Objective: To examine sex differences in the features of coronary artery disease (CAD) of patients who have undergone coronary angiography.
Design: Retrospective study which reviewed clinical and angiographic results from eligible patients who underwent coronary angiography under one cardiologist during a consecutive period.
Setting: Tertiary referral women's health centre.
Patients: 515 patients (167 women, 348 men) who underwent coronary angiography for suspected CAD, excluding those with previously known primary valvular disease, valvular replacement, congenital heart disease, nonischemic cardiomyopathy, history of cocaine-induced myocardial ischemia or infarction, and those who had previously undergone coronary angiography, coronary artery bypass graft or percutaneous transluminal coronary angioplasty.
Main results: Overall, females and males presented at similar ages and with similar prevalences of smoking, diabetes, hypertension, and family histories of premature CAD, albeit women were less likely than men to have a prior history of myocardial infarction. The observed age difference between females and males with coronary disease was less than expected (3.3 +/- 2.3 years, 95% confidence limits). At angiography, women were three times more likely than men to have normal coronary arteries. Yet, in patients found to have coronary disease, there was no sex difference in either the severity or the distribution of the disease. Women were twice as likely as men to have normal left ventricular function on catheterization. However, when all cases of normal angiograms were excluded, multivariate logistic regression analysis showed that, after controlling for other important confounding factors, females were as likely as males to have significant CAD and left ventricular dysfunction on angiography.
Conclusions: Women can develop serious ischemic heart disease that is similar to that in men and at a relatively younger age than previously described. The vulnerability to ischemic heart disease in nonelderly women needs to be emphasized.