Sex differences in prevalence and characteristics of imaging-detected atherosclerosis: a population-based study

Abstract Aims Men are more likely to suffer a myocardial infarction than women, but population-based studies on sex differences in imaging-detected atherosclerosis are lacking. The aims were to assess sex differences in the prevalence of imaging-detected coronary and carotid atherosclerosis, as well as multivariable adjusted associations between sex and atherosclerosis. Methods and results Participants aged 50–65, recruited from the general population to the Swedish Cardiopulmonary bioImage Study (SCAPIS), were included in this population-based cross-sectional study. Comprehensive diagnostics, including coronary computed tomography angiography and carotid ultrasound, were performed. The image findings were any coronary atherosclerosis, coronary stenosis ≥ 50%, segment involvement score (SIS) ≥ 4, coronary artery calcium score (CACS) 100, and any ultrasound-detected carotid plaque. In 25 580 participants (50% women), men had more hypertension (20.3% vs. 17.0%), hyperlipidaemia (9.0% vs. 5.5%), and diabetes (8.5% vs. 4.7%). The prevalence was 56.2% vs. 29.5% for any coronary atherosclerosis (P 0.01), 9.0% vs. 2.3% for coronary stenosis ≥ 50% (P 0.01), 20.2% vs. 5.3% for SIS ≥ 4 (P 0.01), 18.2% vs. 5.6% for CACS 100 (P 0.01), and 60.9% vs. 48.7% for carotid plaque (P 0.01), in men vs. women, respectively. Multivariable adjustment only marginally changed these associations: odds ratios (ORs) (95% confidence interval): 2.75 (2.53–2.99) for coronary atherosclerosis, 2.88 (2.40–3.45) for coronary stenosis ≥ 50%, 3.99 (3.50–4.55) for SIS ≥ 4, 3.29 (2.88–3.75) for CACS 100, and 1.57 (1.45–1.70) for carotid plaque. Conclusion Men had higher prevalence of imaging-detected carotid and coronary atherosclerosis with prevalence in women aged 65 corresponding to men 11–13 years younger. The associations remained after extensive multivariable adjustment.