Author + information
- Received September 19, 2006
- Revision received December 5, 2006
- Accepted December 5, 2006
- Published online April 10, 2007.
- 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
- ↵⁎Reprint requests and correspondence:
Dr. Stephen J. Nicholls, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Mail Code JJ65, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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 mm3vs. 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 mm3vs. −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.
↵1 Dr. Nicholls has received speaking honoraria from Pfizer and AstraZeneca.
↵2 Drs. Tuzcu and Hazen have received speaking honoraria and research support from Pfizer
↵3 Dr. Sipahi has received an educational grant from Pfizer.
↵4 Dr. Nissen has received research support from AstraZeneca, Eli Lilly, Pfizer, Takeda, Sankyo, and Sanofi-Aventis; he has consulted for a number of pharmaceutical companies without financial compensation.
All honoraria, consulting fees, or other payments from any for-profit entity are paid directly to charity, so that neither income nor any tax deduction is received.
- Received September 19, 2006.
- Revision received December 5, 2006.
- Accepted December 5, 2006.
- American College of Cardiology Foundation