Women Have Less Severe and Extensive Coronary Atherosclerosis in Fatal Cases of Ischemic Heart Disease: An Autopsy Study

Study Questions:

Are there differences in disease severity among women versus men after death from ischemic heart disease?


Autopsy reports between January 1, 2006 and December 31, 2008, from the Office of the Chief Medical Examiner of New York City, were examined. Adults ages 21-54 years were included, in which manner of death was natural and a full autopsy report was available. Only deaths which were nonhospital admissions were included. Cases with positive toxicology screens for cocaine were excluded. Deaths which are sudden, unexpected, or accidental are under the jurisdiction of the Office of Chief Medical Examiner. Cases where the cause of death was due to atherosclerotic or arteriosclerotic cardiovascular disease (according to the medical examiner) were included in this analysis. The primary outcome of interest was significant coronary artery disease, defined as ≥75% cross-sectional area stenosis in an epicardial vessel or ≥50% left main stenosis.


A total of 1,686 cases were determined to have a cardiovascular cause of death, of which 639 (128 women and 511 men) met inclusion criteria. Mean age of the women and men was similar (46.2 ± 6.4 vs. 46.5 ± 6.3 years, p = 0.61). A disproportional number of black women were included as compared to black men (57% vs. 30%, p < 0.001). Women were less likely to have obstructive coronary artery disease as compared to men (63% vs. 77%, p = 0.002). There was pathologic evidence of myocardial infarction in 43% of cases, of which 17% had nonobstructive coronary artery disease. No gender-related difference in the frequency of myocardial infarction in the total population was observed (38% women vs. 45% men, p = 0.18). No gender difference was noted among those without significant coronary artery disease (23% vs. 29%, p = 0.45).


The investigators concluded that among younger adults determined at autopsy to have died of ischemic heart disease, women were less likely to have obstructive coronary artery disease.


These data support prior reports, which suggest that women with nonobstructive coronary artery disease are at risk for cardiovascular events, including fatal myocardial infarction. Efforts to improve risk factor prevention and risk stratification among these women may improve survival rates.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Cause of Death, Coronary Artery Disease, Myocardial Infarction, Myocardial Ischemia, Survival Rate, New York City, Cardiology, Autopsy

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