Maladies cardiovasculaires et diagnostic

Comparison of Risk Factor Profile and Angiographic Pattern Among Pre-Menopausal and Post-Menopausal Women Presenting with Angina: Results from a Prospective Single Center Observational Study

Abstract

Arvind Kandoria, Rajeev Bhardwaj, Kunal Mahajan*, Prakash C Negi, Neeraj Ganju, Sanjeev Asotra, Rajeev Merwaha, Davinder Pal Singh, Rajesh Sharma, Vivek Rana, Prince Kumar Paul, and Sanjay Rathore

Background: Coronary artery disease (CAD) has become the major killer in women. The exact mechanism of postmenopausal increase in CAD is still under research. Limited data exists on the comparison of risk factor profiles and angiographic disease patterns in premenopausal and postmenopausal women. Methods: This prospective study included a total of 674 consecutive female patients who underwent coronary angiogram for suspected ischemic heart disease over a period of 2 years from March 2015. Detailed risk factor profiles and angiographic patterns of disease were recorded and analyzed using EPIINFO statistical software. Results: Out of total 674 patients, 137(20.3%) were in the premenopausal group with mean age of (42.05 ± 4.40) years, and 537(79.7%) in the postmenopausal group with mean age of (59.05 ± 8.01) years. Premenopausal women were more likely to be obese (57.7% vs 46.9%, p=0.0), hypothyroid (23.4% vs 10.2%, p<0.0001) and more likely to have a positive family history of premature CAD (38.7% vs 6.3%, p<0.0001). On the other hand, postmenopausal women were more likely to be diabetic (22.5% vs 13.1%, p=0.008), hypertensive (74.3% vs 51.8%, p<0.0001), smokers (29.4% vs 19.7%, p=0.01) and had >3 risk factors more frequently (42.1% vs 30.7%, p=0.009). Atypical chest pain was more common as presenting diagnosis among premenopausal women (23.4% vs 10.2%, p<0.0001). They were also more likely to have positive exercise stress test (62.1% vs 38.3%, p<0.0001) and normal coronary angiogram (59.9% vs 32%, p<0.0002) with endothelial dysfunction (84.7% vs 66.8%, p<0.0001) than post-menopausal women. Post-menopausal women had greater burden of obstructive CAD characterized by more prevalent multivessel disease in the form of double vessel (17.5% vs 8%, p=0.06) and triple vessel disease (20.5% vs 5.8%, p<0.0002). Conclusion: There is a distinct difference between the risk factor profile and angiographic disease pattern among women according to the status of menopause. Recognition of these differences would help in better understanding of relationship of menopause to development of CAD.