February 26, 2015
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 CAD. This HSR&D 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. 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.
Findings published in Circulation: Cardiovascular Quality and Outcomes show that women Veterans undergoing cardiac catheterization in the VA healthcare system have higher rates of non-obstructive CAD or normal coronary arteries than men (23% vs 53%), even when they present with acute coronary symptoms. Compared to male Veterans, female Veterans had similar or lower rates of procedural complications, and lower rates of all-cause rehospitalization. Female Veterans also were younger (57 vs 63 years) with fewer traditional cardiovascular risk factors, but had more obesity, depression, and PTSD than male Veterans. These findings suggest that a significant portion of women Veterans treated in VA catheterization labs have chest pain not related to obstructive CAD, which may represent a complex interplay of psychological stressors and somatic disease.