Sinai Hospital of Baltimore, Baltimore, MD, USA.
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J Thromb Thrombolysis. 2019 Oct;48(3):373-381. doi: 10.1007/s11239-019-01901-1.
Women more often present with angina and non-obstructive coronary artery disease (ANOCA) and have poorer clinical outcomes than men. These findings may be related to sex associated differences in inflammation and thrombogenicity. Consecutive patients (n = 134) with ANOCA (luminal diameter stenosis < 50%) undergoing elective cardiac catheterization were included in post hoc analysis of Multi-Analyte, thrombogenic, and Genetic Markers of Atherosclerosis (MAGMA, NCT01276678) study. Patients with prior revascularization, coronary artery bypass grafting or myocardial infarction were excluded. Blood for thromboelastography, oxidized LDL β2-glycoprotein complex (AtherOx), oxidized-LDL, lipid profile, and urine for 11-dehydrothromboxane B (dTxB) were obtained before catheterization. All women (n = 75) were post-menopausal and tended to be older than men (61.4 ± 10.6 vs. 58.6 ± 9.9 year, p = 0.12), and were significantly more thrombogenic with higher thrombin-induced platelet-fibrin strength (TIP-FCS, mm) (68.0 ± 4.5 vs. 64.5 ± 6.2 mm, p = 0.001), clotting index (0.35 ± 2.22 vs. - 0.72 ± 2.75, p = 0.02), K (measure of the speed to reach 20 mm of clot strength from an amplitude of 2 mm) (2.2 ± 1.6 vs. 1.7 ± 0.5 min, p = 0.01), and fibrinogen activity (degrees) (66.6 ± 7.1 vs. 62.9 ± 7.5, p = 0.009). Markers of inflammation were not significantly different between the two groups. Women had higher total cholesterol, total LDL, LDL subtypes 1 and 2, total HDL, HDL subtypes 2 and 3, and ApoA1 (p < 0.05 for all). On multivariate regression, TIP-FCS remained significantly higher in women (p < 0.0001). Women with ANOCA are more thrombogenic than men. This fundamental difference in thrombogenicity may affect gender-related outcomes and warrants further investigation.
女性更常出现心绞痛和非阻塞性冠状动脉疾病（ANOCA），并且临床预后较男性差。这些发现可能与炎症和血栓形成的性别相关差异有关。在多分析、血栓形成和动脉粥样硬化的遗传标志物（MAGMA，NCT01276678）研究的事后分析中，纳入了 134 例接受选择性心导管检查的ANOCA（管腔直径狭窄<50%）的连续患者。排除了有再血管化、冠状动脉旁路移植术或心肌梗死病史的患者。在导管插入术之前获得了用于血栓弹性图、氧化 LDLβ2-糖蛋白复合物（AtherOx）、氧化 LDL、血脂谱和尿液 11-脱氢血栓烷 B（dTxB）的血液。所有女性（n=75）均绝经且年龄大于男性（61.4±10.6 岁比 58.6±9.9 岁，p=0.12），并且由于凝血酶诱导的血小板-纤维蛋白强度（TIP-FCS，mm）更高而表现出更高的血栓形成倾向（68.0±4.5 毫米比 64.5±6.2 毫米，p=0.001）、凝血指数（0.35±2.22 比-0.72±2.75，p=0.02）、K（从 2 毫米的振幅达到 20 毫米的血凝块强度的速度的测量值）（2.2±1.6 比 1.7±0.5 分钟，p=0.01）和纤维蛋白原活性（度）（66.6±7.1 比 62.9±7.5，p=0.009）。两组之间的炎症标志物没有显著差异。女性的总胆固醇、总 LDL、LDL 亚型 1 和 2、总 HDL、HDL 亚型 2 和 3 和 ApoA1 更高（p<0.05 均有）。多元回归分析显示，女性的 TIP-FCS 仍明显较高（p<0.0001）。ANOCA 女性比男性更具血栓形成倾向。这种血栓形成倾向的根本差异可能会影响与性别相关的结果，值得进一步研究。
