Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an enigma that is being increasingly recognized with the frequent use of angiography following Acute Myocardial Infarction (AMI). The current study is a prospective, contemporary analysis of MINOCA vs. Myocardial Infarction with obstructive coronary artery disease (MI-CAD) in regards to prevalence, clinical features, and in-hospital outcomes. Methods: All consecutive patients undergoing coronary angiography for AMI (as per the Third Universal AMI Definition) in South Australian public hospitals from January 2012 - December 2013 were included. Data was captured by Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR® CathPCI® Registry. The AMI patients were classified as MI-CAD or MINOCA on the basis of the presence or absence of a significant stenosis (≥50%) on angiography. Results: From 4,189 angiography procedures undertaken for AMI, 468 (11%) were classified as MINOCA. Patients with MINOCA were younger (59±15 vs. 64±13 years, p <0.01) and more likely to be female (53% vs. 26%, p <0.01), compared to those with MI-CAD. Age-adjusted analysis comparing patients with MINOCA to MI-CAD revealed differences in: (1) cardiovascular risk factors including hypertension (52% vs. 66%, p<0.01), diabetes (19% vs. 32%, p<0.01), dyslipidemia (46% vs. 62%, p<0.01), and current smoker status (27% vs. 37% p<0.01); (2) AMI type and size with fewer ST elevation myocardial infarcts (27% vs. 41%, p<0.01) and lower peak troponin values (180 ng/L, IQR 353 vs. 264 ng/L, IQR 680, p<0.01) amongst MINOCA patients. Furthermore, the GRACE Score for acute coronary syndrome risk stratification was lower for the MINOCA patients compared to MICAD (150±34 versus 160±35, p <0.01). Despite fewer cardiovascular risk factors, the absence of obstructive coronary artery disease, smaller infarcts, and a lower GRACE score, the in-hospital mortality was similar for MINOCA and MI-CAD patients (2.2% vs. 3.0%, p=0.22). Moreover, MINOCA patients were less likely to receive secondary prevention therapies at discharge including antiplatelet therapy (60% vs. 92%, p<0.01) beta-blockers (41% vs. 65%, p<0.01), statin (55% vs. 88%, p<0.01), ACE-inhibitor/angiotensin receptor blocker (59% versus 81%, p<0.01), or referral to cardiac rehabilitation (15% versus 52%, p<0.01). Conclusions: In contemporary cardiology practice, MINOCA may be more frequent than previously appreciated and has a guarded prognosis despite its apparent lower risk profile. Improving the use of secondary prevention therapies in these patients may improve their prognosis.

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RELATIONSHIP OF OCCUPATION TO THE PRESENCE OF CORONARY ARTERY DISEASE AND CARDIOVASCULAR RISK FACTORS

Southern Medical Journal ◽

10.1097/00007611-199810001-00019 ◽

1998 ◽

Vol 91 (Supplement) ◽

pp. S15

Author(s):

Vaskar Mukerji ◽

Martin A. Alpert ◽

Rita Mukerji ◽

Madhuri Mulekar

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Artery Disease ◽

Relationship Of

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Association of epicardial adipose tissue with cardiovascular risk factors in subjects free from clinical symptoms of coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/eht307.p721 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P721-P721

Author(s):

A. Jermendy ◽

R. Vadas ◽

A. Bartykowszki ◽

Z. S. Bagyura ◽

M. Karolyi ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Adipose Tissue ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Epicardial Adipose Tissue ◽

Clinical Symptoms ◽

Artery Disease

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Epidemiological Analysis of Major Cardiovascular Risk Factors in 1,508 Indian Adults Stratified by Age and Gender

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/119 ◽

2021 ◽

Vol 8 (11) ◽

pp. 608-612

Author(s):

Sunil S. Thanvi ◽

Sunil K. Karna ◽

Utsav B Patel

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Vitamin D3 ◽

Density Lipoprotein ◽

Age And Gender ◽

Artery Disease ◽

And Gender

BACKGROUND Routine screening of healthy individuals for the presence of cardiovascular risk factors is important for identification of high-risk coronary artery disease (CAD) patients at early stage and to provide preventive care. Considering the high burden of CAD, such investigations are of significant importance in Indian context. METHODS In this cross-sectional study, adult individuals (18 – 68 years) were evaluated for pre-existing diseases, lipid profile, blood glucose profile, thyroid profile, haemoglobin (Hb) and vitamins D3 and B12 levels after obtaining informed consent. These variables were compared between patients stratified based on their gender and age (< 40, 40 – 60, > 60 years). RESULTS A total of 1,508 participants (mean age: 49 ± 11 years; 49.9 % females) were investigated. Hypertension, diabetes, dyslipidaemia, anaemia, vitamin D3 and B12 deficiencies, hyperthyroidism, and hypothyroidism were observed in 31.2 %, 26.5 %, 32.0 %, 8.6 %, 35.3 %, 25.1 %, 21.0 % and 0.6 % of patients respectively. Prevalence of hypertension, diabetes, and dyslipidaemia increased with ageing, while deficiencies of Hb, vitamin D3, and vitamin B12 as well as hyperthyroidism and hypothyroidism were comparable across all age groups. Males were more prone to hypertension, diabetes, and dyslipidaemia, while females were more prone to have Hb deficiency, hyperthyroidism, and hypothyroidism. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood sugar (FBS), vitamin D3, and vitamin B12 were elevated with increase in age, while Hb levels decreased. Males exhibited higher levels of TG, low-density lipoprotein cholesterol (LDL-C), TC / HDL, LDL / HDL, FBS, and Hb, while females displayed higher levels of vitamin D3 and B12. CONCLUSIONS Our findings verify the role of age and gender on majority of cardiovascular risk factors. The high prevalence of cardiovascular risk factors is alarming and demands the need for appropriate health-care measures. KEYWORDS Age, Coronary Artery Disease, Gender, Risk Factor

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