Sex Differences in Coronary Disease Health Status Outcomes: the ISCHEMIA Trial.
| Title: | Sex Differences in Coronary Disease Health Status Outcomes: the ISCHEMIA Trial. |
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| Authors: | Grodzinsky A; Saint Luke's Mid America Heart Institute, Saint Luke's Muriel I. Kauffman Institute for Women's Cardiovascular Research, University of Missouri-Kansas City, Kansas City, MO, USA.; Cho YJ; Saint Luke's Mid America Heart Institute, Saint Luke's Muriel I. Kauffman Institute for Women's Cardiovascular Research, University of Missouri-Kansas City, Kansas City, MO, USA.; Jones PG; Saint Luke's Mid America Heart Institute, Saint Luke's Muriel I. Kauffman Institute for Women's Cardiovascular Research, University of Missouri-Kansas City, Kansas City, MO, USA.; Shaw L; Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Merz CNB; Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.; Boden W; VA New England Healthcare System, Bedford, MA, USA.; Stone G; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Mark DB; Duke Clinical Research Institute, Durham, NC, USA.; Spertus JA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.; Maron DJ; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Hochman JS; Department of Medicine, Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, USA.; Reynolds HR; Department of Medicine, Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, USA. |
| Source: | European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2026 Apr 13. Date of Electronic Publication: 2026 Apr 13. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101677796 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2058-1742 (Electronic) Linking ISSN: 20581742 NLM ISO Abbreviation: Eur Heart J Qual Care Clin Outcomes Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Oxford University Press, [2015]- |
| Abstract: | Background: In the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial, women had worse angina than men despite less severe coronary artery disease (CAD) and ischemia. We examined which patient and treatment factors might explain sex-based differences in angina.; Methods: ISCHEMIA randomized patients with moderate or severe ischemia to an initial invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with invasive management reserved for GDMT failure. Coronary CT angiography was performed in most participants. Angina-related health status was collected at baseline and 1-year using the Seattle Angina Questionnaire (SAQ).; Results: Of 4,617 ISCHEMIA participants with complete SAQ data, women averaged 6.5 points (95% CI 5.2-7.8) lower (worse) baseline SAQ summary scores (SS) than men. This difference was not reduced by adjustment for demographics and clinical characteristics. Women had lower unadjusted 1-year SAQ-SS than men (Invasive -3.8 points, Conservative -5.7 points). These sex-based differences were attenuated but not eliminated by adjustment for baseline SAQ-SS. Adjustment for post-randomization treatment (GDMT intensity, risk factor goal achievement and, in the invasive strategy, complete revascularization) did not narrow the sex difference.; Conclusions: Women with chronic CAD in ISCHEMIA had worse angina-related health status than men at baseline and 1-year. Differences were not explained by demographic or clinical characteristics, intensity of GDMT, or completeness of revascularization. It is thus important to consider other factors that may mediate these results, including differences in nociception, coronary microvascular dysfunction and/or vasospasm.; (© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Grant Information: | U01 HL105462 United States HL NHLBI NIH HHS; U01 HL105561 United States HL NHLBI NIH HHS; U01 HL105565 United States HL NHLBI NIH HHS; U01 HL105907 United States HL NHLBI NIH HHS |
| Contributed Indexing: | Keywords: angina; coronary heart disease; patient provider communication; women |
| Entry Date(s): | Date Created: 20260414 Latest Revision: 20260416 |
| Update Code: | 20260416 |
| PubMed Central ID: | PMC13082453 |
| DOI: | 10.1093/ehjqcco/qcag052 |
| PMID: | 41978343 |
| Database: | MEDLINE |
Journal Article