CONGRESS ABSTRACT

BACKGROUND. Women are generally considered at low risk for cardiovascular disease. This led to gender bias and udertreatment of female patients. Women were inadequately represented in clinical trials for a long time, so that scores used in clinical practice  may not be effective in assessing their risk. Moreover, in the past, the prevalence of female heavy smokers was low compared to men, while it has increased worldwide in recent years. This is considered a public health concern, since some studies suggest that, compared with men, women may be more susceptible to smoking-related morbidity and mortality. In our project, we evaluated the rate of cardiovascular events in heavy smoking females, with atypical chest pain and negative functional tests, compared to men. METHODS. From 2010 and 2022, we evaluated 3,588 outpatients aged >35 years (average 64±9, women 55%) for the presence of stable chest pain. We excluded 290 patients who had ECG changes compatible with recent ischemia, history of myocardial infarction or any other major cardiovascular event, evidence of heart failure, left ventricular dysfunction, or cardiomyopathies. In the other 3,298 cases we applied the traditional classification of typical, atypical angina and non-anginal pain. One or more functional tests were performed in all patients to exclude the presence of coronary ischemia. In the end, we had 2,774 patients with atypical chest pain and negative functional tests. Of these, 3.4% were heavy smokers. One year follow-up was carried out to evaluate vital status and any fatal and non-fatal cardiovascular events in these patients.   RESULTS. Table 1 shows the events  at one year in current heavy smokers (≥ 20 cigarettes per day) aged <70 years. Heavy female smokers with atypical chest pain and negative functional tests had a 12% rate of fatal events, significantly higher than men (2,4%).   CONCLUSIONS: in our analyisis, female heavy smokers < 70 years old with atypical chest pain had an extreme high risk of fatal events, despite negative results of functional tests. More efforts should be make to understand if this is due to gender biases in the evaluation of patients, worse performances of functional tests in women, or women are effectively more susceptible to smoking-related morbidity and mortality.