Healthcare

In the 23,771 consecutive patients that referred to coronary angiography, included in the Hamilton Health Sciences Angiography Registry, researchers shown that women have lower rates of severe coronary artery disease than men, but that severe angina in women is more likely to be associated with blockages in the left main and left anterior descending arteries, as well as with three-vessel disease.

Published in July 2010 issue of the Journal of Internal Medicine, lad investigator, Dr Catherine Kreatsoulas from McMaster University, Hamilton, ON said, “it has been well established that women present with atypical symptoms and men present with typical symptoms. Here we found this big group of women who have typical symptoms, CCS (Canadian Cardiovascular Society) class 4 angina, and it’s predictive of severe disease, which could change the prognosis outcome of these patients.”

According to the researcher, the purpose of the study was to investigate the gender differences in the distribution of conventional risk factors and the angiographic pattern of coronary artery disease in younger and older patients, as well as to examine factors associated with severe disease, which was defined as left main artery stenosis >50%, three-vessel disease with >70% stenosis, or two-vessel disease that included a proximal left anterior descending artery stenosis of >70%.

Dr. Kreatsoulas said, “we found that in the presentation at baseline, when we looked at everyone who was coming in, there were some differences in the baseline characteristics. Women were a little bit older, but the presence of diabetes and hyperlipidemia was fairly equivalent between the two groups. On the other hand, men were more likely to be smokers and women more likely to be hypertensive.”

The investigator reported that younger women, those <60 years old, were less likely to have coronary disease compared with older women, but younger women with severe coronary artery disease were more likely to be diabetic and to be a past or present smoker. Older women, on the other hand, tended to have more hypertension.

Regarding the severity of angina, 56.7% of women had class 4 angina, defined by the CCS as the inability to perform daily physical activity without discomfort or pain, compare with 47.8% of men.
Men, on other hand, were more likely to have less severe symptoms (CCS clas 0-2).
Younger and older women were also more likely than men of the same age to have class 4 angina.

In adjusted multivariable regression analysis, male sex, age, diabetes hyperlipidemia, and smoking were independently associated with severe coronary artery disease. CCS class 4 angina was also a significantly stronger predictor of severe disease in women than in men. Class 4 angina increase the risk of severe coronary disease 82% in women compared with a 28% increased risk in men.

Dr. Kreatsoulas said that when they looked at baseline, more men than women did have severe coronary artery disease, but when they started looking at the characteristic, they saw that severe angina is more predictive in women than it was in men.
He said, “the threshold for referring a woman for angiography is higher than it is for men, especially for younger women, and we wanted to show and point out that perhaps we need to investigate the appropriateness of that and to look at the characteristics of patients who should be referred for angiography.”

In their study, the group also noted that younger diabetic women had more severe clinical and angiographic risk profiles than younger diabetic men and that these women represent an “undertreated and underdiagnosed group,” said Dr. Kreatsoulas.