ABSTRACT
INTRODUCTION: Fibrin clot lysability is associated with development of cardiovascular disease (CVD). We evaluated sex-differences in fibrin clot lysability and the association with coronary plaque composition determined by computed tomography angiography (CTA). METHODS: Middle-aged citizens without known CVD were randomly selected from a national registry. A coronary CTA assessed volumes of calcified-, non-calcified-, low-density non-calcified-, and total- plaque using a validated plaque quantification software. A non-enhanced cardiac CT scan assessed the Agatston score. Fibrin structure properties were determined using turbidimetric methods. Plasma concentrations of C-reactive protein and fibrinogen were assessed. RESULTS: 138 individuals (71 women) participated. Men more frequently had coronary plaques compared to women, Pâ¯<â¯0.05. Coronary plaque features were comparable between men and women, Pâ¯>â¯0.05. Women with total plaque volumeâ¯>â¯0â¯mm3 had lower fibrin clot lysability compared to women with total plaque volumeâ¯=â¯0â¯mm3, adjusted difference [95% confidence interval] 10.28 [1.42-19.15], Pâ¯=â¯0.02, and a fibrinogen-dependent lower fibrin clot lysability compared to men with and without coronary plaques, 6.82 [-2.67-16.31], Pâ¯=â¯0.16, and 8.73 [-0.43-17.89], Pâ¯=â¯0.06, respectively. Fibrinogen correlated with all the coronary plaque features (correlation coefficient râ¯=â¯0.42-0.57) only in women with total plaque volumeâ¯>â¯0â¯mm3, all Pâ¯<â¯0.01. CONCLUSION: Asymptomatic women with coronary plaques assessed by coronary CTA have reduced fibrin clot lysability compared to both women without coronary plaques and men, suggesting a sex-dependent link between coronary atherosclerosis and fibrin clot lysability.
Subject(s)
Cardiovascular Diseases/epidemiology , Coronary Artery Disease/epidemiology , Fibrin/metabolism , Plaque, Atherosclerotic/epidemiology , Sex Characteristics , Aged , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Risk FactorsABSTRACT
PURPOSE: The purposes of this study were to compare the presence, extent and composition of coronary plaques in asymptomatic patients with newly diagnosed type 2 diabetes to age- and sex-matched controls. METHODS: Patients with newly diagnosed (<1 year) type 2 diabetes ( n = 44) and controls ( n = 44) underwent contrast-enhanced coronary computed tomography angiography. Advanced plaque analysis including total plaque volume and volumes of plaque components (calcified plaque and non-calcified plaque, including low-attenuation [low-density non-calcified plaque]) was performed using validated semi-automated software. RESULTS: Coronary artery calcification was more often seen in patients with type 2 diabetes (66%) versus controls (48%), p < 0.05. Both the absolute volume (median; interquartile range) of low-density non-calcified plaque (7.9 mm3; 0-50.5 mm3 vs 0; 0-34.3 mm3, p < 0.05) and the increase in low-density non-calcified plaque ratio in relation to total plaque volume ( τ = 0.5, p < 0.001) were significantly higher in patients with type 2 diabetes. More patients with type 2 diabetes had spotty calcification (31% vs 0%, p < 0.05). By multivariate analysis, the presence of any low-density non-calcified plaque was higher in males (odds ratio: 4.06, p < 0.05), who also demonstrated a larger low-density non-calcified plaque volume ( p < 0.001). The presence and extent of low-density non-calcified plaque increased with age, smoking, hypertension and hyperglycaemia, all p < 0.05. CONCLUSION: Asymptomatic patients with newly diagnosed type 2 diabetes had plaque features associated with increased vulnerability as compared with age- and sex-matched controls.