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Observational Study
. 2015 May;16(5):490-9.
doi: 10.1093/ehjci/jeu281. Epub 2014 Dec 23.

Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: a study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry

Yuka Otaki  1 , Heidi Gransar  1 , Victor Y Cheng  2 , Damini Dey  3 , Troy Labounty  1 , Fay Y Lin  4 , Stephan Achenbach  5 , Mouaz Al-Mallah  6 , Matthew J Budoff  7 , Filippo Cademartiri  8 , Tracy Q Callister  9 , Hyuk-Jae Chang  10 , Kavitha Chinnaiyan  11 , Benjamin J W Chow  12 , Augustin Delago  13 , Martin Hadamitzky  14 , Joerg Hausleiter  14 , Philipp Kaufmann  15 , Erica Maffei  8 , Gilbert Raff  11 , Leslee J Shaw  16 , Todd C Villines  17 , Allison Dunning  18 , Ricardo C Cury  19 , Gudrun Feuchtner  20 , Yong-Jin Kim  21 , Jonathon Leipsic  22 , Daniel S Berman  2 , James K Min  23
Affiliations
Observational Study

Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: a study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry

Yuka Otaki et al. Eur Heart J Cardiovasc Imaging. 2015 May.

Abstract

Objective: Prior studies examining coronary atherosclerosis in the young have been limited by retrospective analyses in small cohorts. We examined the relationship between cardiovascular risk factors (RFs) and prevalence and severity of coronary atherosclerosis in a large, prospective, multinational registry of consecutive young individuals undergoing coronary computerized tomographic angiography (CCTA).

Method and results: Of 27 125 patients undergoing CCTA, 1635 young (<45 years) individuals without known coronary artery disease (CAD) or coronary anomalies were identified. Coronary plaque was assessed for any CAD, obstructive CAD (≥50% stenosis), and presence of calcified plaque (CP) and non-calcified plaque (NCP). Among 1635 subjects (70% men, age 38 ± 6 years), any CAD, obstructive CAD, CP, and NCP were observed in 19, 4, 5, and 8%, respectively. Compared with women, men demonstrated higher rates of any CAD (21 vs. 12%, P < 0.001), CP (6 vs. 3%, P = 0.01), and NCP (9 vs. 5%, P = 0.008), although no difference was observed for rates of obstructive CAD (5 vs. 4%, P = 0.46). Any CAD, obstructive CAD, and NCP were higher for young individuals with diabetes, hypertension, dyslipidaemia, current smoking, or family history of CAD; while only diabetes and dyslipidaemia were associated with CP. Increasing cardiovascular RFs was associated with a greater prevalence and extent and severity of CAD, with individuals with 0, 1, 2, ≥3 RFs manifesting a dose-response increase in any CAD (P < 0.001, for trend), obstructive CAD (P < 0.001, for trend), NCP (P < 0.001, for trend), and CP (P < 0.001, for trend). In multivariable analysis adjusting for sex and cardiovascular RFs, male sex was the strongest predictor for any CAD (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.43-2.66, P < 0.001), CP (OR = 1.46, 95% CI = 1.08-1.98, P = 0.01), and NCP (OR = 1.33, 95% CI = 1.06-1.67, P = 0.01); family history of CAD was the strongest predictor for obstructive CAD (OR = 2.71, 95% CI = 1.65-4.45, P < 0.001).

Conclusion: Any and obstructive CAD is present in 1 in 5 and 1 in 20 young individuals, respectively, with family history associated with the greatest risk of obstructive CAD.

Keywords: coronary CT angiography; coronary artery disease; coronary risk factors; young adults.

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Figures

Figure 1
Figure 1
Association between coronary atherosclerosis and number of cardiovascular RFs for (A) the entire study cohort, (B) for male subjects, and (C) for female subjects. CAD, coronary artery disease; obst CAD, obstructive coronary artery disease, pre CP, presence of calcified plaque; pre NCP, presence of non-calcified plaque.
Figure 2
Figure 2
Association between coronary atherosclerosis and number of cardiovascular RFs among asymptomatic patients according to (A) the entire study cohort, (B) for male subjects, and (C) for female subjects.
Figure 3
Figure 3
Association between coronary atherosclerosis and number of cardiovascular RFs among symptomatic patients according to (A) the entire study cohort, (B) for male subjects, and (C) for female subjects. CAD, coronary artery disease; obst CAD, obstructive coronary artery disease; pre CP, presence of calcified plaque; pre NCP, presence of non-calcified plaque.
See this image and copyright information in PMC

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