Letter by Zimmermann et al Regarding Article, “Excess Cardiovascular Risk in Women Relative to Men Referred for Coronary Angiography Is Associated With Severely Impaired Coronary Flow Reserve, Not Obstructive Disease”

Zimmermann, FM Frederik; Zelis, Jo M.; Veer, Manik

doi:10.1161/circulationaha.117.028368

Cited by 1 publication

(2 citation statements)

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“…It has been shown that among persons with acute coronary syndrome, obstructive coronary artery disease is more prevalent in men than in women. 42 Our results suggest that the male-predominance of coronary artery obstruction cannot be extrapolated to the carotid arteries.…”

Section: Discussionmentioning

confidence: 73%

“…38 The incidence rate of cardiovascular disease increases strongly with aging, particularly in women. 41 As such, the cross-sectional design of prior studies and differences in study populations, for example, with a lower age range than our population, may explain the previously reported nonsignificant associations of plaque components with cardiovascular disease in women. We observed that the prevalence of intraplaque hemorrhage and lipid-rich necrotic core was higher in men than in women.…”

Section: Discussionmentioning

confidence: 75%

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Carotid Plaque Composition and Prediction of Incident Atherosclerotic Cardiovascular Disease

Toorn

Bos

Ikram

et al. 2022

Circ: Cardiovascular Imaging

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Background: Whether information on carotid plaque composition contributes to prediction of incident atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. We determined the sex-specific added value of carotid plaque components for predicting incident ASCVD events, beyond traditional cardiovascular risk factors. Methods: Between 2007 and 2012, participants from the population-based Rotterdam Study with asymptomatic carotid wall thickening >2.5 mm on ultrasonography were invited for carotid magnetic resonance imaging. Among 1349 participants (mean age: 72 years [SD±9.3], 49.5% women) without cardiovascular disease, we assessed plaque thickness, luminal stenosis (>30%), presence of intraplaque hemorrhage, lipid-rich necrotic core, and calcification. Follow-up for ASCVD was complete until January 1, 2015. Using Cox proportional hazards models, we fitted sex-specific prediction models including traditional cardiovascular risk factors (base model). We extended the base model by single and simultaneous additions of plaque characteristics and calculated improvement of model performance by the C statistics. Results: During a median follow-up of 4.8 years, 60 men and 48 women developed ASCVD. In women, presence of intraplaque hemorrhage was associated with incident ASCVD (adjusted hazard ratio, 3.37 [95% CI, 1.81–6.25]). The C statistic (95% CI) improved from 0.73 (0.66–0.79) to 0.76 (0.70–0.83) after single addition of intraplaque hemorrhage to the base model. Simultaneous addition of plaque components, plaque thickness, and stenosis did not change the results. In men, only carotid stenosis was statistically significantly associated with incident ASCVD (adjusted hazard ratio, 1.75 [95% CI, 1.00–3.08]); yet, the association diminished after the addition of other plaque characteristics, and no improvements were observed in C statistics. Conclusions: Presence of intraplaque hemorrhage contributes to the prediction of incident ASCVD in women, beyond traditional cardiovascular risk factors, other plaque components, plaque size, and stenosis.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 75%