Noninvasive Assessment of Gender Differences in Coronary Plaque Composition with Multidetector Computed Tomographic Angiography

To date, sparse data are available with regard to gender differences in plaque morphology and composition. The aim of the present report was to assess the differences in coronary plaque burden and composition in a noninvasive manner between women and men using multidetector computed tomographic angiography. The study population consisted of 416 patients (61 ± 13 years), with 148 women (36%). A stenosis of ≥70% in at least one coronary segment was found in 11% of women compared to 25% of men (p <0.0001). Overall, women presented with a significantly lower mean number of segments containing calcified plaques (1.43 ± 2.04 vs 2.25 ± 2.30, p = 0.004) and mixed plaques (1.67 ± 1.23 vs 2.25 ± 2.30, p = 0.05). No such relation was seen with noncalcified plaques (0.72 ± 1.01 vs 0.86 ± 1.06, p = 0.21). In addition, the assessment of the overall proportion of the composition of plaque burden revealed relatively more noncalcified (40% vs 28%), less calcified (38% vs 43%), and mixed (23% vs 28%) plaques in women than in men (p <0.0001). On multivariate analysis of the total plaque burden, the women had a 19% (95% confidence interval 11% to 28%, p <0.0001) greater relative distribution of plaque that was noncalcified compared to the men, and the overall plaque burden was less likely to be calcified (p = 0.006) or mixed (p = 0.019). Similar results were seen in younger and older subjects. In conclusion, gender differences exist, not only in the atherosclerotic disease burden, but also in the underlying plaque composition. Women tended to have more exclusively noncalcified plaque and were less likely to have calcified or mixed plaques compared to men. Future studies are needed to elucidate whether these underlying differences in plaque composition might explain the reduced risk of cardiac events in women.