Cardiac surgeon Jennifer Lawton discusses unique cardiovascular disease risk factors in women and considerations for women undergoing coronary surgery.
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mm here at johNS Hopkins, we have the women's cardiovascular health center and that encompasses a large number of physicians and clinicians that are experts in taking care of women with cardiovascular disease? That may be from the time of pregnancy or the time of menopause or postmenopausal women. We have people in cardiology and cardio obstetrics, cardio oncology and cardiac surgeons that specialize in that care. We know that cardiovascular disease is the number one killer of women in most developed countries and it is the number one killer globally. So what can we do to change these statistics? We know that women are often referred later with cardiovascular disease. They tend to have smaller vessel disease. That's often undetectable on cardiac catheterization. We know that they're less often to be referred for cardiac catheterization or coronary artery bypass grafting surgery. Once they do go to bypass surgery, we know that the mortality rate or the death rate is higher than it is in men. And this is true from older observational studies and also very recent, very large patient databases where women have a much higher rate of dying in hospital within 30 days and within one year of coronary artery bypass grafting surgery. So what can we do to change those statistics? There are a variety of things that we can look at that may be different between women and men other than the obvious, Of course, we can look at the size of women and the size of their coronary arteries? Is that one of the problems? Does it have to do with our choices of conduit for coronary artery bypass grafting? Is it that men and women receive different conduits? Is it that we could perhaps use off pump coronary bypass surgery in women and have equivalent outcomes to men? We've looked at this in many studies and many people have been researching this for many years recently, we noted, and this has been noted since the early 1990s that women are less likely than men to receive an arterial graft. In other words, the artery that we used to bypass the arteries on the heart. We know that those arteries stay open longer and have give the patient prolonged survival. So why shouldn't every patient get an arterial graft? We know women are less likely to receive the left internal mammary artery in the chest wall. Women are less likely to receive the radial artery from the arm. This is opposed to the vein from the leg. The vein from the leg is opened in 10 years and about 50 to 60% of patients. However, the artery in the chest wall, the internal mammary artery is opened in 95% of patients and that's why it prolongs survival. So, in large patients. Studies of over one million patients in this country, we know that women are less likely to receive arterial grafts. So we need to look at what some of the barriers are to giving women arterial grafts. We also need to look at some of the barriers as to why women have different treatment at the time of coronary artery bypass grafting surgery. And by doing this with our specialists at the Women's Cardiovascular Health Center. Hopefully we can reduce the mortality of women after heart surgery. Yeah. Mm. Yeah. Yeah.
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