Coronary heart disease in women : diagnostic and prognostic markers

Abstract: The main part of this thesis investigated a cohort of women younger than 66 years who had recovered from an event of acute coronary syndrome. It assessed the relationship between traditional coronary risk factors, basic clinical parameters, exercise testing results, coronary angiographic findings and recurrent cardiac events during a five-year follow up period. The role of oestrogen on exercise induced myocardial ischemia and exercise capacity in postmenopausal women with coronary artery disease was also assessed. The main findings in the different substudies were as follows: Non-significant coronary lesions were present in a high proportion (37%) of younger female patients with a history of acute coronary syndrome despite the high probability of significant coronary artery disease. Low exercise capacity, low rate pressure product, history of acute myocardial infarction, history of diabetes mellitus, high waist-to-hip ratio and low high-density lipoprotein cholesterol were the parameters that best correlated with the presence of angiographically documented coronary artery disease. Poor exercise capacity and inability to reach high rate pressure product were the exercise test parameters that were the strongest predictors of recurrent cardiac events. History of diabetes mellitus was the strongest independent predictor of adverse cardiac prognosis. Other important predictive factors were history of acute myocardial infarction, angiographically documented left ventricular dysfunction, low level of high-density lipoprotein cholesterol and high level of triglycerides. Female patients admitted for acute myocardial infarction but with a normal coronary angiogram or non-significant coronary lesions were examined with intracoronary ultrasound, which revealed diffuse atherosclerosis with predominantly soft, eccentric and poorly calcified plaques. It is reasonable to assume stimulation of a thrombotic mechanism as responsible for evoking the acute coronary event. Administration of oestrogen to postmenopausal women with stable coronary artery disease did not show any improvement in exercise capacity and did not attenuate the expression of myocardial ischemia.