Paucity of risk factors in women with angina and normal coronary angiograms.

A significant proportion of women who undergo coronary arteriography for investigation of angina have normal coronary angiograms. We wanted to test the hypothesis that screening women with risk factors for coronary arterial disease would reduce the need for subjecting them to this invasive procedure. Comparisons were made between 100 women with normal coronary angiograms and 100 women with angiographic evidence of coronary arterial disease. Both groups had presented with angina and had undergone coronary angiography in 1985 or 1986. Women with angina and normal coronary angiograms had fewer risk factors than those with coronary arterial disease. They were younger (mean 49.0 and 55.9 years, respectively), had less severe angina on presentation (atypical or mild angina: 35% vs 16%), were less likely to have a family history of myocardial infarction (12% vs 53%), were more likely to have never smoked cigarettes (64% vs 13%), and fewer of them had a serum cholesterol in excess of 6 mmol/l (36% vs 64%). Five independent predictors of coronary arterial disease were identified; family history, myocardial infarction, age, hypertension and smoking habit. No women with angina and abnormal coronary angiograms were found to be free of risk factors, whereas 42% of women with angina and normal coronary angiogram were free of risk factors. The data suggests that coronary angiography will probably be normal in women with angina who are free of risk factors.