Added: Charlynn Gran - Date: 13.09.2021 08:17 - Views: 40603 - Clicks: 9174
Even with increasing awareness of sex-related differences in atherosclerotic cardiovascular disease ASCVDit remains unclear whether the progression of coronary atherosclerosis differs between women and men. We sought to compare coronary artery calcium CAC progression between women and men. From a retrospective, multicentre registry of consecutive asymptomatic individuals who underwent CAC scoring, we identified 9, men and 1, women with follow-up CAC scoring. Subgroup analyses showed an independent association between male sex and CAC progression rate only in the low-risk group.
The CAC progression rate is higher in men than in women. This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Due to ethical restrictions by the institutional review board committees of each participating healthcare center, the Korea Initiatives on Coronary Artery Calcification KOICA registry data underlying this study cannot be made publicly available, Looking for sex South Korea ct public availability would compromise patient confidentiality and participant privacy.
Therefore, access to aggregated data will be granted following review by the KOICA steering committee; data access requests can be sent to onlylhw yuhs.
Competing interests: The authors have declared that no competing interests exist. Coronary artery disease CAD is the leading cause of death worldwide for both men and women [ 1 ]. Given the worldwide health and economic implications of atherosclerotic cardiovascular disease ASCVD in women, there is a strong rationale to sustain an effort to control major ASCVD risk factors and apply evidence-based therapies in women [ 2 ]. For example, in older adults, a higher percentage of women than men have hypertension, and the gap will likely increase in the aging society [ 3 ].
The prevalence of diabetes in women is also increasing, which exacerbates the overall risk of ASCVD [ 4 ]. Nevertheless, women are regarded as at lower risk for ASCVD than Looking for sex South Korea ct men, and are not given aggressive preventive medications, such as statins, despite a similar benefit for both women and men [ 5 — 7 ]. Especially, the importance of CAC imaging in women has been repeatedly proven, even in those with a low risk factor burden [ 9 — 12 ].
However, atherosclerosis is a dynamic process. While baseline CAC can be thought of as a single time point in atherosclerosis, the assessment of CAC progression provides insight into the dynamic atherosclerotic process in given individuals. Although male sex is a well-known risk factor for CAC progression [ 13 ], it has not been established whether CAC progression differs by sex. Therefore, Looking for sex South Korea ct aimed to evaluate sex differences in CAC progression in a large cohort of asymptomatic individuals in the general population.
In addition, we attempted to evaluate whether the sex difference varies according to the year ASCVD risk. This retrospective study was approved by Institutional Review Board of Seoul National University Bundang Hospital and that of each participating institution and conducted in accordance with the Declaration of Helsinki. The approval was IRB No. The need for informed consent from study participants was waived.
The Korea Initiatives on Coronary Artery Calcification KOICA registry is an observational, retrospective, multicentre registry of Korean individuals who underwent CAC scoring as a part of a health check-up in a self-referral setting at six healthcare centres [ 14 ]. In the registry, 93, participants were enrolled between April and March Fig 1. Among these, we identified 12, participants who underwent at least two CAC scans; however, 1, of these had incomplete data for the calculation of the year ASCVD risk and were excluded.
Finally, 11, participants remained for the analysis. CAC, coronary artery calcium. During the health check-up, sociodemographic factors, risk profiles, and medication history were collected by a detailed questionnaire. All participants underwent clinical examinations, including a physical examination and laboratory tests.
CAC scores were calculated using the Agatston method [ 18 ]. For participants with more than two CT scans, the square root transformed difference was calculated for each follow-up CT scan, and the earliest follow-up scan with demonstrated CAC progression was included in the analysis. The CAC progression rate was calculated as the annualized difference between the square root of the baseline and last follow-up CAC scores. Kaplan-Meier curves were used to visualize and estimate the distribution of the time to CAC progression according to sex, with differences evaluated using the log-rank test.
The earliest scan date of detected CAC progression was ased as the occurrence of an event. We also evaluated Kaplan-Meier curves using a propensity matched cohort, with a matching ratio of women to men. Univariable and multivariable linear regression analyses were performed to determine the effects of conventional coronary risk factors and the baseline CAC score on the annualized progression of the CAC score. The multivariable analysis was initiated with the following conventional risk factors model 1 : age, male sex, waist circumference, hypertension, dyslipidaemia, diabetes, current smoking, systolic blood pressure, low-density lipoprotein LDL cholesterol, HDL cholesterol, triglyceride, creatinine, high-sensitive C-reactive protein, and glycated haemoglobin HbA1c.
Body mass Looking for sex South Korea ct, diastolic blood pressure, and estimated glomerular filtration rate were excluded from the multivariable analysis because of multicollinearity variance inflation factor of 2. We also performed a multivariable analysis with the addition of the baseline CAC score to the conventional risk factors in model 1 model 2. For subgroup analyses, the variables that remained in the final model of the multivariable analysis were included. The 11, study participants consisted of 9, Looking for sex South Korea ct and 1, women.
Baseline characteristics of the study participants are provided in Table 1. Although age was not ificantly different between men and women, men showed a higher proportion of conventional cardiovascular risk factors, and a higher year ASCVD risk, compared to that in women. Therefore, women tended to be classified into lower risk groups.
