Gender differences in hemostatic potential in coronary artery disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Clinical presentation and contribution of different risk factors in coronary artery disease (CAD) vary between genders. Women are known to be generally older, have more comorbidities and are more likely to present with atypical symptoms. Previous research suggests there are important gender differences in the pathophysiology of CAD. One of the important mechanisms for atherothrombotic events seems to be increased coagulation, for which differences in presentation between genders is not yet fully documented. Purpose Our aim was to investigate a possible correlation between gender and coagulation appraised by overall hemostatic, coagulation and fibrinolytic potentials (OHP, OCP and OFP) in patients with CAD. Methods Consecutive patients after a recent acute myocardial infarction (within 90 days from inclusion) had fasting blood samples withdrawn. OHP, OCP and OFP were determined using thrombin and recombinant tissue-type plasminogen activator by absorbance measurements at 405 nm in 1-minute intervals for 40 minutes. Areas under the curve were constructed for OCP and OHP with the obtained measurements, OFP was calculated as the difference between the two areas: OFP = [(OHP – OCP) / OCP] x 100 (%). Baseline data and cardiovascular risk factors profiles were collected. Proportions were compared using χ2 test, means were compared using t-test, medians were compared using Mann-Whitney U test, linear regression models were constructed for the multivariate analysis. Results We included 117 patients (mean age 56 ± 10 years), 23 (20%) were women. Arterial hypertension was present in 86 (73.5%), diabetes mellitus in 10 (8.5%), dyslipidemia in 75 (64.1%), family history in 46 (39.3%) patients, 54 (46.2%) were active smokers (within 2 years). There were no significant differences in mean age and risk factors presence between genders. Median OCP and median OHP were significantly higher in women (25.1 (interquartile range [IQR] 5.8) vs 21.8 (IQR 5.7), p=0.035; and 9.5 (IQR 4.3) vs 7.8 (IQR 3.1), p=0.032, respectively) while median OFP were similar. Female gender retained its significant predictive value after multivariate adjustment for age and traditional risk factors for OCP (R2 0.25; ANOVA for regression p<0.001; Beta 2.96 [0.61-5.31], p=0.014) and OHP (R2 0.24; ANOVA for regression p<0.001; Beta 2.04 [0.76-3.32], p=0.002). Conclusion In patients after acute myocardial infarction women seem to have a higher procoagulant state, as determined by OCP and OHP. Our findings suggest different pathophysiology of CAD in women, further research is needed to fully understand and address gender differences in CAD.