Sex Differences in Culprit Plaque Characteristics Among Different Age Groups in Patients With Acute Coronary Syndromes

Abstract

Background: Despite the significant decline in cardiovascular mortality in women over the past several decades, sex differences in the underlying pathology of acute coronary syndromes remain poorly understood. Previous postmortem studies have demonstrated sex differences in coronary plaque morphology with a higher prevalence of plaque erosion in young women and more plaque rupture in older women after menopause, whereas men showed no increase in prevalence of plaque rupture with age. However, in vivo data are limited. Methods: This study included patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging of the culprit lesion. The culprit plaque was categorized as plaque rupture, plaque erosion or culprit plaque with calcification, and stratified by age. Features of plaque vulnerability at culprit lesion were also analyzed. Results: In 1368 patients (women=286), women and men had a similar distribution of culprit plaque morphology (plaque rupture versus plaque erosion). However, significant sex differences were found in the underlying mechanisms of acute coronary syndrome among different age groups: women showed a significant ascending trend with age in plaque rupture ( P <0.001) and the features of plaque vulnerability such as lipid plaque ( P <0.001), thin-cap fibroatheroma ( P =0.005), and microstructures including macrophages, cholesterol crystals, and calcification ( P =0.026). No trend was observed in men. Conclusions: Age related sex differences in culprit plaque morphology and vulnerability were identified in patients with acute coronary syndrome: prevalence of plaque rupture and vulnerability increased with age in women but not in men. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01110538 and NCT03479723.

Sex Differences in Coronary Atherosclerotic Phenotype and Healing Pattern on Optical Coherence Tomography Imaging

“…33 Plaque erosion has been identified as the dominant underlying pathology in young women with ACS. 12,13 Plaque Instability and Plaque Healing…”

“…Women show less obstructive coronary artery disease on angiogram, and plaque erosion has been found more frequently in younger women. 11–13 Moreover, men with ACS exhibited significantly higher levels of pericoronary adipose tissue attenuation at the culprit plaque and all 3 major coronary arteries levels, indicating a higher level of vascular inflammation. 14 Postmortem studies in men showed a higher prevalence of disrupted pattern in healed plaques, suggesting previous plaque ruptures as a predominant mechanism for plaque progression in men.…”

Differences in coronary angiographic findings and outcomes between men and postmenopausal women with stable chest pain

“…An autopsy study showed that women had a greater frequency of plaque erosion and distal microvascular embolization, as well as a greater rate of embolization independent of thrombus type or presence of necrosis, than men [31,32]. A recent study showed that plaque rupture and vulnerability increased with age in women but not in men [33].…”

Sex-Specific Associations of the Plasma-Proteome with incident Coronary Artery Disease

“…12 Regarding the latter, differences are observed in plaque composition, vulnerability, and burden between men and women, pointing toward a respectively more atheromatous versus fibrous phenotype. [13][14][15] The plasma proteome reflects the dynamic biological state, which, prior to disease, may provide insight into the mechanisms of (sex-specific) CAD onset. The UK Biobank is a largescale biomedical healthcare database comprising population-scale data of 2,922 unique plasma proteins in 54,219 individuals.…”