Sex differences in health status trajectories among Chinese angina patients: a post-hoc analysis of the GREAT multicenter prospective cohort

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BACKGROUND: Sex differences in health status trajectories among Chinese patients with angina pectoris (AP) remain underexplored in real-world settings. METHODS: This post-hoc analysis utilized data from the GREAT registry, a multicenter, prospective cohort study that enrolled 1,556 consecutive patients with AP from nine hospitals in China between September 2021 and May 2022. Patients were stratified by sex, and their health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline, 3, 6, 9, and 12 months. The SAQ includes five health status domains: physical limitation, angina frequency, angina stability, treatment satisfaction, and quality of life (QoL). The SAQ summary score (SAQ-SS), representing overall angina-related health status, was calculated as the average of physical limitation, angina frequency, and QoL scores. Longitudinal linear mixed-effects models, adjusted for time and potential confounders, were used to evaluate the independent association between sex and changes in SAQ-SS and its domains over time. RESULTS: Among the 1,556 patients with AP (1,112 men; 444 women), women were on average 5 years older and less likely to smoke or consume alcohol. They had lower rates of obesity, a higher prevalence of diabetes, hypertension, and cerebrovascular disease, but less extensive coronary artery disease. At baseline, women had lower SAQ-SS than men (59.52 ± 12.93 vs. 62.64 ± 12.61, P < 0.001). By 12 months, their scores were similar (77.65 ± 7.82 vs. 77.68 ± 7.03, P = 0.94), and a higher proportion of women achieved a clinically meaningful improvement in SAQ-SS (defined as an increase of ≥ 10 points, 71% vs. 62.8%, P = 0.004). In the fully adjusted model accounting for time, age, smoking, alcohol consumption, comorbidities, angina type, coronary interventions, and medication use, women showed significantly greater improvements in SAQ-SS (1.67 points higher; 95% CI: 0.03–3.31; P = 0.046) and QoL domain (2.79 points higher; 95% CI: 0.06–5.51; P = 0.045). CONCLUSIONS: Significant sex differences in health status trajectories were observed among Chinese patients with angina pectoris, with women showing significantly greater improvements over 12 months. These findings underscore the need to better understand factors contributing to sex differences in recovery. STUDY REGISTRATION: Registry Study of Medical Therapy in Patients With Angina Pectoris (GREAT), NCT05050773. Registered on 10 September 2021, https://register.clinicaltrials.gov .

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