Abstract
Background: It is a myth that ischemic heart disease (IHD) is a man’s disease. Angina is a frequent complaint amongst women visiting medical outpatient departments. It is a distinct entity which is poorly understood and misdiagnosed due to vague symptoms. It is thought to be microvascular in origin, usually stable and often associated with inflammation and endothelial dysfunction (ED).
Aims and Objectives: Were to study the gender differences in risk profiles and to explore novel female specific/ nontraditional risk factors (RF) / comorbid conditions in angina patients which could not only help in its identification but also provide new insights into the pathophysiology of angina in women.
Material and Methods: 445 consecutive patients of angina from OPDs of two tertiary hospitals of Punjab and Himachal were included.
Results: Males /Females were 20% /80%. SLE, hypothyroidism, thyrotoxicosis, migraine, hysterectomy, PCOS, ulcerative colitis, asthma and anemia were most common associations found in women especially in age group between 31-40 yrs. The traditional RF were more frequent beyond the age of 40. Smoking, alcoholism and diabetes were more common in males. Stroke, Pulmonary and, renal disease, fatty liver, hyperuricemia, aortic stenosis, stress and viral infections were other comorbidities present in both sexes. Thus unconventional RF should be looked for in females with angina especially younger ones which may be associated with coronary inflammation and ED.
Keywords: Angina, Women, Non Traditional Risk factors.
References
- Gulati, M; Shaw, LJ; Bairey Merz, C. Noel. "Myocardial ischemia in women: lessons from the NHLBI WISE study". (2012)Clinical Cardiology. 35 (3): 141–148.
- Tanya S , Kenkre , Pankaj M et al Ten-Year Mortality in the WISE Study (Women’s Ischemia Syndrome Evaluation) December 2017. Circulation Vol 10, Issue 12
- Elias-Smale SE, Günal A, Maas AH. Gynecardiology: Distinct patterns of ischemic heart disease in middle-aged women. Maturitas. 2015 Jul;81(3):348-52.
- Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I. Incidence and prognostic implications of stable angina pectoris among women and men. JAMA. 2006; 295: 1404–1411
- Marzilli M, Merz CNB, Boden WE, Bonow RO, Capozza PG, Chilian WM, et al. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link! J Am Coll Cardiol. 2012;60(11):951–6
- Maas, A.H.E.M. Characteristic Symptoms in Women with Ischemic Heart Disease Curr Cardiovasc Risk Rep (2019) 13: 17
- Faccini A, Kaski JC, Camici PG. Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases. Eur Heart J. 2016;37(23):1799–806
- Recio-Mayoral A, Mason JC, Kaski JC, Rubens MB, Harari OA, Camici PG. Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease. Eur Heart J 2009;30:1837–1843.
- Cohen DJ, Van Hout B, Serruys PW, Mohr FW, Macaya C, den Heijer P, Vrakking MM, Wang K, Mahoney EM, Audi S, Leadley K, Dawkins KD, Kappetein AP; Synergy between PCI with Taxus and Cardiac Surgery Investigators. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med 2011;364:1016–1026.
- Jaskanwal D Sara,1 Ming Zhang, Hossein Gharib, Hypothyroidism Is Associated With Coronary Endothelial Dysfunction in Women J Am Heart Assoc. 2015 Aug; 4(8): e002225.
- Osken A, Yaylaci S, Aydin E, Kemaloglu Oz T, Ipek G, Atasoy I, Zehir R, Dayi SU. Diffuse coronary vasospasm in a patient with hypothyroidism. Thyroid Res Pract 2016;13:89-91
- Lathia T. Rising prevalence of thyroid disorders. J Mahatma Gandhi Inst Med Sci 2015 ;20:125-7.
- Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol. 2009;54: 1561–1575
- Saghari M., Assadi M., Eftekhari M.,et al. Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X. (2006)BMC Nuclear Med 6:1.
- Leon-Sotomayor L.A. Cardiac migraine–report of twelve cases. Angiology(1974) 25:161–17
- Prinzmetal M, Kennamer R, Merliss R, et al. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375–388
- Reza Nemati, Association Between Migraine Headache and Cardiac Syndrome X Journal of the American College of Cardiology .Volume 67, Issue 17, May 2016
- Arregui A, Cabrera J, Leon-Velarde F, et al. High prevalence of migraine in a high-altitude population. Neurology. 1991;41: 1668-1670.
- Mohammed S. Ellulu,1 Ismail Patimah, Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017 Jun; 13(4): 851–863.
- Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995 Mar 15. 25(4):807-14.
Corresponding Author
Dr Harharpreet Kaur
Professor Medicine, MM Medical College, Kumarhatti, Distt. Solan, Himachal Pradesh, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i1.30
