McMaster University

McMaster University

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Health Sciences

Severe angina poses three times the coronary artery disease risk for women than men

By Laura Thompson
Published: July 8, 2010
Catherine Kreatsoulas
Catherine Kreatsoulas, a PhD candidate in the Department of Clinical Epidemiology and Biostatistics

Each year, heart disease and stroke kills more than seven times as many Canadian women as breast cancer. Still, the perception lingers that heart disease — which can lead to complications including heart attack — is a men’s health problem.

Now research from McMaster University is helping to dispel that myth. A team of researchers has discovered that women who have the most serious form of angina are three times as likely to have severe coronary artery disease (CAD) than men with the same condition.

The findings are published in the July issue of the Journal of Internal Medicine. The research team was led by Dr. Sonia Anand, a professor of medicine and clinical epidemiology and biostatistics in the Michael G. DeGroote School of Medicine. The lead author was Catherine Kreatsoulas, a PhD candidate in the Department of Clinical Epidemiology and Biostatistics.

The McMaster researchers examined the records of 23,771 patients referred for first diagnostic angiography over a six-year period. The patients were grouped into two categories: younger (up to 60 years of age) and older (61 years or older).

The researchers found that women over the age of 60 with the most serious or Class-IV angina faced a 21 per cent higher absolute risk of developing CAD than men. The trend was robust, even in women under 60 who faced an 11 per cent higher absolute risk than men in the same age group.

However, when the data was adjusted for other variables commonly associated with CAD — diabetes, high blood pressure, high cholesterol, smoking and age — Class-IV angina increased the risk by 82 per cent in women and 28 per cent in men. That means that women with severe angina face a three times greater risk of having severe CAD than men.

"CAD is the leading cause of ill health and death in men and women in the western world, accounting for over a third of deaths" Kreatsoulas said. "Our research found that women with Class-IV angina, which means they are unable to perform any activity without symptoms and even suffer angina at rest, are significantly more likely to have severe CAD than men with the same condition."

The authors believe that this information is vital for clinicians deciding which patients to refer for coronary angiography.

"Our finding that severe angina is significantly more likely to predict severe CAD in women than men is very important for clinical practice," said Anand, who holds the endowed Eli Lilly Canada/May Cohen Chair in Women’s Health and the Heart and Stroke Foundation of Ontario/Michael G. DeGroote Chair in Population Health Research.

"We hope that this information will make it easier for doctors to identify women at risk of severe CAD and target diagnostic and treatment strategies accordingly."

Other key findings of the study included:

  • Men were much more likely to have severe CAD than women (37 per cent vs. 22 per cent).
  • Women with severe CAD were significantly older than men with CAD (70 vs. 66 years).
  • A multivariate analysis that took a wide range of factors into account showed that diabetes increased the risk of severe CAD by 100 per cent, high cholesterol by 50 per cent, Class-IV angina by 43 per cent, smoking by 10 per cent, age by five per cent and high blood pressure by one per cent.

The research was sponsored by the CARdiovascular Investigations iN Gender, CARING Network, Population Health Research Institute, Hamilton Health Sciences and McMaster University.

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