logo
Women Survive Longer Than Men After Coronary Bypass

Women Survive Longer Than Men After Coronary Bypass

Medscapea day ago

A meta-analysis of more than 140,000 patients found men and women have similar survival rates during the first decade after undergoing coronary artery bypass grafting (CABG). Beyond 10 years, women show slightly better survival outcomes than men, but both sexes have higher mortality than the general population.
METHODOLOGY:
Researchers analyzed all-cause mortality in CABG patients and non-CABG patients from three databases: MEDLINE, ScienceDirect, and the Cochrane Library.
The analysis included 142,165 patients from eight studies examining long-term (at least 5 years) all-cause mortality as the primary outcome.
The researchers used the Kaplan-Meier method to calculate all-cause mortality, and Cox proportional hazards regression modeling to compare differences between the groups.
TAKEAWAY:
Over a 19-year period, men and women who had undergone CABG were more likely to die of any cause than the general population (hazard ratio [HR] for men, 1.14; 95% CI, 1.05-1.23; P = .002; HR for women, 1.21; 95% CI, 1.01-1.47; P = .045).
= .002; HR for women, 1.21; 95% CI, 1.01-1.47; = .045). Analyses revealed no significant difference in life expectancy compared to the general population in the first 10 years.
Direct comparison between the sexes showed slightly better survival in women than in men after the 10-year mark (HR for men, 1.04; 95% CI, 1.01-1.08; P = .012).
IN PRACTICE:
'In the first years post-CABG as graft patency is high, CABG seems to provide similar results in men and women,' the researchers reported. 'However, in the very long term, with possibly diminishing graft patency, a survival advantage in female patients becomes evident. Beyond menopause, a variety of risk factors are differentially distributed between men and women, which may be associated with longer graft patency. These include smoking, poor diet, lack of physical activity, and alcohol consumption, all of which may contribute longer graft patency in women,' they added.
SOURCE:
The study was led by Hristo Kirov, MD, of the Department of Cardiothoracic Surgery at Friedrich-Schiller-University in Jena, Germany. It was published online on June 11, 2025, in The American Journal of Cardiology .
LIMITATIONS:
The study design had limitations of observational series, including methodological heterogeneity of included studies and residual confounders. Differences in the survival curves after 10 years may be attributed to the lack of long-term follow-up in some of the studies involved in the analysis.
DISCLOSURES:
The authors reported having no relevant financial conflicts of interest.

Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

EGFR+ NSCLC: Experts Weigh Risk vs Reward at ASCO 2025
EGFR+ NSCLC: Experts Weigh Risk vs Reward at ASCO 2025

