Abstract 3652: Coronary Heart Disease Prevention in Women: The Prognostic Significance of Subclinical Atherosclerosis by Carotid Ultrasound
Background: The difficulty of coronary heart disease (CHD) prevention in women is recognized. Reasons include gender disparities in accuracy rates of current diagnostic tests and clinical presentation.
Objective: Assess the utility and prognostic significance of carotid atherosclerosis in predicting CHD in women.
Methods: Women (n=140) scheduled for elective coronary angiography underwent carotid ultrasound and fasting lipid analysis. Subjects were excluded for age (≥ 65), prior history of CHD, and anti-lipid therapy. Severe coronary artery disease (CAD) was defined as stenosis ≥ 50%. Carotid atherosclerosis was defined as IMT ≥ 1 mm in the main body or focal plaque in the main body or bulb. Subjects were followed for a median of 50 months. Future cardiovascular events (CVEs) were defined as Major (death, MI, and stroke), and Any event (Major, revascularization, and new onset heart failure).
Results: 136 women (mean age 53 ± 8) had all data available. 80% (n=108) of subjects were classified as low risk and 1% (n=2) as intermediate risk per Framingham score, with an additional 19% (n=26) having CHD equivalent conditions. Severe CAD was present in 39 (28%) subjects. Carotid atherosclerosis had a sensitivity of 74%, specificity of 49%, and negative predictive value of 83% for CAD. Subjects were categorized into Group 1 (Carotid atherosclerosis, n=79) and Group 2 (no carotid atherosclerosis, n=57). After median follow-up of 50 months, 6 women experienced Major CVEs (Group 1 n = 5; Group 2 n=1). Major event rate for Group 1 was 6.3% vs. 1.8% for Group 2. For Any event, the rates were 22% for Group 1 compared to 9% for Group 2 (p=0.046). The event rates were similar between high-risk (3.8%) and low-risk (3.7%) for Major and 12% vs. 16 % for Any event. Kaplan-Meier survival analysis reveals that women without diagnosis of carotid atherosclerosis enjoyed significantly better event free survival. Negative predictive values for carotid atherosclerosis in predicting angiographic disease, Major events and Any event were 83%, 91% and 98%, respectively.
Conclusion: Carotid atherosclerosis predicts CVEs in young to middle-aged women without high-risk clinical scores. Women without diagnosis of carotid atherosclerosis enjoy excellent long-term event free survival.