SEX-DIFFERENCES IN THE ANATOMY OF CORONARY-ARTERY DISEASE

In a prospective study, the extent and severity of coronary artery dis ease (CAD) as well as the location of coronary stenoses were studied c omparatively, in relation to age and sex, in 192 consecutive women vs 543 selected men, who all underwent coronary angiography during the sa me time period, and who were found to have significant CAD. Overall, t he age of women (59 +/- 8 years) was higher than that of men (55 +/- 8 years), p < 0.001. Also, the prevalence of smoking was higher in men (81% vs 31%, p = 0.0000) and that of diabetes mellitus in women (29% v s 12%, p = 4 x 10(-6)). In addition, women over 50 years old had a hig her incidence of hypertension (51% vs 32%, p = 6 x 10(-5)). Although i n both sexes the prevalence of multivessel CAD increased with age, the prevalence of one-vessel CAD was significantly more and that of three -vessel CAD significantly less common in women than in men, both overa ll (35% vs 16%, p = 4 x 10(-8) and 36% vs 54%, p = 2 x 10(-5), respect ively) and in all age subgroups. However, the location of coronary ste noses did not show important differences between men and women with th e left anterior descending being the most frequently involved artery. Furthermore, the calculated Gensini index, which reflects cumulatively the extent, severity and location of coronary stenoses, was significa ntly higher in men (59.2 +/- 34.6 vs 52.2 +/- 36.2, p = 0.03), implyin g more severe and extensive CAD. The prevalence of angiographically ev ident collateral circulation also increased with age and was significa ntly higher in men than in women (58% vs 48%, p = 0.025). The global l eft ventricular fraction was not different between male and female pat ients in the study 48.1 +/- 14 vs 46.8 +/- 14.5%). It is concluded tha t among patients who develop CAD there are still important age- and se x-related differences in the patterns of coronary anatomy which could be helpful in the clinical evaluation and management of patients with coronary disease, especially women.