Medscape

time30 minutes ago

  • Medscape

EGFR+ NSCLC: Experts Weigh Risk vs Reward at ASCO 2025

This transcript has been edited for clarity. Coral Olazagasti, MD: Hello. My name is Coral Olazagasti, and I'm a thoracic oncologist at Sylvester Comprehensive Cancer Center at the University of Miami. Joining me today is my friend and colleague, Maria Velez, a clinical instructor at UCLA, and also my other friend and colleague, Ana Velázquez Mañana, who's an assistant professor of medicine at UCSF. Today we are super excited because we are speaking about the ASCO 2025 Annual Meeting here in Chicago. We just came out from the oral abstracts for the metastatic setting for non-small cell lung cancer and we want to share some of the data that we learned. We want to start the discussion here today about EGFR -mutant disease in the second-line setting. We're going to start with Maria. Do you want to tell us a little bit about the HERTHENA-Lung02 study? Maria A. Velez, MD, MS: Sure. HERTHENA-Lung02 was a study that evaluated HER3-DXd, which is an antibody-drug conjugate (ADC), in the second-line setting for patients with previously treated EGFR -sensitizing mutations. It was an open-label study where patients received either the HER3-DXd or the investigator's choice chemotherapy, and the primary endpoint was median progression-free survival. The results showed that the median progression-free survival for patients who received HER3-DXd was 5.8 months whereas the median for the chemotherapy arm was 5.4 months. Even though it was a statistically significant difference, it was not a very clinically meaningful difference, with a huge implication that 100% of the patients in this study had treatment-related adverse events and some patients experienced interstitial lung disease (ILD). All in all, taking these data into account, even though there's a huge need in the treatment landscape for second-line EGFR -mutant patients, I think this ADC did not really show a substantial enough clinically meaningful benefit and had a large amount of toxicity. Olazagasti: Not to say that this study didn't show any overall survival (OS) benefit. We're talking about a drug that's not really giving patients a longer life and is also giving many side effects, like you mentioned — a large amount of discontinuation due to ILD, and so much toxicity without that benefit there. I think we'll table that regimen for now. Do you agree? Velez: I agree. Ana I. Velázquez Mañana, MD, MSc: I agree. Clearly, it's disappointing to see the results of not beating chemotherapy in the second-line setting, but I do think that potentially there is a role in the third line or afterwards. We know that patients are going to be getting chemotherapy and amivantamab in the second-line setting. There is a need for further drugs and interventions in the third line if patients don't have other AGAs [actionable oncogenic alterations] or other drivers that we can use targeted therapies for. I am hesitant to give up completely on the drug. I do agree it's quite toxic and very disappointing to unfortunately see these results in the second line. Olazagasti: I agree. Moving on to the next study — Ana, do you want to talk to us about the SACHI study? Velazquez Mañana: The SACHI study was an open-label, randomized trial of savolitinib plus osimertinib vs platinum doublet chemotherapy in patients who, post EGFR TKI, had progressed in the second line and had a MET amplification. We know that MET amplifications are an extremely common mechanism of resistance to EGFR TKI-targeted therapies. Interestingly, in this study, which brings a little bit of heterogeneity, they included patients treated with first- and second-generation EGFR TKIsas well as those treated with third-generation TKIs like osimertinib, which would be our standard of care. They did look to make sure those were T790M negative, those treated with earlier generations. Interestingly, the results on the primary endpoint of progression-free survival (PFS) showed a benefit of 8.2 months in the combination vs 4.5 months in patients treated with doublet chemotherapy. That [benefit] was maintained in both patients treated with earlier-generation TKIs as well as those treated with third-generation TKIs. It also had some efficacy data and overall response rates of 63.2% vs 36.2%. Definitely, as we know, using a MET-targeted therapy is helpful. We already know from the United States that they use an approval in the second line of chemotherapy and amivantamab. That approach leads to responses in patients after EGFR TKIs. I think it's an interesting approach, obviously, to think of sparing patients from chemo in that second line and combining two TKIs, but we have to see if that is better than chemo with amivantamab would've been, which would've been our standard of care here. With savolitinib, we know what the adverse events are. It's a drug that's been approved in China now for years. It's not used in the United States, but I think, based on these studies, it's interesting to see what other studies will come in the future and whether this is a potential approach for us to use. Olazagasti: Definitely it's interesting. I feel like EGFR is the cool kid on the block now. We have so many options and so many studies looking into it, and it's just interesting to see what the future holds and what else is going to come into play. Continuing down the line of the EGFR second-line studies, I'm going to talk about the OptiTROP-Lung03 study. This study uses sacituzumab tirumotecan. It's a phase 3 study of EGFR mutants. Patients had to receive not only TKI but also platinum therapy, and they were randomized into using sacituzumab tirumotecan — we're going to call it sac-TMT because this is very hard to pronounce — vs docetaxel. The primary endpoints of the study were overall response rates, and secondary endpoints were PFS and OS. The study showed that the overall response rate was 45.1% vs 15.6% in the docetaxel arm. Also, there was a PFS benefit. The median PFS was 6.9 compared to only 2.8 in the chemo arm. Even though the median OS is still ongoing, with the median not reached yet, at 12 months there was an OS of 72.8% compared to 43.2%. I think this drug has been approved in China, and I know that in December it received breakthrough FDA designation in the United States. We'll see, again, what the future holds. Do you have any thoughts about this? Velazquez Mañana: We've been seeing from the different TROP2 ADCs that clearly they have a role in EGFR -driven lung cancer. I think it's exciting to see another one. Unfortunately, there are drugs that have many toxicities, so they are hard to manage for patients. Again, on this one I am a little bit conflicted with what the comparator arm is, and one that not necessarily would be our current standard of care. So we are having a large amount of new development and newer drugs, but because of how long it takes to run trials and the newer approvals that come, it's hard to make comparisons and decisions of which ones you should select and the timing of them. Hopefully, we'll get more data in the future. Olazagasti: I think that's the general consensus. And the dilemma that we have right now in the EGFR space, because we have so many approved options, is that there's really not a great sequential treatment. It's not really a one-size-fits-all approach. Some people use osimertinib alone in the first line. Some people use the FLAURA2 study with osimertinib and chemo. Some people prefer the MARIPOSA regimen. These are all pretty decent options, and so bringing these other drugs into the second- and third-line setting, how do we do the sequencing? I think that's really where the dilemma and the problems are going to come about. Institutions may have different orders and different preferences, but I think in these situations it's also important to take each patient into consideration individually because, like we have already mentioned, it's not only about the treatment and then the benefits, but also the side-effect profile. This one in particular didn't have any ILDs compared to in HERTHENA where they had a high rate, but we have to really look into toxicities because it's not only survival for patients and PFS; it's really about quality of life, too. With this great discussion, I think we're going to wrap up for today. Thank you to my friends and colleagues for joining me. Again, this is Coral Olazagasti, speaking from the 2025 ASCO Annual Meeting here in Chicago.

