Heart attack risk differs between men and women
Findings on coronary CT angiography (CTA), a noninvasive test to assess the coronary arteries for blockages, show different risk scenarios for men and women, according to a study presented today at the Radiological Society of North America (RSNA).
Coronary artery disease (CAD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. It is caused by a build-up of fat and other substances that form plaque on vessel walls. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women in the U.S.
Researchers at the Medical University of South Carolina analyzed the results of coronary CTA on 480 patients, mean age 55, with acute chest pain. Approximately 65 percent of the patients were women, and 35 percent were men. The possibility of acute coronary syndrome was ruled out for each of the patients.
Using coronary CTA, the researchers were able to determine the number of vessel segments with plaque, the severity of the blockage and the composition of the plaque.
“The latest CT scanners are able to produce images that allow us to determine whether the plaque is calcified, non-calcified or mixed,” said John W. Nance Jr., M.D., currently a radiology resident at Johns Hopkins Hospital in Baltimore, Md.
By comparing the coronary CTA results with outcome data over a 12.8-month follow-up period, the researchers were able to correlate the extent, severity and type of plaque build-up with the occurrence of major adverse cardiac events, such as a heart attack or coronary bypass surgery. The statistical analysis tested all plaques combined (calcified, non-calcified and mixed) and each individual plaque type separately.
“We found that the risks for cardiovascular events associated with plaque were significantly different between women and men,” Dr. Nance said.
Within the follow-up period, 70 of the patients experienced major adverse cardiac events, such as death, heart attack, unstable angina or revascularization. In total, 87 major adverse cardiac events occurred among the patients during the follow-up period.
What Is a Heart Attack?
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. If blood flow isn’t restored quickly, the section of heart muscle begins to die.
Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities.
Heart attack treatment works best when it’s given right after symptoms occur. If you think you or someone else is having a heart attack, call 9–1–1 right away.
Overview
Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis). The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
When the outcome data were correlated with the CTA combined plaque findings, the results indicated that women with a large amount of plaque build-up and extensive atherosclerosis are at significantly greater cardiovascular risk than men.
Specifically, the risk for major adverse cardiac events was significantly higher in women than in men when extensive plaque of any kind was present or when more than four artery segments were narrowed.
“This research tells us that extensive coronary plaque is more worrisome in women than the equivalent amount in men,” Dr. Nance said.
Heart Disease and Stroke Statistics – 2011 Update
America is winning a battle against heart disease and stroke mortality, but is still losing the war, according to the American Heart Association.
In Heart Disease and Stroke Statistics – 2011, published online in Circulation: Journal of the American Heart Association, the association reports that the death rate from heart diseases declined 27.8 percent from 1997 to 2007 (the most recent final data available), and the stroke death rate fell 44.8 percent.
However, during the same period, the total number of inpatient cardiovascular operations and procedures increased 27 percent. The estimated total cost from heart disease and stroke in the United States for 2007 (including health expenditures and lost productivity) was $286 billion. That’s higher than any other diagnostic group. In 2008, the estimated cost of all cancer and benign tumors was $228 billion, according to the update.
However, when analyzing risk factors associated with the presence of individual types of plaque, the risk for major adverse cardiac events was greater in men, compared to women, when their artery segments contained non-calcified plaque.
Dr. Nance said the new data suggested that the atherosclerotic process, or hardening of the arteries, is not necessarily linear and that more research is needed to better understand the disease.
“Our research confirms that coronary CTA provides excellent prognostic information that helps identify risk, but there are gender differences that need to be considered,” Dr. Nance said.
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Coauthors are U. Joseph Schoepf, M.D., Christopher Schlett, M.D., Garrett Rowe, B.S., J. Michael Barraza, B.S., and Fabian Bamberg, M.D., M.P.H.
Note: Copies of RSNA 2011 news releases and electronic images will be available online at RSNA.org/press11 beginning Monday, Nov. 28.
RSNA is an association of more than 48,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)
Editor’s note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-949-3233.
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Linda Brooks
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Radiological Society of North America