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

International journal of cardiac imaging, vol. 37, pp. 2311–2321

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.).

Authors 17

1. Mohammed El Mahdiui Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

2. Jeff M. Smit Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

3. Alexander R. van Rosendael Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

4. Danilo Neglia

   Fondazione Toscana Gabriele Monasterio

   Affiliation as printed

   Fondazione Toscana Gabriele Monasterio, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy

5. Juhani M. Knuuti

   University of Turku · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland

6. Antti Saraste

   University of Turku · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland

7. Ronny R. Buechel

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland

8. Anna Teresińska

   Institute of Cardiology

   Affiliation as printed

   National Institute of Cardiology, Warsaw, Poland

9. Maria Nazarena Pizzi

   Vall d'Hebron Hospital Universitari

   Affiliation as printed

   Department of Cardiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain

10. Albert Roque

    Vall d'Hebron Hospital Universitari

    Affiliation as printed

    Department of Radiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain

11. Massimo Magnacca
    Affiliation as printed

    ASL12 U.O.C. Cardiologia, Viareggio, Italy

12. Bart J.A. Mertens Aachen Department of Medical Statistics

    Leiden University Medical Center

    Affiliation as printed

    Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands

13. Chiara Caselli

    Istituto di Fisiologia Clinica

    Affiliation as printed

    Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy

14. Silvia Rocchiccioli

    Istituto di Fisiologia Clinica

    Affiliation as printed

    Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy

15. Oberdan Parodi

    Istituto di Scienza e Tecnologie dell'Informazione "Alessandro Faedo" · Istituto di Fisiologia Clinica · National Research Council

    Affiliation as printed

    Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy

    Institute of Information Science and Technologies CNR, Pisa, Italy

16. Gualtiero Pelosi

    Istituto di Fisiologia Clinica

    Affiliation as printed

    Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy

17. Arthur J.H.A. Scholte corresponding Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. A.J.H.A.Scholte@lumc.nl

    Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands