A study of acute coronary syndrome in post-menopausal women
Keywords:Acute coronary syndrome, CAD, Post-menopausal women
Background: Ischemic heart disease (IHD) is the most common, serious, chronic, life-threatening illness. Account for around half of the global burden from these conditions, i.e. around 17.9 million lives each year, 2020 WHO. Although many factors can influence an individual’s risk for coronary artery disease (CAD), some factors are unique to women, including reproductive status. Menopause is associated with significant elevations in serum cholesterol levels and a threefold increase in risk of CAD. It has been suggested that these changes result from a reduction in the level of estrogen. One in every two women will die of heart disease and stroke, compared with only 1 in 28 who will die of breast cancer. Contrary to the belief that CAD is a man’s disease. So, this study was undertaken to study the risk factors, clinical profile and Complications (in hospital) of Acute coronary syndrome in post-menopausal women.
Methods: An observational study conducted in 100 patients with post-menopausal women admitted in Basaveshwar hospital, Kalaburgi, for a period of 6 months. Study subjects selected after applying inclusion and exclusion criteria.
Results: 100 post-menopausal women, 80% were above 50 years, mean age was 59.05 years (±9.97 years). The following risk factors were noted, Hypertension (52%), diabetes (36%), obesity (20%), dyslipidaemia (10%), family history of IHD. Chest pain was the most common presenting complaint in 92%. 39% of the patients were admitted after 12 hours of onset of chest pain.
Conclusion: Acute myocardial infarction (MI) is common in post-menopausal women and they generally present late. Because of the late presentation, the beneficial effects of thrombolytic therapy are denied.
Anderson JL, Morrow DA. Acute Myocardial Infarction. N Engl J Med. 2017;376(21):2053-64.
The sixth report of the joint national committee on prevention, detection; Evaluation and Treatment of High Blood Pressure. Arch Intern Med.1997;152(21):2413-46.
Mohan JC, Narula J. New Universal Definition of Myocardial Infarction. Glob Heart. 2012;7(4):377-80.
Gaziano MJ. Global burden of cardiovascular disease, in Heart disease. A Textbook of cardiology, Braunwald E, Zipes DP, Libby P. Philadelphia: WB Saunders. 2001;1-18.
Enas EA, Kumar SA. Conquering the epidemic of coronary heart disease among Indians: Crucial role of cardiologists. Cardiol Today. 2001;5:282-91.
Welty FK. Women and cardiovascular risk. Am J Cardiol. 2001;88:48J-52.
Eaker ED. Psychosocial risk factors for coronary heart disease in women. Cardiology Clinics. 1998;16(1)103-11.
Eaker ED, Chesebro JH, Sacks FM, Wenger NK, Whisnant JP, Winston M. Cardiovascular disease in women. Circulation. 1993;88(4):1999-2009.
Lewis SJ. Cardiovascular disease in post-menopausal women: Myths and reality. Am J Cardiol. 2002;89(120):SE-11.
Bulliyya G. Risk of coronary heart disease in women after menopause. JIMA. 2000;99(9):478-82.
Chatterjee SS. Risk factors for myocardial infarction in Indian women. Indian Heart J. 1997;39(6):57-69.
Yavagal ST, Rangarajan R, Prabhavathi. Clinical profile of acute myocardial infarction in women. JIMA. 1993;92(9)283-4.
Croft P, Hannaford PC. Risk factors for acute rnyocardial infarction in women, evidence from the Royal College of General Practitioners, Oral Contraceptive Study. Bri Med J. 1989;298:165-8.
Douglas PS, Ginsburg GS. The evaluation of chest pain in womer, NEJM. 1996;334(20)1311-5.
Enas EA, Senthilkuma A. Coronary head disease in worsen. Indian Heart J. 2001;53:282-92.
Carr BR. Disorders of the ovaries and female reproductive tract. Chapter 5 in William's textbook of Endocrinology, Ed 9th Wilson J.D., Foster DW, Kronenburg HM, Larsen PR, Philadelphia: WB Saunder's Company. 1998;776-8.
Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307:813-22.
Dave TH. Profile of coronary heart disease in Indian women, Correlation of clinical, non-invasive and coronary angiographic findings. Indian Heart. 1991;43(1):25-9.
Singh RB. Rural-urban differences in prevalence rate, plasma insulin responses, food intakes and risk of coronary heart disease in elderly populations of North India. JAPI. 1997;45(21):109-13.
Milner KA, Funk M, Richards S, Wilmes RM, Vaccarino V, Krumholz HM. Gender differences in symptom presentation associated with coronary heart disease. Am J Cardiol. 1999;84:396-9.
Stone GW, Grines CL, Browne KF, Marco J, Rothbaum D, O'Keefe J, et al. Comparison of in hospital outcome in men versus women treated by either thrombolytic therapy or primary coronary angioplasty for acute myocardial infarction. Am J Cardiol. 1995;75:987-92.
Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In hospital and 1-year mortality in 1,524 women after myocardial infarction comparison with 4,315 men. Circulation. 1991;83(4):484-91.