Risk factor profile and disease pattern in premenopausal and postmenopausal Indian women presenting with acute coronary syndrome
Biji Soman MBBS, MRCP (UK), D.Card 1, Muneer A Rahaman MD, D.Card, FESC 2, Rajesh Rajan MD, PhD, D.Card, FESC, FACC, FAHA 3, Govindan Vijayaraghavan MD, DM, FRCP (Lond), FRCP (Edin), FACC, FAHA 2
1 Department of Cardiology, Sree Uthram Thirunal Royal Hospital, Kochulloor, Kerala, India
2 Department of Cardiology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
3 Department of Cardiology, Amiri Hospital, Kuwait City, Kuwait
Meditrina Hospital, Pallikkal (PO), Kottarakara - 691 566, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: More women die of cardiovascular diseases than from any other illness. Evaluation of coronary artery disease (CAD) among premenopausal women has been neglected, since it is been considered to be rare. The purpose of this study was to compare the risk factor profile for CAD in premenopausal and postmenopausal Indian women presenting with acute coronary syndrome.
Materials and Methods: This retrospective study was carried out at the Department of Cardiology, in a tertiary care cardiac center in Trivandrum, Kerala, India. Clinical and risk factor data were collected by reviewing hospital records. Coronary angiograms were assessed by two independent cardiologists.
Results: A total of 232 patients were included in the study, of which 66 were in the premenopausal group with mean age of (45.85 ± 4.25) years, and 166 in the postmenopausal group with mean age of (67.40 ± 6.40) years. The incidence of hypertension (31 [46.96%] vs. 133 [80.12%], P < 0.001) and diabetes mellitus (28 [42.42%] vs. 104 [62.65%], P < 0.005) was higher among the postmenopausal women. ST elevation myocardial infarction was significantly higher (5 [7.57%] vs. 31 [18.67%], P = 0.035) among postmenopausal women. Coronary angiography showed that the premenopausal women had higher incidence of angiographically normal coronaries (27 [40.90%] vs. 37 [22.29%], P = 0.004), whereas postmenopausal women had more atherosclerotic triple vessel disease (7 [10.60%] vs. 46 [27.71%], P = 0.005).
Conclusions: The CAD in premenopausal women is mostly nonatherosclerotic and nonobstructive. The conventional risk factors do not play a significant role among this subset of population.