Traditional Cardiovascular Risk Factors and Obstructive Coronary Disease in Patients with Stable Chest Pain: Gender-specific Analysis

Background and Objectives: The effect of gender difference on the association between major cardiovascular risk factors and obstructive coronary artery disease (CAD) has not yet been fully determined. We investigated whether the strength of association between traditional cardiovascular risk factors and obstructive CAD differs according to gender in patients with stable chest pain. Methods: A total of 1,254 patients (61.0±11.2 years, 45.7% women) with stable chest pain who had elective invasive coronary angiography under suspicion of obstructive CAD were reviewed from the KoRean wOmen'S chest pain rEgistry multi-center registry database. Obstructive CAD was defined as ≥50% diameter stenosis in ≥1 epicardial coronary arteries. Age, body mass index, hypertension, diabetes mellitus, dyslipidemia, and smoking were focused as traditional risk factors. Results: Of the total patients, 453 (36.1%) had obstructive CAD (men vs. women: 38.0 vs. 33.9%, p=0.140). In multivariable analyses, old age (≥65 years) (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.37–2.69; p<0.001) was only associated to obstructive CAD in men. In women, however, old age (OR, 2.02; 95% CI, 1.39–2.94; p=0.002), hypertension (OR, 1.76; 95% CI, 1.19–2.61; p=0.005) and diabetes mellitus (OR, 2.06; 95% CI, 1.30–3.26; p=0.002) were associated to obstructive CAD. The association between multiple risk factors and obstructive CAD was stronger in women compared to men. Conclusions: Among women presenting stable angina, those with old age, hypertension, diabetes mellitus or multiple cardiovascular risk factors need a higher suspicion for obstructive CAD.