title: Gender Based Differences in Risk Factor Profile and Coronary Angiography of Patients Presenting with Acute Myocardial Infarction in North Indian Population.
abstract: BACKGROUND
  Coronary Artery Disease (CAD) among women presents atypically with atypical chest pain, neck pain, nausea, fatigue and dyspnoea. Co-existing co-morbidities such as Diabetes Mellitus (DM) and hypertension along with difference in risk factor prevalence makes it necessary to have a gender specific approach.
  
  
  OBJECTIVE
  To study gender specific differences in diagnosing and treating Acute Myocardial Infarction (AMI) in North Indian population.
  
  
  METHODS
  Fifty consecutive men and women presenting with AMI were studied. A detailed history including symptoms, history of DM, hypertension, smoking and dyslipidaemia was obtained. ECG, evaluation of cardiac enzymes (CPK-MB, Troponin I), RBS, lipid profile, two dimensional transthoracic echocardiography and coronary angiography were performed. The data was statistically analysed.
  
  
  RESULTS
  Among 100 patients (50 males and females each), we found a later age at presentation (62 y vs 56.5 y) and higher prevalence of diabetes (52% vs 24%, p=0.004) and hypertension (46% vs 28%) among females but more dyslipidaemia (34% vs 26%), smoking (44% vs 0%, p=0.0) and higher BMI (25.58 vs 23.74, p=0.019) among males. More females presented with atypical symptoms (16% vs 6%) and were detected to have insignificant CAD (14% vs 2%) than males.
  
  
  CONCLUSIONS
  North Indian women with presentation at a later age, with atypical symptoms, more incidences of risk factors such as diabetes and hypertension along with lesser dyslipidaemia and BMI than males need a higher index of suspicion while evaluating them for CAD. Misdiagnosis is more likely because of atypical presentation. A milder disease on angiography and a lower incidence of multiple vessel disease is a common finding. We recommend more and larger Indian studies to acquire more data so that this growing prevalence of CAD in women can be curbed.
authors.affiliation: Senior Resident, Department of Medicine, Tagore Hospital and Heart Care Center , Jalandhar, Punjab, India .
authors.forename: Supriya
authors.initials: S
authors.lastname: Bajaj
authors.affiliation: Director and Head of Department, Department of Medicine, Tagore Hospital and Heart Care Center , Jalandhar, Punjab, India .
authors.forename: Vijay
authors.initials: V
authors.lastname: Mahajan
authors.affiliation: Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Sumit
authors.initials: S
authors.lastname: Grover
authors.affiliation: Consultant, Department of Medicine, Tagore Hospital and Heart Care Center , Jalandhar, Punjab, India .
authors.forename: Amit
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Consultant, Department of Cardiology, Tagore Hospital and Heart Care Center , Jalandhar, Punjab, India .
authors.forename: Nipun
authors.initials: N
authors.lastname: Mahajan
keywords: Atypical; Coronary artery disease symptoms; Diabetes; Dyslipidaemia; Hypertension; Sex differences