Influence of hypertension and diabetes mellitus in pattern of coronary artery disease in women

Abstract

Introduction: Coronary artery disease (CAD) among women is an ignored entity in India. The aim of this study was to evaluate the role of hypertension (HT) and diabetes mellitus (DM) on the extent of CAD in women, admitted with ischemic chest pain. Materials and Methods: We conducted a retrospective analysis of the data of female patients admitted with chest pain suspected of cardiac origin and then underwent diagnostic coronary angiography. We obtained the ages, blood pressures, blood sugar levels, and angiographic findings of these patients after analyzing the patient records and reviewing the coronary angiograms. Results: We studied 163 female patients with a mean age of 58 ± 10.5 years. Of them, 71 (43.5%) had HT, 46 (28%) had DM, and 46 patients (28%) had neither HT nor DM. DM prevalence was higher (12/25, 48.0%) among women with ST-segment elevation myocardial infarction (STEMI) as compared to those with non-STEMI (6/26, 23.1%) or unstable angina (28/112, 25.0%; P = 0.06). In contrast, a higher proportion of the women with unstable angina had neither HT nor DM. Coronary angiography revealed a significant CAD in 86 (52.8%) women. Of them, 34 had DM (odds ratio: 3.542, 95% confidence interval [CI]: 1.669-7.516, P = 0.001) and forty had HT (odds ratio: 1.290, 95% CI: 0.693-2.404, P = 0.422) while12 had neither of the two risk factors. Triple vessel disease was more common in women >50 years of age, but the relationship between risk factors and CAD remained same in both the age groups. Conclusion: We conclude that increasing age along with DM is major risk factors for CAD among women. However, while older women tend to present with more extensive CAD, presentation with noncritical CAD or normal coronaries and muscle bridge is more common in younger women with suspected acute coronary event.