Gender differences in plasma levels of cardiovascular risk markers and severity indices in Saudi patients with angiographic evidence of coronary artery disease

Main Article Content

Syed Shahid Habib
Thamir Al-khlaiwi
Abdulrahman Alhowikan
Zohair Al Aseri
Syed Mohammad Habib
Huthayfah Al-khliwi
Ahmad Omair

Abstract

OBJECTIVE: To evaluate gender difference in non-traditional cardiovascular risk factors among Saudi patients with angiographically defined coronary artery disease (CAD).


METHODS: We recruited 144 (male=105, female=39) patients with CAD who underwent coronary angiography. Laboratory analysis of total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), lipoprotein(a) [Lp(a)], and high sensitivity C-reactive protein (hs-CRP) were performed along with echocardiographic evaluation.


RESULTS: Systolic blood pressure (SBP) was significantly higher in females (138.65±18.67 vs 129.59±21.03 mmHg; p=0.0363). Although no significant difference was observed in TC (4.30±1.36 vs 4.67±1.07 mmol/L), however significantly higher levels of both HDL and LDL were seen in females (0.86±0.17 vs 0.70±0.23 mmol/L; p=0.0592 and 3.50±0.67 vs 2.72±1.13; p=0.0466 respectively). There were no significant differences in TG, Lp(a) and hs-CRP, however females had comparatively higher Lp(a) (30.43±28.89 vs 24.02±23.42 mg/dl) and hs-CRP (1.14±1.46 vs 0.95±1.25 mg/L). On angiography, greater extent of stenosis was observed in left anterior descending and right coronary arteries among males, while the left circumflex artery was affected more in the female patients without statistical significance (p=0.0797; 0.3890 and 0.5032 respectively). Gensini Score in males & females was 60.46±46.17 and 74.39±39.52 respectively (p=0.3013). Significantly narrower aortic root diameter (ARD) was observed among females (27.30±6.66 vs 29.73±3.40 mm; p=0.0293).


CONCLUSION: Female patients have greater risk of cardiovascular diseases due to higher SBP and LDL levels which could lead to a greater Gensini score when compared to male patients. In addition, narrow ARD among females could also be a contributing factor to CAD.

Article Details

How to Cite
Habib, S. S., T. Al-khlaiwi, A. Alhowikan, Z. A. Aseri, S. M. Habib, H. Al-khliwi, and A. Omair. “Gender Differences in Plasma Levels of Cardiovascular Risk Markers and Severity Indices in Saudi Patients With Angiographic Evidence of Coronary Artery Disease”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 15, no. 2, June 2023, pp. 71-7, doi:10.35845/kmuj.2023.22728.
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References

Palmisano B, Zhu L, Eckel R, Stafford J. Sex differences in lipid and lipoprotein metabolism. Mol Metab 2018;15:45-55. https://doi.org/10.1016/j.molmet.2018.05.008

Hajar R. Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views 2017;18(3):109-14. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_106_17

Palmisano B, Zhu L, Stafford J. Role of Estrogens in the Regulation of Liver Lipid Metabolism. Adv Exp Med Biol 2017:1043:227-56. https://doi.org/10.1007/978-3-319-70178-3_12

Blumel JE, Castelo-Branco C, Rocangliolo ME, Bifa L, Tacla X, Mamani L. Changes in body mass index around menopause: a population study of Chilean woman. Menopause 2001;8(4):239-44. https://doi.org/10.1097/00042192-200107000-00004

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. American Heart Association Statistics C, Stroke Statistics S. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119(3):e21-181. https://doi.org/10.1161/CIRCULATIONAHA.108.1912616

Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011 CLINICAL PERSPECTIVE. Circulation 2015;132(11):997. https://doi.org/10.1161/CIRCULATIONAHA.115.015293

Legato MJ. Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: implications for therapy. Am J Cardiol 2000;86(12A):15L-18L https://doi.org/10.1016/s0002-9149(00)01463-6

Hafe P. Gender differences in lipid profile and therapy. Rev Port Cardiol 2019;38(8):571-2. https://doi.org/10.1016/j.repc.2019.09.003

Khaw KT. Where are the women in studies of coronary heart disease? Br Med J 1993;306:1145-6. https://doi.org/10.1136/bmj.306.6886.1145

Pavanello C, Mombelli G. Considering gender in prescribing statins: what do physicians need to know?, Clin Lipidol 2015;10(6):499-512. https://doi.org/10.2217/clp.15.39

Fowler PB. Cardiovascular risk in women: the cardiologist's perspective. J Assoc Physicians 2000;93(6):387-8. https://doi.org/10.1093/qjmed/93.6.387-a

Habib SS. Lipoprotein(a). The bad cholesterol. Saudi Med J 2004;25(4):429-33.

