한빛사 논문
Sang-Eun Lee MD, PhDa,b, Ji Min Sung PhDb,c, Daniele Andreini MD, PhDd, Mouaz H. Al-Mallah MDe, Matthew J. Budoff MDf, Filippo Cademartiri MD, PhDg, Kavitha Chinnaiyan MDh, Jung Hyun Choi MD, PhDi, Eun Ju Chun MD, PhDj, Edoardo Conte MDd, Ilan Gottlieb MD, PhDk, Martin Hadamitzky MDl, Yong Jin Kim MD, PhDm, Byoung Kwon Lee MD, PhDn, Jonathon A. Leipsic MDo, Erica Maffei MDp, Hugo Marques MD, PhDq, Pedro de Araújo Gonçalves MD, PhDq, Gianluca Pontone MD, PhDd, Sanghoon Shin MDa, Peter H. Stone MDr, Habib Samady MDs, Renu Virmani MDt, Jagat Narula MD, PhDu, Daniel S. Berman MDv, Leslee J. Shaw PhDw, Jeroen J. Bax MD, PhDx, Fay Y. Lin MDw, James K. Min MDw, Hyuk-Jae Chang MD, PhDb,c,*
aDivision of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
bYonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
cDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
dCentro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
eHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
fDepartment of Medicine, Los Angeles Biomedical Research Institute, Torrance, California
gCardiovascular Imaging Unit, SDN Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
hDepartment of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
iDepartment of Internal Medicine, Pusan University Hospital, Busan, South Korea
jDepartment of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
kDepartment of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
lDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
mDepartment of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
nDepartment of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
oDepartment of Medicine and Radiology, University of British Columbia, Vancouver, Canada
pDepartment of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale Marche, Urbino, Italy
qUnit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
rDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
sDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
tDepartment of Pathology, CVPath Institute, Gaithersburg, Maryland
uDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
vDepartment of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
wDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
xDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
*Address for correspondence: Dr. Hyuk-Jae Chang, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
Abstract
Objectives
The study sought to explore sex-based differences in total and compositional plaque volume (PV) progression.
Background
It is unclear whether sex has an impact on PV progression in patients with coronary artery disease (CAD).
Methods
The study analyzed a prospective multinational registry of consecutive patients with suspected CAD who underwent 2 or more clinically indicated coronary computed tomography angiography (CTA) at ≥2-year intervals. Total and compositional PV at baseline and follow-up were quantitatively analyzed and normalized using the analyzed total vessel length. Multivariate linear regression models were constructed.
Results
Of the 1,255 patients included (median coronary CTA interval 3.8 years), 543 were women and 712 were men. Women were older (62 ± 9 years of age vs. 59 ± 9 years of age; p < 0.001) and had higher total cholesterol levels (195 ± 41 mg/dl vs. 187 ± 39 mg/dl; p = 0.002). Prevalence of hypertension, diabetes, and family history of CAD were not different (all p > 0.05). At baseline, men possessed greater total PV (31.3 mm3 [interquartile range (IQR): 0 to 121.8 mm3] vs. 56.7 mm3 [IQR: 6.8 to 152.1 mm3] p = 0.005), and there was an approximately 9-year delay in women in developing total PV than in men. The prevalence of high-risk plaques was greater in men than women (31% vs. 20%; p < 0.001). In multivariate analysis, after adjusting for age, clinical risk factors, medication use, and total PV at baseline, despite similar total PV progression rates, female sex was associated with greater calcified PV progression (β = 2.83; p = 0.004) but slower noncalcified PV progression (β = –3.39; p = 0.008) and less development of high-risk plaques (β = –0.18; p = 0.049) than in men.
Conclusions
The compositional PV progression differed according to sex, suggesting that comprehensive plaque evaluation may contribute to further refining of risk stratification according to sex. (NCT02803411).
Key Words : coronary artery atherosclerosis; coronary artery disease; coronary computed tomography angiography; sex difference
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