CAC Progression in Postmenopausal Women Found Double that of Men in New Research

Ella Ishaaya, MD
(courtesy of ACC)

Among postmenopausal women on statin therapy new research suggests that progression of coronary artery calcium (CAC) may be double the rate observed in men matched for age, race, statin use and cardiometabolic risk factors. The findings are being presented at the American College of Cardiology’s (ACC) Annual Scientific Sessions, April 6-8, 2024, in Atlanta, GA.¹

Although CAC progression in men is known to accelerate faster than in women, results of the study may indicate that loss of the cardioprotective effect of estrogen in postmenopausal years appears to bring women to a similar level of risk—and in this study, that was despite treatment with statins.¹

“This is a unique study cohort of only post-menopausal statin users that signals that post-menopausal women may have risk of heart disease that is on par with males,” Ella Ishaaya, MD, an internal medicine physician at Harbor-UCLA Medical Center in Torrance, California, and the study’s lead author said in an ACC press release. “Women are underscreened and undertreated, especially post-menopausal women, who have a barrage of new risk factors that many are not aware of. This study raises awareness of what those risk factors are and opens the door to indicating the importance of increased screening for coronary artery calcium (CAC).”²

For the retrospective study, Ishaaya and colleagues identified 579 postmenopausal women at Harbor-UCLA Medical Center who were receiving statin therapy and who had results available for a baseline CAC scan and a follow-up test at least 1 year later. The participants were matched 1:1 with a cohort of men for age, race, statin use and presence of hypertension and diabetes.¹

The researchers separated the participants into 3 groups based on CAC measure at baseline, 1-99, 100-399, and 400 or greater, and compared the annualized change, according to the study.¹

CAC scores double for women

Ishaaya et al reported that between baseline and follow-up scans, CAC progression was significantly higher among women than men in the baseline CAC group of 1–99 (median and IQR), 8 points (2, 17) vs 4 points (1, 10), (P = .003).¹ The annualized median progression was also significantly higher by a factor of 2 for women vs men with baseline CAC of 100-399 at 31 points (16, 57) vs 16 points (1, 43), respectively, (P =.001).¹ The research team reported no significant difference in progression between men and women with baseline CAC measures of 400 or more.

The postmenopausal drop in estrogen skews a woman’s hormonal balance in favor of testosterone, Ishaaya pointed out, a change that alters how and where the body stores fat and how it is processed—all factors that increase the risk for cardiovascular disease.²

Statin therapy alone may be inadequate to slow CAC progression in postmenopausal women, said the researchers, noting that all study participants were taking the standard of care drugs to treat elevated lipids. The implications for clinical care include increased use of CAC and other CV risk screenings as well as broader implementation of preventive strategies, they concluded.¹

1. Ishaaya E, Kinninger A, Schwarzman L, et al. CAC progression in men and women: is there an inflection at menopause? Presented at: The American College of Cardiology Scientific Sessions; April 6-8, 2024; Atlanta, GA. Accessed April 1, 2024. https://accmedia.org/wp-content/uploads/2024/03/Ishaaya_Menopause_PRO_Abstract.pdf
2. Heart health declines rapidly after menopause. News release. American College of Cardiology. April 2, 2024. Accessed April 2, 2024. https://accmedia.org/wp-content/uploads/2024/03/Ishaaya_Menopause_PRO_Release.pdf