“The study shows that a certain burden of atherosclerosis is at greater risk in postmenopausal women than in men of the same age,” said study author Dr. Leiden University Medical Center, Netherlands. Sophie van Rosendael. “As atherosclerotic plaque burden emerges as a target for deciding the intensity of therapy to prevent heart attacks, the findings may have implications for treatment” (
in what is called a board. Although younger women have heart attacks, women generally develop atherosclerosis later than men and have heart attacks at an older age than men (
), partly due to the protective effect of estrogen. This study investigated whether the prognostic significance of atherosclerotic plaques is the same for women and men at different ages, as this may be important for the selection of treatments to prevent heart attacks.
The study included 24,950 patients referred for coronary computed tomography angiography (CCTA) and enrolled in the CONFIRM registry conducted in six countries in North America, Europe, and Asia. CCTA is used to obtain 3D images of the heart’s vessels.
Total atherosclerotic burden was assessed using the Leiden CCTA score for each coronary segment, which includes the following items: presence of plaque (yes/no), composition (calcified, non-calcified, or mixed), location, and severity of stenosis, with a final score of 0- from to 42. Patients were divided into three previously identified categories for predicting the risk of myocardial infarction: low atherosclerotic burden (from 0 to 5), medium (from 6 to 20) and high (more than 20). Additionally, obstructive coronary artery disease was defined as 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 analyzed gender differences in the rates of major adverse cardiovascular events (MACE), which include all-cause death and myocardial infarction, after adjusting for age and cardiovascular risk factors (hypertension, high cholesterol, diabetes, current smoking, and family history). coronary artery disease).
Atherosclerosis in women
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. As for the primary outcome, the study showed a delay of about 12 years in the onset of coronary atherosclerosis in women: the mean Leiden CCTA risk score was above zero in women between 64 and 68 years of age, and in men between 52 and 56 years of age (p<0.001). In addition, total plaque burden as measured by the Leiden CCTA score was significantly lower in women with 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 prone to non-obstructive disease. Previously, only obstructive atherosclerosis was thought to cause myocardial infarction, but we now know that non-obstructive disease also causes myocardial infarction. is risky”.
Atherosclerosis burden was equally predictive of MACE in premenopausal women (<55 years) and men of the same age group. However, postmenopausal women (aged 55 and older) had a higher risk of MACE for a given score than men. In postmenopausal women, the risk of MACE was 2.21 times and 6.11 times higher in women with moderate and high burden compared to those with low burden. In men aged 55 years and older, the risk of MACE was 1.57 and 2.25 times greater in those with moderate and high burden compared with those with low burden.
Dr. van Rosendael said: “In this study, a higher risk for women compared to men was observed, especially in postmenopausal women with the highest Leiden CCTA score. This may be partly because women have a smaller internal diameter of the coronary arteries, meaning that the same amount of plaque has a greater impact on blood flow can show.”
- Computed tomography angiography in the heart of cardiovascular imaging – (https://esc365.escardio.org/EACVI-Congress/sessions/7262-computerised-tomography-angiography-in-the-heart-of-cardioavascular-imaging)
- Sex- and age-related interactions of coronary atherosclerotic plaque onset and coronary computed tomography prognosis – (https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jead094/7151544?login=false)
- Global Use of Obstructed Coronary Artery Opening Strategies IV-Acute Coronary Syndrome – (https://www.acc.org/latest-in-cardiology/clinical-trials/2010/02/23/19/06/gusto-ivacs-one-year-followup)