Survival rates with coronary artery disease for black women compared with black men

Black women who have coronary artery disease (CAD) may have a worse prognosis than black men who have CAD, compared to black men and women who do not have CAD. A study of 1,719 black patients enrolled in the Cook County (IL) Heart Disease Registry found that death rates from heart disease were similar in men and women. Patients were enrolled in the registry if they were referred for coronary angiography, hospitalized for a heart attack or referred for coronary artery bypass grafting. Those referred for coronary angiography were further subdivided by those who had a normal angiogram, that is, no CAD, and those who had CAD. Although death rates in men and women were similar, when men and women with CAD were compared to men and women without CAD, the women had a much worse prognosis. Women with CAD who suffered a heart attack were 10 times more likely to die than women without CAD. Men with CAD who suffered a heart attack were only four times more likely to die than those without CAD.
Objective.--To evaluate the influence of gender on the prognosis of coronary heart disease among black patients. Design.--Cohort study based on a consecutive sample from a hospital registry, with a mean follow-up of 4 years. Setting.--An inner-city public hospital in Chicago, III. Patients.--The study included 1719 consecutive black patients (780 men and 939 women) who had any one of the following events: cardiac catheterization for presumed coronary heart disease, hospitalization for acute myocardial infarction, or coronary artery bypass grafting. Results.--Hospital and operative mortality rates following acute myocardial infarction and coronary artery bypass grafting were similar between the two sexes. The relative risks for cardiac death in women vs men were 0.88 (95% confidence interval [CI], 0.60 to 1.28), 0.79 (95% CI, 0.53 to 1.17), and 0.79 (95% CI, 0.34 to 1.85) for coronary artery disease, acute myocardial infarction, and coronary artery bypass grafting, respectively, after adjusting for age, history of diabetes, hypertension, angina pectoris and myocardial infarction, number of diseased vessels, and ejection fraction. Compared with patients of the same sex with normal angiograms, relative risk estimates were 5.0, 10.1, and 6.3 for women and were 1.8, 4.0, and 2.0 for men in the same three groups of patients, respectively. Conclusions.--Survival with coronary artery disease in black women is similar to that observed in black men, but relative to members of the same sex without the disease, the prognosis for women is considerably worse than for men.