Extent of coronary atherosclerosis and arterial remodelling in women: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

Q: What are the key findings of this study?

Obstructive coronary artery disease in women was associated with significantly greater percent atheroma volume (36.1% vs 25.4%) and smaller lumen volumes compared to non-obstructive disease.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Suspected ischemia (n=174). Intervention: Obstructive coronary artery disease vs. Non-obstructive coronary artery disease. Primary outcome: Percent atheroma volume (PAV) (p=<0.0001).

Stephen J. Nicholls; E. Murat Tuzcu; Kathy Wolski; B. Delia Johnson; George Sopko; Barry L. Sharaf; Carl J. Pepine; Steven E. Nissen; C. Noel Bairey Merz

doi:10.21037/cdt.2018.04.03

August 1, 2018Cardiovascular Diagnosis and TherapyOpen Access

Extent of coronary atherosclerosis and arterial remodelling in women: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

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Key result

Obstructive CAD in women is linked to ~42% greater PAV versus non-obstructive disease.

P<0.0001
n=174

Why the study?

Does the extent of coronary atherosclerosis and arterial remodelling differ between women with obstructive CAD and non-obstructive CAD?

Study Design

Type

Case-Control (n=174)

Multicenter

Yes

Structured PICO

Does the extent of coronary atherosclerosis and arterial remodelling differ between women with obstructive CAD and non-obstructive CAD?

P

Population

174 women with suspected ischemia referred for coronary angiography, including 87 with non-obstructive coronary artery disease (CAD) and 87 age- and ethnicity-matched women with obstructive CAD.

I

Intervention

Obstructive coronary artery disease (CAD)

C

Comparator

Non-obstructive coronary artery disease (no luminal diameter stenosis >20% in any coronary artery)

O

Outcome

Atheroma burden (percent atheroma volume, total atheroma volume, percentage of images containing plaque) and coronary arterial remodelling (external elastic membrane volume, lumen volume, remodelling index) assessed by intravascular ultrasound (IVUS)surrogate

Main Result

Absolute Event Rate: 36.1% vs 25.4%

p-value: p=<0.0001

Women with obstructive CAD exhibit inadequate compensatory arterial remodeling compared to those with non-obstructive CAD, leading to smaller lumen volumes despite similar external elastic membrane volumes.

Limitations

Indication bias due to the requirement for invasive catheterisation
Uncertain whether findings can be extrapolated to asymptomatic women
Treatment bias due to higher statin use in the obstructive CAD group
Only one coronary artery segment was evaluated per woman
Some segments in the obstructive CAD group contained no stenosis >50%
IVUS provides limited characterization of plaque components
Indication bias due to requirement for clinically indicated coronary angiogram
Treatment bias, as women with obstructive CAD were more likely to receive statin therapy
Only one coronary artery segment was evaluated in each woman

Ask about this paper

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Implication

May refine sex-specific CAD risk assessment in women; hypothesis-generating and requires prospective validation before practice change.

Abstract

BACKGROUND: Information regarding the pathogenesis of ischemic heart disease (IHD) in women is limited. Sex-specific responses to atherosclerosis and coronary arterial remodelling in women versus men have been hypothesized, but limited study exists. METHODS: Case-matched study of 174 women with suspected ischemia referred for coronary angiography: 87 with non-obstructive coronary artery disease (CAD) (no luminal diameter stenosis >20% in any coronary artery) and 87 age and ethnicity matched women with obstructive CAD. Groups were compared with regard to atheroma burden and coronary arterial remodelling assessed by coronary artery intravascular ultrasound (IVUS). CONCLUSIONS: Our findings suggest that women referred to angiography for suspected ischemia, have differing patterns of coronary arterial response to injury with regard to accumulation of atherosclerosis and compensatory remodelling related to the presence and absence of obstructive CAD. Preservation and cultivation of compensatory arterial remodelling may be a novel CAD therapeutic target.

Discussion

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Cite This Study

Nicholls et al. (2018) conducted a case-control in Suspected ischemia (n=174). Obstructive coronary artery disease vs. Non-obstructive coronary artery disease was evaluated on Percent atheroma volume (PAV) (p=<0.0001). Obstructive coronary artery disease in women was associated with significantly greater percent atheroma volume (36.1% vs 25.4%) and smaller lumen volumes compared to non-obstructive disease.

synapsesocial.com/papers/6a05115efba2ba61ab55faed https://doi.org/10.21037/cdt.2018.04.03

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Extent of coronary atherosclerosis and arterial remodelling in women: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Extent of coronary atherosclerosis and arterial remodelling in women: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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