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Relationship between sexual differences and cardiovascular risk factors in the prevalence of asymptomatic coronary disease

Published:November 18, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.022

      Highlights

      • A total of 6434 asymptomatic subjects without known CAD underwent CCTA.
      • The prevalence of CAD (stenosis ≥50%) were compared by sex according to the number of conventional cardiovascular risk factors.
      • There were 1740 women (27.0%) and 4694 men (73.0%) in the study.
      • Asymptomatic CAD was identified in 65 women (3.7%) and 429 men (9.1%), and the association was significant (P < 0.001).
      • As the number of risk factors increased, the risk difference gap in women and men decreased. (P interaction <0.001).

      Abstract

      Background

      This study investigated the sexual differences of coronary artery disease (CAD) prevalence and its association with cardiovascular risk factors in the asymptomatic population.

      Methods

      In total 6434 asymptomatic participants without known CAD (1740 women and 4694 men) underwent coronary computed tomography angiography (CCTA). The prevalence of significant CAD (diameter stenosis ≥50%) and other CCTA findings were compared by sex, and its influence on CAD was investigated in groups stratified by the number of cardiovascular risk factors, including age (>55 years), hypertension, diabetes, dyslipidemia, and current smoking.

      Results

      The prevalence of current smokers, hypertension, and diabetes were higher in men than women. The mean coronary artery calcium score was 13.1 ± 58.4 for women and 51.1 ± 158.2 for men; the coronary atherosclerosis burden indices were significantly higher in men than women. Significant CAD was identified in 65 women (3.7%) and 429 men (9.1%), showing a significant association (adjusted odds ratio [OR] 2.38, P < 0.001). The relatively higher risk for significant CAD in men was observed in patients with fewer risk factors, and the risk difference was not significant in patients with many risk factors (adjusted ORs: 7.69, 3.37, 1.71, 1.31, and 0.88 in patients with 0, 1, 2, 3, and 4–5 risk factors, respectively). The association between sex and risk factor groups was significant (P < 0.001).

      Conclusions

      In the asymptomatic population, a significantly higher CAD prevalence was noted in men than women. However, women with a high number of cardiovascular risk factors showed a CAD prevalence similar to that of men.

