Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
PLoS One. 2021 Apr 8;16(4):e0248884. doi: 10.1371/journal.pone.0248884. eCollection 2021.
Even with increasing awareness of sex-related differences in atherosclerotic cardiovascular disease (ASCVD), it 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 9,675 men and 1,709 women with follow-up CAC scoring. At baseline, men were more likely to have a CAC score >0 than were women (47.8% vs. 28.6%). The probability of CAC progression at 5 years, defined as [√CAC score (follow-up)-√CAC score (baseline)] ≥2.5, was 47.4% in men and 29.7% in women (p<0.001). When we stratified subjects according to the 10-year ASCVD risk (<5%, ≥5% and <7.5%, and ≥7.5%), a sex difference was observed in the low risk group (CAC progression at 5 years, 37.6% versus 17.9%; p<0.001). However, it became weaker as the 10-year ASCVD risk increased (64.2% versus 46.2%; p<0.001, and 74.8% versus 68.7%; p = 0.090). Multivariable analysis demonstrated that male sex was independently associated with CAC progression rate among the entire group (p<0.001). 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. However, the difference between women and men diminishes as the 10-year ASCVD risk increases.
即使人们对动脉粥样硬化性心血管疾病（ASCVD）中与性别相关的差异的认识不断提高，但冠状动脉粥样硬化的进展在女性和男性之间是否存在差异仍不清楚。我们试图比较女性和男性的冠状动脉钙（CAC）进展情况。我们从一项回顾性、多中心的连续无症状个体的 CAC 评分登记处中，确定了 9675 名男性和 1709 名女性进行了随访 CAC 评分。在基线时，男性 CAC 评分>0的可能性高于女性（47.8% vs. 28.6%）。5 年内 CAC 进展的概率定义为[√CAC 评分（随访）-√CAC 评分（基线）]≥2.5，男性为 47.4%，女性为 29.7%（p<0.001）。当我们根据 10 年 ASCVD 风险（<5%、≥5%和<7.5%、≥7.5%）对受试者进行分层时，在低风险组中观察到性别差异（5 年内 CAC 进展，37.6%比 17.9%；p<0.001）。然而，随着 10 年 ASCVD 风险的增加，这种差异变得较弱（64.2%比 46.2%；p<0.001，74.8%比 68.7%；p = 0.090）。多变量分析表明，男性是整个组 CAC 进展率的独立相关因素（p<0.001）。亚组分析表明，只有在低危组中，男性与 CAC 进展率之间存在独立的关联。男性的 CAC 进展率高于女性。然而，随着 10 年 ASCVD 风险的增加，女性和男性之间的差异会减小。
