Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD

Objectives The aim of this study was to evaluate sex differences in plaque morphology in stable coronary artery disease (CAD) patients using a multimodality intravascular imaging approach. Background Differences in atherosclerotic burden and plaque morphology between men and women is a focus of treatment and preventative measures. Methods We retrospectively analyzed data from 383 patients with stable CAD who were referred for angiography and underwent optical coherence tomography. Among them, 128 also underwent intravascular ultrasound (IVUS)/near infrared spectroscopy. Results Of the 383 patients included in the study, 268 were men and 115 were women. Women tended to be older (66 ± 10 years of age vs. 62 ± 11 years of age; p = 0.002) and have more comorbidities including hypertension (97% vs. 90%; p = 0.031), diabetes with insulin use (18% vs. 10%; p = 0.043), obesity (body mass index 30 kg/m² vs. 28 kg/m²; p = 0.022), and lower estimated glomerular filtration rate (88 ml/min/1.73m² vs. 98 ml/min/1.73m²; p = 0.001). Optical coherence tomography data demonstrated that there was no sex difference in plaque morphology as characterized by maximum lipid arc, lipid length, lipid volume index, minimum cap thickness, incidence of thin cap fibroatheroma, microvessels, macrophages, and calcification. There was also no difference in maximal lipid core burden index at the 4-mm maximal segment as seen on near infrared spectroscopy. Plaque characteristics by IVUS were similar between men and women except for an increase in plaque burden in men compared to women in the reference segment (44.4 vs. 39.3; p = 0.031). After adjusting for age, body mass index, percutaneous coronary intervention history, and clinical risk factors, sex was not found to be an independent predictor of severe plaque burden by IVUS. Conclusion Among men and women with stable CAD referred for coronary angiography, there was no difference in plaque characteristics as assessed by multimodality imaging. These findings, which are hypothesis generating, suggest that equally aggressive primary and secondary preventive efforts irrespective of sex must be undertaken.