Gender-specific changes in quality of life following cardiovascular disease

Abstract

Gender-specific changes in Quality of Life (QoL) following cardiovascular disease (CVD) were studied in 208 patients to determine whether gender-related differences in postmorbid QoL result from differences in disease severity, premorbid QoL, or different CVD-related recovery. Premorbid data were available from a community-based survey. Follow-ups were done at 6 weeks, 6 months, and 12 months after diagnosis. Results showed that females had worse QoL at all three postmorbid assessments compared to males. However, multivariate analyses adjusting for premorbid gender differences and disease severity showed no significant gender-related differences for physical and psychologic functioning. Therefore, gender differences in QoL following CVD mainly result from premorbid differences in QoL, age, comorbidity, and disease severity at the time of diagnosis, and do not appear to be the consequence of gender-specific recovery. However, in clinical practice it is important to acknowledge the poorer QoL of females following CVD.

Introduction

Over the past decade, gender issues have received increased attention in social and medical sciences. Health surveys reveal that women have a higher prevalence of medical conditions and psychosocial problems, such as depression, compared to men 1, 2, 3. The case of cardiovascular disease (CVD) is a paradoxical one, as CVD is traditionally regarded as a predominantly male disease [4], while recent studies report that women's CVD related morbidity and mortality after CVD exceed that of men 5, 6, 7.

The majority of studies on quality of life (QoL) in patients with CVD suggest that women do not cope as well physically and psychosocially as men, as concluded in a large review by Brezinka and Kittel [6]. Female patients score worse on psychosomatic symptoms, depression, anxiety, and sleep disturbances compared to their male counterparts [8]. However, the literature is not consistent, and it remains unclear why gender-related differences in QoL exist among CVD patients. There may be at least three theoretical explanations for a gender-related difference in functioning following CVD. These explanations are hypothetical and probably not mutually exclusive. First, gender-related differences might be a consequence of a more severe CVD pathology among women compared to men. These physiologic differences in disease etiology and disease severity between genders may exist, although they are at the present time not well understood [9]. A second explanation for women's poorer functioning after CVD might be that older women in particular generally have lower premorbid levels of functioning than older men. This may, for example, be due to higher levels of morbidity. Numerous studies indicate that in community samples the prevalence of medical and psychologic conditions is higher in women than in men 1, 2, 3. Hence, differences in QoL after CVD between males and females may be ascribed to existing gender differences in QoL, health status, and social disadvantages before the emergence of CVD [10]. A third, related, explanation for women's poorer functioning after CVD might be that women have worse CVD-related recovery than men independently of premorbid levels of functioning. This refers more explicitly to the process of adaptation after CVD has emerged. Although gender differences in risk profiles for CVD have been reported 11, 12, 13, little is known about gender-specific adaptation after CVD. In general, smoking, alcohol consumption, and overweight are the most common risk factors for men; whereas psychologic distress, role pressure, and less strenuous exercise are more characteristic of women 14, 15. Therefore, health–behavioral adaptation processes might be prominent for males, whereas psychosocial adaptation processes might be more relevant among females. The effectiveness of these adaptation processes may differ, which might result in gender-related differences in QoL after CVD.

The objective of the present study is to verify empirically these three explanations. The Groningen Longitudinal Aging Study includes premorbid data, and is pre-eminently suitable for studying these explanations of gender-related differences in QoL of CVD patients. We examined gender-specific changes in physical, psychological, and social functioning (QoL) of elderly subjects in the year after diagnosis of CVD. Moreover, we determined whether gender-related differences in postmorbid QoL are a result of differences in disease severity at the time of diagnosis, differences in premorbid QoL, or premorbid social disadvantages, or gender differences in CVD-related recovery. In comparison to most other studies, our study was truly prospective including one premorbid and three postmorbid assessments. The premorbid measurement was part of a large population based survey in 1993. This design allows an adjustment of possible premorbid gender differences in QoL and other covariates, which were present prior to diagnosis.