Comparison of Risk Factor Profiles and Angiographic Disease Patterns in Premenopausal and Postmenopausal Women Presenting to a Tertiary Care Hospital

Coronary Artery Disease (CAD) is increasingly becoming the disease of the young. Not much is known regarding the risk factors and pattern of CAD in pre-menopausal Indian women. Aim was to study the differences in risk factor profile and coronary angiographic pattern of disease among pre- and post-menopausal women. Methods: A total of 1260 consecutive female patients who underwent coronary angiogram for suspected ischemic heart disease over a period of 2 years from Jan 2019 to Dec 2020 were enrolled. Patients were divided into 2 groups, premenopausal group consisted of 240 (19.04 %) patients and postmenopausal group 1020 (80.95 %). Detailed risk factor profiles and angiographic patterns of disease were recorded and analyzed. Results: Premenopausal women were more likely to be obese (58.3 % Vs 47 %, p=0.05), hypothyroid (25 % Vs 11 %, pless than0.0001) and more likely to have a positive family history of premature CAD (39.7 % Vs 5.89 %, pless than0.0001). On the other hand, postmenopausal women were more likely to be diabetic (23.2 % Vs 12.7 %, p=0.007), hypertensive (73.8 % Vs 52.3 %, pless than0.0001), smokers (31 % Vs 20 %, p=0.01) and had greater than3 risk factors more frequently (43.5 % Vs 31 %, p=0.0071). Atypical chest pain was more common as presenting diagnosis among premenopausal women (24.4 % Vs 11.4 %, pless than0.0001). They were also more likely to have positive exercise stress test (63.5 % Vs 38.3 %, pless than0.0001) and normal coronary angiogram (60.1 % Vs 33.3 %, pless than0.00024) with endothelial dysfunction (85.8 % Vs 67.6 %, pless than0.0001) than post-menopausal women. Post-menopausal women had greater burden of obstructive CAD characterized by more prevalent multivessel disease in the form of double vessel (18.3 % Vs 7.8 %, p=0.071) and triple vessel disease (21.2 % Vs 6.4 %, pless than0.00023). Conclusion: The risk factor profile and angiographic disease pattern among women vary significantly depending on their menopause status. Recognizing these distinctions would aid in a deeper understanding of the connection between m