MI Risks in Women Not So Different

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Researchers have reported that although some studies show that women may have a higher risk of a myocardial infarction (MI) or death due to unusual symptoms, a study using coronary computed tomography angiography reveals that adverse results are not determined by gender.

“Major adverse cardiovascular events, heart attacks or death, occurred in 0.3% of women who were found to be free of coronary artery disease and in 1.2% of women who had mild, but non-obstructive coronary artery disease, compared with 0.3% of men (P=0.87) with no heart disease observed with the imaging technology and 1.1% of men with some non-obstructive heart disease (P=0.95),” said director of medical imaging at St. Paul's Hospital, Vancouver, British Columbia, Jonathon Leipsic, M.D.

“There is a tendency to think women's heart disease is very different from men's heart disease. Our data show that once plaque accumulates in the coronary arteries, the prognosis is very similar between men and women. Men and women behave quite similarly,” Leipsic said in a press conference at the annual meeting of the Radiological Society of North America (RSNA).

Leipsci noted that overall having mild coronary artery disease is worse than not having coronary artery disease, but that it is just as bad for men as it is for women.

For this study, 6,759 people with coronary plaque were observed during CT angiography, the 3-year mortality was 0.3%, while the 3-year mortality for the 4,703 patients observed to have mild coronary artery disease was 1.1%, a difference that was statistically important with a hazard ratio of 1.84 (95% CI 1.28-2.63; P=0.001).

To conduct the study, Leipsic and his team examined the Coronary CT Angiography Evaluation for Clinical Outcomes (CONFIRM) Registry, an international partnership that involved performing CT angiography among 27,725 individuals in 6 different countries.mi women

From that population, the research team pulled 18,158 individuals whose scans showed either no obstruction or coronary arteries that had less than a 50% obstruction. The patients included 8,808 women and 9,350 men.

"We then matched men and women for their pretest likelihood for their risk factors and their type of chest pain," said Leipsci.

The patients were then assessed on the basis of heart attacks or death. The proclivity matching left the researchers with a study population of 11,462 subjects. They recorded 37 heart attacks and 120 of the group died, seven of whom also had heart attacks. The yearly event rate in the study was 0.6%.

"We found that having mild coronary disease is not just incidental but identifies people who are at an increased risk of having a heart attack or dying. We also analyzed out data on the basis of the presence or absence of symptoms or of the type of symptoms, and it does not appear that symptomatology matters," said Leipsic.

For those patients with normal scans, events took place in 0.3% of asymptomatic men and in 0.4% of asymptomatic women (P=0.62). For asymptomatic individuals were non-obstructive coronary plaques, the event rate was 1.2% in men and 1.2% in women (P=0.94). Similar and non-significant findings were seen when Leipsic's team analyzed the outcomes for patients who reported to the clinic for non-anginal chest pain, for those with atypical angina, and for those with typical angina.

Leipsic said his study shows that coronary "CT angiography in patients with low or intermediate risk with atypical or somewhat typical symptoms is a powerful tool not only for diagnosis but also a very good prognostic tool even in the setting of mild coronary narrowing. And we see that the use of this tool is consistent across both men and women."

He also said that his study is good news for women. "Women have been told that if they are having atypical pain they can't rely on tests the way men can. They should not ignore the chest pain but they don't have to worry that they are going to die at a higher rate than men."

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