April 1, 2004
View Full PaperGender-Based Differences in the Prognostic Value of Coronary Calcification
Structured PICO
Does electron beam tomography (EBT) screening for coronary calcification predict all-cause mortality differently in asymptomatic women compared to men?
P
Population
10,377 asymptomatic individuals (40% women) referred by primary care physicians for coronary calcification screening
I
Intervention
Electron beam tomography (EBT) screening for coronary calcification
C
Comparator
Men vs. women across different strata of coronary calcification scores
O
Outcome
All-cause mortalityhard clinical
Coronary calcification screening provides incremental prognostic information over traditional risk factors, with women showing a significantly higher relative risk of death than men at equivalent calcification scores.
Abstract
PURPOSE: To investigate the use of electron beam tomography (EBT) screening to predict all-cause mortality in a large cohort of asymptomatic women and men. METHODS AND RESULTS: We obtained mortality information from the National Death Index in 10377 asymptomatic individuals (40% women) referred by primary care physicians for coronary calcification screening. The average follow-up period was 5 +/- 3.5 years. Univariable and multivariable Cox proportional hazard models were developed to predict all-cause mortality. Women had a lower prevalence of coronary calcification and smaller calcification scores than men (p 1000 (p < 0.0001). Using receiver operating characteristics (ROC) curve analyses to assess coronary calcification added incremental prognostic value to Framingham risk scores (p < 0.0001). CONCLUSIONS: In this cohort of asymptomatic women, coronary calcification screening provided incremental prognostic information after adjustment for traditional risk factors. EBT may be a useful tool for risk stratification in women, where the early diagnosis of coronary heart disease (CHD) remains a strong challenge.