One study reported that sublingual nitroglycerin relieved symptoms in 35% of patients with documented ACS compared with 41% of patients without ACS.113 The relief of chest pain by gastrointestinal cocktails (eg, mixtures of liq- uid antacids, and/or viscous lidocaine, and/or anticholinergic agents) does not predict the absence of ACS.114 3.3.2.2. Demographics and History in Diagnosis and Risk Stratification A prior history of MI is associated with a high risk of obstruc- tive and multivessel CAD.115 Women with suspected ACS are less likely to have obstructive CAD than men. When obstructive CAD is present in women, it tends to be less severe than it is in It has been suggested that coronary microvascular dis- ease and endothelial dysfunction play a role in the pathophysi- ology of NSTE-ACS in patients with nonobstructive CAD.116 Older adults have increased risks of underlying CAD,117,118 mul- tivessel CAD, and a worse prognosis (Section 7.1). A family history of premature CAD is associated with increased coronary artery calcium scores119 and increased risk of 30-day cardiac events in patients with ACS.120,121 Diabetes mellitus, extracardiac (carotid, aortic, or peripheral) arterial disease, and hypertension are major risk factors for poor out- comes in patients with ACS (Section 6.2) with both STEMI122 The current or prior use of aspirin at presentation is associated with increased cardiovascular risk,42 likely reflecting the greater probability that patients who have been prescribed aspirin have an increased cardiovascular risk profile and/or prior vascular Table 3. 