Sex differences in coronary plaque changes assessed by serial computed tomography angiography

Abstract

Long-term data on sex-differences in coronary plaque changes over time is lacking in a low-to-intermediate risk population of stable coronary artery disease (CAD). The aim of this study was to evaluate the role of sex on long-term plaque progression and evolution of plaque composition. Furthermore, the influence of menopause on plaque progression and composition was also evaluated. Patients that underwent a coronary computed tomography angiography (CTA) were prospectively included to undergo a follow-up coronary CTA. Total and compositional plaque volumes were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). To investigate the influence of menopause on plaque progression, patients were divided into two groups, under and over 55 years of age. In total, 211 patients were included in this analysis, 146 (69%) men. The mean interscan period between baseline and follow-up coronary CTA was 6.2 ± 1.4 years. Women were older, had higher HDL levels and presented more often with atypical chest pain. Men had 434 plaque sites and women 156. On a per-lesion analysis, women had less fibro-fatty PAV compared to men (β -1.3 ± 0.4%; p < 0.001), with no other significant differences. When stratifying patients by 55 years age threshold, fibro-fatty PAV remained higher in men in both age groups (p < 0.05) whilst women younger than 55 years demonstrated more regression of fibrous (β -0.8 ± 0.3% per year; p = 0.002) and non-calcified PAV (β -0.7 ± 0.3% per year; p = 0.027). In a low-to-intermediate risk population of stable CAD patients, no significant sex differences in total PAV increase over time were observed. Fibro-fatty PAV was lower in women at any age and women under 55 years demonstrated significantly greater reduction in fibrous and non-calcified PAV over time compared to age-matched men. (ClinicalTrials.gov number, NCT04448691.)

Quantitative and qualitative features of carotid and coronary atherosclerotic plaque among men and women

“…In addition, through CCTA it is possible to understand the female-specific coronary plaque phenotype, which partially explains the epidemiological data mentioned above. Women before menopause tend to have lower CAC score, less high-risk plaque features, less plaque volume, less obstructive CAD ( 27 ) and greater fibrous and non-calcified PAV regression ( 31 ). After menopause, the literature seems to identify a different female-specific coronary plaque phenotype, which tends to be more similar to that one of men: Less non-calcified PAV regression ( 31 ) and smaller number but larger size and higher density of calcified plaque ( 30 ), progressively matching, with a 9-year delay, the total coronary atherosclerotic burden of men ( 33 ).…”

“…Women before menopause tend to have lower CAC score, less high-risk plaque features, less plaque volume, less obstructive CAD ( 27 ) and greater fibrous and non-calcified PAV regression ( 31 ). After menopause, the literature seems to identify a different female-specific coronary plaque phenotype, which tends to be more similar to that one of men: Less non-calcified PAV regression ( 31 ) and smaller number but larger size and higher density of calcified plaque ( 30 ), progressively matching, with a 9-year delay, the total coronary atherosclerotic burden of men ( 33 ). Additionally, taken into consideration that non-calcified PV seems to be influenced mainly by environmental factors, while CAC and calcified PV are linked to genetics ( 55 ), CCTA might be a useful tool to early detect non-calcified plaque in order to start an early lifestyle intervention, thus preventing coronary plaque formation.…”

“…Additionally, El Mahdiui et al ( 31 ) in their study evaluated plaque composition by serial CTA taking into consideration the influence of menopause. What they demonstrated is that men had more fibrofatty percentage atheroma volume (PAV), but pre-menopausal women, younger than 55 years, had greater regression of fibrous and non-calcified PAV over time compared to men of the same age, and given the positive association between non-calcified plaques with ischemia and ACS, these findings are in agreement with the lower risk of symptomatic CAD in young women ( 32 ).…”

A specific plasma lipid signature associated with high triglycerides and low HDL cholesterol identifies residual CAD risk in patients with chronic coronary syndrome

“…The study population was identified within the SMARTool (Simulation Modeling of coronary Artery disease: a tool for clinical decision support) study [20][21][22][23][24][25]. In brief, stable patients with CCS undergoing baseline coronary CTA as part of the EVINCI (Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease; FP7-222915) or ARTreat (Multilevel patient-specific artery and atherogenesis model for outcome prediction, decision support treatment, and virtual hand-on training; FP7-224297) studies, were prospectively enrolled in the SMARTool study and submitted to clinical, molecular and coronary CTA re-evaluation at follow-up (interscan period 6.39 ± 1.17 years).…”

The association of sex-specific hormones with coronary artery plaque characteristics from Miami Heart (MiHeart) study

“…Women develop coronary artery disease (CAD) almost a decade later than men [5] , [6] , [7] . It is also well documented that CAD manifests differently in women compared to men in terms of plaque composition, morphology and vulnerability [8] , [9] , [10] . A recent study on sex differences in CCTA-based plaque volume found low fibrofatty atheroma plaque volume in women compared to men [10] .…”