Coronary artery disease in young women.

Although unusual, coronary artery disease does occur in young women. It may be present to a severe degree between ages 20 and 30, but a typical history of angina pectoris by no means assures the presence of significant coronary artery disease. Proof that oral contraceptives predispose to coronary artery disease is lacking. It seems wise not to recommend them to young women with other known risk factors. Significant risk factors in a group of 1000 women under age 50 studied by cinecoronary arteriography for the evaluation of chest pain included cigarette smoking, hypertension, hypercholesteremia, and glucose intolerance. Combinations of factors increased the risk. Electrocardiographic abnormalities in themselves did not seem to increase the risk of coronary artery disease, but did seem to enhance it in combination with other factors. Electrocardiographic evidence of transmural myocardial infarction without significant coronary artery disease was more common in young women than in young men. Cinecoronary arteriography may possibly be performed after resolution of more severe lesions related to lysis of emboli or thrombi. Special conditions may temporarily increase myocardial oxygen requirements. Angia-like chest pain has been described in patients without significant coronary artery disease. Many have normal electrocardiograms and no known risk factors. Spasm has been mentioned among many possible causes, but is very difficult to tell whether or not underlying atherosclerotic lesions may be present. Whatever the cause, the prognosis for patients with angina-like chest pain and normal coronary arteriography seems excellent; early death is a rarity and improvement is common.