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

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) – atherosclerotic plaque burden - 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 women and men. Methods From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24,950 men and women. This score incorporates plaque extent, severity, location and composition into a single value, and was divided into 3 risk groups as described previously. Median Leiden CCTA score values were modeled per increasing age to assess the delay in onset of plaque in women. Further, sex-differences in the prognostic value for major adverse cardiac events (MACE, myocardial infarction or all-cause death) were investigated using multivariable cox regression analysis, adjusted for age and cardiovascular risk factors. Sex specific differences in prognostic importance are evaluated with interactions, including a pre-defined age threshold of ≥55 years indicating menopause. Results A total of 11,678 women (age 58.5 ± 12.4 years) and 13,272 men (age 55.6 ± 12.5 years) were followed for 3.7 years. The age where the median Leiden CCTA risk score was above zero was 12 years higher in women versus men (64–68 yr in women vs 52–56 yr in men, 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 risk group (adjusted p-interaction = 0.003). In pre-menopausal women, the Leiden CCTA risk score was equally predictive comparable with men. In postmenopausal women, the prognostic value was higher for women, especially in the highest Leiden CCTA risk score (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 of the medical treatment intensity.