European Heart Journal Advance Access originally published online on April 18, 2008
European Heart Journal 2008 29(11):1359-1369; doi:10.1093/eurheartj/ehn142
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Sex differences in atheroma burden and endothelial function in patients with early coronary atherosclerosis
1 Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2 Division of Cardiology, Gachon University of Medicine and Science, Incheon, Republic of Korea
3 Division of Cardiology, Knoyang University Hospital, Daejeon, Republic of Korea
4 Section of Biostatistics, Mayo Clinic, Rochester, MN, USA
5 3 Cardiology Division, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Received 23 October 2007; revised 19 February 2008; accepted 13 March 2008; online publish-ahead-of-print 18 April 2008.
* Corresponding author. Tel: +1 507 255 4152, Fax: +1 507 255 2550, Email: lerman.amir{at}mayo.edu
Aims: Women and men have different clinical presentations and outcomes in coronary artery disease (CAD). We tested the hypothesis that sex differences may influence coronary atherosclerotic burden and coronary endothelial function before development of obstructive CAD.
Methods and results: A total of 142 patients (53 men, 89 women; mean ± SD age, 49.3 ± 11.7 years) with early CAD simultaneously underwent intravascular ultrasonography and coronary endothelial function assessment. Atheroma burden in the left main and proximal left anterior descending (LAD) arteries was significantly greater in men than women (median, 23.0% vs. 14.1%, P = 0.002; median, 40.1% vs. 29.3%, P = 0.001, respectively). Atheroma eccentricity in the proximal LAD artery was significantly higher in men than women (median, 0.89 vs. 0.80, P = 0.04). The length of the coronary segments with endothelial dysfunction was significantly longer in men than women (median, 39.2 vs. 11.1 mm, P = 0.002). In contrast, maximal coronary flow reserve was significantly lower in women than men (2.80 vs. 3.30, P < 0.001). Sex was an independent predictor of atheroma burden in the left main and proximal LAD arteries (both P < 0.05) by multivariate analysis.
Conclusion: Men have greater atheroma burden, more eccentric atheroma, and more diffuse epicardial endothelial dysfunction than women. These results suggest that men have more severe structural and functional abnormalities in epicardial coronary arteries than women, even in patients with early atherosclerosis, which may result in the higher incidence rates of CAD and ST-segment myocardial infarction in men than women.
Key Words: Atherosclerosis • Endothelium • Sex differences