Comorbidity is a commonly proposed reason for explaining gender discrepancies in bypass surgery. In other words, women tend to develop heart disease along with other complicating conditions that increase the risk of cardiovascular intervention, especially surgery.
Comorbid conditions include diabetes, dysrhythmia, heart failure, hypertension, and old infarction. Presence of any comorbid condition in a patient greatly reduces the likelihood that he/she will receive bypass surgery.
Estrogen has cardiovascular protective effect
One of the comorbidity conditions that has been thoroughly investigated is diabetes. It is commonly observed that Coronary heart disease (CHD) is less common among pre-menopausal women than in men; below the age of 55 years, the incidence of CHD in women is one third of that of men. Interestingly, this difference disappears after the onset of menopause, and at age 75 years, women are at an equal risk as men. This is attributed to the reduced levels of female sex hormones in post-menopausal women.
Female sex hormone, especially estrogen, is known to have cardiovascular protective effect due to several mechanisms
Below is a chart that summarizes the cardiovascular protective effect of estrogen.
Diabetes interferes with the cardiovascular protective effects of estrogen
Due to mechanisms not yet understood, diabetes is known to interfere with the cardiovascular protective effects of female sex hormone in pre-menopausal women. Clinically, poor glycemic control in the body due to diabetes is manifested in the following ways.
Diabetic women are at a higher risk of CHD than diabetic men
Results of studies presented above indicate that there is a sex difference in the risk for CHD in individuals with diabetes. Below is a table that quantitatively compares the effect of diabetes and established CHD (previous history of heart disease) on subsequent cardiovascular disease mortality for the two sexes.
Even after adjusting for other risk factors such as age, smoking, hypertension, and etc., diabetic women have a larger increase in risk for CHD than diabetic men. (3.8 vs. 2.1) Since the intensity of management of diabetic patients is based on their risk for cardiovascular disease, and because diabetic women may be at a higher risk than diabetic men, current guidelines for treatment of women with diabetes may need to be more aggressive.
|Symptom Presentation| / |Comorbidity| / |Mortality|