Coronary Artery Disease In Women Research Articles

Coronary Artery Disease in Women—Review of Risk Factors and Emerging Concepts

Coronary Artery Disease in Women—Review of Risk Factors and Emerging Concepts

Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis.

Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019. This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná. A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected. In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.

Clinical characteristics of first myocardial infarction in women by history of adverse pregnancy outcomes

Abstract Background Adverse pregnancy complications are known risk factors for future coronary artery disease in women and small studies suggest that a history of hypertensive disorders of pregnancy are associated with ST-elevation myocardial infarction (STEMI) at the time of myocardial infarction. (1) Recent evidence from a population-based study also suggests that middle aged women with a history of either hypertensive disorders of pregnancy or a small for gestational age infant have a different segmental-level pattern of coronary artery atherosclerosis as detected by coronary computed tomography angiography. (2) Purpose To study clinical characteristics of first-time myocardial infarction by adverse pregnancy outcome history (preterm delivery, hypertensive disorders of pregnancy [including preeclampsia and gestational hypertension], and small for gestational age infant). Methods In 8,320 women age ≤65 years with first myocardial infarction in Sweden 2007-2022, we used logistic regression to estimate the association between adverse pregnancy outcome history and presenting with STEMI (vs. non ST-elevation myocardial infarction [NSTEMI]), in-hospital revascularization, and peak troponin >75th percentile, respectively. In addition to age-adjusted results, we also considered predictors of coronary artery disease (body mass index, diabetes, hypertension, smoking status and dyslipidemia). Results In total, 1301 (15.6 %) women with a first myocardial infarction had a history of preterm delivery, 887 (10.7 %) women had a history of small for gestational age infant, 1078 (13.0 %) women had a history of hypertensive disorders of pregnancy, and 3,128 (37.6%) women presented with STEMI. The odds of presenting with STEMI were higher in women with a history of delivering a small for gestational age infant (age-adjusted odds ratio 1.40, 95% CI 1.22-1.61), as well as the odds of in-hospital revascularization (odds ratio 1.30, 95% CI 1.12-1.50), and peak troponin >75th percentile (odds ratio 1.23, 95% CI 1.05-1.43). Accounting for predictors of coronary artery disease did not change these estimates substantially. No consistent associations were observed between preterm delivery or hypertensive disorders of pregnancy and outcomes. Conclusion(s) Among women presenting with a first myocardial infarction, a history of small for gestational age infant was associated with clinical characteristics indicating larger myocardial injury. The extent to which this is relevant for the prevention and treatment of coronary artery disease in women warrants further studies.

Incidence and prevalence rates of coronary artery disease in women with and without rheumatoid arthritisin Kentucky Women's Health Registry.

Aim: To investigate the incidence and prevalence rates of coronary artery disease (CAD) in women with and without rheumatoid arthritis (RA). Methods: Data was collected from the Kentucky Women's Health Registry (2007, 2008, 2009 and 2010) with 3982, 6730, 6898 and 7944, respectively. Results: Women with RA and reported CAD were over 45years. 10% of women with RA reported CAD, while 4% of women without RA reported CAD. The incidence of CAD in women with RA were 10, 5.2 and 3.4% while the incidence of CAD in women without RA were 2.2, 2.2 and 1.4% in 2007-2010, 2008-2010 and 2009-2010, respectively. Conclusion: The incidence and prevalence of CAD was greater in women with RA compared with women without RA.

