The Risk Factor And Features Of Coronary Artery Calcification In Postmenopause Women

Aim: Coronary heart disease (CHD) is a major cause of sudden cardiac death for women.Many studies show the onset age in women is later ten years later than men. The morbidity and mortality of CHD increase in postmenopausal women. Coronary artery calcification(CAC) is a marker of coronary atherosclerosis. To test of CAC has a positive predictive value of cardiovascular events. Recently, the application of CT becomes more and more widely, and using coronary artery calcification score (CACS) by CT to assess the quality and quantity of CAC has been widely used in clinical life. In this study, we observe characteristics of coronary calcification and degree of calcified lesion especially in postmenopausal women patients , and we use Nomogram method to establish a severe stenosis risk factor model of postmenopausal women to provide basis for prevention and treatment of coronary heart disease in postmenopausal women.Methods: In this study, we select two groups of asymptomatic physical examination and suspected coronary heart disease as study subjects. Asymptomatic people were 1087 women older than 40 years old residents from April 2014 to August 2015 lived in communities in Eastern Hebei province, Tangshan City, Hebei province. We took them standardize questionnaires, selected clinical basic information, medical history, smoking history, physical activity time, depression, coronary artery calcium score, ABI inspection and detection of biochemical indexes. Of those patients, there were 379 pre-menopause and 608 post-menopause women. 888 were CACS ?10 and 106 were CACS >10. And we also collect 318 women who are admitted to hospital because of suspected coronary heart disease coronary from June 2016 to December 2016. Of those patients, there were 56 pre-menopause and 262 post-menopause women. 208 were CACS ?10 and 110 were CACS>10. By comparing two groups of related information, we explore the risk factors of coronary artery calcification in women and study pathological features of coronary calcification by using the coronary CTA observation in women. We use the Spearman to detect the correlation between CACS and the characteristics of coronary artery in women.Then, we used Logistic regression to study the risk factors of coronary calcification in post menopause women and find out the pathological features of coronary calcification by using the coronary in the early menopause women and in numbers of children >3 women, and we use the Nomogram method to establish and verify the risk model of severe stenosis in postmenopausal women.Results: 1?All the study subjects were divided according to CACS?10 and CACS >10. Asymptomatic and suspected coronary heart disease women were significantly different in proportion of age, hypertension, diabetes, dyslipidemia, PAD and menopause(P<0.05).And menopause is an independent risk factor in women(OR= 1.026, 95 %Cl 1.017-1.036,P<0.001; OR=1.063, 95 %CI 1.037-1.090, P <0.001). 2?According to CTA results,postmenopause women has more severe coronary stenosis (SSS>5: 30.9% vs. 5.9%; CT-Leaman score>5: 39.2% vs. 9.1%), and 54.2% women have more non-calcification, 35.5%women have non-obstructive CAD and 5.7% women have more than three numbers of segments with plaque. Compared with premenopause women, 159 segments with coronary calcification trend to occur in the LAD. 3. Comparing the results of CACS and CTA, we find higher CACS has more severer stenosis coronary and more widespread of calcification(SIS: 52.2% vs. 1.4%, P<0.001; SSS: 82.6% vs. 4.9%,P<0.001; CT-leaman score:100% vs. 13.4%, P<0.001) .However, 15 women CACS=0 but they also have obstructive CAD by CTA results. The spearman correlation analysis showed that CACS were positive associated with CT-Leaman and CT-Gensini score (r=0.720, P<0.05; r=0.593, P<0.05).4.After studying of asymptomatic women we find age(OR: 1.099,95%CI1.032-1.171,P=0.003;OR: 1.114, 95%CI 1.072-1.157, P<0.001), hypertension (OR: 2.001,95%CI:1.179-3.397; P=0.010; OR: 2.608, 95%CI: 1.362-4.993,P=0.004) , dyslipidemia(OR=2.341,95%CI: 1.269-4.319, P=0.006),PAD (OR=6.711,95 %CI 1.607-28.025,P=0.009;OR=8.11, 95 %CI 1.442-45.726, P=0.018) , early menopause (OR: 1.013,95%CI: 1.005-1.021, P=0.002;OR=5.489,95%CI: 2.675-11.263, P<0.001) and numbers of children >3 (OR=1.084,95%CI: 1.014-1.159, P=0.018 ; OR: 1.309, 95%CI: 1.204-4.427, P=0.012) are independent risk factor of calcification in postmenopausal women.5.According to CTA results,early menopause women have more severe coronary stenosis(SIS>5: 15.9%vs.6.0%, =0.018; SSS>5: 36.5%vs.16.6%, P=0.001; CT—Leaman score>5: 50.8% vs.35.2%, P=0.020) and 49 segments with coronary calcification trend to occur in the LAD. And more severer stenosis happens in LAD segments. Numbers of children >3 women have more severe coronary stenosis (SIS>5: 13.3% vs.6.3%, P=0.056;SSS>5: 30.1%vs.17.8%, P=0.020; CT—Leaman score> 5 : 42.2% vs.37.9%, P=0.033)and 53 segments with coronary calcification trend to occur in the LAD. And more severer stenosis happens in LAD segments.6?The innital C-index of Nomogram is 0.789,after 1000 bootstrap method to verify the internal model validation, the corrected C-index is 0.768,and the area under the curve of ROC analysis is 0.789 (95%CI: 0.731-0.847,P<0.001)?Conclusion:1?Menopause is an independent risk factor of calcification in women. 2?Compared with menopausal women, menopausal women coronary artery lesions are widely distributed, have more plaque burden, easy to produce non-calcified plaques, have often non-blocking stenosis, and the anterior descending branch is more prone to obstructive stenosis.3?CACS was positively correlated with coronary stenosis and plaque burden, but CACS = 0 patients did not completely rule out obstructive lesions. 4?Age, hypertension, dyslipidemia,peripheral vascular disease, early menopause, maternal pregnancy number > 3 were postmenopal women coronary artery calcification independent risk factors. 5?Compared with non-premature menopausal women, early menopausal women with coronary artery disease distribution is widespread, have more coronary artery stenosis degree and anterior descending are easy to merge stenosis. Compared with women with maternal contraception?3, the number of pregnant women >3 of the menopausal women with coronary artery disease distribution is widespread, have more coronary stenosis degree and anterior descending easy to merge stenosis. 6?Nomogram predictive model can effectively predict the risk of severe stenosis in menopausal women. In this study, the risk factors of coronary artery calcification and the characteristics of coronary artery lesion in postmenopausal women showed that menopausal women had their own cardiovascular risk factors and coronary artery disease characteristics and built the risk factor model for severe stenosis of coronary heart disease in postmenopausal women.The conclusion can provide a reference for the risk stratification of coronary heart disease for postmenopausal women, screening for high risk of coronary heart disease and And provide reference for different risk groups to formulate corresponding treatment plan.