The prevalence of cardiac risk factors in women 45 years of age or younger undergoing angiography for evaluation of undiagnosed chest pain.
BACKGROUND
Relatively little is known about the prevalence of cardiac risk factors, the use of noninvasive testing and the medical management of younger women (younger than 45 years of age) undergoing evaluation for chest pain.


OBJECTIVE
To determine the rate of angiographically critical coronary artery disease (CAD) in women under the age of 45 years who were sent for first-time evaluation of chest pain requiring cardiac catheterization, and to determine the prevalence of cardiac risk factors, the role of noninvasive testing and the quality of medical management in these patients.


METHODS
A retrospective chart review was performed on all female patients aged 45 years or younger from February 1997 to December 2000 (n=187) without prior known CAD referred for diagnostic cardiac catheterization. Chart information was studied, including catheterization results, cardiac risk factors, noninvasive testing done before catheterization (within six months) and medications at discharge.


RESULTS
Angiographically critical CAD was found in 55 of 187 patients (29%), of whom 52% had single-vessel disease. One hundred twenty-one patients (65%) had completely normal coronary arteries. The most prominent cardiac risk factor for all study patients was a family history of premature CAD (67%), followed by smoking (55%) and dyslipidemia (55%). When compared with people without CAD, women with CAD had a higher prevalence of dyslipidemia (72% versus 47%, P=0.002), diabetes (29% versus 9%, P<0.001) and smoking (67% versus 50%, P=0.03). Noninvasive testing including exercise stress testing (calculated sensitivity of 44% and a specificity of 73%), and stress sestamibi scintigraphy (sensitivity of 67%, specificity of 30%) were both found to be poor predictors of those with CAD. Of all patients diagnosed as having critical CAD (n=55), 40% were discharged on an angiotensin-converting enzyme inhibitor, 73% on acetylsalicylic acid and 69% on a beta-blocker.


CONCLUSIONS
The present study implies that younger women with CAD may have a higher prevalence of dyslipidemia, diabetes and smoking. The high percentage of women with minimally diseased or normal coronary arteries emphasizes the importance of confirmatory testing and poor use of noninvasive testing. The medical management of young women diagnosed with CAD is seemingly suboptimal, which may have important implications in later years of life.
D000328:Adult; D006328:Cardiac Catheterization; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects