Table of Content - Volume 5 Issue 2 - February 2017
Comparative study of coronary artery disease in asymptomatic perimenopausal and post-menopausal women
Neelima S Deshpande1*, Snehal S Paul2, Chintamni S Deshpande3
1Professor and H O D. Department of Medicine, Government Medical College, Latur, Maharashtra, INDIA. 2Senior Resident, Department of Medicine, Dr. V.M .Government Medical College, Solapur, Maharashtra, INDIA. 3Student, MIP College of Physiotherapy, Latur, Maharashtra, INDIA. Email: drneelima08@gmail.com
Abstract A randomised study was carried out in a tertiary health care hospital to study risk factors and incidence of Coronary Artery disease in 100 peri menopausal and post menopausal women. Out of 100 patients 71 patients were postmenopausal while 29 were preimenopausal. 48 patients had abnormal ECG findings, out of which 31 patients were from postmenopausal group, while 17 were from perimenopausal group. Out of these 48 patients having abnormal ECG changes 6 patients were positive for treadmill stress test. All were postmenopausal. While patients with abnormal 2D-ECHO findlings were from both perimenopausal as well as postmenopausal group. Out of various risk factors found in this study waist to hip ratio>0.8, age≥55 years were most commonly observed. Other common risk factors noted were obesity, hypertension and dyslipidemia. Diabetes and tobacco chewing was seen in lesser number of patients. Key Words: Perimenopausal, postmenopausal, Treadmill stress test.
INTRODUCTION Heart disease is the first killer of women in the modern era, regardless of age, race and of ethnicity, although its prevalence rises after menopause. Modern women have professional and housewife responsibilities, consume excess of fat and cardbohydrates, smoke, do not exercise regularly and do not have enough time to rest. This situation leads to overweight, dyslipidemia, arterial hypertension, impaired glucose tolerance and diabetes. Coronary heart disease is assuming serious dimension in developing countries. It is expected to be the single most important cause of death in India by the next 5 years. Although many women and their physicians underestimate the risk. A randomised study was carried out in a tertiary health care hospital to study risk factors and incidence of Coronary Artery disease in 100 peri menopausal and post menopausal women.
MATERIAL AND METHODS Study Design: A randomized case study was carried out in a tertiary health care hospital. 100 asymptomatic perimenopausal and postmenopausal women of age 40 to 70 years were evaluated for evidence of coronay heart disease. Women with history of coronary artery disease and valvular heart disease were excluded from the study. Each patients history included family history of coronary artery disease, history of smoking or tobaco chewing, physical activities and job details. Physical examinations included measurment of weight, waist to hip ratio, body mass index and blood pressure. All the patients underwent routine biochemical investigations, 12 Lead ECG, 2D echo cardiography including heart chembers dimentions and ejection fraction. All patients were subjected to treadmill - stress testing by modified Bruce protocol.
RESULTS The common risk factors observed in this study were waist to hip ratio more than 0.8 in 53 patients, followed by age> 55 years noted in 48 patients, obesity in 29 patients, hypertension in 17 patients and dyslipidiemia in 16 patients. In the present study we observed 48 patients with abnormal ECG findings. These abnormal ECG changes were in the form of ST-segment depression, T wave inversion, left ventricular hypertrophy along with ST-segment depression, ventricular premature complexes, left bundle branch blook. It was observed that, 6 patients had positive treadmill stress test.
Table 1: Distribution of patients according risk factors
Figure 1:
Table 2: Showing various abnormal ECG findings in various age group
Table 3: Age-wise distribution of abnormal 2D ECHO Findings:
Table 4: Results of treadmill stress test
Figure 2:
Figure 3:
Table 5: Treadmill stress test results with reference to age
Table 6: Positive treadmill stress test results in association with various risk factors
Table 7: Positive treadmill-stress test results in perimenopausal and postmenopausal women
chi2 = 2.68, P>0.05
In this study we observed that 6 patients were positive for treadmill stress test. Out of these 6 patients all were from postmenopausal age group. There was no significant difference observed between the number of asymptomatic females with positive treadmill stress test in the perimenopausal and the postmenopausal age groups (p>0.05). Out of these 6 patients positive for treadmill stress test, in which we did 2D-ECHO, 1 patients had left ventricular diastolic dysfunction with left ventricular dialatation, 1 patients had dialated hypertrophied left ventricle with normal function, 2 patients had normal 2 D-ECHO findings.
DISCUSSION In the present study 71 patients were in postmenopausal group, while 29 patients were in perimenopausal group. In the present study, out of 100 patients, 5 (5%) patients were diabetic, 17 (17%) patients were hypertensive, 29(29%) were obese, 16 (16%) were having dyslipidmia and 6 (6%) were tobacco chewers. In the study conducted by Tandon et al1, 21% patients were diabetic, 56% hypertensive, 78% obese, 39% with dyslipidemia, and 4% were tobacco chewers and 0.5% were smokers. This difference in observations may be because of inclusion criteria, as they included only postmenopausal women as study group, along with prior history of diabetes mellitus and hypertension, and these two co-morbid conditions are found to co-exist with the other risk factors of CAD like dyslipidemia, obesity and tobacco addiction, in many patient.
CONCLUSIONS
REFERERNCES
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