MISC 15. Trends in Survival of Women Younger and Older Than 55 Years After Major Vascular Intervention: A Sex and Age Comparison

Abstract

The literature has shown a correlation between estrogen production and vascular protection (anti-inflammatory and vasoprotective effects). Therefore, as estrogen production decreases after menopause, there is an increase in cardiovascular risk. The aim of this study was to evaluate survival of women younger and older than 55 years after major vascular intervention and to compare it with that of age-matched men. This retrospective study included 604 patients who underwent open and endovascular interventions at our institution from 2014 to 2017. All vascular access and vein procedures were excluded. Groups were generated on the basis of age (18-55 years, 56-80 years, and >80 years) and sex. Kaplan-Meier estimates of 3-year survival were performed. Among 604 patients who received major intervention, 221 (37%) were female, and a majority were 61 to 75 years old (60%). There was a significant increase in hypertension, hyperlipidemia, and peripheral artery disease prevalence from women younger than 55 years to women older than 55 years (Table). For women, there was a significant decrease in survival between 18- to 55-year-olds and 56- to 80-year-olds after major vascular surgery (P = .04; Fig 1, A). There was not a significant difference between these age groups for men (Fig 1, B). For women, there was no significant decrease in survival between 56- to 80-year-olds and >80-year olds (P = .85), although there was in increase in hypertension, hyperlipidemia, and peripheral artery disease prevalence; however, there was a significant decrease for men between these two groups (P = .02). Overall 3-year survival was better for women than for men (Fig). Compared with women younger than 55 years, women older than 55 years had significantly more risk factors as they aged and worse survival after major vascular intervention. This trend was not present in men of the same age and therefore may indicate a significant role of this transition of hormonal production for women compared with men in vascular outcomes. Further research with larger sample sizes is warranted.TableRisk factors associated with each sex and age groupRisk factorMen (n = 383)Women (n = 221)18-55 years (n = 50)56-80 years (n = 260)>80 years (n = 73)18-55 years (n = 48)56-80 years (n = 133)>80 years (n = 40)Diabetes mellitus11 (22)112 (43)20 (27)7 (15)42 (32)9 (23)Hypertension31 (62)215 (83)59 (81)21 (44)105 (79)39 (98)Cardiovascular disease12 (24)112 (43)30 (41)8 (17)50 (38)11 (28)Pulmonary disease10 (20)84 (32)14 (19)5 (10)46 (35)10 (25)Renal disease9 (18)53 (20)12 (16)7 (15)14 (11)9 (23)Hyperlipidemia17 (34)177 (68)55 (75)13 (27)89 (67)37 (93)Peripheral artery disease18 (36)151 (58)36 (49)13 (27)78 (59)29 (73)Values are reported as number (%). Open table in a new tab