Characteristics of women with ischemic sudden cardiac death

Background Sudden cardiac death (SCD) is a significant mode of death causing 15-20% of all deaths in high-income countries. Coronary artery disease (CAD) is the most common cause of SCD in both sexes, and SCD is often the first manifestation of underlying CAD in women. This case-control study aimed to determine the factors associated with SCD due to CAD in women. Methods The study group consisted of women with CAD-related SCD (N = 888) derived from the Fingesture study conducted in Northern Finland from 1998 to 2017. All SCDs underwent medicolegal autopsy. The control group consisted of women with angiographically verified CAD without SCD occurring during the 5-year-follow-up (N = 610). To compare these groups, we used medical records, autopsy findings, echocardiograms, and electrocardiograms (ECGs). Results Subjects with SCD were older (73.2 ± 11.3 vs. 68.8 ± 8.0, p < 0.001) and were more likely to be smokers or ex-smokers (37.1% vs. 27.6%, p = 0.045) compared to control patients. The proportion of subjects with prior myocardial infarction (MI) was higher in controls (46.9% vs. 41.4% in SCD subjects, p = 0.037), but in contrast, SCD subjects were more likely to have underlying silent MI (25.6% vs. 2.4% in CAD controls, p < 0.001). Left ventricular hypertrophy (LVH) was more common finding in SCD subjects (70.9% vs. 55.1% in controls, p < 0.001). Various electrocardiographic abnormalities were more common in subjects with SCD, including higher heart rate, atrial fibrillation, prolonged QTc interval, wide or fragmented QRS complex and early repolarization. The prevalence of Q waves and T inversions did not differ between the groups. Conclusions Underlying LVH and previous MI with myocardial scarring are common and often undiagnosed in women with CAD-related SCD. These results suggest that untreated CAD with concomitant myocardial disease is an important factor in SCD in women.

Sex differences in coronary artery bypass graft surgery outcomes: a narrative review.

Coronary artery bypass grafting (CABG) is the most commonly performed cardiac surgery globally and in the United States, however, women have worse outcomes than men. We aim to examine the possible drivers of this sex difference in CABG outcomes. A narrative review using a current search of the most recent literature on this topic. The sex difference in outcomes after CABG has persisted despite advances in the field, with women having well-described worse operative mortality and morbidity than men. Several explanatory mechanisms have been proposed for these differences. These include, but are not limited to, preoperative factors such as the natural history of coronary artery disease in women, older age, and higher prevalence of comorbidities at the time of presentation for CABG surgery. Intraoperative factors have also been proposed to play a role, including the smaller coronary artery size and greater coronary artery reactivity in women, the degree of intraoperative hemodilution anemia, the type of grafting, and the completeness of revascularization. However, no definitive etiology has been identified to date. The sex difference in outcomes after CABG remains present, and despite numerous proposed etiopathologies, the main driver remains unclear. Further research is needed to identify, and address, the root cause of this difference, and greater participation of women in cardiovascular and cardiac surgery trials is crucial.

Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction

BackgroundThe representation of women in heart failure studies has been inadequate, resulting in a knowledge gap regarding the prognostic impact of coronary artery disease (CAD) on all-cause mortality in women with newly diagnosed heart failure and reduced ejection fraction (HFrEF). ObjectivesThis study aims to assess the prognostic impact of CAD in women with HFrEF. MethodsUsing the Western Denmark Heart Registry, the authors identified 891 women and 2,403 men referred for first-time coronary angiography because of HFrEF. The authors stratified for presence of CAD, estimated 10-year all-cause mortality, and calculated crude and adjusted HRs (aHRs) with 95% CIs. ResultsThe 10-year mortality was 60% in women with CAD and 27% in women without CAD; for men, the corresponding numbers were 54% and 36%. When adjusted for comorbidities, women without CAD had a lower relative 10-year mortality than men without CAD (aHR: 0.73; 95% CI: 0.58-0.91), whereas women with CAD had similar relative mortality as men with CAD (aHR: 1.00; 95% CI: 0.81-1.24) (Pinteraction = 0.037). Assessed by the number of coronary vessels with significant stenosis, CAD extent was associated with mortality for both women (P < 0.01) and men (P < 0.01). However, compared to those without CAD, the aHR was higher for women with any degree of CAD (aHR ranging from 1.61 [95% CI: 1.09-2.38] for diffuse CAD to 2.01 [95% CI: 1.19-3.40] for 3-vessel disease) than for men with 3-vessel disease (aHR: 1.51; 95% CI: 1.19-1.91). ConclusionsIn patients with newly diagnosed HFrEF, the presence and extent of CAD has significantly greater prognostic impact among women than among men.

