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Gender differences in thrombogenicity among patients with angina and non-obstructive coronary artery disease

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Abstract

Women more often present with angina and non-obstructive coronary artery disease (ANOCA) and have poorer clinical outcomes than men. These findings may be related to sex associated differences in inflammation and thrombogenicity. Consecutive patients (n = 134) with ANOCA (luminal diameter stenosis < 50%) undergoing elective cardiac catheterization were included in post hoc analysis of Multi-Analyte, thrombogenic, and Genetic Markers of Atherosclerosis (MAGMA, NCT01276678) study. Patients with prior revascularization, coronary artery bypass grafting or myocardial infarction were excluded. Blood for thromboelastography, oxidized LDL β2-glycoprotein complex (AtherOx), oxidized-LDL, lipid profile, and urine for 11-dehydrothromboxane B2 (dTxB2) were obtained before catheterization. All women (n = 75) were post-menopausal and tended to be older than men (61.4 ± 10.6 vs. 58.6 ± 9.9 year, p = 0.12), and were significantly more thrombogenic with higher thrombin-induced platelet–fibrin strength (TIP–FCS, mm) (68.0 ± 4.5 vs. 64.5 ± 6.2 mm, p = 0.001), clotting index (0.35 ± 2.22 vs. − 0.72 ± 2.75, p = 0.02), K (measure of the speed to reach 20 mm of clot strength from an amplitude of 2 mm) (2.2 ± 1.6 vs. 1.7 ± 0.5 min, p = 0.01), and fibrinogen activity (degrees) (66.6 ± 7.1 vs. 62.9 ± 7.5, p = 0.009). Markers of inflammation were not significantly different between the two groups. Women had higher total cholesterol, total LDL, LDL subtypes 1 and 2, total HDL, HDL subtypes 2 and 3, and ApoA1 (p < 0.05 for all). On multivariate regression, TIP–FCS remained significantly higher in women (p < 0.0001). Women with ANOCA are more thrombogenic than men. This fundamental difference in thrombogenicity may affect gender-related outcomes and warrants further investigation.

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Acknowledgements

This study was supported by a research grant from Sinai Hospital of Baltimore. Thromboelastography supplies were provided by Haemonetics® Corp. VAP© testing was provided by Atherotech® Inc. Urinary 11-dehydrothromboxane B2 and AtherOx testing were provided by Corgenix Medical Corp. We wish to acknowledge Tania Gesheff RN, MSN, Kiran Kalra, MBBS, and Cescelle Barbour RN, MSN for their contributions to this study.

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  1. Rahul Chaudhary and Ajaypaul Sukhi contributed equally to the manuscript.

Authors and Affiliations

  1. Sinai Hospital of Baltimore, Baltimore, MD, USA

    Rahul Chaudhary, Ajaypaul Sukhi & Amit Rout

  2. Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Rahul Chaudhary

  3. Indiana University, Bloomington, IN, USA

    Rahul Chaudhary

  4. Peter Lee Associates, Sydney, Australia

    Rohit Chaudhary

  5. Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA

    Manila Jindal, Ankit Vyas & Kevin Bliden

  6. Platelet and Thrombosis Research, Baltimore, MD, USA

    Udaya Tantry

  7. Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Paul Gurbel

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  1. Rahul Chaudhary
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Paul Gurbel reports serving as a consultant for Daiichi Sankyo/Lilly, Bayer, AstraZeneca, Accumetrics, Merck, Medtronic, Janssen, CSL, and Haemonetics; receiving grants from the National Institutes of Health, Daiichi Sankyo, Lilly, CSL, AstraZeneca, Haemetics, Harvard Clinical Research Institute, and Duke Clinical Research Institute; receiving payment for lectures, including service on speakers’ bureaus, from Lilly, Daiichi Sankyo, and Merck; receiving payment for development of educational presentations from Merck, the Discovery Channel, and Pri-Med; Dr. Gurbel is holding stock or stock options in Merck, Medtronic, and Pfizer; and holding patents in the area of personalized antiplatelet therapy and interventional cardiology. No other authors report any potential conflicts of interest.

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Chaudhary, R., Sukhi, A., Chaudhary, R. et al. Gender differences in thrombogenicity among patients with angina and non-obstructive coronary artery disease. J Thromb Thrombolysis 48, 373–381 (2019). https://doi.org/10.1007/s11239-019-01901-1

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