Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium
Abstract 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...
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| Veröffentlicht in: | European heart journal 2018-11, Vol.39 (41), p.3727-3735 |
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| creator | Shaw, Leslee J Min, James K Nasir, Khurram Xie, Joe X Berman, Daniel S Miedema, Michael D Whelton, Seamus P Dardari, Zeina A Rozanski, Alan Rumberger, John Bairey Merz, C Noel Al-Mallah, Mouaz H Budoff, Matthew J Blaha, Michael J |
| description | Abstract
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 |
| doi_str_mv | 10.1093/eurheartj/ehy534 |
| format | Article |
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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 mm3, 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.]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehy534</identifier><identifier>PMID: 30212857</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - mortality ; Clinical Research ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic - complications ; Plaque, Atherosclerotic - epidemiology ; Prognosis ; Risk Factors ; Sex Distribution ; Vascular Calcification - complications ; Vascular Calcification - epidemiology</subject><ispartof>European heart journal, 2018-11, Vol.39 (41), p.3727-3735</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-833c693e027fa41a01aa5f7eee422dd7cc07fc4228638d922f5e11d72967c6293</citedby><cites>FETCH-LOGICAL-c498t-833c693e027fa41a01aa5f7eee422dd7cc07fc4228638d922f5e11d72967c6293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30212857$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shaw, Leslee J</creatorcontrib><creatorcontrib>Min, James K</creatorcontrib><creatorcontrib>Nasir, Khurram</creatorcontrib><creatorcontrib>Xie, Joe X</creatorcontrib><creatorcontrib>Berman, Daniel S</creatorcontrib><creatorcontrib>Miedema, Michael D</creatorcontrib><creatorcontrib>Whelton, Seamus P</creatorcontrib><creatorcontrib>Dardari, Zeina A</creatorcontrib><creatorcontrib>Rozanski, Alan</creatorcontrib><creatorcontrib>Rumberger, John</creatorcontrib><creatorcontrib>Bairey Merz, C Noel</creatorcontrib><creatorcontrib>Al-Mallah, Mouaz H</creatorcontrib><creatorcontrib>Budoff, Matthew J</creatorcontrib><creatorcontrib>Blaha, Michael J</creatorcontrib><title>Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description><![CDATA[Abstract
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 mm3, 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.]]></description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular Diseases - complications</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Clinical Research</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Plaque, Atherosclerotic - complications</subject><subject>Plaque, Atherosclerotic - epidemiology</subject><subject>Prognosis</subject><subject>Risk Factors</subject><subject>Sex Distribution</subject><subject>Vascular Calcification - complications</subject><subject>Vascular Calcification - epidemiology</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9rFTEQx4Mo9rV69yQ5CrI2PzbZXQ9CWVoVCj1UwVtIk0lfSnazJtmH77835dWHnjzNMPOZ7wzzRegNJR8oGfg5rGkLOpWHc9juBW-foQ0VjDWDbMVztCF0EI2U_Y8TdJrzAyGkl1S-RCecMMp60W3Qcgu_sPXOQYLZQMZ-xkYH450Hi5egf66A9WxxiPN9UyBNtZ2sjzudzRp0wlNMRQdf9h9xvMuQdrr4OGfsUpxw2QIeL0Y81krl_Dq9Qi-cDhleP8Uz9P3q8tv4pbm--fx1vLhuTDv0pek5N3LgQFjndEs1oVoL1wFAy5i1nTGkc6bmveS9HRhzAii1HRtkZyQb-Bn6dNBd1rsJrIG5JB3Ukvyk015F7dW_ndlv1X3cKcnI0AtWBd49CaRYn5CLmnw2EIKeIa5ZMUoEkZK3vKLkgJoUc07gjmsoUY9GqaNR6mBUHXn793nHgT_OVOD9AYjr8n-535xfpLE</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Shaw, Leslee J</creator><creator>Min, James K</creator><creator>Nasir, Khurram</creator><creator>Xie, Joe X</creator><creator>Berman, Daniel S</creator><creator>Miedema, Michael D</creator><creator>Whelton, Seamus P</creator><creator>Dardari, Zeina A</creator><creator>Rozanski, Alan</creator><creator>Rumberger, John</creator><creator>Bairey Merz, C Noel</creator><creator>Al-Mallah, Mouaz H</creator><creator>Budoff, Matthew J</creator><creator>Blaha, Michael J</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20181101</creationdate><title>Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium</title><author>Shaw, Leslee J ; Min, James K ; Nasir, Khurram ; Xie, Joe X ; Berman, Daniel S ; Miedema, Michael D ; Whelton, Seamus P ; Dardari, Zeina A ; Rozanski, Alan ; Rumberger, John ; Bairey Merz, C Noel ; Al-Mallah, Mouaz H ; Budoff, Matthew J ; Blaha, Michael J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-833c693e027fa41a01aa5f7eee422dd7cc07fc4228638d922f5e11d72967c6293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular Diseases - complications</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Clinical Research</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Plaque, Atherosclerotic - complications</topic><topic>Plaque, Atherosclerotic - epidemiology</topic><topic>Prognosis</topic><topic>Risk Factors</topic><topic>Sex Distribution</topic><topic>Vascular Calcification - complications</topic><topic>Vascular Calcification - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shaw, Leslee J</creatorcontrib><creatorcontrib>Min, James K</creatorcontrib><creatorcontrib>Nasir, Khurram</creatorcontrib><creatorcontrib>Xie, Joe X</creatorcontrib><creatorcontrib>Berman, Daniel S</creatorcontrib><creatorcontrib>Miedema, Michael D</creatorcontrib><creatorcontrib>Whelton, Seamus P</creatorcontrib><creatorcontrib>Dardari, Zeina A</creatorcontrib><creatorcontrib>Rozanski, Alan</creatorcontrib><creatorcontrib>Rumberger, John</creatorcontrib><creatorcontrib>Bairey Merz, C Noel</creatorcontrib><creatorcontrib>Al-Mallah, Mouaz H</creatorcontrib><creatorcontrib>Budoff, Matthew J</creatorcontrib><creatorcontrib>Blaha, Michael J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shaw, Leslee J</au><au>Min, James K</au><au>Nasir, Khurram</au><au>Xie, Joe X</au><au>Berman, Daniel S</au><au>Miedema, Michael D</au><au>Whelton, Seamus P</au><au>Dardari, Zeina A</au><au>Rozanski, Alan</au><au>Rumberger, John</au><au>Bairey Merz, C Noel</au><au>Al-Mallah, Mouaz H</au><au>Budoff, Matthew J</au><au>Blaha, Michael J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>39</volume><issue>41</issue><spage>3727</spage><epage>3735</epage><pages>3727-3735</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract
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 mm3, 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.]]></abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30212857</pmid><doi>10.1093/eurheartj/ehy534</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Cardiovascular Diseases - complications Cardiovascular Diseases - mortality Clinical Research Female Follow-Up Studies Humans Male Middle Aged Plaque, Atherosclerotic - complications Plaque, Atherosclerotic - epidemiology Prognosis Risk Factors Sex Distribution Vascular Calcification - complications Vascular Calcification - epidemiology |
| title | Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium |
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