COMORBIDITIES IN PATIENTS WITH ISCHEMIC HEART DISEASE: GENDER DIFFERENCES

Background. The problem of comorbidity in ischemic heart disease (IHD) has always been given increased attention, due to the high social significance of cardiovascular diseases. However, often the problem solution involved studying cardiac pathology along with concomitant diseases, such as diabetes mellitus, pulmonary or kidneys pathology, etc., but not a comprehensive approach, which takes into account all available comorbidities. An important issue that should be considered in the shift to the personalized medicine is the presence of gender differences, which varies greatly and depends on different correlations with specific comorbidities.

Aim. To study gender differences in comorbidities in patients with IHD.

Material and methods. 742 patients with IHD examined in the Research Institute for Complex Issues of Cardiovascular Diseases in 2011 before elective coronary by-pass surgery were included into the study. All the patients were divided into 2 groups depending on the gender: Group 1 – 147 females, Group 2 – 595 males.

Results. The obtained results reported that women were commonly older than men and more often had excess body weight (p<0.001). The majority of current smokers were males (p<0.001). During preoperative preparation, the development of myocardial infarction (MI) was observed in 12.9% of women and 7.4% of men (p=0.031), while the history of MI was more often found in male patients (p=0.004). The evaluation of the severity of angina pectoris and chronic heart failure (CHF) revealed that in men the I and II functional classes (FC) of angina (p=0.057 and p=0.007, respectively) and stage I CHF (p<0.001) were prevailed, whereas women had angina FC 3-4 (p=0.005 and p=0.050, respectively) and stage IIa CHF (p<0.001). Women more often than men suffered from hypertension (p=0.01) and atrial fibrillation (p=0.024), while peripheral artery disease prevailed among men (p=0.022). The analysis of comorbidities showed that disorders of carbohydrate metabolism, thyroid disease, bronchial asthma and varicose disease were more common in female patients (p<0.05), whereas chronic hepatitis (p=0.079) and urolithiasis – in males (p=0.028). The comorbidity score did not differ significantly between the study groups  (p>0.05), wherein the average level of comorbidity score prevailed among men (70.4%) and women (66%).

Conclusion. Detection of comorbidities in IHD patients based  on gender differences is advisable to improve both  the  immediate results of surgical management and further preventive measures.

1. Shlyakhto E.V., Konradi A.A. Key areas and prospects for translational research in cardiology. Vestnik Roszdravnadzora. 2015;5:33-7. (In Russ.) [Шляхто Е.В., Конради А.О. Основные направления и перспективы трансляционных исследований в кардиологии. Вестник Росздравнадзора. 2015;5:33-7].

2. Chung J.S., Young H.N., Moreno M.A., et al. Patient-centred outcomes research: brave new world meets old institutional policies. Fam Pract. 2017;34(3):296-300. doi: 10.1093/fampra/cmw129.

3. Bouchard C., Antunes-Correa L.M., Ashley E.A., et al. Personalized preventive medicine: genetics and the response to regular exercise in preventive interventions. Prog Cardiovasc Dis. 2015;57(4):337-46. doi: 10.1016/j.pcad.2014.08.005.

4. Pefoyo A.J., Bronskill S.E., Gruneir A., et al. The increasing burden and complexity of multimorbidity. BMC Public Health. 2015;15:415. doi: 10.1186/s12889-015-1733-2.

5. Rocca W.A., Boyd C.M., Grossardt B.R., et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336-49. doi: 10.1016/j.mayocp.2014.07.010.

6. Smith S.M., Soubhi H., Fortin M., et al. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205. doi: 10.1136/bmj.e5205.

7. Chamberlain A.M., St Sauver J.L., Gerber Y., et al. Multimorbidity in heart failure: a community perspective. Am J Med. 2015;128(1):38-45. doi: 10.1016/j.amjmed.2014.08.024.

8. Tolpygina S.N., Martsevich S.Yu., Deev A.D. The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the “Prognosis IHD” Register. Rational Pharmacotherapy in Cardiology. 2015;11(6):571-6. (In Russ.) [Толпыгина С.Н., Марцевич С.Ю., Деев А.Д. Влияние сопутствующих заболеваний на отдаленный прогноз пациентов с хронической ишемический болезнью сердца по данным регистра «Прогноз ИБС». Рациональная Фармакотерапия в Кардиологии. 2015;11(6):571-6]. doi: 10.20996/1819-6446-2015-11-6-571-576.

9. Oganov R.G. Vascular comorbidity: general approaches to prevention and treatment. Rational Pharmacotherapy in Cardiology. 2015;11(1):4-7. (In Russ.) [Оганов Р.Г. Сосудистая коморбидность: общие подходы к профилактике и лечению. Рациональная Фармакотерапия в Кардиологии. 2015;11(1):4-7].

10. Akhmedova E.B., Mardanov B.U., Badeynikova K.K., Mamedov M.N. Quality of Life, Clinical and Biochemical Parameters in Hypertensive Patients with Comorbid Conditions. Rational Pharmacotherapy in Cardiology. 2017;13(1):31-5. (In Russ.) [Ахмедова Э.Б., Марданов Б.У., Бадейникова К.К., Мамедов М.Н. Исследование качества жизни и параметров клинико-биохимического спектра у больных артериальной гипертензией и коморбидными состояниями. Рациональная Фармакотерапия в Кардиологии. 2017;13(1):31-5]. doi: 10.20996/1819-6446-2017-13-1-31-35.

11. Tavlueva E.V., Yarkovskaya A.P., Barbarash O.L. Relationship of diabetes mellitus with proinflammatory status in STEMI females and males. Kompleksnye Problemy Serdechno-Sosudistyh Zabolevanij. 2014;1:42-6. (In Russ.) [Тавлуева Е.В., Ярковская А.П., Барбараш О.Л. Взаимосвязь сахарного диабета с провоспалительным статусом у женщин и мужчин с ИМПST. Комплексные Проблемы Сердечно-Сосудистых Заболеваний. 2014;1:42-6]. doi: 10.17802/2306-1278-2014-1-42-46.

12. Zykov M.V. The course and risk stratification of acute coronary syndrome in conjuction with renal dysfunction and various treatment strategies (literature review). Kompleksnye Problemy Serdechno-Sosudistyh Zabolevanij. 2014;3:68-78. (In Russ.) [Зыков М.В. Особенности течения и стратификации риска осложнений острого коронарного синдрома в сочетании с почечной дисфункцией и различной стратегией лечения (обзор литературы). Комплексные Проблемы Сердечно-Сосудистых Заболеваний. 2015;3:68-78]. doi: 10.17802/2306-1278-2015-3-68-78.

13. Violán C., Foguet-Boreu Q., Roso-Llorach A., et al. Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study. BMC Public Health. 2014;14:530. doi: 10.1186/1471-2458-14-530.

14. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi:

15. St Sauver J.L., Boyd C.M., Grossardt B.R., et al. Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2):e006413. doi: 10.1136/bmjopen-2014-006413.

16. Rizza A., Kaplan V., Senn O., et al; FIRE study group. Ageand gender-related prevalence of multimorbidity in primary care: the Swiss FIRE project. BMC Fam Pract. 2012;13:113. doi: 10.1186/1471-2296-13-113.

17. van Oostrom S.H., Gijsen R., Stirbu I., et al. Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys. PLoS One. 2016;11(8):e0160264. doi: 10.1371/journal.pone.0160264.

18. Holzer B.M., Siebenhuener K., Bopp M., Minder C.E. Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Popul Health Metr. 2017;15(1):9. doi: 10.1186/s12963-017-0126-4.

19. Shalnova S.A., Oganov R.G., Deev A.D., et al. Comorbidities of ischemic heart disease with other noncommunicable diseases in adult population: age and risk factors association. Kardiovaskuljarnaja Terapija i Profilaktika. 2015;4:44-51. (In Russ.) [Шальнова С.А., Оганов Р.Г., Деев А.Д. и др. Сочетания ишемической болезни сердца с другими неинфекционными заболеваниями в популяции взрослого населения: ассоциации с возрастом и факторами риска. Кардиоваскулярная Терапия и Профилактика. 2015;4:44-51]. doi: 10.15829/1728-8800-2015-4-44-51.

20. Boytsov S.A., Luk’yanov M.M., Yakushin S.S., et al. Cardiovascular diseases registry (RECVASA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatientpolyclinic practice. Kardiovaskuljarnaja Terapija i Profilaktika. 2015;4:44-51. (In Russ.) [Бойцов С.А., Лукьянов М.М., Якушин С.С., и др. Регистр кардиоваскулярных заболеваний (РЕКВАЗА): диагностика, сочетанная сердечнососудистая патология, сопутствующие заболевания и лечение в условиях реальной амбулаторнополиклинической практики. Кардиоваскулярная Терапия и Профилактика. 2014;6:44-50]. doi: 10.15829/1728-8800-2014-6-44-50.

21. Zulman D.M., Pal Chee C., Wagner T.H., et al. Multimorbidity and healthcare utilisation among highcost patients in the US Veterans Affairs Health Care System. BMJ Open. 2015;5(4):e007771. doi: 10.1136/bmjopen-2015-007771.

22. Dunlay S.M., Chamberlain A.M. Multimorbidity in Older Patients with Cardiovascular Disease. Curr Cardiovasc Risk Rep. 2016;10. pii: 3. doi: 10.1007/s12170-016-0491-8.

23. Suidan R.S., Leitao M.M. Jr, Zivanovic O., et al. Predictive value of the Age-Adjusted Charlson Comorbidity Index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovariancancer. Gynecol Oncol. 2015;138(2):246-51. doi: 10.1016/j.ygyno.2015.05.034.

24. Barbarash O.L., Semjonov V.Yu., Samorodskaya I.V., et al. Comorbidity in coronary heart disease patients undergoing bypass grafting: an experience of two surgery centers. Russian Journal of Cardiology. 2017;3:6-13. (In Russ.) [Барбараш О.Л., Семенов В.Ю., Самородская И.В. и др. Коморбидная патология у больных ишемической болезнью сердца при коронарном шунтировании: опыт двух кардиохирургических центров. Российский Кардиологический Журнал. 2017;3:6-13]. doi: 10.15829/1560-4071-2017-3-6-13.