Sex based differences in association between plaque burden and ischemia—a CREDENCE trial substudy
European Heart Journal - Cardiovascular Imaging
Abstract
AIMS: Women with coronary artery disease (CAD) typically have less severe stenosis and lower plaque burden than men but have disproportionately high adverse cardiovascular event rate. This study evaluated sex-based differences in quantitative plaque burden and its association with ischemia. METHODS AND RESULTS: A post-hoc exploratory analysis of the CREDENCE trial included 612 symptomatic patients (184 women, 428 men) with suspected stable CAD who underwent CCTA and invasive coronary angiography with fractional flow reserve (FFR) measurements. Total, calcified, and total non-calcified plaque burden and volume were quantified. Ischemia was defined as FFR ≤0.8. Women were older (66.5 ± 9.1 vs. 63.5 ± 10.3 years, p = 0.001) with lower prevalence of smoking. They exhibited less high-risk plaque, shorter lesion length, and lower stenosis severity. Plaque burden and volume were significantly lower in women across all components (all p < 0.05), except for calcified plaque burden. A 5% increase in plaque burden was significantly associated with ischemia in women for total plaque (OR = 1.28, 95% CI [1.12-1.46], p < 0.001), calcified plaque (OR = 1.31, 95% CI [1.10-1.57], p = 0.003), and total non-calcified plaque (OR = 1.33, 95% CI [1.05-1.67], p = 0.017). In men, only total and total non-calcified plaque burden were significant predictors of ischemia. Significant sex interactions were observed for total (p = 0.015) and calcified plaque burden (p = 0.046), indicating differential effects in women and men, but not for diameter stenosis (p = 0.928). CONCLUSION: Despite having a lower overall plaque burden, women exhibit a stronger association between plaque burden and ischemia than men. Further investigation in prospective studies is warranted to better understand potential sex-related differences in CAD.
Authors 38
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Nankai University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden ,
School of Medicine, Nankai University , Tianjin ,
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University of Brawijaya · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden ,
Faculty of Medicine, Universitas Brawijaya , Malang ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Department of Biomedical, Surgical and Dental Sciences, University of Milan , Milan ,
Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan ,
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IRCCS Ospedale Galeazzi - Sant'Ambrogio
Affiliation as printed
Department of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio , Milan ,
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Yonsei University · Severance Hospital · Yonsei University Health System
Affiliation as printed
Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System , Seoul ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Affiliation as printed
School of Medicine, Nankai University , Tianjin ,
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University of Turku · Leiden University Medical Center · Turku University Hospital
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden ,
Turku University Hospital and University of Turku Department of Cardiology, , Turku ,
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Utrecht University · University Medical Center Utrecht
Affiliation as printed
Department of Cardiology, Utrecht University Medical Center , Utrecht ,
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Hanyang University Seoul Hospital · Hanyang University Medical Center · Hanyang University
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Korea College of Medicine, Hanyang University , Seoul ,
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Catholic Kwandong University International St. Mary's Hospital · Catholic Kwandong University
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine , Incheon ,
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Universidade Católica Portuguesa
Affiliation as printed
Faculdade de Medicina da Universidade Católica Portuguesa Unit of Cardiovascular Imaging, , Lisboa ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Pusan National University Hospital
Affiliation as printed
Department of Cardiology, Pusan National University Hospital , Busan ,
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Inje University Ilsan Paik Hospital
Affiliation as printed
Division of Cardiology, Inje University Ilsan Paik Hospital , Goyang ,
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Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine , Chuncheon ,
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Seoul National University · Seoul National University Hospital
Affiliation as printed
Department of Internal Medicine, Seoul National University Hospital , Seoul ,
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Keimyung University Dongsan Hospital · Keimyung University
Affiliation as printed
Cardiovascular Center, Keimyung University Dongsan Hospital , Daegu ,
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Ewha Womans University · Ewha Womans University Seoul Hospital
Affiliation as printed
Division of Cardiology, Department of Internal Medicine, Ewha Women’s University Seoul Hospital , Seoul ,
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Asheville Cardiology Associates
Affiliation as printed
Mobile Cardiology Associates , Mobile, AL ,
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Fondazione Toscana Gabriele Monasterio
Affiliation as printed
Department of Imaging, Fondazione Toscana Gabriele Monasterio , Pisa ,
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Affiliation as printed
Cardiac Center of Texas , McKinney, TX ,
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Fu Wai Hospital · State Key Laboratory of Cardiovascular Disease
Affiliation as printed
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital , Beijing ,
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Fu Wai Hospital · State Key Laboratory of Cardiovascular Disease
Affiliation as printed
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital , Beijing ,
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Affiliation as printed
Houston Methodist Hospital Department of Cardiology, , Houston, TX ,
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Affiliation as printed
Houston Methodist Hospital Department of Cardiology, , Houston, TX ,
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St. Luke's International Hospital
Affiliation as printed
Cardiovascular Center, St. Luke's International Hospital , Tokyo ,
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Medical University of South Carolina
Affiliation as printed
Medical University of South Carolina Division of Cardiovascular Imaging, , Charleston, SC ,
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Affiliation as printed
Saint Luke’s Mid America Heart Institute Department of Cardiology, , Kansas City, MO ,
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Massachusetts General Hospital
Affiliation as printed
Massachusetts General Hospital Department of Cardiology, , Boston, MA ,
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Louisville Metabolic and Atherosclerosis Research Center
Affiliation as printed
Heart Center Research, LLC, Huntsville, AL ,
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Affiliation as printed
Renown Heart and Vascular Institute, Reno, NV ,
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Affiliation as printed
Oconee Heart and Vascular Center, St. Mary's Hospital, Athens, GA ,
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Affiliation as printed
Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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