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Coronary Blood Flow in Women From the CENTURY Trial
Key result
Female sex linked to ~33% higher coronary blood flow and lower MACE rates versus males.
- P<0.0001
- n=1,028
Why the study?
Clinically manifest CAD in women is delayed by up to 2 decades compared with men without a defined physiological basis.
Are there sex differences in quantitative coronary blood flow and clinical outcomes among patients in the CENTURY trial?
Population
331 women and 697 men from the CENTURY trial
Comparison
Women vs men
Design
Post hoc analysis of randomized CENTURY trial
Follow-up
14 years
Authors
Discussion
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Overview
May inform sex-specific coronary flow norms in imaging; leaves open causal protection and needs prospective validation.
JACC Imaging · cohort study. Coronary flow may need sex-specific norms: women's is 33% higher. Coronary Blood Flow in Women From the CENTURY Trial Clinically manifest CAD in women is delayed by up to 2 decades compared with men without a defined physiological basis. Are there sex differences in quantitative coronary blood flow and clinical outcomes among patients in the CENTURY trial? 1028 participants, Post hoc analysis of randomized CENTURY…. Female sex was associated with 33% higher rest and stress coronary blood flow and significantly lower rates of major adverse cardiac events compared with male sex (P<0.0001). Women had approximately half the rates of all-cause mortality (log-rank P = 0.0223), death or myocardial infarction (log-rank P = 0.0138), revascularization (log-rank P… Rest and stress coronary blood flow were 33% higher in women than in men across all comparable strata of age, body mass index, risk factors, and treatment. Read the evidence. See where experts stand. synapsesocial.com/papers/6aa7afef79e9260bc85aac80
Key Points
- To determine the physiological basis for the delayed onset of clinically manifest coronary artery disease in women compared to men by evaluating quantitative coronary blood flow and coronary flow capacity.
- Post hoc analysis of the randomized CENTURY trial (NCT00756379) tracking 331 women and 697 men across 14 years of follow-up.
- Cardiovascular risk factors, coronary artery calcium, quantitative coronary blood flow, and coronary flow capacity were measured using positron emission tomography.
- Women had approximately half the rates of all-cause mortality (log-rank P = 0.0223), death or myocardial infarction (log-rank P = 0.0138), revascularization (log-rank P = 0.0004), and major adverse cardiac events (log-rank P < 0.0001) compared with men.
- Rest and stress coronary blood flow were 33% higher in women than in men across all comparable strata of age, body mass index, risk factors, and treatment.
- Integration of flow rates with smaller female vessel diameters indicated an estimated 82% higher global endothelial shear stress in women, representing a hypothesized chronic antiatherogenic protective mechanism.
Study Design
Type
RCT (n=1,028)
Randomization
Randomized
Structured PICO
Are there sex differences in quantitative coronary blood flow and clinical outcomes among patients in the CENTURY trial?
P
Population
1,028 participants (331 women and 697 men) from the randomized CENTURY trial followed for up to 14 years to assess sex differences in coronary blood flow and clinical outcomes.
I
Intervention
Female sex (observational comparison)
C
Comparator
Male sex
O
Outcome
Quantitative coronary blood flow (CBF) and coronary flow capacity measured by positron emission tomography, and clinical outcomes (all-cause death, death or myocardial infarction, revascularization, and major adverse cardiac events)surrogate
Main Result
p-value: p=<0.0001
Women have significantly higher rest and stress coronary blood flow compared to men, which may contribute to higher antiatherogenic endothelial shear stress and delayed onset of clinically manifest coronary artery disease.
Limitations
- post hoc analysis
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Gould et al. (2026) conducted an RCT in Coronary artery disease (n=1,028). Female sex vs. Male sex was evaluated on Major adverse cardiac events (p=<0.0001). Female sex was associated with 33% higher rest and stress coronary blood flow and significantly lower rates of major adverse cardiac events compared with male sex (P<0.0001).