Young women and CAD: A retrospective clinical audit at Kauvery Heart City

Dharsshini. N

Group Clinical Pharmacist, Kauvery Hospital, Trichy, Tamil Nadu

Introduction

Coronary artery disease remains a leading cause of morbidity and mortality among women worldwide, often underdiagnosed and undertreated due to atypical presentations and low awareness (Patel et al., 2015). Traditionally considered a disease of older adults, CAD is increasingly being diagnosed in younger populations, including women under the age of 45. This early onset is alarming as it may carry a more aggressive clinical course and long-term consequences for patients, families, community, the country and the world.

Diabetes, hypertension, dyslipidaemia and hypothyroidism are well established contributors to CAD. However, in younger women, these risk factors may often go unrecognized or undiagnosed leading to delays in intervention and treatment.

Especially in urban populations, lifestyle changes, sedentary behaviour, dietary shifts and increasing stress levels have contributed to a rising burden of CAD in younger women population. Yet, comprehensive data specifically focusing on young women remains limited.

This study aims to assess the prevalence and pattern of CAD in women with a specific focus on those under 45 years of age, admitted to Kauvery Heart city, Trichy. It also evaluates the associated risk factors, angiographic patterns and treatment strategies, highlighting gaps in diagnosis and management, particularly such young female patients.^1,2

Methodology

This study employed a retrospective observational design based on a clinical data audit at Kauvery Heart city, Trichy conducted over the course of one year (January to December 2024). The data was collected from the hospital records of female patients diagnosed with coronary artery disease(CAD)

Study Population: Women of all age groups diagnosed with CAD during 2024.

Sample Size: A total of 1710 women were included, out of which 110 women aged < 45 years were selected for focused risk factor analysis.

Data Collection: Patient records were reviewed to extract data on demographics, clinical presentation, age, comorbidities (diabetes, hypertension, hypothyroidism, dyslipidaemia, anemia) demographic findings, treatment modality (PTCA, CABG, medical) and readmission status.

Analysis: Descriptive statistics were used to calculate percentage of various risk factors and disease patterns.

Results

A retrospective clinical data audit on Coronary Heart disease in Women under the of 45 and below taken from heart city (KHC), Trichy for one year (2024) and analysed for common and uncommon risk factors for CAD at young age.

A total of n= 1710 women population were admitted with coronary artery disease in the year of 2024 in heart city. In which n = 110 were women diagnosed with CAD under 45 age and below.

Table 1: Total women patients with CAD in 2024

Total women patients with CAD 2024(n=1710)
Overall CAD in women	CAD under 45 yr
1600(94%)	110(6.40%)

Risk Factors of young age women CAD patients were observed. Out of 110 patient population, 89 patients (80.9%) were with Diabetes, HTN, Hypothyroidism, dyslipidaemia and anaemia. 21 (19.9%) didn’t have any common risk factors.

Table 2: Total women patients with CAD under age 45 years and below

Total women patients with CAD under age 45 and below - 2024(n=110)
CAD under 45 yrs	Percentage
Risk factors (DM ,HTN, hypothyroidism, dyslipidemia etc.)	89	80.90%
No common risk factors	21	19.90%

Fig (1): Age wise category for women patients under age 45 with CAD

Out of 110 patients, 53(48%) were in the age group of 41-45 years. 38% in the age group of 36-40, followed by 14% in 30-35 age group.

Table 3: Age wise category for women patients under 45 with CAD

Age wise category for women patients under 45 with CAD
AGE	Percentage	N = 110
30-35	14%	15
36-40	38%	42
41-45	48%	53

Fig (2): Risk Factors wise category for patients under 45 with CAD

Diabetes(n=63) was the predominant risk factor seen in most patients, followed by HTN with (n=30).

Dyslipidaemia was observed in n=14 patients. (A total of 21 patient’s lipid profile was only taken out of 110 patients) In which 11 patients had borderline and abnormal lipid values.

Uncommon risk factors like Lp(a), Apo lipoproteins, Homocysteine and others are not monitored in Heart city.

Table 4: Risk Factors wise category for patients under 45 with CAD

Risk Factors wise category for patients under 45 with CAD
Risk Factors	Percentage	Frequency
Diabetes	57.20%	63
Hypertension	27.20%	30
Hypothyroidism	14.50%	16
Dyslipidemia	12.72%	14
Chronic Anemia	5.45%	6

Fig (3): Status of Women population under 45 for one year

Fig (4): Readmissions of women patients under 45 diagnosed with CAD

Fig (5): Treatment patterns of Women population under 45 for one year

28 patients had single vessel disease, followed by 11 with DVD and 13 with TVD. 10 Patients were on medical management.

