Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries

TY - JOUR

T1 - Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries

AU - Aziz, Ahmed

AU - Hansen, Henrik Steen

AU - Sechtem, Udo

AU - Prescott, Eva

AU - Ong, Peter

N1 - Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2017/11/7

Y1 - 2017/11/7

N2 - Background Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. Objectives The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). Methods Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression. Results The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female–male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients. Conclusions Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.

AB - Background Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. Objectives The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). Methods Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression. Results The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female–male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients. Conclusions Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.

KW - Acetylcholine/pharmacology

KW - Aged

KW - Angina Pectoris/epidemiology

KW - Coronary Vasospasm/chemically induced

KW - Coronary Vessels/drug effects

KW - Dose-Response Relationship, Drug

KW - Europe/epidemiology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Sex Characteristics

KW - Vasodilator Agents/pharmacology

KW - Vasomotor System/drug effects

U2 - 10.1016/j.jacc.2017.09.016

DO - 10.1016/j.jacc.2017.09.016

M3 - Journal article

C2 - 29096805

SN - 0735-1097

VL - 70

SP - 2349

EP - 2358

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -