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Women More Prone To Acute Aortic Condition

Women More Prone To Acute Aortic Condition

According to a new study released today in The Annals of Thoracic Surgery, women who experience acute aortic dissection—a spontaneous and catastrophic tear in one of the body’s main arteries—are not only older and have more advanced disease than men when they seek medical care, but they are also more likely to die.

Women More Prone To Acute Aortic Condition

Data from the previous several decades show disparities in both presentation and prognosis between males and females with acute aortic dissection, with females having a higher death rate, according to Thomas G. Gleason, MD, of Brigham and Women’s Hospital in Boston, Massachusetts. This study emphasizes the importance of continued research into these sex disparities, which may lead to more sophisticated sex-directed initiatives to enhance outcomes.

Women More Prone To Acute Aortic Condition

Lauren Huckaby, MD, of the University of Pittsburgh in Pennsylvania, Dr. Gleason, and colleagues examined the International Registry of Acute Aortic Dissection (IRAD) Interventional Cohort (IVC) to investigate gender differences in presentation, operative approach, and outcomes in patients with type A acute aortic dissection (TAAD). The IRAD is the world’s biggest consortium of centers (55 institutions in 12 countries) that collects and analyses data on clinical aspects of aortic dissection; the IVC was established to give a more thorough insight into surgical techniques and methods for aortic dissection.

According to the Stanford classification, aortic dissections are classified into two categories (A and B) based on the location of the rupture in the aorta. The rip in type A dissection starts where the aorta exits the heart (ascending aorta) and commonly spreads from the top to lower parts of the aorta, impairing blood flow throughout the body. Type A aortic dissections are more likely to go to the heart, where they can be fatal by rupturing into the pericardial sac that surrounds the heart. 

As per multi-society clinical practice recommendations, up to 40% of persons with aortic dissections die promptly, and the risk of mortality increases by 1% for every hour that the diagnosis and surgical repair are delayed.

The researchers identified 2,823 individuals who had TAAD between 1996 and 2018 and had an operational repair or a surgical procedure as part of a hybrid repair in the IRAD-IVC database. Females made up around 34% of the patients.

TAAD did not impact female patients but, they were significantly older than male patients (65.4 years versus 58.6 years on average) and had different presenting symptoms, such as low blood pressure and greater evidence of malperfusion (loss of blood supply to a vital organ), with a higher prevalence of shock (31.3 percent versus 22.2 percent) and coma/altered consciousness (11.5 percent versus 7.5 percent).

According to Benjamin A. Youdelman, MD, of Maimonides Medical Center in Brooklyn, New York, who was not involved in this study, these differences in clinical presentation suggest that women may be waiting longer than males to seek medical care. This might be because female patients are stoic, not viewing their symptoms as signals of a serious disease and not prioritizing their care.

As a consequence, women are seeking medical attention later in life with a higher percentage of women in shock and mental status changes that are frequently attributed to a stroke, which can further delay the correct diagnosis of aortic dissection as the cause, as per Dr. Youdelman, who works very closely with the Think Aorta US aortic disease awareness campaign. All of this contributes to women having poorer early outcomes following aortic dissection than males. For a long time, it has been recognized that the result of aortic dissection is based on time to treatment: the sooner a person is treated, the better.
The researchers plan to do more research to better understand what causes acute aortic syndromes in each sex, as well as to more correctly assess dissection risk and guide tailored treatment options.

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