Sex Based Differences in Association Between Plaque Burden and Ischemia -- a CREDENCE Trial Substudy

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Sex Differences in Health

Background:

• Women with coronary artery disease (CAD) often present with less severe stenosis and lower plaque burden compared to men.
• Despite these differences, women experience disproportionately higher rates of adverse cardiovascular events.

Purpose of the Study:

• To evaluate sex-based differences in quantitative plaque burden.
• To assess the association between plaque burden and ischemia in women and men with suspected stable CAD.

Main Methods:

• A post-hoc analysis of the CREDENCE trial included 612 patients (184 women, 428 men) undergoing CCTA and invasive coronary angiography with fractional flow reserve (FFR).
• Quantitative plaque burden (total, calcified, non-calcified) and volume were measured.
• Ischemia was defined as FFR ≤0.8.

Main Results:

• Women were older and had lower smoking prevalence but exhibited less high-risk plaque, shorter lesion length, and lower stenosis severity.
• Overall plaque burden and volume were significantly lower in women, except for calcified plaque burden.
• A 5% increase in total plaque burden was significantly associated with ischemia in women (OR=1.28) and men, with significant sex interactions for total and calcified plaque burden.

Conclusions:

• Despite lower plaque burden, women show a stronger association between plaque burden and ischemia compared to men.
• These findings suggest potential sex-related differences in CAD pathophysiology.
• Further prospective studies are needed to elucidate these sex-specific CAD mechanisms.