      Keywords

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      References

        • Roth G.A.
        • Johnson C.
        • Abajobir A.
        • Abd-Allah F.
        • Abera S.F.
        • Abyu G.
        • Ahmed M.
        • Aksut B.
        • Alam T.
        • Alam K.
        • Alla F.
        • Alvis-Guzman N.
        • Amrock S.
        • Ansari H.
        • Ärnlöv J.
        • Asayesh H.
        • Atey T.M.
        • Avila-Burgos L.
        • Awasthi A.
        • Banerjee A.
        • Barac A.
        • Bärnighausen T.
        • Barregard L.
        • Bedi N.
        • Belay Ketema E.
        • Bennett D.
        • Berhe G.
        • Bhutta Z.
        • Bitew S.
        • Carapetis J.
        • Carrero J.J.
        • Malta D.C.
        • Castañeda-Orjuela C.A.
        • Castillo-Rivas J.
        • Catalá-López F.
        • Choi J.-Y.
        • Christensen H.
        • Cirillo M.
        • Cooper L.
        • Criqui M.
        • Cundiff D.
        • Damasceno A.
        • Dandona L.
        • Dandona R.
        • Davletov K.
        • Dharmaratne S.
        • Dorairaj P.
        • Dubey M.
        • Ehrenkranz R.
        • El Sayed Zaki M.
        • Faraon E.J.A.
        • Esteghamati A.
        • Farid T.
        • Farvid M.
        • Feigin V.
        • Ding E.L.
        • Fowkes G.
        • Gebrehiwot T.
        • Gillum R.
        • Gold A.
        • Gona P.
        • Gupta R.
        • Habtewold T.D.
        • Hafezi-Nejad N.
        • Hailu T.
        • Hailu G.B.
        • Hankey G.
        • Hassen H.Y.
        • Abate K.H.
        • Havmoeller R.
        • Hay S.I.
        • Horino M.
        • Hotez P.J.
        • Jacobsen K.
        • James S.
        • Javanbakht M.
        • Jeemon P.
        • John D.
        • Jonas J.
        • Kalkonde Y.
        • Karimkhani C.
        • Kasaeian A.
        • Khader Y.
        • Khan A.
        • Khang Y.-H.
        • Khera S.
        • Khoja A.T.
        • Khubchandani J.
        • Kim D.
        • Kolte D.
        • Kosen S.
        • Krohn K.J.
        • Kumar G.A.
        • Kwan G.F.
        • Lal D.K.
        • Larsson A.
        • Linn S.
        • Lopez A.
        • Lotufo P.A.
        • El Razek H.M.A.
        • Malekzadeh R.
        • Mazidi M.
        • Meier T.
        • Meles K.G.
        • Mensah G.
        • Meretoja A.
        • Mezgebe H.
        • Miller T.
        • Mirrakhimov E.
        • Mohammed S.
        • Moran A.E.
        • Musa K.I.
        • Narula J.
        • Neal B.
        • Ngalesoni F.
        • Nguyen G.
        • Obermeyer C.M.
        • Owolabi M.
        • Patton G.
        • Pedro J.
        • Qato D.
        • Qorbani M.
        • Rahimi K.
        • Rai R.K.
        • Rawaf S.
        • Ribeiro A.
        • Safiri S.
        • Salomon J.A.
        • Santos I.
        • Santric Milicevic M.
        • Sartorius B.
        • Schutte A.
        • Sepanlou S.
        • Shaikh M.A.
        • Shin M.-J.
        • Shishehbor M.
        • Shore H.
        • Silva D.A.S.
        • Sobngwi E.
        • Stranges S.
        • Swaminathan S.
        • Tabarés-Seisdedos R.
        • Tadele Atnafu N.
        • Tesfay F.
        • Thakur J.S.
        • Thrift A.
        • Topor-Madry R.
        • Truelsen T.
        • Tyrovolas S.
        • Ukwaja K.N.
        • Uthman O.
        • Vasankari T.
        • Vlassov V.
        • Vollset S.E.
        • Wakayo T.
        • Watkins D.
        • Weintraub R.
        • Werdecker A.
        • Westerman R.
        • Wiysonge C.S.
        • Wolfe C.
        • Workicho A.
        • Xu G.
        • Yano Y.
        • Yip P.
        • Yonemoto N.
        • Younis M.
        • Yu C.
        • Vos T.
        • Naghavi M.
        • Murray C.
        Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.
        J. Am. Coll. Cardiol. 2017; 70: 1-25https://doi.org/10.1016/j.jacc.2017.04.052
        • Knuuti J.
        • Wijns W.
        • Saraste A.
        • Capodanno D.
        • Barbato E.
        • Funck-Brentano C.
        • Prescott E.
        • Storey R.F.
        • Deaton C.
