Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2023; 15(4): 154-164
Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.154
Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Oshita C and Uchimura Y contributed to the acquisition of data and Teragawa H contributed to the writing and revision of the manuscript; All the authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the JR Hiroshima Hospital Institutional Review Board (Approval No. 2022-38).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Furthermore, in the retrospective cohort study, we have shown the information about the present study, on our web site (http://www.jrhh.sakura.ne.jp/annnai/torikumi.html), as an opt-out method.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Teragawa, FACC, FACP, FAHA, FESC, MD, PhD, Chief Physician, Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroki-teragawa@jrhh.or.jp
Received: January 11, 2023
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
Abstract
BACKGROUND

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.

AIM

To investigate and compare the clinical characteristics and prognosis of VSA in women aged < 60 years from those in women aged ≥ 60 years.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Acetylcholine, Young female, Smoking, Vasospastic angina, 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.