Atherosclerosis is the narrowing of arteries due to deposits of fat and cholesterol in what is called plaque, often called coronary heart disease (CHD). While young women do have heart attacks, in general, women develop CHD later in life than men and have heart attacks at an older age than men, in part because of the protective effect of estrogen.
A new study examined whether the prognostic importance of atherosclerotic plaques are the same for women and men at different ages as this could be important for selecting treatments to prevent heart attacks.
The amount of CAD was measured from coronary computed tomography angiography (CCTA), a non-invasive but highly accurate way to assess the burden of plaque in heart arteries.
From a large multi-center CCTA registry the "Leiden CCTA score" was calculated in 24, 950 individuals. A total of 11,678 women (avg age 58 years) and 13,272 men (56 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).
The Leiden CCTA risk score was independently associated with MACE like death and heart attack. The risk was significantly higher for women within the highest score group.
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 than men.
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.
One of the authors commented "Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.
Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment."