Women more likely than men to die after heart surgeryBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7336.504/a (Published 02 March 2002) Cite this as: BMJ 2002;324:504
All rapid responses
Thank you for publishing a thought provoking article by David
Spurgeon in BMJ 2002;324,504a on higher mortality in females after heart
operations. While the learned reviewer has given a comprehensive report of
his experiences, I am afraid if we accept the text and the message in the
present format, it appears to contradict our conventional day to day
In most animals, both vertibrates and invertibrates (particularly
man), males have shorter lives and are less resistant to infection than
females. Darwin regarded this shorter life span in males as a natural and
constitutional peculiarity due to sex alone. It is well known that in
humans there is higher mortality/abortion among male than female fetuses.
This trend continues even after birth till puberty. Finally, women appear
to outlive men by around 8 years. The contributing factors possibly
include (a) the existence of single X chromosomes in males, which leaves
men at the mercy of expressed harmful recessive genes; (b) heterozygosity
of the genes for X chromosome controlling immunoglobin synthesis, etc.,
leading to greater heterogenecity of antibody response in females.
According to Nobel Laureate Prof. R.E. Billingham, males are more disposed
than females to dysentry, gonorrhoea, syphilis, tetanus, typhoid, yellow
fever, meningitis, pneumonia, rabies, to name a few.(1). However, females
have to pay a price for their superior immune effector response, both
cellular and humoral, against self components leading to a higher rate of
auto-immune diseases in females.
Even in our day to day experiences with mice in our laboratory for
heterotransplant surgery, we frquently come across a striking differential
mortality in male and female mice. In a germ free environment, this
disparity in life expectancy between males and females is largely reduced.
With this backdrop of conventional information, may I suggest to my
learned colleagues involved in heart surgery to look into certain aspects
which may provide a greater understanding about the higher rate of female
mortality in heart surgery. Is it possible to sequentially assess the
TH1/TH2 cytokine responses in males and females before and after heart
surgery? Secondly, is it possible to form a United Cardiac Surgey
Mortality and Morbidity Assessment Rating Scale to compare male and female
heart surgery data on the lines of the United Parkinson's Disease Rating
Scale or the McGill's Pain Rating Scale?
Dr.Niranjan Bhattacharya, Dr. Anuradha Das , Dr.Banya Biswas,
Dr.Mahua Bhattacharya, Dr.Tarashankar Bandopadhyay, Dr.Monomita Patra, Dr.
Reference: (1) Billingham RE, "Immunlogic Advantages and
Disadvantages of being A Female" in Clark DA and Croy BA, eds.,
REPRODUCTIVE IMMUNOLOGY,Proceedings of the Third International Congress on
Reproductive Immunology held in Toronto, Canada, 1-5 July, 1986 (Elsevier
Science Publishers, Amsterdam, 1986).
Competing interests: No competing interests