Pro-atherogenic monocytes as risk prediction marker for severe coronary artery disease in post-menopausal women

Abstract Background Menopause increases cardiovascular risk, yet sex-specific risk markers remain unclear. Monocytes are relevant in atherosclerosis and in the early phase of myocardial healing after ischemia. Age dependent inflammation has been described in both male and female patients. The impact of menopause on monocyte distribution and its relevance to coronary artery disease (CAD) is unknown. Methods Leukocytes from 185 individuals (110 female, 75 male) were analysed via flow-cytometry, with monocytes categorized by CD14 and CD16 expression. Serum estrogen, progesterone, and FSH levels were correlated with monocyte percentages in postmenopausal women. CAD severity was assessed using the SYNTAX Score I and the number of affected vessels. Results Postmenopausal women had higher classical monocytes than premenopausal women, while levels remained stable in men. Non-classical monocytes decreased after menopause. Classical monocytes negatively correlated with estrogen and were associated with CAD severity in women only, with a predictive capacity of 0.778. Youden’s Index identified a cut-off of 74.8% (sensitivity: 0.83, specificity: 0.62). Conclusion Pro-atherosclerotic (CD14++CD16-) monocytes increase by menopause. Amount of classical monocytes represent a risk prediction marker for severity of coronary artery disease in post-menopausal women only and may serve for individualized risk prediction in women.Graphical abstract