title: Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial.
abstract: OBJECTIVE
  The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD).
  
  
  BACKGROUND
  Although established CAD presentations differ by sex, little is known about stable, suspected CAD.
  
  
  METHODS
  The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression.
  
  
  RESULTS
  Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men.
  
  
  CONCLUSIONS
  Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.
authors.forename: Kshipra
authors.initials: K
authors.lastname: Hemal
authors.forename: Neha J
authors.initials: NJ
authors.lastname: Pagidipati
authors.forename: Adrian
authors.initials: A
authors.lastname: Coles
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Daubert
authors.forename: Svati H
authors.initials: SH
authors.lastname: Shah
authors.forename: Kevin
authors.initials: K
authors.lastname: Ariani
authors.forename: Renée P
authors.initials: RP
authors.lastname: Bullock-Palmer
authors.forename: Beth
authors.initials: B
authors.lastname: Martinez
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006334:Heart Function Tests; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D016017:Odds Ratio; D010045:Outpatients; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors