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Sex differences in atheroma burden and endothelial function in patients with early coronary atherosclerosis

Seung Hwan Han1, Jang Ho Bae, David R Holmes

  • 1Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

European Heart Journal
|April 22, 2008
PubMed

Insights

Men exhibit greater coronary artery disease (CAD) burden and endothelial dysfunction than women, even in early stages. These sex differences in coronary atherosclerosis may explain higher CAD incidence in men.

Area of Science:

  • Cardiovascular Medicine
  • Atherosclerosis Research
  • Sex Differences in Disease

Background:

  • Coronary artery disease (CAD) presents differently in women and men, with varying clinical outcomes.
  • Existing research suggests potential sex-based disparities in the development and progression of CAD.

Purpose of the Study:

  • To investigate whether sex influences coronary atherosclerotic burden and endothelial function in early stages of CAD, before obstructive disease develops.
  • To test the hypothesis that sex differences impact the structural and functional characteristics of coronary arteries.

Main Methods:

  • The study included 142 patients (53 men, 89 women) with early CAD.
  • Intravascular ultrasonography and coronary endothelial function assessments were performed simultaneously.
  • Multivariate analysis was used to determine independent predictors of atheroma burden.

Main Results:

  • Men showed significantly greater atheroma burden in the left main and proximal LAD arteries compared to women.
  • Atheroma eccentricity was higher in men, and the length of coronary segments with endothelial dysfunction was longer.
  • Maximal coronary flow reserve was significantly lower in women, and sex was an independent predictor of atheroma burden.

Conclusions:

  • Men exhibit more severe structural abnormalities (greater atheroma burden, more eccentric plaques) and functional deficits (diffuse endothelial dysfunction) in epicardial coronary arteries than women.
  • These findings suggest that pronounced sex differences in early coronary atherosclerosis may contribute to the higher incidence of CAD and myocardial infarction in men.
  • The study highlights the importance of considering sex-specific factors in the pathogenesis and clinical presentation of coronary artery disease.
Abstract

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