Tags: Heart | Surgery | Linked | Strokes | Women

Heart Surgery Linked to Strokes in Women

Tuesday, 01 May 2001 12:00 AM

Dr. Victor G. Davila-Roman, MD, said that an analysis of data from more than 400,000 coronary artery bypass surgeries and/or heart valve surgeries done in 1995 and 1996 indicates that women are not only more likely to have a stroke than men are, but that "strokes in women are more likely to be fatal strokes." The study is published in the May 1 issue of Circulation, Journal of the American Heart Association.

Davila-Roman of Washington University School of Medicine, St. Louis, said in an interview with United Press International that gender remained "an independent risk factor for stroke even after we adjusted for known stroke risks." Those known stroke risks include high blood pressure, high cholesterol, smoking, age, and diabetes.

The data in this study come from the Society of Thoracic Surgery's National Cardiac Surgery Database, which includes records from operations performed at a large number of hospitals nationwide. Davila-Roman said that 32 percent of the 416,347 heart surgery patients in the database were women. Davila-Roman said that 3.3 percent of the patients had a stroke in what is called the perioperative period, meaning immediately before, during or after surgery.

"For women the rate was 3.8 percent compared to 2.4 percent for men," Davila-Roman said. Moreover, at 30 days after surgery the death rate for women was 5.7 percent compared to 3.5 percent for men.

Dr. Charles W. Hogue, Jr., a co-author of the study, said estrogen probably plays a role in the increased stroke risk. He added that animal studies suggest that estrogen may protect brain cells from injury. Hogue, who is from Washington University School of Medicine, said there are also animal data that suggest that estrogen may limit the extent of brain injury when a stroke occurs.

It is well known that women generally don't develop heart disease until after the onset of menopause, usually sometime in the 50s. The patients included in this study fit this pattern: 42 percent of the women were older than 70 at the time of their heart surgery, compared to only 30 percent of the men who were over 70.

Dr. Nicea Goldberg a spokesperson for the American Heart Association, said that this study is one of several studies that suggest women have a worse outcome after heart surgery than men do. But Goldberg said, "we still have to do the research to find out why."

Goldberg, who heads the women's heart program at Lenox Hill Hospital in New York, said that it is too early to suggest that the explanation is hormonal. She explained, "there is a big hole in this study and that is lack of information about hormone replacement."

Davila-Roman agreed that it is unfortunate that the surgery database does not include information about hormone replacement. He said, "we don't really know how many of these women were taking estrogen at the time of their surgery."

For many years physicians believed that women who took estrogen replacement after menopause were protecting their hearts, said Goldberg. But newer studies suggest that "often women who take hormone replacement therapy are actually very healthy women and it is that healthy lifestyle that protects them," she said.

Still other studies, she said, have suggested that estrogen "does not have a beneficial role in prevention of stroke." But Hogue and Davila-Roman both hypothesize that hormonal status may be the best explanation for the difference in stroke risk. They are testing this theory in a new study funded by the National Institutes of Health.

In the new study Davila-Roman said that women would be randomized to either estrogen treatment or placebo before, during and immediately after heart surgery. "Before and after surgery we will use an estrogen or placebo patch and during surgery we will give intravenous estrogen or placebo," he said.

Meanwhile, Hogue said it would be a mistake to use the latest findings as a reason to avoid heart surgery. He said, "the main message for women, and for men, is that cardiac surgery is life-saving and very safe. We don't want to scare anyone away from surgery."

Copyright 2001 by United Press International.

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Dr. Victor G. Davila-Roman, MD, said that an analysis of data from more than 400,000 coronary artery bypass surgeries and/or heart valve surgeries done in 1995 and 1996 indicates that women are not only more likely to have a stroke than men are, but that strokes in women...
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Tuesday, 01 May 2001 12:00 AM
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