Compositional plaque progression in women and men with non-obstructive coronary artery disease

Caroline Annette Berge Hondros; Ingela Khan; Margrete Solvik; Silja Hanseth; Eva Kristine Ringdal Pedersen; Siren Hovland; Terje Hjalmar Larsen; Mai Tone Lønnebakken

doi:10.1016/j.ijcha.2024.101352

Compositional plaque progression in women and men with non-obstructive coronary artery disease

Int J Cardiol Heart Vasc. 2024 Feb 7:51:101352. doi: 10.1016/j.ijcha.2024.101352. eCollection 2024 Apr.

Authors

Caroline Annette Berge Hondros^{1

2}, Ingela Khan², Margrete Solvik¹, Silja Hanseth^{2

3}, Eva Kristine Ringdal Pedersen^{1

2}, Siren Hovland^{1

4}, Terje Hjalmar Larsen^{1

5}, Mai Tone Lønnebakken^{1

2}

Affiliations

¹ Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
² Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
³ Department of Medicine, Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009 Bergen, Norway.
⁴ Norwegian Registry of Invasive Cardiology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
⁵ Department of Biomedicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.

Abstract

Background: In coronary artery disease (CAD), plaque progression and plaque composition are associated with cardiovascular risk. Whether compositional plaque progression in non-obstructive CAD differs between women and men is less studied.

Methods: We included 31 patients (42% women) with chronic non-obstructive CAD from the Norwegian Registry of Invasive Cardiology, undergoing serial coronary computed tomography angiography (CCTA) on clinical indication (median inter-scan interval 1.8 [1.5-2.2] years). We performed quantitative and qualitative plaque analysis of all coronary artery segments.

Results: Women were older compared to men (65 ± 8 years vs. 55 ± 12 years, p = 0.019), while there was no difference in the prevalence of hypertension, diabetes, smoking or statin treatment between groups. At baseline, women had a higher total plaque burden, more calcified plaques, and less fibro-fatty and necrotic core plaques compared to men (all p < 0.05). During follow-up, men showed faster progression of fibro-fatty plaques (4.0 ± 5.4 % per year vs. -0.6 ± 3.1 % per year, p = 0.019) and a greater reduction of fibrous plaques (-7.3 ± 6.1 % per year vs. 2.1 ± 7.2 % per year, p = 0.003) compared to women even after age adjustment. At follow-up, total plaque burden remained higher in women compared to men (24.9 ± 3.3 % vs. 21.1 ± 2.6 %, p = 0.001), while men had an increase in fibro-fatty (21.2 ± 9.3 % vs. 28.6 ± 9.8 %, p = 0.004) and necrotic core plaques (5.6 ± 3.6 % vs. 10.8 ± 7.2 %, p = 0.006), and a decrease in fibrous plaques (69.0 ± 11.9 % vs. 54.7 ± 13.7 %, p < 0.001). Women's plaque composition remained unaltered.

Conclusion: In non-obstructive CAD, serial CCTA demonstrated a higher total plaque burden and a stable plaque composition in women, while men had a faster progression of unstable low-attenuating fibro-fatty plaques.Clinical trial registration: ClinicalTrials.gov: Identifier NCT04009421.

Keywords: Coronary computed tomography angiography; Non-obstructive coronary artery disease; Plaque composition; Plaque progression; Sex differences.

Associated data

ClinicalTrials.gov/NCT04009421