Features of the outpatient management in ischemic heart disease

Introduction. Peculiarities of the ischemic heart disease (IHD) course are different in men and women. In general, this problem is not studied enough; however, understanding the specific features of the disease can help to adjust the approach to its diagnosis and early detection, which will improve the prognosis for patients. Aim. To find peculiarities of the course of IHD and statistically significant differences in the expected manifestations of IHD in female and male outpatients. Materials and methods. An analysis of outpatient medical records of 120 men and 110 women with IHD diagnosed between June and December 2024, retrieved from the archive of the University Clinic of Donetsk State Medical University named after M. Gorky, was performed. The following parameters were assessed: age; IHD duration; results of echocardiography (EchoCG) (ejection fraction), electrocardiography (ECG) / Holter monitoring, blood biochemistry; comorbidities (obesity, diabetes mellitus, hypertension), history of myocardial infarction (MI) and interventions. Results. When comparing these groups, significant differences were found in the age and duration of IHD: on average, men were diagnosed with IHD earlier and the IHD history was longer. There were no statistically significant differences in hemodynamic parameters according to EchoCG data, but most patients had signs of left ventricular (LV) remodeling (LV mass index over 120 g/m2 had 150 patients). According to ECG/Holter monitoring data, significant differences were found in the number of patients with diagnosed atrioventricular (AV) block: 60 in women and 30 in men, and in all cases men had complete AV block, as a result, they were implanted with pacemakers; while in women, the 1st degree AV blockade prevailed. Statistically significant differences were found in achieving the low-density lipoprotein cholesterol targets (for all patients with IHD ≤1,4 mmol / l): 67% in women vs. 38% in men (p < 0,05). There were more people with a history of MI among men (40 vs. 10 in women). Open coronary revascularization for IHD (multivessel disease / left coronary artery ostium involvement) was performed in 50 men. In the group of women, 20 coronary revascularizations were performed (p = 0,01), and endovascular revascularization was performed significantly more often in this group. Men were diagnosed with NYHA class III, and women – with class II. Conclusion. IHD develops in men on average 5–7 years earlier, and men are much more likely to have a history of MI. With an increase in duration of IHD, the volume of coronary lesions also grows, as well as lesions of other main vessels, in particular, brachiocephalic arteries, progresses, therefore, the open myocardial revascularization is more often used. This trend is observed mainly in men. Men have a higher class of CHF, which may be associated with both a greater number of comorbidities and complications, and a longer duration of IHD.