Gender Differences in Plaque Characteristics by Coronary Computerized Tomographic Angiography

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Journal of the American College of Cardiology


Background: The onset and progression of coronary artery disease (CAD) varies between genders. Females with CAD present later in life but with higher mortality in the presence of severe disease. This study sought to characterize differences among men and women’s coronary plaque composition by Coronary Computerized Tomographic Angiography (CTA) relative to their presentation. Methods: Patients with angina or abnormal stress testing who underwent CTA and then invasive coronary angiography (ICA) were retrospectively identified. CT data was analyzed for: plaque features (positive or negative remodeling, calcification, disruption) plaque volume (PV), and presence of low attenuation plaque (LAP). Plaque data was analyzed by gender and standard patient risk factors, and compared between genders. Results: Among 135 patients, 88 were male and 57 female. Females had lower total plaque volume and volume of LAP than males despite risk adjustment (RA) (mean RA PV 125.37mm3 vs 178.00mm3 , p = 0.0165) and (mean RA LAP volume of 23.93mm3 vs 42.91mm3 , p = 0.0391). Females and males had a similar probability of manifesting positively remodeled plaques and calcified plaques ((75.81% vs 74.61%, OR: 1.07 95% CI 0.68 to 1.67) and (85.92% vs 70.04% p= 0.8196 respectively)). Conclusion: Females with angina or abnormal stress testing have lower total plaque volume and volume LAP by CTA. This suggests women with subclinical CAD may be undertreated which may account for higher mortality seen in women as the disease progresses.




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