men for post-surgery complications?
Intent on uncovering where cardiac care for women required attention, a Women’s Health Research at Yale-funded study by Viola Vaccarino, MD, PhD, was the first to alert the medical community that women had worse outcomes compared to men after coronary artery bypass graft (CABG) surgery.
The study found that the difference in outcomes could not be explained by pre-surgery health status, current illness, or a variety of patient characteristics. In the six to eight weeks following surgery, the most likely time for complications, women were nearly twice as likely as men to be readmitted to the hospital (20.5% of women, 11% of men), have infections, report lower physical functioning, and experience more depressive symptoms.
“We found that at six months after surgery, both women and men showed improvement in their functional status, but women had about half of the improvement compared to men,” said Dr. Vaccarino, now a professor of cardiovascular research and the chair of the Department of Epidemiology at Emory University.
Thanks to these findings and the subsequent work of many others committed to improving cardiac health for all, cardiology research and clinical care has come a long way since this important 2003 foundational study was published. For example, robotic surgery has made it easier to operate on the small vessels of a woman’s heart. And extensive research into the use of statins, the most common cholesterol-lowering drug, before and after bypass surgery has found these medications substantially reduce the risk of common post-surgery complications for women and men.
“If we are going to address this higher risk for adverse outcomes, we need further trials dedicated to women.”
Dr. Mario Guadino, Weill Cornell Medicine
Nonetheless, a March 2023 study by Mario Guadino, MD, PhD, and colleagues in JAMA Surgery noted that even though overall outcomes following bypass surgery have improved, women remain at a higher risk for complications than do men.
This does not mean the approximately 111,000 women who undergo a coronary artery bypass graft every year face a difficult recovery. Rather, it means we must maintain our focus on sex differences in the biology of heart disease, and women need to be adequately represented in clinical trials.
“I think the general feeling in the medical and research community was that with the progressive improvement in CABG outcomes the sex gap would have disappeared and, as a result, research and clinical trials specific to women were not always prioritized,” said Dr. Guadino, a cardiologist and professor at Weill Cornell Medicine. “If we are going to address this higher risk for adverse outcomes, we need further trials dedicated to women.”
A study led by Dr. Guadino is now underway using an innovative design to increase enrollment of women in a cardiac clinical trial. Moreover, it aims to generate meaningful data on the risks and benefits, for both men and women, of grafting multiple arteries in bypass surgery.
Advancements which improve the health and health care of women are a worthy investment. With one of its first research grants, Women’s Health Research at Yale funded Dr. Vaccarino’s study with the intention of bettering outcomes for women. Now, in its twenty-fifth year, the center remains committed to deliberate efforts that usher in change and welcomes reminders of the importance of long-term efforts. With continued investment comes the greatest payout of all – improved health and well-being.