Sex Differences in Coronary Inflammation and Atherosclerosis Phenotypes in Response to Imaging Marker of Stress-Related Neural Activity
Neng Dai, Xianglin Tang, Xinyu Weng, Haidong Cai, Jianhui Zhuang, Guangjie Yang, Fan Zhou, Ping Wu, Bao Liu, Shaofeng Duan, Yongfu Yu, Weifeng Guo, Zhiguo Ju, Longjiang Zhang, Zhenguang Wang, Yuetao Wang, Bin Lu, Hongcheng Shi, Juying Qian, Junbo Ge- Cardiology and Cardiovascular Medicine
- Radiology, Nuclear Medicine and imaging
BACKGROUND:
Sex-specific differences in coronary phenotypes in response to stress have not been elucidated. This study investigated the sex-specific differences in the coronary computed tomography angiography-assessed coronary response to mental stress.
METHODS:
This retrospective study included patients with coronary artery disease and without cancer who underwent resting 18 F-fluorodexoyglucose positron emission tomography/computed tomography and coronary computed tomography angiography within 3 months. 18 F-flourodeoxyglucose resting amygdalar uptake, an imaging biomarker of stress-related neural activity, coronary inflammation (fat attenuation index), and high-risk plaque characteristics were assessed by coronary computed tomography angiography. Their correlation and prognostic values were assessed according to sex.
RESULTS:
A total of 364 participants (27.7% women and 72.3% men) were enrolled. Among those with heightened stress-related neural activity, women were more likely to have a higher fat attenuation index (43.0% versus 24.0%; P =0.004), while men had a higher frequency of high-risk plaques (53.7% versus 39.3%; P =0.036). High amygdalar 18 F-flourodeoxyglucose uptake (B-coefficient [SE], 3.62 [0.21]; P <0.001) was selected as the strongest predictor of fat attenuation index in a fully adjusted linear regression model in women, and the first-order interaction term consisting of sex and stress-related neural activity was significant ( P <0.001). Those with enhanced imaging biomarkers of stress-related neural activity showed increased risk of major adverse cardiovascular event both in women (24.5% versus 5.1%; adjusted hazard ratio, 3.62 [95% CI, 1.14–17.14]; P =0.039) and men (17.2% versus 6.9%; adjusted hazard ratio, 2.72 [95% CI, 1.10–6.69]; P =0.030).
CONCLUSIONS:
Imaging-assessed stress-related neural activity carried prognostic values irrespective of sex; however, a sex-specific mechanism linking psychological stress to coronary plaque phenotypes existed in the current hypothesis-generating study.
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