Abstract 3337: Sex Differences in Atheroma Burden and Endothelial Function in Patients with Early Coronary Atherosclerosis
Background: Women and men have shown differential clinical presentation and outcomes in coronary artery disease (CAD). There is a differential association of sex on early coronary atherosclerosis. The current study was designed to test the hypothesis that sex differences might influence the coronary atherosclerotic burden and coronary endothelial function prior to the development of obstructive CAD.
Methods and results: One hundred forty two patients (male: 53 (37.3%), female: 89 (62.7%), mean age: 49.3 ± 1.0 years) with early CAD simultaneously underwent intravascular ultrasound (IVUS) and coronary endothelial function assessment. Atheroma burdens in left main and proximal left anterior descending (LAD) artery were significantly greater in men compared to women (median [IQR]: 23.0 [14.3, 32.4] vs. 14.1 [8.1, 21.8] %, p=0.002, 40.1 [30.3, 49.7] vs. 29.3 [18.2, 42.4] %, p=0.001, respectively). Atheroma eccentricity in proximal LAD was significantly higher in men compared to women (0.89 [0.78, 0.94] vs. 0.80 [0.70, 0.93], p=0.040). The length of the coronary segments with endothelial dysfunction in men was significantly longer compared to women (39.2 [0.0, 71.6] vs. 11.1 [0.0, 38.5] mm, p=0.002). In contrast, maximal coronary flow reserve (CFR) in women was significantly lower compared to men (2.80 [2.40, 3.20] vs. 3.30 [2.90, 3.80], p<0.001). Furthermore, gender was an independent predictor of atheroma burden in left main, proximal LAD (all, p<0.05) and a predictor of the length of endothelial dysfunction with borderline significance (p=0.059) by multivariate analysis.
Conclusions: Men with early CAD have greater atheroma burden, eccentric atheroma and more diffuse endothelial dysfunction in epicardial coronary artery than women, while women have lower CFR. These structural and functional gender differences in patients with early CAD may explain the differential clinical presentations and outcomes of CAD between women and men.