Abstract
Background and aimsClinical atherosclerosis manifestations are different in women compared to men. Since endothelial shear stress (ESS) is known to play a critical role in coronary atherosclerosis development, we investigated differences in anatomical characteristics and endothelial shear stress (ESS)–related plaque growth in human coronary arteries in men compared to women. Methods1183 coronary arteries (male/female: 944/239) from the PREDICTION study were studied for differences in artery/plaque and ESS characteristics, and ESS-related plaque progression (6–10 months follow-up) among men and women and after stratification for age. All characteristics were derived from IVUS-based vascular profiling and reported per 3 mm-segments (13,030 3-mm-segments (male/female: 10,465/2,565)). ResultsCoronary arteries and plaques were significantly smaller in females compared to males; but no important differences were observed in plaque burden, ESS and rate of plaque progression. Change in plaque burden was inversely related to ESS (p<0.001) with no difference between women versus men (β: -0.62 ± 0.13 vs −0.68 ± 0.05, p=0.62). However, stratification for age demonstrated that ESS-related plaque growth was more marked in young women compared to men (<55 years, β: −2.02 ± 0.61 vs −0.33 ± 0.10, p=0.007), reducing in magnitude over the age-categories up till 75 years. ConclusionsCoronary artery and plaque size are smaller in women compared to men, but ESS and ESS- related plaque progression were similar. Sex-related differences in ESS-related plaque growth were evident after stratification for age. These observations suggest that although the fundamental processes of atherosclerosis progression are similar in men versus women, plaque progression may be influenced by age within gender.
Highlights
Coronary artery disease is the leading underlying cause of mortality in both men and women, clinical presentation of the disease is very different
Among the 479 total patients included in the baseline analysis of plaque characterization there were 384 men and 95 women, who contributed 944 male and 239 female coronary arteries
Coronary blood flow was lower in women resulting in similar endothelial shear stress (ESS) in the coronary arteries of women compared to men
Summary
Coronary artery disease is the leading underlying cause of mortality in both men and women, clinical presentation of the disease is very different. Since endothelial shear stress (ESS) is known to play a critical role in coronary atherosclerosis development, we investigated differences in anatomical characteristics and endothelial shear stress (ESS)–related plaque growth in human coronary arteries in men compared to women. Methods: 1183 coronary arteries (male/female: 944/239) from the PREDICTION study were studied for differ ences in artery/plaque and ESS characteristics, and ESS-related plaque progression (6–10 months follow-up) among men and women and after stratification for age. Conclusions: Coronary artery and plaque size are smaller in women compared to men, but ESS and ESS- related plaque progression were similar. Sex-related differences in ESS-related plaque growth were evident after strat ification for age These observations suggest that the fundamental processes of atherosclerosis pro gression are similar in men versus women, plaque progression may be influenced by age within gender
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