Postmenopausal ladies with clogged arteries are at increased threat of coronary heart assaults than males of comparable age, in accordance with analysis introduced at EACVI 2023, a scientific congress of the European Society of Cardiology (ESC), and revealed in European Coronary heart Journal – Cardiovascular Imaging. The examine in almost 25,000 adults used imaging methods to look at the arteries and adopted sufferers for coronary heart assaults and loss of life.

The examine suggests {that a} given burden of atherosclerosis is riskier in postmenopausal ladies than it’s in males of that age. Since atherosclerotic plaque burden is rising as a goal to determine the depth of remedy to forestall coronary heart assaults, the findings could influence remedy. Our outcomes point out that after menopause, ladies may have the next dose of statins or the addition of one other lipid-lowering drug. Extra research are wanted to verify these findings.”

Dr. Sophie van Rosendael, Study Creator, Leiden College Medical Centre, the Netherlands

Atherosclerosis is the narrowing of arteries resulting from deposits of fats and ldl cholesterol in what known as plaque. Whereas younger ladies do have coronary heart assaults, on the whole, ladies develop atherosclerosis later in life than males and have coronary heart assaults at an older age than males, partly due to the protecting impact of oestrogen. This examine examined whether or not the prognostic significance of atherosclerotic plaques are the identical for men and women at completely different ages as this could possibly be necessary for choosing remedies to forestall coronary heart assaults.

The examine included 24,950 sufferers referred for coronary computed tomography angiography (CCTA) and enrolled within the CONFIRM registry, which was carried out in six international locations in North America, Europe, and Asia. CCTA is used to acquire 3D photos of the arteries within the coronary heart.

Complete atherosclerotic burden was rated utilizing the Leiden CCTA rating, which includes the next gadgets for every coronary section: plaque presence (sure/no), composition (calcified, noncalcified or blended), location, and severity of narrowing, for a ultimate worth of 0 to 42. Sufferers have been divided into three classes beforehand discovered to foretell the danger myocardial infarction: low atherosclerotic burden (0 to five), medium (6 to twenty) and excessive (over 20). As well as, obstructive coronary artery illness was outlined as 50% narrowing or extra.

The first final result was the distinction in Leiden CCTA rating between men and women of comparable age. The investigators additionally analysed intercourse variations within the charges of main adversarial cardiovascular occasions (MACE), which included all-cause loss of life and myocardial infarction, after adjusting for age and cardiovascular threat elements (hypertension, excessive ldl cholesterol, diabetes, present smoking and household historical past of coronary artery illness).

A complete of 11,678 ladies (common age 58.5 years) and 13,272 males (common age 55.6 years) have been adopted for 3.7 years. Concerning the first final result, the examine confirmed an roughly 12 12 months delay within the onset of in ladies: the median Leiden CCTA threat rating was above zero at age 64 to 68 years in ladies versus 52 to 56 years in males (p<0.001). As well as, the general plaque burden as quantified by the Leiden CCTA rating was considerably decrease in ladies, who had extra non-obstructive illness.

Dr. van Rosendael mentioned: “The outcomes verify the beforehand reported delay within the begin of atherosclerosis in ladies. We additionally discovered that ladies usually tend to have non-obstructive illness. It was previously thought that solely obstructive atherosclerosis brought on myocardial infarction however we now know that non-obstructive illness can be dangerous.”

The burden of atherosclerosis was equally predictive of MACE in premenopausal ladies (aged underneath 55 years) and males of the identical age group. Nonetheless, in postmenopausal ladies (age 55 years and older), the danger of MACE was increased than males for a given rating. In postmenopausal ladies, in comparison with these with a low burden, these with a medium and excessive burden had 2.21-fold and 6.11-fold increased dangers of MACE. Whereas in males aged 55 years and older, in comparison with these with a low burden, these with a medium and excessive burden had 1.57-fold and a couple of.25-fold higher dangers of MACE.

Dr. van Rosendael mentioned: “On this examine, the elevated threat for girls versus males was particularly noticed in postmenopausal ladies with the very best Leiden CCTA rating. This could possibly be partly as a result of the inside diameter of coronary arteries is smaller in ladies, which means that the identical quantity of plaque might have a bigger influence on blood move. Our findings hyperlink the identified acceleration of atherosclerosis growth after menopause with a major enhance in relative threat for girls in comparison with males, regardless of the same burden of atherosclerotic illness. This will likely have implications for the depth of medical remedy.”