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. 2023 Aug 23;24(9):1180-1189.
doi: 10.1093/ehjci/jead094.

Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

Sophie E van Rosendael  1 , A Maxim Bax  1 , Fay Y Lin  2 , Stephan Achenbach  3 , Daniele Andreini  4   5 , Matthew J Budoff  6 , Filippo Cademartiri  7 , Tracy Q Callister  8 , Kavitha Chinnaiyan  9 , Benjamin J W Chow  10 , Ricardo C Cury  11 , Augustin J DeLago  12 , Gudrun Feuchtner  13 , Martin Hadamitzky  14 , Joerg Hausleiter  15 , Philipp A Kaufmann  16 , Yong-Jin Kim  17 , Jonathon A Leipsic  18 , Erica Maffei  7 , Hugo Marques  19   20   21 , Pedro de Araújo Gonçalves  19   22 , Gianluca Pontone  4   5 , Gilbert L Raff  9 , Ronen Rubinshtein  23 , Todd C Villines  24 , Hyuk-Jae Chang  25 , Daniel S Berman  26 , James K Min  27 , Jeroen J Bax  1 , Leslee J Shaw  2 , Alexander R van Rosendael  1
Affiliations

Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

Sophie E van Rosendael et al. Eur Heart J Cardiovasc Imaging. .

Erratum in

Abstract

Aims: The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes.

Methods and results: From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P < 0.001). The Leiden CCTA risk score was independently associated with MACE: score 6-20: HR 2.29 (1.69-3.10); score > 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004).

Conclusion: Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.

Keywords: coronary artery disease; coronary computed tomography angiography (CCTA); prognosis; sex differences.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Abbreviations: CCTA, coronary computed tomography angiography; MACE, major adverse cardiovascular event
Figure 1
Figure 1
Stenosis severity according to sex. (A) Sex-based difference in prevalence of no CAD. (B) Sex-based difference in the prevalence of CAD divided by obstructive and non-obstructive. Abbreviations: CAD, coronary artery disease; CCTA, coronary computed tomography angiography.
Figure 2
Figure 2
Median Leiden CCTA score per age category. Sex-based difference in median CCTA risk score per age category (4 years). CCTA, coronary computed tomography angiography.
Figure 3
Figure 3
CCTA risk score by age deciles and sex. Median Leiden CCTA risk score displayed per age decile and sex. CCTA, coronary computed tomography angiography.
Figure 4
Figure 4
Survival curves for women and men per CCTA score category. *Kaplan–Meier figure for men and women according to the different CCTA risk score groups. *N = 17 750. CCTA, coronary computed tomography angiography.
See this image and copyright information in PMC

Comment in

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