        • Cuisset T.
        • Agewall S.
        • Dickstein K.
        • Edvardsen T.
        • Escaned J.
        • Gersh B.J.
        • Svitil P.
        • Gilard M.
        • Hasdai D.
        • Hatala R.
        • Mahfoud F.
        • Masip J.
        • Muneretto C.
        • Valgimigli M.
        • Achenbach S.
        • Bax J.J.
        ESC guidelines for the diagnosis and management of chronic coronary syndromes.
        Eur. Heart J. 2019; 41: 407-477https://doi.org/10.1093/eurheartj/ehz425
        • Douglas P.S.
        • Hoffmann U.
        • Patel M.R.
        • Mark D.B.
        • Al-Khalidi H.R.
        • Cavanaugh B.
        • Cole J.
        • Dolor R.J.
        • Fordyce C.B.
        • Huang M.
        • Khan M.A.
        • Kosinski A.S.
        • Krucoff M.W.
        • Malhotra V.
        • Picard M.H.
        • Udelson J.E.
        • Velazquez E.J.
        • Yow E.
        • Cooper L.S.
        • Lee K.L.
        Outcomes of anatomical versus functional testing for coronary artery disease.
        N. Engl. J. Med. 2015; 372: 1291-1300https://doi.org/10.1056/NEJMoa1415516
        • The SCOT-HEART Investigators
        Coronary CT angiography and 5-year risk of myocardial infarction.
        N. Engl. J. Med. 2018; 379: 924-933https://doi.org/10.1056/NEJMoa1805971
        • Moon S.J.
        • Chun E.J.
        • Yoon Y.E.
        • Park K.S.
        • Jang H.C.
        • Lim S.
        Long-term prognostic value of coronary computed tomography angiography in an asymptomatic elderly population.
        J. Am. Heart Assoc. 2019; 8https://doi.org/10.1161/JAHA.119.013523
        • Crea F.
        • Battipaglia I.
        • Andreotti F.
        Sex differences in mechanisms, presentation and management of ischaemic heart disease.
        Atherosclerosis. 2015; 241: 157-168https://doi.org/10.1016/j.atherosclerosis.2015.04.802
        • Baldassarre L.A.
        • Raman S.V.
        • Min J.K.
        • Mieres J.H.
        • Gulati M.
        • Wenger N.K.
        • Marwick T.H.
        • Bucciarelli-Ducci C.
        • Bairey Merz C.N.
        • Itchhaporia D.
        • Ferdinand K.C.
        • Pepine C.J.
        • Walsh M.N.
        • Narula J.
        • Shaw L.J.
        Noninvasive imaging to evaluate women with stable ischemic heart disease.
        JACC Cardiovasc. Imag. 2016; 9: 421-435https://doi.org/10.1016/j.jcmg.2016.01.004
        • Garcia M.
        • Mulvagh S.L.
        • Bairey Merz C.N.
        • Buring J.E.
        • Manson J.E.
        Cardiovascular disease in women: clinical perspectives.
        Circ. Res. 2016; 118: 1273-1293
        • Paulus J.K.
        • Shah N.D.
        • Kent D.M.
        All Else being equal, men and women are still not the same: using risk models to understand gender disparities in care.
        Circ. Cardiovasc. Qual. Outcomes. 2015; 8: 317-320https://doi.org/10.1161/CIRCOUTCOMES.115.001842
        • Park G.-M.
        • Cho Y.-R.
        • Lee S.-W.
        • Yun S.-C.
        • Won K.-B.
        • Ann S.H.
        • Kim Y.-G.
        • Kim S.-J.
        • Roh J.-H.
        • Kim Y.-H.
        • Yang D.H.
        • Kang J.-W.
        • Lim T.-H.
        • Jung C.H.
        • Koh E.H.
        • Lee W.J.
        • Kim M.-S.
        • Lee K.-U.
        • Park J.-Y.
        • Kim H.-K.
        • Choe J.
        • Lee S.-G.
        Prediabetes is not a risk factor for subclinical coronary atherosclerosis.
        Int. J. Cardiol. 2017; 243: 479-484https://doi.org/10.1016/j.ijcard.2017.05.073
        • Goff D.C.
        • Lloyd-Jones D.M.
        • Bennett G.
        • Coady S.
        • D’Agostino R.B.
        • Gibbons R.
        • Greenland P.
        • Lackland D.T.
        • Levy D.
        • O’Donnell C.J.
        • Robinson J.G.
        • Schwartz J.S.
        • Shero S.T.
        • Smith S.C.
        • Sorlie P.
        • Stone N.J.
        • Wilson P.W.F.
        ACC/AHA guideline on the assessment of cardiovascular risk.
        J. Am. Coll. Cardiol. 2013; 63: 2935-2959https://doi.org/10.1016/j.jacc.2013.11.005
        • Yang D.H.
        • Kang S.-J.
        • Koo H.J.
        • Chang M.
        • Kang J.-W.
        • Lim T.-H.
        • Baek S.
        • Han S.
        • Lee P.H.
        • Roh J.-H.
        • Ahn J.-M.
        • Park D.-W.
        • Lee S.-W.
        • Lee C.W.
        • Park S.-W.
        • Park S.-J.
        • Mintz G.S.
        • Kim Y.-H.
        Coronary CT angiography characteristics of OCT-defined thin-cap fibroatheroma: a section-to-section comparison study.
        Eur. Radiol. 2018; 28: 833-843https://doi.org/10.1007/s00330-017-4992-8
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J. Am. Coll. Cardiol. 1990; 15: 827-832https://doi.org/10.1016/0735-1097(90)90282-T
        • Leber A.W.
        • Becker A.
        • Knez A.
        • von Ziegler F.
        • Sirol M.
        • Nikolaou K.
        • Ohnesorge B.
        • Fayad Z.A.
        • Becker C.R.
        • Reiser M.
        • Steinbeck G.
        • Boekstegers P.
        Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system.
        J. Am. Coll. Cardiol. 2006; 47: 672-677https://doi.org/10.1016/j.jacc.2005.10.058
        • Min J.K.
        • Shaw L.J.
        • Devereux R.B.
        • Okin P.M.
        • Weinsaft J.W.
        • Russo D.J.
        • Lippolis N.J.
        • Berman D.S.
        • Callister T.Q.
        Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality.
        J. Am. Coll. Cardiol. 2007; 50: 1161-1170https://doi.org/10.1016/j.jacc.2007.03.067
        • Tunstall-Pedoe H.
        • Kuulasmaa K.
        • Amouyel P.
        • Arveiler D.
        • Rajakangas A.M.
        • Pajak A.
        Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents.
        Circulation. 1994; 90: 583-612https://doi.org/10.1161/01.CIR.90.1.583
        • Luepker R.V.
        WHO MONICA project: what have we learned and where to go from Here?.
        Public Health Rev. 2011; 33: 373-396https://doi.org/10.1007/BF03391642
        • Jousilahti P.
        • Vartiainen E.
        • Tuomilehto J.
        • Puska P.
        Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland.
        Circulation. 1999; 99: 1165-1172https://doi.org/10.1161/01.CIR.99.9.1165
        • Benjamin E.J.
        • Muntner P.
        • Alonso A.
        • Bittencourt M.S.
        • Callaway C.W.
        • Carson A.P.
        • Chamberlain A.M.
        • Chang A.R.
        • Cheng S.
        • Das S.R.
        • Delling F.N.
        • Djousse L.
        • Elkind M.S.V.
        • Ferguson J.F.
        • Fornage M.
        • Jordan L.C.
        • Khan S.S.
        • Kissela B.M.
        • Knutson K.L.
        • Kwan T.W.
        • Lackland D.T.
        • Lewis T.T.
        • Lichtman J.H.
        • Longenecker C.T.
        • Loop M.S.
        • Lutsey P.L.
        • Martin S.S.
        • Matsushita K.
        • Moran A.E.
        • Mussolino M.E.
        • O’Flaherty M.
        • Pandey A.
        • Perak A.M.
        • Rosamond W.D.
        • Roth G.A.
        • Sampson U.K.A.
        • Satou G.M.
        • Schroeder E.B.
        • Shah S.H.
        • Spartano N.L.
        • Stokes A.
        • Tirschwell D.L.
        • Tsao C.W.
        • Turakhia M.P.
        • VanWagner L.B.
        • Wilkins J.T.
        • Wong S.S.
        • Virani S.S.
        On behalf of the American Heart Association Council on epidemiology and prevention statistics committee and stroke statistics subcommittee, heart disease and stroke statistics—2019 update: a report from the American Heart Association.
        Circulation. 2019; 139https://doi.org/10.1161/CIR.0000000000000659
        • Bots S.H.
        • Peters S.A.E.
        • Woodward M.
        Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010.
        BMJ Glob. Health. 2017; 2e000298https://doi.org/10.1136/bmjgh-2017-000298
        • Wilson P.W.F.
        • D’Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847https://doi.org/10.1161/01.CIR.97.18.1837
        • D’Agostino R.B.
        • Vasan R.S.
        • Pencina M.J.
        • Wolf P.A.
        • Cobain M.
        • Massaro J.M.
        • Kannel W.B.
