Compositional plaque progression in women and men with non-obstructive coronary artery disease

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Vascular Biology

Background:

• Coronary artery disease (CAD) risk is linked to plaque progression and composition.
• Differences in compositional plaque progression between sexes in non-obstructive CAD are understudied.

Purpose of the Study:

• To investigate sex-based differences in plaque composition and progression in patients with non-obstructive CAD.
• To compare plaque burden and composition changes over time between women and men.

Main Methods:

• Serial coronary computed tomography angiography (CCTA) from 31 patients with non-obstructive CAD.
• Quantitative and qualitative plaque analysis of all coronary artery segments.
• Comparison of plaque progression and composition between men and women.

Main Results:

• Women were older and had higher baseline total plaque burden, more calcified, and less fibro-fatty/necrotic core plaques than men.
• Men showed faster progression of fibro-fatty plaques and reduction of fibrous plaques compared to women.
• At follow-up, women maintained higher total plaque burden with stable composition, while men increased fibro-fatty and necrotic core plaques.

Conclusions:

• Women with non-obstructive CAD exhibit higher plaque burden and stable plaque composition over time.
• Men demonstrate faster progression of unstable, low-attenuating fibro-fatty plaques.
• Serial CCTA reveals distinct sex-specific patterns of plaque progression in non-obstructive CAD.