Highlights
- •High-intensity statin therapy (HIST) reduces cardiovascular events, however, sex-related differences in effects are not well characterized.
- •Our current analysis of 3 coronary IVUS trials of HIST suggest that women achieve greater reductions in coronary atheroma volume compared with men.
- •Gender differences seem more related to lower atherogenic lipoprotein levels than inflammatory or anti-atherogenic lipoprotein levels.
- •These findings underscore the importance to improve upon trends of less aggressive lipid therapy in women with known atherosclerotic disease.
Abstract
Background and aims
High-intensity statin therapy (HIST) reduces cardiovascular events, however, sex-related
differences in treatment effects are not well characterized.
Methods
A patient-level post hoc pooled analysis of 3 randomized trials utilizing serial coronary intravascular ultrasound
was undertaken, testing the anti-atherosclerotic effects of HIST in coronary disease
patients. Sex-related differences in changes (Δ) in coronary percent atheroma volume
(PAV) were ascertained following 18–24 months of HIST (atorvastatin 80 mg or rosuvastatin
40 mg daily), and further characterized according to on-treatment lipid and lipoprotein
levels.
Results
In women (n = 451) compared with men (n = 1190), on-treatment levels of LDL-C (68 ± 24
vs. 67 ± 22 mg/dl, p=0.62) and apoB (77 ± 23 vs. 76 ± 20 mg/dL, p=0.51) were similar; levels of HDL-C (53 ± 12 vs. 47 ± 11 mg/dl, p < 0.001), apoA1 (154 ± 26 vs. 140 ± 24 mg/dl, p < 0.001), triglycerides [122 (95, 158) vs. 114 (89, 154) mg/dl, p=0.012] and CRP [1.7 (0.9, 3.8) vs. 1.1 (0.6, 2.7) mg/l, p < 0.001] were higher; while the total cholesterol/HDL-C (TC/HDL-C) ratio was lower
(2.9 ± 0.8 vs. 3.1 ± 0.8, p < 0.001). Compared with men, women harbored significantly lower baseline PAV (34.8 ± 8.7
vs. 38.3 ± 8.8%, p < 0.001), yet demonstrated significantly greater PAV regression (ΔPAV -1.07 ± 0.26
vs. -0.66 ± 0.23%, p=0.02). When achieved on-treatment levels of LDL-C were <64 mg/dl, apoB <73 mg/dl,
non-HDL-C <88.8 mg/dl, and TC/HDL-C <2.99, women demonstrated significantly greater
PAV regression than men. Multivariable analysis revealed female sex to independently
associate with PAV regression (coefficient −0.66, p=0.02).
Conclusions
Women demonstrate greater degrees of coronary plaque regression compared with men
following long-term HIST, especially in the setting of lower achieved atherogenic
lipoprotein levels.
Keywords
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Article info
Publication history
Published online: September 15, 2016
Accepted:
September 15,
2016
Received in revised form:
August 31,
2016
Received:
April 5,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
