article published in indian heart journal 2014

2. BACKGROUND

3. It is a myth that coronary artery
disease (CAD) is less common and
less severe in women

4. Myths vs Facts
MYTHS FACTS
Men are more
likely to have
heart disease
Heart disease is the #1 killer of men and women; 50,000
more women than men die of heart disease every year
Cancer is a
bigger threat than heart
disease
Nearly twice as many US women die from heart disease
and stroke than from all cancers combined
Doctors are aware
of women’s risk for heart
disease and act
accordingly
Undertreatment and underdiagnosis of heart disease in
women contributes to excess mortality in women

5. Cardiovascular disease mortality trends for males and females (United States: 1979–2007).
Wenger N K Circulation. 2012;126:604-611
Copyright © American Heart Association, Inc. All rights reserved.
WOMEN
MEN

6. Women and CAD Risk Factors
1. American Heart Association. 1999 Heart and Stroke Statistical Update. 1998
2. Mosca L, et al. Circulation. 1999
Higher prevalence of avoidable risk factors1
↑ blood cholesterol, ↑ TG
↑ physical inactivity
↑ overweight (body mass index, 25.0-29.9)
Diabetes is a more powerful risk factor for CAD2
3- to 7-fold in women vs 2- to 3-fold in men
↓ HDL cholesterol levels more predictive of CAD2
Women counseled less about nutrition, exercise, and
weight control2
1. American Heart Association. 1999 Heart and Stroke Statistical Update. 1998
2. Mosca L, et al. Circulation. 1999

7. A case-control comparison of the relative risk for MI based on sex : the INTERHEART study:
Case-control study. Lancet 364:937, 2004

8. Diabetes is a relatively greater risk factor for CHD in
women than in men;
it increases a woman’s risk for CHD by 3-7 fold, with only a
2-3 fold increase in diabetic men
Risk for fatal CHD in diabetic women is 3.5 times higher
than in nondiabetic women
Risk in diabetic men is only 2.0 times higher than
nondiabetic men)
Huxley R, Barzi F, Woodward M: Excess risk of fatal coronary heart disease associated with
diabetes in men and women: Meta-analysis of 37 prospective cohort studies. BMJ 332:73, 2006

9. Huxley RR,Woodward M. Cigarette smoking as a risk factor for coronary heart
disease in women compared with men: a systematic review and meta-analysis of
prospective cohort studies. Lancet. 2011;378:1297–1305
A recent systematic review and
meta-analysis involving >2 million
people uniformly showed a 25%
increased coronary risk among
women smokers than men
smokers

10. • In comparison with their male counterparts,
women with angina have a doubled morbidity
and mortality.
• Women with stable ischemic heart disease
have more MIs than men do.
• Women with CHD, and, in particular, women
<50 years of age, have a doubled mortality
after MI.

11. Despite their greater symptom burden of
angina and its consequent morbidity and
mortality, and despite their older age and
higher risk factor burden,
women paradoxically have less severe
obstructive coronary disease at elective
angiography than do men
Bairey-Merz CN. The Yentl syndrome is alive and well. Eur Heart J. 2011;32:1313–1315
PARADOX

12. 3 mechanisms proposed :
adverse coronary reactivity,
microvascular dysfunction,
plaque erosion/distal micro-embolization
1. Abnormal coronary vasomotion as a prognostic indicator of cardiovascular events in women: results from the
National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation (WISE). Circulation.
2004 Feb 17; 109(6):722-5.
2. Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation.
1998 Jun 2; 97(21):2110-6

13. Angiographic prevalence and
pattern of coronary
artery disease in women
Babu Ezhumalai
Balachander Jayaraman
JIPMER PUDUCHERRY

14. AIM
To study the prevalence and pattern of CAD
in women undergoing CAG

15. STUDY DESIGN
• Retrospective Analysis
• 3 Yr Data
• Women With Probable CAD
• Discharge Cards And Angio Reports
• 2 Groups <55 yrs , >55 yrs
• Normal Vs Non-significant Vs Intermediate Vs
Obstructive
• SVD Vs DVD Vs TVD

16. RESULTS

17. CLINICAL PROFILE OF WOMEN UNDERGOING CORONARY ANGIOGRAM

18. ANGIOGRAPHIC PROFILE OF WOMEN UNDERGOING
CORONARY ANGIOGRAM

19. DISTRIBUTION OF CORONARY ARTERY DISEASE
IN WOMEN UNDERGOING CORONARY
ANGIOGRAM

20. ANALYSIS

21. • Almost equal number of young (257) and elderly
(243)women undergoing angiogram
• ACS presentation 107 vs 107
• Presentation with stable angina was more common in
younger 134 vs 104
• Prevalence of OBSTRUCTIVE CAD = 45.4 % , more in elderly
136 vs 91
• Increased prevalence of normal coronaries and non-
significant lesions in younger women
• Increased prevalence of multivessel and left main disease in
elderly women
DESPITE AN INCREASE IN THE RISKS OF CAD
AND INCIDENCE OF ACS AT YOUNGER AGE ,
YOUNGER FEMALE STILL HAVE LOWER
ATHEROSCLEROTIC BURDEN , LESSER
PREVALENCE OF OBSTRUCTIVE LESIONS
AND BETTER LV FUNCTIONS--- “FEMALE
PATTERN CAD”

22. LIMITATIONS
• USE OF IVUS , OCT, FFR – INTERMEDIATE
LESIONS
• NO SMOKERS
• AVERAGE AGE

23. TAKE HOME MESSAGE
CVD esp. CAD is by far the biggest health risk for
women.
Awareness is still less than it needs to be.
Myocardial ischemia has specific sex differences
Despite a lower prevalence of obstructive CAD in
women, women have a higher prevalence of
symptoms, ischemia, and mortality relative to
men.
Same holds true for young vs older women
We have to have a better understanding of “MALE
PATTERN VS FEMALE PATTERN IHD”

24. THANK-YOU