Evaluation of coronary artery risk factors in premenopausal women (<45 years): a single-center prospective study

Alok Suresh Shinde, Anand Narendra Shukla, Priyadarshini Mahadev Dixit


Background: The present study was designed to evaluate the association of conventional coronary risk factors in the angiographically proven cases of younger women (<45 years) with significant CAD along with clinical profile and coronary angiographic findings.

Methods: This was a hospital-based prospective study conducted at a tertiary-care center in India. A total of 200 premenopausal women (age ≤45 years) who presented with chest pain likely to be of cardiac origin were enrolled. Each patient was subjected to routine clinical investigations, examination of complete lipid profile, follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin; and underwent non-invasive cardiac examination and coronary angiography.

Results: Mean age of patients was 39.1±4.98 years. A total of 64 (32%) patients had history of spontaneous abortions and 80 (40%) patients presented with ST-elevated myocardial infarction. Increased FSH, LH and prolactin levels was found in 70 (35%), 20 (10%), and 88 (44%) patients, respectively. Total 196 (98%) patients underwent coronary angiography which revealed presence of significant CAD in 122 (63%) cases and of which 80 patients underwent coronary angioplasty and 12 underwent coronary artery bypass grafting. Of all, 8 death were reported up to the mean follow-up of 11 months.

Conclusions: The study stated that premenopausal females (<45 years) represent a special subgroup where non-conventional risk factors play an important role in occurrence of CAD. So, careful history taking with detailed menstrual and obstetric history should be considered in such group of patients.


Follicular stimulating hormone, Prolactin, Premature coronary artery disease, Premenopausal women, Percutaneous coronary intervention

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Proudfit WL, Welch CC, Siqueira C, Morcerf FP, Sheldon WC. Prognosis of 1000 young women studied by coronary angiography. Circulation. 1981;64:1185-90.

Welch CC, Proudfit WL, Sheldon WC. Coronary arteriographic findings in 1,000 women under age 50. The American journal of cardiology. 1975;35:211-15.

Vaccarino V, Krumholz HM, Yarzebski J, Gore JM, Goldberg RJ. Sex differences in 2-year mortality after hospital discharge for myocardial infarction. Annals of internal medicine. 2001;134:173-81.

Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998;97:596-601.

Nair M, Prabhakaran D. Why do South Asians have high risk for CAD? Global Heart. 2012;7:307-14.

Waters DD, Halphen C, Theroux P, David P-R, Mizgala HF. Coronary artery disease in young women: clinical and angiographic features and correlation with risk factors. The American journal of cardiology. 1978;42:41-7.

Gurevitz O, Jonas M, Boyko V, Rabinowitz B, Reicher-Reiss H. Clinical profile and long-term prognosis of women≤ 50 years of age referred for coronary angiography for evaluation of chest pain. The American journal of cardiology. 2000;85:806-09.

Guiteras P, Chaitman BR, Waters DD, Bourassa MG, Scholl J-M, Ferguson RJ, et al. Diagnostic accuracy of exercise ECG lead systems in clinical subsets of women. Circulation. 1982;65:1465-74.

Oliver-Williams CT, Heydon EE, Smith GC, Wood AM. Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis. Heart. 2013;99:1636-44.

Gupta S, Gupta VK, Gupta R, Arora S, Gupta V. Relationship of high-sensitive C-reactive protein with cardiovascular risk factors, clinical presentation and angiographic profile in patients with acute coronary syndrome: An Indian perspective. Indian heart journal. 2013;65:359.

Noel Bairey Merz C, Johnson BD, Sharaf BL, Bittner V, Berga SL, Braunstein GD, et al. Hypoestrogenemia of hypothalamic origin and coronary artery disease in premenopausal women: a report from the NHLBI-sponsored WISE study. Journal of the American College of Cardiology. 2003;41:413-19.

Chu MC, Rath KM, Huie J, Taylor HS. Elevated basal FSH in normal cycling women is associated with unfavourable lipid levels and increased cardiovascular risk. Human Reproduction. 2003;18:1570-73.

Therkelsen KE, Abraham TM, Pedley A, Massaro JM, Sutherland P, Hoffmann U, et al. Association between prolactin and incidence of cardiovascular risk factors in the Framingham Heart Study. Journal of the American Heart Association. 2016;5:e002640.

Reuwer AQ, Twickler MT, Hutten BA, Molema FW, Wareham NJ, Dallinga-Thie GM, et al. Prolactin levels and the risk of future coronary artery disease in apparently healthy men and women. Circulation: Cardiovascular Genetics. 2009;2:389-95.