Coronary Artery Disease in Women: Getting to Know Gender Related Disparities

Coronary Artery Disease in Women: Getting to Know Gender Related Disparities

Incidental Breast Arterial Calcifications and Assessment of Coronary Artery Disease Risk: A Review and Recommendation.

Coronary artery disease (CAD) continues to be the leading cause of morbidity and mortality in women, contributing to about 20%, or nearly 400,000, of female deaths annually in the United States. Despite their significant burden from CAD, women have been traditionally underrepresented in trials, and therefore, there is still much to be studied regarding the sex-based variations that have been reported regarding the pathophysiology, clinical presentation, efficacy of diagnostic workup, and response to therapy in CAD. Previous studies have reported that breast arterial calcifications, commonly found incidentally on screening mammography, may be associated with risk of CAD; however, there are currently no specific guidelines concerning reporting and quantification practices, as well as further workup recommendations for patients who are found to have vascular calcifications. Thus, the question remains whether breast arterial calcifications can serve as a sex-specific marker for CAD, and whether there is enough evidence to support the use of mammography as a screening tool for CAD in women. In this review, we will summarize the current understanding of cardiovascular disease in women, the existing literature regarding breast arterial calcifications and current reporting practices, and the association of vascular calcifications with CAD risk; based on the collected evidence, we will make a recommendation whether screening mammography and breast arterial calcifications should be used to assess CAD risk, and if so, what additional workup, if any, we recommend in women found to have breast arterial calcifications on imaging.

Sex hormones and risk of coronary artery disease in women.

Sex hormones and risk of coronary artery disease in women.

Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE).

Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

Coronary artery disease in women.

Cardiovascular disease is the leading global cause of death in women but remains underdiagnosed and undertreated. Health professionals play an important role in improving the heart health of Australian women. Routine heart health checks should be offered to all women 45 years of age and older and to all Aboriginal and Torres Strait Islander women 30 years of age and older. Cardiovascular risk assessment in women must include traditional and sex-specific risk factors, including their pregnancy history and early-onset menopause. Women with pregnancy-related hypertensive and metabolic disorders have an increased long-term cardiovascular risk and require close monitoring. Women with acute coronary syndrome may not experience classical chest pain. More often, they experience cardiovascular events in the absence of obstructive coronary disease and have poorer cardiovascular outcomes. The recognition of sex-specific differences and more sex-specific trials are key to improving clinical outcomes.

Abstract 10184: The Risk Factors for Ischemic Sudden Cardiac Death in Women

Background: Sudden cardiac death (SCD) is a significant cause of death accounting for 15-20 % of all deaths in Western countries. Coronary artery disease (CAD) is the most common cause of SCD. Even though women are at a lower risk for SCD &amp; CAD, the decline in mortality of these conditions has been slower in women than in men. Previous studies have shown that CAD is more challenging to detect in women, hence SCD is often the first manifestation of underlying CAD among women. The aim of this case-control study was to determine factors associated to SCD due to CAD in women. Methods: The study group consists of women with ischemic SCD (N=888) derived from the Fingesture study conducted in Northern Finland from 1998 to 2017 and all SCDs were autopsy verified. The control group consisted of women with angiographically verified CAD without SCD occurring during the 5-year-follow-up (N=610) from Artemis study. To perform comparison between these groups, we utilized medical records, autopsy findings, echocardiograms and ECGs. Results: Subjects with SCD were older (73.2±11.3 vs. 68.8±8.0 p &lt; 0.001) and were more likely to be smokers or ex-smokers (37.1% vs. 27.6 %, p = 0.045). The proportion of subjects with prior myocardial infarction (MI) was higher in controls (46.9 % vs. 41.4 % in SCD subjects, p = 0.037), but in contrast, SCD subjects were more likely to have underlying silent MI (25.6 % vs. 2.4 % in CAD controls, p &lt; 0.001). Decreased left ventricular ejection fraction (LVEF 35-55 %) was more common finding in SCD subjects than in CAD controls (33.1% vs. 8.7 %, p &lt; 0.001, respectively) as well as LV hypertrophy (70.9 % vs. 55.1 %, p &lt; 0.001, respectively). Various ECG-abnormalities were more common in SCD subjects including higher heart rate, prolonged QTc- and JTc-intervals, wide or fragmented QRS-complex, short PR-interval and early repolarization. The prevalence of Q-waves and T-inversions did not differ between these groups. Conclusions: Underlying CAD and MI are often underdiagnosed in women with ischemic SCD considering the high proportion of silent myocardial infarctions and the number of subjects without prior CAD diagnosis. LV hypertrophy as well as decreased LVEF were more frequent findings in SCD subjects. Several ECG abnormalities were more common among subjects with SCD.

