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Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.

Publication ,  Journal Article
Hemal, K; Pagidipati, NJ; Coles, A; Dolor, RJ; Mark, DB; Pellikka, PA; Hoffmann, U; Litwin, SE; Daubert, MA; Shah, SH; Ariani, K; Martinez, B ...
Published in: JACC Cardiovasc Imaging
April 2016

OBJECTIVES: The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD). BACKGROUND: Although established CAD presentations differ by sex, little is known about stable, suspected CAD. METHODS: The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression. RESULTS: Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men. CONCLUSIONS: Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

April 2016

Volume

9

Issue

4

Start / End Page

337 / 346

Location

United States

Related Subject Headings

  • Sex Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Outpatients
  • Odds Ratio
  • North America
  • Multivariate Analysis
 

Citation

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Hemal, K., Pagidipati, N. J., Coles, A., Dolor, R. J., Mark, D. B., Pellikka, P. A., … Douglas, P. S. (2016). Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging, 9(4), 337–346. https://doi.org/10.1016/j.jcmg.2016.02.001
Hemal, Kshipra, Neha J. Pagidipati, Adrian Coles, Rowena J. Dolor, Daniel B. Mark, Patricia A. Pellikka, Udo Hoffmann, et al. “Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.JACC Cardiovasc Imaging 9, no. 4 (April 2016): 337–46. https://doi.org/10.1016/j.jcmg.2016.02.001.
Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. 2016 Apr;9(4):337–46.
Hemal, Kshipra, et al. “Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.JACC Cardiovasc Imaging, vol. 9, no. 4, Apr. 2016, pp. 337–46. Pubmed, doi:10.1016/j.jcmg.2016.02.001.
Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, Hoffmann U, Litwin SE, Daubert MA, Shah SH, Ariani K, Bullock-Palmer RP, Martinez B, Lee KL, Douglas PS. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. 2016 Apr;9(4):337–346.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

April 2016

Volume

9

Issue

4

Start / End Page

337 / 346

Location

United States

Related Subject Headings

  • Sex Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Outpatients
  • Odds Ratio
  • North America
  • Multivariate Analysis