Nonobstructive Coronary Artery Disease at Angiography and Gender-Specific Indicators for Cardiovascular Events: 5-Year Follow-Up of the LIFE Heart Study

Background: Patients with cardiac complaints but without confirmed diagnosis of coronary heart disease by angiography frequently develop cardiac events in the following years. This follow-up study investigated the frequency of cardiac symptoms and cardiovascular events (CVE) 5 years after initial angiography of patients with nonobstructive coronary artery disease (NobCAD, LIFE Heart study), with the aim to identify gender-specific indicators for CVE. Methods: In 2014/2015, 1462 women and men with NobCAD, defined as no or non-relevant obstructive coronary artery disease were identified among 2660 subjects participating in the observational angiographic LIFE Heart study. Questionnaires of 820 responding patients were analyzed. Results: The median observation time was 55 months. Cardiac symptoms were found in 53.6% of all patients, significantly more often in women than in men (59.4% vs. 48.8%; p = 0.002). CVE occurred in 46.1% of all participants (n = 378/820). Patients with cardiac symptoms had a 2.94 time higher risk for CVE than those without cardiac symptoms (p \textless 0.001). Men with no cardiac symptoms had significantly more CVE (p = 0.042) than women. Common risk factors for CVE comprised cardiac symptoms, atrial fibrillation, and age. Sex-specific risk factors comprised body mass index (BMI) \geq25 kg/m2 for women and anxiety for men. Conclusions: Patients with cardiac symptoms have about three times higher risk for CVE within 5 years than patients without cardiac symptoms. Sex differences exist in patients without symptoms where men were at higher risk for CVE. Atrial fibrillation was the strongest indicator for CVE, whereas anxiety was an indicator only in men and BMI \geq25 kg/m2 only in women, suggesting sex- and gender-specific phenotypic profiles.