Women are more likely than men to die from aortic dissection or tearing

Jun 16 2004

“While women are less likely than men to suffer from a life-threatening tear in the aortic wall, they are more likely to die from it.   Female patients with aortic dissection deserve special attention focused on strategies to improve early diagnosis, management and outcomes,” said Christoph Nienaber, M.D., head of the Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine in Germany.

Researchers say 2,000 new cases per year of aortic dissection are reported in the United States and 3,000 annually in Europe.

The major difference in death rates between men and women was in people 66 to 75 years-old.

In one of the first studies to examine gender differences related to aortic dissection, researchers found that women have:

•         Different symptoms of acute aortic dissection.
•         Less and different pain at the onset than men, which may delay their treatment.
•         More in-hospital complications, which may contribute to the higher death rate.

“New ‘female classic’ symptoms have to be defined.  If ‘not-so-typical’ female symptoms are taken seriously by both the affected women and the medical community, female patients will hopefully have better outcomes,” said Nienaber, co-founder of the International Registry of Aortic Dissection (IRAD).

This study evaluated 1,078 acute aortic dissection patients (732 men and 346 women IRAD) to determine differences in symptoms, treatment and death rates.  Participants were an average 62 years old.  Researchers studied two types of aortic dysfunction: acute type A dissection, a tear in the aorta above the heart, and acute type B, a tear in the aorta below the heart.  Caucasians comprised 87 percent of the patients.

The women in the registry with aortic dissection were older than the men.  More than a quarter (28.6 percent) of the men were 70 years old or more, while almost half (49.7 percent) of the women were.  The ratio of type A versus type B dissection was roughly 2:1 in both genders, with 61 percent type A dissection in men and 65.9 percent type A dissection in women.  And while a history of hypertension was more frequent in women, prior cardiac surgery was more prevalent among men.

Diagnostic imaging, such as CT scans, MRIs and echocardiograms, identified impending tears more frequently among the women, and women were more likely to be managed with medication than with surgery.  In those managed medically, women were less likely to receive immediate treatment with intravenous beta-blockers.

Women experienced less pain and a more gradual, building chest or back pain.  By contrast, men described the pain as ripping, sudden and devastating.

The study found that fewer women than men sought treatment within six hours of the start of symptoms, and 40 percent of women in the study waited more that 24 hours before seeking medical help.  Researchers also noted that women were more likely to become comatose or suffer altered mental states after experiencing aortic dissection.

Women arrived at the hospital an average 4.7 hours from symptom onset later than men, which “is likely to negatively impact outcomes in women,” Nienaber said.

The greatest gender-related difference was a higher death rate among women undergoing surgery to correct aortic tears – 32 percent of the women with type A dissection died compared with 22 percent of the men.   

“There is some speculation that women may traditionally ignore pain longer than men, are less open about serious symptoms or simply are less cared for than their male partners,” Nienaber said.  “A woman traditionally will sooner send for a doctor for her husband – than the other way around. We should realize these culture-related differences and address them to improve medical practice.”