The influence of gender on the risk for subsequent ischemic events (i.e., myocardial infarction, stroke, critical limb ischemia) in patients with coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD) is not well known.
Patients and Methods:
FRENA is an ongoing, observational registry of consecutive outpatients with symptomatic CAD, CVD, or PAD. We compared the incidence of subsequent ischemic events according to gender.
As of July 2008, 2607 patients had been enrolled, of whom 713 (27%) were women. Women were significantly older and had diabetes or hypertension more often than men. Over a mean follow-up of 14 months, 228 patients (8.7%) developed subsequent events (myocardial infarction 72; ischemic stroke 76; critical limb ischemia 98). Of these, 37 (16%) were fatal. On univariate analysis, women had an increased incidence of subsequent ischemic events than men (odds ratio: 1.3; 95% CI: 1.0-1.8). On multivariate analysis, any influence of gender had disappeared. The most common type of subsequent event was one that was identical to the patient’s initial manifestation, but women experienced events in the same vascular bed more often than men, particularly women initially presenting with CVD: 92% of women vs 62% of men with CVD had subsequent stroke (odds ratio: 6.5; 95% CI: 1.5-4.7).
Women had a higher incidence of subsequent ischemic events in the same vascular bed than men, particularly those with CVD. They also had a worse outcome than men, but this may be explained by the confounding effect of additional variables.