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. 2021 Jul;37(7):2311-2321.
doi: 10.1007/s10554-021-02204-4. Epub 2021 Mar 10.

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

Mohammed El Mahdiui  1 , Jeff M Smit  1 , Alexander R van Rosendael  1 , Danilo Neglia  2 , Juhani Knuuti  3 , Antti Saraste  3 , Ronny R Buechel  4 , Anna Teresinska  5 , Maria N Pizzi  6 , Albert Roque  7 , Massimo Magnacca  8 , Bart J Mertens  9 , Chiara Caselli  10 , Silvia Rocchiccioli  10 , Oberdan Parodi  10   11 , Gualtiero Pelosi  10 , Arthur J Scholte  12
Affiliations

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

Mohammed El Mahdiui et al. Int J Cardiovasc Imaging. 2021 Jul.

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.).

Keywords: Coronary artery disease; Coronary computed tomography angiography; Menopause; Sex.

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Conflict of interest statement

The department of Cardiology of Leiden University Medical Center received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. The University Hospital Zurich holds a research agreement with GE Healthcare. Ronny R. Buechel reports receiving speaker honoraria from GE Healthcare. J. Knuuti discloses speaker fees from GE Healthcare, Merck, Lundbeck and Bayer and study protocol consultancy fees from GE Healthcare and AstraZeneca outside of submitted work.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population
Fig. 2
Fig. 2
Plaque changes on a per-lesion analysis shown for women and men. The line graphs represent the estimated average trend from baseline to 12 years for both groups based on a linear mixed modelling, with tests for the systematic between-group differences as well as for differences in trend. Circles represent the estimated mean percentage at the time point the follow-up scan was performed. PAV percentage atheroma volume
Fig. 3
Fig. 3
Quantitative assessment of coronary plaques in a male and female patient at baseline and follow-up. Panel A represents quantitative coronary plaque analysis of a 62-year-old male patient of the mid-left anterior descending artery at baseline (A1) and after 5.4 years follow-up (A2). During follow-up reduction of necrotic core and an increase in fibrous and fibrous fatty can be observed. Panel B represents quantitative coronary plaque analysis of a 58-year-old female patient of the proximal circumflex artery at baseline (B1) and after 5.9 years follow-up (B2). A reduction of necrotic core and the formation of dense calcium can be observed during follow-up. DS diameter stenosis
Fig. 4
Fig. 4
Plaque changes on a per-lesion analysis shown for women and men stratified according to the age group (< 55 vs ≥ 55 years old). The line graphs represent the estimated average trend from baseline to 12 years for both groups based on a linear mixed modelling, with tests for the systematic between-group differences as well as for differences in trend. Circles represent the estimated mean percentage at the time point the follow-up scan was performed. PAV percentage atheroma volume
See this image and copyright information in PMC

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