Differences between Men and Women Veterans Undergoing Cardiac Catheterization in VA
Coronary artery disease (CAD) remains the leading cause of death among women in the United States. Women who have served in the military may have an even higher risk of CAD than non-Veteran women, given the overall worse health status and higher number of CAD risk factors in the Veteran population, but little is known about the characteristics and treatment of women Veterans suspected of having clinically significant CAD. This study sought to determine whether there were gender differences in clinical characteristics and comorbidities, coronary anatomy and treatment, and procedural complications and long-term outcomes after diagnostic catheterization. Using data from the national VA Clinical Assessment, Reporting and Tracking (CART) Program, investigators identified 85,936 Veterans (3,181 women) who underwent initial diagnostic catheterization between 10/07 and 9/12 at any of 77 VA catheterization labs. Using these data, investigators assessed gender differences in demographics, indications, coronary anatomy, cardiac treatments, and outcomes.
- Female Veterans were younger (57 vs 63 years) with fewer traditional cardiovascular risk factors, but had more obesity, depression, and PTSD than male Veterans.
- Compared to male Veterans, female Veterans had lower rates of obstructive CAD (23% vs 53%), similar or lower rates of procedural complications, and lower rates of all-cause rehospitalization.
- Women Veterans had lower mortality at one year, even when adjusted for age, presence of obstructive disease, and multiple comorbidities.
- These findings suggest that a significant portion of women Veterans treated in VA catheterization labs have chest pain not related to obstructive CAD. This may represent a complex interplay of psychological stressors and somatic disease, but further research is needed.
- Although CART data have been shown to be highly accurate, misclassification may still occur, and more detailed information regarding stress testing types and results was not available. In addition, detailed symptom description, stress testing, biomarker, and EKG data were not available.
- Cause of death could not be separated into cardiac-specific mortality since this information was not collected in VA data sets. Additional variables, such as aspirin use and left ventricular ejection fraction, also were not available.
This study was funded by HSR&D, and Dr. Maddox was supported by a Career Development Award. Dr. Maddox is part of VA/HSR&D's Ischemic Heart Disease Quality Enhancement Research Initiative (IHD-QUERI), and HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, CO.
Davis M, Maddox T, Langner P, et al. Characteristics and Outcomes of Women Veterans Undergoing Cardiac Catheterization in the Veterans Affairs Healthcare System: Insights from the VA CART Program. Circulation: Cardiovascular Quality and Outcomes. March 2015;8(2 Suppl 1):S39-47.