Coronary disease & ACSSecondary analysis
Sex based differences in association between plaque burden and ischemia—a CREDENCE trial substudy
- post hoc exploratory analysis of the CREDENCE trial
Authors' conclusion
Despite having a lower overall plaque burden, women exhibit a stronger association between plaque burden and ischaemia than men. Further investigation in prospective studies is warranted to better understand potential sex-related differences in CAD.
Study context
- Population
- Symptomatic patients with suspected stable coronary artery disease (CAD) who underwent CCTA and invasive coronary angiography with fractional flow reserve (FFR) measurementswomen 184 · men 428
- Participants
- 612 symptomatic patients
- Comparison
- Sex-based differences in quantitative plaque burden and its association with ischaemia
- Womenn = 184
- Menn = 428
Primary result
As reported in the abstract
Age
P = 0.001
Further findings
Association of a 5% increase in plaque burden with ischaemia (FFR ≤0.8) in women
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| 5% increase in total plaque burden · women, total plaque | 1.28 (1.12–1.46) | P < 0.001 | |
| 5% increase in calcified plaque burden · women, calcified plaque | 1.31 (1.10–1.57) | P = 0.003 | |
| 5% increase in total non-calcified plaque burden · women, total non-calcified plaque | 1.33 (1.05–1.67) | P = 0.017 | |
| 0.512Odds ratio (log scale) |
Plaque characteristics
- Plaque burden and volume significantly lower in women across all components, except for calcified plaque burden
- all P < 0.05
- Women had a lower prevalence of smoking, less high-risk plaque, shorter lesion length, and lower stenosis severity
Predictors of ischaemia in men
- In men, only total and total non-calcified plaque burden were significant predictors of ischaemia
Sex interactions
- Total plaque burden interaction
- P = 0.015
- Calcified plaque burden interaction
- P = 0.046
- Diameter stenosis interaction (not significant)
- P = 0.928
Original publication
Sex based differences in association between plaque burden and ischemia—a CREDENCE trial substudy. Eur Heart J Cardiovasc Imaging. Published 11 August 2026. doi:10.1093/ehjci/jeag212
Summarised from the published abstract; every number is checked against it