Abstract 11795: Sex Modifies Compositional Plaque Progression in Non-Obstructive Coronary Artery Disease

Abstract

Introduction: Coronary artery disease (CAD) is a progressive disease where plaque composition is associated with cardiovascular events. Whether sex modifies compositional plaque progression in non-obstructive CAD is less explored. Methods: We identified 34 patients with non-obstructive CAD (<50% stenosis) undergoing clinically indicated serial coronary computed tomography angiography (CCTA) with >1 year interscan interval from the Norwegian Registry of Invasive Cardiology. All coronary segments were analyzed at baseline and follow-up using a semi-automated analysis software. We assessed the annual progression rate in total and compositional plaque volumes among women and men. Results: In the total study population (mean age 59.9 ± 11.3 years, median interscan interval 1.9 years [interquartile range (IQR): 1.6-2.3 years]), 41% were women. Women were older (64.9 ± 8.0 years vs. 56.3 ± 12.0 years, p=0.025), while there was no significant difference in the prevalence of hypertension, diabetes, statin treatment or smoking between groups (all p>0.05). Women had a higher total plaque burden at baseline and follow-up compared to men (p=0.017 and p=0.026, respectively), and their plaque composition remained unaltered (Figure 1). To the contrary, men had a higher progression rate of hypodense plaque proportions, comprising necrotic core (-30 - 30 HU) and fibrous fatty (31 - 130 HU) plaque (p=0.046 and p=0.019, respectively), with an associated increase in diseased segments at follow-up (p=0.003). Conclusions: In non-obstructive CAD, women had a higher plaque burden and an unaltered plaque composition, while men had faster progression of hypodense plaque proportions in serial CCTA. Whether sex differences in compositional plaque progression is associated with prognosis in non-obstructive CAD needs further investigation.