Challenging the statistics for women

Summer 2019

When Donna Peterson developed a cough and had difficulty breathing, she knew something was wrong. She couldn’t make it up a flight of stairs without being winded and was waking up tired every morning.

“I could not figure out why I was so tired. Something in the back of my mind was telling me that this wasn’t right.”

To her surprise, a visit to the doctors resulted in the discovery of a very large aneurysm and a problem with her aortic valve. Donna was referred to a specialist, and soon underwent surgery to remove the aneurysm by replacing her ascending aorta and arch.

Aneurysms are medical emergencies requiring surgery, but how are women affected differently than men? Dr. Michael Chu, Scientist at Lawson Health Research Institute and Cardiac Surgeon at LHSC, is exploring this question.

Dr. Chu is studying sex-specific differences in outcomes following aortic surgery. Partnering with Dr. Jennifer Chung at University Health Network in Toronto, the team conducted the largest study of its kind to examine data from 1,700 patients who underwent aortic surgery across 10 sites in Canada.

Researchers looked at three different outcomes – early death, stroke and complications. They found that, compared to men, women experience worse outcomes across every measure.

The results showed women were two times more likely to experience a stroke or death after surgery. Women were 80 per cent more likely to die, 90 per cent more likely to experience a stroke, and 40 per cent more likely to experience a complication. The risk remained when researchers controlled for patients’ age, weight, pre-operative health and co-morbidities.

“We found that when facing an aortic arch surgery, you’re slightly less than twice as likely to die if you’re a woman. In many areas of cardiovascular medicine, we know women tend to have worse outcomes. The question becomes why,” says Dr. Chu, who also leads the Canadian Thoracic Aortic Collaboration (CTAC) - an organization of aortic specialists. This research was an initiative of CTAC.

“The next step is to figure out how we fix this problem because, with today’s medicine, there should not be a difference.”

Researchers suspect these sex-specific differences might be related to common issues. Women tend to be older, show symptoms later in the disease process and have larger aneurysms for their body size. Women also don’t tend to show the typical symptoms males experience like chest pain or dizziness.

Dr. Chu stresses the importance for clinicians to screen for these heart conditions in women. When female patients present with abnormal symptoms, aortic aneurysm and dissections should be considered as the possible diagnosis and treatment option. These symptoms may include shortness of breath and trouble breathing, low blood pressure, trouble swallowing, fatigue, nausea, sweating and general weakness.

The growing body of evidence related to aneurysms is showing that women cannot be treated the same as male patients. For one, the guidelines for classifying aneurysms need to be adjusted for the patient’s size. Dr. Chu also encourages clinicians to consider surgery earlier in the disease process which leads to better outcomes.

“All scientific research should address the differences between men and women going through medical procedures,” says Chu. “By focusing our research on these new technologies, we can help narrow the gap and improve outcomes for patients.”

Donna recovered quickly from her surgery and, two years later, she feels great. She continues to work on rehabilitation exercises, stressing the need for women to be their own health advocate and coach.

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