Risk Factor Differences Among Men and Women

1
Risk Factor Differences Among Men and Women
With High Risk Coronary Artery Disease C
Kreatsoulas, MSc, Rutaba K, MSc, MK Natarajan,
MD, FRCPC, JL Velianou, MD, FRCPC and SS Anand,
MD, PhD, FRCPC The CARING Network, Hamilton
Health Sciences and McMaster University,
Hamilton, ON, Canada
The CARING Network
Background
Discussion
Results

• The proportion of patients with high risk CAD
  increases with age in both men and women
• Although women are more likely to present with
  CCS class 3 or 4 angina, men are more likely to
  be diagnosed with high risk CAD regardless of age
  
• When patients were analysed according to age
  strata, the effect of sex on the risk factors
  varied
• Specifically, younger women with high risk CAD
  were twice as likely to have diabetes compared to
  men
• More total males smoke than total females and
  smoking was statistically significant in men and
  especially young women
• Even though the prevalence in females sharply
  declined with age, smoking remained a significant
  predictor in women across all age groups male
  smokers however, did not have the same sharp
  decline and smoking was not found to be a
  significant predictor of high risk CAD in any age
  group
• This finding goes against our understanding of
  smoking and early CAD a possible explanation is
  that the highest risk males have died of AMI and
  have been removed from the population pool,
  creating a healthy survivor effect
• Hypertension was found to be a significant
  predictor of high risk CAD in total men and women
• Hyperlipidemia was a significant predictor of
  high risk CAD, regardless of sex and age
• Our regression models revealed that diabetes
  and hyperlipidemia are strong predictors of high
  risk CAD as was the interaction between sex and
  the 50-70 age category

• Previous reports suggest that differences in
  the burden of coronary artery disease (CAD) and
  risk factor profiles between the sexes exist
• CAD risk factor prevalence varies substantially
  with age among women and failure to account for
  age may have promoted the belief that women are
  lower risk of CAD compared to men
• We studied the prevalence of CAD and risk
  factor profiles in men and women with high risk
  coronary anatomy matched by age

The study population included 15, 274 (63.4) men
and 8,812 (36.6) women who were referred for
coronary angiography Compared to men, women
presented more often with CCS Class 3 or 4 angina
than men (66.7 versus 64.5), yet fewer women
had high risk coronary anatomy (24.9 (n2274)
vs. 40.7 (n6626). While, the proportion of
patients with high risk CAD increased across all
age categories in both men and women, the sex
difference in the prevalence of high risk CAD
remained.

• Risk factor profiles revealed that women were
  older, had higher rates of diabetes, and
  hypertension than men
• Men were more likely to be smokers
• Hyperlipidemia rates were similar
• When stratified according to age category the
  prevalence rates changed

Table 1 Gender and Age Specific Baseline
Characteristics of Hamilton Catheterization
Registry (April 2000-2004)
Table 2 Risk Factor Prevalence Rates Stratified
According to Sex and Age
Objective

• To determine sex patterns of obstructive CAD and
  risk factor distribution by
• age-sex strata
• study the association of known CAD risk factors
  in age-sex strata among a cohort of women and men
  referred for coronary angiography

Methods

• Risk factor profiles were analysed among 24,086
  consecutive men and women undergoing coronary
  angiography in the Hamilton Health Sciences
  Catheterization Registry
• Study period was between April 2000 to December
  2004
• Urgent and elective patients with no previous
  angiographically diagnosed CAD were included
• Patients were analysed according to coronary
  morphology High risk CAD was defined as left
  main stenosis gt50, 3-vessel disease or 2-vessel
  disease including a proximal LAD gt 70 lesion
• Patients with high risk CAD were divided into
  three age categories lt50 years of age, 50-70
  years and gt70 years
• Baseline characteristics were compared using
  ANOVA for continuous variables and ?2 for
  dichotomous variables
• Several logistic regression models were
  constructed to determine the predictors of high
  risk CAD using independent predictors of sex,
  age, risk factors and interaction terms

Table 3 Predictors of High Risk Coronary Artery
Disease
Graph Prevalence of High Risk CAD and CCS Class
3/4 by Age and Sex
Conclusions

• Women referred for cardiac catheterization have
  lower rates of high risk CAD compared to men
  across all age groups
• While conventional risk factors including
  diabetes and hyperlipidemia are the primary
  determinants of CAD, overall the presence of
  diabetes in young women is a strong predictor of
  high risk CAD
• These data suggest that risk factors in young
  men and women be identified and treated
  aggressively when present