Sex Differences in Associations of Arterial Compliance With Coronary Artery Plaque and Calcification Burden

Abstract

BackgroundCoronary artery disease is a leading killer of women. Arterial stiffness predicts myocardial infarction, and postmenopausal women have lower arterial compliance (AC) than men. We hypothesized that lower AC would be associated with greater burden of coronary artery plaque and calcification, and that these associations would be stronger in women than men.Methods and ResultsWe evaluated 3639 consecutive adults without coronary artery disease history who had coronary computed tomography between 2006 and 2014. Coronary artery calcification was calculated using the Agatston method. Plaque extent was assessed by the number of arterial segments with visible plaque divided by the number of visualized segments ×100 (percent plaque score). Indexed AC was calculated as stroke volume index/central pulse pressure. We used step‐wise multivariable linear regression to assess associations of log indexed AC with log (percent plaque score+1) and log (coronary artery calcification+1). Sex‐specific models were performed if the interaction sex×AC was significant. Mean age was 57±11 years, 53% were men, and 71% were hypertensive. Interaction term sex×AC was significant for both models (P=0.008 for percent plaque score and 0.022 for coronary artery calcification). Lower indexed AC was associated with higher percent plaque score and coronary artery calcification in women (β±SE: −0.231±0.113, P=0.042 and −0.334±0.166, P=0.044, respectively), but not in men (β±SE: −0.062±0.104, P=0.551 and 0.114±0.173, P=0.510, respectively).ConclusionsLower AC is associated with greater burden of coronary artery plaque and calcification in women, but not in men. Our findings highlight low AC as a correlate of more‐advanced coronary artery disease and as a potential link to the worse cardiovascular outcomes in women.

Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study

“…Yet, even in high functioning healthcare systems such as Sweden and the UK there appear to be systematic differences in the use of evidence-based medicine that disadvantages women 8. However, the QIs did not fully explain the sex differences in survival following AMI, and we also acknowledge sex differences in symptomatology, health-seeking behaviour4 5; comorbidity burden,7 vascular physiology, incidence of MINOCA6; and pharmacokinetics and pharmacodynamics 29…”

“…For acute myocardial infarction (AMI), women have higher early mortality rates and lower longer term survival than men 2 3. Women with AMI are more likely to have non-chest pain symptoms,4 longer delays in seeking medical care following symptom onset,5 myocardial infarction with non-obstructive coronary arteries (MINOCA)6 and a different comorbidity burden 7. However, such factors may not fully explain their disadvantaged outcomes.…”

Sex differences in mechanisms of arterial stiffness

“…In addition, recent studies have demonstrated sex differences in the effects of arterial compliance on the development and impact of coronary artery disease. Specifically, lower arterial compliance (indicative of elevated arterial stiffness) is associated with a higher burden of coronary artery plaque and calcification in women not men (Coutinho et al, ). Furthermore, lower arterial compliance was also associated with impaired coronary microvascular function, as measured by myocardial flow reserve in women not men (Coutinho et al, ).…”

“…Women also develop greater increases in pulse pressure and arterial stiffness with aging, at least some of which appears to be independent of body and aortic size (Coutinho, Borlaug, Pellikka, Turner, & Kullo, ; Dart et al, ; Mitchell et al, ). In addition, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction are the more commonly diagnosed forms of CVD in women and are associated with elevated arterial stiffness in women (Beale, Meyer, Marwick, Lam, & Kaye, ; Coutinho et al, ; Coutinho, Yam, Chow, Dwivedi, & Inacio, ). Overall, substantial sex differences are observed in the development of arterial stiffness, not only in the timing but also in the setting of CVD risk factors such as diabetes mellitus and obesity.…”

Determinants of change in blood pressure in Ghana: Longitudinal data from WHO-SAGE Waves 1–3

“…It is noteworthy that the current study reports of a dramatic increase in voluntary health insurance between W1 and W3. Along with CHPs, the Ministry of Health, in 2005, introduced the regenerative health and nutrition programme (RHNP) as part of its effort to curb the rising trend of NCDs [65,70] while, in 2014, the ministry collaborated with the Novartis Foundation to launch the community-based hypertension improvement program (ComHIP). This program continues to conduct community-based BP screening and BP monitoring in many parts of the country [41].…”