Women Fare Worse Than Men After Bypass

They suffer more depression and anxiety a year later

MONDAY, Nov. 24, 2003 (HealthDayNews) -- Women who have coronary bypass surgery report a better quality of life following the procedure, but are not nearly as satisfied as men who have similar surgery.

Women reported significantly higher levels of depression and anxiety a year after surgery than men did, even though both groups showed improvements in memory, verbal ability and concentration as well as quality of life, according to a Duke University Medical Center study.

"This study prompts us to ask the question, 'Why are women not achieving the same benefits as men?,'" says lead author Barbara Phillips-Bute, an assistant research professor at Duke. "We need to find a way to come up with interventions that will help women achieve the same benefits as men."

Phillips-Bute says some of the reasons for the difference could be that women overall have less success with the surgery than men because their arteries are smaller and the vessels used in the bypass tend not to last as long. Another possibility is that their diminished post-surgical quality of life could be affected by environment or personality rather than solely by cardiac health.

Yet another factor could be cultural considerations, she adds.

Nearly half the women who had surgery lived alone, lowering the possibility of at-home help after their operation, while nearly 85 percent of the men were married, which could mean their wives were caring for them, she says. Also a consideration could be that a woman's traditional caretaking role might push her toward resuming tasks too early after surgery.

"Social support scores for men and women at this age show that women tend to be the caretakers, and perhaps these women, even when they are not feeling well, are expected to take over their caretaking roles after surgery," Phillips-Bute says.

"This study points out the need for doing this kind of by-sex data. We need to understand why this difference is so -- is it the physiology of women or life circumstances? -- and what can be done to improve their quality of life," says Sherry Marts, vice president for scientific affairs for the Society of Women's Health Research, a Washington, D.C., nonprofit advocacy group that promotes the improvement of women's health through research.

For the study, which appears in the Nov. 24 issue of Psychosomatic Medicine, Phillips-Bute and her colleagues enrolled in a clinical trial 280 patients (96 women and 184 men) who were having bypass surgery. Before and then one year after the operation, the participants were given a battery of tests to measure their quality of life and cognitive performance.

The quality-of-life tests measured how easily they performed daily tasks, like dressing or preparing meals, as well their social support system, their feelings about their general health, and whether they suffered from anxiety or depression. Cognitive tests measured their memory, ability to concentrate, and do abstract thinking.

After controlling for other factors like age -- women who undergo bypass tend to be older than men, for instance -- level of education, race, weight, and history of illnesses like diabetes, Phillips-Bute found that, on average, both sexes had improvements in their cognitive abilities and in their quality of life. However, the women's quality of life improved far less than the men's, a finding that surprised her.

"I had anticipated that, after we controlled for all the pre-operative differences, we wouldn't see these issues remain," she says.

Her results, Phillips-Bute says, should make women and their doctors more aware of the importance of good post-operative care.

"One question women should ask themselves is whom can they look to after surgery to give them the kind of moral and physical support they need," she says.

More information

Interesting statistics about the differences between men and women who have heart disease can be found at the Society for Women's Health Research. The Mayo Clinic offers an explanation of who is a candidate for coronary bypass surgery.

SOURCES: Barbara Phillips-Bute, Ph.D., assistant research professor, department of anesthesiology, Duke University Medical Center, Durham, N.C.; Sherry Marts, Ph.D., vice president of scientific affairs, Society for Women's Health Research, Washington, D.C.; Nov. 24, 2003, Psychosomatic Medicine
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