Women with nonobstructive coronary artery disease may have worse health outcomes than men

Women with nonobstructive coronary artery disease (NOCAD) had poorer physical and mental health status; more physical limitations, fatigue, anxiety and negative affectivity; and less physical activity compared with men with the same condition, according to an observational cohort study.

The researchers defined NOCAD as detected visible wall irregularities but no obstructive coronary luminal narrowing in one or more epicardial arteries. NOCAD is also known as mild stenosis.

Lead researcher Paula M.C. Mommersteeg, PhD, of Tilburg University in the Netherlands, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on Feb. 21.

The study, known as TWIST, evaluated patients with NOCAD who received coronary angiography or 64-slice computed tomography (CT) between January 2009 and January 2013.

“We were very intrigued by these sex and gender differences—we had not thought they would be so apparent,” Mommersteeg said in a news release.

A total of 523 patients met the inclusion criteria and completed questionnaires that were sent and returned via postal mail. The mean age was 61 years old, and 51 percent of patients were women. The researchers collected data within three months of patients undergoing coronary angiography or CT. The patients self-reported their sex, age, marital status, educational level and lifestyle factors, while the researchers retrieved data on disease status and history, medication use and comorbidities through patient hospital records.

The researchers also selected an age- and sex-matched group of 1,347 people from the Dutch general population living in the southern provinces of the Netherlands between 2007 and 2010.

Men and women with NOCAD were less likely to have received a college education, were more often overweight and obese, more often reported comorbid hypertension, dyslipidemia or a history of MI, PCI, CABG or heart failure and were more likely to use cardiac medications.

Within the NOCAD group, women were three years older on average compared with men, were less likely to have a partner, receive a college education and be employed and were more likely to be divorced or widowed.

Compared with the control group, men and women with NOCAD had a lower general health status, elevated fatigue, more anxiety, more depressive symptoms, more negative affectivity, less physical activity and a higher propensity for a Type D personality.

Within the NOCAD group, women had significantly lower physical and mental health status, more fatigue, more physical limitations, more anxiety, more negative affectivity and less physical activity compared with men. However, men and women with NOCAD had no differences in reported angina frequency, angina stability, disease perception, treatment satisfaction or depressive symptoms.

The researchers noted that only 64 percent of eligible patients were willing to participate. They did not have information on the non-responders, so they could not determine if the results would be generalizable to other patient populations.

“This study shows that patients with NOCAD have adverse health status and more psychosocial distress compared with the general population,” the researchers wrote. “Women showed impaired health status and more psychosocial distress compared with men, but these differences were not exclusive for patients with NOCAD. Additional adjustment for age, education, partner, employment, and alcohol use showed that these other factors explained the [sex and gender] differences in psychosocial factors in the NOCAD group.”