Abstract 11461: Women with Coronary Artery Disease and Higher Cardiorespiratory Fitness Have Lower Coronary Artery Calcium Scores

Abstract

Introduction: Higher coronary artery calcium (CAC) scores have been associated with increased cardiovascular (CVD) events and mortality. Women develop coronary artery disease (CAD) on average 10-15 years older than men and have worse outcomes than men when CVD events occur. The effect of exercise capacity on CAC scores in women with CAD is unclear. Objective: To determine if exercise capacity is predictive of CAC scores in men and women with CAD. Methods: A total of 203 men and 38 women with known CAD had CAC scores measured using noncontrast multidetector coronary tomography. All subjects underwent maximal exercise treadmill testing with calculation of metabolic equivalents of task (METs) achieved as a measure of cardiorespiratory fitness. Results: Mean (SD) age was not different in men and women: 62.7 (7.9) and 64.4 (6.8) years, P=0.239, respectively. CAC scores were significantly lower in women compared to men: median [IQR]: 114.0 [27.5, 321.0] Agatston units vs 535.3 [182.9, 1367.4] respectively, (P<0.001) and were lower in women than men at any given age (Fig 1A). Female CAC scores did not equal those of men until women were 20 years older (Fig 1A). After adjustment for age, METs were associated with CAC scores in both men and women (Fig 1B). However, after multivariate adjustment for age, LDL-cholesterol, waist circumference, diabetes status and hypertension,, METs remained an independent predictor of CAC score in women (P=0.011) but not in men (P=0.223). Conclusions: Despite having known CAD, female CAC scores did not equal those of men until women were 20 years older. The independent association of METs with CAC score in women supports counseling women to exercise to maximize their cardiorespiratory fitness to minimize CAC scores. Since higher CAC scores predict adverse CVD events and mortality, lower CAC scores should protect women from development of CVD events and possibly lower their worse outcome.