Multimodality Imaging Analysis Finds No Difference in Plaque Characteristics Among Men and Women with CAD

No difference exists in plaque characteristics assessed by multimodality imaging among men and women with stable coronary artery disease (CAD) referred for coronary angiography, according to a study presented on April 2 at ACC.16 in Chicago and simultaneously published in JACC: Cardiovascular Imaging.

The study, led by Aditya S. Bharadwaj, MD, et al, retrospectively analyzed data from 383 patients – 268 men and 115 women – with stable CAD who were referred for coronary angiography and underwent optical coherence tomography (OCT). After adjusting for age, body mass index, percutaneous coronary intervention history, hypertension, insulin, clinical risk factors, and total cholesterol, gender was not found to be an independent predictor of severe plaque burden by intravascular ultrasound (IVUS). The findings could have an impact on the preventive measures recommended to women with stable CAD.

The authors note that over the past two decades the prevalence of CAD has increased among middle-aged women and decreased among middle-aged men. As such, the authors evaluated the differences in plaque morphology between men and women with stable CAD using a multimodality approach with IVUS, OCT, and near infrared spectroscopy (NIRS) techniques. Of the 383 patients analyzed, 133 also underwent IVUS/NIRS imaging.

The women in the study tended to be older (66 years of age vs. 62 years of age for men) and have more comorbidities such as diabetes, hypertension, and lower estimated glomerular filtration rate. There was no meaningful variation in history of smoking, previous myocardial infarction, or statin use. The OCT imaging data showed no significant difference in reference lumen CSA, minimum lumen CSA, or area stenosis. In addition, no difference was seen in plaque morphology between men and women. The IVUS/NIRS imaging data showed no significant difference between external elastic membrane CSA and lumen CSA in both reference and stenotic segment. However, there was a statistically significant increase in plaque burden among men as compared to women in the reference segment.

The authors assert that the clinical implications of the study's results must be viewed in the context of the increasing incidence of CAD among women, the fact that women presenting with CAD are older and have more comorbidities, and that women have worse prognosis compared to men. Preventive measures and treatment often focus on differences in atherosclerotic burden and plaque morphology between men and women. Because the multimodality imaging data shows no difference in the noted plaque characteristics between women and men, "equally aggressive primary and secondary prevention measures must be undertaken irrespective of sex."

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