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Original research article
Gender differences in health-related quality of life in patients undergoing coronary angiography
  1. Crystel M Gijsberts1,2,
  2. Pierfrancesco Agostoni3,
  3. Imo E Hoefer1,
  4. Folkert W Asselbergs3,4,5,
  5. Gerard Pasterkamp1,
  6. Hendrik Nathoe3,
  7. Yolande E Appelman6,
  8. Dominique P V de Kleijn1,2,7,8 and
  9. Hester M den Ruijter1
  1. 1Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
  3. 3Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
  4. 4Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
  5. 5Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, UK
  6. 6Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
  7. 7Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  8. 8Cardiovascular Research Institute, National University Heart Centre, National University Health System, Singapore, Singapore
  1. Correspondence to Crystel M Gijsberts; c.m.gijsberts{at}


Background Health-related quality of life (HRQOL) reflects the general well-being of individuals. In patients with coronary artery disease (CAD), HRQOL is compromised. Female patients with CAD have been reported to have lower HRQOL. In this study, we investigate gender differences in HRQOL and in associations of patient characteristics with HRQOL in patients with coronary angiography (CAG).

Methods We cross-sectionally analysed patients from the Utrecht Coronary Biobank undergoing CAG. All patients filled in an HRQOL questionnaire (RAND-36 and EuroQoL) on inclusion. RAND-36 and EuroQoL HRQOL measures were compared between the genders across indications for CAG, CAD severity and treatment of CAD. RAND-36 HRQOL measures were compared with the general Dutch population. Additionally, we assessed interactions of gender with patient characteristics in their association with HRQOL (EuroQoL).

Results We included 1421 patients (1020 men and 401 women) with a mean age of 65 in our analysis. Women reported lower HRQOL measures than men (mean EuroQoL self-rated health grade 6.84±1.49 in men, 6.46±1.40 in women, p<0.001). The reduction in RAND-36 HRQOL as compared with the general Dutch population was larger in women than in men. From regression analysis, we found that diabetes, a history of cardiovascular disease and symptoms of shortness of breath determined HRQOL (EuroQoL) more strongly in men than in women.

Conclusions Women reported lower HRQOL than men throughout all indications for CAG and regardless of CAD severity or treatment. As compared with the general population, the reduction in HRQOL was more extreme in women than in men. Evident gender differences were found in determinants of HRQOL in patients undergoing CAG, which deserve attention in future research.

Trial registration NCT02304744 (


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