Postmenopausal women with clogged arteries are more likely to have heart attacks than men of the same age, according to research presented at EACVI 2023, a scientific conference of the European Society of Cardiology (ESC), and published in the European Heart Journal – Cardiovascular Imaging. The study of nearly 25,000 adults used imaging techniques to scan arteries and followed patients for heart attacks and death.
The study suggests that a certain atherosclerotic burden is more severe in postmenopausal women than in men of that age. As atherosclerotic plaque burden is emerging as a target for determining the intensity of treatment for heart attack prevention, the findings may influence treatment. Our results suggest that after menopause, women may need a higher statin dose or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.”
Dr. Sophie van Rosendael, S.Ptudy writer, Leiden University Medical Centre, The Netherlands
Atherosclerosis is the narrowing of the arteries due to the deposition of fats and cholesterol in what is called plaque. While younger women suffer heart attacks, in general, women develop atherosclerosis later in life than men, and they get heart attacks at an older age than men, in part because of the protective effect of estrogen. This study examined whether the prognostic significance of atherosclerotic plaques is the same for women and men of different ages as this may be important for choosing treatments to prevent heart attacks.
The study included 24,950 patients who were referred for computed tomography coronary angiography (CCTA) and enrolled in the CONFIRM registry, which was performed in six countries in North America, Europe and Asia. CCTA is used to obtain 3D images of the arteries in the heart.
The overall burden of atherosclerosis was graded using the Leiden CCTA score, which includes the following items for each coronal segment: presence of plaque (yes/no), composition (calcified, non-calcified or mixed), location, and severity of stenosis. For a final value the patients were divided into Three categories have been previously found to predict myocardial infarction risk: low (0 to 5), moderate (6 to 20) and high (more than 20) atherosclerotic burden. In addition, obstructive coronary artery disease was defined as a stenosis of 50% or greater.
The primary outcome was the difference in the Leiden CCTA score between women and men of the same age. The researchers also analyzed gender differences in rates of major adverse cardiovascular events (MACE), which included all causes of death and myocardial infarction, after adjusting for age and cardiovascular risk factors (high blood pressure, high cholesterol, diabetes, current smoking and family history). injury). 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. With regard to the primary outcome, the study showed a delay of about 12 years in the onset of Coronary arteriosclerosis In women: The mean Leiden CCTA risk score was above zero at ages 64 to 68 years in women versus 52 to 56 years in men (P < 0.001). In addition, total plaque burden as quantified by the Leiden CCTA score was significantly lower in women, who had more non-obstructive disease.
Dr van Roosendael said: “The results confirm the previously reported delay in the onset of atherosclerosis in women. We also found that women are more likely to have non-occlusive disease. It was previously thought that only obstructive atherosclerosis caused myocardial infarctions but we do know Now that non-obstructive disease is also a risk.”
Atherosclerotic burden was equally predictive of MACE in premenopausal women (those <55 years of age) and men of the same age group. However, in postmenopausal women (55 years and older), the risk of MACE was higher than in men to a certain degree. In postmenopausal women, compared to women with low burden, women with medium and high burden had a 2.21-fold and 6.11-fold higher risk of MACE. Whereas in men aged 55 years and over, compared with those with low burden, those with medium and high burden had a 1.57-fold and 2.25-fold greater risk of developing MACE.
Dr van Roosendael said: “In this study, the higher risk among women and men was particularly observed in postmenopausal women with the highest CCTA Leiden score. This could be in part because the inner diameter of the coronary arteries is smaller in women, which means that it can The same amount of plaque has a greater effect on blood flow.Our findings link the known acceleration of the development of atherosclerosis after menopause with a significantly increased relative risk for women compared to men, despite a similar burden of atherosclerotic disease.This may have implications for the severity of The medical treatment “.
Van Rosendael, SE, et al. (2023) Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary tomography. European Journal of Cardiology – Cardiovascular Imaging. doi.org/10.1093/ehjci/jead094.