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Gender differences in the severity and extent of coronary artery disease
Joseph Chiha1, Paul Mitchell2, Bamini Gopinath2
1Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia.
Insights
Women presenting with suspected angina have significantly less severe coronary artery disease (CAD) than men. This study found women are more likely to have normal or less obstructive coronary arteries, especially when not experiencing myocardial infarction.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of mortality globally.
- Investigating sex-based differences in CAD presentation and severity is crucial for targeted treatment.
- Suspected angina presentation can vary between men and women, necessitating differentiated diagnostic approaches.
Purpose of the Study:
- To determine if women with suspected angina exhibit less severe coronary artery disease compared to men.
- To quantify differences in coronary artery disease burden using established scoring systems.
Main Methods:
- Analysis of 994 participants undergoing coronary angiography for chest pain investigation.
- Exclusion of patients with prior coronary artery bypass surgery, stenting, or incomplete angiograms.
- Calculation of extent and vessel scores based on invasive coronary angiography findings.
Main Results:
- Women without myocardial infarction showed a lower CAD burden, with 50% having normal coronary arteries in the 30-44 age group and 40% in the 45-59 age group.
- Women had significantly lower mean extent scores (19.6 vs. 36.8) and vessel scores (0.7 vs. 1.3) compared to men (P < 0.0001).
- While women with myocardial infarction had a lower mean extent score, the difference was not statistically significant (34.8 vs. 41.6; P = 0.18).
Conclusions:
- A significant disparity exists in CAD severity and burden between men and women presenting with suspected angina.
- Women are more prone to having normal or less severe coronary artery disease than age-matched men.
- These differences are particularly pronounced in women who do not present with myocardial infarction.
Objective:
To investigate whether women presenting with suspected angina would show less severe coronary artery disease in than men as determined by the extent score.
Methods:
We examined 994 participants of the Australian Heart Eye Study presenting for coronary angiography in the investigation of chest pain from June 2009 to February 2012. People were excluded if there was a history of coronary artery bypass surgery, previous stenting procedure or incomplete angiogram scoring. An extent and vessel score was calculated using invasive coronary angiography. Normal coronary arteries were defined as having no luminal irregularity (Extent score = 0). Obstructive coronary artery disease was defined as a luminal narrowing of greater than 50%.
Results:
Women compared to men without infarction had a lower burden of CAD with up to 50% having normal coronary arteries in the 30-44 year group and 40% in the 45-59 year group. Compared to men, women with chest pain had lower mean extent scores (19.6 vs 36.8; P < 0.0001) and lower vessel scores (0.7 v 1.3; P < 0.0001). Although the mean extent score was lower in women than men with myocardial infarction, this was not statistically significant (34.8 vs 41.6 respectively; P = 0.18).
Conclusion:
There is a marked difference in coronary artery disease severity and burden between females and males presenting for the investigation of suspected angina. Women are more likely to have normal coronary arteries or less severe disease than age-matched men, particularly if they do not present with myocardial infarction.
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