Title: Assessing the effect of hypertension on the severity of coronary artery lesions in young
female with acute coronary syndrome
Version: 1 Date: 29 Jun 2024
Reviewer's report:
The manuscript presents a comprehensive study evaluating the impact of hypertension on
coronary artery lesions in young women (aged # 44 years) diagnosed with acute coronary
syndrome (ACS). The study includes a significant sample size of 5220 patients undergoing
coronary angiography, with a focused analysis on 1772 patients after excluding those with
diabetes, hypercholesterolemia, and smoking. The primary objective is to provide insights into
how hypertension influences the severity of coronary artery lesions in this specific demographic.
Strengths of the manuscript relies on:
1. Large Sample Size: The study's strength lies in its extensive sample size and long duration,
spanning from January 2003 to January 2022, ensuring robust data and comprehensive analysis.
2. Focused Demographic: Targeting young females with ACS is crucial, given the rising
incidence and unique pathophysiology in this group.
3. Detailed Methodology: The methodology is well-defined, with clear inclusion and exclusion
criteria, ensuring a focused and relevant study population.
4. Significant Findings: The study reveals significant differences in the severity of coronary
artery lesions between hypertensive and non-hypertensive groups, highlighting the exacerbating
role of hypertension.
5. Clinical Relevance: The findings underscore the importance of hypertension management in
young women to mitigate severe coronary events.
Weaknesses of the manuscript are follows:
1. Retrospective Design: As a retrospective study, it inherently carries the limitations associated
with such designs, including potential biases in data collection and patient recall.
2. Lack of Quantitative Assessment: The study does not utilize advanced imaging techniques
like IVUS or OCT for a more precise quantification of plaque burden and severity.
3. Self-reported Hypertension Data: Hypertension history and treatment adherence were based
on patient self-reports, which might introduce reporting bias.
The manuscript successfully highlights the detrimental impact of hypertension on coronary
artery lesions in young women with ACS. The significant differences in the proportion of type
B2 and C lesions, as well as the number and length of stent implantations, emphasize the need
for stringent hypertension management in this demographic to reduce the incidence and severity
of ACS. The study's findings are crucial for guiding clinical strategies and preventive measures
for cardiovascular health in young women.
Recommendations:
1. Future studies should incorporate prospective designs and advanced imaging modalities for
more detailed and quantitative analysis.
2. A focus on improving hypertension awareness and management among young women could
be beneficial in reducing the risk and severity of ACS.
3. Exploration of the underlying mechanisms linking hypertension to increased coronary lesion
severity in young females would further enrich the findings and aid in targeted interventions.
Overall, this study provides valuable insights and a strong foundation for future research
and clinical practices aimed at improving cardiovascular outcomes in young women with
hypertension.