gender differences in thrombogenicity among patients with angina and non-obstructive coronary artery disease

Women more often present with angina and non-obstructive coronary artery disease (anoca) and have poorer clinical outcomes than men. these findings 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 b2 (dtxb2) 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 affect gender-related outcomes and warrants further investigation.