Aljawini N, Aldakhil LO, Habib SS. High-Risk Lipoprotein(a) Levels in Saudi Women and Its Relationship to Menopause and Adiposity. Nutrients 2023;15(3):693. https://doi.org/10.3390/nu15030693

Hong GB, Gao PC, Chen YY, Xia Y, Ke XS, Shao XF et al. High-Sensitivity C-Reactive Protein Leads to Increased Incident Metabolic Syndrome in Women but Not in Men: A Five-Year Follow-Up Study in a Chinese Population. Diabetes Metab Syndr Obes 2020;13:581-90. https://doi.org/10.2147/DMSO.S241774

Málek F, Dvořák J, Skalníková V, Mates M, Kmoníček P, Vávrová Z, Neužil P. Correlation of lipoprotein(a) with the extent of coronary artery disease in patients with established coronary atherosclerosis: gender differences. Eur J Prev Cardiol 2015;22(5):603-5. https://doi.org/10.1177/2047487314527849

Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51(3):606. https://doi.org/10.1016/s0002-9149(83)80105-2

Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol 2007;50:2128-32. https://doi.org/10.1016/j.jacc.2007.05.056

Reckelhoff JF. Gender differences in hypertension. Curr Opin Nephrol Hypertens 2018;27(3):176-81. https://doi.org/10.1097/MNH.0000000000000404

Staessen JA, Ginocchio G, Thijs L, Fagard R. Conventional and ambulatory blood pressure and menopause in a prospective population study. J Human Hypertens 1997;11:507-14. https://doi.org/10.1038/sj.jhh.1000476

Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol 2018;3(4):280-87. https://doi.org/10.1001/jamacardio.2018.0022

Nikkila M, Pitkajarvi T, Koivula T, Lehtomaki E, Jokela H. Age-related changes and sex differences in serum lipid concentrations in health-screening subjects. Cardiovasc Risk Factors 1991;1:204-10.

Hjortland MC, McNamara PM, Kannel WB. Some atherogenic concomitants of menopause: the Framingham Study. Am J Epidemiol 1976;103:304-11. https://doi.org/10.1093/oxfordjournals.aje.a112228

Hamman RF, Bennett PH, Miller M. The effect of menopause on serum cholesterol in American Pima Indian women. Am J Epidemiol 1975;102:164-9. https://doi.org/10.1093/oxfordjournals.aje.a112143

Nicholls SJ, Nelson AJ. HDL and cardiovascular disease. Pathology 2019;51(2):142-7. https://doi.org/10.1016/j.pathol.2018.10.017

Habib SS, Abdel-Gader AM, Kurdi MI, Al-Aseri Z, Soliman MM. Lipoprotein(a) is a feature of the presence, diffuseness, and severity of coronary artery disease in Saudi population. Saudi Med J 2009;30(3):346-52.

Lip GYH, Blann AD, Jones AF, Beevers DG. Effects of hormone-replacement therapy on hemostatic factors, lipid factors, and endothelial function in women undergoing surgical menopause: Implications for prevention of atherosclerosis. Am Heart J 1997;134:764-71. https://doi.org/10.1016/s0002-8703(97)70062-0

Jenner JL, Ordovas JM, Lamon-Fava S, Schaefer MM, Wilson P, Castelli WP etal. Effects of age, sex, and menopausal status on plasma lipoprotein(a) levels: the Framingham Offspring Study. Circulation 1993;87:1135–41. https://doi.org/10.1161/01.cir.87.4.1135

Habib SS, A Al Masri A. Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease. Pak J Med Sci 2013;29(6):1425-9. https://doi.org/10.12669/pjms.296.330228

Qasim AN, Budharaju V, Mehta NN, St Clair C, Farouk S, Braunstein S et al. Gender differences in the association of C-reactive protein with coronary artery calcium in type-2 diabetes. Clin Endocrinol (Oxf) 2011;74(1):44-50. https://doi.org/10.1111/j.1365-2265.2010.03879.x

Habib SS, Aslam M, Hameed W. Gender differences in lipids and lipoprotein (a) profiles in healthy individuals and patients with type 2 diabetes mellitus. Pak J Physiol 2005; 1(1-2).

Bahlmann E, Cramariuc D, Minners J, Lønnebakken MT, Ray S, Gohlke-Baerwolf C, et al. Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging 2017;18(4):404-12. https://doi.org/10.1093/ehjci/jew159. Erratum in: Eur Heart J Cardiovasc Imaging 2017;18(5):611. https://doi.org/10.1093/ehjci/jew159