Gender-related risk of myocardial infarction and subclinical coronary atherosclerosis: a Danish population cohort study.

BACKGROUND AND AIMS: To assess the prevalence of subclinical coronary atherosclerosis and its association with myocardial infarction, death or myocardial infarction, and clinically driven coronary revascularization in asymptomatic women and men in a Danish general population cohort.

METHODS

Asymptomatic women (n = 5710, 57%) and men (n = 4293, 43%) >40 years underwent coronary computed tomography angiography. The primary endpoint was myocardial infarction, while secondary endpoints were death or myocardial infarction combined and clinically driven coronary revascularization.

RESULTS

From 40 through to >80 years of age, women had less subclinical coronary atherosclerosis than men (P for gender interaction <.0001), both in persons with and without cardiovascular risk factors. Median follow-up was 6.0 years (interquartile range: 3.9-9.5). In individuals with vs without obstructive subclinical coronary atherosclerosis, the adjusted hazard ratio for having a myocardial infarction was 4.1 (95% confidence interval: 1.5-11) in women and 12 (4.6-34) in men (P for gender interaction = .24). Corresponding hazard ratios for death or myocardial infarction combined were 1.9 (1.3-2.9) and 2.7 (1.9-3.9), respectively (P for gender interaction = .30). Finally, corresponding hazard ratios for clinically driven coronary revascularization were 23 (5.2-106) and 34 (11-106), respectively (P for gender interaction = .35).

CONCLUSIONS

For the same degree of subclinical coronary atherosclerosis, women may have a lower risk of myocardial infarction than men. These novel findings show that in asymptomatic women and men, the presence of obstructive subclinical coronary atherosclerosis conferred a fourfold and 12-fold risk of myocardial infarction.