Gender-Based Comparison of Cardiovascular Risk Factors and Diseased Coronary Vessels in Patients Undergoing Coronary Angiography

Abstract

Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide and is influenced by a combination of modifiable and non-modifiable cardiovascular risk factors. Although CAD has traditionally been considered more common in males, increasing evidence indicates important gender-related differences in cardiovascular risk profiles, clinical presentation, disease distribution, and coronary angiographic findings. This study was conducted to compare gender-based differences in cardiovascular risk factors and the pattern, extent, and severity of diseased coronary vessels among patients undergoing coronary angiography. A cross-sectional observational study was conducted in the cardiology departments of Khyber Teaching Hospital, Hayatabad Medical Complex, and Lady Reading Hospital, Peshawar, Pakistan, over a three-month period from May 2026 to July 2026. A total of 341 patients aged above 25 years who underwent coronary angiography and fulfilled the inclusion criteria were enrolled using non-probability consecutive sampling. Demographic characteristics and cardiovascular risk factors were obtained through a structured data collection proforma and review of medical records, while the pattern, severity, and number of diseased coronary vessels were assessed from coronary angiography reports. Data were analyzed using SPSS version 24, with appropriate statistical tests used to determine gender-based differences and a p-value of ≤0.05 considered statistically significant. Among the 341 participants, 212 (62.2%) were males and 129 (37.8%) were females, with an overall mean age of 60.38 ± 11.16 years. Hypertension was the most prevalent cardiovascular risk factor (82.1%), followed by sedentary physical activity (69.2%) and diabetes mellitus (49.3%). Smoking was significantly more common among males, whereas sedentary physical activity was significantly more common among females. However, no statistically significant gender differences were observed for hypertension, diabetes mellitus, obesity, or family history of CAD. Angiographic assessment showed that focal and diffuse coronary artery disease were similarly distributed between males and females, with no statistically significant association between gender and disease pattern (p=0.812). Severe coronary stenosis was the most common severity category in both genders, and the difference in stenosis severity was not statistically significant (p=0.207). Single-vessel disease was the most frequent angiographic finding, affecting 151 (44.3%) patients, followed by double-vessel disease in 120 (35.2%) and triple-vessel disease in 70 (20.5%) patients. The distribution of single-, double-, and triple-vessel disease was comparable between males and females, with no statistically significant gender difference (χ²=0.234, df=2, p=0.889). The left anterior descending artery was the most frequently affected coronary vessel, followed by the right coronary artery and left circumflex artery. Overall, the findings indicate that gender differences in this study were more prominent in selected behavioral cardiovascular risk factors, particularly smoking and physical inactivity, than in the angiographic extent or severity of coronary artery disease. The findings emphasize the importance of gender-sensitive cardiovascular risk assessment while supporting individualized evaluation of coronary angiographic disease rather than assuming greater coronary disease severity or extent solely on the basis of gender.