Advancing Sex and Gender Considerations in Perioperative Cardiovascular-Risk Assessment

Abstract

Several clinical areas within cardiac sciences are known as leaders in advancing research to reduce sex- and gender-related disparities in cardiovascular health outcomes. Despite the well-known increased risks of adverse cardiovascular events (myocardial injury, myocardial infarction, arrhythmia, heart failure and mortality) in the perioperative period after noncardiac surgery, 1 Devereaux P.J. Biccard B.M. Sigamani A. et al. association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017; 317: 1642-1651 Crossref PubMed Scopus (367) Google Scholar ,2 Botto F. Alonso-Coello P. Chan M.T. et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120: 564-578 Crossref PubMed Scopus (550) Google Scholar this field lags behind other areas of cardiovascular health in examining sex and gender-specific considerations. 3 Lindsay W.A. Murphy M.M. Almghairbi D.S. et al. Age, sex, race and ethnicity representativeness of randomised controlled trials in peri-operative medicine. Anaesthesia. 2020; 75: 809-815 Crossref PubMed Scopus (11) Google Scholar Further, despite the recent Canadian Cardiovascular Society (CCS) endorsement of recommendations to include sex- and gender-specific considerations in clinical practice guideline development and application, 4 Tannenbaum C. Norris C.M. McMurtry M.S. Sex-specific considerations in guidelines generation and application. Can J Cardiol. 2019; 35: 598-605 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar the 2017 CCS Guidelines for Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery do not provide any sex- or gender-specific recommendations for cardiovascular risk assessment or management. 5 Duceppe E. Parlow J. MacDonald P. et al. Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017; 33: 17-32 Abstract Full Text Full Text PDF PubMed Scopus (321) Google Scholar This absence may reflect the paucity of sex-specific data in this field, particularly as commonly used perioperative risk-assessment tools do not include sex- or gender-specific variables, 5 Duceppe E. Parlow J. MacDonald P. et al. Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017; 33: 17-32 Abstract Full Text Full Text PDF PubMed Scopus (321) Google Scholar and perioperative randomized controlled trials have at least a 25% underrepresentation of female participants. 3 Lindsay W.A. Murphy M.M. Almghairbi D.S. et al. Age, sex, race and ethnicity representativeness of randomised controlled trials in peri-operative medicine. Anaesthesia. 2020; 75: 809-815 Crossref PubMed Scopus (11) Google Scholar Association of Preeclampsia With Myocardial Injury Among Patients Undergoing Noncardiac Surgery: The PREECLAMPSIA-VISION StudyCanadian Journal of CardiologyVol. 37Issue 12PreviewIn women, preeclampsia has a known association with increased long-term cardiovascular morbidity and mortality. However, it is unknown whether it is associated with increased postoperative cardiovascular morbidity and mortality in women. We aimed to determine if preeclampsia is an independent risk factor for myocardial injury after noncardiac surgery (MINS) and postoperative 30-day mortality. Full-Text PDF