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Sex differences in coronary artery size assessed by intravascular ultrasound
S E Sheifer1, M R Canos, K P Weinfurt
1Division of Cardiology and Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA. sheifers@gusun.georgetown.edu
Insights
Women have smaller coronary arteries (left main and LAD) than men, independent of body size. This intrinsic sex difference may impact cardiovascular disease outcomes and treatment strategies.
Area of Science:
- Cardiology
- Vascular Biology
- Sex Differences in Medicine
Background:
- Women experience poorer outcomes following myocardial infarction and coronary revascularization.
- Smaller coronary artery size is a potential contributing factor, but previous studies were confounded by body size and arterial remodeling.
- The independent effect of sex on coronary artery dimensions remained unclear.
Purpose of the Study:
- To investigate whether intrinsic sex differences exist in coronary artery dimensions.
- To determine if sex independently predicts coronary artery size after accounting for body surface area and other factors.
Main Methods:
- Intravascular ultrasound was used to measure left main (LM) and proximal left anterior descending (LAD) coronary artery segments in 50 men and 25 women.
- Arterial and luminal areas were measured, corrected for body surface area, and analyzed using univariate and multiple linear regression.
- Analyses controlled for body surface area and plaque area to isolate the effect of sex.
Main Results:
- Women had smaller uncorrected LM and LAD arterial and luminal areas compared to men.
- After adjusting for body surface area, sex remained an independent predictor of LM and LAD arterial area.
- Even after controlling for plaque area, sex independently predicted the luminal area of the LAD artery.
Conclusions:
- Coronary arteries (LM and LAD) are intrinsically smaller in women compared to men, irrespective of body size.
- This finding suggests a fundamental sex-based influence on coronary dimensions.
- Further research into the mechanisms behind these differences could inform new therapeutic approaches for women with coronary artery disease.
Background:
Women have worse outcomes after myocardial infarction and coronary revascularization. The explanations are likely multifactorial but may include smaller coronary artery size. Smaller luminal diameter has been confirmed angiographically; however, because of possible confounding effects of coronary remodeling, angiographically silent atherosclerosis, and body size, it is unclear if there is a true sex influence on arterial size.
Methods:
We performed intravascular ultrasound on left main (LM) and proximal left anterior descending (LAD) coronary artery segments that were free of significant atherosclerosis in 50 men and 25 women. Arterial and luminal areas were measured by planimetry and corrected for body surface area. We evaluated associations between sex and coronary dimensions with univariate and then multiple linear regression analyses.
Results:
Mean uncorrected LM and LAD arterial areas were smaller in women than in men (21.53 vs 26.95 mm(2), P <.001, and 14. 68 vs 19.94 mm(2), P =.002, respectively), as were mean LM and LAD luminal areas (15.94 vs 18.79 mm(2), P =.020, and 10.13 vs 12.71 mm(2), P =.036, respectively). In multivariate models accounting for body surface area and controlling for other factors, sex independently predicted corrected LM and LAD arterial area. In analyses that additionally controlled for plaque area, sex independently predicted corrected LAD luminal area.
Conclusions:
LM and LAD arteries are smaller in women, independent of body size. This suggests an intrinsic sex effect on coronary dimensions. Future studies should investigate underlying mechanisms because they may lead to novel therapeutic strategies and improved outcomes for women with coronary artery disease.