2023-05-11 13:59:59
The study of nearly 25,000 adults used imaging techniques to examine the arteries and followed patients for heart attacks and death. “The data suggest that a given burden of atherosclerosis is more risky in postmenopausal women than in men.” men that age,” says study author Sophie van Rosendael of the Leiden University Medical Center (Netherlands).
“As atherosclerotic plaque burden is becoming a target for deciding the intensity of therapy to prevent myocardial infarctions, 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.”
Atherosclerosis is the narrowing of the arteries due to fatty and cholesterol deposits in what is called plaque. Although young women suffer myocardial infarctions, in general, women develop atherosclerosis later than men and suffer myocardial infarctions at a later age than men,3 partly due to the protective effect of estrogens. examined whether the importance of atherosclerotic plaques is the same for women and men at different ages, as this could be important in selecting treatments to prevent myocardial infarctions.
The study included 24,950 patients referred for coronary computed tomography angiography (CTA) and enrolled in the CONFIRM registry, which was conducted in six countries in North America, Europe, and Asia. CTCA is used to obtain three-dimensional images of the arteries of the heart. Total atherosclerotic burden was assessed using the Leiden ACTC score, which incorporates the following elements for each coronary segment: presence of plaque (yes/no), composition (calcified, noncalcified, or mixed), location, and severity of narrowing, to a final value from 0 to 42.4. Patients were divided into three categories that have previously been shown to predict the risk of myocardial infarction: low (0 to 5), medium (6 to 20), and high (>20) atherosclerotic burden. In addition, obstructive coronary disease was defined as narrowing of 50% or more.
The primary outcome was the difference in the ACTC Leiden score between women and men of similar age. The investigators also analyzed gender differences in rates of major adverse cardiovascular events (MACE), including death from any cause and myocardial infarction, after adjusting for age and cardiovascular risk factors (hypertension, high cholesterol, diabetes, current smoking and family history of coronary heart disease).
A total of 11,678 women (mean age: 58.5 years) and 13,272 men (mean age: 55.6 years) were followed for 3.7 years. For the primary outcome, the study showed a delay of approximately 12 years in the onset of coronary atherosclerosis in women: the median Leiden CCTA risk score was greater than zero at age 64 to 68 years in women vs. to 52 to 56 years in men.
The increased risk in women compared to men was especially observed in postmenopausal women
In addition, the overall plaque burden quantified by the CCTA Leiden score was significantly lower in women, who had more non-obstructive disease. Van Rosendael stated: “The results confirm the previously reported delay in the onset of atherosclerosis in women. We have also observed that women are more likely to have non-obstructive disease. It used to be believed that only obstructive atherosclerosis caused myocardial infarction, but now we know that non-obstructive disease is also at risk.”
Atherosclerosis burden was equally predictive of MACE in premenopausal women (less than 55 years) and in men of the same age group. However, in postmenopausal women (older than 55 years), the risk of MACE was higher than in men for a given score. In postmenopausal women, compared with those with low burden, those with medium and high burden had a 2.21-fold and 6.11-fold increased risk of MACE. In men 55 years and older, compared with low-burden men, medium- and high-burden men had a 1.57- and 2.25-fold increased risk of MACE.
Rosendael believes that “in this study, the increased risk in women compared to men was observed especially in postmenopausal women with the highest ATCC Leiden score.
This could be partly because the inner diameter of the coronary arteries is smaller in women, which means that the same amount of plaque could have a greater impact on blood flow. Our results link the known acceleration of the development of atherosclerosis after menopause with a significantly increased relative risk in women compared with men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment.”
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