Risk factors of premature coronary artery disease in women in Kashgar area

Risk factors of premature coronary artery disease in women in Kashgar area

Association between iron status and incident coronary artery disease: a population based-cohort study

Disorders of iron metabolism has been implicated in cardiovascular disease. However, the association of serum iron stores and coronary artery disease (CAD) remains inconsistent. Here, we investigated the associations of serum iron metabolism with the incidence of CAD, the severity of coronary artery stenosis, metabolic biomarkers, and the risk of major adverse cardiovascular event (MACE). A total of 643 CAD patients and 643 healthy controls were enrolled to assess the associations of serum iron status with the presence of CAD, the severity of CAD, and the risk of MACE. Serum iron metabolism and other metabolic markers were measured in all subjects. All statistical analyses were analyzed using SPSS22.0 software and STATA statistical package. Serum level of iron metabolism markers, including serum iron, unsaturated transferrin iron binding capacity (UIBC), Total iron binding capacity (TIBC) levels, in CAD groups was significantly lower than the control group (P < 0.001). UIBC and TIBC were negatively correlated with ferritin in both sexes. Each unit increase of serum iron and TIBC were found to have a protective role for CAD in women (iron: OR 0.794, 95% CI (0.647–0.973), TIBC: OR 0.891, 95% CI (0.795–0.999), P < 0.05). However, high ferritin level was significant associated the CAD incident in both sexes (OR 1.029, 95% CI (1.002–1.058) in men, OR 1.013, 95% CI (1.0–1.025) in women, P < 0.05). Serum iron metabolism markers exhibited no significant association with the severity of CAD. Increased serum level of iron and TIBC levels were found to have a protective role for CAD in women, but not in men. Elevated serum ferritin is independently and positively associated with CAD in men and women.

Effect of eight weeks of electrical muscle stimulation on the interleukin-6 and interleukin-10 levels in overweight women

Introduction: Nowadays more people are overweight more than before. Overweight can be considered as having more body fat than desired. Overweight or obesity increases the relative risk of diabetes and coronary artery disease in women. Therefore, this research investigates the effect of eight weeks of electrical muscle stimulation on the interleukin-6 and interleukin-10 levels in overweight women. Research method: In this research, we selected 34 overweight women and then randomly divided into three groups: control (10 people), resistance training (12 people) and resistance training + EMS (12 people). Then, two experimental groups performed resistance exercises for 8 weeks and 2 sessions per week, each session 20 minutes. In order to check the research variables, we collected 5 cc of blood from the research samples 48 hours before and after the test. We used Shapiro-Wilk test and analysis of covariance with SPSS version 24 software for statistical analysis of the research. Results: The analysis of IL-6 serum levels of the participants before and after eight weeks of intervention through covariance analysis showed that the difference between groups (control groups, resistance training and resistance training + EMS) was not statistically significant (p = 0.307).

TCT-558 Unique Features of Coronary Artery Disease in Women Based on Coronary Angiography Data of More Than 50,000 Patients

TCT-558 Unique Features of Coronary Artery Disease in Women Based on Coronary Angiography Data of More Than 50,000 Patients

The Role of Breast Arterial Calcification on Mammogram as a Predictor for Risk of Coronary Artery Disease in Women

Introduction and Aim: Cardiovascular disease is a leading cause of death worldwide. Thus, the detection of mammographic arterial calcifications can be an early, noninvasive instrument for predicting the possible development of coronary heart disease in women. The current work aimed to assess the significance of Breast arterial calcification (BAC) detected by digital mammogram and its relation to coronary artery calcium score and degree of coronary artery stenosis if present.&#x0D; Patients and methods: The study included 100 female patients submitted to digital mammography for breast cancer screening programs and showed BAC then coronary artery calcification (CAC) score and multidetector coronary computed tomography angiography (MDCCTA) had done to determine the severity of coronary artery stenosis.&#x0D; Results: The age was ranged between 40 and 80 years; the mean was 56.7+9.42 years. The prevalence of positive BAC and CAD were 50% and 10%, respectively. Hypertension, diabetes mellitus (DM), hyperlipidemia, and Family history of cardiovascular disease was higher in the BAC (+) than in BAC (-) group. The presence of BAC appears to strongly and proportionately correlate with CAC Score and Coronary artery stenosis as determined by coronary CTA (r =0.809, and r = 0.811, respectively).&#x0D; Conclusion: BAC can indicate a risk of CAD development. Besides, there was a significant correlation between BAC and some cardiac risk factors ( e.g., age, family history of CAD, and DM).

Coronary Artery Disease in Women: Lessons Learned from Single-Center SPECT Registry and Future Directions for INOCA Patients.

Background and objectives: Myocardial perfusion imaging with cardiac single-photon emission tomography (SPECT) is widely available for the detection of coronary artery disease (CAD) with high diagnostic and prognostic accuracy for women. A large proportion of symptomatic women with true myocardial perfusion defects in SPECT referred to coronary angiography have an absence of CAD—a condition named INOCA (ischemia with nonobstructive CAD). Additionally, the INOCA endotypes are rarely correctly diagnosed, and therefore, no tailored therapy is prescribed. Materials and methods: The cardiac SPECT for women was performed from 2018 to 2021. Patients with perfusion defect were analyzed according to further prescribed diagnostic tests used to diagnose CAD. According to the diagnostic criteria, patients with INOCA were selected as candidates for invasive microvascular physiology measurements. The correlation was calculated between SPECT results and clinical characteristics, symptoms, and risk factors. Results: A total of 726 women with suspected CAD were analyzed. True myocardial perfusion defects were detected in 125 patients (17.2%). During coronary angiography in 70 (56.0%) women, atherosclerosis in epicardial arteries was not observed. In 17 (20.9%) patients, obstructive CAD was present. Correlation was found between perfusion defect in SPECT and cardiovascular risk factors, including overweight, obesity, arterial hypertension, and dyslipidemia. Women with typical angina were more likely to have INOCA, but with “noncardiac” symptoms—CAD. In total, 68 female patients met three inclusion criteria for INOCA and were selected as candidates for invasive diagnostic testing. Conclusions: The created registry proves the important role of cardiac SPECT and great need for the development of invasively detected physiological measurements. The combination of both interventions could significantly change the future directions for INOCA patients, improving treatment strategies and clinical outcomes, especially knowing the number of risk factors and varying clinical presentation. The study will be continued by performing invasive testing of coronary microvascular function to expand the competence about what is known about INOCA patients.

The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A gender-based multi-center study

ObjectivesIn a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and MethodsThis was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. ResultsIn a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n = 113), while 6.9% were young men (n = 254). Traditional risk factors such as hypertension (p = 0.73), diabetes (p = 0.61), and family history of premature CAD (p = 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p = 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. ConclusionsObstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women.