Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

Sophie E. van Rosendael, A. Maxim Bax, Fay Y. Lin, Stephan Achenbach, Daniele Andreini, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin J. DeLago, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A. Kaufmann, Yong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo MarquesPedro de Araújo Gonçalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Todd C. Villines, Hyuk Jae Chang, Daniel S. Berman, James K. Min, Jeroen J. Bax, Leslee J. Shaw, Alexander R. van Rosendael

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AIMS: The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. METHODS AND RESULTS: From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P < 0.001). The Leiden CCTA risk score was independently associated with MACE: score 6-20: HR 2.29 (1.69-3.10); score > 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). CONCLUSION: Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.

Original languageEnglish
Pages (from-to)1180-1189
Number of pages10
JournalEuropean heart journal. Cardiovascular Imaging
Issue number9
Publication statusPublished - 23 Aug 2023


  • coronary artery disease
  • coronary computed tomography angiography (CCTA)
  • prognosis
  • sex differences


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