Risk factor profiles of young women with vasomotor non-obstructive versus obstructive coronary syndromes: Importance of non-traditional and sex-specific risk factors

BackgroundHeart disease is the leading cause of premature death for women in Canada. Ischemic heart disease (IHD) is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI CAD). This study aims to study the prevalence of traditional and non-traditional IHD risk factors and their relationships with (M)INOCA compared to MI-CAD and non-MI CAD in young women.MethodsThis study investigated women who presented with premature (≤55 years old) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) or the Study to Avoid cardioVascular Events in BC (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD or non-MI CAD.ResultsA total of 254 women enrolled between 2015-2022 were analyzed: 77 INOCA and 37 MINOCA from the WHC and 66 with non-MI CAD and 74 MI-CAD from SAVEBC. Regression analyses demonstrated that migraines and preeclampsia/gestational hypertension were the most significant risk factors with higher likelihood to associate with premature (M)INOCA relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood to associate with premature CAD.ConclusionThere are significant differences in the risk factor profiles of patients with premature (M)INOCA compared to obstructive CAD.