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J Am Coll Cardiol, 2007; 49:1546-1551, doi:10.1016/j.jacc.2006.12.039 (Published online 26 March 2007). © 2007 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: HEART DISEASE IN WOMEN

Rate of Progression of Coronary Atherosclerotic Plaque in Women

Stephen J. Nicholls, MBBS, PhD, FRACP, FACC^_*,,,1,_*, Kathy Wolski, MPH^_*, Ilke Sipahi, MD^_*,3, Paul Schoenhagen, MD^_*,, Timothy Crowe, BS^_*, Samir R. Kapadia, MD, FACC^_*, Stanley L. Hazen, MD, PhD^_*,,,2, E. Murat Tuzcu, MD, FACC^_*,2 and Steven E. Nissen, MD, FACC^_*,4

^_* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Cell Biology, Cleveland Clinic Foundation, Cleveland, Ohio
Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Diagnostic Radiology, Cleveland Clinic Foundation, Cleveland, Ohio.

Manuscript received September 19, 2006; revised manuscript received December 5, 2006, accepted December 5, 2006.

^_* Reprint requests and correspondence: Dr. Stephen J. Nicholls, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Mail Code JJ65, 9500 Euclid Avenue, Cleveland, Ohio 44195. (Email: nichols1{at}ccf.org).

Objectives: The purpose of this study was to determine the relationship between gender and the extent of coronary atherosclerosis assessed by intravascular ultrasound (IVUS) and its rate of progression in subjects treated with established medical therapies.

Background: It is uncertain whether the pathophysiology of coronary artery disease (CAD) differs between genders.

Methods: A systematic analysis was performed of 978 subjects who participated in serial studies of atheroma progression. Genders were compared with regard to the extent of coronary atheroma at baseline and subsequent change in response to use of established medical therapies.

Results: Women were more likely to have a history of hypertension and higher levels of body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and systolic and diastolic blood pressure. Despite this, women had less plaque in terms of percent atheroma volume (PAV) (33.9 ± 10.2% vs. 37.8 ± 10.3%, p < 0.001) and total atheroma volume (TAV) (148.7 ± 66.6 mm³ vs. 194.7 ± 84.3 mm³, p < 0.001). With medical therapy, the rate of change of PAV (0.7 ± 0.6% vs. 0.7 ± 0.5%, p = 0.92) and TAV (–2.3 ± 3.2 mm³ vs. –1.9 ± 2.9 mm³, p = 0.84) did not differ between genders. In the setting of intensive risk factor modification, there was no significant difference between genders with regard to the rates of plaque progression or regression.

Conclusions: Despite the presence of more risk factors, the extent of atheroma in women with angiographic CAD is less than in men in subjects participating in clinical trials that employed serial assessments with IVUS. The finding that the rate of plaque progression or regression does not differ between genders in the setting of intensive risk factor modification supports the use of established medical therapies in women with CAD.

Abbreviations and Acronyms   CAD = coronary artery disease   CRP = C-reactive protein   EEM = external elastic membrane   HDL = high-density lipoprotein   IVUS = intravascular ultrasound   LDL = low-density lipoprotein   PAV = percent atheroma volume   TAV = total atheroma volume

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