Troubling Case Links Vaping to Aggressive Lung Cancer
Troubling Case Links Vaping to Aggressive Lung Cancer

Gizmodo

time31 minutes ago

  • Gizmodo

Troubling Case Links Vaping to Aggressive Lung Cancer

Vaping might be safer than cigarette smoking, but they carry their own health risks. A New Jersey man's electronic cigarette habit likely contributed to his fast-spreading, fatal lung cancer, his doctors say. Doctors at the AtlantiCare Regional Medical Center in Atlantic City detailed the tragic death this month in the American Journal of Case Reports. The 51-year-old former smoker and longtime vaper developed an aggressive lung cancer that killed him just months after diagnosis. Though a causative link isn't confirmed, the authors say more studies are needed to figure out vaping's cancer risk. According to the report, the man visited a local hospital sometime in 2020 after he started to cough up blood. During the prior month, he had also been experiencing symptoms of weight loss, chest discomfort, and shortness of breath. Tests soon revealed that he had a form of non-small cell lung carcinoma, specifically determined to be squamous cell carcinoma. The cancer had already started to spread and break off into pieces that reached the heart, making surgery unfeasible. He was discharged and quickly placed on chemotherapy, but to no avail. The man's health continued to rapidly deteriorate and he died three months after his diagnosis. The man had a history of cigarette smoking, the equivalent of 10 pack-years (meaning he smoked roughly a pack a day for 10 years). But he told the doctors he quit in 2009 and switched exclusively to e-cigarettes for the next 11 years. He regularly received lung and heart check-ups, and his last chest X-ray two years earlier was normal, suggesting his cancer only recently emerged. Because of the aggressive and non-responsive nature of the cancer, his relatively young age (most cases are caught in people over 65) and the lack of recent cigarette use, the doctors suspect that vaping probably played a part in his death. 'While causality cannot be established, the case highlights a potential association between [vaping] and malignancy,' they wrote. People have gotten seriously sick from vaping before, though usually under specific circumstances. In 2019, for instance, a mysterious lung disease that affected thousands of people in the U.S. was ultimately traced back to toxic additives primarily used in THC-containing vapes (while the initial outbreak did subside, these cases still appear occasionally). Other chemicals used to flavor vapes have also been tied to rare lung illnesses. But this appears to be one of the first case reports to explicitly link vaping and lung cancer. Other isolated reports have found a connection between vaping and mouth cancer. Some studies have also suggested that people who both vape and smoke (so-called dual users) have a higher risk of lung cancer than people who only smoke. At the same time, the overall research to date doesn't appear to show a significant added risk of lung cancer among people who only vape and have never smoked. And studies have also long found that vaping is less harmful in general than smoking. Given that this case is only one anecdote, the doctors aren't pushing for formal changes to screening guidelines just yet. But they are calling for further studies to untangle the unique dangers that vaping may pose.

