Angina pectoris after coronary angiography or revascularization in pre- and postmenopausal women with coronary artery disease
Authors: Eskuri M A E , Kentta T V , Kiviniemi A , Tulppo M , Lepojarvi S , Piira O P , Perkiomaki J S , Huikuri H V , Junttila M J 
Published: October 2024

Abstract

Background
Menopause is a known risk factor of coronary artery disease (CAD) in women. Earlier studies indicate that the incidence of angina pectoris (AP) increases with age. Some studies suggest that menopause would be a risk factor for AP in women with history of myocardial infarction (MI). However, the evidence is still incomplete.

Purpose
The aim of this study was to determine whether pre- or postmenopausal women are more symptomatic after revascularization using Canadian Cardiovascular Society (CCS) grading and New York Heart Association (NYHA) classification. We also wanted to evaluate whether the presence of type two diabetes (T2D) had an impact of the volume of the symptoms of CAD.

Methods
ARTEMIS Study contains 1,947 subjects with angiographically documented CAD with or without T2D (women 31.8%). Nondiabetic patients were matched with T2D patients for age, sex, prior MI and revascularization. Information of the menopause was from 610 women.

Results
Total of 584 women were at postmenopausal stage and only 26 were at premenopausal stage. The mean age of the premenopausal women was 57.5±10.8 years (P&lt;0.001) and 69.4±7.5 years in postmenopausal women (P&lt;0.001). Among premenopausal women 46.2% were active or ex-smokers and 26.8% of postmenopausal women still smoked or had smoked in the past (P=0.031). There was not statistically significant difference in other baseline characteristics: BMI, LDL or BNP levels, systolic or diastolic blood pressure, syntax score prior or after the revascularization and prevalence of prior MI.
Over half of the postmenopausal women (57.4%, p&lt;0.001) reported to suffer chest pain CCS grade ≥ 2 after the revascularization whereas only one fifth of the premenopausal women (23.1%, P&lt;0.001) reported the same level of AP. T2D seemed to increase the symptoms of CAD as 33.3% of the premenopausal and 61.7% of the postmenopausal women with T2D reported AP with severity of CCS grade ≥ 2 (P=0.050). CCS 2 symptoms were reported by 45.7% of the postmenopausal and 19.2% of the premenopausal women, and CCS 3 symptoms by 11.6% of the postmenopausal women, yet only 3.8% of the premenopausal women (p=0.001 for both, respectively). Three quarter of the premenopausal women reported CCS 1 level of symptoms but only 42.6% of the postmenopausal women (P=0.003). Prevalence of each of CCS grade reported within pre- and postmenopausal women with and without T2D are shown in the Table 1.
None of the premenopausal women reported NYHA ≥ 2 dyspnea, and the same level of shortness of breath was reported also only from 4.3 % of the postmenopausal women (p=0.005). Among postmenopausal women with T2D, NYHA ≥ 2 symptoms were more common, though statistical significance was not obtained (9.2%, P=0.196).

Conclusion
Postmenopausal women seem to experience more CAD-related symptoms after angiography or revascularization compared premenopausal women. Presence of T2D seems to associate with higher CCS grade after revascularization.