A study by doctors from the State-run Sri Jayadeva Institute of Cardiovascular Sciences and Research has found late presentation to hospitals by women with severe coronary artery disease to be a major factor for higher mortality.
The research titled - “Clinical and Angiographic Profile of Women with Acute Coronary Syndrome (ACS) from a Large Tertiary Cardiac Care Centre in South India – An Observational Study” has been published in the Indian Journal of Cardiovascular Disease in Women in December 2022.
The study led by Veena Nanjappa and a team of doctors from the Department of Cardiology at Jayadeva’s Mysuru centre and C.N. Manjunath, institute director, has found hypertension followed by diabetes to be the most common comorbidity seen in the group of 529 women who were studied. ST-elevation myocardial infarction (STEMI) was the most common presentation.
Risk factors
“The present study is the largest single-center data of ACS in women from the country. Cardiovascular disease is presently the most common cause of mortality in women. Major heart attack studies that guide daily clinical practice have disproportionately enrolled men. Women with heart attack have more risk factors than men and traditional risk factors like diabetes and hypertension affect the cardiovascular system differently in women, due to which the prognosis is also very poor in women,” Dr. Nanjappa told The Hindu.
The mean age of presentation in this study is 43 years in premenopausal age and 63 years in the postmenopausal age group. ”Most women, in our study, were in the postmenopausal group (84.25%). About 40% of the premenopausal and 56% of the postmenopausal group had diabetes, and 45% of the premenopausal and 61% in the postmenopausal group had hypertension. Anaemia was seen in 55% of cases and dyslipidemia with elevated LDL cholesterol was seen in 66% of cases,” she said.
“Higher deaths were seen in patients presenting late to the hospital and in worse stages. While 178 patients (33.65%) with ACS reached a hospital in less than 24 hours after symptom onset, 119 (22.49%) patients presented within 24-48 hours. As many as 95 patients (17.96%) presented in 48-72 hours and 25.9% patients presented late after 72 hours,” Dr. Nanjappa said.
More studies involving women with the focus on demographic, clinical risk profile, CAD, and treatment strategies pattern would help in the formulation of evidence-based guidelines to prevent and treat optimally,” the doctor asserted.
Dr. Manjunath said there is only a marginal difference in the distribution of patients from urban and rural areas which is alarming. This highlights the fact that coronary disease is no longer a disease limited to urban populations, he said.
“This fact will have a cascading effect on health economic policies. There is a need for addressing and preventing these risk factors at a primary health-care level, and a robust system of linking the primary care to tertiary centers for better health- care,” he said.
Premenopausal
Dr. Manjunath, who stated that over 35% of those presenting with heart attacks are below 45 years, asserted that the most worrying factor is that it is affecting more women in the reproductive age group now, unlike in the past when women got it mostly after menopause.
Another study by Dr. Nanjappa and her team corroborates this. “Hormonal milieu was not found to be different in the 50 premenopausal women with heart attack versus those who did not have an attack. This was based on the premise that estrogen is a protective hormone. The women were followed up for a duration of six months, ” said Dr. Nanjappa.
The research titled “Study of Acute Coronary Syndrome in Premenopausal Women in Correlation with Sex Hormones” has also been published in The Indian Journal of Cardiovascular Disease in Women in December 2022.
