At the Kahn Center, we evaluate men and women similarly and use advanced imaging techniques and lab assessments for precision diagnosis and disease assessment. We recognize women are at risk.
One advance is the use of coronary CT angiography with computer assisted readings like Cleerly Health. Quantitative coronary plaque measures differ in prognostic value between women and men. It remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes.
A
new study compared cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain.
STUDY
Data from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary computed tomography angiography arm was analyzed, quantifying total coronary plaque volume and burden (plaque burden [PB]; % vessel volume), including calcified, noncalcified, and low-attenuation components.
Associations with major adverse cardiovascular events (death, myocardial infarction, or unstable angina hospitalization) were assessed over a median 26 months..
RESULTS:
Among 4267 patients (mean age, 60.4±8.2; 2199 women), plaque was less frequent in women (55% versus 75%; P<0.001), with lower total plaque volume but similar total PB and incident major adverse cardiovascular events (2.3% versus 3.4%).
Major adverse cardiovascular event risk became elevated at lower PB in women than in men: for total PB, hazard ratio crossed 1.0 at 20% in women versus 28% in men, reaching hazard ratio 1.5 at 32% in women versus 42% in men, respectively.
Noncalcified PB showed a similar pattern, crossing hazard ratio 1.0 at 7% in women versus 9% in men; hazard ratio 1.5 at 13% in women versus 20% in men.
Findings were similar after adjustment for atherosclerotic cardiovascular disease risk score.
CONCLUSIONS:
In women, major adverse cardiovascular events appeared to emerge at a lower PB, and to rise more sharply.
Findings support sex-specific interpretation of coronary computed tomography angiography-derived plaque metrics for timely intervention in women.
It is not known why cardiovascular events are higher in women than men at comparable burdens of plaque in the coronary arteries. Arteries tend to be smaller on average in women. Hormonal changes may play a role.
At the Kahn Center, we will continue to take an aggressive approach to disease evaluation in women and work to lower the risk using all reasonable modalities.
