Similar plaque burden, different risks: Why CCTA might one day alter treatment in postmenopausal women

New data suggest that the burden of atherosclerosis on imaging might not be as indicative of major cardiovascular events as a person’s age and sex. 

Details of the research were presented this week in Barcelona at EACVI 2023—the annual meeting of the European Society of Cardiology. During the presentation, experts shared that their findings suggest that postmenopausal women are more likely to suffer a heart attack or death than men of similar age with the same plaque burden. This suggests that coronary computed tomography angiography findings could be used to guide treatment decisions within the demographic, experts involved in the research noted. 

“Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment,” explained study author Sophie van Rosendael, PhD, of Leiden University Medical Center in the Netherlands. “Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug.” 

For their study, the team utilized CCTA imaging from nearly 25,000 participants enrolled in the CONFIRM registry. They rated participants’ plaque burden from 0 to 42 based on the presence of plaque, composition, location and severity of narrowing (Leiden CCTA score). These scores were assessed alongside participants’ age, sex, cardiovascular risk factors, family history and history of major adverse cardiovascular events (MACE). 

For women, the onset of coronary atherosclerosis lagged 12 years behind men. Women more often displayed nonobstructive disease and they also had a significantly lower overall plaque burden in comparison to men.  

However, postmenopausal women (55 and older) with medium to high plaque burden were reported to have 2.21-fold and 6.11-fold higher risks of MACE than those with low burden. In contrast, in men of the same age with the same burden, these risks were just 1.57-fold and 2.25-fold higher. 

“In this study, the elevated risk for women versus men was especially observed in postmenopausal women with the highest Leiden CCTA score,” Rosendael noted. “This could be partly because the inner diameter of coronary arteries is smaller in women, meaning that the same amount of plaque could have a larger impact on blood flow.” 

If confirmed by additional studies, these findings could impact treatment regimens for affected patients, Rosendael added. 

Hannah murhphy headshot

In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.

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