Plaque distribution proves that men are from Mars, women from Venus

Just as the classic book by John Gray is supposed to help improve communication between the two sexes, so too might gender differences in plaque characteristics provide better communication among clinicians regarding clinical differences between men and women in presentation and outcomes of adverse coronary events.

In that regard, researchers from North Shore University Hospital in Manhasset, NY, have documented the tendency for men's coronary arteries to have more flow-limiting focal lesions and women's arteries to have more diffuse areas of calcification.

"The different distribution of plaque in men and women may provide insight into means of evaluating coronary artery plaques and mechanisms of plaque rupture," according to Dr. John Makaryus, a resident in internal medicine who, along with colleagues, presented a poster at the 2007 annual meeting of the North American Society for Cardiac Imaging.

Arterial calcium as measured by 64-slice CT angiography is a useful marker for atherosclerotic plaque burden. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized, calcified plaques as a result of the increased risk of plaque rupture and subsequent acute coronary syndrome, according to the poster.

Researchers retrospectively reviewed 164 coronary arteries (410 coronary segments) from 41 patients (30 men) who underwent coronary angiography due to CT findings. Coronary arteries were analyzed for individual segment coronary stenosis/plaque characterization as well as total vessel calcium (Agatston) score quantification.

There was no significant age difference between the men and women. The presence of risk factors in both groups was comparable, although the men had a higher overall rate in each category: diabetes mellitus, hypertension, smoking history, and dyslipidemia.

On comparison of all total vessel calcium scores, men had a higher total mean calcium score than women in each individual vessel and each vessel segment. Furthermore, while men tended to have more significant degrees of plaque calcification, women tended to have more diffuse calcium lesions than men, with 81% of women having multiple lesions compared with only 43% of men.

The results were as follows for men vs. women, respectively:

• left main total vessel calcium score: 71 vs. 40 (p = 0.477)

• left anterior descending: 399 vs. 204 (p = 0.228)

• left circumflex: 159 vs. 99 (p = 0.499)

• right coronary: 274 vs. 13 (p = 0.309)

Women had an average of 2.4 lesions, while men averaged 1.8. While the values were not statistically significant, likely a result of the small sample size, there is a trend toward more focal calcified lesions in men and more diffuse, lipid-laden plaque burden in women, according to researchers.

For more from the Diagnostic Imaging archives:

Vessel imagers focus on plaque characterization

Women's heart centers bring forth fresh perspectives

Researchers confront strengths, limitations of 64-slice CTA