Angiographic and risk factors evaluation of coronary artery disease in premenopausal female population

Objective: This study was designed to evaluate the risk factors and angiographic profile of coronary artery disease in premenopausal females. Traditionally premenopausal females are thought to be at low risk for coronary artery disease but only few studies have been done to exactly look for the risk factors and angiographic picture in this subset of patients. Background: Coronary artery disease in premenopausal females appears to have particularly poor prognosis. Evaluation of risk factors associated and relative importance of risk factors in this subset of population needs more studies. Methods: We evaluated 100 premenopausal patients who presented with acute coronary syndrome or chest pain considered to be anginal in origin. Traditional risk factors were reviewed in all patients and association with angiographically detectable corornary artery disease was made. Also,cases were compared with age and sex matched controls who had normal coronaries. Results: Out of 100 patients 33 patients presented with Effort Angina (EA), 15 with Unstable Angina (UA) ,4 with NSTEMI and 48 with STEMI. The mean age was 45.67±6.28 years. Only 2 patients had no risk factors and 17 patients had all the 4 risk factors evaluated. Out of all cases 17 patients had normal coronaries, 16 had non-obstructive disease and 65 had significant disease. Amongst patients with obstructive disease 37 had SVD, 17 had DVD, 8 had TVD and 5 had significant LMCA disease. Among the traditional risk factors analyzed no significant difference amongst the three angiographic groups were seen. On comparative analysis between cases and controls significant difference was present with reference to diabetes, hypertension, total cholesterol, LDL,TG and BMI. After multivariate analysis DM (p=0.016), HTN (p=0.000) and BMI (p=0.002) were found to be significantly associated with the patient group. Conclusion: Premenopausal females with coronary artery disease are not so uncommon entity as initially thought. These patients have high prevalence of conventional risk factors as compared to normal population. Majority of these patients had significant disease in our study. However conventional risk factors failed to predict the presence of angiographically significant disease in this group of patients.