Abstract
Introduction: Women referred for coronary artery bypass grafting (CABG) have worse metabolic disorders. The latter are associated with adverse cardiovascular (CV) events and bear a worse prognosis in women. Yet, our understanding of the sex-specific impact of metabolic disorders on mortality after CABG is limited. Aim: To evaluate the interaction of sex with metabolic abnormalities on mortality after CABG, with the hypothesis that they would lead to higher mortality in women. Methods: In a prospective cohort (2006-19), we selected patients who underwent elective isolated CABG, excluding early (<48h) mortality, atrial fibrillation/flutter, pacemaker/defibrillator or heritable dyslipidemia. Sex-specific predictors of all-cause mortality after CABG and their interaction with sex were assessed with Cox proportional hazard models (stepwise selection for each model). Diabetes was defined as per Canadian Diabetes Association Guidelines. Results: We included 6,177 individuals (17% women) in this analysis. All-cause mortality incidence was 438 (9%) and 119 (11%) in men and women respectively (p=0.01) over a median of 5.7 yrs. Compared to men, women were older (67 ± 9 vs 65 ± 9 yrs), more likely to have hypertension (85% vs 78%), diabetes (40% vs 34%), abdominal obesity (82% vs 51%), chronic kidney disease (27% vs 15%), LVEF ≥40% (94% vs 92%) and had higher LDL-cholesterol (72 [17-238] vs 67 [10-221] md/dL) (all p<0.05). Prior myocardial infarction was similar in both sexes (11%, p=0.48). Predictors of mortality are in Figure 1. An interaction between sex and diabetes was found (p=0.03), suggesting worse impact of diabetes in women after CABG. Conclusion: Women undergoing CABG have worse CV risk factors and metabolic risk profile, including diabetes which significantly increased mortality risk vs men. Studies are needed to evaluate which sex- or gender-related factors, like poorer diabetes management or reduced participation in cardiac rehabilitation, may be involved.
Published Version
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