Sex differences in plaque characteristics by intravascular imaging in patients with coronary artery disease
Monique E Ten Haaf1, Melissa Rijndertse, Jin M Cheng
1Department of Cardiology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
Insights
Women with coronary artery disease (CAD) showed less plaque burden and more favorable plaque characteristics than men, despite a worse cardiovascular risk profile. Further studies are needed to assess clinical outcomes.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
Background:
- Coronary artery disease (CAD) affects both sexes, but differences in plaque characteristics are not fully understood.
- Understanding sex-based differences in coronary plaque is crucial for risk stratification and treatment.
Purpose of the Study:
- To investigate sex differences in coronary plaque burden and composition in patients with CAD.
- To compare plaque characteristics between women and men using advanced imaging techniques.
Main Methods:
- Virtual histology intravascular ultrasound (VH-IVUS) and near-infrared spectroscopy (NIRS) were used to analyze non-culprit coronary arteries.
- 178 women and 581 men with stable angina pectoris (SAP) or acute coronary syndrome (ACS) were included.
Main Results:
- Women had lower plaque burden (VH-IVUS) and total plaque volume compared to men, irrespective of diagnosis.
- Specific plaque components like necrotic core and dense calcium were also lower in women.
- Near-infrared spectroscopy (NIRS) showed a lower lipid core burden index (LCBI) in women, particularly in SAP.
Conclusions:
- Women with CAD exhibit more favorable plaque characteristics than men, even with a higher cardiovascular risk.
- These findings suggest potential sex-specific differences in CAD pathophysiology that warrant further investigation.
Aims:
We aimed to study sex differences in coronary plaque burden and plaque composition in patients with coronary artery disease (CAD).
Methods And Results:
Virtual histology intravascular ultrasound (VH-IVUS) and near-infrared spectroscopy (NIRS) imaging of a non-culprit coronary artery was performed in 178 (23.5%) women and 581 (76.5%) men who underwent invasive management of stable angina pectoris (SAP) or acute coronary syndrome (ACS). Women were older and had a worse cardiovascular risk profile than men, but less extended angiographic coronary disease. Irrespective of the presenting diagnosis, women had lower VH-IVUS-derived plaque burden than men (38.1% vs. 40.5% in SAP, and 35.9% vs. 38.8% in ACS). Standardised (mean 211 vs. 263 mm3 in SAP, and 199 vs. 245 mm3 in ACS) total plaque volume was lower in women. Volumes of fibrous tissue, fibro-fatty tissue, necrotic core and dense calcium were also lower in women. NIRS-derived lipid core burden index (LCBI) was lower in women, in particular in SAP (mean LCBI in the worst 4 mm 220 vs. 240). The observed differences remained significant after adjustment for clinical characteristics.
Conclusions:
Women had more favourable plaque characteristics than men, despite their worse risk profile. Long-term follow-up studies are required to evaluate the clinical consequences.
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