Be careful out there.
http://www.theheart.org/article/1323073.do?utm_campaign=newsletter&utm_medium=email&utm_source=20111205_EN_Heartwire
Women with extensive coronary artery plaque have a significantly higher risk for major adverse cardiac events, including MI, than their male counterparts, according to new research presented here at the Radiological Society of North America (RSNA) 2011 Scientific Assembly and Annual Meeting [1].
| Dr John W Nance Jr |
"In general, men tend to have more calcified plaque than women, but women are actually at greater risk when they do have plaque in their coronary arteries," Dr John W Nance Jr (Johns Hopkins Hospital, Baltimore, MD) said in an interview. "This is not only true just for heart attacks, it's true for any cardiovascular event, including unstable angina, revascularization, and sudden cardiac death."
In research done when he was at the Medical University of South Carolina in Charleston, Nance and his group sought to determine whether there were gender differences in the predictive value of findings on cardiac CT angiography (CTA) for cardiovascular events in men and women presenting with acute chest pain who did not have acute coronary syndrome.
"Anecdotally, we do see differences in the amount and types of plaques between different types of patients, not only between men and women, but between African Americans and whites," he said.
"We also see very strong differences in outcomes that different types of patients are having. Men have a much higher risk of having heart disease, but we also notice that we get more women coming to the emergency department for chest pain, which doesn't seem to make sense. This was an attempt to try to tease out why some of those findings might be true," Nance said in an interview.
In the study, 480 patients, mean age 55 years (range 44-66 years; 35% male), who presented to the emergency department with acute chest pain underwent contrast-enhanced CTA. The researchers noted the number of vessel segments with plaque, the severity of the blockage, and the composition of the plaque.
The patients were followed for the occurrence of major adverse cardiac events (MACE), including MI, unstable angina, revascularization, and cardiac death.
During a follow-up period of 12.8 months, the researchers noted that the risks for cardiovascular events associated with plaque were significantly different between women and men.
Overall, 87 events (three cardiac deaths, 13 MIs, 33 revascularizations, and 38 cases of unstable angina) occurred in 70 patients.
There were significant differences with respect to gender and presence and extent of plaque and stenosis between subjects with and without MACE, Nance reported.
The risk associated with having more than four coronary segments of any plaque was significantly higher in women than in men (HR 113.9 vs HR 66.9, p<0.01 for both) compared with men and women without plaque.
Women with any plaque had a significantly higher risk of major cardiovascular events than men (HR 49.3 vs HR 39.1, p<0.001 for both), compared with women and men without plaque.
"This research tells us that extensive coronary plaque in women is more worrisome than the equivalent amount in men," Nance said.
"People want to know what the take-home message is for women, but there really isn't a good one. They should pretty much be doing what they should have been doing to begin with, which is eating correctly and exercising," he said.
But there is an important message to physicians, he said. "When you get the test results back, you have to interpret them not in a 'one-size-fits-all' kind of way. If it is a woman with copious amounts of calcified plaque, she may warrant more aggressive risk-modification measures than a man with the equivalent amount of calcified plaque. In any event, the new data suggest that the atherosclerotic process is not necessarily linear and that we need to do more research to better understand the disease."
Nance added that coronary CTA can provide important prognostic information to identify risk, as long as gender differences are kept in mind.
Dr David Levin (Thomas Jefferson University Hospital, Philadelphia, PA) agreed that coronary CTA is an important prognostic tool.
"These were all patients who had chest pain. Chest pain can be associated with all sorts of other things or maybe even nothing, but if somebody has chest pain and then undergoes coronary CTA and they are shown to have plaque, that shows that they are at a greatly increased risk for a major cardiovascular event," Levin said.
"I think that this is certainly one of the most interesting things about the study, that it establishes that coronary CTA is very important in determining prognosis of patients. So if you have chest pain and you go to the ER and the CTA shows your arteries are clean, basically that means that you are not at any risk of having a heart attack," Levin continued. "Whereas if you do have plaque, even though that plaque may not be the cause of your chest pain, your risk is considerably higher and that should stimulate your doctor to prescribe medication and get you to alter your lifestyle to try to reduce the likelihood of a future heart attack. Knowledge is power, and coronary CTA can provide that knowledge."
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