Sex and sociocultural gender norms score differences in major adverse cardiac events and mortality five years following coronary angioplasty

OBJECTIVE: Research on adverse outcomes following percutaneous coronary intervention (PCI) yields conflicting findings regarding sex-specific outcomes, suggesting that focusing solely on biological differences may be insufficient. Therefore, we explored the impact of both sex and a composite sociocultural gender norms score on major adverse cardiac events (MACE) among patients in the five years following PCI.

METHODS: Among 1571 participants (Mage=64.03±10.99; 77.2% male) 13.1% experienced MACE and 7.8% faced mortality (39.3% cardiac-related) within the five-year follow-up. A sociocultural gender norms score (higher: more feminine, lower: more masculine), derived from occupational status and type, educational status, and civil status, was constructed. Binary logistic regressions analyzed the main effects of sex and sociocultural gender norms, and their interaction, while adjusting for age and medical covariates.

RESULTS: No sex differences were observed. More feminine sociocultural gender norms scores were associated with cardiac outcomes (OR=1.16 (95%CI: 1.03-1.32) and all-cause mortality (OR=1.62 (95%CI: 1.17-2.26). However, an intricate interplay between sociocultural gender norms and adverse outcomes appeared when adjusting for covariates: older age, cardiac history, and comorbid disorders were among the covariates, which correlated negatively with outcomes and with sociocultural gender norms.

CONCLUSIONS: While the sociocultural gender norms score emerged as a better explanatory factor for outcomes than sex, its effects overlapped with multiple medical covariates and age, emphasizing the need for deeper exploration of this complex interplay. These findings mark the initial stage in a broader understanding of gender's role in outcomes.