43 patients had no CAD, in which 23 patients underwent CAG which shows normal findings.

Table 5: Treatment pattern wise category for patients under 45 with CAD

Discussion

The study highlights the prevalence and characteristics of coronary artery disease (CAD) among women under 45 at Kauvery Heart City, Trichy, in 2024. Out of 1710 female CAD patients, 110 (6.4%) were under 45, underscoring the presence of early – onset CAD in this demographic Tab 1. Out of 110 women diagnosed with CAD under 45 years, the largest proportion 48% (n=58) belonged to the 41 -45 years’ age group Tab 2. This gradient supports existing literature that cardiovascular risk factors and clinical manifestation of CAD tend to accumulate with age, even in younger populations.
According to our study, it is evident that peri-menopausal women are more prone to the risk of coronary artery disease. The decline in oestrogen during peri – menopause reduces its protective cardiovascular effects, leading to increased LDL cholesterol and decreased HDL cholesterol levels, thereby elevating CAD risk. According to European Heart Journal (2024) highlights the menopause leads to altered vascular function and increased inflammation, contributing to higher CAD risk.
Furthermore, it brings attention to the importance of including younger age groups in heart disease prevention policies, as early – onset CAD poses a risk of long term health burden and diminished quality of life if left unaddressed.
A significant proportion (80.9%) of these younger women had identifiable risk factors such as diabetes mellitus, hypertension, hypothyroidism, dyslipidaemia and anaemia. This aligns with previous literature showing that more than 80% of young CAD patients in South Asia present with metabolic risk factors like dyslipidaemia and hypertension (Peters et al, 2014).³ Moreover, diabetes appears to have a more severe impact on women’s cardiovascular health with studies indicating a 3-7-fold increase in CAD risk among diabetic women compared to non- diabetic women (Huxley et al, 2006; Kanaya et al., 2002).^4,5
Lipid profile was not taken in spite of dyslipidaemia being a major risk factor. It was noted that 21 patients were assigned for checking lipid profile out of 110. In which 14 patients had abnormal lipid profile. Abnormal lipids promote atherosclerosis leading to Coronary Artery Disease. According to Indian Heart Journal (2024)⁶, Most national studies have reported higher prevalence of hypercholesterolemia in most Southern and a few North Indian states, more in urban than rural areas, whereas the prevalence of high triglycerides and low HDL cholesterol is similar throughout the country.
45 patients had normal cardiac functioning.
Treatment patterns revealed that PTCA was performed in 27 patients and CABG in 16, reflecting active management in selected cases. With an 18.1 % readmission rate, the findings stress the importance of follow-up care, lifestyle interventions, and possibly structured cardiac rehabilitation. There was no record of thrombolysis done for any women patient under 45.
Low readmission rates (18%) is a prove that women health are often neglected by their family and by themselves.

Major limitation of our study was that we were not able to extract details regarding family prevalence of CAD and also limited details on hyperlipidaemia, even though Lipids are a major risk factor among young population. Uncommon risk factors like Apo lipoprotein (a) were not evaluated for any population.

Conclusion

In our study, metabolic risk factors contributed to CAD in young females. Our data highlights the importance of investigating lipids and its potential to prevent cardiovascular disease in women.
Creating awareness about the modifiable risk factors and their timely management can create an impact on the future of cardiovascular disease in women.
Conventional and female-specific risk factors, novel biomarkers, and genetic analysis should be evaluated for better patient outcome and prognosis.

Reference

Patel, V., et al. (2015). Unique Aspects of Coronary Artery Disease in Indian Women. *Indian Heart Journal*, 67(5), 395–401.
Agrawal, A., et al. (2023). Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review. *Journal of International Medical Research*, 51(7), 03000605231187806.
Peters SA, Huxley RR, Woodward M. (2014). Diabetes as a risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis. *Diabetologia*, 57(8), 1542–1551.
Huxley R, Barzi F, Woodward M. (2006). Excess risk of fatal coronary heart disease associated with diabetes in women compared with men: meta-analysis of 37 prospective cohort studies. *BMJ*, 332(7533), 73–78.
Kanaya AM, Grady D, Barrett-Connor E. (2002). Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. *Archives of Internal Medicine*, 162(15), 1737–1745.
Jitendra PS. Sawhney et al, CSI clinical practice guidelines for dyslipidemia management: Executive summary, Indian Heart Journal, Volume 76, Supplement 1, 2024, Pages S6-S19.

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Applied Medical Statistics

Young women and CAD: A retrospective clinical audit at Kauvery Heart City