Postmenopausal women with clogged arteries have a greater risk of heart attack than men of similar age, a European conference has heard.
A Dutch study, presented to delegates at EACVI 2023 and published in European Heart Journal – Cardiovascular Imaging, came to the conclusion after examining the arteries of almost 25,000 adults using imaging techniques and following them for heart attacks and death.
Study author Dr Sophie van Rosendael of Leiden University Medical Centre said: “The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it is in men of that age.
“Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment. Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.”
Generally, women develop atherosclerosis later in life than men and have heart attacks at an older age than men, partly because of the protective effect of oestrogen.
This study examined whether the prognostic importance of atherosclerotic plaques is the same for women and men at different ages, as this could be important for selecting treatments to prevent heart attacks.
The study included 24,950 patients, all of whom were referred for coronary computed tomography angiography (CCTA) and were enrolled in the CONFIRM registry, conducted in six countries in North America, Europe, and Asia.
The Leiden CCTA score was used to rate total atherosclerotic burden and participants were divided into three categories to predict the risk myocardial infarction: low atherosclerotic burden (0 to 5), medium (6 to 20) and high (over 20). Obstructive coronary artery disease was defined as 50% narrowing or more.
In total, 11,678 women, with an average age of 58.5 years, and 13,272 men, whose average age was 55.6 years, were followed for 3.7 years.
The study showed an approximately 12-year delay in the onset of coronary atherosclerosis in women: the median Leiden CCTA risk score was above zero at age 64 to 68 years in women compared to 52 to 56 years in men. The overall plaque levels were significantly lower in women, who had more non-obstructive disease.
Dr van Rosendael said: “The results confirm the previously reported delay in the start of atherosclerosis in women. We also found that women are more likely to have non-obstructive disease. It was formerly thought that only obstructive atherosclerosis caused myocardial infarction but we now know that non-obstructive disease is also risky.”
The burden of atherosclerosis was equally predictive of major adverse cardiac event (MACE) in women under 55 years and men of the same age group.
However, in women over 55 the risk of MACE was higher than men for a given score. Compared to those with a low burden, women over 55 with a medium and high burden had 2.21-fold and 6.11-fold higher risks of MACE. In men of the same age group, those with a medium and high burden had 1.57-fold and 2.25-fold greater risks of MACE compared to those with a low burden.
Dr van Rosendael said: “Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment.”
Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary CT will be presented at EACVI 2023.
van Rosendael SE, Bax AM, Lin FY, et al. Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary CT. Eur Heart J Cardiovasc Imaging 11 May 2023; doi:10.1093/ehjci/jead094.
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