Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium
Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium
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DOI：
10.1093/eurheartj/ehy534
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发表时间：
2018-11-01
影响因子：
39.3
通讯作者：
Blaha, Michael J.
中科院分区：
文献类型：
--
作者：
Shaw, Leslee J.;Min, James K.;Blaha, Michael J.
病理学证据支持独特的性别特异性机制作为急性心血管（CV）事件的前兆。目前的证据表明，长期CV风险的女性相比，男性的冠状动脉钙（CAC）的措施仍然incomplete.Methods和results一个共63 215名无症状的女性和男性参加了多中心，CAC联盟与中位数随访12.6年。采用Agatston评分和其他CAC指标（病变和血管数量、病变大小、体积和斑块密度）收集合并队列方程（PCE）风险评分和风险因素数据。采用考克斯比例风险模型估计CV死亡率（n = 919）。计算性别相互作用。女性和男性的平均PCE风险评分分别为5.8%和9.1%（P < 0.001）。在CAC亚组中，与男性相比，女性钙化病变（P < 0.0001）和血管（P = 0.017）较少，病变大小较大（P < 0.0001），斑块密度较高（P = 0.013）。对于无CAC的女性和男性，长期CV死亡率相似（P = 0.67），而可检测到的CAC与女性CV死亡风险比男性高1.3倍相关（P <0.001）。CAC病变更广泛、数量更多或更大的女性心血管死亡率更高。女性和男性心血管疾病（CVD）死亡率的相对危险度分别为：多支CAC为8.2 vs. 5.1，≥ 5个CAC病变为8.6 vs. 5.9，病变大小≥ 15 mm（3）为8.5 vs. 4.4。进一步的研究显示，与男性相比，具有较大尺寸和更多CAC病变的女性的CVD死亡率高2.2倍（P < 0.0001）。此外，CAC密度是不预测CV死亡率在女性（P = 0.51），但男性（P < 0.001），当控制CAC体积和心脏危险factors.Conclusion我们的总体研究结果支持，超越Agatston评分的措施提供了重要的线索，动脉粥样硬化斑块的性别差异，并可能进一步完善风险检测和重点预防护理策略。
Aims Pathologic evidence supports unique sex-specific mechanisms as precursors for acute cardiovascular (CV) events. Current evidence on long-term CV risk among women when compared with men based on measures of coronary artery calcium (CAC) remains incomplete.Methods and results A total of 63 215 asymptomatic women and men were enrolled in the multicentre, CAC Consortium with median follow-up of 12.6 years. Pooled cohort equation (PCE) risk scores and risk factor data were collected with the Agatston score and other CAC measures (number of lesions and vessels, lesion size, volume, and plaque density). Cox proportional hazard models were employed to estimate CV mortality (n = 919). Sex interactions were calculated. Women and men had average PCE risk scores of 5.8% and 9.1% (P < 0.001). Within CAC subgroups, women had fewer calcified lesions (P < 0.0001) and vessels (P = 0.017), greater lesion size (P < 0.0001), and higher plaque density (P = 0.013) when compared with men. For women and men without CAC, long-term CV mortality was similar (P = 0.67), whereas detectable CAC was associated with 1.3-higher hazard for CV death among women when compared with men (P < 0001). Cardiovascular mortality was higher among women with more extensive, numerous, or larger CAC lesions. The relative hazard for cardiovascular disease (CVD) mortality for women and men was 8.2 vs. 5.1 for multivessel CAC, 8.6 vs. 5.9 for >= 5 CAC lesions, and 8.5 vs. 4.4 for a lesion size >= 15 mm(3), respectively. Additional explorations revealed that women with larger sized and more numerous CAC lesions had 2.2-fold higher CVD mortality (P < 0.0001) as compared to men. Moreover, CAC density was not predictive of CV mortality in women (P = 0.51) but was for men (P < 0.001), when controlling for CAC volume and cardiac risk factors.Conclusion Our overall findings support that measures beyond the Agatston score provide important clues to sex differences in atherosclerotic plaque and may further refine risk detection and focus preventive strategies of care.