Sex differences in the anatomy of coronary artery disease

In a prospective study, the extent and severity of coronary artery disease (CAD) as well as the location of coronary stenoses were studied comparatively, in relation to age and sex, in 192 consecutive women vs 543 selected men, who all underwent coronary angiography during the same time period, and who were found to have significant CAD. Overall, the 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% vs 12%, p = 4 × 10 −6). In addition, women over 50 years old had a higher incidence of hypertension (51% vs 32%, p = 6 × 10 −5). Although in 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 overall (35% vs 16%, p = 4 × 10 −8 and 36% vs 54%, p = 2 × 10 −5, respectively) and in all age subgroups. However, the location of coronary stenoses did not show important differences between men and women with the 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 significantly higher in men (59.2 ± 34.6 vs 52.2 ± 36.2, p = 0.03), implying more severe and extensive CAD. The prevalence of angiographically evident collateral circulation also increased with age and was significantly higher in men than in women (58%) vs 48%, p = 0.025). The global left ventricular fraction was not different between male and female patients in the study 48.1 ± 14 vs 46.8 ± 14.5%). It is concluded that among patients who develop CAD there are still important age- and sex-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.