Women also showed lower baseline CAC scores compared to those in men. The median duration between the initial and last follow-up scan was 2. During follow-up, 3, of 9, men The absolute increase in CAC score in men and women was The mean CAC progression rate for men and women was 0.
Comparison of the cumulative proportion of CAC progression between men and women revealed that the chance of CAC progression was higher in men than in women proportion of CAC progression at 5 years, In the Kaplan-Meier curves from the propensity score matched cohort, men demonstrated a higher risk of CAC progression than did women S1 Fig.
Univariable linear regression analyses showed that almost all conventional risk factors, including male sex, were ificantly associated with the CAC progression rate Table 2. In the multivariable model with conventional risk factors model 1male sex remained as a ificant predictor, along with age, waist circumference, hypertension, diabetes, hyperlipidaemia, current smoking, LDL cholesterol, HDL cholesterol, triglyceride, creatinine, and HbA1c Table 3. Similar were observed in the multivariable model with the additional inclusion of the baseline CAC score model 2.
The present study demonstrated a sex difference in CAC progression in a large of asymptomatic individuals. Looking for sex South Korea ct probability of CAC progression was higher in men than in women, and the difference grew over time.
Data regarding differences in CAC progression between men and women are sparse.
However, when CAC progression was separately analysed, no sex difference was observed. This may be due to the fact that the study population in this report comprised patients with suspected CAD, and the women were ificantly older than the men In contrast, the present study included asymptomatic men and women, and there was not a ificant sex difference in age.
Additionally, we evaluated the dynamic change in CAC progression over time. The probability of CAC progression was non-linear, and the trend gradually diverged as time progressed. In the present study, men demonstrated a higher proportion of conventional cardiovascular risk factors and higher year ASCVD risk than did women. Therefore, not surprisingly, the baseline CAC score was ificantly higher in men than in women. This supports the hypothesis that a higher burden of cardiovascular risk factors and more severe baseline coronary atherosclerosis in men contributes to the rapid progression of coronary atherosclerosis [ 22 ].
When we analysed sex differences in CAC progression according to clinical risk profiles, we found that the probability of CAC progression at 5 years in men was approximately twice that in women for the lowest year ASCVD risk group. However, the gap between the probability curves was decreased in the intermediate risk group, and the curves finally merged in the highest risk group. Additionally, male sex was a ificant predictor for CAC progression only in the lowest risk group.
Thus, atherosclerosis progression is similar for both sexes, among those under multiple risk factors, despite an underlying sex difference. Consistent with this, the CONFIRM study reported that after propensity score matching, men and women Looking for sex South Korea ct no or non-obstructive CAD exhibited the same rates of mortality and myocardial infarction [ 23 ].
The Looking for sex South Korea ct data suggest that men and women at comparably high risk levels experience coronary atherosclerosis progression in a similar manner, before the onset of adverse cardiac events.
The retrospective observational de of our study introduced several limitations. First, the present study cohort of self-referred healthy individuals may not be fully representative of the general population, and the risk of selection bias must be considered. Even though this was a large multicentre study, the of enrolled women was smaller than that for men, and there were relatively smaller s of women in the higher risk groups, which may have limited the representativeness in the subgroup analyses.
This reflects the fact that women seek fewer medical services than do men in this self-referred setting. Second, because of the absence of a specific study protocol guiding follow-up scanning, the interscan duration was relatively short [2. Nevertheless, the median duration between the initial and last scans did not differ between women and men.
Furthermore, to minimize the potential influence of variations in the interscan duration, we analysed the association of annualized CAC progression with various cardiovascular risk factors, including male sex. Additionally, we lacked data regarding menopause and hormone replacement therapy. As postmenopausal women are under atherogenic conditions [ 25 ], it would be valuable to compare the CAC progression between postmenopausal women and age-matched men. Finally, since we lacked detailed information regarding medication use, we could not include statin use in the multivariable analysis.
Considering the emerging evidence Looking for sex South Korea ct that statins impact the increase in CAC, further studies are desired to evaluate whether the prominent CAC progression in men than in women is associated with greater statin use. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Even with increasing awareness of sex-related differences in atherosclerotic cardiovascular disease ASCVDit remains unclear whether the progression of coronary atherosclerosis differs between women and men.
Funding: The author s received no specific funding for this work. Introduction Coronary artery disease CAD is the leading cause of death worldwide for both men and women [ 1 ]. Methods Study population This retrospective study was approved by Institutional Review Board of Looking for sex South Korea ct National University Bundang Hospital and that of each participating institution and conducted in accordance with the Declaration of Helsinki.
Download: PPT. Ascertainment of risk factors During the health check-up, sociodemographic factors, risk profiles, and medication history were collected by a detailed questionnaire. Baseline characteristics The 11, study participants consisted of 9, men and 1, women.
Sex differences in CAC progression The median duration between the initial and last follow-up scan was 2. Fig 2. Fig 3. Fig 4. Association of sex with CAC progression rate Univariable linear regression analyses showed that almost all conventional risk factors, including male sex, were ificantly associated with the CAC progression rate Table 2.
Table 2. Univariate analysis for factors associated with the CAC progression rate. Table 3. Multivariate analysis for factors associated with the CAC progression rate. Discussion The present study demonstrated a sex difference in CAC progression in a large of asymptomatic individuals.Looking for sex South Korea ct
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