Sex Differences in Polyvascular Disease　― Implications for Lipid-Lowering Management and Cardiovascular Outcomes ―

Abstract

Background: Sex differences exist in atherosclerotic cardiovascular disease, partly due to the anti-atherosclerotic properties of estrogens in women. While polyvascular disease (PolyVD) exhibits worse outcomes, it is unknown whether women have an impact on cardiovascular outcomes of PolyVD.

Methods and Results: We analyzed 678 coronary artery disease patients receiving PCI. PolyVD was defined as the concomitance of ischemic stroke and/or lower extremity arterial disease (LEAD). The occurrence of 3-year major adverse cardiovascular events (MACE; i.e., all-cause death + non-fatal myocardial infarction + ischemic stroke + ischemic-driven non-culprit lesion revascularization + LEAD) was compared between men and women with and without PolyVD, respectively. Women accounted for 17.8% and 21.1% of patients with and without PolyVD, respectively (P=0.34). In patients without PolyVD, women presented marginally higher on-treatment low-density lipoprotein cholesterol (LDL-C) levels (101.5 vs. 93.0 mg/dL; P=0.05). However, women exhibited a lower 3-year MACE risk (adjusted hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.11–0.88; P=0.02). In patients with PolyVD, women exhibited higher LDL-C levels (103.0 vs. 82.0 mg/dL; P=0.04). Furthermore, even after adjusting clinical demographics and risk factor control, the 3-year MACE risk did not differ between males and females (adjusted HR 0.67; 95% CI 0.29–1.57; P=0.36).

Conclusions: Women without PolyVD were less likely to experience 3-year MACE, whereas cardiovascular outcomes in women with PolyVD were similar to men with PolyVD. These findings suggest a need to intensify anti-atherosclerotic management in both men and women with PolyVD.