1. Sex- and location-specific differences among three cardiovascular risk factors were found to be associated with cardiovascular mortality.
Evidence Rating Level: 3 (Average)
Converging evidence suggests that sex and location are associated with the burden of arteriosclerosis. Most studies, however, focus on individual risk factors rather than sex-specific cardiovascular risk profiles. A cohort of 2,357 participants (M age = 69.0 years, 53% female) from the population-based Rotterdam Study underwent non-contrast computed tomography (CT) scans to quantify calcification, which is a proxy measure for arteriosclerosis. The coronary arteries (CAC), aortic arch (AAC), intracranial (ICAC) and extracranial carotid arteries (ECAC), vertebrobasilar arteries (VBAC), and aortic valve (AVC) were the locations of focus. This study used principal component analysis (PCA) of eight sex-specific cardiovascular risk factors to establish risk profiles based on shared between-factor variance. The associations between severe calcification in regions of interest and PCA risk profiles were determined using a sex-stratified multivariable logistic regression. A total of three cardiovascular risk profiles in both sexes emerged: 1) anthropometry, glucose, and HDL cholesterol; 2) blood pressure; and, 3) smoking and total cholesterol. The strongest associations among women were found in profile 2 with severe ICAC and ECAC (adjusted OR [95% CI] = 1.32 [1.14 to 1.53]) and profile 3 with severe calcification in all areas except AVC. Among men, profile 2 possessed the strongest associations with VBAC (adjusted OR [95% CI] = 1.31 [1.12 to 1.52]) and profile 3 with ACC (adjusted OR [95% CI] = 1.28 [1.09 to 1.51]). The strongest, independent associations with cardiovascular mortality were found with ECAC (HR [95% CI] = 2.11 [1.22 to 3.66]) and AVC in women (HR [95% CI] = 2.05 [1.21 to 3.49]) and with the CAC in men (HR [95% CI] = 2.24 [1.21 to 3.78]). Overall, this study suggests that there are sex- and location-specific differences in arteriosclerosis etiology. Further, this study provides a foundation for future research on these differences across risk profiles.
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