Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.154
Peer-review started: January 11, 2023
First decision: January 31, 2023
Revised: February 6, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: April 26, 2023
Processing time: 99 Days and 4.8 Hours
We frequently encounter cases of women with vasospastic angina (VSA). Additionally, some women with VSA are younger than 60 years old. However, it is unknown whether the characteristics of VSA in women aged < 60 years are different from those in women aged ≥ 60 years.
To investigate and compare the clinical characteristics and prognosis of VSA in women aged < 60 years from those in women aged ≥ 60 years.
We enrolled 94 women with VSA who were diagnosed using the spasm provocation test. According to the age at diagnosis, the patients were divided into two groups: Group Y (age < 60 years, n = 17) and Group O (age ≥ 60 years, n = 77). Flow-mediated dilation (FMD) and nitroglycerin (NTG)-induced dilation (NID) of the brachial artery were performed and assessed using brachial ultrasonography. Moreover, conventional coronary risk factors, such as atherosclerotic lesions (stenosis > 20%) detected using coronary angiography and focal spasms (coronary spasm within one segment of one coronary artery), and major cardiovascular adverse events (MACE) were assessed in both groups.
Smoking was more prevalent in Group Y than in Group O (P = 0.04). FMD was similar in both groups (Group O: 4.3% ± 3.2%, Group Y: 4.5% ± 3.3%; P = 0.75), whereas NID was higher in Group Y (20.5% ± 8.6%) than in Group O (13.6% ± 5.3%, P < 0.01). Atherosclerosis was not detected in Group Y but was detected in Group O (61%, P < 0.01). Focal spasms were less frequent in Group Y (12%) than in Group O (38%, P = 0.04). The incidence of major adverse cardiac events did not differ between the two groups (P = 0.40).
Women aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristics may be affected by smoking habits and vascular smooth muscle dysfunction.
Core Tip: We investigated whether the clinical background and prognosis of women aged < 60 years with vasospastic angina (VSA) differ from those of women aged ≥ 60 years with VSA. We showed that smoking was more frequent in women aged < 60 years with VSA. We found a significantly greater peripheral vascular response to nitroglycerin in such patients. Coronary angiography revealed fewer atherosclerotic lesions and focal spasms in such patients. Smoking status and vascular dysfunction may have influenced the above clinical characteristics in women aged < 60 years with VSA.