Differences in Clinical Characteristics between Men and Post-menopausal Women with Chest Pain who Have Normal Coronary Arteries

Abstract

Background and Objectives: Atherosclerosis is the main mechanism for coronary artery disease (CAD). However, normal coronary arteries may be present on coronary angiography (CAG) in patients with suspected CAD. This study investigated the difference in clinical characteristics and prognoses between men and post-menopausal women who have normal coronary arteries. Methods: Study data were obtained from a registry of patients with chest pain who underwent CAG. We dichotomized patients with normal coronary arteries according to sex as follows: men and post-menopausal women. The primary outcomes were the composite clinical events of rehospitalization due to one of the following: acute coronary syndrome, stroke, or worsening of heart failure. Results: Among 999 patients, there were 623 post-menopausal women patients. According to the final diagnosis, microvascular angina was more frequent in post-menopausal women, and vasospastic angina was more frequent in men. The rate of composite clinical events was significantly lower in post-menopausal women than in men. Post-menopausal women had a significant higher cumulative clinical event-free survival rate at the long-term follow-up. Current smoking was independently associated with increased risk of adverse clinical events by 13.34-fold, after adjusting for confounding factors. Conclusions: Post-menopausal women have a better prognosis than men with suspected cardiovascular disease but no obstructive lesions. Among those patients, men had more vasospastic angina, while women had more microvascular angina. Because current smoking is an important factor in rehospitalization for cardiovascular events, clinicians need to be aware of the importance of lifestyle modification for patients with normal coronary arteries. this the gender-specific difference