Are there gender differences in patients presenting with unstable angina?
Introduction
Coronary artery disease is a leading cause of morbidity and mortality in women. In the United Kingdom, an estimated 900,000 women suffer from angina, and coronary artery disease accounts for a fifth of all deaths in women. Although women have a lower prevalence of coronary heart disease than men, the incidence of angina continues to rise with age in women in contrast to men, in whom angina increases with age initially, peaking between 55 and 65 years before declining [1], [2]. The mean age of onset of angina is greater in women (64 years vs. 61 years) and they are more likely to present with angina than myocardial infarction, unstable angina or death due to coronary artery disease. In contrast, almost half of the men have myocardial infarction as their first presentation. Women with stable angina have a worse risk profile with a higher incidence of hypercholesterolaemia, diabetes mellitus and hypertension. They have been reported to undergo cardiac catheterisation less frequently than men [3], [4], [5], [6], [7]. The outcome of the subsequent revascularisation procedure may be less favourable in women [8], [9]. Women with myocardial infarction have also been reported to be treated with thrombolysis less commonly than men, but this observation may be confounded by an age bias [10], [11], [12].
Unstable angina accounts for a large number of hospital admissions for coronary artery disease. Twice as many men are admitted with unstable angina, reflecting the higher prevalence of coronary artery disease in men. Although gender exerts an influence in the presentation of chronic stable angina, there are limited studies on gender differences in patients presenting with unstable angina [13]. We therefore investigated the influence of gender in patients presenting with unstable angina.
Section snippets
Patients and methods
We retrospectively studied the case notes of all patients with unstable angina and transferred to our institution (under the care of Dr Fox) with a view to coronary angiography and further management in a 42-month period between January 1994 and June 1997 inclusive. We investigated the past medical history including a history of angina pectoris, previous myocardial infarction and coronary artery bypass graft operation and the presence of risk factors. Most patients underwent coronary
Results
During this 42-month period, a total of 313 in-patients with a diagnosis of unstable angina were referred with a view to urgent coronary angiography and further management. All patients were accepted on the basis of ischaemic chest pain (angina post-myocardial infarction, 36 men, 18 women; electrocardiogram (ECG) showing ST elevation, 21 men, nine women; ECG showing ST depression, 59 men, 27 women; ECG showing T-wave changes, 87 men, 48 women; no significant ECG change, seven men, one woman).
Discussion
Our study highlights both the similarities and differences in men and women with unstable angina. There were more men with unstable angina referred for coronary angiography over the period of study, reflecting the higher prevalence of ischaemic heart disease in men. There was no apparent difference in the age of the patients. This is an interesting finding since the presentation of stable angina in women is usually delayed by several years. It may be that unstable angina in women truly
References (23)
- et al.
Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population
Am Heart J
(1986) - et al.
Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB
J Am Coll Cardiol
(1997) - et al.
Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men
Lancet
(1992) - et al.
Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation
Circulation
(1993) - et al.
Differences in the use of procedures between women and men hospitalized for coronary heart disease
New Engl J Med
(1991) - et al.
Sex differences in the management of coronary artery disease
New Engl J Med
(1991) - et al.
Cardiovascular health and disease in women
New Engl J Med
(1993) - et al.
Sex bias in considering coronary bypass surgery
Ann Intern Med
(1987) - et al.
Access to coronary catheterisation: fair shares for all?
Br Med J
(1993) - et al.
Results of percutaneous transluminal coronary angioplasty in women
Circulation
(1993)
Higher in-hospital mortality in female patients following coronary artery bypass surgery: a population-based study
Clin Invest Med
Cited by (11)
Are examination findings important in screening for angina in the Malaysian patient?
2005, Preventive MedicineLong-term prognosis of women with non-ST-segment elevation acute coronary syndromes. A case-control study
2002, Revista Espanola de CardiologiaInflammation, hormones, the blood and the heart; Are cardiologists learning to be internists again?
2000, International Journal of CardiologyCoronary revascularization for non-ST elevation acute coronary syndrome: State of the art
2006, Journal of Cardiovascular Medicine