title: Characteristics and outcomes of women veterans undergoing cardiac catheterization in the Veterans Affairs Healthcare System: insights from the VA CART Program.
abstract: BACKGROUND
  The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse outcomes, despite having less obstructive coronary artery disease than men. Whether these differences exist among women veterans in the veterans affairs healthcare system is unknown.
  
  
  RESULTS
  Data on 85 936 veterans (3181 women) undergoing initial cardiac catheterization between October 1, 2007, and September 30, 2012, were examined using the national veterans affairs Clinical Assessment Reporting and Tracking (CART) Program. Sex differences in demographics, indications, coronary anatomy, cardiac treatments, and outcomes were analyzed. Women veterans were younger (56.9 versus 63.0 years, P<0.0001) with fewer traditional cardiovascular risk factors, but with more obesity, depression, and posttraumatic stress disorder than men. Women had lower rates of obstructive coronary artery disease than men (22.6% versus 53.3%). Rates of procedural complications were similar in both genders. Adjusted outcomes at 1 year showed women had lower mortality (hazard ratio, 0.74; confidence interval, 0.60-0.92) and less all-cause rehospitalization (hazard ratio, 0.87; confidence interval, 0.82-0.93), but no difference in rates of unplanned percutaneous coronary intervention.
  
  
  CONCLUSIONS
  Women veterans undergoing catheterization are younger, have more obesity, depression, and posttraumatic stress disorder, less obstructive coronary artery disease, and similar long-term outcomes, compared with men. These findings suggest a significant portion of women veterans may have chest pain not attributable to obstructive coronary artery disease. Further research into possible causes, such as endothelial dysfunction or concurrent psychological comorbidities, is needed.
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.).
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Davis
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.).
authors.forename: Paula
authors.initials: P
authors.lastname: Langner
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.).
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: From the VA Ann Arbor Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); University of Michigan Healthcare System, Ann Arbor, MI (M.B.D., C.S.D.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., P.L., M.E.P., J.S.R.); and University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.). duvernoy@umich.edu.
authors.forename: Claire S
authors.initials: CS
authors.lastname: Duvernoy
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003863:Depression / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
keywords: cardiac catheterization; coronary artery disease; outcomes research; sex; women