Coronary artery disease - The greatest threat to women's health.

To the Editor,

We have greatly enjoyed reading the recently published article by Pathak LA et al. [1]. There is an overwhelming evidence that gender disparities do exist in the risk factor profile and the management of patients with coronary artery disease (CAD) [2]. The authors have retrospectively analyzed the clinical and angiographic profile of 3250 women undergoing coronary angiogram over a period of 6 years. This is a large cohort and results are likely to influence the future research on the effect of various risk factors on the development of CAD in women. However, we have few concerns:

The authors have not analyzed the distribution of various risk factors according to different age categories among women. It would have better reflected the differences in the risk factor profile among young and elderly women and might have provided causal implications.

Similarly, it would have been better to look for the differential pattern of angiographic findings across different age categories. Limited contemporary data exist on the differences in angiographic profile among young and elderly Indian women [3].

Third, we would like to bring attention towards the possible typographical errors. There are discrepancies in the data provided in the pie-charts and the text. In the pie-chart demonstrating the modes of clinical presentation, it is mentioned that unstable angina/NSTEMI was observed in 60%, STEMI in 20%, stable angina in 16% and atypical presentation in 4%. However in the text, these percentages are different (NSTEMI 51%, STEMI 13% and stable angina 25%). Similarly, discrepancies exist between the values mentioned in the pie-chart on angiographic profile and the supported text.

Lastly, the data were collected retrospectively by authors from a single center in Mumbai, India. Since the characteristics of CAD patients vary with socio-demographic profiles, and 69% of Indian population is rural [2], further studies are warranted across other parts of the country to assess the clinical and angiographic profiles among women. This would help in the planning of preventive health programs against rising burden of CAD among women.

Conflict of interest

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Funding

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Authors contributions

Criteria for inclusion in the authors’ list= All the authors contributed equally to prepare this manuscript.

Manuscript has been read and approved by all the authors, and the requirements for authorship have been met, and each author states that the manuscript represents honest work.