This author interview is by Dr Amgad N Makaryus, of Hofstra NSLIJ School of Medicine.  Dr Makaryus' full paper, Implications of Gender Difference in Coronary Calcification as Assessed by CT Coronary Angiography, is available for download in Clinical Medicine Insights: Cardiology.

Please summarize for readers the content of your article.

Arterial calcium as measured by multi-slice computed tomography coronary angiography (CTA) is a reliable predictor of cardiovascular disease risk. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized calcified plaques as a result of the increased risk of plaque rupture, migration, and subsequent acute coronary syndrome. We sought to examine coronary artery calcium scores as measured via CTA to assess the extent of calcification and plaque distribution in women compared to men. A total of 138 patients referred for CTA were evaluated. A total of 552 coronary arteries were evaluated in 138 patients (85 men, 53 women). The average age for females was 64.4 ± 10.8 years and for males 60.0 ± 12.8 years. On comparison of all total vessel calcium scores, males had a higher total mean calcium score than females in each individual vessel. The results were as follows for males versus females, respectively: left main total vessel calcium score 46.49 versus 16.71 (P = 0.167); left anterior descending 265.21 versus 109.6 (P < 0.003); left circumflex 130.5 versus 39.7 (P < 0.004); and right coronary 213.5 versus 73.8 (P < 0.01). The odds of having a total calcium score >100 (versus not) was 3.62 times greater in males relative to females, given that all the other cardiovascular risk factors are adjusted for (95% confidence interval: 1.37-9.54). There are clear differences between males and females regarding total vessel calcium scores and therefore risk of future adverse coronary events. Males tended to have higher average calcium scores in each coronary artery than females with a greater tendency to have multiple vessel involvement. Using this information, more large-scale, randomized controlled studies should be performed to correlate differences in the extent of coronary calcification with the observed variance in clinical presentation during coronary events between males and females as a means to potentially establish gender-specific therapeutic regimens.  

How did you come to be involved in your area of study?

North Shore University Hospital in Manhasset, New York, USA, is a busy tertiary care hospital performing a large number of cardiac CTA in clinical practice. I became involved in this study while directing the cardiology CT program at our hospital to evaluate the gender differences in coronary calcification.

What was previously known about the topic of your article?

Differences between men and women in the presentation, diagnosis, assessment, as well as prognosis of cardiovascular disease are evident and have prompted a worldwide campaign to redefine cardiovascular disease as a female as well as male disease and to structure treatment guidelines specifically for women.  Numerous theories attempting to explain these differences have been posited over the past 50 years. Nevertheless, no single unifying explanation can account for the gender gap. The cause of these observed differences is likely an amalgam of numerous variables, which have each been shown to individually contribute to observed variations including differences in vascular beds, hormonal factors, as well as lifestyle issues. Our study indicates that in addition to the differences already described, there are stark dissimilarities between men and women in the composition, distribution, and location of intracoronary lesions which may explain some of the observed variations in clinical presentation, sequelae, and outcomes.

How has your work in this area advanced understanding of the topic?

We found that there are clear differences between males and females regarding total vessel calcium scores and therefore risk of future adverse coronary events. Males tended to have higher average calcium scores in each coronary artery than females with a greater tendency to have multiple vessel involvement. Using this information, more large-scale, randomized controlled studies should be performed to correlate differences in the extent of coronary calcification with the observed variance in clinical presentation during coronary events between males and females as a means to potentially establish gender-specific therapeutic regimens. 

What do you regard as being the most important aspect of the results reported in the article?

Our report points to differences between the genders with respect to coronary artery plaque and calcium distribution which may point to the answer and cause for observed presentation variations with respect to cardiac disease in men versus women.

If you would like to include a link to a departmental webpage, LinkedIn profile, or other webpage where readers can learn more about your work paste it below:

Hospital Webpage: https://www.northshorelij.com/find-care/find-a-doctor/internal-medicine/dr-amgad-nihad-makaryus-md-11317737

LinkedIN: https://www.linkedin.com/in/amgadmakaryus

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