In older patients with hardened arteries, women at greater risk for CV events vs. men
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Key takeaways:
- In people with a high burden of atherosclerosis aged 55 years or older, women had greater risk for a heart attack or CV death than men.
- The same was not true in people younger than 55 years.
Among people aged 55 years or older who had a high burden of coronary atherosclerosis, women were at greater risk for a major adverse cardiovascular event than men, researchers reported.
However, among people younger than 55 years who had a high burden of coronary atherosclerosis, the risk for a major adverse CV event did not differ by sex, according to a study presented at the European Association of Cardiovascular Imaging Congress and simultaneously published in European Heart Journal – Cardiovascular Imaging.
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“The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it is in men of that age,” Sophie E. van Rosendael, MD, from Leiden University Medical Centre in the Netherlands, said in a press release. “Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment. Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.”
The researchers analyzed 24,950 patients (11,678 women) from six countries who were referred for coronary CT angiography (CCTA) and included in the CONFIRM registry. The mean age of women was 58.5 years and the mean age of men was 55.6 years.
The researchers calculated the Leiden CCTA score, which incorporates coronary plaque presence, extent, composition, severity and location, for all patients. A score of 0 to 5 was defined as low atherosclerotic burden, a score of 6 to 20 was defined as medium atherosclerotic burden and a score of 21 to 42 was defined as high atherosclerotic burden.
The outcomes of interest were difference in Leiden CCTA score in men and women of similar age and major adverse CV events, defined as CV death or MI. Mean follow-up was 3.7 years.
The age range where the median Leiden CCTA score was above 0 was about 12 years higher in women (64 to 68 years) than in men (52 to 56 years; P < .0001), van Rosendael and colleagues found.
“The results confirm the previously reported delay in the start of atherosclerosis in women,” van Rosendael said in the release. “We also found that women are more likely to have nonobstructive disease. It was formerly thought that only obstructive atherosclerosis caused myocardial infarction, but we now know that nonobstructive disease is also risky.”
Compared with low atherosclerotic burden, medium atherosclerotic burden was associated with major adverse CV events (HR for women = 2.29; 95% CI, 1.69-3.1; HR for men = 1.64; 95% CI, 1.29-2.08), as was high atherosclerotic burden (HR for women = 6.71; 95% CI, 4.36-10.32; HR for men = 2.38; 95% CI, 1.73-3.29), according to the researchers.
In patients with high atherosclerotic burden, the risk for major adverse CV events was higher in women than in men (adjusted P for interaction = .003), they found.
In premenopausal women, the Leiden CCTA score was equally predictive of major adverse CV events as it was in men of a similar age, the researchers wrote.
However, in postmenopausal women, the score’s prognostic value for major adverse CV events was higher than in men of a similar age (HR for women with medium atherosclerotic burden = 2.21; 95% CI, 1.57-3.11; HR for men with medium atherosclerotic burden = 1.57; 95% CI, 1.19-2.09; HR for women with high atherosclerotic burden = 6.11; 95% CI, 3.84-9.7; HR for men with high atherosclerotic burden = 2.25; 95% CI, 1.58-3.22; adjusted P for interaction by sex in those with high atherosclerotic burden = .004), they wrote.
“In this study, the elevated risk for women vs. men was especially observed in postmenopausal women with the highest Leiden CCTA score,” van Rosendael said in the release. “This could be partly because the inner diameter of coronary arteries is smaller in women, meaning that the same amount of plaque could have a larger impact on blood flow. Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment.”
References:
- van Rosendael S, et al. Eur Heart J Cardiovasc Imaging. 2023;doi:10.1093/ehjci/jead094.
- Women with hardened arteries may need stronger treatment to prevent heart attacks than men. www.escardio.org/The-ESC/Press-Office/Press-releases/women-with-hardened-arteries-may-need-stronger-treatment-to-prevent-heart-attack. Published May 11, 2023. Accessed May 12, 2023.
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van Rosendael S, et al. Computerized tomography angiography in the heart of cardiovascular imaging. Presented at: European Association of Cardiovascular Imaging Congress; May 10-12, 2023; Barcelona, Spain.
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