        General cardiovascular risk profile for use in primary care: the Framingham heart study.
        Circulation. 2008; 117: 743-753https://doi.org/10.1161/CIRCULATIONAHA.107.699579
        • Conroy R.
        Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
        Eur. Heart J. 2003; 24: 987-1003https://doi.org/10.1016/S0195-668X(03)00114-3
        • Shaw L.J.
        • Min J.K.
        • Nasir K.
        • Xie J.X.
        • Berman D.S.
        • Miedema M.D.
        • Whelton S.P.
        • Dardari Z.A.
        • Rozanski A.
        • Rumberger J.
        • Bairey Merz C.N.
        • Al-Mallah M.H.
        • Budoff M.J.
        • Blaha M.J.
        Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC consortium.
        Eur. Heart J. 2018; 39: 3727-3735https://doi.org/10.1093/eurheartj/ehy534
        • Blaha M.J.
        • Nasir K.
        • Rivera J.J.
        • Choi E.-K.
        • Chang S.-A.
        • Yoon Y.E.
        • Chun E.J.
        • Choi S.
        • Agatston A.
        • Blumenthal R.S.
        • Chang H.-J.
        Gender differences in coronary plaque composition by coronary computed tomography angiography.
        Coron. Artery Dis. 2009; 20: 506-512https://doi.org/10.1097/MCA.0b013e328331368d
        • Pagidipati N.J.
        • Hemal K.
        • Coles A.
        • Mark D.B.
        • Dolor R.J.
        • Pellikka P.A.
        • Hoffmann U.
        • Litwin S.E.
        • Udelson J.
        • Daubert M.A.
        • Shah S.H.
        • Martinez B.
        • Lee K.L.
        • Douglas P.S.
        Sex differences in functional and CT angiography testing in patients with suspected coronary artery disease.
        J. Am. Coll. Cardiol. 2016; 67: 2607-2616https://doi.org/10.1016/j.jacc.2016.03.523
        • Lubbers M.
        • Coenen A.
        • Bruning T.
        • Galema T.
        • Akkerhuis J.
        • Krenning B.
        • Musters P.
        • Ouhlous M.
        • Liem A.
        • Niezen A.
        • Dedic A.
        • van Domburg R.
        • Hunink M.
        • Nieman K.
        Sex differences in the performance of cardiac computed tomography compared with functional testing in evaluating stable chest pain: subanalysis of the multicenter, randomized CRESCENT trial (calcium imaging and selective CT angiography in comparison to functional testing for suspected coronary artery disease).
        Circ. Cardiovasc. Imag. 2017; 10https://doi.org/10.1161/CIRCIMAGING.116.005295
        • Williams M.C.
        • Kwiecinski J.
        • Doris M.
        • McElhinney P.
        • D’Souza M.S.
        • Cadet S.
        • Adamson P.D.
        • Moss A.J.
        • Alam S.
        • Hunter A.
        • Shah A.S.V.
        • Mills N.L.
        • Pawade T.
        • Wang C.
        • Weir-McCall J.R.
        • Bonnici-Mallia M.
        • Murrills C.
        • Roditi G.
        • van Beek E.J.R.
        • Shaw L.J.
        • Nicol E.D.
        • Berman D.S.
        • Slomka P.J.
        • Newby D.E.
        • Dweck M.R.
        • Dey D.
        Sex-specific computed tomography coronary plaque characterization and risk of myocardial infarction.
        JACC Cardiovasc. Imaging. 2021; 14: 1804-1814https://doi.org/10.1016/j.jcmg.2021.03.004
        • Plank F.
        • Beyer C.
        • Friedrich G.
        • Wildauer M.
        • Feuchtner G.
        Sex differences in coronary artery plaque composition detected by coronary computed tomography: quantitative and qualitative analysis.
        Neth. Hear. J. 2019; 27: 272-280https://doi.org/10.1007/s12471-019-1234-5
        • Nasir K.
        • Cainzos-Achirica M.
        • Valero-Elizondo J.
        • Ali S.S.
        • Havistin R.
        • Lakshman S.
        • Blaha M.J.
        • Blankstein R.
        • Shapiro M.D.
        • Arias L.
        • Saxena A.
        • Feldman T.
        • Budoff M.J.
        • Ziffer J.A.
        • Fialkow J.
        • Cury R.C.
        Coronary atherosclerosis in an asymptomatic U.S. population: miami heart study at baptist health South Florida.
        JACC Cardiovasc. Imaging. 2022; 15: 1604-1618https://doi.org/10.1016/j.jcmg.2022.03.010