Gender disparities in vascular disease.
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Date
2013
Authors
Dreyer, Rachel Patricia
Editors
Advisors
Beltrame, John Francis
Artall, Margaret
Zeitz, Christopher John
Schrader, Geoffrey David
Artall, Margaret
Zeitz, Christopher John
Schrader, Geoffrey David
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Thesis
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Abstract
Background and Objectives: This thesis investigates sex/gender disparities in a range of vascular disorders. Specific aims include, (1) To evaluate gender differences in chronic stable angina patients attending general practitioner clinics in relation to (a) health status, and (b) potential contributing clinical factors. (2) To investigate gender differences in Door-to-Balloon (DTB) time amongst patients with ST-Elevation myocardial infarction (STEMI) receiving percutaneous coronary intervention (PCI) in relation to (a) the components of DTB time in women, and (b) the independent effect of gender on DTB time. (3) To examine sex differences in cardiac haemodynamic parameters in patients with STEMI, especially if (a) female sex is an independent determinant of pulmonary capillary wedge pressure (PCWP), and (b) whether elevated PCWP is a determinant in all-cause 30-day mortality/re-infarction. (4) To evaluate gender differences in peripheral artery disease (PAD) patients attending Dutch vascular clinics in relation to (a) long term mortality/major adverse cardiovascular events, and (b) self reported symptomatic health status. Methods: Each chapter of this thesis employs different quantitative methods to evaluate clinical outcomes and health status in arrange of coronary and peripheral disorders. Specifically, chapters 3 and 6 employ patient-reported health status measures derived from both generic and disease specific instruments. Chapters 4 and 5 employ clinical outcome measures such as hospital performance metrics and haemodynamic endpoints. For cross sectional data, analyses have been adjusted for age and conventional clinical risk factors in order to compare genders. In terms of multivariate statistics, linear or logistic regression has been employed relevant to the analyzed outcome. For longitudinal data, Cox proportional hazards models and Kaplin Meier curves were conducted as well as imputation for missing data. Summary of major findings: (1) Compared with men, women with stable angina have worse angina-related health outcomes. Despite this, women were less likely to (a) undergo revascularisation therapies, (b) receive cardio-protective agents or (c) be referred for any specialist cardiology review (Chapter 3). (2) Analysis of the DTB time components in patients with STEMI confirmed a delay in both diagnosis and the initiation of PCI therapy in women. Furthermore, gender was found to be an independent determinant of DTB (Chapter 4). (3) Women with STEMI undergoing PCI have an elevated PCWP compared with men. In addition, female sex, hypertension and creatine kinase estimated infarct size were the independent predictors of an elevated PCWP. The effect of female sex on 30-Day mortality/re-infarction was partially mediated through PCWP, which had its own direct effect on 30-day outcomes. (4) In patients with PAD, there was found to be no significant effect of gender on mortality/major adverse cardiovascular events, however, women had poorer physical/mental health status scores at baseline and 12 months compared with men. Conclusion: Gender disparities in relation to poorer health status and poor clinical outcomes are evident in both coronary and peripheral artery disease. These findings confirm that the gender disparity conundrum in contemporary cardiovascular health is ‘alive and well’ in 2012. Future gender specific research into women’s cardiovascular health is essential in bridging this gap in knowledge.
School/Discipline
School of Medicine
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2013
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.