Sex Differences in Coronary Arterial Calcification in Symptomatic Patients.

Autor: Kim BS; Department of Internal Medicine, North Shore University Hospital. Zucker School of Medicine at Hofstra/Northwell Health. Manhasset, New York. Electronic address: bkim11@northwell.edu., Chan N; Department of Internal Medicine, Cleveland Clinic. Cleveland, Ohio., Hsu G; Department of Internal Medicine, North Shore University Hospital. Zucker School of Medicine at Hofstra/Northwell Health. Manhasset, New York., Makaryus AN; Department of Cardiology, Nassau University Medical Center, East Meadow, New York; Department of Cardiology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York., Chopra M; Vanderbilt University, Nashville, Tennessee., Cohen SL; Department of Radiology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York; Institute of Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY., Makaryus JN; Department of Cardiology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York; Institute of Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2021 Jun 15; Vol. 149, pp. 16-20. Date of Electronic Publication: 2021 Mar 20.
DOI: 10.1016/j.amjcard.2021.03.025
Abstrakt: Despite the increasing use of Coronary Artery Calcium (CAC) scoring for cardiovascular risk stratification in asymptomatic patients, the gender differences in CAC among symptomatic patients have not been well evaluated. We analyzed patients presenting to the emergency department (ED) with chest pain suggesting possible coronary artery disease (CAD) who received coronary computed tomography angiography (CCTA). Ordinal logistic regression was used to determine the odds ratio for the association of traditional cardiovascular risk factors and CAC. Patients with a CAC score ≥ 100 were followed for cardiovascular events or changes in medical management. Our cohort included 542 individuals (263 male, 279 female). Ordinal logistic regression model showed that among traditional cardiovascular risk factors, male sex had the highest odds ratio (OR) of 3.04 (p < 0.001, 95% CI [2.01, 4.59]) for the presence of CAC. Also, males had more diffuse distribution of coronary atherosclerosis (p=0.01). Subgroup analysis revealed that obesity was a bigger risk factor in male patients (OR 2.16), while smoking showed the greatest effect (OR 4.27) on CAC in women. Of patients who had CAC > 100 with an average follow-up of 346 days, there was an increase in both aspirin and statin use, yet significant sex differences were observed especially in patients with non-obstructive lesions on CCTA. Among male patients with non-obstructive lesions, 68.2% were on aspirin and 86.4% were on statin therapy after the CCTA compared to 27.3% and 45.5% respectively in their female counterparts. In conclusion, sex not only is the most powerful predictor for higher CAC among traditional cardiovascular risk factors in symptomatic patients but also influences the contribution of various traditional risk factors to elevated CAC. Furthermore, the discovery of CAD led to the initiation of medical therapy in male patients more frequently than in female patients, even after adjusting for the degree of luminal stenosis detected on coronary CT angiography.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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