Department of Internal Medicine, North Shore University Hospital. Zucker School of Medicine at Hofstra/Northwell Health. Manhasset, New York.
Department of Internal Medicine, Cleveland Clinic. Cleveland, Ohio.
Am J Cardiol. 2021 Jun 15;149:16-20. doi: 10.1016/j.amjcard.2021.03.025. Epub 2021 Mar 20.
Despite the increasing use of Coronary Artery Calcium (CAC) scoring for cardiovascular risk stratification in asymptomatic patients, the gender differences in CAC among symptomatic patients have not been well evaluated. We analyzed patients presenting to the emergency department (ED) with chest pain suggesting possible coronary artery disease (CAD) who received coronary computed tomography angiography (CCTA). Ordinal logistic regression was used to determine the odds ratio for the association of traditional cardiovascular risk factors and CAC. Patients with a CAC score ≥ 100 were followed for cardiovascular events or changes in medical management. Our cohort included 542 individuals (263 male, 279 female). Ordinal logistic regression model showed that among traditional cardiovascular risk factors, male sex had the highest odds ratio (OR) of 3.04 (p < 0.001, 95% CI [2.01, 4.59]) for the presence of CAC. Also, males had more diffuse distribution of coronary atherosclerosis (p=0.01). Subgroup analysis revealed that obesity was a bigger risk factor in male patients (OR 2.16), while smoking showed the greatest effect (OR 4.27) on CAC in women. Of patients who had CAC > 100 with an average follow-up of 346 days, there was an increase in both aspirin and statin use, yet significant sex differences were observed especially in patients with non-obstructive lesions on CCTA. Among male patients with non-obstructive lesions, 68.2% were on aspirin and 86.4% were on statin therapy after the CCTA compared to 27.3% and 45.5% respectively in their female counterparts. In conclusion, sex not only is the most powerful predictor for higher CAC among traditional cardiovascular risk factors in symptomatic patients but also influences the contribution of various traditional risk factors to elevated CAC. Furthermore, the discovery of CAD led to the initiation of medical therapy in male patients more frequently than in female patients, even after adjusting for the degree of luminal stenosis detected on coronary CT angiography.
尽管冠状动脉钙化 (CAC) 评分在无症状患者的心血管风险分层中越来越多地被使用，但有症状患者中 CAC 的性别差异尚未得到很好的评估。我们分析了因疑似冠心病 (CAD) 而到急诊科就诊并接受冠状动脉计算机断层扫描血管造影 (CCTA) 的胸痛患者。我们使用有序逻辑回归来确定传统心血管危险因素与 CAC 之间关联的比值比。对 CAC 评分≥100 的患者进行心血管事件或医疗管理变化的随访。我们的队列包括 542 人（263 名男性，279 名女性）。有序逻辑回归模型显示，在传统心血管危险因素中，男性的 CAC 阳性比值比 (OR) 最高为 3.04（p<0.001，95%CI [2.01, 4.59]）。此外，男性冠状动脉粥样硬化的分布更为弥漫（p=0.01）。亚组分析显示，肥胖是男性患者更大的危险因素（OR 2.16），而吸烟对女性 CAC 的影响最大（OR 4.27）。在 CAC>100 的患者中，有 542 人，平均随访 346 天，尽管在 CCTA 上发现非阻塞性病变，但使用阿司匹林和他汀类药物的人数均有所增加，而且在男性和女性之间观察到显著的性别差异。在 CCTA 上发现非阻塞性病变的男性患者中，有 68.2%使用阿司匹林，86.4%使用他汀类药物，而女性患者中分别为 27.3%和 45.5%。总之，在有症状患者中，性别不仅是传统心血管危险因素中 CAC 升高的最强预测因素，而且还影响各种传统危险因素对 CAC 升高的贡献。此外，即使在调整冠状动脉 CT 血管造影检测到的管腔狭窄程度后，与女性患者相比，发现 CAD 后男性患者更频繁地开始接受药物治疗。
