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Gender-based differences in the prognostic value of coronary calcification
Paolo Raggi1, Leslee J Shaw, Daniel S Berman
1Tulane University School of Medicine, New Orleans, Louisiana 70112, USA. praggi@tulane.edu
Journal of Women'S Health (2002)
|May 8, 2004
Summary
Electron beam tomography (EBT) screening for coronary calcification improves mortality prediction in asymptomatic women. This cardiac screening tool offers valuable prognostic information beyond traditional risk factors, aiding early diagnosis of heart disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary heart disease (CHD) risk stratification in asymptomatic individuals is crucial for preventive strategies.
- Traditional risk factors may not fully capture the heterogeneity of CHD risk, particularly in women.
- Early detection of subclinical atherosclerosis is essential for timely intervention.
Purpose of the Study:
- To evaluate the utility of electron beam tomography (EBT) screening in predicting all-cause mortality among asymptomatic men and women.
- To determine if coronary calcification burden, assessed by EBT, provides incremental prognostic value beyond established risk factors.
- To explore potential sex differences in the relationship between coronary calcification and mortality risk.
Main Methods:
- A large cohort of 10,377 asymptomatic individuals (40% women) undergoing coronary calcification screening via EBT was studied.
- Mortality data were obtained from the National Death Index, with an average follow-up of 5 years.
- Univariable, multivariable Cox proportional hazard models, and receiver operating characteristic (ROC) curve analyses were employed to assess mortality prediction.
Main Results:
- Women exhibited lower coronary calcification prevalence and scores than men (p < 0.0001).
- Higher mortality rates were observed in older, diabetic, hypertensive, and smoking individuals.
- Risk-adjusted Cox models revealed a significantly greater probability of death in women compared to men across all calcification strata (p = 0.007).
- Relative risks for women increased substantially with higher coronary calcification scores (p < 0.0001).
- EBT-derived coronary calcification significantly enhanced the prognostic value of Framingham risk scores (p < 0.0001).
Conclusions:
- Coronary calcification screening using EBT provides significant incremental prognostic information for all-cause mortality in asymptomatic women, independent of traditional risk factors.
- EBT emerges as a valuable tool for risk stratification in women, addressing challenges in the early diagnosis of CHD.
- These findings support the use of EBT for comprehensive cardiovascular risk assessment in asymptomatic populations, with particular attention to sex-specific differences.