Acute Coronary Syndrome in Women: Age and Menstrual Cycle-based Profile: A Prospective Study

Objectives: Cardiovascular diseases (CVDs), such as coronary artery disease (CAD) and acute coronary syndrome (ACS), rank among the top causes of mortality worldwide. Historically seen as mainly impacting men, it is now more widely acknowledged that CVD significantly endangers women’s health as well. Increasing studies suggest the essential impact of reproductive elements on the risk of CAD and ACS in women. This research seeks to determine the risk connection between reproductive stages and ACS. Furthermore to access the influence of factors such as age at menarche, years of repro , number of pregnanacies, and menopause status on the incidence of ACS in women. Materials and Methods: This was a prospective, observational research carried out in the cardiology department of a tertiary care facility in Northern India. The study included all female patients over 18 years who were diagnosed with CAD using clinical criteria and diagnostic tests, attending either the cardiology outpatient department or admitted to the inpatient department. Information on demographic and clinical features, reproductive factors like age at menarche, years of reproduction, history of pregnancies (count), perimenopausal or menopausal status, hormone replacement therapy, and medical menopause (hysterectomy) was documented on a prepared proforma. Results: The results reveal that women in the sixth decade (35.8%) were at the highest risk of ACS. At least one risk factor for CVD was present in all the patients with hypertension (60%), being the most common cardiovascular risk factor, followed by diabetes (46.6%). More than one risk factor was present in 40%. Regarding the ACS stratum, Non ST elevation myocardial infarction (NSTEMI) was the most common finding (51.6%). On analysis of the reproductive factors with risk of ST elevation myocardial infarction (STEMI) and NSTEMI, results showed that women who started menstruating later (>15 years of age) ( P = 0.05) and those with a shorter span of reproductive years were significantly ( P = 0.04) likely to have STEMI compared to those who started menstruating earlier or had a longer span of reproductive years. However, the number of pregnancies was not related to STEMI and NSTEMI as a risk factor. Conclusion: To the best of our knowledge, this is the first study in the literature from India reporting that women menstruating later (>15 years of age) and those with a shorter span of reproductive years were significantly more vulnerable to ACS than women with early menarche and with a longer span of reproductive years. These findings can be utilized to recognize high-risk women and focus on strategies to protect them from the risk of ACS in future.