Abstract
Even with increasing awareness of sex-related differences in atherosclerotic cardiovascular disease (ASCVD), it remains unclear whether the progression of coronary atherosclerosis differs between women and men. We sought to compare coronary artery calcium (CAC) progression between women and men. From a retrospective, multicentre registry of consecutive asymptomatic individuals who underwent CAC scoring, we identified 9,675 men and 1,709 women with follow-up CAC scoring. At baseline, men were more likely to have a CAC score >0 than were women (47.8% vs. 28.6%). The probability of CAC progression at 5 years, defined as [√CAC score (follow-up)-√CAC score (baseline)] ≥2.5, was 47.4% in men and 29.7% in women (p<0.001). When we stratified subjects according to the 10-year ASCVD risk (<5%, ≥5% and <7.5%, and ≥7.5%), a sex difference was observed in the low risk group (CAC progression at 5 years, 37.6% versus 17.9%; p<0.001). However, it became weaker as the 10-year ASCVD risk increased (64.2% versus 46.2%; p<0.001, and 74.8% versus 68.7%; p = 0.090). Multivariable analysis demonstrated that male sex was independently associated with CAC progression rate among the entire group (p<0.001). Subgroup analyses showed an independent association between male sex and CAC progression rate only in the low-risk group. The CAC progression rate is higher in men than in women. However, the difference between women and men diminishes as the 10-year ASCVD risk increases.
Highlights
Coronary artery disease (CAD) is the leading cause of death worldwide for both men and women [1]
Age was not significantly different between men and women, men showed a higher proportion of conventional cardiovascular risk factors, and a higher 10-year atherosclerotic cardiovascular disease (ASCVD) risk, compared to that in women
The present study demonstrated a sex difference in CAC progression in a large number of asymptomatic individuals
Summary
Coronary artery disease (CAD) is the leading cause of death worldwide for both men and women [1]. Given the worldwide health and economic implications of atherosclerotic cardiovascular disease (ASCVD) in women, there is a strong rationale to sustain an effort to control major ASCVD risk factors and apply evidence-based therapies in women [2]. Adverse trends in ASCVD risk factors among women are an ongoing concern. In older adults, a higher percentage of women than men have hypertension, and the gap will likely increase in the aging society [3]. The prevalence of diabetes in women is increasing, which exacerbates the overall risk of ASCVD [4]. Women are regarded as at lower risk for ASCVD than are men, and are not given aggressive preventive medications, such as statins, despite a similar benefit for both women and men [5,6,7]
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