Academic journal article Iranian Journal of Public Health

Gender Differences in the Risk of Coronary Artery Disease in Iran

Academic journal article Iranian Journal of Public Health

Gender Differences in the Risk of Coronary Artery Disease in Iran

Article excerpt


Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran.

Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as post-procedural data were collected. The data were, subsequently, compared between the men and women.

Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001).

Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Keywords: Coronary artery disease, Risk factors, Male, Female, Iran.


The recent years have witnessed a dramatic decline in cardiac mortality, but ischemic heart disease is still the leading killer in many parts of the world (1). In Iran, similarly, coronary artery disease (CAD) is the principal culprit for mortality, morbidity, and disability (2).

CAD may be common in both sexes, but there are differences in various aspects of the disease between men and women. Despite approximately equal prevalence rates for both sexes in their seventh decade of life, the ischemic heart disease prevalence in females is relatively low before menopause (3, 4). In the last forty years, although age-adjusted death due to cardiovascular disease has decreased, this decline has been less significant in women (5). As a case in point, more CAD-related deaths have occurred in women than men in the United States since 1984 (6). In the year 2000, in comparison with males, about 60,000 more cardiovascular-related deaths were reported amongst females there (7). Supplementary evidence shows that much as male admissions due to CAD are more frequent, women have not only higher one-year death and reinfarction rates (8) but also higher in-hospital mortality rates (5). Furthermore, when considering females of all ages, ischemic heart disease is at the top of the killers list (even higher than breast cancer), with higher annual mortality rates in women under the ages of 35, 45, and 55 years (7). A recent report from the Center for Disease Control shows that whereas only 22% of all deaths in woman are due to cancer, 38% of them are secondary to ischemic heart disease (9). Sex differences in coronary artery disorders are not all inevitable. Lawlor et al., analyzing data from fifty countries, maintained that environmental factors were important in the occurrence of CAD in both sexes: Whereas the highest sex ratios for mortality from CAD were detected in Poland, France, and Norway, the lowest ratios were seen in rural China, Cuba, and Armenia (5). The Murray and Lopez study, published by the World Health Organization in 1996, reported that cardiovascular disorders were responsible for 49% of deaths at the age of 60 and over in women of developing countries; this percentage for men in those countries was 42% (10). …

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