Mild coronary artery disease may not differ between sexes

Men and women may not really be all that different when it comes to mild coronary artery disease.

A prospective, multinational registry analysis found that 1.2% of women and 1.1% of men with mild, non-obstructive coronary artery disease on coronary CT angiography experience a major adverse cardiovascular event, heart attack or death, each year.

For those free of coronary artery disease (CAD), the event rate was 0.3% for both sexes, reported at the annual meeting of the Radiological Society of North America.

Women’s heart disease is typically viewed as different from men’s heart disease, in part because of women’s unique presenting symptomatology. Studies such as the Women’s Health Initiative have also reported that women with nonspecific or a typical chest pain have a twofold greater risk for nonfatal MI.

Importantly, all prior data have been reliant on invasive coronary angiography for anatomical coronary assessment, observed by Health Care Heart Center at St. Paul’s Hospital, Vancouver, B.C.

The current analysis, however, used data from the prospective CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, which tracks roughly 28,000 individuals in North America, Europe and Asia who have undergone coronary CT angiography.

What we realize is that CT identifies mild disease in the wall in a way that the invasive angiogram does not. So suddenly, when you say you have a normal invasive angiogram, there may still be mild disease in the arteries, whereas when you have a normal CT in a woman, our data would suggest that those women do very well, even if they have symptoms. They identified 18,158 patients in the CONFIRM registry with no disease or mild CAD with less than 50% stenosis. Propensity matching for risk factors, chest pain, and extent of disease left 11,462 patients (average age, 55 years).

The annual major adverse cardiovascular event (MACE) rate was 0.6% overall, and was significantly different between patients with a normal CT and those with non-obstructive disease (0.3% vs. 1.1%).

This mild disease we see on CT is not just incidental. It actually identifies patients who are at increased risk of having a heart attack and dying, with an increased risk of 1.84 for the overall cohort.

Notably, 3-year MACE-free survival was similar among men and women without coronary plaque on CT as well as those with non-obstructive disease.

Event rates were lower in men and women with normal CT scans and elevated in both sexes in the setting of non-obstructive disease, regardless of the nature of chest pain and even in the absence of chest pain.