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Sex differences in independent factors associated with coronary artery disease

Geschlechtsunterschiede in mit koronarer Herzkrankheit unabhängig assoziierten Risikofaktoren

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Summary

Background

Women undergoing coronary angiography (CA) due to chest pain are more likely to present with less extensive coronary artery disease (CAD) than men, which might be attributed to different effects of cardiovascular risk factors on coronary atherogenesis between sexes. The aim of the present study was to evaluate sex differences in independent factors associated with obstructive and non-obstructive CAD in a large consecutive cohort of patients undergoing elective CA.

Methods

Data from 7819 patients (2653 women and 5184 men), including cardiovascular risk factors, clinical presentation, CAD severity and treatment decisions were analysed.

Results

Women were older than men (65 ± 11 vs. 63 ± 11 years, p < 0.001); low-density lipoprotein cholesterol (LDL; 125 ± 38 vs. 122 ± 37 mg/dL, p < 0.001) and high-density lipoprotein cholesterol (HDL) cholesterol levels (62 ± 18 vs. 51 ± 15 mg/dL, p < 0.001) were higher in women; and smokers were more frequently men (14.4 vs. 20.1 %, p < 0.001). Men more frequently had an obstructive CAD (41.1 vs. 65.6 %, p < 0.001). Multivariable analyses revealed age, HDL cholesterol, hypercholesterolaemia, diabetes mellitus, arterial hypertension and a positive family history being associated with obstructive CAD in both sexes, whereas smoking was independently associated with obstructive CAD only in women. The association of hypercholesterolaemia with obstructive CAD was stronger in men. For non-obstructive CAD, no sex-specific associated factors could be identified.

Conclusion

The impact of smoking and hypercholesterolaemia on coronary atherosclerosis is different between women and men. This might be taken into account when planning individual interventions to reduce cardiovascular risk.

Zusammenfassung

Hintergrund

Bei Frauen, die sich aufgrund von Brustschmerzen einer Koronarangiographie unterziehen müssen, findet sich im Vergleich zu Männern seltener eine relevante koronare Herzkrankheit (KHK). Dies könnte auf den unterschiedlichen Einfluss kardiovaskulärer Risikofaktoren auf die KHK bei Frauen und Männern zurückzuführen sein. Das Ziel der aktuellen Studie lag darin, geschlechtsspezifische Unterschiede in unabhängig mit signifikanter und nicht-signifikanter KHK assoziierten Faktoren in einem großen konsekutiven Patientenkollektiv, bei dem eine elektive Koronarangiographie durchgeführt wurde, zu untersuchen.

Methoden

Von 7819 Patienten (n = 2653 Frauen, n = 5184 Männer) wurden kardiovaskuläre Risikofaktoren, die klinische Präsentation, die Schwere der KHK und therapeutische Entscheidungen analysiert.

Resultate

Frauen waren älter als Männer (65 ± 11 vs. 63 ± 11 Jahre, p < 0,001), LDL- (125 ± 38 vs. 122 ± 37 mg/dL, p < 0,001) und HDL-Cholesterin Werte (62 ± 18 vs. 51 ± 15 mg/dL, p < 0,001) waren höher bei Frauen, Rauchen fand sich häufiger bei Männern (14,4 vs. 20,1 %, p < 0,001). Bei Männer wurde häufiger eine signifikante KHK diagnostiziert (41,1 vs. 65,6 %, p < 0,001). In multivariablen Analysen waren das Alter, das HDL-Cholesterin, eine Hypercholesterinämie, ein Diabetes mellitus, eine arterielle Hypertonie und eine positive Familienanamnese mit dem Vorliegen einer signifikanten KHK bei beiden Geschlechtern assoziiert. Rauchen war nur bei Frauen unabhängig mit einer signifikanten KHK korreliert. Die Assoziation von Hypercholesterinämie mit einer signifikanten KHK war bei Männern stärker ausgeprägt. Für die nicht-signifikante KHK konnten keine Geschlechtsunterschiede in den unabhängig assoziierten Faktoren identifiziert werden.

Schlussfolgerung

Der Einfluss von Rauchen und Hypercholesterinämie auf eine KHK ist bei Frauen und Männern unterschiedlich. Dies könnte zukünftig bei der Planung von individuellen Interventionen zur Reduktion des kardiovaskulären Risikos berücksichtigt werden.

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Acknowledgement

Prof. Hanno Ulmer, head of the Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, assisted in statistical analyses.

Conflict of interest

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. University Clinic for Internal Medicine III (Cardiology), Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Alois Suessenbacher MD, Maria Wanitschek MD, Jakob Dörler MD, Matthias Frick MD,  Otmar Pachinger MD & Hannes F.W. Alber MD

  2. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, 6020, Innsbruck, Austria

    Sabrina Neururer

  3. Rehabilitation Clinic Münster in Tyrol, Gröben 700, 6232, Münster, Austria

    Hannes F.W. Alber MD

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  1. Alois Suessenbacher MD
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  2. Maria Wanitschek MD
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Correspondence to Hannes F.W. Alber MD.

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Suessenbacher, A., Wanitschek, M., Dörler, J. et al. Sex differences in independent factors associated with coronary artery disease. Wien Klin Wochenschr 126, 718–726 (2014). https://doi.org/10.1007/s00508-014-0602-9

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  • DOI: https://doi.org/10.1007/s00508-014-0602-9

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