journal club cad in women
TRANSCRIPT
BACKGROUND
It is a myth that coronary artery disease (CAD) is less common
and less severe in women
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
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
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
A case-control comparison of the relative risk for MI based on sex : the INTERHEART study: Case-control study. Lancet 364:937, 2004
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
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
• 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.
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
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
Angiographic prevalence and pattern of coronary
artery disease in women
Babu EzhumalaiBalachander Jayaraman
JIPMER PUDUCHERRY
AIM
To study the prevalence and pattern of CADin women undergoing CAG
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
RESULTS
CLINICAL PROFILE OF WOMEN UNDERGOING CORONARY ANGIOGRAM
ANGIOGRAPHIC PROFILE OF WOMEN UNDERGOING CORONARY ANGIOGRAM
DISTRIBUTION OF CORONARY ARTERY DISEASE IN WOMEN UNDERGOING CORONARY ANGIOGRAM
ANALYSIS
• 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”
LIMITATIONS
• USE OF IVUS , OCT, FFR – INTERMEDIATE LESIONS
• NO SMOKERS • AVERAGE AGE
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 differencesDespite 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 womenWe have to have a better understanding of “MALE
PATTERN VS FEMALE PATTERN IHD”
THANK-YOU