What to Do During a Heart Attack: 5 Essential Tips to Survive
What to Do During a Heart Attack: 5 Essential Tips to Survive

CNET

time38 minutes ago

  • CNET

What to Do During a Heart Attack: 5 Essential Tips to Survive

It can be tough to figure out if you or someone else is having a heart attack, especially since they're easily confused with panic attacks. Panic attacks generally aren't life-threatening, although they may feel like it. On the other hand, a heart attack can be fatal. A heart attack is when the blood flow to the heart is blocked. When the heart doesn't get enough oxygen supply, it can become life-threatening. Heart attacks are medical emergencies that can lead to serious issues and death if ignored, and they should be addressed as soon as possible. CNET There are several factors at play when it comes to surviving a heart attack or saving a life, but the most crucial bit is being able to identify correctly when one is taking place and remembering the five key steps. Now, as we're in summer with warmer weather, health issues that you may not be aware of may flare up. We've put together this guide to help you be better prepared, with life-saving tips for heart attacks. Learn more about heart health tips by reading how to check your heart metrics at home, six important blood tests to take and understanding the importance of your blood type. Common symptoms of a heartWhen you think "heart attack," classic symptoms such as chest discomfort might first come to mind. Heart attacks can present differently in men and women and in people with certain diseases, like diabetes. Heart attack symptoms could include: Chest discomfort, pain or pressure that radiates up to your jaw, your back and/or your left shoulder Bad indigestion or nausea Extreme fatigue Shortness of breath Feeling generally unwell "Essentially anything from the belly button up," says Dr. Khadijah Breathett, a heart failure transplant cardiologist and tenured associate professor of medicine at Indiana University. "Constant pressure should raise concern that you should see your doctor, and it's OK if it's something else. We'd rather have an individual come see a health care professional and get evaluated rather than toughing it out at home, because that is what contributes to the escalating risk of death." 1. Call 911, no matter what If you feel any of the above symptoms, even if you aren't sure it's a heart attack, you should call 911 immediately, doctors recommend. "If you feel unwell, or you're starting to have chest discomfort, seek medical attention quickly, because the sooner you get treated, the better," says Dr. Grant Reed, an interventional cardiologist and director of Cleveland Clinic's STEMI program. "A lot of patients ignore their symptoms, and by the time they come in, their heart muscle has already died." Richard T. Nowitz/Getty Images The No. 1 indicator of how well you're going to do after a heart attack is how fast you recognize your symptoms, Reed adds. There's a strong relationship between when you start to have your heart attack (which is generally when symptoms start) and how fast doctors can open up the blocked coronary artery that's causing it -- the shorter the time, the better the outcomes, not just regarding survival but also the likelihood of heart failure or needing to be readmitted to the hospital. When you get to the hospital, medical professionals will likely perform an electrocardiogram, which will determine the diagnosis of a heart attack. If it is a heart attack, you'll be taken to the cardiac catheterization laboratory, where a coronary angiography will be performed. If you have a blockage in your coronary artery, the doctors will offer treatment with a balloon and a stent to keep the artery open. Many people are hesitant to seek emergency medical care due to a lack of insurance or immigration status. In the US, hospitals are required to treat all people who come in with life-threatening emergencies. "It's a lot better to be treated and deal with the financial ramifications after the fact," Reed says. In most cases, costs can be sorted out with the hospital, he adds. jayk7/Getty Images 2. Have an ambulance take you to the hospital If you suspect you're having a heart attack, don't drive yourself to the hospital: Call an ambulance. You could lose consciousness and hurt yourself or others on the road, says Dr. Joel Beachey, a cardiologist at Mayo Clinic Health System in Eau Claire, Wisconsin. The same goes for having a loved one drive you -- if your symptoms worsen, they won't be able to help you while they're driving, and may be distracted. Paramedics can provide the best and fastest care while you're on the way to the hospital, including giving you an assessment and providing some treatment, Beachey says. If you're with someone who is having heart attack symptoms and becomes unconscious, you should first call 911 and then engage in CPR, Breathett says. (You can find free CPR training at your local American Heart Association branch and many other places.) 