Traditional cardiovascular risk factors and the presence of obstructive coronary artery disease in men and women

Background — Extensive research has demonstrated the importance of traditional cardiovascular risk factors in predicting acute coronary events. Our main objective was to evaluate the relationship between traditional risk factors and the presence of obstructive coronary artery disease (CAD), and to explore potential differences in men versus women.

Methods — An observational study was conducted in a population-based cohort of stable patients who underwent cardiac catheterization in Ontario, Canada. We examined the relationship of diabetes, hypertension, hyperlipidemia and smoking with the presence of obstructive CAD in men and women using multivariable logistic regression models.

Results — Of the 46,490 patients who were included in our study, 61.2% were men and 38.8% were women. We found that 97% of patients with obstructive CAD had at least one conventional cardiovascular risk factor. The adjusted odds ratios (OR) for obstructive CAD in women with diabetes (OR 1.51), hypertension (OR 1.38), and smoking (OR 1.39) were statistically significantly higher than in men (OR 1.20 for diabetes, OR 1.08 for hypertension, OR 1.14 for smoking, P < 0.001). The sex difference was even greater for patients with multiple risk factors. For example, the association with obstructive CAD in women with four cardiac risk factors (OR 4.30; 95% CI 3.49-5.28) was almost doubled when compared to men (OR 2.26; 95% CI 1.99-2.57, P < 0.001).

Conclusions — Almost all patients with stable CAD undergoing cardiac catheterization had at least one traditional cardiac risk factor. Importantly, the association between multiple cardiac risk factors and the presence of obstructive CAD is substantially stronger in women than men.