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Women with nonobstructive CAD exhibit reduced health status, more psychosocial distress vs. men
Among patients with nonobstructive CAD, women face a lower health status, more negativity and more anxiety compared with men, according to findings published in Circulation: Cardiovascular Quality and Outcomes.
“This study shows that patients with [nonobstructive CAD] have adverse health status and more psychosocial distress compared with the general population,” Paula M. C. Mommersteeg, PhD, assistant professor of medical and clinical psychology at Tilburg University in the Netherlands, and colleagues wrote. “Women showed impaired health status and more psychosocial distress compared with men, but these differences were not exclusive for patients with [nonobstructive CAD].”
Researchers reviewed data from 523 patients in the TweeSteden Hospital Tilburg in the Netherlands with nonobstructive CAD (mean age, 61 years, 51% women) between January 2009 and January 2013. The reference group included 1,347 people from the Dutch general population whose data were collected between 2007 and 2010. Participants in the reference group were matched by sex and age to those with nonobstructive CAD.
The 12-item Short Form Health Survey (SF-12) was completed by both groups to measure their health status, whereas the Seattle Angina Questionnaire was utilized for just the nonobstructive CAD group. The Fatigue Assessment Scale, Hospital Anxiety and Depression Scale, Global Mood Scale and the Type D Scale-14 were also used to assess both groups.
Compared with the reference group, men and women with nonobstructive CAD presented with higher rates of fatigue, increased anxiety, lower health status, greater tendency for type D personality, more depressive symptoms, more negative affectivity and less positive affectivity, according to the researchers.
Women with nonobstructive CAD had lower rates of social inhibition (11%) vs. the reference group of women (22%), although type D personality was more common in women with nonobstructive CAD (31%) vs. the women in the reference group (17%).
Researchers also analyzed data between men and women who had nonobstructive CAD. Women showed a lower physical health status on SF-12 (42.4 ± 10.2) compared with men (45.9 ± 10.8), lower mental health status on SF-12 (42.4 ± 12 vs. 46.1 ± 11.5) and higher rates of fatigue (23.7 ± 6.7 vs. 22.1 ± 7.2).
The researchers found women reported higher levels of psychological distress than men, including anxiety (6.9 ± 4.3 vs. 5.6 ± 4.1), depression (5.3 ± 3.9 vs. 4.9 ± 4.1) and negative affect (12.2 ± 8.1 vs. 11.1 ± 9.2).
“In spite of evidence that women benefit from the same therapies as men, they continue to receive less aggressive therapy, which is reflected in higher health care resource utilization and adverse health status outcomes,” Mommersteeg and colleagues wrote. – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Although it seems self-evident that patients with nonobstructive CAD referred for coronary angiography or CT typically for suspected ischemia would have greater psychosocial burden compared with the general public due to their symptoms and concern, little prior work has documented this.
Implications of the study include that we should not ignore nonobstructive CAD in patients with suspected ischemia and that women have a greater disease burden due to age, education, income and other factors. These are societal issues that should be addressed to optimize health for women. We need clinical trials to advise guidelines regarding treatment of nonobstructive CAD.
Increasingly, health care needs to measure holistic wellness, which is now possible due to patient-reported outcomes and electronic health records.