3. Take aspirin, if you have it If you're having heart attack symptoms and have access to aspirin, take a full dose of 325 mg after calling the ambulance, Beachey says. (If you have baby aspirin, which comes in an 81 mg dose, take four of those.) He recommends chewing it instead of swallowing, so it gets into your system faster. The reason? When you're having a heart attack, a plaque inside your arteries becomes unstable and ruptures, which forms a blood clot that can close off supply to that artery. Taking aspirin can help break down some of that blood clot. ER4. Advocate for yourself In an ideal world, healthcare providers would take all patient concerns seriously when it comes to heart attack symptoms, but studies show women and people of color are less likely to receive adequate treatment for heart attacks and heart disease. For example, older Black women were 50% less likely to be treated when they arrived at a hospital with a heart attack or coronary artery disease symptoms than white women, including after accounting for education, income, insurance status and other heart health complications like diabetes and high blood pressure, a 2019 study found. "It's been very clear over most of our history in the US that women and people of color are not heard," Breathett says. "Their symptoms get dismissed, and they have worse outcomes. As a health care system, we have a lot more work to do to change that system so that each person can get equitable care irrespective of their demographic." Until that time comes, patients need to be their own advocates and speak up for themselves, she adds. If they aren't being heard, they have the right to seek care elsewhere. One tip recommended by a resident on TikTok: If you feel a provider isn't taking your symptoms seriously, for heart health or otherwise, you can ask the provider, "What is your differential diagnosis?" A differential diagnosis is a term to describe what the different diseases are that could be contributing to your symptoms, basically asking the provider to explain why they've ruled out a heart attack and what else it could be. "That might help a person realize, oh, I haven't effectively tested to make sure this is not cardiac disease," Breathett says. You can also bring a family member or friend to help ask questions on your behalf. Write down questions in advance if you can, so you can have them addressed during your short visit. And call back with any questions that weren't answered. If you're not satisfied or feel that you're not being heard, seek out another care team. 5. Work on prevention You've heard it a million times, but that's because it's true: The best way to prevent a heart attack is by maintaining a healthy diet, doing moderate exercise for 120 to 150 minutes per week, keeping your cholesterol and blood pressure under control and not attacks can happen to people of any age, race or gender. You should get regular physical exams with your primary care provider to assess your risk and make lifestyle changes that can help with prevention. Some people might also benefit from taking a baby aspirin every day as a preventative measure, but you'll need to talk to your care provider about that. Exercise is important even if you have a history of heart trouble, Beachey says. Knowing what to do to prevent and respond to a heart attack is just one of the many important elements of your health you should know about. Read on to discover the best workouts to strengthen your heart, the difference between the types of cholesterol and how your diet affects your health. Plus, if you're looking for new ways to monitor your metrics, check out CNET's list of recommended fitness trackers and blood pressure monitors.

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into a world of global content with local flavor? Download Daily8 app today from your preferred app store and start exploring.
app-storeplay-store