The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review

Abstract

Cardiovascular disease has remained one of the leading causes of mortality in the world. The basic pathophysiology of coronary artery disease (CAD) is a reduction of the blood flow in coronary vessels, leading to restricted blood flow to the heart muscle. Both modifiable and non-modifiable risk factors contribute to its multifactorial etiology. The clinical presentation ranges from asymptomatic to typical symptoms like chest pain, shortness of breath, and left arm or jaw pain. The purpose of this review is to investigate and analyze the variation of CAD depending on the biological sex, age, race, or ethnicity and how it might differ in the studied population while comparing the symptoms and prognosis of CAD. For this research, PubMed's database was used. A total of 926 articles were selected using pre-determined inclusion and exclusion criteria, with 74 articles eligible to be included in the narrative review. Studies were selected from the general population of patients with CAD, regardless of their severity, stage of diagnosis, and treatment plan. The scale for the assessment of non-systematic review articles (SANRA) was used to assess the quality of the study. As humans age, the incidence of CAD increases, and people over 75 are more likely to have multiple-vessel CAD. It has been observed that South Asians have the highest rate of CAD at 24%, while the White population has the lowest at 8%. The prevalence of CAD also depends on race, with the White population having the lowest rate at 3.2%, followed by Hispanics at 5%, Black women at 5.2%, and Black men at 5.7%. Younger Black women tend to have more chest pain. Men with CAD commonly experience chest pain, and women are more likely to present with atypical symptoms. Modifiable risk factors such as smoking and alcoholism are more commonly observed in young men than in young women. Coronary artery disease in the elderly, female, minority, and Black patients is associated with a higher mortality rate. Acknowledging the prevalence of certain risk factors, signs, results, and responses to treatment in certain socio-demographic groups, as well as the provision and accessibility of diagnosis and treatment, would lead to a better outcome for all individuals. The impact of this shift can range from an earlier diagnosis of CAD to a faster and more customized treatment plan tailored to each patient's individual requirements.

Keywords: age; artery disease; ethnicity; race; sex.

Figure 1. Identification of new studies via PubMed’s databases

Results from the search conducted for the identification of new studies via PubMed’s database.

Figure 2. Overview of the intersectionality of non-modifiable risk factors, i.e, sex, age, race, and ethnicity on the risk, presentation, and outcomes of CAD

CAD: Coronary artery disease, PCI: Percutaneous coronary intervention, NHW: Non-Hispanic White, TVD: Triple-vessel disease Image created by authors and based on the data from the studies included in this review.

Figure 3. Distribution of NSTEMI patients with a bachelor’s degree by race

NSTEMI: Non-ST-elevation myocardial infarction Image created by authors and based on the data from the studies included in this review.

Figure 4. Distribution of patients with income ≥ $50,000 by race

Image created by authors and based on the data from the studies included in this review.

Figure 5. Odds ratios of PCI receipt by ethnicity

This figure was created based on the data from other studies adopted by Tertulien et al. [63]. PCI: Percutaneous coronary intervention