For the first time, researchers have discovered a genetic factor associated with an increased risk of heart attack in young women. This factor is predictive of fibromuscular dysplasia, a disease of the arteries different from atherosclerosis and which can lead to tearing of the coronary arteries.
The first genetic risk factor for acute and spontaneous tearing (dissection) of the coronary arteries in young women has been identified in the largest study of this disease to date. This genetic link may contribute to the clinical coexistence between acute and spontaneous coronary artery dissection and fibromuscular dysplasia.
The rs9349379-A allele is associated with a higher risk of acute and spontaneous coronary artery dissection in all studies. In meta-analysis of 1055 patients with acute and spontaneous coronary artery dissection and 7190 controls, this genetic variation increases the risk of dissection by 67% (95% confidence interval: 1.50 to 1.86).
Women are also affected
Contrary to popular belief, men are not the only ones to suffer from heart attacks: they are more and more frequent in women. In question atherosclerosis and smoking of course but a recent study, presented at the European Congress of Cardiology had shown that acute and spontaneous dissection of the coronary arteries was a major cause of atypical heart attack in women under 60 years old. This coronary tear is 4 times more common in women than in men.
Coronary artery dissection
Spontaneous coronary artery dissection is thus an increasingly recognized cause of acute coronary syndromes, mainly in young and middle-aged women. Previous observational studies had revealed the frequency of the association of this dissection of the coronary arteries with vascular abnormalities such as fibromuscular dysplasia and not with atherosclerosis, unlike what is found in men.
A team of researchers investigated the link between this disease and a genetic anomaly PHACTR1/EDN1, a genetic risk factor for several vascular diseases, in which the non-coding variant of the rs9349379 locus would act as a potential activator of the endothelin- 1 (EDN1).
An atypical presentation
Spontaneous coronary artery dissection (SCAD) occurs when the inner wall of an artery tears and separates from the outer wall of the artery. The blood from the arteries enters the tear, spreads in the space between the 2 walls and forms a clot which, in fine, narrows the lumen of the artery and blocks blood circulation.
Symptoms are similar to those of a heart attack and include chest pain, throbbing, pain in the arms, shoulders, or jaw, as well as nausea, shortness of breath, abnormal sweating, and lightheadedness empty. On the other hand, the radiological images during coronary angiography are very different.
Differentiated support
The early recurrences of this coronary obstruction on dissection of the arteries and fibromuscular dysplasia testify to a real problem in the treatment of these acute and spontaneous dissections of the coronary arteries in young women. This is also what could be responsible for the poorer results in the management of myocardial infarction in women compared to men.
This study confirms that fibromuscular dysplasia plays a major role in acute and spontaneous coronary artery dissection, a frequent cause of myocardial infarction in women under 60 years of age. Further research is needed to determine the most appropriate treatment for these patients who suffer a heart attack whose aftermath is not as good as in men. Already, a genetic predisposition is identifiable.
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