Postmenopausal women with clogged arteries are at higher risk of heart attacks than men of comparable age, in keeping with research presented at EACVI 2023, a scientific congress of the European Society of Cardiology (ESC), and published in European Heart Journal – Cardiovascular Imaging. The study in nearly 25,000 adults used imaging techniques to look at the arteries and followed patients for heart attacks and death.

The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it’s in men of that age. Since atherosclerotic plaque burden is emerging as a goal to choose the intensity of therapy to forestall heart attacks, the findings may impact treatment. Our results indicate that after menopause, women might have a better dose of statins or the addition of one other lipid-lowering drug. More studies are needed to substantiate these findings.”

Dr. Sophie van Rosendael, Study Writer, Leiden University Medical Centre, the Netherlands

Atherosclerosis is the narrowing of arteries on account of deposits of fat and cholesterol in what known as plaque. While young women do have heart attacks, generally, women develop atherosclerosis later in life than men and have heart attacks at an older age than men, partially due to the protective effect of oestrogen. This study examined whether the prognostic importance of atherosclerotic plaques are the identical for ladies and men at different ages as this may very well be essential for choosing treatments to forestall heart attacks.

The study included 24,950 patients referred for coronary computed tomography angiography (CCTA) and enrolled within the CONFIRM registry, which was conducted in six countries in North America, Europe, and Asia. CCTA is used to acquire 3D images of the arteries in the guts.

Total atherosclerotic burden was rated using the Leiden CCTA rating, which includes the next items for every coronary segment: plaque presence (yes/no), composition (calcified, noncalcified or mixed), location, and severity of narrowing, for a final value of 0 to 42. Patients were divided into three categories previously found to predict the chance myocardial infarction: low atherosclerotic burden (0 to five), medium (6 to twenty) and high (over 20). As well as, obstructive coronary artery disease was defined as 50% narrowing or more.

The first final result was the difference in Leiden CCTA rating between ladies and men of comparable age. The investigators also analysed sex differences within the rates of major hostile cardiovascular events (MACE), which included all-cause death and myocardial infarction, after adjusting for age and cardiovascular risk aspects (hypertension, high cholesterol, diabetes, current smoking and family history of coronary artery disease).

A complete of 11,678 women (average age 58.5 years) and 13,272 men (average age 55.6 years) were followed for 3.7 years. Regarding the first final result, the study showed an roughly 12 12 months delay within the onset of coronary atherosclerosis in women: the median Leiden CCTA risk rating was above zero at age 64 to 68 years in women versus 52 to 56 years in men (p<0.001). As well as, the general plaque burden as quantified by the Leiden CCTA rating was significantly lower in women, who had more non-obstructive disease.

Dr. van Rosendael said: “The outcomes confirm the previously reported delay in the beginning of atherosclerosis in women. We also found that ladies usually tend to have non-obstructive disease. It was formerly thought that only obstructive atherosclerosis caused myocardial infarction but we now know that non-obstructive disease can be dangerous.”

The burden of atherosclerosis was equally predictive of MACE in premenopausal women (aged under 55 years) and men of the identical age group. Nevertheless, in postmenopausal women (age 55 years and older), the chance of MACE was higher than men for a given rating. In postmenopausal women, in comparison with those with a low burden, those with a medium and high burden had 2.21-fold and 6.11-fold higher risks of MACE. While in men aged 55 years and older, in comparison with those with a low burden, those with a medium and high burden had 1.57-fold and a couple of.25-fold greater risks of MACE.

Dr. van Rosendael said: “On this study, the elevated risk for ladies versus men was especially observed in postmenopausal women with the best Leiden CCTA rating. This may very well be partly since the inner diameter of coronary arteries is smaller in women, meaning that the identical amount of plaque could have a bigger impact on blood flow. Our findings link the known acceleration of atherosclerosis development after menopause with a big increase in relative risk for ladies in comparison with men, despite an identical burden of atherosclerotic disease. This may increasingly have implications for the intensity of medical treatment.”

Source:

European Society of Cardiology

Journal reference:

van Rosendael, S. E., et al. (2023) Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography. European Heart Journal – Cardiovascular Imaging. doi.org/10.1093/ehjci/jead094.