Sex Differences in Risk Factors Profile and Angiographic Pattern of the Patients Undergoing Coronary Angiography
Introduction: Coronary artery disease (CAD) is a costly problem and its presentations and risk factors may differ by sex. Objective: This study aimed to evaluate the risk factors profile and angiographic pattern of the patients undergoing coronary angiography, according to their gender. Methods: This cross-sectional study was conducted on 741 patients who were referred for coronary angiography from March to August 2018 at Imam Ali cardiovascular center, western Iran. Using a checklist, we collected the demographic, clinical, biochemical, and lab parameters and angiographic findings in these patients. Also, differences between groups were compared using Chi-square and independent t-tests. Results: Women were different from men in terms of the prevalence of hypertension (71.7% vs. 45.3%), diabetes mellitus (34.9% vs. 17.8%), and hypercholesterolemia (26.4% vs. 17.1%). Whereas, men were more likely to be smoker (28.7% vs. 0%) and obese (42.09±16.68 vs. 29.12±4.72). Total Cholesterol and Triglycerides were higher in women compared to men, which were statistically significant. Glucose plasma was significantly higher in women compared to men (p=0.01). Both atherogenic (low-density lipoprotein (LDL)) and protective (high-density lipoprotein (HDL)) cholesterol were higher in women than men. Women were more likely to take antiplatelet (i.e. Aspirin) and antihypertensive therapies (i.e. beta-Blocker, angiotensin receptor blockers (ARBs), and angiotensin converting enzyme (ACE) inhibitors) than men. Also, it was shown that, Men were more likely to have two-vessel disease (p=0.041) and three-vessel disease (P=0.013) compared to women. Disease in the right coronary artery (RCA) (28.9% vs. 14.4%), circumflex (LCx) (26.0% vs. 15.3%), and left anterior descending (LAD) (37.8% vs. 26.4%) was more plausible to occur in men compared to women (p≤0.05). Conclusion: Access and use of health care programs are needed to control CAD risk factors. The findings of the current study showed the significance of gender in the extent of coronary artery blockages.
2. Shyu KG, Wu CJ, Mar GY, Hou CJY, Li AH, Wen MS, et al. Clinical characteristics, management and in-hospital outcomes of patients with acute coronary syndrome-observations from the Taiwan ACS full spectrum registry. Acta Cardiol Sin. 2011;27:135-44.
3. Feeman Jr W. Risk factors versus inflammation in atherothrombotic disease. Circ. 2002;106:e31.
4. Shemirani, H., and K. H. Separham. The relative impact of smoking or Hypertension on severity of premature coronary artery disease. Iran Red Crescent Med J. 2007;9(4):177-181.
5. Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute myocardial infarction in the young—The University of Michigan experience. Am Heart J. 2002;143(1):56-62.
6. Sachdev M, Sun JL, Tsiatis AA, Nelson CL, Mark DB, Jollis JG. The prognostic importance of comorbidity for mortality in patients with stable coronary artery disease. J Am Coll Cardiol. 2004;43(4):576-82.
7. Califf R, Armstrong P, Carver J, D'agostino R, Strauss W. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol. 1996;27(5):1007-19.
8. Nakamura M. Angiography is the gold standard and objective evidence of myocardial ischemia is mandatory if lesion severity is questionable. - Indication of PCI for angiographically significant coronary artery stenosis without objective evidence of myocardial ischemia (Pro)-. Circ J. 2011;75(1):204-10.
9. Topol EJ, Nissen SE. Our preoccupation with coronary luminology: the dissociation between clinical and angiographic findings in ischemic heart disease. Circ. 1995;92(8):2333-42.
10. Yamagishi M, Hosokawa H, Saito S, Kanemitsu S, Chino M, Koyanagi S, et al. Coronary disease morphology and distribution determined by quantitative angiography and intravascular ultrasound--re-evaluation in a cooperative multicenter intravascular ultrasound study (COMIUS). Circ J. 2002;66(8):735-40.
11. Bajaj S, Mahajan V, Grover S, Mahajan A, Mahajan N. Gender based differences in risk factor profile and coronary angiography of patients presenting with acute myocardial infarction in north Indian population. J Clin Diagn Res. 2016;10(5):OC05-7.
12. Cheng CI, Yeh KH, Chang HW, Yu TH, Chen YH, Chai HT, et al. Comparison of baseline characteristics, clinical features, angiographic results, and early outcomes in men vs women with acute myocardial infarction undergoing primary coronary intervention. Chest. 2004;126(1):47-53.
13. Butala NM, Desai MM, Linnander EL, Wong YR, Mikhail DG, Ott LS, et al. Gender differences in presentation, management, and in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from Egypt. PLoS One. 2011;6(10):e25904.
14. Yasar AS, Turhan H, Basar N, Metin F, Erbay AR, Ilkay E, et al. Comparison of major coronary risk factors in female and male patients with premature coronary artery disease. Acta Cardiol. 2008;63(1):19-25.
15. Deepti G, Kiran R, Bharathi V. Gender Difference in Risk Factor Profiles in Patients Referred for Coronary Angiogram. Ind J Car Dis Wom. 2016;1(2):11-6.
16. Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. 2016;9(4):337-46.
17. Gupta R, Sharma K, Gupta A, Agrawal A, Mohan I, Gupta V, et al. Persistent high prevalence of cardiovascular risk factors in the urban middle class in India: Jaipur Heart Watch-5. J Assoc Physicians India. 2012;60(3):11-6.
18. Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, et al. Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. Natl Med J India. 2007;20(3):115-20.
19. Jarrah MI, Hammoudeh AJ, Al-Natour DB, Khader YS, Tabbalat RA, Alhaddad IA, et al. Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention. Saudi Med J. 2017;38(2):149-55.
20. Enas E, Senthilkumar A. Coronary artery disease in Asian Indians: an update and review [online] Internet J Cardiol. 2001;1(2):1-22.
21. Hendricks AS, Goodman B, Stein JH, Carnes M. Gender differences in acute myocardial infarction: the University of Wisconsin experience. WMJ. 1999;98(8):30-3, 6.
22. Dubey RK, Oparil S, Imthurn B, Jackson EK. Sex hormones and hypertension. Cardiovasc Res. 2002;53(3):688-708.
23. Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016;352:h6704.
24. Giannoglou GD, Antoniadis AP, Chatzizisis YS, Damvopoulou E, Parcharidis GE, Louridas GE. Sex-related differences in the angiographic results of 14,500 cases referred for suspected coronary artery disease. Coron Artery Dis. 2008;19(1):9-14.
25. Jong P, Mohammed S, Sternberg L. Sex differences in the features of coronary artery disease of patients undergoing coronary angiography. Can J Cardiol. 1996;12(7):671-7.
26. Roeters van Lennep J, Zwinderman A, Roeters van Lennep H, Westerveld H, Plokker H, Voors A, et al. Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997. No evidence for the Yentl syndrome. Eur Heart J. 2000;21(11):911-8.
27. Enbergs A, Bürger R, Reinecke H, Borggrefe M, Breithardt G, Kerber S. Prevalence of coronary artery disease in a general population without suspicion of coronary artery disease: angiographic analysis of subjects aged 40 to 70 years referred for catheter ablation therapy. Eur Heart J. 2000;21(1):45-52.
28. Leaf DA, Sanmarco ME, Bahl RA. Gender differences in coronary angiographic findings from 1972 through 1981 in Los Angeles, California. Angiology. 1990;41(8):609-15.
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