Sex- and Age-Specific Interactions of Coronary Atherosclerotic Plaque Onset and Coronary Computed Tomography Prognosis Summary Goals Atherosclerotic plaque totality derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment needed by patients. This study examines differences in age of onset and prognostic significance of atherosclerotic plaque burden between sexes. Methods and results From a large multicenter CCTA registry, the Leiden CCTA score was calculated in 24,950 individuals. A total of 11,678 women (58.5 ± 12.4 years) and 13,272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or heart attack). myocardium). The age at which the median risk score was above zero was 12 years older in women than in men (64–68 years vs. 52–56 years, respectively, P < 0.001). Leiden CCTA risk score was independently associated with MACE: score 6-20: HR 2.29 (1.69-3.10); score > 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P interaction = 0.003). In premenopausal women , the risk score was equally predictive and comparable to that in men. In postmenopausal women , the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). Conclusion Women developed coronary atherosclerosis approximately 12 years later than men. Postmenopausal women within the highest atherosclerotic burden group had a significantly higher risk of MACE than their male counterparts, which may have implications for the intensity of medical treatment. |
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Postmenopausal women with clogged arteries have a higher risk of heart attacks than men of similar age, according to research presented at EACVI 2023, a scientific congress of the European Society of Cardiology (ESC) and published in European Heart Journal - Cardiovascular Imaging . The study of nearly 25,000 adults used imaging techniques to examine arteries and followed patients for heart attacks and death.
"The study suggests that a given burden of atherosclerosis is more risky in postmenopausal women than in men of that age," said study author Dr. Sophie van Rosendael, of Leiden University Medical Center, the Netherlands. . “As atherosclerotic plaque burden is emerging as a target for deciding the intensity of therapy to prevent heart attacks, the findings may affect treatment. Our results indicate that after menopause, women may require a higher dose of statins or the addition of another lipid-lowering drug. “More studies are needed to confirm these findings.”
Although young women have heart attacks, they generally develop atherosclerosis later than men and have heart attacks at an older age, in part because of the protective effect of estrogen.
This study examined whether the prognostic significance of atherosclerotic plaques is the same for women and men at different ages, as this could be important for selecting treatments to prevent heart attacks.
The study included 24,950 patients referred for coronary computed tomography angiography (CCTA) and enrolled in the CONFIRM registry, which was conducted in six countries in North America, Europe, and Asia. CCTA is used to obtain 3D images of the arteries of the heart.
Total atherosclerotic burden was scored using the Leiden CCTA score, which incorporates the following items for each coronary segment: presence of plaque (yes/no), composition (calcified, non-calcified or mixed), location and severity of narrowing, for a value final 0 to 42.4 Patients were divided into three categories previously found to predict the risk of myocardial infarction: low (0 to 5), medium (6 to 20) and high (more than 20) atherosclerotic burden. Additionally, obstructive coronary artery disease was defined as a narrowing of 50% or more.
The primary outcome was the difference in Leiden CCTA score between women and men of similar age. The researchers also looked at sex differences in rates of major adverse cardiovascular events (MACE), which included all-cause death and myocardial infarction, after adjusting for age and cardiovascular risk factors (hypertension , high cholesterol, diabetes, current smoking, and family history of coronary artery disease).
A total of 11,678 women (mean age 58.5 years) and 13,272 men (mean age 55.6 years) were followed for 3.7 years. Regarding the primary outcome, the study showed a delay of approximately 12 years in the onset of coronary atherosclerosis in women: the median Leiden CCTA risk score was greater than zero at the age of 64 to 68 years in women. women compared to 52 to 56 years in men (p<0.001). ). Furthermore, total plaque burden quantified by the Leiden CCTA score was significantly lower in women, who had more nonobstructive disease.
Dr van Rosendael said: “The results confirm the previously reported delay in the onset of atherosclerosis in women. We also found that women are more likely to have non-obstructive disease . Previously it was thought that only obstructive atherosclerosis caused myocardial infarction, but now we know that non-obstructive disease is also risky.”
Atherosclerosis burden was equally predictive of MACE in premenopausal women (younger than 55 years) and men of the same age group.
However, in postmenopausal women (over 55 years), the risk of MACE was higher than in men for a given score.
In postmenopausal women, compared with those with low burden, those with medium and high burden had a 2.21- and 6.11-fold increased risk of MACE. While in men aged 55 years or older, compared to those with low burden, those with medium and high burden had a 1.57 and 2.25 times higher risk of MACE.
Dr. van Rosendael said: “In this study, the elevated risk for women versus men was especially observed in postmenopausal women with the highest Leiden CCTA score. This could be partly because the inner diameter of the coronary arteries is smaller in women, meaning the same amount of plaque could have a greater impact on blood flow. Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared with men, despite a similar burden of atherosclerotic disease. “This may have implications for the intensity of medical treatment.”
